Originally published in Psychology Today
Source: Photo by Oscar Keys on Unsplash
Did you go unseen as a child who survived trauma? Maybe you know someone who endured their pain in silence without ever getting the help they needed. We can end silent suffering by learning to see the quiet ways children ask to be seen.
Children manage emotional pain and trauma in two different ways: by externalizing their pain or internalizing it.
Children who externalize
When these kids have reached their emotional limit, they act out. They yell, throw something, tantrum, anything to get the pain and anger out. These are the children we see. These are the children we guide to get help.
Children who internalize
When these kids have reached their emotional limit, they act in. They dissociate, shut down, isolate, try to become numb to their pain. These are the kids we overlook. These are the children frequently ignored for mental healthcare services.
Culturally we orient ourselves toward treating children who act out, since they are easily noticed and disruptive. The problem is not that these children are getting help, but that we begin to associate only externalized symptoms of trauma as calls for help. Then we make the mistake of thinking that children who do not act out do not need help.
This fallacy costs children with internalized symptoms the mental health treatment they need to overcome their suffering. According to psychotherapists Kristin Silver, Meera Kumari, Danette Conklin, and Gunnur Karakurt (2018), the long-term effects of untreated childhood trauma are severe and contribute to the development of depression and anxiety later in life.
One way to address this problem is to learn what symptoms of internalized trauma look like. This will support these children in healing from their trauma and reducing their chances of developing a mental health disorder in adulthood. Below is a list of 14 symptoms of internalized trauma.
14 signs a child may need to be referred to therapy
Frequently mentally checks out or is lost in a trance
Engages in negative self-talk
Has frequent stomachaches and headaches
Works very hard to be perfect
Displays an inability to self-regulate or self-sooth
Has trouble staying on task
May show signs of having a learning disability
In art, may draw themselves represented in negative ways
Has difficulty sleeping
Is overly sensitive to touch or sound
May exhibit needy and clingy behaviors
Overreacts to minor frustrations
Has a difficult time making friends
Starts puberty early
These 14 signs of internalized trauma are frequently overlooked because we tend to seek out and treat existing unwanted behaviors in children and gloss over or dismiss a child’s internal state when they are acting as they are expected to.
However subtle, these internalized symptoms of trauma are noticeable if you know what to look for. With this list of symptoms, we may become more attuned to the internal states of the children we spend time with and recognize when they need help.
References
Silver, K. E., Kumari, M., Conklin, D., & Karakurt, G. (2018). Trauma and health symptoms in a community sample: Examining the influences of gender and daily stress. American Journal of Family Therapy, 46(2), 153–167. https://doi.org/10.1080/01926187.2018.1461031