Safe Words as Trauma-Informed Communication for Neurodivergent Individuals and C-PTSD Survivors: A Critical Review

Hannah Whitfield, May 2025

Introduction

Neurodivergent individuals - including those with ADHD, autism, and Pathological Demand Avoidance (PDA) profiles - and survivors of complex PTSD (C-PTSD) often face heightened challenges in communication and emotional regulation. Traits such as hypervigilance and rejection sensitivity can lead to misinterpreting social cues or perceiving threat where none is intended. Trauma-informed approaches to interaction emphasise safety, trust, and clarity in communication as key principles. In this context, safe words have emerged as a proactive reassurance and de-escalation strategy. A safe word is a pre-agreed code (a word, phrase, or signal) that either party in an interaction can use to convey a specific message, typically to pause, stop, or signal safety, without ambiguity. This review critically examines the use of safe words as a trauma-informed communication tool for neurodivergent people and those with C-PTSD, evaluating how and why they may reduce emotional dysregulation, prevent misinterpretation of social cues, and support relational trust. UK-based research, clinical frameworks (NHS guidance, charities like Mind and the Anna Freud Centre), and peer-reviewed studies are highlighted to ground this discussion.

Communication Challenges in Neurodivergence and C-PTSD

Hypervigilance and Misreading Social Cues: Hypervigilance - a state of constant alertness to potential threats - is common in both neurodivergent populations and trauma survivors. In ADHD, for example, individuals may adopt hypervigilance as a defence mechanism, remaining “in a heightened state of sensitivity to the social and emotional cues” around them. This unwavering alertness is intended to safeguard against negative feedback or criticism, but it can become exhausting and anxiety-provoking. Likewise, C-PTSD often leaves people “continually in survival mode,” such that even small everyday cues (a change in tone of voice, a minor change in routine) may signal “life or death danger” to the brain. In children who have experienced developmental trauma, the stress response may never entirely switch off in safe environments, leaving little capacity for reasoning and causing benign gestures by others to feel threatening. Autistic individuals, too, can experience a form of hypervigilance; many autistic people report trauma from “social difficulties and confusion,” such as chronic misunderstandings. This constant scanning for threats means that innocuous social cues are easily misinterpreted. Research on rejection sensitive dysphoria (RSD) - an extreme rejection sensitivity often noted in ADHD - illustrates this well: “hypervigilance emerges from an acute sensitivity to the potential for rejection, resulting in a tendency to scrutinise even the most subtle social cues.”. In practice, the neurodivergent or trauma-affected person may read neutral facial expressions, slight changes in plans, or mild criticism as signs of impending rejection or conflict. Such misperceptions can trigger disproportionate emotional reactions.

Emotional Dysregulation: Because of these hair-trigger threat perceptions, many neurodivergent people and C-PTSD survivors experience intense emotional dysregulation. Emotions can escalate rapidly - an ADHD partner might go from calm to furious “like a flash flood” when feeling criticised, or an autistic person might have a meltdown or shutdown if overwhelmed. C-PTSD is associated with difficulty managing the intensity of emotions/ the sudden mood swings in response to triggers. Rejection sensitivity can amplify emotional pain at the slightest hint of criticism. Moreover, when hypervigilant, the person’s nervous system is primed for fight-or-flight. Trauma experts note that a survivor’s brain often remains “stuck” in the primitive threat-response mode, with reduced activation of the rational brain. The capacity to self-soothe or interpret others’ intentions as benign is significantly impaired in this state. The result is that a minor misunderstanding or perceived slight can spiral into a crisis: panic, rage, or dissociation out of proportion to the situation. The individual may later recognise the overreaction, but the physiological fear response hijacks their behaviour in the moment.

Interpersonal Trauma and Trust Issues: Those with histories of interpersonal trauma (as is typical in C-PTSD) often struggle profoundly with trust and communication in relationships. Repeated abuse or betrayal conditions a person to expect harm in close relationships. They may become suspicious and mistrustful, perceiving “innocuous cues as signs of danger or rejection. Consequently, offers of help or expressions of love can be met with doubt or defensiveness. Autistic and ADHD individuals who have faced bullying or constant criticism can similarly develop protective scepticism. The UK’s working definition of trauma-informed practice recognises that trauma can fundamentally damage one’s ability to feel safe or develop trusting relationships. Hypervigilance in relationships often manifests as “overreacting to minor issues and an incessant need for reassurance. A partner’s slight delay in replying to a text, for instance, might send someone with C-PTSD into a spiral of fear that they are angry or leaving. In sum, these populations' psychological and neurological underpinnings- an overactive threat system (amygdala hyperactivity, heightened adrenaline) and an underactive calming system (prefrontal regulation) - set the stage for frequent miscommunication and conflict. Therefore, any communication strategy intended for this group must explicitly counteract fear, clarify intent, and provide steady reassurance.

