Understanding Trauma, Stored Trauma, and Postpartum Mental Health: A Science-Based Guide
Most of us have been taught that trauma only affects a small percentage of people who have experienced extreme events. But emerging research suggests something far more expansive: that most of us, regardless of our life circumstances, may be carrying unresolved trauma in our bodies without even knowing it.
In this article, we explore a more inclusive and nuanced understanding of what trauma actually is, including how the body stores trauma, what that stored trauma looks like in everyday life, and the essential steps required to reprocess and release it.
What You'll Learn in This Article
Why trauma is far more common than previously understood, and why it has less to do with the events themselves and more to do with how the body responds to them.
How unresolved trauma gets stored in the body at a cellular and systemic level, and why so many everyday patterns, behaviors, and symptoms may actually be signs of stored trauma rather than personality quirks or character flaws.
The essential three-step sequence required to safely and effectively release stored trauma from the body, and why skipping steps or rushing the process can cause more harm than good.
Table of Contents
The Critical Line of Overwhelm
Too Much Too Fast
Too Little for Too Long
Moving, Shifting, Always Changing
Neuroception: The Body's Subconscious Safety System
Capacity Deposits and Withdrawals
Neuroception's Calculation
The Three Operating States
A Note on Postpartum Mental Health and Trauma Physiology
The Hormonal Landscape of the Postpartum Period
How This Primes the Body for Survival States
What This Looks Like in Everyday Postpartum Life
Why This Matters
How Trauma Affects Cell Biology
The Cell Danger Response
Why the Body Holds On to Trauma
The Trauma Loop
Signs, Symptoms, and Patterns of Stored Trauma
Pattern 1: Disconnection
Pattern 2: Disruption
Pattern 3: Depletion
Pattern 4: Dysregulation
Pattern 5: Disease
Specific Symptoms of Trauma Physiology
Releasing Stored Trauma: The Essential Three-Step Process
Step 1: Safety and Stabilization
Step 2: Support and Pendulation
Step 3: Expansion, Integration, and Rehabilitation
What Is Trauma?
The events that can lead to trauma come in many forms, including physical, sexual, emotional, and psychological, and all forms carry the potential to be equally devastating in terms of the imprint they leave behind. As Dr. Bessel Van Der Kolk's research has repeatedly shown, chronic emotional abuse and neglect can be just as devastating as physical or sexual abuse.
But here is the critical insight that changes everything: it isn't the specifics of the event that determine whether something becomes traumatic. It's whether or not we were able to respond to it in proactive ways. Being able to take action moves fear-based neurochemicals through the system and allows us to maintain our sense of agency. When that ability to act is blocked, trauma can take root.
Dr. Nicole LePera defines trauma as anything that "results from any stress that exceeds our ability to emotionally process the experience, causing continued dysregulation to our body's nervous system."
And Dr. Aimie Apigian, author of The Biology of Trauma, offers perhaps the most expansive and compassionate definition of all: trauma is not an event. It is the experience the body had going through the event. It is anything that, for any reason and at that particular moment, overwhelmed the body's capacity to cope.
If the word "trauma" carries too much charge, Dr. Apigian suggests using the word "overwhelm" in its place. Because at its core, that is exactly what trauma is: an experience of overwhelm that exceeded the body's capacity to process and move through it.
And that capacity is not only highly individual, it is also highly variable, depending on a wide range of internal and external factors.
A Special Note on Postpartum Mental Health and Trauma Physiology
This information is especially relevant for women in the postpartum period. As we’ll explore in depth later in this post, the dramatic hormonal shifts that follow birth can dramatically lower the body's Critical Line of Overwhelm, priming the nervous system for exactly the kinds of survival states we’re about to explore.
While everything explored in this post applies broadly to the human experience, I’d like to call special attention to one population in particular: women in the postpartum period.
The postpartum period is widely understood to be emotionally challenging, yet it’s still largely framed in terms of mood disorders, namely postpartum depression and postpartum anxiety. What’s far less commonly discussed is how the profound hormonal shifts of the postpartum period can prime the nervous system for exactly the kinds of survival states we have been exploring in this post, creating a biological environment in which the body's Critical Line of Overwhelm is dramatically lowered and the trauma response becomes far easier to trigger.
The Universal Steps in the Body's Trauma Response
According to Dr. Apigian, there are five universal steps in the body's trauma response. Understanding these steps is important because they clarify experiences we might have previously dismissed as "just stress," and they reveal the profound physiological significance of moments in which we felt trapped or powerless.
