Can Trauma Cause Chronic Fatigue? How Freeze Links Attachment, Autoimmunity and Exhaustion, with Dr. Aimie Apigian
Updated: 8 hours ago
Research links trauma, especially childhood trauma, with a higher risk of chronic fatigue, though it shows an association rather than proof of cause. Dr. Aimie Apigian, a double board-certified physician in preventive medicine and addiction medicine and author of The Biology of Trauma, explains the link through the freeze response: a nervous system that has learned to shut down whenever life is too much keeps conserving energy, and over time the exhaustion builds.
In a population study from Georgia, adults with chronic fatigue syndrome reported far more childhood trauma than adults without it, and the more trauma, the higher the risk. Dr. Aimie's work explains why that pattern might start so early, and why the same pattern can show up as autoimmunity.
She knows the freeze response from the inside. When she began her Somatic Experiencing trainings with Peter Levine, she would start to go into freeze during the lectures, before the class had even reached the exercises. Her own health told the same story: autoimmune markers that were very high without a clear reason, a diagnosis of chronic fatigue, and a long list of digestive problems.
That combination sent her looking for what connected them. In this solo episode, recorded as a live teaching session, she explains what the freeze response is, how early attachment can build a strong pull toward it, how she connects freeze to fatigue and autoimmunity, and what it takes to rewire it.
Research links childhood trauma with a higher risk of chronic fatigue syndrome. Dr. Aimie explains the link through the freeze response, the part of the stress response that comes when something is too much and the body shuts down to conserve energy. When an infant's nervous system is overwhelmed again and again without enough co-regulation, freeze becomes a default that carries into adulthood. Rewiring it takes small, consistent daily practice that works directly with the nervous system.
Can trauma cause chronic fatigue?
Trauma is linked to chronic fatigue in research, and Dr. Aimie explains the connection through the freeze response. When the nervous system repeatedly moves into freeze, the body conserves energy, and she sees fatigue as a downstream effect of that pattern.
She describes chronic fatigue and autoimmunity as only two of many conditions associated with adverse childhood experiences. In her framework, a nervous system that can go into a stress response and then return to calm stays regulated. A nervous system that does not return, and keeps dropping into freeze, is what she sees leading toward chronic fatigue and autoimmunity.
She also names the biology that makes freeze more likely: mitochondrial inefficiencies, which mean the cells, especially the nerve cells, have a harder time making energy, along with inflammation and biochemical imbalances. When energy is already low, the body prioritizes how it spends it.
What is the freeze response, and where does it fit in fight or flight?
The freeze response is part of the stress response, and it comes later than fight or flight. When a threat first appears, the body responds with a large burst of energy, which Dr. Aimie compares to a surge of adrenaline. Her example is a car that ran a red light while she and her dog were crossing the street: she was yelling, active, using every bit of energy to respond.
Freeze comes when that response becomes too much. The trigger, she explains, is anything that is too much, either because it came too fast for the body to process or because the body has had too few resources for too long. She describes this using polyvagal theory, a model of the nervous system that many trauma clinicians use, as a dive down from the high-energy sympathetic state into overwhelm.
Freeze response: the part of the stress response that comes when something is too much, when the body shifts from high energy into shutdown and conserves energy.
What does the freeze response feel like in the body?
The freeze response feels like energy draining out of you. Dr. Aimie describes a knot in the stomach, wanting to hide, putting on a fake smile, and disconnecting so that you are no longer hearing what people around you are saying. Shame is often part of it.
Many people describe it as heaviness more than tiredness: the muscles work, but moving an arm feels hard because of how heavy it feels. Sadness and thoughts like "what's the point, I give up" come with it, as the body goes into conservation of energy.
In the class, she invites people to take the "posture of too much": head down, as if a weight were on the shoulders. Then she asks two questions. Does this feel familiar? And what thoughts come while you hold it? The thoughts that come are often about wanting to avoid everything, turn it all off or just be asleep. Those thoughts, she points out, come from the posture.
Freeze also hides behind the ways we keep ourselves out of it. Caffeine, chocolate, exercise, busyness and multitasking can all keep a person functional. When the coping mechanism is taken away, the freeze is right there.
What makes some people go into freeze more easily?
Two things decide how easily a person goes into freeze: how much stress the system is carrying, and how much capacity it has to carry it. Dr. Aimie uses the image of a tree branch. A branch gives way when too much weight is put on it, or when the branch itself is not strong enough to hold it.
