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The Body Keeps the Score by Bessel van der Kolk.
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Trauma has become one of those broad psychological terms that is often thrown around but seldom truly understood; even in the field of psychiatry, trauma has historically been a nebulous term with a wide range of symptoms and treatments. In The Body Keeps the Score, the author explores how the understanding and treatment of trauma has evolved as new technologies, research, and fields of science emerged.

Trauma can stem from a one-time event or an ongoing experience—from abuse to a severe car accident to wartime combat—and can cause a lifetime of flashbacks, nightmares, isolation, insomnia, hypervigilance, and rage. Until just a few decades ago, there was no umbrella diagnosis for trauma; instead, patients were wrongly diagnosed with depression, mood disorders, substance abuse, even schizophrenia. Incorrect diagnoses led to ineffective treatments and patients’ continued suffering.

The effects of trauma live on not only in the emotional mind and the chemical makeup and circuitry of the brain, but also in the body’s physiology. Traumatic experiences rewire the brain to cause people to be hypervigilant to threats: The slightest hint of a threat sends trauma sufferers into a fight-or-flight response, triggering stress hormones to flood their bodies and keep them in a state of hyperarousal long after the perceived threat is gone. Over time, hypervigilance and hyperarousal cause physical ailments and hamper trauma sufferers’ ability to function emotionally and socially.

Trauma’s Impact on the Mind

Mentally and emotionally, trauma affects how survivors interact with people and the world around them.

  • Trauma survivors experience isolation, unable to trust anyone after suffering pain and abuse at the hands of another person. Additionally, sufferers don’t believe anyone could understand how they feel. Furthermore, they struggle to read people’s emotions and intentions through their physical expressions because they’re so consumed by their hypervigilance that they can’t connect with other people; they see most people as threats, and they don’t give off an open, welcoming vibe to invite others to approach them.
  • Trauma survivors are often more haunted by shame at what they did or didn’t do during the traumatic event—whether or not they could’ve rationally acted any differently—than by the atrocity of their abusers’ actions.
  • Trauma survivors typically develop learned helplessness—a sense of powerlessness and resignation to their circumstances—after experiencing an inescapable trauma, such as a car accident, combat zone, or physical assault.
  • Trauma survivors suffer from flashbacks, which can be triggered by almost anything (e.g. an image, sound, smell, or phrase that reminds the trauma survivor of their traumatic event) and bring on a bombardment of fragmented memories of their traumatic experience. It can happen any time, anywhere, and you never know how long the flashback will last.
    • Flashbacks keep survivors stuck in their traumatic event, so that they’re never able to be fully engaged in the present. As a result, they typically go through life feeling numb.

Trauma’s Impact on the Brain

Traumatic experiences are so overwhelming that parts of the brain go offline while others go into overdrive, and as a result, your brain fails to process the traumatic event and integrate it into the timeline of your life, as it would any other experience. Consequently, the trauma never becomes part of the past; it’s ever-present (as evidenced by the pervasive flashbacks and near-constant state of fight or flight).

Brain scans reveal that when trauma survivors experience flashbacks, their brains react as if the actual trauma were happening in that moment.

Your brain has three parts:

  1. The reptilian brain, which manages your most primitive functions such as breathing, eating, sleeping, and expelling waste.
  2. The limbic system—the mammalian brain—which manages emotions, looks out for danger, and helps you navigate social networks.
  3. The neocortex—the rational brain—which operates logic, language, creativity, empathy, and the ability to plan for the future and reflect on the past.

Together, the reptilian brain and the limbic system (the two most primitive parts of your brain) make up the emotional brain. The emotional brain alerts you to danger and, if necessary, jump-starts your pre-programmed reactions, like the fight-or-flight response, before your rational brain weighs in to determine if the threat is really a threat (e.g. you might jump back at the sight of a snake, only to realize it’s just a rope). However, trauma hinders the brain from accurately and effectively perceiving threats, so trauma survivors go through life constantly jumping in response to non-threats.

Trauma’s Impact on the Body

Your mind and body are inextricably connected: Emotions give you physical sensations (e.g. butterflies in your stomach) and are revealed in your facial expressions and body language. By the same token, physical sensations impact your mood and emotions—a soft, warm breeze puts you at ease, while loud, clanging noises put you on edge.

Trauma and flashbacks cause intense emotions and physical sensations that are so overwhelming that survivors cope by suppressing both their emotions and physical sensations. As a result, they become disconnected from their bodies—unable to identify and interpret their physical sensations—which makes it impossible to feel fully alive, take care of their bodies and minds, and effectively engage with other people.