The Startle is an inner state of hypervigilance. A surge of noradrenaline, a stress hormone stored in our tissues, causes our senses to sharpen and become hyper-attuned so that we can quickly gather information about a potential threat.
The Stress is an inner state of high energy, commonly known as fight-or-flight. The purpose of this step is to take action to overcome the presenting threat, whether that threat is real, imagined, or perceived.
The Wall is an inner state of powerlessness. When fighting or fleeing are not possible, the body shifts into powerlessness. The wall can be formed by physical barriers that make escape impossible, or by internal barriers like deeply held limiting beliefs that stop us from trying in the first place.
The Freeze is an inner state of paralysis. This is sometimes described as pressing the gas pedal and the brake simultaneously. We are revved up and yet completely stuck. Importantly, the freeze state is not always visible from the outside. A person can appear to be functioning normally while experiencing intense internal paralysis and panic.
The Shutdown is an inner state of collapse or heaviness, sometimes called the flop response. This is the body's last resort to survive, conserving energy by dissociating from or immobilizing the body entirely. Animals playing dead is a well-known example of this response.
As Dr. Apigian writes, "These steps reveal that trauma is not an event that happens to us but what happens inside of us when we feel trapped and powerless."
The Critical Line of Overwhelm
Each of us has what Dr. Apigian calls a Critical Line of Overwhelm: a threshold that separates what will be stressful from what will be traumatic. She describes it simply as "an exact line between what grows us and what breaks us."
Our body crosses that critical line for two distinct reasons: too much too fast, and too little for too long.
Too Much Too Fast
Imagine holding a heavy rock above your head. Your muscles will strain and your stress response will engage to meet the challenge. As long as you can hold the rock, your body remains in its energy surge state, working to overcome the stress. But the moment you can no longer hold it, the rock crushes you.
If the rock was simply far too heavy from the start, and you were given no time to prepare, you would be powerless from the very beginning.
In today's modern world, the constant bombardment of stressors without adequate time and space to process them can create micro-traumas in the body. A large bucket filled rapidly with small stones still crushes us under its cumulative weight. The same is true of emotional processing. When the body is flooded with emotions it doesn't have the capacity to safely contain, trauma can occur. This is one of the reasons why going slowly in trauma healing is so essential. Attempting too much healing too fast can, in fact, re-traumatize.
Dr. Apigian makes an important point here: the mind does not determine the difference between stress and trauma. The body does. Terms like "chronic stress" and "burnout" actually describe what is, physiologically speaking, the shutdown step of the trauma response. When we use stress management techniques to address what is actually a trauma state, we leave the underlying condition unaddressed and allow it more time to grow.
Too Little for Too Long
On the other end of the spectrum, a rock that is not very heavy at all will eventually become unbearable if we are never allowed to put it down. Without rest, even the lightest weight crushes us at our point of exhaustion.
Trauma from too little for too long is a gradual progression into overwhelm that often feels sudden only because the warning signs accumulated quietly over time. It is not a single incident that pushes us over the line but the chronicity of unmet needs. Childhood emotional neglect, ongoing emotional isolation within a relationship, and chronic nutrient deficiencies are all examples of this form of trauma.
Moving, Shifting, Always Changing
Crucially, our Critical Line of Overwhelm is not fixed. It moves and shifts from day to day and from one season of life to another. Something that energizes us on one day may overwhelm us on another. This is why understanding the concept of neuroception is so essential.
Neuroception: The Body's Subconscious Safety System
Neuroception is a term coined by Dr. Stephen Porges, the founder of Polyvagal Theory. It describes the body's subconscious system for detecting safety and threat in our environment and within ourselves.
Think of neuroception as the most sophisticated self-driving system ever created, one that runs a constant scan of our inner and outer world. It processes information from all of our senses, registers subtle cues from our relationships and social interactions, monitors internal biology including inflammation levels, hormone levels, and energy reserves, and factors in our past experiences, which create a personalized filter for what constitutes safety or danger for each of us.
According to Dr. Apigian, two key factors shape neuroception's ongoing assessment: our capacity and the demands we face. Together, these determine our Window of Tolerance, which demarcates the tipping points between the body's rest-digest-and-connect mode and its fight-flight-freeze-fawn-flop mode.
Capacity: Deposits and Withdrawals
Our capacity can be understood like a bank account. What goes into that account, and what gets withdrawn from it, determines our ability to meet life's demands at any given moment.
