When discussing trauma and grief, we oftentimes hear about the fight-or-flight response of Post-Traumatic Stress Disorder (PTSD), but as trauma research grows, so too does our understanding of how trauma responses emerge from the physiology altered by trauma(s).
It’s important to note that no one theory is right or wrong. Rather, these tools may inform survivors how to better understand their response to environmental triggers, intrusive thoughts, nightmares, or re-traumatization.
3Fs: An example in physiology
In the early history of trauma research, the adaptive survival mode that kicks in response to danger was known as “fight-or-flight.” Stephen Porges’ Polyvagal Theory added the “freeze” response. In his own studies, Porges theorizes that the evolution of the human system also changed the vagal pathway which automatically shifts our system from “rest-and-digest” to “fight/flight/freeze.” This adaptive strategy also allowed humans to respond and regulate social environments (Porges, 2009).
| Response Type | Definition |
| Fight | Confronting the perceived threat |
| Flight | Fleeing the perceived threat |
| Freeze | Immobilizing in light of the perceived threat |
What exactly is a Vagus nerve?
In brief, the Vagus Nerve is the 10th cranial nerve (nerves that originate directly from the brain and not the spinal cord). This nerve regulates our respiration rate and heart rate, stimulates gut motility and certain secretions of the digestive system, and relaxes/constricts certain muscles in our trunk.
Dr. Porges (2009) proposes that our adaptive behavioral strategies are the result of physiology; therefore, in his theory, we can manually stimulate the vagus nerve to increase vagal tone thereby allowing us to manage fight/flight/freeze.
4Fs: An example in trauma typology
Pete Walker (2014) defines 4Fs from a trauma typology perspective and proposes differential diagnoses of complex PTSD:
| Response Type | Definition | May present as… | Mislabeled as… |
| Fight | posturing against or confronting the perceived threat. | explosive outbursts, anger, defiance, or demanding. | Narcissistic |
| Flight | fleeing or symbolically fleeing the perceived threat by way of a “hyperactive” response. | anxiety, fidgeting, over-worrying, workaholic tendencies, or fidgeting. | OCD |
| Freeze | dissociating in response to the perceived threat. | spacing out, losing time, feeling unreal, brain fog, or feeling numb. | Dissociative Disorder |
| Fawn | Placating the perceived threat in an attempt to forestall imminent danger. | People-pleasing, fear to express self, flattery, “yes” person, exploitable, fear of fitting in | Codependent Disorder |
Walker’s trauma typology proposes that we may experience one or a hybrid of the above, e.g. fight/fawn (mislabeled as borderline), flight/freeze (mislabeled as schizoid), etc. Walker uses this model to explain the personality of childhood trauma survivors in relation to complex PTSD and developmental trauma disorder (neither are currently recognized in the DSM-V).
6Fs: But wait, there’s physiologically more!
Dr. Curtis Reisinger suggested that the fight-or-flight response to stress was simplistic and incomplete (no kidding, we first used “fight-or-flight” in 1915 and have had several emerging theories and treatment strategies since then).
This theory adds the following trauma responses:
| Response Type | Definition | Other Clinical Terms Used |
| Flood | Being flooded with emotions in response to a perceived threat. | Emotional flooding, emotional dysregulation |
| Fatigue/Flop | Feeling tired or sleepy in response to a perceived threat. | Disassociating, numbing |
Dr. Reisinger points out that “sleeping” is often observed in infants who shut down when presented with excess stress. Neonatal Intensive Care Units advocate trauma-informed research and education on how infants may demonstrate stress (appear to shut down, holding breath, gagging, sneezing, yawning, flailing, hyperextension, etc.) and ways in which infants may require supports to self-regulate (moving, grasping, visual locking, hand-to-mouth, suckling, etc.).
Well into adulthood, we continue to re-require strategies and supports to regulate our bodies when encountering traumatic stressors. A “shut down” response in adults may present as disassociation (mind-body disconnection), depersonalization (sensed loss of self or identity), derealization (sensed loss of reality), or numbing (U.S. Department of Health and Human Services, SAMHSA, 2014).
