Overcoming Self-Blame and Self-Shame

Tips from a chronic pain recovery therapist

This week, I’m doing something a little different. Instead of my usual blog post, I’m going to share with you an excerpt of a new book that I am honored to be interviewed in! Healing Honestly: The Messy and Magnificent Path to Overcoming Self-Blame and Self-Shame by my friend Alisa Zipursky is “the least retraumatizing read on childhood sexual abuse — for survivors, by a survivor.”

I personally love this book and was thrilled to be interviewed in it about healing from chronic pain. Whether or not you identify as a survivor of childhood sexual abuse (CSA), I hope this excerpt will help you make sense of the connection between stressful experiences and the tension we hold in our bodies — and offer you tips on untangling the shame and blame that we place on ourselves for the ways that our bodies respond to stress. When we start to untangle the knots of self-shame and self-blame, we create the space in which our symptoms can begin to unwind too!

The following was excerpted with permission from Healing Honestly: The Messy and Magnificent Path to Overcoming Self-Blame and Self-Shame 2023 Berrett-Koehler Publishers www.bkconnection.com

Now I get to introduce you to a friend of mine, Anna Holtzman, LMHC, who has helped me so much on my chronic pain journey. Anna is a licensed therapist and chronic pain expert whose expertise is at the intersection of chronic pain and trauma. She is also a childhood sexual trauma survivor, and you know we love survivor-to-survivor wisdom!

A year ago, I was dealing with chronic migraines. At my request, Anna sent me information about how chronic pain works in the body, along with resources like guided imagery and journaling prompts. One of the coolest things I learned was that research shows that simply learning about how chronic pain works can in and of itself be an effective treatment for pain. So many fellow CSA survivors struggle with physical pain, like shoulder/neck/ back pain, migraines, and pelvic pain the way I have. It isn’t a coincidence, and it certainly isn’t our fault.


Anna explained to me, “Pain is nothing but a danger signal and triggered by fear. Sometimes the danger is physical, like a broken leg; sometimes the danger is emotional, like emotional abuse.” She continued, “Pain is a danger alarm created in our brains when our nervous systems feel unsafe. This is a process that doesn’t happen consciously, nor is it based on decisions we make.”

There are loads of examples of how this mind-body connection works. If we are nervous about a job interview, having a difficult conversation, or awaiting results of an important test, we may get stomach pains, nausea, loss of appetite, tightness in our neck and back. Or, if you’re me, you get the nervous bubble gut and you’re just grateful to make it through without pooping your pants. We don’t decide to get an upset stomach or back pains during these high-stress experiences; they are things that happen subconsciously.

There are these one-off stressful experiences, “but when you are dealing with chronic stress or chronic trauma, it can cause chronic pain. We can see examples around us, like having a super stressful job, which is an everyday experience, which may lead us to have headaches or back pain most days,” said Anna.

It all sounds too simple, right? Well, that’s kind of the point, she said. “This is all actually very simple. We all intuitively understand the connection between pain and trauma and our mind and body. But we’ve been conditioned to distrust our own knowledge of our own emotional and physical experience. We have been gaslit into believing our emotional feelings are not valid.”

While the world outside of us tells us that physical and emotional pain are completely different things, one being considered “real” and provable and the other constantly invalidated and dismissed, they are interwoven inside of us.

Anna explained, “Physical pain and emotional pain are created in very similar parts of the brain, so the two are inextricably connected. They are coordinated aspects of stress response, so we cannot divorce one from the other, not ever. Even if you have pain from a bone, there’s an emotional response to that from the physical sensation of the broken bone.” I can personally attest to that as someone who, as a kid, all on separate occasions, broke her leg, three toes, one finger, and an arm (from literally, I shit you not, napping on the couch while watching Baywatch reruns and slowly rolling over onto the floor, landing on my arm. Yes, it was just a regular couch.)

Anna continued, “Chronic pain is a result of the chronic tension between the part of us that wants to fight back and the part of us that has learned to be afraid to fight back, probably for good reasons, at least in childhood or before you had allies to support you.”

To illustrate the point, she offered us this prompt:

  • First, let’s imagine lots of angry energy inside of you, the kind of fury of fighting back against all that is wrong. Tap into the anger and fury that is a part of each of us.
  • Now that you’ve tapped into that feeling of righteous anger, try suppressing all that fighting energy with all of your might.
  • What does your body feel like when you try to suppress your anger and fighting energy? It may feel pretty tense and tight in your body. If each of us sustained that for a while, we might start to feel some pain.
  • Now that this little experiment is over, give your limbs a light shake or do some deep exhalations to release all that tension and discomfort, because that isn’t a pleasant feeling!

Presumably, if we continued to suppress and silence the natural fight response in us for long periods of time, say our whole childhood, we can see how some pain would start to develop. So this prompt is helping us understand a little better how chronic pain comes from this tension of suppressing our healthy natural emotional selves. Whether the prompt was illuminating to you or not, that’s okay; we have more to learn together!


In further exploring the chronic pain and CSA survivor relationship, Anna explained to me that there are some common survival behaviors that we survivors engage in that can perpetuate chronic pain.

  1. Vigilance and preparing for the threat of danger.
    Many survivors experience hypervigilance as a part of their trauma. I feel I am often on high alert, playing worst-case scenarios in my head as a way to anticipate danger and prepare for ways to deal with the fallout. Do you observe yourself being constantly on high alert? No shame if you do! This was developed for good reasons!

