Trauma after abuse: what remains and how it heals

“I left two years ago. Why do I still jump when someone in the building slams a door?”

The sentence comes out almost angrily, as if the body were betraying something the mind sorted out long ago. The move is behind her, the divorce is final, the new job is going well. On paper it is all over. And yet at every loud noise in the stairwell her breath stops for a moment, her shoulders rise, her eyes look for the exit. Then comes the shame: it isn’t dangerous any more, so what is wrong with me?

Nothing is wrong. This is often how trauma after abuse shows itself — not as a memory someone tells, but as a state it throws them into. In this piece I will describe what often remains after an abusive relationship, why trauma from a close relationship is different from other kinds, and what research says about how it heals.

Before I begin: I am not a specialist in domestic violence, and this piece is not a tool for judging whether you are in danger. If the abuse is still going on, or you fear it, safety comes before everything else — call 112, the police on 113, or the free SOS helpline for women and children experiencing violence, 080 11 55 in Slovenia.

When the danger is over, the body doesn’t know it yet

The nervous system learns from experience, not from the calendar. Someone who has lived for months or years beside a person whose mood could flip into threat in an instant has developed an extraordinarily precise alarm. It recognised the tone of a voice, the way the key turned in the lock, the silence before an outburst. That alarm was clever at the time. It kept the person alive.

When the danger ends, the alarm does not switch itself off. It keeps searching for signs and finds them even where there are none — in a slammed door, a man’s voice in a shop, a message without a full stop at the end. We call this state hypervigilance. I described in more detail how an experience is held in the body, and why releasing it often takes more than understanding, in How trauma stays written in the body — and how the body can let it go.

How often abuse leaves a mark

In 1999 the psychologist Jacqueline Golding brought together studies on the mental health of women who had experienced partner violence in a meta-analysis. On average, around 64% of the women had signs of post-traumatic stress disorder and around 48% had depression. These figures need to be read with care: many of the studies were carried out in shelters and among women seeking help, that is, among people with very severe experiences. But the message is clear — the after-effects of abuse are not the exception but something to be expected.

A later review by Kylee Trevillion and colleagues in 2012 confirmed the link from the other direction: people with mental health difficulties had more often experienced domestic violence, among both women and men. The relationship between abuse and mental health therefore runs both ways — abuse leaves after-effects, and vulnerability exposes a person to abuse.

Post-traumatic stress disorder has a precise description in the diagnostic manuals; you will find a short explanation under post-traumatic stress disorder. For this piece something else matters more: a diagnosis is not a condition for deserving help. Even if you do not meet all the criteria, the after-effects of abuse can narrow your life every day.

Why trauma from a relationship is different

An accident, an earthquake or an attack by a stranger are terrible, but they come from outside. Violence in an intimate relationship comes from the person who was supposed to be a safe harbour. This has two consequences that other traumas do not carry to the same degree.

The first is that abuse in a relationship is rarely a single event. It is often a series of repeated experiences stretching over years, during which the person could neither escape nor resist. As early as 1992, in her book Trauma and Recovery, the psychiatrist Judith Herman pointed out that this kind of prolonged entrapment leaves different marks from a one-off event. Today, in the international classification of diseases ICD-11, this corresponds to complex trauma, or complex post-traumatic stress disorder: alongside the familiar signs of PTSD, there are difficulties regulating emotions, a deeply negative view of oneself and difficulties in relationships.

The second consequence is betrayal. When you are hurt by someone you loved, it is not only your sense of safety in the world that collapses. Your trust in your own judgement collapses too: how did I not see it, how did I stay, how could I love someone who did this to me? These questions are often more painful than the memories themselves.

The traces people describe most often

Everyone carries the after-effects in their own way, but some patterns recur so often that they are worth knowing — if only so you know you are not alone:

• Intrusive memories and triggers. Images that come unbidden, nightmares, a sudden wave of fear at a smell, a song or a word. The body reacts as if it were happening now.
• Avoidance. A route through town that skirts a particular street. Avoiding films, conversations and people that recall that time.
• Numbness and detachment. A feeling of living behind glass, as if things were happening to someone else. Sometimes gaps in memory.
• Irritability and sleeplessness. A body that no longer knows how to rest, because rest once meant being caught off guard.
• Physical complaints. Headaches, pain, digestive problems, fatigue. The effects of physical injuries can also be lasting, so they are worth having checked by a doctor.

Many people describe something else that is harder to notice: they no longer know what they want. Years of adapting to someone else have erased contact with their own wishes. The question “and what do you want?” sets off emptiness or panic.

Shame and the voice that stays

The most stubborn after-effect of abuse is often not fear but shame. Anyone who has spent a long time hearing that they are stupid, incompetent, over-dramatic and to blame often takes that voice with them. The partner is gone, but his words keep speaking — now in the first person. I wrote about how abuse changes self-image in Self-image after abuse: when you believe it was your fault, and about shame as an emotion in Shame: the emotion that whispers “There is something wrong with me”.

Here I would add just one thought. Shame after abuse often has a double bottom: shame about what happened, and shame about having stayed. The second is often heavier. It helps if you can see it as the result of the same mechanism — the abusive relationship was built in a way that made leaving harder. That was not your mistake. It was part of the abuse.

How trauma after abuse heals

Judith Herman described recovery from prolonged trauma in three phases that the profession still uses today. They are not strict rules but a map that shows what needs to come first.

The first phase is safety. Without it, nothing else works. Safety means safe housing and an end to contact with the violence, as far as possible, but also safety in the body: sleep, food, movement, people around whom you can settle. When contact with a former partner is unavoidable, for instance because of children, this phase matters all the more and often needs the help of legal and social services.