Capacity deposits come in many forms. Biologically speaking, quality sleep, nourishing food, mindful movement, restorative breathwork, a healthy microbiome, good blood and lymphatic flow, stable blood sugar levels, and a balanced nervous system all make generous deposits. Emotionally and psychologically, genuine connection with others who make us feel seen and accepted, joy and play, skill development, and successfully navigating challenges also replenish our reserves.
Capacity withdrawals come in the form of demands. Every demand, whether running a marathon or managing a difficult conversation, requires a withdrawal from the capacity account. Biologically, poor sleep, inadequate nutrition, over-exercising, excessive alcohol, shallow breathing, an imbalanced gut microbiome, and systemic inflammation all drain our reserves. Emotionally and psychologically, being around depleting people, unresolved conflict, over-committing, perfectionism, people-pleasing, negative self-talk, and persistent worry all draw from the same account.
Importantly, Dr. Apigian notes that whether a demand is "good" or "bad," simple or complex, physical or emotional, it all factors into the same calculation.
Neuroception's Calculation
The calculation neuroception is constantly running is straightforward: it weighs our available capacity against current demands. If capacity exceeds demands, we remain on the stress side of the Critical Line of Overwhelm and utilize the body's energy surge to build resilience. If demands exceed capacity, neuroception defaults to the trauma response to protect us.
Notably, neuroception treats all threats as equal. As Dr. Apigian writes, "Our logical mind might say 'it's just feelings,' but our neuroception processes unbearable emotional pain as a survival threat."
The Three Operating States of the Nervous System
Based on Polyvagal Theory, our physiology shifts between three operating states in response to neuroception's ongoing assessment. Dr. Apigian refers to these states as the Calm-Alive State (balanced arousal), the Activation State (hyperarousal, encompassing the startle and stress stages of the trauma response), and the Trauma State (hypoarousal, encompassing the freeze and shutdown stages).
Understanding this subconscious process is the key to reclaiming agency over the body. When we are unaware of it, our body responds in ways that feel confusing and frustrating. When we bring it into conscious awareness, we can begin to work with it intentionally.
A 2011 study of over one thousand parole rulings made by eight judges illustrates this physiological reality vividly. After judges took a break, 65 percent of cases were granted parole. The highest percentage of favorable rulings occurred at the beginning of the day and steadily declined toward zero before spiking back to 65 percent immediately following lunch, then declining again. What reads as a pattern of judicial decision-making is, at its root, a story about biological capacity and depletion.
The Hormonal Landscape of the Postpartum Period
During pregnancy, levels of estrogen and progesterone rise to extraordinarily high levels, higher than at any other point in a person's life. Within hours of delivery, both hormones drop sharply and dramatically. This hormonal freefall is one of the most rapid and significant hormonal shifts the human body ever experiences, and it happens at the precise moment when physical recovery, sleep deprivation, and the enormous demands of newborn care all converge.
This hormonal withdrawal has a direct and measurable impact on the brain and nervous system:
Progesterone is a natural neurosteroid with calming, GABA-enhancing effects. GABA is the brain's primary inhibitory neurotransmitter, the one responsible for a felt sense of calm, safety, and groundedness. When progesterone drops sharply after delivery, so does its calming influence on the nervous system, leaving many new parents feeling inexplicably anxious, edgy, and on high alert even in the absence of any identifiable threat.
Estrogen plays a significant regulatory role in the serotonin and dopamine systems, both of which are deeply involved in mood stability, motivation, and the felt sense of wellbeing. When estrogen drops postpartum, serotonin and dopamine signaling is disrupted, contributing to the emotional flatness, irritability, tearfulness, and loss of joy that characterize the postpartum experience for so many.
Cortisol, the body's primary stress hormone, remains elevated in the postpartum period as the body attempts to meet the enormous demands of recovery and newborn caregiving. Chronically elevated cortisol keeps the nervous system in a state of low-grade activation, perpetually scanning for threat, perpetually on guard.
Oxytocin, often called the bonding hormone, surges during and after birth and plays a critical role in maternal bonding and social connection. However, sleep deprivation, high stress, and the absence of adequate social support all suppress oxytocin release, which can compromise the very felt sense of connection and safety that helps regulate the nervous system in this vulnerable period.
