Agency refers to the prereflective feeling of initiating and controlling one's actions and their consequences 5,6. Although conceptually distinct, the sense of body ownership, that refers to the experience that one's body and experiences belong to oneself, and the sense of agency are deeply intertwined within multisensory and predictive processes integrating proprioception, interoception, motor intentions, and sensory feedback. Crucially, agency anchors the self as an actor in the world: it is through agency that perception, action, and meaning are dynamically coupled, within the past, present and future. Indeed, acting involves not only controlling one's actions in the present, but also anticipating their future consequences and embedding them within an autobiographical contin Psychiatric research has extensively examined alterations of body ownership and control, particularly in dissociation. By contrast, agency has received comparatively little attention in trauma research, despite growing evidence that it is profoundly altered in PTSD and its dissociative subtypes 7,8.From an enactive and predictive-processing perspective, a traumatic event (TE) overwhelms the individual's capacity to act meaningfully on the environment. The TE exceeds available sensorimotor and cognitive models, leaving no reliable predictions to guide perception or action 9,10. Neurobiologically, this corresponds to hyperactivation of threat-detection systems alongside reduced prefrontal and hippocampal regulation 111213.Clinically, this collapse of agency is experienced as helplessness, freezing, or tonic immobility, hallmark features of peritraumatic distress 14. These states reflect not merely fear, but a failure of agency-an inability to initiate or modulate action in response to threat. Peritraumatic dissociation may then emerge as a protective response, disconnecting perception and bodily experience from overwhelming stimuli 7,15. While dissociation can reduce immediate suffering, its intensity predicts subsequent PTSD, suggesting that early agency failure has lasting consequences 16,17. Trauma thus constitutes more than a disruption of safety or meaning: it is a sensorimotor rupture in which the self is no longer experienced as an embodied and effective agent in the world within a temporal continuity. The traumatic event is not integrated as an episode located in the past, but remains experientally present, fragmented and decontextualized 181920.If trauma entails a collapse of agency, PTSD symptoms can be reinterpreted as efforts-often maladaptive-to restore it. This reframing shifts symptoms from being mere pathological residues to being understandable, though costly, adaptive strategies. Intrusive thoughts and flashbacks may represent attempts to reprocess the TE and regain control over its unfolding. Repetitive mental replay can be seen as a search for an alternative action trajectory-an effort to reconstruct causality and agency retrospectively 212223. Similarly, behavioral reenactments and risk-taking, particularly observed in complex PTSD, may reflect attempts to actively appropriate danger rather than remain passively subjected to it 15. Avoidance behaviors can be understood as compensatory strategies to reassert agency by controlling exposure to triggers 24. When internal regulation fails, avoiding environments, sensations, or relationships becomes the only reliable means of preventing further loss of control. Substance use may function analogously, modulating perception and affect to restore a sense of mastery, albeit transiently 25. Negative cognitions, including guilt and self-blame, paradoxically preserve agency by locating causality within the self rather than in an uncontrollable world. "If it was my fault, then I had control" becomes a psychologically coherent-though damaging-solution to helplessness 16,26. Hypervigilance and chronic arousal further illustrate this logic: constant monitoring of threat aims to prevent future agency collapse, even as it entrenches anxiety and physiological dysregulation 27. Finally, dissociation occupies a paradoxical position. It simultaneously reflects a loss of agency and an active strategy to counter passive helplessness. By disengaging from perception or embodiment, individuals may reclaim a minimal sense of control over overwhelming experience-at the cost of coherence, presence, and long-term functioning 28,29.Viewing PTSD through the prism of agency has important implications. First, it offers a unifying account linking peritraumatic responses, symptom clusters, and chronicity. Second, it complements cognitive and emotional models by foregrounding the embodied dimension of trauma, emphasizing action, sensorimotor prediction, and environmental engagement. Third, it challenges clinicians to consider not only how patients remember trauma, but how they experience themselves as agents in everyday life, but also within an assimilated past and an anticipable future. Restoring agency may thus represent a core therapeutic target across PTSD subtypes, including dissociative and complex presentations, for which treatment guidelines remain limited 30,31. While established therapies may indirectly support agency by improving regulation and narrative coherence, an explicit focus on agency could help explain nonresponse and guide innovation.Psychological trauma can be understood as a profound loss of the SA, disrupting the individual's capacity to act meaningfully on the world. PTSD symptoms, in turn, reflect persistent attempts to repair this rupture-attempts that are understandable, adaptive in intent, yet often self-defeating. Re-centering agency in trauma theory invites a shift from viewing PTSD solely as a disorder of fear or memory toward recognizing it as a disorder of action, control, and embodied selfhood. Such a perspective may open new avenues for conceptual clarity and therapeutic progress in a field still marked by significant unmet needs.
Adrien et al. (Mon,) studied this question.