Violence can also create long-term effects including distress, flashbacks, anxiety, inability to concentrate, feelings of unreality, depression, and suicidal ideation. Even where the abuse has no long-term physical effects or causes post-traumatic stress disorder, the survivor of an abusive relationship will often suffer from low self-esteem and feelings of worthlessness. Survivors commonly comment that they feel somehow “different” from their peers, as if their experiences have somehow set them apart from the rest of society. Due to the controlling aspects of an abusive relationship, survivors may have difficulty making personal decisions and easily feel overwhelmed by everyday life.