Thyroid function can also become dysregulated in the postpartum period, with postpartum thyroiditis affecting an estimated 5 to 10 percent of new mothers. Since the thyroid governs metabolic rate and energy production at the cellular level, thyroid dysregulation compounds the depletion and exhaustion that already characterize the postpartum period, further draining the capacity account and lowering the Critical Line of Overwhelm.
How This Primes the Body for Survival States
Recall that neuroception, the body's subconscious safety detection system, is constantly weighing available capacity against current demands. In the postpartum period, capacity is at one of its lowest points in a person's life while demands are at one of their highest. The hormonal shifts described above drain the capacity account from multiple directions simultaneously, while the physical demands of recovery, the cognitive demands of learning to care for a newborn, the emotional demands of identity reorganization, and the social demands of navigating changing relationships all make extraordinary withdrawals from that same account.
The result is that the postpartum nervous system is operating with a dramatically narrowed Window of Tolerance. What would be manageable stress in another season of life can genuinely overwhelm the postpartum body and nervous system, crossing that Critical Line of Overwhelm into a trauma response.
Furthermore, the sleep deprivation that is nearly universal in the postpartum period is not simply inconvenient. It is physiologically destabilizing. Sleep is one of the most essential biological mechanisms through which the nervous system regulates itself, clears oxidative stress, and processes emotional experiences. Chronic sleep disruption in the postpartum period keeps the body in a persistent state of low-grade physiological stress, further sensitizing the nervous system and making the trauma response easier to activate.
Add to this the reality that birth itself can be a traumatic experience. Studies suggest that somewhere between 25 and 34 percent of birthing people describe their birth experience as traumatic, and approximately 9 percent go on to develop PTSD specifically related to childbirth. When the birth experience itself has crossed the Critical Line of Overwhelm and left an incomplete trauma response in the body, the postpartum period begins in an already activated nervous system state, with depleted capacity and enormous ongoing demands.
What This Looks Like in Everyday Postpartum Life
Through the lens of trauma physiology, many of the experiences that are normalized or minimized in postpartum culture begin to look quite different.
The hypervigilance that has a new parent bolting awake at the slightest sound, unable to sleep even when the baby is sleeping, is the nervous system stuck in the Activation State, scanning perpetually for threat. The emotional numbness, disconnection from the body, and inability to feel joy even in tender moments with a new baby can reflect the Disconnection and Depletion patterns of stored trauma physiology rather than a simple mood disorder. The freeze response can look like staring at a crying baby and feeling completely unable to act, not out of a lack of love or competence, but because the nervous system has shifted into paralysis. The shutdown response can look like the profound flatness, exhaustion, and emotional withdrawal that is so often labeled simply as postpartum depression.
Fawning, another survival response, can manifest as an extreme prioritization of the baby's needs and everyone else's needs to the complete exclusion of one's own, not because it is chosen but because the nervous system has learned that self-erasure is the safest strategy for maintaining connection and avoiding conflict.
None of these responses are signs of failure. They are signs of a nervous system doing exactly what nervous systems do when capacity is overwhelmed and safety feels uncertain.
Why This Matters
Understanding the postpartum period through the lens of trauma physiology matters enormously, because it reframes what is happening in the body and brain of a new parent as a physiological reality rather than a personal failing.
It also clarifies why standard approaches to postpartum mental health, including medication and talk therapy alone, so often fall short. When the body is in a state of trauma physiology, the foundational work must begin at the level of the nervous system and biology, establishing safety, replenishing capacity, and gently completing the incomplete cycles of activation that the body is still holding.
This means that the most powerful support for postpartum mental health may not begin with words at all. It may begin with sleep, nourishment, gentle movement, nervous system regulation practices, adequate social support, and the radical permission to do less and receive more, which together begin to make deposits back into a severely overdrawn capacity account.
And it means that the first and most important thing we can offer anyone in the postpartum period is not advice or a to-do list, but the felt experience of genuine safety.
How Trauma Affects Cell Biology
Just as the whole person has a Critical Line of Overwhelm, so does every cell in the body. Scientists call the degree to which a cell can maintain balance under stress its "homeostatic capacity." When demands exceed what a cell can sustain, it engages its own version of the trauma response: the Cell Danger Response.
The Cell Danger Response
The Cell Danger Response is the cellular equivalent of hitting the emergency brakes and shifting into protective shutdown mode. When this occurs, normal cellular functioning is overridden and the sole priority becomes survival. This is part of why we can feel so heavy, exhausted, and depleted when the body is in shutdown.