Emotional flooding (or emotional dysregulation) occurs when the survivor experiences an intense barrage of emotions in the presence of a perceived threat.
In addition to survivors, emotional flooding may also be increasingly more common for Autistic individuals and other neurodivergents. Other examples of people who may experience emotional flooding include those with bipolar disorder, borderline personality disorder, ADHD, and Rejection Sensitive Dysphoria.
A Summary on Trauma Responses
The trauma response is not typically a “one and done” process where someone experiences a “fight response.” While the initial reaction may vary, trauma responses are often reported as being variable to the individual (U.S. Department of Health and Human Services, SAMHSA, 2014).
A trauma response can be better depicted as something like a pendulum. Similar to a meltdown, distress symptoms are initially present and require supports for the individual to self-regulate and discharge trauma energy (the internal cocktail of stress hormones that are amped up from trauma and every trigger thereafter).
However, when that need is not satisfied, the person becomes increasingly dysregulated. Without supports to self-regulate the intensity may continue to escalate until eventually coming to a crashing point. Some survivors describe a whole host of emotions and some report pure numbness and disconnect.
It’s also extremely important to recognize that the trauma response is appropriately adaptive when a person’s physiology has been altered by trauma. True trauma work addresses quality of life on an individualized basis, regulation of the environment, skills for developing a relaxed-muscle body, social supports such as accommodations, and recognizing that healing trauma is only one part of the whole individual experience.
Autistic and Neurodivergent Trauma
According to one study, Autistic children and adults “are at an increased risk of developing PTSD following exposure to traumatic life events” (Rumball, Happé, & Grey, 2020). Not only might trauma affect most autistic children and adults, but PTSD can develop traits that may present similarly to Autism.
Subsequently, Autistic Trauma presents itself in such a way that Autistic people may experience the above physiological trauma response coupled with repressed emotions and stims, masking and burn-out particularly in environments that do not provide supports that support both healing and empowering Autistic authenticity.
References
Porges, S. W. (2009). The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic Journal of Medicine, 76(4 suppl 2). https://doi.org/10.3949/ccjm.76.s2.17
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. (2014). Trauma-informed care in behavioral health services.
Rumball, F., Happé, F. and Grey, N. (2020), Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM-5 and Non-DSM-5 Traumatic Life Events. Autism Research, 13: 2122-2132. https://doi.org/10.1002/aur.2306
Walker, P. (2014). Complex Ptsd: from surviving to thriving: a guide and map for recovering from childhood trauma. Azure Coyote.
Further Reading
Living with PTSD on the Autism Spectrum by Lisa Morgan and Mary Donahue
Accessing the Healing Power of the Vagus Nerve by Stanley Rosenberg
- The 6Fs of Trauma Responses - September 28, 2021
- Neuroception 101: How the mindbody scans and adapts for safety and danger - August 5, 2021
18 Responses
Really interested in fatigue-flop, after my breaking point school pressure trap at age 13 – 14 was expressed in a symptom of unresponsive catatonic states. This is a verifier that it was not voluntary to have those states: when there has always been the logical problem that any writing about the known reasons for having them and what I was fearing can make it sound voluntary.
– Case published in PhD thesis Destination Unknown, by Ewelina Rydzewska, University of the West of Scotland 2013
The only autistic I can talk about with any credibility is me, and yep, was diagnosed cPTSD about 16 years ago now, which was a couple years before a paid professional finally said, “You aren’t bipolar (was diagnosed in mid 1980s) and never have been bipolar, you are autistic, here’s why …”. And man, did getting The Correct Diagnosis improve life and pretty quickly!
This is really interesting to me. I exhibit all but fight And sometimes I do that if I am overwhelmed from us and three standpoint. I was also born six weeks early and can definitely attest to the neonatal intensive care unit being traumatizing. I had a much longer comment, but my Internet messed up and somehow when I hit post it didn’t actually save the comments and so when I refresh the page it somehow it got deleted and I don’t have the spoons to redo it all.
