87 Ways “The Body Keeps the Score” After Trauma
Trauma is not only remembered in the mind; it is carried in the body. In the work of two of the best-known trauma physicians, Judith Lewis Herman, M.D., and Bessel van der Kolk, M.D., trauma appears not merely as an emotional wound, but as a whole-body condition affecting arousal, sleep, breathing, digestion, pain, movement, bodily awareness, and even immune functioning. Herman’s Trauma and Recovery and van der Kolk’s The Body Keeps the Score help explain why psychological abuse can produce physical symptoms, physical changes, and body-based survival responses.
How Psychological Abuse Shows Up in the Body
87 examples of physical trauma responses from The Body Keeps the Score and Trauma and Recovery
Psychological abuse can include emotional abuse, neglect, chronic indifference, threats, manipulation, humiliation, coercive control, betrayal, intimidation, gaslighting, abandonment, and repeated violations of trust. Herman and van der Kolk show that these experiences do not remain “only emotional.” They can alter the body’s alarm system, stress hormones, sleep, breathing, digestion, pain responses, movement, bodily awareness, and immune functioning. The chart below gathers 87 examples from Herman’s and van der Kolk’s writings of physical manifestations of trauma — all with citation-ready book titles and PDF page numbers.
1. Nervous system alarm, hyperarousal, and startle responses
| Trauma/body response |
Citation-ready source |
| Trauma produces lasting changes in physiological arousal, emotion, cognition, and memory |
Herman, Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror (1992), PDF p. 34. |
| Hyperarousal; body stays on alert for danger |
Herman, Trauma and Recovery (1992), PDF p. 36. |
| Startles easily |
Herman, T&R (1992), PDF p. 36. |
| Irritability / reacts strongly to small provocations |
Herman, T&R (1992), PDF p. 36. |
| Hyperalertness / vigilance for danger |
Herman, T&R (1992), PDF p. 36. |
| Chronic arousal of the autonomic nervous system |
Herman, T&R (1992), PDF p. 36. |
| Increased heart rate and blood pressure when reminded of trauma |
Herman, T&R (1992), PDF p. 36. |
| Elevated baseline arousal; body always on alert |
Herman, T&R (1992), PDF p. 37. |
| Extreme startle response to unexpected stimuli |
Herman, T&R (1992), PDF p. 37. |
| Trouble tuning out repetitive stimuli; responds as if each repetition is new danger |
Herman, T&R (1992), PDF p. 37. |
| Brain/body alarm system triggers run, hide, fight, or freeze |
van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2014), PDF p. 54. |
| Amygdala danger signals release cortisol and adrenaline |
van der Kolk, The Body Keeps the Score (2014), PDF p. 61. |
| Cortisol/adrenaline increase heart rate, blood pressure, and breathing rate |
van der Kolk, TBKTS (2014), PDF p. 61. |
| PTSD can involve prolonged startle or aggressive outbursts |
van der Kolk, TBKTS (2014), PDF p. 61. |
| Faulty alarm systems lead to blowups or shutdowns |
van der Kolk, TBKTS (2014), PDF p. 62. |
| Trauma can leave people bothered by sounds and lights, or prone to blow up/withdraw |
van der Kolk, TBKTS (2014), PDF p. 349. |
2. Stress hormones, physiological defense, and the body staying in danger mode
| Trauma/body response |
Citation-ready source |
| PTSD body continues defending against a past threat |
van der Kolk, TBKTS (2014), PDF p. 53. |
| When escape/action is blocked, the brain keeps secreting stress chemicals |
van der Kolk, TBKTS (2014), PDF p. 54. |
| Long after danger passes, the brain may keep signaling the body to escape |
van der Kolk, TBKTS (2014), PDF p. 54. |
| Stress hormones can remain elevated and contribute to fear, depression, rage, and physical disease |
van der Kolk, TBKTS (2014), PDF p. 54. |
| Extreme experiences cause secretion of stress hormones |
van der Kolk, TBKTS (2014), PDF p. 219. |
| Helplessness and immobilization prevent stress hormones from being used for defense |
van der Kolk, TBKTS (2014), PDF p. 219. |