The Cell Danger Response affects specific aspects of cellular biology in the following ways:
Mitochondria are perhaps the most dramatically transformed. Their physical shape changes from long and flexible to round and rigid. Their energy production shifts from their normal pathway to a backup approach that requires less oxygen but produces far less energy and generates significantly more oxidative stress, which then damages cell membranes, DNA, and the mitochondria themselves.
Cell membranes transform from flexible, active gateways to rigid barriers, restricting the flow of nutrients and signals into and out of the cell, and reducing intercellular communication.
The nucleus is also affected, as the proteins that normally protect and repair DNA stop their regular maintenance work, leaving DNA vulnerable to damage.
How the Trauma Response Affects the Body's Systems
At a system-wide level, trauma causes every system in the body to reduce energy consumption, which means everything slows down. This widespread slowdown is part of why lingering trauma in the body is so often confused with laziness, procrastination, apathy, and depression.
The Nervous System is recalibrated by unresolved trauma in a way that negatively affects neuroception, causing the nervous system to misinterpret benign and innocent situations as dangerous threats. As Dr. Van Der Kolk writes, "After trauma the world is experienced with a different nervous system that has an altered perception of risk and safety."
The Brain is affected by the inflammatory effects of the trauma response, which decreases levels of feel-good neurochemicals including serotonin, dopamine, and GABA. This leads to mental fog, fatigue, disconnection, and dark or hopeless thoughts. Furthermore, brain inflammation lowers the threshold for the Critical Line of Overwhelm, making it easier to cross and easier to trigger additional inflammation, creating a self-sustaining loop.
The Immune System, left without resolution, becomes compromised by persistent inflammatory states, leaving us vulnerable to infections and sensitivities. Over time, chronic immune dysregulation can create confusion between the body's own tissues and invading pathogens, creating conditions for various forms of autoimmunity.
The Digestive System is significantly affected as well. During a trauma response, the vagus nerve completely shifts digestive functioning, causing blood flow to become stagnant, the muscles that move food through the system to go lax, and the intestinal barrier to become permeable, which is commonly known as leaky gut. This permeability then contributes to additional system-wide inflammation.
The Nature of Stored Trauma
So far we have explored what happens in the body during an acute trauma response. Now we turn to something equally important: what happens when that response never reaches completion.
Stored trauma leads to the continued activation of the trauma response even when the circumstances or events that caused it are no longer present. In extreme cases, the cluster of symptoms associated with stored trauma is severe enough to meet the diagnostic criteria for PTSD. However, based on everything we have explored in this post, it is likely that most of us are carrying stored trauma in the body. It is simply that the effects are often far more subtle than a clinical PTSD diagnosis would suggest.
As Dr. Apigian writes, "Our past shows up in our present in how we parent, how we work, how we love, and how we care for ourselves. Sometimes symptoms are obvious, like panic attacks with specific triggers. More often, they're subtle, the constant need to please others, the inability to say no, the persistent neck pain, or the exhaustion that never quite lifts."
Why the Body Holds On to Trauma
A trauma imprint is created and stored anytime the body crosses the Critical Line of Overwhelm without returning to the Calm-Alive state. The body, like any system, operates in rhythms and cycles. When a cycle is prematurely stopped, the body seeks resolution and completion by reactivating the loop when triggered. Trauma is stored in the body in the form of tripwires: recurring opportunities the body creates to complete the cycle it never got to finish.
Dr. Apigian identifies four levels at which the trauma response cycle must find completion in order for full healing to occur: biological (including both cells and systems), physical or somatic, mental (beliefs and parts of self), and neuroception.
Each level requires its own specific form of completion. At the biological level, cells must complete the Cell Danger Response in order for recovery and repair to occur. At the systems level, the flood of adrenaline released during the activation phase must be metabolized and discharged. This is why the instinctive shaking and trembling that animals do after escaping a predator is so important. It is the body's built-in mechanism for clearing excess adrenaline, and the same mechanism exists in us.
At the somatic level, the body needs to complete the protective movements that were blocked during the trauma response. As Dr. Apigian notes, incomplete protective movements become stored as somatic memory. Completing them, through the body's own impulses rather than through random movement, is what creates a genuine somatic reset.
At the level of mind and beliefs, parts of ourselves can fragment and become frozen in time at the moment of a traumatic experience. These parts remain frozen, waiting to be seen, reclaimed, and returned to safety. Willpower alone will not move them. They need to experience safety before they can relax their adaptive coping mechanisms.