Ah, spoons, and a shortage thereof. A concept understood all too well. Wish I had a couple dozen to send you. Maybe tomorrow will come with more than today did.
I find this kind of material very helpful. Please keep it coming. I’ve thought about reading the Porges book over the years, but it looks a bit intimidating to me (and oriented to professionals?). Of the references you list, is there an intro/overview of these topics for laypersons that would be a good one to start with?
Hey, thanks for the question and thoughts. A book that I personally recommend to people who are interested in understanding trauma is The Body Keeps the Score by Bessel van der Kolk. He doesn’t so much focus on reducing the trauma response to these deceptively neat categories, but he discusses how trauma affects our body and how that impacts how trauma survivors function.
Let me know if you have any other thoughts or questions. Thanks!
Kind of ironically, I’m pretty sure I’ve seen that book at my mom’s place—and I’m pretty sure she’s not planning on reading it, either. Thanks very much for the recommendation. I’ll check it out.
I really like this a lot. I experienced disassociation and depersonalization regularly over the past decade, and it’s so helpful to recognize that it was connected with trauma, overwhelm, and burnout.
This is the clearest description I have read of the variations in trauma responses. And it’s very helpful to read how about how it can intersect with autism. Thank you for this.
Thank you. This is a really clear and helpful framework
This type of information is extremely useful to me. Please keep sending it. Throughout the years, I’ve considered reading the Porges book, but it seems a little scary (and maybe written for professionals?). Is there a primer or summary of these subjects for laypeople in any of the sources you give that would be a good place to start?
Sorry for such a late response. Dr. Porges is currently working at my alma mater, excitingly enough! So, his contribution to trauma research is steeped in his Polyvagal Theory. Many of his books are written for clinical practice and his research for academia. I’m not entirely sure if he himself has provided more of an abridged work on his theory, but Deb Dana writes for laypeople. Perhaps you could try her book, Polyvagal Practices: Anchoring the Self in Safety? Shortly after I provided this synthesis at Terra Vance’s request, Dr. Porges wrote a book called Polyvagal Safety and how to implement his ideas in therapeutic presence for autistics, trauma survivors, sexual assault survivors, COVID-19, etc… If you ever get brave, he’s amazing. 🙂 My article does no justice to what he’s done!
Ok, so, this is dumb. There aren’t 6 F’s. There aren’t 4. There aren’t even 3. There’s 2. Just 2. Fight, and flight. Every single other made-up F being shoe-horned into this is just flight taking a slightly different form. Every form of flight is just another way to escape from danger. Freezing is waiting for the danger to go away from you, fawning is a way to disarm the danger, flopping is just a different way to freeze (see prior list item), and flooding is either going to be classic flight or yet another way to freeze, depending on the particular form it’s taking.
This kind of “expansion” doesn’t add nuance. It makes things more rigid. It limits understanding. By adding another cutesy F every time someone identifies a slight variation in their own trauma response, we move further and further away from actually seeing and comprehending the purpose of that response. But I guess I shouldn’t expect anything other than rigidity from a site which provides “no-cost, ad-free, high-quality [lol] articles by autistic writers and professionals [lol again].”
Those theories aren’t exclusive to this website, and I’m personally not Autistic – I’m just an Occupational Therapist (I do not diagnose or prescribe). Nonetheless, I do honestly see where the alliteration affect can be extremely grating and almost infantilizing for some survivors, I’ve been their myself. I would much rather prefer to call it what it is to me, a state of hyperarousal, but I work with patients who have varying levels of health literacy, different preferences for education, and who may not be of your intellect, yes; therefore, I have to write based on the request. In this case, I was asked to synthesize the Fs; I recommend exploring the primary authors (Dr. Porges, Dr. Reisinger, and Pete Walker) who wrote about them. Those individuals do have had a sizable impact in trauma theory and research. Their work is well beyond just this itty bitty article.
have had*
I apologize for the typos.
amazing post, really helpful! I am becoming more familiar with it now that I started in private! Joys, keep becoming more amazing and successful.