Because thinking about the trauma and feeling as if you are in danger is upsetting, people who have been through traumas often try to avoid reminders of the trauma. Sometimes survivors are aware that they are avoiding reminders, but other times survivors do not realize that their behavior is motivated by the need to avoid reminders of the trauma.

Ways of avoiding thoughts, feelings, and sensations associated with the trauma can include:

Actively avoiding trauma-related thoughts and memories

Avoiding conversations and staying away from places, activities, or people that might remind you of the trauma

Trouble remembering important parts of what happened during the trauma

Shutting down emotionally or feeling emotionally numb

Trouble having loving feelings or feeling any strong emotions

Finding that things around you seem strange or unreal

Feeling strange

Feeling disconnected from the world around you and things that happen to you

Avoiding situations that might make you have a strong emotional reaction Feeling weird physical sensations

Feeling physically numb

Not feeling pain or other sensations

Losing interest in things you used to enjoy doing

Trying to avoid thinking about the trauma and avoiding treatment for trauma-related problems may keep a person from feeling upset in the short term, but avoiding treatment means that in the long term, trauma symptoms will persist

Secondary symptoms are problems that arise because of the posttraumatic re-experiencing and avoidance symptoms. For example, because a person wants to avoid talking about a traumatic event, she might cut off from friends, which would eventually cause her to feel lonely and depressed. As time passes after a traumatic experience, more secondary symptoms may develop. Over time, secondary symptoms can become more troubling and disabling than the original re-experiencing and avoidance symptoms.

Associated symptoms don't come directly from being overwhelmed with fear; they occur because of other things that were going on at the time of the trauma. For example, a person who is psychologically traumatized in a car accident might also be physically injured and then get depressed because he can't work or leave the house.

All of these problems can be secondary or associated trauma symptoms:

Depression can develop when a person has losses connected with the trauma or when a person avoids other people and becomes isolated.

Despair and hopelessness can result when a person is afraid that he or she will never feel better again.

Survivors may lose important beliefs when a traumatic event makes them lose faith that the world is a good and safe place.

Aggressive behavior toward oneself or others can result from frustration over the inability to control PTSD symptoms (feeling that PTSD symptoms run your life). People may also become aggressive when other things that happened at the time of trauma make the person angry (the unfairness of the situation). Some people are aggressive because they grew up with people who lashed out and they were never taught other ways to cope with angry feelings. Because angry feelings may keep others at a distance, they may stop a person from having positive connections and getting help. Anger and aggression can cause job problems, marital and relationship problems, and loss of friendships.

Self-blame, guilt, and shame can arise when PTSD symptoms make it hard to fulfill current responsibilities. They can also occur when people fall into the common trap of second-guessing what they did or didn't do at the time of a trauma. Many people, in trying to make sense of their experience, blame themselves. This is usually completely unwarranted and fails to hold accountable those who may have actually been responsible for the event. Self-blame causes a lot of distress and can prevent a person from reaching out for help. Sometimes society also blames the victim of a trauma. Unfortunately, this may reinforce the survivorâs hesitation to seek help.

People who have experienced traumas may have problems in relationships with others because they often have a hard time feeling close to people or trusting people. This is especially likely to happen when the trauma was caused or worsened by other people (as opposed to an accident or natural disaster).

Trauma survivors may feel detached or disconnected from others because they have difficulty feeling or expressing positive feelings. After traumas, people can become overwhelmed by their problems or become numb and stop putting energy into their relationships with friends and family.

Survivors may get into arguments and fights with other people because of the angry or aggressive feelings that are common after a trauma. Also, a person's constant avoidance of social situations (such as family gatherings) may create hurt feelings or animosity in the survivorâs relationships.

Less interest or participation in things the person used to like to do may result from depression following a trauma. When a person spends less time doing fun things and being with people, he or she has fewer chances to feel good and have pleasant interactions.

Social isolation can happen because of social withdrawal and a lack of trust in others. This often leads to the loss of support, friendships, and intimacy, and it increases fears and worries.

Survivors may have problems with identity when PTSD symptoms change important aspects of a person's life such as relationships or whether the person can do his or her work well. A person may also question his or her identity because of the way he or she acted during a trauma. For instance, a person who thinks of himself as unselfish might think he acted selfishly by saving himself during a disaster. This might make him question whether he really is who he thought he was.

Feeling permanently damaged can result when trauma symptoms don't go away and a person doesn't believe they will get better.

Survivors may develop problems with self-esteem because PTSD symptoms make it hard for a person to feel good about him- or herself. Sometimes, because of how they behaved at the time of the trauma, survivors feel that they are bad, worthless, stupid, incompetent, evil, etc.

Physical health symptoms and problems can happen because of long periods of physical agitation or arousal from anxiety. Trauma survivors may also avoid medical care because it reminds them of their trauma and causes anxiety, and this may lead to poorer health. For example, a rape survivor may not visit a gynecologist and an injured motor vehicle accident survivor may avoid doctors because they remind him or her that a trauma occurred. Habits used to cope with posttraumatic stress, like alcohol use, can also cause health problems. In addition, other things that happened at the time of the trauma may cause health problems (for example, an injury).

Survivors may turn to alcohol and drug abuse when they want to avoid the bad feelings that come with PTSD symptoms. Many people use alcohol and drugs as a way to try to cope with upsetting trauma symptoms, but it actually leads to more problems.