When you suppress or can’t understand what your physical sensations are telling you, the body finds other ways to demand your attention: Many trauma survivors develop psychosomatic issues (physical ailments that have no physical cause) such as migraines, neck and back pain, fibromyalgia, asthma, digestive issues, irritable bowel syndrome, and chronic fatigue.

Childhood Sources of...

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The Body Keeps the Score Summary The Body Keeps the Score Guide Prologue: Trauma Haunts Many People for Life

We tend to think of trauma in its most extreme forms, such as PTSD in veterans, rape victims, and survivors of tragedies like 9/11. But nearly everyone is likely to either suffer from trauma or know someone who does—whether from a tragedy or accident, domestic violence, childhood abuse, or witnessing violence as a child.

Regardless of how many years or decades have passed since the traumatic event(s), your brain and body continue to feel the effects. Trauma rewires the brain to cause people to be hypervigilant to threats and repeat the same mistakes, seemingly compulsively.

In this summary,...

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The Body Keeps the Score Summary The Body Keeps the Score Guide Chapter 1: Developing a Definition of Trauma and PTSD

Trauma can stem from a one-time event or an ongoing experience. And each person who experiences trauma deals with it differently; two people who experience the same traumatic event may cope with it in entirely different ways—some people become irritable and have explosive rage, while others shut down emotionally or repress it entirely.

The range of symptoms, lack of uniformity, and occasionally the repression or denial of the traumatic event itself can make trauma difficult to identify and diagnose. As a result, there was no single diagnosis of the collective symptoms of trauma until just a few decades ago.

Despite the range of causes, symptoms, and severity, all trauma sufferers have common neurological and physiological effects that last until effective treatment can heal both the mind and the body.

(Shortform note: Trauma is the umbrella term for the mental, emotional, neurological, and physical response to an intensely distressing or disturbing traumatic event. Posttraumatic stress disorder (PTSD) is the diagnosis most commonly associated with trauma, but as we’ll discuss, not every trauma survivor fits the definition of PTSD; other disorders that can result from...

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The Body Keeps the Score Summary The Body Keeps the Score Guide Chapter 2: The Mental and Emotional Scars of Trauma

The effects of trauma are three-pronged: the mind (mental and emotional), the brain (brain wave frequencies and neurological reactions), and the body. First, we’ll explore how trauma impacts the mind.

Isolation and Shame

One of the lasting impacts of trauma is an inability to develop intimate relationships with others: After experiencing such suffering at the hands of another person, how can you trust anyone again?

Additionally, how can anyone possibly understand how you feel, with the exception of other trauma survivors? These two questions cause many trauma survivors to be extremely isolated.

What’s more, many trauma survivors feel paralyzing shame about their own behavior during a traumatic episode. In some cases, the survivor may have lashed out in response to the trauma and subsequently feels shame about it; for instance, the day after Tom’s platoon was ambushed in Vietnam, he killed children and raped women in a nearby village in a vengeful rage. The shame of his actions later haunted him mercilessly.

In other cases, trauma survivors feel shame about their behavior—regardless of any rational reality of whether they could’ve acted any differently. This is...

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The Body Keeps the Score Summary The Body Keeps the Score Guide Chapter 3: Your Brain on Trauma: Flashbacks and Memories

The advent of brain-imaging technology in the early 1990s gave scientists new insight into the way brains process information, memories, sensations, and emotions. With these tools, researchers learned that trauma leaves an imprint on the mind, brain, and body that has long-term effects on how you survive in the present. Trauma not only changes how and what you think but also your capacity to think.

Flashbacks Alter Brain Functions

In the face of trauma, part of your brain shuts down and causes you to lose your ability to articulate your feelings, your sense of time, your ability to make sense of your body’s sensations, and your ability to store that information. The emotional brain takes over, kicking up your emotional arousal, physiological reaction, and muscle activity. All this causes the trauma to be stored as fragments of sensory information—sounds, smells, sensations, and images—instead of a coherent narrative. This is the basis for flashbacks.

In one study, eight trauma survivors recreated scenes of their traumas—essentially triggering flashbacks—as they had their brains scanned to see the reactions. The researchers found that participants’ amygdalas (the...

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The Body Keeps the Score Summary The Body Keeps the Score Guide Chapter 4: Understanding Trauma Through Brain Anatomy

Your brain’s primary function is to ensure your survival. This entails:

  • Signaling when your body needs essentials such as food, water, rest, shelter, safety, and sex.
  • Interpreting the world around you to point you in the right direction to find and satisfy those essential needs.
  • Creating the energy and initiating the actions to achieve those tasks.
  • Warning you of dangers and opportunities you may encounter as you pursue those tasks.
  • Adapting to act and respond to changing circumstances along the way.