Finally, at the level of neuroception, all other systems must register safety before neuroception itself can reset. We know neuroception has reset not through logic but through a felt sense of safety within the body: that calm, alive, present quality that signals that the cycle is complete.
For the body to complete a trauma response at all four levels, three elements are required: time, energy, and safety. In a culture built on busyness, fear, and disconnection, all three of these are in short supply. We move from overwhelm to overwhelm, fueled by caffeine and urgency, and we carry the cultural expectation that if we don't quickly "get over" experiences and move on, something is wrong with us.
As Dr. Apigian writes, we add shame to an already heavy emotional burden, and in doing so, we make it even harder for the body to find its way back home.
The Trauma Loop
When the trauma response cycle goes unresolved, a trauma loop forms. A trauma loop is a repeating emotional and behavioral sequence created by the nervous system in response to incomplete processing. It acts as a kind of veil layered over our perception, keeping neuroception in a state of persistent hypervigilance.
When a trauma loop is active, there is a persistent background current of anxiety even when circumstances are objectively fine. The nervous system misreads cues of safety as cues of danger. Simple tasks and ordinary environments can become sources of overwhelm. And every time the loop activates, it reinforces itself through the power of neuroplasticity: neurons that fire together wire together.
Over time, the trauma loop becomes so automatic that it becomes the default baseline. Stored, unresolved trauma ultimately shapes not just the nervous system but who we are and how we show up in the world.
Signs, Symptoms, and Patterns of Stored Trauma
Please note: the following is offered for educational and informational purposes only and is not intended to be used for diagnostic purposes. The presence of any of these patterns or symptoms does not necessarily indicate stored trauma.
Rather than asking "have I experienced trauma?", Dr. Apigian invites us to ask a different question: "Do I have trauma patterns in my life right now?" She identifies five distinct patterns that emerge when the body is holding stored trauma.
Pattern 1: Disconnection
Disconnection is essentially about living numbed out and from the head up. Disconnected from bodily sensations and the natural undulations of the emotional landscape, a person caught in this pattern feels perpetually "fine" but never tremendously alive or genuinely moved by life. They may hover at the periphery of their experiences rather than fully inhabiting them, limiting closeness in relationships and burying themselves in work, substances, excessive exercise, or constant stimulation to avoid feeling too deeply.
The clearest sign of disconnection is an aversion to stillness. Sitting alone in quiet, full-feeling presence is exactly what is most avoided, because it is in that space that the body and emotions can finally be heard.
The survival benefit of disconnection is that it protects us from feeling pain. The unintended cost is that it protects us from joy, richness, and the fullness of life as well. We cannot selectively numb. When we numb one category of emotion, we numb them all.
Pattern 2: Disruption
Disruption is about blocked and slowed movement, both in the body and in life. It emerges from chronic immobilization and leads to stagnation at every level, including compromised blood and lymphatic flow, digestive motility issues, an increased pull toward sedentary behavior, and a tendency to loop in repetitive thought patterns and stagnant emotional residue from the past.
What makes disruption particularly tricky is that it is rather functional on the surface. From the outside, someone caught in disruption appears to be moving through life normally. Internally, however, there is a profound sense of stuckness, like being caught on a merry-go-round they cannot stop. They are mobilized enough to get by but paralyzed enough to feel deeply stuck.
The survival benefit of disruption is that it keeps us from moving too far and becoming too visible in a nervous system that equates visibility with danger. The cost is that by playing small, we stay small, failing to live up to our potential in careers, relationships, and habits.
Pattern 3: Depletion
Depletion is what happens when the body gets stuck in energy conservation mode. When this pattern is present, we never feel fully recharged or ready to engage with life. The symptoms of depletion are commonly and understandably mistaken for depression, lack of motivation, apathy, or laziness.
We may rely on stimulants like coffee or nicotine to keep going, manufacture stress through deadlines to access an adrenaline surge, or over-schedule ourselves so that we run on fumes and don't have to sit with our own exhaustion. The body's wisdom in this state says that staying depleted is safer than accessing full vitality.
The cost of depletion is that the very things that help to heal trauma and generate wellness, including connection, creativity, play, and self-care, feel too energetically demanding and are therefore avoided.
