High-Functioning Trauma: Hidden Signs of Unresolved Trauma
When we picture someone struggling with the effects of trauma, we usually imagine a life that has visibly come apart. It might look like a person who is finding it difficult to hold down relationships or a job, or someone who is struggling to go about their day-to-day life.
But trauma doesn’t always present this way. Some people dealing with the after-effects of trauma can hold down a career and a household, with nothing pointing toward the internal battle they face on a daily basis.
This is what’s known as high-functioning trauma, where the effects run underneath a life that appears entirely under control.
If this sounds like it might describe you, this page helps to explain how trauma works, but most importantly, where you can find the treatment you deserve. We will cover:
- What trauma and high-functioning trauma are.
- How the trauma stays out of sight.
- The hidden signs of unresolved trauma.
- How high-functioning trauma is treated.
- When a higher level of care is needed.
What Is Trauma?
Before looking at the high-functioning aspect of trauma, it first helps to understand exactly what trauma is.
Trauma is the lasting effect of an event that a person experienced as harmful or life-threatening. The ‘lasting effect’ part means that it continues influencing how a person feels and copes long after the event itself has passed.
We often think of trauma as resulting only from extreme experiences like war or childhood abuse. While these are major drivers of trauma, common life experiences can also be traumatic, such as:
- The death of a loved one.
- Divorce.
- Illness.
That is part of why trauma is actually far more common than many realize, with most people having at least one traumatic experience in their life.[1] Everyone reacts to experiences and setbacks differently. What may be traumatic for one person may feel like an upsetting but manageable situation for someone else.
Even for two people who both experience a situation as traumatic, the lasting impact can be different. For many, the aftereffects of trauma are temporary and generally fade away with time. But others are seriously impacted by the event, and the aftereffects can carry on for years afterwards.[2]
What High-Functioning Trauma Means
High-functioning trauma is a descriptive phrase rather than a formal diagnosis, and you won’t find it listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders) or the other manuals that clinicians use. It’s used as a way of naming the situation in which someone continues to manage their day-to-day demands, while still holding the effects of trauma.
Research on people living with post-traumatic stress disorder (PTSD) has found that the severity of someone’s symptoms and how well they function are only loosely connected.[3] This means that the two don’t move together, and someone could be having real difficulty on the inside, while holding down their life on the outside.
Being able to function despite the internal distress is a big part of why the people around them often have no idea what they’re going through.
How Trauma Symptoms Are Hidden
Trauma symptoms can be severe, so the idea that someone could keep them hidden may sound unlikely. Even if a person is high-functioning, it doesn’t mean they’re completely free of trauma symptoms. The mind has several ways of keeping difficult feelings out of view, and someone who functions well has usually become very practiced at using them.
Emotional Suppression
One of the main ways trauma stays out of sight is through emotional suppression. This is when a person gets into the habit of pushing feelings down rather than letting them surface. For someone who believes the feelings could completely overwhelm them, suppressing them can seem like the responsible thing to do.
But pushing the feelings down doesn’t make them disappear. Research shows that habitually suppressing emotions is linked with poorer mental health and with fewer of the positive states that support wellbeing.[4] Emotional suppression also takes a lot out of you, so doing it long-term often leaves people exhausted.
Masking
Masking, while not a formal clinical term, has a lot of relevance here. It’s closely tied to suppression, and works like the outward version, where the person hides behind a calm and composed “mask.” They may smile at the right times and seem relaxed in front of other people, but internally they’re struggling.
The term “masking” is used mostly in the neurodivergent literature, but research has also begun to connect it with trauma. One study of autistic adults found that those who masked more heavily reported more past experiences of interpersonal trauma, alongside higher anxiety and lower self-esteem.[5]
The Body’s Own Survival Responses
Some of what stays hidden isn’t a choice at all, but the body’s automatic reaction to the threat it’s experienced. When the brain senses danger, it sets off a survival response before the thinking mind has any say in the matter.
The three responses with the strongest research are fight, flight, and freeze:[6]
- Fight can present as irritability or a need to control situations.
- Flight can look like restlessness or keeping yourself busy all the time to avoid confronting the feelings the traumatic event is causing.
- Freeze can look like emotional numbness or going blank when something difficult comes up.
These responses aren’t always obvious to spot in real time, which is one reason the trauma can go unnoticed for so long.
A fourth response, called “fawn,” is another discussed state, but presents slightly differently. Someone in a fawn state might manage threats by keeping others happy and smoothing things over before any conflict can occur.[7] It’s relevant in this discussion because it’s an understood trauma coping strategy.
However, when a person who never causes trouble and always accommodates others, it can be hard to spot their own difficulties or needs from the outside.
Hidden Signs of Unresolved Trauma
So far, we’ve covered a few symptoms of unresolved trauma that you may spot in someone considered high-functioning. But one or two symptoms on their own don’t necessarily mean the person is dealing with trauma. It’s more how they present that indicates that trauma is present, especially if they cluster.
