Holiday Triggers in Trauma Therapy: 5 Presentations to Prepare For

Read Time: 9 minutes

Every November, something shifts in the caseload. Clients who were steady in September start arriving activated. Sessions fill with the same handful of stories: the flight home, the dinner table, the relative nobody mentions, the drink that was supposed to be just one. The holidays are not a single stressor. They are a cluster of predictable pressures that land on the exact places where trauma lives: family, food, routine, belonging, and control.

The numbers back up what clinicians already feel. In the American Psychological Association's 2023 Harris Poll survey, 89 percent of U.S. adults said the holidays cause them stress, and 41 percent said their stress increases during this stretch of the year. The American Psychiatric Association's 2025 Healthy Minds Poll found nearly half of adults were worried about grief or missing someone, and about a third were bracing for difficult family dynamics or loneliness. For people with trauma histories, those general-population worries are the surface layer. Underneath them are the specific clinical presentations this post is about.

This guide walks through five holiday triggers we see most often, what each tends to look like in session, a free TTI guide you can use right away, and the training that goes deeper. You don't have to navigate this season alone, and neither do your clients.

Browse all ten featured courses in one place: Support for the Holiday Season →

Five seasonal triggers and what clinicians may see in session. Download and share with your consultation group.

1. Dissociation: Returning to the places where it happened

The holiday trigger. For many survivors, going home for the holidays means walking back into the physical space tied to the original harm. The same hallway. The same smell of the kitchen. The same person at the head of the table. Even clients who have done substantial processing can find that place-based cues bypass everything they've built, because the body recognizes the room before the mind does.

What you may see in session. Clients who return from a family visit may present flatter than usual, lose the thread mid-sentence, or describe the trip in a strangely distant way: "I don't really remember Thursday." Some report losing time. Some notice a part of them "took over" to get through dinner. Others arrive in dorsal shutdown that looks like fatigue or depression, and only on closer inspection turns out to be a protective collapse. If you aren't tracking for dissociation, these moments are easy to misread as resistance, avoidance, or a mood episode.

This matters for treatment outcomes. The TOP DD research program, the largest body of treatment research on dissociative disorders to date, found that when clinicians are trained to recognize and work directly with dissociation, patients show reduced symptoms, fewer unsafe behaviors, and improved functioning. Dissociation-informed care isn't a specialty add-on. It's foundational.

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2. OCD: When the routine that holds everything together disappears

The holiday trigger. OCD runs on structure, and the holidays dismantle it. Travel removes the familiar environment. Guests move things. Shared bathrooms, airports, crowded stores, and unfamiliar kitchens raise contamination and harm fears. Family members who don't understand the disorder either push too hard or accommodate too much. For the client who has built a workable life around predictability, two weeks of disruption can undo months of progress.

What you may see in session. Rituals that had quieted come back louder. Reassurance-seeking spikes, sometimes toward you. Clients may report that a parent or partner has started participating in compulsions again (checking the stove with them, answering the same question repeatedly) because it was easier than a scene at the table. You may also see trauma-related obsessions intensify after family contact. Comorbid OCD and PTSD is common, and clients with both tend to present with more severe OCD symptoms and poorer treatment response than those with OCD alone. The holiday spike can look like "the OCD got worse," when what actually happened is that trauma got activated and the OCD moved in to manage it.

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3. Eating disorders: A season built around food and bodies

The holiday trigger. From Thanksgiving through New Year's, nearly every gathering is organized around a meal, and nearly every meal comes with commentary. Comments about plates, about weight, about who has "been good" and who deserves a second helping. For a client with an eating disorder, these are not small moments. They are the exact conditions the disorder was built to survive. Research on individuals with eating disorders during the COVID-19 disruptions found that lack of structure, being in a triggering environment, and limited social support were among the most commonly cited reasons symptoms worsened. The holidays reproduce all three at once.

What you may see in session. Restriction before the trip and bingeing or purging after. A client who skips the session the week of the big meal. Shame that shows up as self-attack in the days following a gathering. Body-checking behaviors that intensify. You may also see the eating disorder reassert itself as a regulation strategy right when trauma processing was starting to move, which is a signal to slow down and reassess readiness rather than push forward.

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4. Attachment: Family-of-origin dynamics and the empty chair

The holiday trigger. The holidays are a stress test for attachment. Clients are asked to spend extended time with the very people who shaped their earliest templates for safety, closeness, and threat, often in the house where those templates were formed. For clients with disorganized attachment, this is a particular bind: the same person is both the source of comfort and the source of fear, and there is no behavioral strategy that resolves it. Disorganized attachment in infancy is strongly associated with frightening, frightened, or unpredictable caregiving, and its sequelae persist well into adulthood. Put that adult back at the table with that caregiver and the old collapse of strategy returns.