| Thwarted action can keep fueling inappropriate fight/flight/freeze responses |
van der Kolk, TBKTS (2014), PDF p. 219. |
| Body needs restoration to baseline safety and relaxation |
van der Kolk, TBKTS (2014), PDF p. 219. |
3. Fight, flight, freeze, collapse, and immobilization
| Trauma/body response |
Citation-ready source |
| Freeze response / shutdown when resistance is futile |
Herman, T&R (1992), PDF p. 42. |
| Fight, flight, freeze, or collapse |
van der Kolk, TBKTS (2014), PDF pp. 82–85. |
| Threat mobilizes muscles, heart, and lungs for fight or flight |
van der Kolk, TBKTS (2014), PDF p. 84. |
| Collapse response: heart rate plunges, breathing difficulty, gut stops or empties |
van der Kolk, TBKTS (2014), PDF p. 84. |
| Disengagement, collapse, and freeze |
van der Kolk, TBKTS (2014), PDF p. 84. |
| Chronic traumatization may show as immobilization |
van der Kolk, TBKTS (2014), PDF p. 85. |
| Immobilization keeps the body in shock / learned helplessness |
van der Kolk, TBKTS (2014), PDF p. 54. |
| Trauma survivors may continue the futile action begun during the trauma |
van der Kolk, TBKTS (2014), PDF p. 55. |
| Suppressed impulses to hit, push, or run may remain in the body |
van der Kolk, TBKTS (2014), PDF p. 220. |
4. Sleep disturbance and nightmares
| Trauma/body response |
Citation-ready source |
| Poor sleep / sleeps poorly |
Herman, T&R (1992), PDF p. 36. |
| Nightmares |
Herman, T&R (1992), PDF pp. 36–37. |
| Sleep disturbance; takes longer to fall asleep |
Herman, T&R (1992), PDF p. 37. |
| Noise sensitivity during sleep |
Herman, T&R (1992), PDF p. 37. |
| Frequent waking at night |
Herman, T&R (1992), PDF p. 37. |
| Traumatic nightmares that recur with immediacy |
Herman, T&R (1992), PDF pp. 37, 39. |
| Chronic insomnia, anxiety, depression, or physical symptoms as disguised trauma presentations |
Herman, T&R (1992), PDF p. 157. |
5. Flashbacks, traumatic memory, and body-based memory
| Trauma/body response |
Citation-ready source |
| Flashbacks / reliving the event as if it is happening now |
Herman, T&R (1992), PDF p. 37. |
| Traumatic memories encoded as vivid sensations and images |
Herman, T&R (1992), PDF p. 38. |
| Bodily-sensation-based traumatic memory |
Herman, T&R (1992), PDF p. 39. |
| High adrenaline / stress hormones deeply imprint memory |
Herman, T&R (1992), PDF p. 39. |
| Intense physical/emotional reaction to reminders of the traumatic event |
Herman, T&R (1992), PDF p. 37. |
| After trauma, the world is experienced through a different nervous system |
van der Kolk, TBKTS (2014), PDF p. 53. |
6. Dissociation, numbing, constriction, and sensory shutdown
| Trauma/body response |
Citation-ready source |
| Constriction / numbing response of surrender |
Herman, T&R (1992), PDF p. 35. |
| Dissociation / altered consciousness under terror |
Herman, T&R (1992), PDF pp. 35, 42. |
| Sensory disruption; sense organs may stop functioning under overwhelming terror |
Herman, T&R (1992), PDF p. 35. |
| Autonomic nervous system becomes dissociated from the rest of the organism |
Herman, T&R (1992), PDF p. 35. |
| Ignoring gut feelings / numbing bodily awareness |
van der Kolk, TBKTS (2014), PDF p. 99. |
| Sensory shifts can trigger shutdown or panic |
van der Kolk, TBKTS (2014), PDF p. 99. |
| Feeling unsafe in the body |
Herman, T&R (1992), PDF p. 160. |
7. Breathing, throat, voice, heart, and chest responses
| Trauma/body response |
Citation-ready source |
| Dry throat, tense voice, faster heart, rapid/shallow breathing |
van der Kolk, TBKTS (2014), PDF p. 83. |
| Voice becomes faster/strident; heart pumps faster; sweat glands activate |
van der Kolk, TBKTS (2014), PDF p. 84. |
| Collapse response can include breathing difficulty |
van der Kolk, TBKTS (2014), PDF p. 84. |
| Trouble breathing, swallowing spasms, pounding heart, facial numbness, involuntary movements, migraine headaches |
Herman, T&R (1992), PDF p. 127. |
| Gut-wrenching feelings and heartbreak as body-brain experiences |
van der Kolk, TBKTS (2014), PDF p. 76. |
