Breaking the Silence: Uncovering the Lingering Impact of Hidden Trauma

Hidden Trauma: Silent Scars That Linger

Breaking the Silence: Uncovering the Lingering Impact of Hidden Trauma by @JHermanKleiger #trauma #mentalhealth #silence

Psychologically traumatizing events can be obvious, highly visible, and easily recognized. At the same time, some may remain hidden, leaving invisible scar tissue that makes it less obvious to others and even to the individual who has suffered less visible forms of trauma.

Let’s shine a light on hidden forms of trauma. But first, a quick review of the phenomenon of PTSD is helpful. 

Visible and Recognizable Forms of PTSD

Over the last 40 years, we’ve witnessed an explosion of interest in psychological trauma among mental health professionals and the lay public alike. Beginning in the 1970s and ‘80s, attention turned to the effects of combat on soldiers in Vietnam as Posttraumatic Stress Disorder, or PTSD, was recognized as an official condition by the DSM.

Countless books and articles have reviewed research about the symptoms and course of psychological trauma, diagnostic methods, and treatment approaches for PTSD. Most of the attention in those first few decades focused on high-impact, life-threatening single-event traumas, such as combat, sexual assault, or natural disasters, which were referred to as “shock” or Type I trauma

Interest in PTSD broadened to those situations in which posttraumatic symptoms (chiefly, re-experiencing intrusive memories and dreams related to the trauma; avoidance of stimuli associated with the trauma, and alterations in arousal and reactivity) are delayed by more than six months following the traumatic event or are the result of chronic trauma or recurrent episodes of trauma (Type II or “strain” trauma).

What characterizes this form of trauma is not only its repetitive nature but also its inescapable quality. Termed “Complex PTSD,” this form of trauma often occurs in the crucible of an abusive relationship (physically, sexually, emotionally, or verbally), often beginning in childhood, as in the case of child abuse or torture.

Recognized as a separate form of trauma by the ICD-11 (but not the DSM-5-TR), C-PTSD includes symptoms typical for PTSD, along with difficulties in emotional regulation, a damaged sense of self, and mistrust. The fact that relational trauma of child abuse becomes woven into the fabric of the developing personality makes this chronic form of trauma so damaging to the growing youngster.  

Hidden Trauma

What is meant by “hidden trauma? In one sense, all forms of psychological trauma are invisible if we contrast them with physical trauma. In fact, the absence of physical wounds may make others question the existence of PTSD in an otherwise healthy-looking individual.

However, hidden forms of trauma, in the context of PTSD, involve traumatic situations that are (1) less evident to others and, perhaps even to those who have suffered less overt forms of trauma, (2) less discussible because of the nature of the traumatizing event, and, relatedly, (3) minimized or ignored.

These categories are not mutually exclusive and may be related to each other. Let’s look at each. 

Less Evident Forms of Traumatization

Two forms of hidden trauma are bullying victimization and what is called “religious trauma syndrome.”  

Bullying Victimization. Bullying has been around forever but was not historically viewed as a form of traumatization. Instead, it was seen as an unfortunate, normative aspect of growing up. Euphemistically referred to as “teasing” or “scapegoating,” bullying was generally considered an aspect of a hard-knock life.

However, with the widening scope of trauma, attention was directed to untoward childhood experiences that have lasting effects on a growing child’s sense of self, emotional regulation, and social connections and belonging. In more recent years, bullying has been understood as a form of developmental trauma and placed under the rubric of C-PTSD. 

Breaking the Silence: Uncovering the Lingering Impact of Hidden Trauma by @JHermanKleiger #trauma #mentalhealth #silence

Social media has acted as an accelerant playing a significant role in perpetuating and accentuating childhood bullying. Loneliness, hopeless feelings, and depression may develop in the wake of chronic, unremitting bullying. Children and teens, especially girls, show increased risks of suicidal feelings in the context of cyberbullying.

Thirteen Aubrey experienced daily taunting at school. Pushed and groped at school, Aubrey was assailed again online, as cruel taunts and social media posts made fun of her physical appearance, her clothes, and her family. Bitter, angry, depressed, and lonely, Aubrey was finally taken to therapy after she attempted to take her life. (Source:

Religious Trauma Syndrome (RTS) relates both to the chronic abuses of harmful religious indoctrination and the impact of severing the connection with one’s religion and faith community. Some view RTS as a form of C-PTSD because of the impact on development in the case of children who are exposed to a system of extreme, authoritarian religious indoctrination.

In addition to the long-term developmental aspects, RTS also applies to the trauma of breaking away from such a faith-based family and community. Although adolescents and adults may experience breaking away from this kind of restrictive community as liberating, the challenges of leaving are significant.   

