Understanding Control-Seeking Behaviours After Life-Changing Injury: A Trauma-Informed Perspective for Case Managers

Case managers working with individuals after a life-changing injury often encounter behaviours that are perceived as "controlling." These may include insisting on specific routines, resisting care changes, micromanaging interactions, or becoming distressed when plans deviate from expectations. While such behaviours can sometimes be misunderstood as personality traits or interpersonal difficulties, they are frequently rooted in the psychological impact of trauma.

Recognising the possibility of trauma as a driver of behaviours is crucial. A trauma-informed perspective can help case managers interpret these behaviours more accurately, respond compassionately, and support recovery more effectively

Why Control-Seeking Behaviours Emerge

1. Loss of Agency and Safety
   A sudden injury often strips individuals of independence, predictability, and safety. When one’s body or circumstances feel unpredictable, exerting control over the external environment can become a way of regaining a sense of agency. Even seemingly "minor" preferences, such as how a bed is made or how medication is administered, can symbolise a fight to reclaim stability.

2. Hypervigilance as a Trauma Response
   Psychological trauma frequently leaves people in a heightened state of alertness, scanning for potential threats. In the aftermath of injury, this hypervigilance may manifest as controlling behaviour, closely monitoring caregivers, questioning medical decisions, or resisting changes, because unpredictability feels dangerous.

3. Avoidance of Re-Traumatisation
   Following trauma, individuals may be highly sensitive to reminders of their loss, pain, or vulnerability. By controlling their surroundings, they attempt to minimise exposure to situations that could reawaken distressing memories or emotions. Control is not about power over others; it is a protective strategy against further psychological injury.

4. The Fight for Identity
   Trauma and disability often disrupt a person’s sense of self. Former roles—such as worker, parent, or athlete—may feel diminished or inaccessible. In response, a need for control may emerge as an effort to preserve autonomy and dignity. It becomes a way of asserting, “I am still me.”

Implications for Case Managers

• Avoid Personalisation: When behaviours are framed as symptomatic rather than wilful, case managers are less likely to feel attacked or dismissed, and more able to respond constructively.

• Promote Collaboration: Offering choices wherever possible, such as regarding timing, routines, or rehabilitation goals, can reduce the need for defensive control-seeking.

• Use Trauma-Informed Principles: Safety, trust, collaboration, empowerment, and choice are essential guiding values when supporting individuals with potential trauma histories.

• Support Psychological Care: Not all controlling behaviours indicate unresolved trauma, but when patterns are intense, persistent, or distressing, psychological assessment and therapy may be warranted. Facilitating referrals can help address the underlying trauma rather than only the surface behaviours.

• Reflect on Power Dynamics: Case management inherently involves coordinating resources and services, which can unintentionally reinforce feelings of dependency. Being mindful of language and decision-making processes can help reduce perceived imbalances.

Key Takeaway

Control-seeking behaviours after life-changing injury are not simply difficult personality traits (although they can be in some cases). Instead, they can represent attempts to cope with overwhelming loss, fear, and vulnerability. By interpreting these behaviours through a trauma-informed lens, case managers can shift from frustration to empathy, and from resistance to collaboration, ultimately fostering a more supportive environment for recovery and adjustment.

 At Healthy You, our focus is on helping case managers thrive in demanding roles. Through training, supervision, and peer forums, we create spaces where you can build resilience, share experiences, and strengthen practice. If you’d like to explore these themes further, or simply hear how other case managers are approaching their work, join one of our free Case Manager Confidential sessions — a confidential forum designed to offer both support and practical insight.

For details, contact sarahsawyer@healthyyoultd.co.uk