Indictors of trauma are often contradictory. Most indictors can be considered “normal” reactions to stressors at one time or another. If clusters of indictors are present over an extended period of time, further investigation should take place. It is important to understand that it is not unusual for this population to seek treatment repeatedly for acute discomfort, and to terminate treatment before the chronic issues are managed. The effects of early sexual abuse last well into adulthood, affecting relationships, work, family, and life in general.
Self-Perception
-Difficulty knowing how to feel and experiencing a very narrow range of feelings
-Difficulty in handling feelings, trouble in recognizing, managing and appropriately expressing feelings
-Being afraid of your feelings
-Restricted range of affect (e.g., unable to have loving feelings)
-Low self-esteem, self-doubt, feeling you’re not a worthwhile person, feeling bad, dirty, or ashamed of self
-Poor self-image in general, self-deprivation
-Guilt, shame, self-blame
-Constant search for approval and nurturance
-Long-standing feelings of guilt
-Very low tolerance for painful issues
-Experiencing times when you feel as though you’ve “left” your body
-Inability to be alone
-Overcompensation with perfectionism
-Chronic people pleasing
-Passive or overly pleasing behavior
-Chronic monitoring of words and actions
-Wearing excessive clothing, such as long sleeves in hot weather
-Inappropriate seductive dressing
-Self-abuse, skin-carving
-Self-abuse behaviors, self-devaluation, self- destructiveness
-Self sabotage
-Poor body image
-Overwhelming sense of shame, guilt, responsibility
-Confusion
-Extreme discomfort around losing control
-Need to be invisible
-Limited tolerance for happiness
-Learned helplessness
-Chronic solemnity or attention seeking
-Overt or covert revictimization
-Pattern of re-victimization, not able to say “no” especially to sex
-Inability to take risks
-Wearing excessive or revealing clothing
-Wearing layers of clothing, even in the summer – caused by body image issues
-Self mutilating behavior, skin-carving, tattooing (also addictive)
-Expectation of early death
-Sense of being is denigrated, “something is wrong with me,” feeling different from peers/others
-Feelings of worthlessness
-Powerlessness, vulnerability, damaged sense of self-efficacy
-Feeling of detachment or estrangement from others
-Low self-esteem
-Personal space/privacy issues
-Damaged goods, low self-esteem
-Feeling crazy, different, marked
-Distorted body image/poor body image
-Self-mutilation
-Guilt
-Shame
-Self-blame
-Constant search for approval and nurturance
-Social Alienation, feeling different from others, not accepted, stigmatized
-Having trouble feeling a sense of belonging anywhere
-Isolation
-Lack of supports
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Relationships
-Intolerance of or constant search for intimacy
-Chronically troubled relationships, disruption of relationships
-History of ambivalent or intensely conflictive relationships
-History of being involved in emotionally, psychological and/or physically violent relationships (emotionally, physically)
-Conflict-laden relationships
-Relationships do not grow gradually, go too fast
-Exaggerated willingness to remain in dysfunctional or abusive relationships
-Issues with trust, intimacy, relationships
-Issues with boundaries, control, abandonment, blurred boundaries, strong fear of abandonment
-Boundary issues: lack of, needing to be in control, power issues, fear of losing control
-Boundary rigidity or no boundaries (physically, emotionally, sexually)
-Sympathy issues
-Extreme discomfort around conflict
-Chronic issues around trust, inability to trust or indiscriminate trust
-Discomfort in close relations
-Role confusion
-Sense of betrayal and isolation
-Lack of supports, family unsupportive of counseling
-Poor peer relations
-Discomfort in close relations, over-attachment and/or indiscriminate in relationships
-Strong desire to control events and people
-Withdrawal from others
-Repeating of family dramas
-Memories of domestic violence in childhood
-History of multi-victimizations in other forms
-Tendency towards re-victimization
-Difficulty with authority
-Experiencing panic when people get too close
-Fighting, blaming, mistrusting
-Poor communication skills
-Difficulty with intimacy
-Inability to commit, trouble making a commitment
-Issues with boundaries, control, abandonment