Your brain has three parts that work together to achieve its primary functions.

  1. The reptilian brain
  2. The limbic system, or the mammalian brain
  3. The neocortex

Trauma alters the balance between these three parts, ramping up activity in some areas and weakening others. As we’ll see, trauma causes the more primitive parts of your brain to be overactive, while hindering the parts responsible for empathy, creativity, and abstract thought—which are critical to thriving in a community and in everyday life.

The Reptilian Brain

The reptilian brain is the most primitive part of your brain and develops while you’re in the womb. It’s responsible...

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The Body Keeps the Score Summary The Body Keeps the Score Guide Chapter 5: Your Mind Impacts Your Body and Vice Versa

Your mental and physical states are inextricably connected. Both positive and negative emotions can give you physical sensations—like when the hair on the back of your neck stands up in the face of a threat, or you feel butterflies in your stomach when you’re excited.

Other people pick up on your mental and emotional state through your facial expressions and body language, and likewise, you read other people’s emotions and intentions through their physical expressions. However, if your mind and emotions are hijacked by a hypervigilance to danger—as is the case with trauma sufferers—it prevents you from relaxing enough to connect with other people; they don’t read an open, welcoming state in your posture, and you mistakenly see them as threatening.

Researcher Stephen Porges’s Polyvagal Theory explains how our social interactions with others, and the way we read each others’ body language, impacts our emotions—for instance, why hearing a soothing voice can calm you, and why feeling ostracized by other people can make you angry or cause you to shut down. Your mirror neurons (which help you pick up on other people’s actions, emotions, and intentions and are responsible for...

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Shortform Exercise: Nonverbal Communication in Social Interactions

As a baby, your interactions with your caregivers help you develop the ability to read people’s moods and emotions through their nonverbal cues, including body posture, tone of voice, and eye contact. Your ability to do this is critical in social interactions throughout your life.


Think of a recent conversation you had with someone who you knew was upset simply by reading their body language. What could you discern through their facial expressions, tone of voice, posture, and other nonverbal clues?

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The Body Keeps the Score Summary The Body Keeps the Score Guide Chapter 6: Traumatized People Disconnect From Their Physical Sensations

Recognizing the physical sensations in your body—as basic as feeling cold or hungry—is at the core of your sense of self: How can you know what you enjoy, need, or want if you don’t understand how you feel on the most basic level?

Before you develop language or consciousness, your physical awareness begins in the womb—feeling your mother’s movements and hearing the whooshing of fluids flowing around you. As you get older, physical sensations continue to provide information about your internal condition and your environment. Effectively reading sensory cues is essential to staying safe and healthy.

Many trauma survivors suffer major disconnection from their bodies, which makes it impossible for them to feel fully alive, take care of their bodies and minds, and effectively engage with other people.

Some survivors lose feeling in whole areas of their bodies, and can’t even determine what kind of object they’re holding in their palm by touch alone. Some survivors of chronic childhood trauma are so disconnected from their bodies that they can’t even recognize themselves in the mirror.

Sensory Unawareness in the Brain

Researchers asked people to think about...

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Shortform Exercise: Recognizing Your Own Body Awareness

Recognizing the physical sensations in your body—as basic as feeling cold or hungry—is at the core of your sense of self, but for most people it’s so natural that you probably don’t even think about it. Use this exercise to notice your body awareness.


Take a moment and focus on your body. Write all the sensations you notice—the feel of the chair against your back, your empty stomach growling, the smell of the room, the tension in your shoulders.

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The Body Keeps the Score Summary The Body Keeps the Score Guide Chapter 7: Resilience Builds From Birth

From the moment you’re born, every interaction with your caregivers helps form your understanding of the world and teaches you how to have relationships with others; this comes through your attachment and attunement to your caregiver, which we’ll describe below. In fact, the biggest predictor of your ability to cope with challenges in life is the security you feel with your primary caregiver during the first two years of your life.

Attachment

As a baby, since you’re unable to care for yourself, you must rely on your caregivers to meet your most basic needs, from food and clothing to safety and comfort. Your attachment—how well your caregivers meet your needs—determines how well you’ll take care of these needs for yourself later in life. Furthermore, the more responsive your caregivers are to you, the more responsive you’ll be to others.

Babies are programmed to form an attachment no matter what, so the quality of that attachment depends upon the kind of caregiver they have.

Caregivers’ own traumas and mental health issues can impede their ability to care for and provide secure attachment. Children without a healthy attachment tend to dissociate and shut...

