Using Physical Pain to Show a Character’s Past Trauma

There doesn’t seem to be much info out there to tell writers how to realistically capture emotions and trauma while still leaving room for plot, characterization, and genre tropes.

The most common problem I see is that the character THINKS about their past trauma—they have flashbacks and backstory—but the writer seems to forget that the character is a whole person. Trauma (past or present) should be felt in the character’s whole body, and pain is one of the devices that is often overlooked to show that trauma, to show increasing tension, to show internal conflict and build character arc.

Writing the Lived Experience

Readers are not looking to read a lab report. The objective listing of details and descriptions (or symptoms) add little meaning for readers without context—particularly, emotional context.

The lived experience of trauma must include how a character’s emotions affect the body alongside the impacts to more tangible effects, like relationships and school and work.

If your goal is to create an emotional connection with readers, show them how this trauma FEELS in every fiber of the character’s being (where it’s relevant to the story). Show how that trauma makes every decision more difficult because going against whatever revives the emotional pain or creates a sense of being ‘unsafe’ is essentially creating an internal war the character feels they can’t win.

Google can give you lists and clinical symptoms, but I’ve found forums a great source of lived-experience info because people often share their personal accounts as they look for support or advice.

Note from Angela: To help writers brainstorm emotional wounds and understand how they shape a character’s behavior, fears, missing needs, false beliefs, etc. and impact character arc, we created The Emotional Wound Thesaurus: A Writer’s Guide to Psychological Trauma.

But keep going with your curiosity. How does the trauma affect the character’s thinking, priorities, choices and decisions, confidence, energy levels, goals – everything? This is a fantastic way to show escalation of internal tension for your character!

When Does Trauma Cause Physical Pain?

The obvious answer is physical injury, right? If you’re hit by a car, you’re likely to experience trauma … and a broken leg. However, writers often overlook physical pain as a sign that trauma memories and emotions are being suppressed or denied, how long-term trauma responses take a physical toll on the body, and how thoughts or patterns of thinking can create pain in the body. Coping strategies lose efficacy over time and psychosomatic pain turns into chronic or even life-long medical issues.

Pain from emotional trauma is the body’s desperate attempt to warn us that something isn’t right and needs our immediate attention. Use this natural function to SHOW your reader that everything is not okay.

Ripley pressed the heel of her hand into her sternum, her shoulders caving around the pain. But what if Steve is at the party? What if she has to talk to him? The pain deepened and her pulse kicked at her throat. She leaned back into the chair, stretching to relieve the pain but there was no escaping it. She can’t see him. Like that afternoon had never happened. Like he’d never held her down. Her chest tightened more. Her ribs ached with every breath, wouldn’t expand for a deep breath. Her heart pounded up into her throat. Was she dying?

Use Pain to Show Trauma Backstory

Pain is a great device to show a backstory of trauma. Many writers are familiar with using minor aches or pain to show stress or tension, and that’s fine. The language of a stiff spine, clenched fists, or aching shoulders and necks is very relatable. But there’s so much more to it than that.

Try using pain that gets ignored, suppressed, or self-medicated without seeking treatment. Consider illness or pain that has no medical explanation (psychosomatic or psychogenic), or a series of worsening symptoms and diagnoses. Show a character desperately seeking to validate that their pain isn’t all in their heads. It’s important to show the character’s thinking behind the pain (their internal reaction to it) for the reader to understand what’s going on. It’s a great use of subtext.

Sally stuffed three chocolate-covered peanuts in her mouth and on the first bite a sharp pain shot up into her sinus. Her tongue carefully moved the nuts farther back in her mouth to avoid the sensitive tooth. She still had a couple of solid molars to chew with.

Use Pain and the Body as an Alarm System for Readers

Some trauma pain is psychosomatic (physical symptoms without a medical cause). For instance, anxiety can cause heart attack-like symptoms: racing pulse, intense chest pains, and shortness of breath. These are actual physical symptoms that drive people to emergency rooms all the time. You can clarify that the attack isn’t really heart-related by showing your reader the other key symptoms that don’t fit the diagnosis, such as the randomness of the attacks, the character’s pain remaining static in intensity for a long period of time, an attack being brought on by specific thoughts or upcoming events, etc.

Resource Alert:
Writing About Pain

But there are also medical conditions, physical illnesses, and disabilities that can result from emotional trauma. Fibromyalgia and psychogenic seizures can be caused by psychological distress. There are measurable markers of emotional pain from trauma, such as elevated cortisol levels. According to the Mayo Clinic:

“Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain’s use of glucose and increases the availability of substances that repair tissues.

Cortisol also curbs functions that would be nonessential or harmful in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with the brain regions that control mood, motivation and fear.”

Your character and the reader likely won’t be aware of an elevated cortisol level; maybe that’s just for you to know. But it’s now plausible for your character to develop diabetes even though they don’t eat a lot of sugar, to be more susceptible to illness, struggle to lose weight, have irregular and/or very painful menstrual cycles, experience sugar cravings after panic or intense stress, have sudden outbursts of anger or rage, or constantly be dealing with dental problems. Some of these aren’t pain signals specifically, but they cause a waterfall effect of growing physical problems.

Pain Builds upon Pain

Let’s look closer at the chain reaction of trauma pain. Consider sleep disruptions from emotional trauma (something that is super common). Exhaustion has all kinds of implications for the body and the mind: headaches or migraines, body aches, joint pain, clumsiness, stinging eyes, rapid breathing, elevated resting heart rate, sudden heart rate spikes, impaired thinking and reasoning, lack of focus, low energy, memory issues, depression… You get the idea.

Now, compound that even further. Your character starts having performance issues at work. One day, they forget to pick up the baby from daycare. They get in an accident because they can’t focus while driving. They slip on the stairs and suffer a concussion.

For a character who is tired or in pain, EVERYTHING is more difficult.

Be Honest About the Consequences of Living with Pain

I love the spoon theory (the economy of energy) to explain how debilitating pain can be. Let’s say a person without chronic pain begins each day with ten spoons (total available energy for the day). They go for a run, which uses up two spoons, spend half a spoon on a shower, and use five spoons over the course of their work day. They return home in the evening with two and a half spoons left for a hobby, to make dinner, or go out to the bar.

The person who is managing chronic physical/emotional pain or is struggling with depression, PTSD, or anxiety may begin most days with only five spoons, and that shower might cost them two. They learn to hoard their spoons because they’re a finite resource that has to last all day. Just like in real life, that chronic pain will change everything for your character—their thinking patterns, priorities, decision-making abilities, susceptibility to depression. Everything.

The body’s response to trauma is very unique and individual, but when we use it strategically, it’s a great way to show not just past trauma, but internal tension, characterization, and conflict, as well.

How could you incorporate any of these tips into your WIP?

For more help on showing your character’s pain, stress, and other after affects of emotional trauma, visit this database.