EMOTIONAL REGULATION & NERVOUS SYSTEM • April 2026

LAST UPDATED: APRIL 2026

The Cardiologist Who Knows the Vagus Nerve

Kira is 40, a cardiologist in Boston. She knows exactly what the vagus nerve does. She can explain polyvagal theory to a medical student. She can describe the neurophysiology of the stress response with clinical precision. She cannot explain why, eight months after leaving a covert narcissistic relationship, her shoulders still rise toward her ears when someone’s voice takes on a particular tone — the same tone her ex used just before he got very quietly, patiently, devastatingly critical of something she’d done.

She knows the relationship is over. She knows she is safe. She knows, intellectually, that the voice she’s hearing belongs to a colleague who is not her ex and has no intention of being quietly devastating. Her shoulders don’t know this. They rise anyway. She has tried telling them to stop. They don’t listen to her.

Kira’s experience is the central paradox of somatic recovery from covert narcissistic abuse: the body does not respond to cognitive instruction. It responds to experience. For a deeper look at why this gap between knowing and feeling exists, read about narcissistic abuse and complex PTSD. And the experience it is responding to — the years of chronic, low-level threat that characterized the covert narcissistic relationship — is stored in the body as a pattern of response that does not automatically dissolve when the cognitive understanding arrives. The shoulders that rise toward the ears are not a failure of insight. They are a neurological reality. And they require a neurological response.

Why the Body Doesn’t Know the Relationship Is Over

Bessel van der Kolk, MD, psychiatrist and trauma researcher, author of The Body Keeps the Score, provides the essential framework for understanding why the body holds what the mind has already released. The traumatic experience is not stored in the brain as a narrative — a story with a beginning, middle, and end that can be revised when new information arrives. It is stored as sensory fragments: the particular tone of voice, the specific facial expression, the quality of silence that preceded the next episode of quiet devastation. This is the neurological basis of what I describe in the article on the neurobiology of gaslighting. These sensory fragments are stored in the subcortical brain — the amygdala, the brainstem, the body itself — in ways that are not accessible to conscious revision.

When the nervous system encounters something that pattern-matches to one of these sensory fragments — a tone of voice, a quality of silence, a particular kind of eye contact — it activates the stored threat response before the conscious mind has any awareness that a threat has been detected. The shoulders rise. The chest tightens. The breath shallows. The body is in the past, even while the mind is in the present.

This is not a failure of insight or will. It is the normal functioning of a nervous system that has been trained, over years, to respond to specific threat cues with specific defensive responses. The training was adaptive — it protected the woman during the relationship. The challenge is that the training persists after the relationship ends, because the nervous system does not automatically un-learn what it has been taught.

The Incomplete Defensive Action: What the Body Is Still Holding

Peter Levine, PhD, developer of somatic experiencing and author of Waking the Tiger, provides the specific mechanism for understanding what the body is holding after covert narcissistic abuse. In response to threat, the nervous system mobilizes for defensive action — fight, flight, or freeze. In acute, single-incident trauma, this mobilization is often completed: the person fights, flees, or freezes and then returns to regulation. In chronic, relational trauma — the kind that covert narcissistic abuse produces — the mobilization is repeatedly interrupted.

The threat is never acute enough to trigger a complete defensive response. It is never resolved. The covert narcissist’s tactics are specifically designed to prevent the target from completing a defensive response — to keep her in a state of chronic, low-level mobilization that never reaches the threshold of action. The result is that the body accumulates incomplete defensive actions: the impulse to speak that was suppressed, the impulse to leave that was overridden, the impulse to fight back that was trained out of her. These incomplete actions stay stored in the body as chronic tension, collapse, or vigilance.

Somatic recovery from covert narcissistic abuse involves, in part, helping the body complete what it started — giving the nervous system permission to discharge the activation that has been stored as incomplete defensive actions. This is not dramatic. It does not require re-enacting the original threat. It requires sustained, gentle attention to the body’s signals — the kind of attention that somatic experiencing and sensorimotor psychotherapy provide.

Neuroception: The Body’s Threat-Detection Below Conscious Awareness

Stephen Porges, PhD, neuroscientist and author of The Polyvagal Theory, provides the framework for understanding why Kira’s shoulders rise before she consciously registers the threat. Porges’ concept of neuroception — the nervous system’s unconscious, below-conscious threat-detection process — explains why the body responds to threat cues faster than the thinking mind can process them.

In a covert narcissistic relationship, the nervous system is trained to detect the specific threat cues of that relationship with extreme sensitivity. This is part of why the signs of a covert narcissist relationship are so hard to identify in the moment — the nervous system has been organized around detecting subtle cues rather than obvious ones. The particular tone of voice that preceded the quiet devastation. The specific quality of silence that meant something was wrong. The particular facial expression that preceded the withdrawal of warmth. These cues are registered by the nervous system at a subcortical level — below the threshold of conscious awareness — and they trigger the threat response automatically.