8. Pain, migraines, musculoskeletal symptoms, and somatic complaints
| Trauma/body response |
Citation-ready source |
| Psychosomatic complaints |
Herman, T&R (1992), PDF p. 36. |
| Tremulousness after combat stress |
Herman, T&R (1992), PDF p. 62. |
| Chronic insomnia, anxiety, depression, or physical symptoms as disguised trauma presentations |
Herman, T&R (1992), PDF p. 157. |
| Physical pain in legs and feet in a torture survivor with severe post-traumatic symptoms |
Herman, T&R (1992), PDF p. 159. |
| Severe chronic back pain linked to trauma/emotional states |
Herman, T&R (1992), PDF p. 167. |
| Migraine headaches or asthma attacks as stress responses |
van der Kolk, TBKTS (2014), PDF p. 99. |
| Somatic symptoms without clear physical basis are common in traumatized children and adults |
van der Kolk, TBKTS (2014), PDF p. 100. |
| Chronic back and neck pain |
van der Kolk, TBKTS (2014), PDF p. 100. |
| Migraines |
van der Kolk, TBKTS (2014), PDF p. 100. |
| Fibromyalgia |
van der Kolk, TBKTS (2014), PDF p. 100. |
| Tight shoulders, tense facial muscles, restricted body when emotions are held inside |
van der Kolk, TBKTS (2014), PDF p. 218. |
| Holding back tears, sounds, or movements takes enormous energy |
van der Kolk, TBKTS (2014), PDF p. 218. |
9. Digestive and gut responses
| Trauma/body response |
Citation-ready source |
| Collapse response: gut stops or empties |
van der Kolk, TBKTS (2014), PDF p. 84. |
| Body bombarded by visceral warning signs |
van der Kolk, TBKTS (2014), PDF p. 99. |
| Digestive problems / spastic colon / irritable bowel syndrome |
van der Kolk, TBKTS (2014), PDF p. 100. |
10. Immune, autoimmune, chronic fatigue, and stress-related disease
| Trauma/body response |
Citation-ready source |
| Suppressing unbearable physiological reactions can produce physical symptoms |
van der Kolk, TBKTS (2014), PDF p. 53. |
| Fibromyalgia, chronic fatigue, and autoimmune diseases |
van der Kolk, TBKTS (2014), PDF p. 53. |
| Stress hormones can remain elevated and contribute to fear, depression, rage, and physical disease |
van der Kolk, TBKTS (2014), PDF p. 54. |
| Chronic fatigue |
van der Kolk, TBKTS (2014), PDF p. 100. |
| Some forms of asthma |
van der Kolk, TBKTS (2014), PDF p. 100. |
11. Bodily awareness, boundaries, movement, and restoration
| Trauma/body response |
Citation-ready source |
| Reactivity and hyperarousal needing physical strategies |
Herman, T&R (1992), PDF p. 160. |
| Disrupted bodily functions: sleep, eating, exercise |
Herman, T&R (1992), PDF p. 160. |
| Movement helps breathing deepen and release tension |
van der Kolk, TBKTS (2014), PDF p. 219. |
| Terrified people may need a sense of body boundaries and location in space |
van der Kolk, TBKTS (2014), PDF p. 219. |
| Body needs restoration to baseline safety and relaxation |
van der Kolk, TBKTS (2014), PDF p. 219. |
12. Coping through the body: self-harm, substances, eating, and risk-taking
| Trauma/body response |
Citation-ready source |
| Self-harm, self-mutilation, eating disorders, substance abuse, impulsive risk-taking |
Herman, T&R (1992), PDF p. 166. |
| Drug use, alcohol, or self-injury may be attempts to cope with unbearable physical pain of emotions |
van der Kolk, TBKTS (2014), PDF p. 76. |
13. Trauma as embodied injury, not only emotional injury
| Trauma/body response |
Citation-ready source |
| Trauma overwhelms ordinary systems of control, connection, and meaning |
Herman, T&R (1992), PDF p. 33. |
| Trauma literally reshapes both body and brain |
van der Kolk, TBKTS (2014), PDF front matter / back-cover text. |
Summary: Together, Herman and van der Kolk show that trauma is not merely an emotional reaction. It can become a body-level survival state: the nervous system remains on alert, stress hormones keep firing, sleep and digestion are disrupted, pain and immune symptoms may appear, and the body may alternate between fight, flight, freeze, collapse, numbness, and panic.
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