The advice columnist E Jean Carroll was so traumatized recalling her alleged rape by Donald Trump that she was “doubled over with stomach pain”, a leading clinical psychologist told a New York jury on Wednesday. Dr Leslie Lebowitz told Trump’s civil trial that Carroll exhibits aspects of post-traumatic stress disorder, including physical pain, without fitting the full clinical diagnosis as a result of the alleged assault in 1996. “She does have symptoms that fit into the rubric of PTSD,” said Lebowitz. The psychologist added that “Carroll lives with a higher level of chronic fearfulness” than before the alleged attack. Carroll is seeking damages for alleged rape in a New York department store changing room, and for defamation after the former US president said she was lying when she went public with her accusations in 2019. Lebowitz, who interviewed Carroll for about 20 hours, said the advice columnist experiences intrusive physical symptoms of the alleged attack. These included “squirming in her seat” as she recounted the experience of Trump’s fingers in her vagina. These symptoms worsened, she said, when Trump ran for the White House and was in the news, but diminished again in time. The psychologist concluded Carroll has been harmed in three main ways. These include suffering from “painful intrusive memories” for many years and a “diminishment” in how she thinks and feels about herself. But Lebowitz said that perhaps the most prominent effect was Carroll “manifests avoidance syndromes” that have stopped her having a romantic life. “Following her encounter with Mr Trump she began to shut down in the presence of eligible men,” said Lebowitz. “She’s avoiding anything that reminds her of the threat.” The psychologist said Carroll described the behavior as like a metal shutter pulled down over a store front. Carroll testified earlier in the trial that she stopped having sex after the alleged assault at the age of 53. “If I meet a man who is a possibility, it’s impossible for me to even look at him and smile,” she said. Lebowitz described this as typical “avoidance behavior”. Pressed on why Carroll insisted in a book and in public that she was “not a victim”, was “fine”, and that she had “never suffered” as a result of the attack, the psychologist said that the advice columnist was presenting a particular face to the world. Lebowitz said Carroll “fiercely identified with being strong” and as a person who “marched on”, and that a public admission of the impact on her would have harmed that. “Being raped meant to her being the victim, being stupid, being dirty,” she said. “For most of the years she simply blamed herself for the assault. She thought she had done something stupid.” Last week, Trump’s lawyer pressed Carroll under cross-examination about why she didn’t scream if she was being raped, and why she had offered differing explanations for doing so. Carroll said a number of factors could all have been at play. “I’m telling you he raped me whether I screamed or not,” she said last week. Lebowitz told the trial on Wednesday it was not uncommon for victims of sexual assault to stay silent while they were being attacked. She said Carroll’s brain would have been flooded with stress hormones, which can lead to unexpected behavior. Lebowitz gave the imaginary example of a woman who “doesn’t scream even if they’re being raped in the stands of the public library even if we imagine they would”. She said stress hormones also have a major impact on what people remember about a traumatic incident. “Our brain doesn’t hold on to things that at the time don’t seem important. Our brains hold on to things that seem emotionally salient,” she said. Lebowitz said that is why people can remember details of a traumatic incident without remembering the exact date or where they were living at the time. Under cross-examination, Lebowitz agreed that she had not applied any behavioral tests to assess if Carroll was lying about the alleged attack. The trial continues.