Trauma-Informed Communication: Emphasising Safety and Clarity

Trauma-informed communication frameworks stress the importance of creating a sense of safety, choice, and collaboration in interactions. The NHS and UK charities encourage approaches that “see beyond an individual’s behaviours” and ask what the person needs to feel safe. A key goal is to prevent re-traumatisation - avoiding triggers that could cause the person to re-experience past trauma. In practical terms, this means using language and signals that do not inadvertently replicate the tone of past abuse or rejection. For example, caregivers of trauma-affected children are advised to keep a neutral tone and open body language, since “interrogative” language or harsh gestures can “mobilise fear and shame” in the child. Instead of barking orders or sudden changes, trauma-informed practice suggests giving control where possible and signalling intentions.

In the context of neurodivergence, similar principles apply. The National Autistic Society highlights how adjusting communication can build trust for demand-avoidant autistic children. Parents are coached to remove direct demands and adopt a more collaborative tone - using phrasing like “could you show me?” instead of “you must” - so that “your child will start to trust you as an emotionally safe space” and see that “you are on their side.” This reflects a general truth: trust grows when an individual consistently experiences the other party as predictable, non-threatening, and validating their feelings. UK-based approaches like the PACE model (Playfulness, Acceptance, Curiosity, Empathy) similarly encourage caregivers to respond to an upset neurodivergent or traumatised person with calm empathy and explicit assurance of safety, rather than punishment or dismissal. The core trauma-informed principles - safety, trustworthiness, choice, collaboration, and empowerment - all point to the value of clear, agreed-upon communication tools. A safe word is one such tool that directly operationalises these principles: it provides a sense of control (the individual can use it to influence the interaction), it is established collaboratively in advance, and its purpose is to reinforce safety and trust.

The Role of Safe Words as a Proactive Strategy

What Are Safe Words in This Context? While the term “safe word” is perhaps best known from its use in BDSM or therapy contexts to stop unwanted activity, its application here is broader. A safe word or code word in everyday relationships is a mutually agreed signal that halts the current interaction pattern or conveys a crucial emotional message in one succinct phrase. Importantly, the safe word is typically a neutral or even silly word that would not otherwise come up in conversation - for example, someone might choose “balloons” or “penguin” - to ensure its unmistakable and non-threatening. When invoked, this word means that one person feels either overwhelmed, misinterpreted, or unsafe, and both parties should pause and regroup. In a proactive reassurance mode, the person can also use it before the situation escalates - essentially as a preventive “all is well” signal when they sense the other’s anxiety rising.

Examples of Safe Word Use: Emerging literature and anecdotal reports provide many illustrations of how safe words or signals can be used for emotional safety:

• De-escalating Conflict in Relationships: Therapists working with neurodivergent couples advise establishing a safe word or phrase (e.g. “Pause Point”) that either partner can say during an argument to stop the argument before it escalates further. This interruption allows both to cool down and prevents the fight-or-flight cycle from worsening. Marriage guidance sources likewise attest that “good safe words are an invaluable tool to deescalate an argument”, serving as a clear signal that it’s time for both sides to step back. As one counsellor noted, the neutrality of the word helps if someone suddenly yells “balloons!” in the middle of a heated debate; it’s hard to take offence or continue arguing. The absurdity or uniqueness of the word defuses tension, and shifts focus to the agreed-upon meaning (“we need to stop now for the sake of our relationship”). In UK practice, even NHS resources for young people with ADHD suggest agreeing on a “code word with friends or family to step away from arguments,” highlighting that this tactic is recognised as applicable beyond the therapy room.

• Preventing Meltdowns in Autism/PDA: Families of autistic individuals, particularly those with PDA traits, have adapted safe word strategies as well. The PDA Society and related guides recommend creating a family safety plan that includes “our code word” - a special word anyone in the family can use to indicate imminent meltdown. For instance, a child who feels a sensory or emotional overload coming on might say the code word to alert parents that they need to reduce demands or retreat to a calm space. Conversely, a parent might gently use the code word to signal the child that they recognise the child is near breaking point. The code word thus acts as a non-judgmental acknowledgement of the child’s internal state and a cue for everyone to implement calming measures, without the need for lengthy explanation in the heat of the moment. One Welsh neurodivergence guide suggests, “think of a word that you can use as a family that lets everyone know a meltdown is about to happen.” By planning this, the family normalises the idea that anyone can call a timeout when needed, which reduces shame and misunderstanding around meltdowns.