For people growing up in such a community, the religious environment met all their major social and emotional needs. It provided a predictable, structured support system and gave them a coherent view of the world, a spiritual connection, a purpose and meaning, and a sense of self and morals. As we can see, the early impact of an authoritarian religious indoctrination, compounded by the multiple losses in social relationships, sense of self-coherence, and meaning, can have profound effects on such individuals.  

Such was the case with Riva, a thirty-something woman raised in a restrictive religious community in which her parents were leaders in their insular religious sect. When she finally left, she felt free; however, her sense of liberation at freeing herself from the constraints of her family and community soon gave way to an emptiness she described as “a gigantic hole that I can’t fill.” She spoke of a loss of meaning stemming from the belief that “If there isn’t really a God, then nothing matters.” 

One can think of RTS as a form of early traumatization followed by a catastrophic social rupture that leaves the survivor feeling lost and disconnected from family and without a mature spiritual belief system and solid sense of herself.   

Undiscussable Forms of Trauma

Some traumatic events and losses are not easily discussed. Clearly, an essential healing element involves being able to share one’s traumatic experience with a sympathetic support system. But what happens when the nature of the traumatic event cannot be openly shared?  

Talking about the loss of a loved one is generally received by a sympathetic audience, but what happens if the loved one takes his or her own life? How do we share this kind of unspeakable loss?

The word ”unspeakable” is key.

It is impossibly hard for survivors to share openly that their loved one has died by suicide. Some listeners find it hard enough to talk with survivors about losing a family member, but this difficulty may be compounded if the loss is the result of suicide. Survivors, themselves, may feel ashamed and unable to open up about the nature of their loved one’s death. 

There are other forms of unspeakable trauma and loss. Imagine the experience of those whose child, spouse, brother, or sister has perpetrated an act of violence. Parents of school shooters, rapists, and murderers face the trauma of destroyed lives, the contempt of their communities, the shame of what their family member has done, and the loss of that individual, either through death or incarceration. How do they metabolize their trauma?

How do they heal? Where can they find a sympathetic ear? 

Minimized or Ignored Trauma

Minimized and ignored forms of trauma and loss overlap with unrecognized traumatization. The key here is that they are overlooked or never considered from the perspective of traumatization. Common types of unrecognized or normalized trauma and loss include miscarriages and abortions. 

Miscarriages are viewed normatively because they occur so frequently. However, they can be devastating losses. Similarly, a stillborn infant is the loss of a child the parents never knew. Although miscarriages may have a more sympathetic audience, many in one’s support system may not fully grasp the depth of pain associated with miscarriages. 

 Abortion may amplify the traumatization and loss associated with miscarriages. A heated political issue, those who seek abortions are bombarded by internal and external pressures regarding their decision. Unlike miscarriages, abortion may be less easily discussed and shared; and for many, it may remain an unvoiced mixture of shame, guilt, loss, and relief.

Many may find it extremely difficult to share the myriad, conflicting feelings surrounding this painful, private decision. Abortion trauma can be further compounded when the life of the mother is threatened by a hostile legal system. 

There is a category of searing losses that are never put to rest––the disappearance of a family member with no resolution of the loss. In the wake of such a disappearance, survivors may experience a great deal of support from a well-meaning community. However, what happens when the missing family member is never found? The world moves on, but the surviving family member cannot.  

Some forms of trauma are hidden behind violent acts and criminal behavior. Those who commit crimes need to be accountable, but we too easily overlook the trauma in the pasts of such individuals. Too often, society is indifferent or vindictive toward those who have committed crimes and unwilling to consider the horrible backgrounds of the perpetrators.  

At a conference on Evil, renowned psychoanalyst Salman Akhtar said words to the effect, “Show me a serial killer, and I’ll show you an abused child.” Most of us are probably not receptive to such an idea. I recall how many audience members rejected Akhtar’s statement. “Evil is evil,” I heard people say.   

While childhood physical, sexual, emotional, and verbal are well-recognized forms of trauma, what about the effects of neglect and parental uninvolvement? Childhood Emotional Neglect (CEN)& Parental involvement involves a trauma that is often hidden because it’s something that didn’t happen.

Physical and sexual abuse is something that happened or was done to the child. Neglect and uninvolvement is something that was not given to them.  

First responders are occupationally predisposed to secondary trauma in their work. Fire and rescue workers, police officers, and emergency medical personnel (especially during the first years of the pandemic) are especially susceptible to the pile-up of stress secondary to habitual exposure to traumatic events. 

What about the effects of poverty and growing up in violent neighborhoods, where redlining has eviscerated essential services and hollowed out communities? 