-Impaired ability to trust
-Difficulty forming relationships, difficulty with trust and/or intimacy
-Blurred boundaries
-Impaired ability to judge the trustworthiness of others
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Addictions
-Substance abuse, such as drug/alcohol abuse
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Eating disorders
-Over or under eating
-Being very thin or overweight
-Eating or not eating to have a sense of control we didn’t have over the abuse
-Anorexia
-Bulimia
-Binging/purging
-Compulsive over-eating
-Eating for comfort
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Sleep Issues
-Difficulty sleeping
-Insomnia, chronic insomnia
-Fear of being alone, particularly at night
-Fear of sleeping alone
-Nightmares, night terrors (pursuit, torture, powerlessness, and suffocation)
-Disruption in sleep patterns, nightmares, night terrors
-Fear of the dark
-Unexplained fears of being alone at night
-Fear of the dark
-Difficulty falling or staying asleep
-Early morning waking and inability to go back to sleep
-Waking up after sleeping 8 hours, but not feeling rested
-Other sleep disorders
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Anxiety
-Intense fearfulness, unexplained fearfulness
-Phobias or irrational/inexplicable fears
-Fear & resistance to long-term treatment
-Persistent frightening thoughts
-Fear of abandonment and other abandonment issues
-Stress disorders
-PTSD
-Nightmares (repeated scary dream as a child)
-Re-experiencing event or flash backs of abuse
-Disturbing recollections during day
-Avoidance of places that remind of trauma
-Anniversaries of the event are often very difficult
-Severe cases have trouble working or socializing, in some cases, may be chronic
-Occasionally, the illness doesn’t show up until years after the event
-Inability to recall an important aspect of the trauma
-Difficulty concentrating
-Irritability or outbursts of anger
-Suspiciousness
-Hypervigilance: strong startle response; extremely overprotective parenting
-Sense of dread
-Creation of crises
-Nightmares
-Avoidance certain people and/or places
-Sense of doom about the future
-Frozen or numbed emotions, especially with people they were once close to
-All or nothing extremes in behavior or thinking
-Extremely high or low risk taking
-Sense of a foreshortened future (ie, doesn’t expect to have career, marriage, children, or normal life span)
-Obsessive/compulsive behaviors (not necessarily Obsessive/Compulsive Disorder)
-Phobias; suffocation and murder
-Easily startled, such as by sounds or touch
-Exaggerated startle response, hyper alertness
-OCD
-Panic attacks
-Agitation
-Denial
-Helplessness
-Anxiety disorders, phobias (esp. in children)
-Feelings of being disconnected from body
-Intruding thoughts, memories, images, or reliving past trauma
-Worrying about and/or feeling that you’re going crazy, fear of insanity
-Shutdown under stress
-Numbing out emotionally – “1,000 – yard stare”
-Dissociation
-Extreme discomfort around mirrors
-Chronic sense of powerlessness or out of control
-Can discuss trauma with no affect (spurs disbelief from others)
-Inappropriate, sometimes extreme guilt/shame
-Increased nervousness, numbness or depression when own child reaches the age the parent was when victimized
-Chronic avoidance of seemingly benign things
-Seasonal emotional cycles corresponding with abuse (not related to SAD)
-Feeling very young and vulnerable during stressful periods (often returns to the age when the abuse first occurred)
-Depersonalization, feeling oneself to be unreal & everyone else to be real, or vice versa
-Intense anxiety and/or avoidance of gynecological exams
-Excessive fear of the dentist
-Unexplained anxiety/panic, when with individuals from childhood
-Feeling overly grateful/appreciative from small favors by others
-Blocking out periods of one’s life (usually ages 1-12) or a specific person or place
-Obsession with suicide at various times of the year or after triggering events
-Unexplained fears of suffocation
-Paranoia
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Medical
-Lowered thresholds for pain
-Poor contraceptive practices
-Poor adherence to medical recommendations
-*Pseudocyesis
-Chronic back pain
-Psychosomatic illnesses
-Chronic aches and pains, other musculoskeletal complaints, chronic arthritis or joint pain
-Skin disorders
-Vaginal or Pelvic Pain
-Headaches, chronic headaches, migraines
