Uncontrollable recollections, images or spontaneous reliving of aspects of trauma (e.g., overwhelming thoughts or feelings, outbreaks of anger, rapid mood swings, helplessness or irrational feelings) are the most common symptoms that cause the individual or family distress. Sometimes the impact of trauma surfaces in the form of extreme anxiety, cycles of depression, pervasive fear, self-blame and an inability to trust (self and others). The client may feel fragmented, separated or different from others. Frequently, there is a feeling of unfillable emptiness inside, as if one is an impostor. Over time, individuals may find themselves participating in increasingly destructive behaviors to provide a connection and to break the numbness.

Maladaptive coping behaviors include:

• Alcohol/drug misuse or abuse
  
  
• Self-cutting or intentional infliction of pain on the body
  
  
• Involvement in abusive relationships
  
  
• Compulsive, self-degrading sexual behavior, or inhibition of sexual responses
  
  
• Disordered eating
  
  
• Compulsive gambling
  
  
• Compulsive shopping/spending
  
  
• Cybersex