The one factor which is invariably present for the trauma survivor is that of intrusive thoughts and imagery. These are often seen as the hallmark of Post-traumatic Stress Disorder, although the extent to which they dominate a person’s life varies considerably. Sometimes, when the victim of the trauma has been a loved one or particularly in the case of traumatic-bereavement, intrusive imagery may be present of what a person imagines happened rather than of something they actually witnessed. These are known as ‘elaborated intrusions.’

In the immediate aftermath of a trauma intrusive thoughts and images are likely to be present most of the time, often preventing the sufferer from sleeping. This is naturally extremely upsetting, but it needs to be emphasised that it is part of the normal adjustment process, as a victim ‘works through’ the trauma. After a while the thoughts and imagery will fade, perhaps only reasserting themselves just before sleep or on first waking. During the daytime the images may be at the back of the mind, but activity enables distraction from these.