    “The habit of vigilance perpetuates chronic pain because it keeps our danger alarm on high alert all the time. Pain is a danger signal, so when we fear we are in danger, our body sends us pain as a message, Anna explained. If we spend a lot of time with our danger alarms going off, this can continue our cycles of pain.
  2. People pleasing and suppressing anger.
    Many of us can relate to being conditioned to suppress anger, because if we tried expressing it when we were younger, we may have received explicit or implicit signals that it wasn’t safe for us to be angry. Have you observed any people-pleasing/appeasing tendencies within yourself? Again, no shame if you have! This was developed for good reasons! (Yes, I will repeat this again because it is worthy of repetition!)

    “The people-pleasing/appeasing/suppressing anger survival behaviors perpetuate chronic pain in a few ways, including that when we have the urge to fight back but have to suppress it, it is as though our internal gas pedal and brake pedal are being slammed on simultaneously, which causes physical tension,” Anna explained.
  3. Perfectionism and self-criticism (I am the best at this one!)
    My therapist says I am the best at criticizing myself for things that aren’t my fault — which also fulfills my perfectionist tendencies, so take that. We can be so hard on ourselves in hopes that it prevents us from “inviting” (we never actually invite abuse from someone, hence the quotation marks) abuse from someone else. Do you join me in having a lot of perfectionism and self-criticism tendencies too?

    When I asked Anna how this survival behavior contributes to chronic pain, she explained, “When we are perfectionists and intense self-critics, we are terrorizing ourselves all day long, and that turns on our danger alarms and sends signals of pain within us.” I did a true, honest-to-God spit-take when she said this last one, because it was so real to me that my only option was to hysterically laugh.

It’s no wonder so many of us deal with chronic pain! Look at all the coping strategies we had to develop just to try to stay safe and function in the world as survivors. Those same things can cause us pain. Thinking about all this together fills me up with a deep feeling of compassion for all of us.


A really important aspect of pain for us CSA survivors is that sometimes danger is a present-time threat, like touching a hot stove, but other times danger can be a conditioned response that reminds us of past danger or abuse. We can be going about our days and then get a headache or back pain and not know why, but it could be because we smelled or heard or saw something that subconsciously reminded us of our abuse. Anna explained that this can be a confusing part of pain, especially if we are trying to explain it to people who don’t know what it’s like to have trauma and experience triggers.

“An example I like to use is that when we get near a flame, our body automatically recoils from it because we know It’s dangerous. How do we know it’s dangerous? We aren’t consciously thinking about how fire is dangerous, so we must move our hand. We aren’t thinking about the first time we learned fire is dangerous. We may not consciously remember how and when we learned fire was dangerous, but our nervous system remembers fire is dangerous to touch, so our nervous system is recoiling our hand from the flame,” Anna said.

For some of us, we experienced chronic pain throughout our childhood. For others, we didn’t experience it until adulthood. Sometimes people ask, “Why now?!” to their pain who didn’t experience pain in their childhood.

“Often with chronic pain, we experience the pain when our bodies are safe enough to relax our survival mechanisms a bit and we determine, in a subconscious place, that it’s safe enough for us to fully feel the pain connected to the stress,” Anna explained.


I’ve heard some people imply that we have chronic pain because our emotions are too big, or too hard, for our minds to process, so our bodies store them. When I asked Anna about this, she told me that every one of her trauma teachers has said that people suppress their feelings because they are too overwhelming, and that’s what leads to chronic pain.

“In my opinion, that is bullshit,” I was surprised to hear her say. “I don’t think we are unable to handle big feelings. Or that there are feelings too big for our nervous systems to handle. But rather, it’s that we can’t handle big feelings in isolation. We need companionship in order to safely process our feelings.”

We weren’t born suppressing our emotions. We learned to suppress our emotions because we learned from the people around us that we were not going to receive empathy and companionship with our feelings. Expressions of our feelings were met with silence, criticism, denial, and even punishment. Bad f — -ing things. At the same time, we learned that our physical pain would be taken seriously and met with some sympathy and support. So our bodies brilliantly channeled all our pain and emotions into the parts of us that would receive care and support when hurt. Fancy, smart moves from our bodies.

“We feel physical pain because it has a greater chance of being socially validated than emotional pain, and we stuff emotional pain down because we know we aren’t going to get empathy for it and the world around us has shown us it isn’t safe to process it,” Anna shared. Are there ways you’ve seen your physical pain garner more support and empathy than your emotional pain throughout your life?

The good news is that, as adults, we can seek out empathetic witnesses to our pain, like a trusted friend or a good therapist, who can offer us companionship that allows us to safely express our big feelings.

“Feeling our feelings without the presence of compassion makes our nervous system freak the f — – out because it feels exposed and vulnerable to potential threats. But feeling our feelings in the presence of compassion makes our nervous system feel safe,” Anna told me.

What is most important is for each of us to know we aren’t alone in our pain. “You are not crazy, and none of this is your fault. It is possible for you to find relief, and while you can never prevent all pain, it absolutely can get better,” Anna offered.

I know that was a lot of information about chronic pain and trauma! What kinds of emotions, including potentially unpleasant ones, does all of this bring up for you? However you feel, it is totally normal.

Want to read more? Grab a copy of the book, Healing Honestly: The Messy and Magnificent Path to Overcoming Self-Blame and Self-Shame!


Medika Life has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by Medika Life

Anna Holtzman
Anna Holtzmanhttp://www.annaholtzman.com
Anna Holtzman is a chronic pain recovery therapist and coach based in New York City.
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