After the relationship ends, the neuroception system continues to scan for these specific cues. It finds them in other people, in other contexts, in other relationships — because the cues are not unique to the covert narcissist. Other people also use that tone of voice. Other people also go quiet in that particular way. The nervous system cannot distinguish between the original threat and the pattern-match. It activates the threat response in both cases.

This is why Kira’s shoulders rise when her colleague’s voice takes on a particular tone. Her neuroception system has detected a pattern-match to the original threat cue. Her conscious mind knows the colleague is not her ex. Her neuroception system does not care. It has already activated the response.

The Polyvagal Ladder: Where Your Nervous System Is Living

Deb Dana, LCSW, author and polyvagal theory clinician, author of The Polyvagal Theory in Therapy, provides the practical framework for understanding where the nervous system is living after covert narcissistic abuse. Dana’s “polyvagal ladder” describes three states of nervous system activation:

At the top of the ladder is the ventral vagal state — the state of safety, social engagement, and regulation. This is the state in which the person feels genuinely safe, connected, and present. It is the state from which genuine healing is possible.

In the middle of the ladder is the sympathetic state — the state of mobilization, fight or flight, anxiety, and hypervigilance. This is the state in which the chronic stress of the covert narcissistic relationship has trained the nervous system to live. The woman in this state is always scanning for threat, always preparing for the next episode, always managing the covert narcissist’s emotional state.

At the bottom of the ladder is the dorsal vagal state — the state of immobilization, numbness, and disconnection. This is the state the nervous system enters when threat is overwhelming and escape is impossible. The woman in this state is not anxious — she is numb. She is not hypervigilant — she is disconnected. This is the “freeze and go numb” response, and it is the body’s last-resort protection when fight and flight are not available.

After covert narcissistic abuse, many women find themselves oscillating between the sympathetic and dorsal vagal states — between hypervigilance and numbness — without access to the ventral vagal state of genuine safety and regulation. Somatic recovery involves, in part, rebuilding the capacity to access the ventral vagal state — to feel genuinely safe in the body, not just cognitively safe.

The Fawn Response and Its Somatic Residue

Pete Walker, MA, therapist and author of Complex PTSD: From Surviving to Thriving, provides the framework for understanding the specific somatic residue of the fawn response — the survival strategy that is most characteristic of covert narcissistic abuse targets. The fawn response is the learned tendency to appease, accommodate, and manage the emotional state of the threatening person in order to avoid the threat. It is the response that develops when fight and flight are not viable options — when the threat is a person you love, depend on, or cannot leave.

The somatic residue of the fawn response is specific: the chronic bracing of the body in preparation for the next episode, the habitual suppression of one’s own needs and signals in order to attend to the other person’s, the physical collapse that occurs when the fawning fails and the threat materializes anyway. These somatic patterns do not automatically dissolve when the relationship ends. They have been trained into the body over years, and they require direct, sustained attention to resolve.

How It Shows Up in Driven Women

Leila is 38, a tech executive in San Francisco. She’s been working with a somatic therapist for four months. Last week, for the first time, she noticed she was sitting in a chair without bracing. Just sitting. Her therapist pointed it out. She hadn’t noticed how long her body had been holding itself in preparation for something. She doesn’t know what she was preparing for. She knows her nervous system does.

Leila’s experience — the moment of noticing she is sitting without bracing — is the specific milestone of somatic recovery that is most significant for driven women. Because driven women are trained to override body signals, they often don’t notice the chronic bracing until it stops. They don’t notice the chronic tension until it releases. They don’t notice the chronic hypervigilance until they experience a moment of genuine regulation.

Kira, the cardiologist, has a specific additional challenge: she knows the neuroscience. She can describe exactly what is happening in her nervous system when her shoulders rise. This knowledge is useful — it prevents her from pathologizing her response, from concluding that she is broken or weak. But it does not, by itself, change the response. Knowing the mechanism of a trauma response does not resolve it. The body needs direct attention, not just cognitive understanding.

If you recognize Kira’s or Leila’s experience — the shoulders that rise despite your better knowledge, the moment of noticing you were bracing — you may want to read more about the specific exercises for rebuilding your sense of reality and how they address the somatic dimension of recovery.

Both/And: Your Body Isn’t Broken — and It Also Needs Direct Attention

This is the essential Both/And: Your Body Isn’t Broken — and It Also Needs Direct Attention.

The body’s continued reactions after covert narcissistic abuse are not pathology. They are the nervous system doing exactly what it was designed to do under prolonged threat. The shoulders that rise, the chest that tightens, the gut that clenches — these are the body’s intelligent responses to the patterns it was trained to recognize as dangerous. The body is not broken. It is doing its job.