• Reassurance for Hypervigilant Minds: In relationships where one person has C-PTSD or severe anxiety, some couples develop a safe word that means explicitly “I am not your enemy” or “you are safe.” For example, a partner might say the agreed-upon word when they notice the traumatised individual withdrawing or giving them a suspicious look, as a way of proactively breaking the cycle of mistrust. While formal research on this specific practice is sparse, it aligns with trauma therapist advice that “gently, yet assertively, reminding the individual… and reassuring them of their safety can help mitigate the intensity of the episode.” In essence, the safe word in these moments functions like a grounding mantra - it brings the person back to the present safety of the relationship. Some individuals also use a non-verbal safe signal (like a hand sign or card) in public settings to convey reassurance or the need for help without drawing attention.

• Classrooms and Therapeutic Settings: Safe words are not limited to home life. Teachers working with neurodivergent or trauma-affected students sometimes establish a private signal the student can use to step out of class when overwhelmed, or conversely, that the teacher can use to convey support. A trauma-informed teaching resource in the UK suggests using a neutral “traffic light” system or word so that a child can indicate feeling unsafe or, if the teacher says the word, it affirms that the child is in a safe space. In therapy, clients with trauma histories might have an agreed-upon word to indicate that a topic is too triggering, allowing the therapist to pivot. These scenarios illustrate the versatility of safe words as an accommodation to standard communication. This simple adaptation can make interactions safer and more manageable for those with atypical neuropsychological profiles.

How Safe Words Reduce Dysregulation and Build Trust

Interrupting the Fear Cycle: Safe words are effective in large part because they interrupt the cycle of rising anxiety or conflict before it reaches the point of no return. From a neurological perspective, they serve as a “pattern interrupt” that can engage the cortex (thinking brain) to rein in the amygdala (fear centre). For someone spiralling into fight-or-flight mode, hearing or speaking the safe word is a concrete external cue that forces a moment of reflection: “We’ve used the code - that means we need to pause.” This brief pause can prevent further adrenaline escalation and allows each person to employ coping skills (deep breathing, grounding, etc.) that would otherwise be bypassed in an unchecked outburst. As one relationship advisor notes, a safe word “draws a boundary before the other partner oversteps,” and things aggravate beyond repair. It is essentially a circuit-breaker for emotional flooding.

By halting a confrontation or overstimulating activity early, safe words help keep emotional arousal within a tolerable range (often referred to in trauma therapy as the “window of tolerance”). Instead of a full-blown rage or panic attack, the individuals can calm down more quickly. Over time, experiencing these successful de-escalations can teach the hypervigilant brain that not every conflict or trigger ends in disaster. In other words, it facilitates new learning (extinction) that counteracts fear conditioning. Peer-reviewed research on PTSD supports the idea that safety signals and controlled stopping can aid emotional regulation; PTSD is characterised by impaired fear inhibition, and techniques that engage cognitive decision-making (like choosing to pause via a safe word) directly bolster the prefrontal cortex’s regulating role. Thus, safe words leverage a psychological mechanism of empowerment: the person is not helpless in the face of their emotional surges - they or their trusted other can actively intervene, reducing panic.

Preventing Misinterpretation: A significant benefit of safe words for neurodivergent and traumatised individuals is the removal of ambiguity. Many social cues are subtle or implicit (a raised eyebrow, a change in tone), and neurotypical people often expect others to “read between the lines.” But for someone with autism or ADHD, mind-reading these cues is notoriously challenging, and for someone with trauma, ambiguous cues tend to be automatically interpreted most negatively. The safe word, by contrast, is an explicit metacommunication. It cuts through the noise of social nuance. For example, rather than an autistic person having to infer that their partner’s sigh means “I’m just tired, not angry at you,” the partner might say “apple” (the safe word) to convey “my mood is not your fault.” This explicit signalling helps counteract the neurodivergent person’s tendency to assume the worst. Indeed, part of rejection sensitivity involves perceiving rejection “even in situations where it’s not occurring”. Safe words can act as a reality check in those moments. Because the safe word’s meaning is agreed in advance, it leaves little room for misinterpretation: its usage is a reassurance that the perceived threat is not real. In cognitive-behavioural terms, it’s like a safety anchor that re-orients the person to a different interpretation of events (e.g., “My friend said our safe word, which means I’m not being rejected right now”). This can prevent the rapid cognitive distortions that lead to emotional meltdowns.