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The Body Keeps the Score Summary The Body Keeps the Score Guide Chapter 8: Treatments to Heal the Mind, Brain, and Body

As the fields of science and psychology have evolved, so have the understanding and treatment of trauma. There are three general approaches to treatment.

  1. Top-down: Talking, connecting with other people, opening up about your traumatic memories and their present-day effects.
  2. Medication: Using prescription drugs that inhibit trauma survivors’ overactive internal alarm systems, or affect the brain’s chemistry in some other way to alleviate the symptoms of trauma.
  3. Bottom-up: Seeking physical experiences that connect the body and mind to counteract feelings of helplessness, rage, and emotional collapse that plague trauma survivors.

The goal of treatment is to regain control of yourself and your thoughts, feelings, and body. Generally, this involves four steps:

  1. Learn how to be calm and focused.
  2. Find a way to stay calm in the face of sensations (images, sounds, smells) associated with your trauma.
  3. Learn how to be present and engage with the people around you.
  4. Don’t hide things from yourself, such as the ways you adapted in order to survive during and after your trauma.

First we’ll explore top-down trauma treatments and discuss their benefits and drawbacks....

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The Body Keeps the Score Summary The Body Keeps the Score Guide Chapter 9: Medication Revolutionized Mental Disorders

Throughout history, available technology dictated the understanding and treatment of mental and emotional issues. Before the Enlightenment, mental illness and emotional issues were attributed to God, demons, sin, magic, and witchcraft. In the 19th Century, scientists began viewing behavior as a result of people’s adaptation to the complex world around them.

In the early 1950s, French scientists discovered a chemical compound that could make psychiatric patients less agitated and delusional. This introduced the brain-disease model of viewing mental problems as “disorders” that could be treated with drugs to adjust brain chemistry.

The brain-disease model and growth of pharmacology changed the field of psychiatry in several ways.

  • Mental problems were not approached as a nebulous issue in the emotional mind, but as a measurable abnormality in brain chemicals that could be corrected with drugs.
  • Doctors had another tool besides talk therapy.
  • Drug sales created income for doctors and profits for pharmaceutical companies.
  • Grants from pharmaceutical companies funded studies and laboratories.

However, **the availability of drugs has become a substitution...

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The Body Keeps the Score Summary The Body Keeps the Score Guide Chapter 10: Bottom-Up: Engaging the Body in Healing

The bottom-up approach to treatment uses physical experiences that connect the body and mind. This empowers patients to inhabit their bodies, be present, and learn how they can affect their emotions—all of which help them to counteract feelings of helplessness, rage, and emotional collapse.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is a treatment in which patients revisit their trauma while focusing on a therapist’s finger moving side-to-side. In contrast to exposure therapy, which aims to desensitize patients through repeatedly revisiting the traumatic memory, EMDR uses the trauma as merely a starting point leading to other, seemingly unrelated thoughts and memories.

While researchers don’t know exactly how EMDR works, the treatment helps people get in touch with loosely connected memories and images and then integrate their traumatic experience into a broader context. After EMDR treatment, patients are able to look at the traumatic event as they would another memory—something that’s in the past, that doesn’t have power over them in the present. Furthermore, one study showed that not only was EMDR more...

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The Body Keeps the Score Summary The Body Keeps the Score Guide Epilogue: Invest in Prevention

Awareness of trauma and its effects is steadily increasing, as more research is published and more treatments become available. However, there is much room for change in the way our society addresses and prevents trauma.

Unemployment, poverty, struggling schools, inadequate housing, social isolation, and relatively easy access to firearms all create fertile grounds for trauma—and still, we see cuts to food stamps, opposition to universal healthcare and stricter gun laws, high rates of incarceration, and an overdependence on...

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Table of Contents

  • 1-Page Summary
  • Prologue: Trauma Haunts Many People for Life
  • Chapter 1: Developing a Definition of Trauma and PTSD
  • Chapter 2: The Mental and Emotional Scars of Trauma
  • Chapter 3: Your Brain on Trauma: Flashbacks and Memories
  • Chapter 4: Understanding Trauma Through Brain Anatomy
  • Chapter 5: Your Mind Impacts Your Body and Vice Versa
  • Exercise: Nonverbal Communication in Social Interactions
  • Chapter 6: Traumatized People Disconnect From Their Physical Sensations
  • Exercise: Recognizing Your Own Body Awareness
  • Chapter 7: Resilience Builds From Birth
  • Chapter 8: Treatments to Heal the Mind, Brain, and Body
  • Chapter 9: Medication Revolutionized Mental Disorders
  • Chapter 10: Bottom-Up: Engaging the Body in Healing
  • Epilogue: Invest in Prevention