-TMJ syndrome
-Backaches, chronic back pain
-Chest pressure/pain
-Erection problems or ejaculatory difficulty
-Asthma, other respiratory ailments
-Dizziness/fainting
-Difficulty swallowing, gagging
-Recurrent gastrointestinal problems, chronic gastrointestinal problems such as IBS, Colitis, Nausea, Stomachaches, constipation or diarrhea paired with other physical symptoms, lower abdominal pain
-Chronic fatigue
-Insomnia
-Weight loss/gain
-Frequent illness
-Failure to thrive
-Abusing body by not exercising
-Difficulty in being aware of what your body is telling you
-Failure to heed their own body signals
-Alienation from the body
-Failure to take care of one’s body
-Poor/distorted body image
-Difficulty with swallowing, gagging, excessive fear of the dentist,
-Repugnance to water on face when bathing
-Feelings of suffocation
-Chronic minor illnesses (colds etc)
-Clothes which obscure or over-emphasize body
-Numbing of bodily areas, numbing out physically
-Lack of movement – particularly in therapy
-Rigidity of control around natural body functions
-Body “memories”
-Increased anxiety during relaxation exercises
-Sudden heart palpitations or sweating
-Chronic pelvic pain
-Pseudocyesis
-Poor adherence to medical recommendations
-Unexplained pain, itching, discomfort, swelling, bleeding, bruises, or irritation of mouth, genital or anal area
-Rectal or vaginal bleeding
-Trauma to mouth or genitals
-Repeated urinary infections or genital blockages
-Pregnancy
-Difficulty in walking or sitting
-Torn, stained or bloody clothing
-Gynecological difficulties, chronic gynecological disorders (even in children)
-Chronic venereal disease or infections
-Fibromyalgia
-Other somatizing disorders
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Depression
-Depressed mood most of the day, nearly every day
-Feeling sad or empty or observations made by others (e.g. appears tearful)
-Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
-Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
-Insomnia (inability to sleep) or hypersomnia (sleep too much) nearly every day
-Psychomotor (movements) agitation or retardation nearly every day or (observable by others, not merely subjective feelings of restlessness or being slowed down)
-Fatigue or loss of energy nearly every day
-Feelings of worthlessness or excessive or inappropriate guilt nearly every day
-Diminished ability to think or concentrate, or indecisiveness, nearly every day
-Marked impairment in your ability to function socially, occupationally, and/or educationally
-Indecisiveness, nearly every day
-Feeling helpless or hopeless
-Self-esteem is inflated or enlarged or you have thoughts grandiose
-Decreased need for sleep or you feels rested after only 3 hours of sleep
-More talkative than usual or feel pressured to keep talking
-You become excessively involved in pleasurable activities that have a high potential for painful consequences, such as engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments
-Mood disturbance or change in functioning are noticed by others. Unequivocal change in functioning that is uncharacteristic of the person when not symptomatic
-Flight of ideas or have racing thoughts
-Distractibility in focusing attention too easily drawn on unimportant or irrelevant external stimuli)
-Or other symptoms that cause significant distress or impairment in social, occupational, or other important areas of functioning
-Distinct period of persistently elevated, expansive, or irritable mood, that’s clearly different from the usual nondepressed mood
-Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
-Impaired/poor concentration at work or school
-Bouts of crying, crying uncontrollably
-Extreme moodiness
-Anger, hostility
-Dysthymic Disorder (Chronic depression)
-Overwhelmed, even by everyday situations
-Depressed most days (most of life)
-Low self-esteem
-Difficulty making decisions
-Significant distress or impairment in social, occupational areas
-Diminished interest in performing normal tasks or pursuing usual interests
-Patterns of powerlessness
-Poor attention span
-Isolating oneself from family and friends and avoiding social situations
-Chronic lethargy
-Loss of interest in things they used to enjoy
-Markedly diminished interest or participation in significant activities
-Significant distress or impairment in social, occupational, or other important areas of functioning
-Listlessness
-Withdrawal
-Anger