Fostering Relational Trust and Empowerment: Establishing a safe word requires a collaborative discussion, which can build trust. The process sends a message: “We recognise there may be misunderstandings or overwhelm, and we are tackling this together proactively.” For a trauma survivor not used to having their needs respected, this experience of co-designing a safety plan can be powerful. It shifts the relationship dynamic toward one of partnership in emotional safety. When the safe word is honoured consistently - i.e. when each person reliably stops or offers comfort as agreed whenever the word is spoken - it reinforces the sense that boundaries will be respected, and emotional safety is mutual. Trust, especially for C-PTSD survivors, is often damaged by prior experiences of boundaries being violated or pleas for help ignored.

In contrast, the safe word system practically guarantees a response; it is a promise made tangible. Over time, the hypervigilant individual starts to “feel safe [and] trust others” more in the relationship, because they have evidence that their partner or supporter takes their distress seriously and will respond in a supportive way. This aligns with findings that “listening without judgment, expressing empathy and understanding, and offering reassurance can create a sense of safety and trust within the relationship.” The safe word encapsulates all three of those actions: it is a tool born of non-judgmental recognition of the person’s limits, it is used with empathy (“I see you’re at your limit; let’s pause”), and it is fundamentally reassuring (“we have a plan to prevent harm here”).

For neurodivergent individuals, safe words also confer a sense of autonomy and acceptance of their differences. Rather than forcing neurotypical communication norms (which might lead to shame when they can’t meet them), using a code word is an accommodation that says: “It’s okay that you need this; we will adapt.” This can greatly support self-esteem and reduce the anxiety of masking one’s difficulties. In PDA, where control and autonomy are central needs, having a safe word gives the person a measure of control over situations that provoke anxiety, thereby lowering that anxiety in the first place. In short, safe words function as a relational safety net, not preventing all triggers or conflicts, but catching them early so they do less damage. When demonstrated repeatedly, this safety net becomes the foundation for deeper trust and more open communication. The individual can engage more in relationships, knowing there’s an “emergency brake” if things go awry.

UK Perspectives and Frameworks

Using safe words or signals fits well within UK mental health communication frameworks. While not a formally studied intervention, it appears as a recommended technique across various UK sources:

• NHS and Clinical Guidance: The idea of code words is recognised in NHS-approved advice for managing behavioural crises. For instance, as noted, the NHS Healthier Together guidance for ADHD explicitly advises agreeing on a code word to interrupt arguments or overwhelming situations safely. This situates safe words as a legitimate self-help strategy in mainstream care. Additionally, NHS trauma-informed practice guidelines emphasise creating environments where individuals feel in control and can make choices in their care. By giving patients or loved ones a voice to say “stop” at any time (via a safe word), practitioners and carers operationalise that principle of choice and control, potentially preventing the “re-experiencing of… sensations” that comes with triggers and avoiding re-traumatisation.

• Charities and Therapeutic Programmes: Organisations like Mind and the Anna Freud Centre (through the UK Trauma Council) consistently highlight the need for proactive planning around triggers. While they may not explicitly use the term “safe word” in literature, they advocate for personalised coping strategies and clear communication. The UK Trauma Council’s resources on trauma and the brain underscore how predictability and immediate reassurance can calm an overactive threat system (for example, suggesting teachers signal to a child that a feared event will not occur, thereby reassuring safety). The Adoption UK/Adoption England materials we examined explicitly mention including a “neutral (safe) word or a symbol” in a child’s safety plan to express when they feel calm, uncertain, or distressed. This shows that UK practitioners working with children recognise the utility of simple signals in emotional communication.

• Research from UK Institutions: As a critical review, it must be noted that direct empirical research on “safe words for reassurance” is limited. There are, however, related lines of research in the UK. Dr. Freya Rumball at King’s College London, for example, has illuminated the high rates of PTSD in autistic people and the necessity of adapting support to their communication style. This suggests interventions must bridge communication gaps, precisely what safe words aim to do. Another relevant research concept is “predictive processing” models of C-PTSD, which propose that the brains of trauma survivors are constantly predicting danger. A clear, salient cue that contradicts a false danger prediction (like a safe word indicating “no danger now”) could theoretically update those predictions over time. We also see cross-disciplinary interest in methods to improve emotional self-regulation in ADHD and autism (e.g., studies on mindfulness, cognitive reframing), which aim to prevent emotional overshoot. While safe word usage per se might not yet be an academic focus, it is consistent with these evidence-based trends - it’s a form of external cognitive cueing to manage internal dysregulation.

