Patriarchal Trauma in Appalachian Literature examines the effects of subjugation on women as it is represented in three novels set in Appalachia. I define patriarchal trauma as an act causing mental anguish to a woman and perpetrated against her because she is a woman. I use the term to encompass violent, catastrophic harms but more particularly to pinpoint the traumatic effects of the quotidian, systemic deprivation of women’s autonomy. Reconsidering classic texts such as James Still’s River of Earth and Robert Morgan’s Gap Creek: The Story of a Marriage as narratives of women’s trauma establishes a lineage on the subject, which culminates in Lee Smith’s more recent Guests on Earth. This project eschews authenticity as an analytical tool, turning instead to modes of argument in feminism’s toolkit to delineate the potentially grim outcomes for women whose agency is constricted or usurped. While patriarchal control mechanisms such as domestic violence and sexual abuse inflict readily observable injuries on women, I argue that common, everyday subordination to men can exact a similar emotional toll, especially on women who strenuously defy male dominance. These traumatic states, I further contend, have previously been read as inevitable acquiescence or a genuine desire for subjugation in River and Gap Creek, respectively, while experiences of trauma in Guests are directly portrayed as mistaken interpretations of madness. Reassessing women characters’ numb, compliant, depressed, or enraged emotions as responses to patriarchal trauma challenges the practice of pathologizing women’s rebellion.