AND those reactions don’t resolve through insight alone. They need direct, body-based attention. The woman who understands, cognitively, that she is safe — but whose body continues to respond as if she isn’t — is not failing at recovery. She is experiencing the normal gap between cognitive understanding and somatic integration. That gap closes through direct work with the body: somatic experiencing, sensorimotor psychotherapy, EMDR, body-based mindfulness, movement. Not through more thinking.

Both truths are important. She’s not broken. She also can’t think her way out of this.

The Systemic Lens: The Mind/Body Split in Medicine and Why It Costs Women Most

We cannot discuss somatic recovery without discussing the cultural context in which it happens. The Systemic Lens: The Mind/Body Split in Medicine and Why It Costs Women Most.

Western medicine has operated on a Cartesian split between mind and body since the seventeenth century. The mind is the seat of reason, consciousness, and the self. The body is a machine that the mind inhabits. This split has produced a medical culture in which somatic complaints — particularly women’s somatic complaints — are routinely dismissed as “psychosomatic,” meaning “not real.” The woman who presents with chronic tension, chronic fatigue, chronic gut problems, or chronic pain after a traumatic relationship is often told that there is nothing physically wrong with her — that it’s “all in her head.” The dismissal is both medically inaccurate and deeply harmful.

Driven women are particularly trained to override body signals. The woman who has built a career on her capacity to push through — to work through the headache, to ignore the exhaustion, to suppress the gut feeling in favor of the data — has been practicing the suppression of body signals for years. This dynamic is part of what I call somatic debt — the body’s accumulated ledger of suppressed signals and unprocessed activations. This means she often has more somatic residue stored from the covert narcissistic relationship than a woman who has maintained a closer relationship with her body, because she has been suppressing the body’s signals throughout the relationship rather than attending to them.

The recovery of somatic awareness — the restoration of the capacity to hear and trust what the body is saying — is therefore not just a healing practice. It is the reclamation of a relationship with the body that has been systematically suppressed by both the covert narcissistic relationship and the cultural training that preceded it. For more on how this connects to overall trauma recovery, read the article on practical somatic tools for trauma recovery.

What Somatic Recovery Actually Involves

Somatic recovery from covert narcissistic abuse involves several specific dimensions. First, the restoration of interoceptive awareness — the capacity to hear the body’s signals without immediately overriding them. Second, the completion of incomplete defensive actions — the gentle, supported discharge of the stored activation that the body has been holding. Third, the rebuilding of the ventral vagal state — the capacity to feel genuinely safe in the body, not just cognitively safe. Fourth, the development of body-based resources for regulation — practices that help the nervous system return to regulation when it is activated. The seven-phase model of trauma recovery provides a useful map for understanding where somatic work sits in the larger recovery arc.

This work is most effective with a skilled somatic therapist. It is also supported by body-based practices that can be done independently: somatic experiencing exercises, polyvagal-informed movement, breath work, and the body-based exercises in the five exercises article. You can also read more about rebuilding trust in your own perceptions for the cognitive dimension of this work.

A note on pacing: somatic recovery work needs to be titrated — done in small enough doses that the nervous system can integrate the experience without becoming overwhelmed. It’s also worth understanding why you feel worse before you feel better in trauma therapy so that early discomfort doesn’t derail the work. The driven woman who approaches somatic work with the same intensity she brings to professional challenges — who wants to do more, go deeper, work harder — often finds that the somatic work produces flooding rather than integration. The nervous system cannot be pushed faster than it can integrate. The most effective somatic work is slow, gentle, and titrated: small amounts of activation, followed by full return to regulation, repeated over time. This is the opposite of the driven woman’s instinct. It is also the approach that produces the most lasting change.

Stephen Porges, PhD, neuroscientist and author of The Polyvagal Theory, provides the framework for understanding why titration is essential. Porges’ polyvagal theory establishes that the nervous system’s capacity for social engagement — the ventral vagal state that is the foundation of genuine safety — is built through the accumulation of small, safe experiences. The nervous system cannot be pushed into the ventral vagal state. It can only be invited there, through the repeated experience of small moments of safety, attunement, and regulation. Somatic recovery is the practice of creating those small moments, consistently, over time. The accumulation is the healing.

Related Reading

• van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking, 2014.
• Levine, Peter A. Waking the Tiger: Healing Trauma. North Atlantic Books, 1997.
• Porges, Stephen W. The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. W.W. Norton, 2017.
• Dana, Deb. The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. W.W. Norton, 2018.
• Ogden, Pat, Kekuni Minton, and Clare Pain. Trauma and the Body: A Sensorimotor Approach to Psychotherapy. W.W. Norton, 2006.

If any of this lands close to home and you’re ready for clinical support, you can connect with Annie’s team.

Medical Disclaimer

Medical Disclaimer