Pattern 4: Dysregulation
Dysregulation is about reactivity. When this pattern is present, responses tend to be either over the top or barely there. We might startle into a panic when someone gently touches our shoulder, or observe a situation that calls for a response with calm detachment. Internally, the heart may race at minor stressors, digestion may become unreliable, body temperature may fluctuate unpredictably, and emotions may feel either overwhelming or entirely inaccessible.
The stranger dimension of dysregulation is when it goes on long enough that it becomes our normal and even our preferred state. As Dr. Apigian notes, like someone who has lived in a noisy city and becomes uncomfortable with quiet, we can grow so accustomed to dysregulation that regulation itself feels foreign and unsettling. Drama and intensity become familiar. Calmness produces anxiety. Many of us unconsciously recreate high-stress situations in our lives because we have adapted to them as our baseline.
Pattern 5: Disease
When trauma accumulates in the body and remains unresolved over extended periods of time, disease eventually manifests. Research examining the relationship between Adverse Childhood Experiences and later health outcomes has found what is known as a dose-response relationship: the more adverse experiences someone had in childhood, the higher their risk of developing multiple chronic health conditions later in life.
Chronic health conditions that frequently emerge from accumulated trauma include autoimmunity, metabolic syndrome, chronic pain, chronic fatigue, IBS and digestive disorders, and mental health conditions like anxiety and depression. As Dr. Apigian writes, citing research in her field, the strongest predictor of disease is not weight, lifestyle, or genetics. It is the amount of trauma burden the body is carrying.
Symptoms, in this light, are not problems to be solved. They are messengers to be listened to: signs and hints that can be used to solve the much larger puzzle at play.
Specific Symptoms of Trauma Physiology
Beyond the five broad patterns, stored trauma can also present through a range of more specific symptoms, including:
Loss of curiosity. Easily over-stimulated or hyper-reactive startle responses. Irritability. Dissociation, which can range from a floaty out-of-body experience all the way to the more ordinary and everyday experience of not being fully present, scrolling compulsively, zoning out in conversation, or avoiding things that need doing. Immobilization, which can appear as a visible freeze but also manifests as an inability to start a project, chronic procrastination, or a pull toward hours of sitting without movement, particularly when accompanied by an inner sense of overwhelm or self-doubt.
Markedly elevated or suppressed heart rate in response to minor stressors. Low Heart Rate Variability, which signals an imbalance between the sympathetic and parasympathetic branches of the nervous system. Paradoxical responses to sensory stimuli, such as extreme reactions to soft sounds or unusual calm in response to typically startling ones. Impaired sensing, including disconnection from the body and an inability to feel sensations in parts of the body. A reduced capacity to feel fully alive, resulting from a shutdown of the midline brain structures responsible for our sense of self and inner reality.
Relational patterns in which small issues register as major threats, patterns of over-dependence or hyper-independence, and a difficulty establishing genuinely intimate connections. Fear of the bodily sensations of fear itself, which can escalate into full-body panic responses. Somatic symptoms including chronic back or neck pain, fibromyalgia, migraines, IBS, chronic fatigue, and in some cases asthma. And a diminished sense of personal agency, the felt sense of being able to affect change in one's own life.
Releasing Stored Trauma: The Essential Three-Step Process
To release stored trauma from the body, we must walk the path out in reverse: the way the trauma got in is the way the trauma gets out.
Dr. Apigian refers to this as the Essential Sequence, and it contains three stages: Safety, Support, and Expansion. This maps closely onto the Triphasic Model of trauma treatment, which also contains three stages: Safety and Stabilization, Pendulation, and Integration and Rehabilitation.
Step 1: Safety and Stabilization
Safety is the essential foundation upon which everything else is built. Without it, nothing else will hold. The approach here is to start small and move slowly. Consistent, gentle efforts are far more effective than intense, sporadic ones. Choosing a somatic exercise that generates a felt sense of safety and completing it for just 30 seconds at a time, several times per day, is a genuinely powerful starting point.
As Dr. Van Der Kolk describes, reclaiming a sense of safety within the body involves reestablishing ownership over the body and mind. For most people, this involves finding a way to become calm and focused, learning to maintain that calm in response to reminders of the past, finding a way to be fully present and engaged with life, and releasing the need to keep secrets from oneself about how survival has been managed.
Here is a counterintuitive but important thing to understand about this stage: as the body begins to feel safe and shifts out of shutdown, anxiety, panic, anger, and activation often surge. This is not a sign that something is going wrong. It is a sign that something is going right. How trauma got in is how trauma gets out, only in reverse. As the body moves out of Stage 5 shutdown, it instinctively reverses back through the earlier stages of the trauma response. Feeling worse is often the first step on the path back to feeling better.