-Irritability
-Difficulty experiencing pleasure
-Unexplained sadness, and/or depression
-Suicidal thoughts, attempts and play (in children)
-Inability to express anger
-Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
-Suicidality
-Thoughts of suicide daily
-Suicide threats and/or attempts
-Sadness
-Suicide attempts
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Sexual
-Erection problems or ejaculatory difficulty
-Inability to achieve orgasm, or feel desire or experience arousal for sex
-Sexually complicated relationships
-Relationships may often be all about sex
-Black outs with certain upsetting moments, especially sexual
-Difficulty relating to others except on sexual terms
-Abnormal perspective on sexuality
-Aberrant sexual behavior
-Desired sex may include aspects as abuse
-Manipulation of body size to avoid sexual attention
-Sexual dysfunction
-Sexually transmitted diseases
-Difficulty “staying present” during sex
-Difficulty saying NO to sex
-Experiencing numbness, pain, or panic during sex/intimacy
-Feeling exploited sexually or using your sexuality in a way that exploits others
-Using your sexuality to exploits others
-Avoiding sex, sexual inhibition, never having sex
-Pursuing sex you really don’t want, promiscuity, seductive behavior
-Sexual acting out, “sexaholism”, history of prostitution, performing in porn films
-Prostitution
-Anonymous sexual encounters
-Indiscriminate sexual behavior
-Oscillation between asexual or compulsive sexual behavior
-Flashbacks of abuse during sex
-Sexual extremes
-Inappropriate sexual arousal
-Crying during or after sex
-Sexual codependency
-Feeling “dirty”
-Fetishes and eroticism that mimics the abuses
-Sexual blackmail
-Sex perceived as “bad” or “powerful”
-Confusion about sexual identity (particularly if perpetrator was same sex)
-Sexual fantasies that usually have common themes that mimic the trauma
-Shame around sexual arousal themes
-Sexual arousal paired with fear, shame, guilt, powerlessness, or power
-Excessive masturbation
-Recapitulating their experience by trying to abuse others
-Inappropriate dress, such as tight or revealing clothes or overdressing, such as wearing layers of clothing regardless of the weather
-Difficulty relating to others except in sexual or seductive ways
-Unusual interest in or avoidance of all things sexual or physical
-Extreme fear of being touched
-Unwillingness to submit to physical examination
-Difficulty with becoming aroused and feeling sensations
-Sex feels like an obligation
-Sexual thoughts and images that are disturbing
-Inappropriate sexual behaviors or sexual compulsivity
-Vaginal pain
-Feeling dissociated while having sex
-Detachment or emotional distance while having sex
-Being afraid of sex or avoiding sex
-Guilt, fear, anger, disgust or other negative feelings when being touched
-Pattern of re-victimization, unable to say “no” to sexual relationship
-Strong sexual identity – difficult when partner does not wish to be sexual
-Becoming involved with someone who reminds you of abuser or who you know isn’t good for you
-Chronic choosing of unavailable mates or addicted partners (particularly with sexual issues)
-Misconceptions and confusion about sexual behavior
-Confusion about what’s right or wrong about sexual behavior
-Fearful memories get associated with sex
-May become sexual aggressive, or tend to extremes, either a heightened sensitivity and attraction to sexual behavior or highly negative feelings to all sexual activity
-Confusion over sexual identity and fear of homosexuality is abused by the same sex
-Sexual issues and extremes
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Religious
-Rigid religiosity
-Extremely anti-religious
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Mental Health
-Personality disorders
-Multiple personalities
-Depression
-Anxiety
-Symptoms of posttraumatic stress disorder (PTSD)
-Bipolar Disorder
-Dissociation
-Splitting/ de-personalization, shutdown under stress
-Dazed/blunted affect
-Chronic high risk behaviors
-Aversion to making noise during crying, laughing, or playing
-Hiding or cowering behaviors (even in therapy)
-Amnesia; “Gaps” in childhood memory
-Blocking of memories, especially between age one and 12
-Themes of powerlessness
Hostility
Betrayal
Rage/Inappropriate anger
-Grief
-Disorientation
-All or nothing extremes in behavior or thinking
-Powerlessness
-Denial
-Repeated self-injury
-Expectation of early death