Breaking the Silence: Uncovering the Lingering Impact of Hidden Trauma by @JHermanKleiger #trauma #mentalhealth #silence

Finally, how much do we think about the traumatic plight of migrants? They leave behind a familiar world of home, family, and friends but also, for many, a home that turned hostile and threatening. They make perilous journeys, spend much, if not all, of what they have, suffer exploitation, and finally reach a land where the welcome is more than ambivalent.

Deep inside whatever it is that has propelled them, they carry scars of unimaginable loss and traumatization. 

Recognizing Signs of Hidden Trauma

Hidden trauma is not just hidden from others, but it can also be disguised and veiled to the trauma survivor, who may, like others around them, either discount or minimize the impact of hidden and implicit forms of trauma and loss. However, while the source of the trauma itself may be hidden, its effects are not.

Survivors may experience myriad symptoms, including depression, anxiety, anger, moodiness, and shame. Such feelings are not endpoints themselves or the ultimate causes of the individual’s pain and suffering, but instead, they are signals or symptoms of something else. These are pains that tell us something is wrong.  

Sleep, the biological truth-teller, knows something is wrong before we do. Difficulties falling or staying asleep may be somatic signals of things we must pay attention to. Hypervigilance and hyperarousability may also be behavioral signals of unrecognized trauma. 

The signs of hidden trauma may be seen in behavior, including avoidance of people or places that arouse uncomfortable feelings. Such individuals may feel disconnected and detached and have difficulties with trust and intimacy without understanding why. Survivors may use addictive substances or food to self-soothe or self-medicate to numb or distract themselves from their hidden trauma.    

Although all these symptoms are transdiagnostic, meaning they are not indications of specific causes or sources of pain, they may suggest the presence of unrecognized trauma. The point is that none of these symptoms or behaviors, by themselves, indicate hidden or buried trauma. Finding out more about that possibility will require more information.  

For more information about common signs of hidden trauma, see here.

Getting Help

There are many avenues to getting help. Treatment begins with a good evaluation by a mental health professional (psychologist, psychiatrist, social worker, psychiatric nurse, licensed professional counselor) with experience in recognizing symptoms/behaviors that might represent the presence of unrecognized and unprocessed trauma.

Through interviews, history taking, speaking with family members, and possibly psychological assessment, a link between presenting symptoms and underlying problems can be made.  

Trauma-specific treatments include a variety of methods, including: 

  • Individual talk therapy 
  • Group therapy 
  • EMDR (Eye movement desensitization and reprocessing 
  • Mindfulness, yoga, and meditation 

Here is a helpful resource for those interested in understanding more about PTSD, hidden forms of trauma, signs and symptoms, and available treatments. 

A final note: not all bad things that happen to us constitute trauma. There is a danger of stretching the trauma concept to the point that it becomes overly inclusive and trivializes the experiences of traumatized individuals.

At the same time, it is harmful to turn a blind eye to those more subtle, less obvious forms of traumatization. In this blog, I’ve attempted to shine a light on some of these hidden forms of trauma. No doubt, I’ve missed some. 

Hidden Trauma in Literature

Fictional accounts of trauma provide windows into how we experience, respond to, try to avoid awareness of, and eventually recover from trauma. For a list of fiction writers who have dealt with various facets of trauma, whether it is overt or hidden, click on the link to list.  

Reading Trauma Narratives: The Contemporary Novel and the Psychology of Oppression by Laurie Vickroy treats the subject of PTSD by turning to literature for insights into how trauma survivors exist “inside and outside their traumas, wanting both to remember and to forget.”  

Lead characters in my novels, The 11th Inkblot and Tears Are Only Water, struggle with a layering of early trauma (the disappearance of a parent and suicide of a family member) and subsequent forms of loss and victimization. Both protagonists, Anton Zellinsky and Carmine Luedke, remain unaware of the traumatic undercurrents in their lives until they are finally helped to face and free themselves from their hidden traumas. 


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  1. Richard M. Waugaman, M.D. on March 5, 2024 at 9:06 am

    This is fabulous, Jim. Amazingly comprehensive.

    Religious trauma makes me think of a wonderful novel by David Guterson, The Final Case. It is a fictionalized treatment of the actual felony conviction of two abusive parents, after the death of their adopted daughter. They were home-schooling religious fanatics. We have since learned that some (not all) home-schooling parents are religious fundamentalists. The Washington Post has reported that the “research” that convinced many states to allow parents not to send their children to school was largely bogus, written by a strong supporter of religious fundamentalism, that is contributing to Trump’s democracy-threatening popularity.

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