Living in an unresolved trauma system: Women's experiences of infertility-related distress through an adaptive information processing lens.

BackgroundInfertility-related distress is associated with elevated rates of anxiety, depression, grief, and identity disruption. While existing frameworks often conceptualise infertility distress through stress and coping paradigms, these approaches may not fully explain the cumulative and reactivating experience of infertility distress. Trauma-informed perspectives, including the Adaptive Information Processing (AIP) model, may offer an alternative framework for understanding infertility-related distress.ObjectivesTo explore how women experiencing infertility describe and make meaning of their experiences, and whether their narratives reflect processes consistent with trauma-informed and AIP frameworks.DesignQualitative study embedded within a randomised controlled trial of Eye Movement Desensitisation and Reprocessing (EMDR) therapy for infertility-related distress, using baseline pre-intervention session transcripts.MethodsEighteen women experiencing infertility-related distress participated in an initial EMDR assessment and case conceptualisation session. Sessions were audio-recorded, transcribed verbatim, and analysed using Reflexive Thematic Analysis within an experiential and contextualist framework informed by trauma-informed perspectives and the AIP model.ResultsFive interconnected themes were identified: (1) The Burden of Responsibility, (2) Defectiveness and Diminished Worth, (3) Loss of Autonomy and Suspended Futures, (4) Threat, Vulnerability and Mistrust, and (5) Isolation and Disconnection. Participants described infertility as a cumulative, unresolved experience, often characterised by shame, self-blame, uncertainty, diminished agency, loss of trust, and relational disconnection. Infertility generated distress and reactivated broader beliefs about responsibility, worth, safety, control, and belonging. Interpreted through the AIP model, these findings suggest distress may be maintained by the repeated activation of inadequately processed experiences organised around of shame, helplessness, threat, and loss.ConclusionFindings suggest that infertility may be experienced as both a traumatising and a re-traumatising process that disrupts identity, agency, safety, and belonging. A trauma-informed framework informed by the AIP model may provide a useful lens for understanding the enduring psychological impact of infertility and informing interventions that address unresolved experiences underlying infertility-related distress.