The second phase is remembrance and mourning. Only once a person is safe can they safely return to what happened — at a pace they can manage, and with someone accompanying them. Mourning here is not only mourning for the relationship. It is also mourning for the years, for an image of oneself, for a trust that is no longer there.

The third phase is reconnection. With people, with work, with the future, with yourself. The abuse is no longer the centre of the story, but a part of it. I described what this means in the first year after leaving in Recovering from an abusive relationship: the first year.

What research shows about treatment

The good news is that trauma after abuse heals — not always quickly and not always completely, but often very noticeably. The World Health Organization’s guidelines for post-traumatic stress disorder in adults recommend trauma-focused psychotherapies, such as trauma-focused cognitive behavioural therapy and EMDR. Approaches have also been developed specifically for women after partner violence. In 2004 Edward Kubany and colleagues tested, in a randomised trial, so-called cognitive trauma therapy for battered women, which pays particular attention to guilt and shame. Compared with participants who were still waiting for treatment, their symptoms of PTSD and depression fell markedly.

A 2011 study by Katherine Iverson and colleagues showed something else of interest: women whose post-traumatic symptoms decreased more during therapy were less likely to experience partner violence again in the following months. Trauma, then, is not only a consequence of the past — it can also affect how safe a person’s life is going forward.

What happens in therapy? Often the first step is far less dramatic than people expect. You don’t have to tell everything straight away. A conversation might sound something like this (the conversation is composite, not a real person):

“I thought you’d ask me to tell you everything from the beginning.”
“Not now. First I’d like to know how you’re sleeping.”
“Badly. I wake at three and listen.”
“What are you listening for?”
“…Whether the door is opening. Even though I know it can’t.”
“Then let’s start there. With what your body is still doing to protect you.”

In relational family therapy, in which I am training, we are also interested in how old experiences repeat in new relationships. Someone who has survived abuse may feel confused or even bored beside a kind partner, and strangely “at home” with someone unpredictable. This is not fate. It is a learned pattern that can be brought into awareness. And this is where work with a new, safe partner can later be helpful too. But never joint therapy with the person who was violent — where there is abuse, couples therapy is not an appropriate form of help.

Exercise: mapping one trigger

This exercise is an adapted version of the trigger map tool in the knowledge base. The aim is not to relive anything but to understand: so that the alarm turns from something unpredictable into something you know. If the exercise overwhelms you, stop — that is not failure but information that this step needs support.

1. Choose one small moment from the past week when you flinched, when your chest tightened or you suddenly pulled back. Not the worst one — a medium one.
2. Write down what was outside. A sound, a smell, a tone of voice, a facial expression, the time of day. Be as precise as you can.
3. Write down what happened in your body. Where you felt tension, what your hands did, your breath, your gaze.
4. Ask yourself what your body was trying to protect you from. Often you will recognise an old situation that had something in common with this moment. Write it in one sentence, without detail.
5. Add one sentence about the present: “Back then, this meant danger. Today I am in … , with … , and …” Then, for a few breaths, feel your feet on the floor and name three things you can see around you.

The exercise does not erase the trigger. But it gives the body the experience that you can notice it, name it and return to the present. It also helps to know your window of tolerance — the range of arousal within which you can still think and feel at the same time.

Where this story doesn’t apply

When I write about trauma, I am aware of the risk of sounding as though abuse always leaves a permanent wound. That is not true. In an influential 2004 review, George Bonanno pointed out that many people recover over time after severe experiences without lasting disorders — that resilience is more common than we long believed. If you don’t have all the difficulties described here after abuse, that doesn’t mean it was “not bad enough” or that you are not feeling something. It means every path is different.

Second, not every difficulty after abuse is trauma. Sleeplessness, fatigue or pain can have physical causes too, so seeing your GP is a good first step. When depression, anxiety or sleeplessness are very pronounced, it makes sense to talk to a psychiatrist about help as well — medication and psychotherapy are not mutually exclusive.

Third, the word trauma can become an identity. It helps by giving a name to what is happening, but it must not become all that you are. Likewise, recovery does not mean you have to draw something good out of the experience. I wrote about the pressure to be strengthened by everything that doesn’t kill you in “What doesn’t kill you makes you stronger” — why that isn’t true of trauma.

And finally: if the abuse is still going on, it is not “trauma after abuse” but abuse. Then safety comes first, and processing only afterwards. Therapy that works on memories while a person is still living in danger can do more harm than good.

Where you can turn

If you are in immediate danger, call 112 or the police on 113 in Slovenia. The SOS helpline for women and children experiencing violence is free on 080 11 55 in Slovenia, including for talking about the after-effects that remain after abuse. When your thoughts are very dark, the Klic v duševni stiski crisis line, 01 520 99 00 in Slovenia, is available from 7 pm to 7 am, and the Samarijan helpline, 116 123 in Slovenia, around the clock. You will find an overview of the organisations that help in Where to get help with abuse in Slovenia: a map for the first step. For working through trauma, it is worth finding a therapist with training and experience specifically in trauma work.

What to remember

• After abuse, the body often keeps acting as if the danger were still there — this is not weakness but learned protection.
• After-effects are common: in a meta-analysis, around 64% of women after partner violence had signs of PTSD and around 48% had depression.
• Trauma from a close relationship is often prolonged and bound up with betrayal, so it affects self-image and trust.
• Recovery moves from safety through remembrance and mourning to reconnection — and trauma-focused therapies help.
• If the abuse is still going on, safety comes first. Help in Slovenia: 080 11 55, 113, 112.