  
  

In summary, UK clinical practice and scholarly insight provide a supportive backdrop for the use of safe words, even if they often describe the concept in broader terms (such as “safety signals,” “grounding techniques,” or “communication agreements”). The approach aligns with the trauma-informed care values adopted by the NHS and charities: it enhances safety, trust, empowerment, and collaboration. As an area for further research, UK academics could formally evaluate how safe word agreements impact outcomes like frequency of meltdowns or relationship satisfaction in neurodivergent and trauma-affected populations. For now, our literature - from case studies, qualitative reports, and related research on communication and trauma - suggests that safe words are a promising low-cost intervention grounded in sound psychological principles.

Conclusion

Using safe words as a trauma-informed communication strategy appears to offer clear benefits for neurodivergent individuals and those with complex PTSD. By providing a pre-arranged beacon of clarity, safe words tackle several core challenges at once: they temper emotional dysregulation by halting negative escalation, they short-circuit the misreading of social cues by injecting an unambiguous message, and they strengthen relational trust through collaboration and consistency. This review has drawn on UK-focused frameworks and research to contextualise why such a simple tool can be effective. In a hypervigilant mind “always on red alert” and “living life ready for nuclear war to start at any moment,” a trusted person’s use of a safe word can be profoundly disarming - in the positive sense of disarming the internal alarm system. It tells the nervous system, “Stand down, you are safe.” Over time, this helps rewrite expectations in relationships from inevitable harm to possible safety.

Critically, it must be acknowledged that safe words are not a panacea. They rely on the commitment and understanding of all parties involved; if a safe word is ignored or used sarcastically, it can backfire and erode trust. There is also the risk that an individual in extreme dysregulation might be unable to process the safe word in the moment. For instance, someone in a flashback might not register the partner saying “yellow.” Therefore, safe words work best as part of a larger toolkit, which includes a calm tone of voice, active listening, and perhaps other grounding techniques. They are one component of a comprehensive trauma-informed or neurodiversity-affirming approach.

From a clinical and academic standpoint, more research (especially in the UK) could deepen our understanding of this strategy. Future studies could investigate how frequently neurodivergent individuals use safe words in practice or measure physiological stress responses before and after a safe word intervention. They could also explore unintended consequences - do some individuals become over-reliant on safe words, for example, or does it ever inhibit natural conflict resolution? Thus far, however, the prevailing evidence and expert opinion suggest that the judicious use of safe words is overwhelmingly positive, creating a buffer against the worst outcomes of hypervigilance and emotional flooding. As one marriage advisor quipped, “When we look back, one of the simple things we could have used to save such trauma would have been a safe word.”

In conclusion, safe words exemplify how nuanced psychological insights can be translated into a practical communication hack. They acknowledge the unique needs of neurodivergent and trauma-affected minds for explicitness and safety. Implemented with care, a safe word becomes more than just a word - it becomes a symbol of mutual understanding, a promise of safety, and a tool for healing relational wounds. In a world of often unspoken expectations, this overt agreement to protect each other’s emotional well-being can be, as the evidence suggests, a game-changer for improving trust and reducing miscommunication in these vulnerable populations.

References

• Adoption England (2021). Trauma-Informed Approach to Family Time and Staying in Touch. (Recommendation to use neutral safe words/signals in communication plans).

• Beacon House UK (2020). Developmental Trauma Close-Up. (Effects of trauma on hypervigilance and interpreting cues).

• Compassion Behavioural Health (2023). Complex PTSD and Relationships – Triggers & Effects. (Importance of reassurance for safety and trust).

• Dashnaw, D. (2023). Conflict Styles and Repair Mechanisms in Neurodiverse Couples. (Use of safe word “Pause Point” to de-escalate arguments).

• National Autistic Society (2022). Post-traumatic stress disorder in autistic people – Dr. F. Rumball. (High PTSD prevalence in autism; social cue difficulties).

• NHS Healthier Together (2023). ADHD – Tips for Managing Frustration & Anger. (Advice to agree on a code word to step away from arguments).

• Marriage.com (2018). Prevent Arguments from Escalating – Decide on a Safe Word. (Safe word “balloons” as neutral de-escalation tool).

• Neurodivergent Insights (2023). Rejection Sensitive Dysphoria and Its Painful Impact. (Hypervigilance to social cues in RSD).

• UK Government (2022). Working Definition of Trauma-Informed Practice. (Trauma impairs sense of safety and trust; need to avoid re-traumatisation.)