A trauma response, a current threat,
or both?
I’m not traumatised. I just don’t let strangers grab my arm any more.
Why not every difficult experience is trauma, why a trauma response can also be understandable, how present danger and past harm can coexist, and why people should choose their own words.
What this is: a guide to not over- or under-reading trauma.
Why it matters: disabled people are often assumed to be traumatised, or not believed when they are.
The sharpest reframe: a response to a current risk isn’t a symptom.
One thing to take away: ask whether the response is costing something the person wants to change.
The short version
Disabled people often meet events that could be traumatic: emergency surgery, being restrained, repeated disbelief, abuse, discrimination. That doesn’t mean every disabled person is traumatised, or that every cautious or angry response is a trauma symptom. SAMHSA’s own definition depends on how events are experienced and what effects they have, not on the events alone. A disability-informed approach asks the person how they understand their experience, distinguishes a trauma response from a sensible precaution, and lets people choose the words: some find “trauma” or a diagnosis validating; others find it pathologising.
You might recognise this
Illustrative statementsDrawn together from common experiences. They are not quotes from individual people.
What makes something trauma
Established theorySAMHSA describes trauma as resulting from an event or circumstances, experienced as harmful or threatening, with lasting adverse effects. All three parts matter: the same event can be traumatic for one person and not for another. Diagnoses such as post-traumatic stress disorder (PTSD) and, in the WHO’s ICD-11, complex PTSD describe particular patterns of lasting effects. Most people who go through difficult events don’t develop either.
Dympna is 50 and has been blind since birth. She sees a counsellor for low mood after a bereavement. The counsellor notices that Dympna tenses when anyone approaches her unexpectedly and suggests this might be “trauma from all the times people have grabbed you”. Dympna laughs. “No. It’s because people grab me. I tense so I don’t get pulled into the road.”
Dympna is a fictional teaching example, not a real person.
A trauma response, a sensible precaution, or both?
Our frameworkA sensible precaution
Tensing when grabbed, double-checking a care plan, bringing a witness to an assessment. These respond to real, current risks.
A trauma response
Reactions that persist when the danger has passed, intrude unwanted, or stop someone living as they want: flashbacks, nightmares, being unable to enter a hospital at all.
Both at once
Many people have some of each. Caution about hospitals can be sensible, and also more intense than the person wants.
Neither
Anger, grief or frustration about ableism are often ordinary responses to ordinary injustice.
These aren’t opposites. A trauma response can itself be understandable and reasonable. Someone can face a present danger and also have PTSD symptoms. And protective behaviour can be useful in one situation and restrictive in another. The person is usually the best judge of which applies, and the useful question is often: is this response costing you something you want to change?
Letting people choose the words
Our framework- Some find the language of trauma validating. A diagnosis can explain years of distress, open access to treatment, and say “this was serious”.
- Some find it pathologising. It can locate the problem in their reactions rather than in what was done to them, or make disability sound like a wound.
- Some want both: recognition that something harmful happened, without being defined by it.
Trauma-informed practice doesn’t require anyone to accept the word. It requires services to act on the principles anyway. See also When Disability Gets Misread as Psychology.
What it might sound like
I wondered whether that tension might be trauma from being grabbed so often.
No. It’s because people grab me. It’s still happening.
Thank you, that’s a better explanation than mine. Is it something you’d want to change, or is it doing its job?
It’s doing its job. What I’d like is for people to ask before they touch me.
Then perhaps that belongs in the list of things that are wrong with the world, rather than with you.
What changes: the counsellor drops the trauma framing and returns to the bereavement, which is what Dympna came for. Later, Dympna mentions one memory, of being separated from her mother as a small child for an eye operation, that she does find distressing. That one, she says, might be worth talking about.
What stays open to inquiry
Respecting Dympna’s understanding doesn’t end the conversation. Collaborative assessment can continue alongside it:
- What does she want help with? (The bereavement, first.)
- When does her caution protect her, and when, if ever, does it cost her something she minds?
- Is she distressed in situations she herself considers safe enough?
- Are there particular memories she wants to address? (Possibly one.)
- What would a useful change look like, to her?
Her answers shape the work. The therapist doesn’t decide them in advance in either direction.
What needs attention here?
A cautious response is called trauma
Possible focus: whether it responds to current, real risk
Watch for: pathologising sensible precautions
The person rejects the word ‘trauma’
Possible focus: their own words for their experience
Watch for: insisting on the label
A diagnosis would help the person
Possible focus: assessment and access to treatment
Watch for: withholding it to avoid labelling
Anger at ableism
Possible focus: what happened, and what the person wants to do
Watch for: treating it as a symptom
Possible starting points, agreed with the person, not rules.
How you’d know it helped
- The person’s own understanding of their experience is respected.
- Sensible precautions are not treated as symptoms.
- Trauma responses the person wants to change are taken seriously.
Words you can use
For clientsQuestions worth carrying, as a therapist
Therapist Reflection- Am I assuming trauma because the person is disabled?
- Have I asked how they understand their own response?
- Am I mistaking a sensible precaution for a symptom?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Trauma as event, experience and effect: SAMHSA (2014), SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. PTSD and complex PTSD: World Health Organization, ICD-11.
The distinction between trauma responses and reasonable responses, and the guidance on language, are this site’s synthesis.
Dympna and the dialogue are constructed for learning. She is not a real person.
We have not located research on how disabled people themselves distinguish trauma responses from protective precautions.
Last reviewed: October 2026.
How to cite this page: Donaghey, C. (2026). A Trauma Response, a Current Threat, or Both?. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/trauma-informed-approaches/trauma-or-a-reasonable-response/ (Accessed: [date]).