The weight is the stress a system has carried, and how early it started. The strength of the branch is the biology, including mitochondrial function, inflammation and biochemical balance. Big traumatic events can create a strong pull toward freeze. For many people, though, the pull began much earlier, in their first relationships.
Can childhood trauma cause chronic fatigue?
In Dr. Aimie's framework, childhood stress can set up chronic fatigue by building a strong pull toward the freeze response that starts in infancy. An infant is born without a nervous system that can calm itself. A baby gets upset quickly and needs someone to co-regulate them, bringing the nervous system back down into the calm state where the baby is playing with their feet and putting their toes in their mouth.
Every baby needs a different amount of that support, depending on their genetics and their experience in utero. When the environment cannot give enough, the baby's system is overwhelmed so quickly that it goes straight into freeze. She gives examples without blame: a newborn who needs life-saving care in the NICU and is separated from the only voice they know, a family where the parents love their child and are simply busy, or ordinary practices, such as carrying a young baby facing outward into a busy street, that bring more stimulation than a young nervous system can handle without a parent to turn toward.
If an infant goes into freeze daily, or several times a day, the pathway gets stronger each time. As neurons that fire together wire together, freeze becomes the default. Dr. Aimie describes her own adult version: she hardly had a true sympathetic response, and went straight to the energy drain, the knot in the stomach and the wish to hide until she could get home and zone out with a movie.
Co-regulation: one nervous system helping another return to calm, as a caregiver does for an infant who cannot yet calm themselves.
How does the freeze response lead to fatigue?
The freeze response leads to fatigue because the body keeps cycling between pushing and collapsing, and each cycle draws down its reserves. Dr. Aimie describes it this way: many people go back and forth between "I'm just done with it all" and "I'm super stressed and trying to get everything done," and then collapse again into fatigue and overwhelm.
Over time, she explains, the body depletes the nutrients it has and cannot bounce back. Rest does not feel restful either. When people try to relax, they often slip right back into the fatigue and the feeling of freeze, which does not feel good, so they keep themselves activated in some way. The fatigue keeps building the more often the nervous system goes into freeze.
Regulation: being able to stay in, or return to, the calm, curious, connected parasympathetic state after a stress response.
How does Dr. Aimie connect the freeze response to autoimmunity?
Dr. Aimie connects the freeze response to autoimmunity through a parallel she sees between the two. Freeze, in her description, is about shame: I don't belong, there's something wrong with me, I'm not good enough. Autoimmune conditions are the body making antibodies against its own tissues instead of against a foreign threat like a bacteria or a virus. She describes the emotional message and the cellular one as the same: you must be the problem, so stay small and stay hidden. In her experience, that biology usually takes a few decades to become an autoimmune condition.
This is her clinical framework. Research supports an association between childhood adversity and autoimmune disease: a 2025 meta-analysis found a small overall effect, with links for rheumatoid arthritis, psoriasis, multiple sclerosis and inflammatory bowel disease, though not for lupus. For more on autoimmunity specifically, see Episode 133.
What does a strong pull toward freeze cost?
Freeze can feel safe, and it also keeps a person small and hidden. Dr. Aimie explains that it carries a real benefit: it lessens the panic and numbs a person a bit. The same numbing takes away joy and happiness.
She also sees freeze driving changes in the biology, including the immune system, the digestive system and the nervous system itself, that people often do not notice until much later. That is why she encourages people to recognize the pattern early. Plenty of people get through life this way, she says, and many feel like they are trudging up a mountain carrying a huge backpack.
How do you rewire a strong pull toward freeze?
Rewiring a strong pull toward freeze takes working directly with the nervous system, a little every day. Dr. Aimie explains that using thoughts and logic to change a felt experience does not work, because the brain can only steer the nervous system once a person is already calm and grounded. The posture exercise makes the point: the thoughts followed the body.
Her key principle is consistent, gentle pressure. One exercise, then a therapy session a week later, then another a week after that, brings some shifts. Doing a little every single day does much more, because each day the nervous system practices a choice besides freeze. The aim is a wider window of tolerance, and short, effective tools to stay in it.
She also shares ways to stay present when freeze starts to pull: something behind your back for support, hands on your belly to bring the breath back down, taking notes, and, in her case, an acupressure mat. Noticing when your mind comes back, and marking it, builds awareness of how often you leave.
Window of tolerance: the capacity to hold stress without shutting down into freeze or tipping into overwhelm.