Then there is the client who is not going home at all. Family estrangement is far more common than most people realize. In the first large national survey on the topic, 27 percent of U.S. adults reported being estranged from a family member, and about 10 percent from a parent or child. A later nationally representative study estimated that roughly a quarter of adults are estranged from their father and about 6 percent from their mother. For these clients, the holidays bring a different kind of activation: the cultural saturation of family imagery, the questions from well-meaning colleagues about plans, and the grief of a loss that has no ritual attached to it.

What you may see in session. Regression to childhood roles within hours of arriving home: the caretaker, the peacemaker, the invisible one. Fawn responses that leave the client exhausted and resentful. Clients with avoidant patterns who go quiet and report "it was fine" while their bodies say otherwise. Clients with anxious patterns who spiral after a single offhand comment. Clients with disorganized patterns who swing between approach and retreat, who may dissociate at the table, and who struggle to describe what happened afterward. Emotional neglect is especially easy to miss in this season because there is no event to point to, just an absence that gets louder when everyone is supposed to be together.

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5. Addictions: Alcohol everywhere, and stress on top of it

The holiday trigger. Alcohol is woven into almost every holiday event, and for many clients the pressure to drink comes from the same family members whose behavior drove the use in the first place. Add disrupted routines, missed meetings, financial strain, grief, and extended exposure to old relational wounds, and the season becomes a sustained stress load with constant access to the substance. Stress is one of the most reliable predictors of craving and relapse across substance use disorders, operating through disruptions in the body's adaptive stress response that make flexible coping harder and drug-seeking more automatic. Trauma survivors carry those disruptions into the season already.

What you may see in session. Cravings that return after long quiet. The "just one" rationalization. Cancellations the week of a family event, and then shame-driven avoidance of the next session. Secrecy that wasn't there in October. And underneath, the dissociative function of the use: numbing, spacing out, leaving the body. For clients with trauma histories, the drink is rarely about the drink. It's a state shift away from unbearable affect. If you can name that function with them before the season starts, you've changed the conversation.

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References

American Psychological Association. (2023, November 30). Even a joyous holiday season can cause stress for most Americans [Press release]. Survey conducted by The Harris Poll, Nov. 14–16, 2023, among 2,061 U.S. adults. https://www.newswise.com/articles/even-a-joyous-holiday-season-can-cause-stress-for-most-americans

American Psychiatric Association. (2025, November). Americans are more anxious than last year about the upcoming holidays; health care and the economy also major concerns for many [Press release]. APA Healthy Minds Poll. https://www.psychiatry.org/news-room/news-releases/americans-more-anxious-about-the-holidays

Brand, B. L., Schielke, H. J., Putnam, K. T., Putnam, F. W., Loewenstein, R. J., Myrick, A., Jepsen, E. K. K., Langeland, W., Steele, K., Classen, C. C., & Lanius, R. A. (2019). An online educational program for individuals with dissociative disorders and their clinicians: 1-year and 2-year follow-up. Journal of Traumatic Stress, 32(1), 156–166. https://escholarship.org/uc/item/2t4688wb

Granqvist, P., Sroufe, L. A., Dozier, M., Hesse, E., Steele, M., van IJzendoorn, M., ... Duschinsky, R. (2017). Disorganized attachment in infancy: A review of the phenomenon and its implications for clinicians and policy-makers. Attachment & Human Development, 19(6), 534–558. https://doi.org/10.1080/14616734.2017.1354040

Pillemer, K. (2020). Fault lines: Fractured families and how to mend them. Avery. https://search.worldcat.org/oclc/1145305518

Pinciotti, C. M., Wetterneck, C. T., & Riemann, B. C. (2022). Symptom severity and presentation in comorbid OCD and PTSD: A clinical replication. Bulletin of the Menninger Clinic, 86(3), 183–203. https://cmpinciotti.owlstown.net/publications/18496-symptom-severity-and-presentation-in-comorbid-ocd-and-ptsd-a-clinical-replication

Reczek, R., Stacey, L., & Thomeer, M. B. (2023). Parent–adult child estrangement in the United States by gender, race/ethnicity, and sexuality. Journal of Marriage and Family, 85(2), 494–517. https://doi.org/10.1111/jomf.12898

Sinha, R. (2024). Stress and substance use disorders: Risk, relapse, and treatment outcomes. Journal of Clinical Investigation, 134(16), e172883. https://www.jci.org/articles/view/172883

Termorshuizen, J. D., Watson, H. J., Thornton, L. M., Borg, S., Flatt, R. E., MacDermod, C. M., Harper, L. E., van Furth, E. F., Peat, C. M., & Bulik, C. M. (2020). Early impact of COVID-19 on individuals with self-reported eating disorders: A survey of ~1,000 individuals in the United States and the Netherlands. International Journal of Eating Disorders, 53(11), 1780–1790. https://doi.org/10.1002/eat.23353