Below are some of the hidden trauma symptoms to look out for if you’re concerned about someone close to you, or even yourself:[8]
- Being on constant alert, even when the situation doesn’t call for it.
- Feeling emotionally detached from the people around you.
- Avoiding people or places tied to the past event.
- Difficulties in either staying asleep or falling asleep.
- Irritability that feels out of character.
When several of these start presenting together, especially when they mark a clear change from someone’s usual behavior or attitude, they may be hidden trauma symptoms.
Mission Connection is here to help you or your loved one take the next steps towards an improved mental well-being.
You Weren’t Meant to Live This Way
If you’ve read this far and started to recognize the signs of high-functioning trauma in yourself, there’s a good chance you’ve been managing this for a long time.
You may have built a life that works on the surface, but part of you is now wondering if that’s simply how life is now.
The answer is no; it’s not supposed to be this way, and there are things you can do.
Two things keep a lot of people exactly where you are now. The first is the fear of what happens when you slow down and address what happened. When you’ve spent years keeping the lid on your troubles, lifting it might be the last thing you want to consider doing. Fear of what may come out can mean it feels safer to leave the lid shut.
Secondly, you may have been in survival mode for so long that it’s come to feel like part of your personality. If you don’t know any other way to live, why would you feel the need to change?
But that reluctance has nothing to do with personal failing. Avoidance is a huge part of how trauma works, and it can help temporarily when the distress is particularly severe. In these cases, anything that helps you get through it can be beneficial in the short term. The problem is that avoidance keeps you from facing what happened to you.[9]
If this feels like you, know that there is help available. Trauma treatment can start regardless of when the event happened, whether that be a decade or a month ago.
How High-Functioning Trauma Is Treated
Due to the complex nature of trauma, there are many different types of trauma treatment your therapist may include in your plan. Four of the most effective include:
Trauma- Focused Cognitive Behavioral Therapy (TF-CBT)
TF-CBT works by connecting how you think, how you feel, and the events that took place. The aim isn’t to relive the event over again; rather, the focus is on the beliefs that trauma left behind. These are ideas like the world being dangerous or that what happened to you is somehow your fault.
The evidence behind TF-CBT is strong, with a large review finding that it produced a large reduction in symptoms compared with no treatment at all.[10]
Cognitive Processing Therapy (CPT)
CPT was first developed for PTSD and centers on the memories of the event. It doesn’t ask you to describe the event in detail, but instead, to notice the conclusions you drew at the time and work out whether they still hold. Once you realize they don’t, CPT helps you rework those conclusions.
Research is very encouraging and shows that the average person treated with CPT did better afterward than around 89% of those who received no active treatment.[11]
Prolonged Exposure
The name can sound intimidating, but the idea behind prolonged exposure is a lot gentler than it sounds. This therapy helps you approach memories and situations slowly, in a safe and controlled way.
The idea is that, eventually, the memories start to lose their power over you. You’re not forced into anything quickly, and you set the pace throughout treatment.
The APA considers Prolonged Exposure, along with CPT and CBT, as first-line treatments for PTSD.[12]
Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR) is a little different from the three talking therapies we’ve explained so far. Your therapist will ask you to bring a difficult memory to mind while following a back-and-forth movement with your eyes.
This appears to help the brain process that memory in a safer way than before. It also doesn’t rely on talking through every detail of what happened. For people who have never been able to put the event into words, or who find talking about it makes things worse, EMDR can be a gentler approach.
The APA considers EMDR a second-line treatment for the treatment of PTSD.[12]
When Is a Higher Level of Care Needed?
For many people, weekly outpatient therapy is enough to make real progress. But there are situations when a more intensive level of support is beneficial. This might be if the trauma has been present for a long time or if past treatment hasn’t brought lasting change.
In those situations, a step up from a standard weekly outpatient session could help. For example, a partial hospitalization program (PHP) offers intensive treatment for several hours a day, all while you continue living at home.
An intensive outpatient program (IOP) is another option that provides more structured support but with more flexibility around work and other daily commitments.
Both give your treatment team far more contact time, which allows for the right therapy and, where needed, medication to be delivered together rather than in isolated weekly windows.
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Find Trauma Support at Mission Connection
If anything on this page has resonated with you or someone you care about, now may be the time to talk with someone about what’s going on. Carrying unresolved trauma and trying to hold everything together is exhausting and isn’t something that you have to keep doing.
Mission Connection provides mental health treatment for adults, including those who are carrying unresolved trauma. Our team of licensed mental health professionals goes beyond traditional treatment and provides life-changing care.
Our clinical team uses approaches with strong evidence behind them, including:
- CBT.
- CPT.
- EMDR.
We offer several options for effective outpatient treatment, including in-person programs at our locations in California, Virginia, and Washington, virtual telehealth, and a hybrid program that combines in-person and virtual care.
If you’re not sure where to begin, the team at Mission Connection can help. Reach out to us online or call us at 866-833-1822 to find out how we can support your long-term recovery. Our compassionate team is available 24/7 to answer your questions and provide guidance with no obligation.