Key Takeaways
Research links childhood trauma with a higher risk of chronic fatigue syndrome. It shows association, not proof of cause.
The freeze response is part of the stress response. It comes when something is too much.
Freeze feels like energy draining out: heaviness, a knot in the stomach, wanting to hide, disconnecting.
How easily a person freezes depends on the stress they carry and the capacity of their biology to carry it.
Infants need co-regulation. When it is not enough for them, freeze can become a default from the start of life.
In Dr. Aimie's framework, fatigue builds as the body cycles between pushing and collapsing.
Coping mechanisms such as caffeine and busyness can hide a freeze response.
She sees a parallel between the shame of freeze and the body attacking its own tissues in autoimmunity.
Thoughts alone do not rewire the nervous system. Body-based practice does.
Consistent, gentle daily practice works better than occasional sessions.
Notable Quotes
"The freeze response is actually part of that stress response, but it doesn't come until later." - Dr. Aimie Apigian
"There is a clear trigger for the freeze response. And that trigger is anything that is too much." - Dr. Aimie Apigian
"This is what a lot of people describe. It's not just that I'm tired. It's that I feel so heavy." - Dr. Aimie Apigian
"If a stress comes your way, your body is going to be like, you know, I don't have enough energy for that. So I'm just going to go into this, I don't care, I don't care, because I don't have the energy to care." - Dr. Aimie Apigian
"When an infant is born, they actually do not have a developed nervous system and a fully developed capacity to keep their own nervous system calm. They actually require someone else to do that for them." - Dr. Aimie Apigian
"When you talk to parents, of course, they love their child, they would never do anything that was intentionally harmful. And yet, it's just lack of knowledge that we do this." - Dr. Aimie Apigian
"If starting as a young child, as an infant, someone is going into that freeze response, probably on a daily basis, if not a few times a day, right? They're paving a highway." - Dr. Aimie Apigian
"When I got diagnosed with autoimmune condition, my autoimmune markers were very high without really a clear reason. I was diagnosed with chronic fatigue." - Dr. Aimie Apigian
"The freeze response is all about shame. And feeling like I don't belong. There's something wrong with me. I'm not good enough." - Dr. Aimie Apigian
"There is a benefit to the freeze response and that is it does, it does numb us a bit. But then it also takes away our ability to feel joy and happiness..." - Dr. Aimie Apigian
"Using our brain, our logic, our thoughts to change our felt experience and our nervous system do not work." - Dr. Aimie Apigian
Episode Takeaway
I did not know I had a strong pull toward freeze. I thought my childhood had been stressful in the way everyone's is, and I thought the way I shut down was just my personality. Then I started my Somatic Experiencing trainings, and I would go into freeze while the instructors were still lecturing, before we had even reached the exercises. That is how strong the pull was.
My labs told the same story. My autoimmune markers were very high without a clear reason. I was diagnosed with chronic fatigue, and I had a ton of digestive issues. I looked at that list and asked why all of these conditions, the ones associated with early life stress, were showing up in me. That question is where I went deeper into this work.
Here is what I found. The freeze response is a normal part of the stress response. It comes when something is too much. When a baby's nervous system is overwhelmed again and again without enough co-regulation, freeze becomes the path that system takes most easily, and every time it goes there, the path gets stronger. By adulthood, it may take very little to send us there: the energy drains, the stomach knots, and we want to hide until we can get home.
Living there has a cost. Our body keeps cycling between pushing to get everything done and collapsing again, and over time it depletes what it has. Even rest stops feeling restful, because when we slow down we slip right back into the heaviness. So we keep ourselves going with caffeine, busyness or whatever works, and the fatigue keeps building underneath.
I also see a parallel in autoimmunity. Freeze carries a message of shame: something is wrong with me, I don't belong, I'm not good enough. In autoimmunity, the body makes antibodies against its own tissues. The message at both levels is that I am the problem, so stay small and stay hidden.
None of this is a judgment of you or of your parents. Many of us carry some degree of attachment insecurity, and so much of it comes from parents who loved their child and simply did not know what their child's nervous system needed. The good news is that this pattern can be rewired. One of the most meaningful parts of my life has been working with adoptive families and watching children's nervous systems learn to trust and feel secure.
The way there is consistent, gentle pressure. We cannot think our way out of freeze. We work directly with the nervous system, with short practices done a little every day, and we build the window of tolerance one day at a time until freeze stops being the only option.