Step 2: Support and Pendulation
Support is the life raft that keeps us afloat as previously frozen emotions surge back through the system. Without adequate support at this stage, those emotional waves can push us back over the Critical Line of Overwhelm, activating the trauma response again and causing more harm than healing.
The goal of this stage is to develop the ability to stay present with and move through stress, anxiety, and activation, without allowing those feelings to send us back down the familiar pathway into overwhelm and shutdown.
Different forms of support will be most helpful at different points in the healing journey. Somatic healing work helps the body complete the protective movements it never got to finish. Trauma-informed naturopathic care can support gut healing, mitochondrial restoration, and neurotransmitter rebalancing. Therapists trained in approaches like Internal Family Systems (IFS) or Parts Work can help retrieve and reintegrate the frozen parts of self. And trauma-informed therapists trained in Eye Movement Desensitization and Reprocessing (EMDR) can be particularly effective for trauma memory processing.
Two things are worth noting here. First, healing trauma is multifaceted and rarely linear, and it is unlikely that any single modality will address every layer. Second, and equally important, even with outside support, we must take full personal responsibility for actualizing change in our lives. No guide or practitioner can do the work for us. Healing requires us to reclaim our agency and become the hero we have long been waiting for.
Step 3: Expansion, Integration, and Rehabilitation
Expansion is where we build new capacity and begin to experience life more fully than we did before. It is where growth into deeper connection, health, and vitality becomes possible.
This stage can only be entered sustainably when a solid foundation of safety and support has already been established. Attempting to rush into expansion without that foundation risks destabilizing everything that has been carefully built. Slow and steady is not just advisable here, it is essential.
Being able to consistently return to the Calm-Alive state, what Dr. Apigian calls the Window of Tolerance, is the clearest signal that we are ready to move into this stage. The work of expansion then becomes the gradual, gentle, and joyful reclamation of all the parts of life that trauma had made inaccessible.
Why Talk Therapy, Alone, Doesn't Work
Talk therapy, psychoanalysis, cognitive-behavioral therapy, and exposure therapy all have meaningful roles in a comprehensive healing process. But they do not work as the primary or first-line approach to treating stored trauma.
This is because talk therapy engages what is known as autobiographical self-awareness. It asks us to narrate the story of what happened to us in language. The problem is that language-based self-awareness does not activate the Medial Prefrontal Cortex (MPFC), the region of the brain essential for emotional change. What does activate the MPFC is moment-to-moment self-awareness, which is grounded in physical sensations rather than words.
As Dr. Van Der Kolk explains, trauma stories serve an important function. They reduce isolation and provide a framework for understanding suffering. But they can also obscure something more essential: that trauma radically changes people. And the feeling of no longer being yourself is extraordinarily difficult to communicate through language alone.
He goes on to describe the alternative: engaging the self-observing, body-based self system, which speaks through sensations, tone of voice, and physical tension. When we follow the interoceptive pathways inward rather than narrating outward, things begin to shift. This is not to say that words and story have no place in healing. They do. But they are not the starting point, and they are not the primary medicine.
True healing requires an integrative approach that addresses all levels of our being where we are stuck: mind, body, and biology, and in that specific order.
Looking Ahead
In part two of this series, we will go into detail about the first stage of the trauma healing process: creating safety within the body. We will explore the specific methods we can use to begin signaling safety to the nervous system, as well as how and why they work.
References + Further Reading
Books
Apigian, A. (2024). The Biology of Trauma: How the Body Holds Fear and How to Heal It. Portfolio/Penguin.
Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.
Articles
Dekel, S., Stuebe, C., and Dishy, G. (2017). Childbirth induced posttraumatic stress syndrome: A systematic review of prevalence and risk factors. Frontiers in Psychology, 8, 560. Retrieved from frontiersin.org
Stagnaro-Garcia, A., Pearce, E., Chazenbalk, G., and Negro, R. (2011). Postpartum thyroiditis. Nature Reviews Endocrinology, 7(10), 575–587.
Hendrick, V., Altshuler, L.L., and Suri, R. (1998). Hormonal changes in the postpartum and implications for postpartum depression. Psychosomatics, 39(2), 93–101.
Seng, J. and Taylor, J. (Eds.). (2015). Trauma Informed Care in the Perinatal Period. Dunedin Academic Press.