This is the Biology of Trauma®: our health conditions can reveal the patterns our body has been holding, whether we understand them yet or not. If you want to know which pattern of stored trauma your body is running, start with my 2-Minute Assessment for Stored Trauma. When you are ready for guided, daily practice with your nervous system, the Foundational Journey is where I take people through the essential sequence before the deeper work begins.
Frequently Asked Questions
Is chronic fatigue a trauma response?
In Dr. Aimie's framework, chronic fatigue can be a downstream effect of the freeze response, the body's energy-conserving shutdown when stress is too much. Research shows childhood trauma is associated with chronic fatigue syndrome, though fatigue has many causes.
What does the freeze response feel like?
It feels like energy draining out of you. People describe heaviness, a knot in the stomach, wanting to hide, putting on a fake smile, and disconnecting from what is happening around them.
Is the freeze response the same as fight or flight?
It is part of the same stress response, and it comes later. Fight or flight is high energy. Freeze comes when the threat becomes too much, and the body shifts into conserving energy.
Why do I feel worse when I try to relax?
Dr. Aimie explains that when someone with a strong pull toward freeze slows down, they often slip back into the fatigue and heaviness of freeze. That feels uncomfortable, so many people keep themselves activated instead.
How does insecure attachment lead to the freeze response?
Infants cannot calm their own nervous systems and need a caregiver to co-regulate them. When that support is not enough for a particular baby, the baby is overwhelmed quickly and goes into freeze, and repeated freeze builds a default that can last into adulthood.
Why do coffee and staying busy help me function?
Dr. Aimie describes caffeine, chocolate, exercise, busyness and multitasking as coping mechanisms that keep a person functional and out of freeze. When they are taken away, the freeze underneath often shows up.
Can I think my way out of the freeze response?
Not on its own. Dr. Aimie explains that thoughts and logic cannot change the felt experience of the nervous system unless a person is already calm and grounded, so the work has to be body-based.
How often do I need to practice to rewire freeze?
A little every day. Dr. Aimie's principle is consistent, gentle pressure: short daily practice shifts the nervous system more than occasional, spaced-out sessions.
In This Episode
What happens in the nervous system during a stress response?
Why did Dr. Aimie go into freeze during her own trainings?
How can you stay present while learning about freeze?
What triggers the freeze response?
What makes some people go into freeze more easily?
What happens when the body dives into freeze?
What is the "posture of too much," and what does it reveal?
How do coping mechanisms hide a freeze response?
Why is insecure attachment connected to freeze?
How does freeze become a default from infancy?
How does Dr. Aimie connect freeze to autoimmunity and fatigue?
How did her own diagnoses lead her into this work?
What does a strong pull toward freeze cost?
How do you rewire the nervous system out of freeze?
Resources and Guides
2-Minute Assessment for Stored Trauma (free): find out which pattern of stored trauma your body is running, including a strong pull toward freeze, and where to begin.
The Foundational Journey: a 5-week guided journey through the essential sequence, with the somatic and parts practices that lay the foundation for deeper trauma work.
The Biology of Trauma by Dr. Aimie Apigian, with a foreword by Dr. Gabor Maté.
Related Podcast Episodes
For when autoimmunity is the diagnosis and you want the full picture of how it builds.
For when the roots go back before you have memories.
For when the exhaustion stays even while you work on your nervous system.
Your Host
Dr. Aimie Apigian is a double board-certified physician in preventive medicine and addiction medicine, author of The Biology of Trauma (foreword by Dr. Gabor Maté) and the founder of the Biology of Trauma® framework. She is trained in Somatic Experiencing and NeuroAffective Touch, and she brings her own experience with autoimmunity and chronic fatigue to this work.
Research
Heim C, Nater UM, Maloney E, Boneva R, Jones JF, Reeves WC. Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Archives of General Psychiatry. 2009;66(1):72-80. doi:10.1001/archgenpsychiatry.2008.508
Jesuthasan J, Watson CJ, Hafeez D, Lynch-Kelly K, Danese A, Pollak TA. Childhood adversity as a risk factor for autoimmune disease: a systematic review and meta-analysis with implications for psychiatry. Brain, Behavior, and Immunity. 2025;128:643-653. doi:10.1016/j.bbi.2025.04.036
Bakermans-Kranenburg MJ, van IJzendoorn MH. The first 10,000 Adult Attachment Interviews: distributions of adult attachment representations in clinical and non-clinical groups. Attachment & Human Development. 2009;11(3):223-263. doi:10.1080/14616730902814762
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