What Is Trauma?

Trauma is a word that we hear batted around quite frequently.  What exactly is it?

We used to think that trauma came from major life events like being in a combat zone, sexual assault, natural disaster, or more pervasive experiences like an abuse-filled childhood.  Trauma comes in many more ways than previously thought and no two situations are ever the same.  We now classify trauma as Big T Trauma (large events) such as being shot at or small t trauma (smaller events) like an icy cold stare from your very distant father.

Then there is cumulative trauma where a series of events can lead to larger and larger burdens on an individual - where “they can’t get up for air”

How your brain works

If you think about how your brain functions, it focuses on the negative a lot.  This is a protective mechanism.  It remembers negative events so that you can protect yourself more easily when you think you will be injured.  In other words, the body is remembering so that it can protect itself.  Think of burning yourself on a hot stove.  Sometimes these signals get a little bit crossed.  For example, you may be afraid of being injured and this gets moved over to “I’m afraid of driving across bridges” - sometimes it doesn’t seem logical but our brains are making connections and storing these memories and sometimes the “wires get crossed”

 Initial Reactions to Trauma

These can include exhaustion, confusion, sadness, anxiety, agitation, numbness, dissociation, and physiological arousal.  You might experience a few or all these symptoms.  The more worried and stressedpeople are, the more exhausted they can become and the more tense and constricted muscles can become.  Over time the muscles become exhausted and ineffectual.  After a traumatic event or repeated trauma, people respond differently, experiencing a wide range of physical and emotional reactions.  There is no right or wrong way to think, feel, or respond to trauma.  It’s traumatic!  Everyone will react differently, so don’t judge your reactions and/or compare them to other people’s reactions.

The Physiological Effects of Trauma

Trauma sensitizes the hypothalamic-pituitary-adrenal (HPA) axis, which is the body’s central stress response system.  You can think of this as the juncture of our central nervous system and endocrine system, which makes us more reactive to stress and more likely to increase the stress hormone cortisol.  In certain situations, hormones like cortisol are crucial.  (Cortisol, the primary stress hormone, increases sugars in the bloodstream, enhances your brain’s use of glucose, and increases the availability of substances that repair tissues.)

Unfortunately, cortisol can be toxic when it is chronically high—ultimately leading to increased risks of health conditions such as depression or heart disease.  Remove the stressor, and the body’s hormones should respond back to “normal”.  The problem: Someone who is exposed to trauma may continue to produce these hormones, leading to adverse effects on the body over time.  When enough trauma is present, people will expect it and anticipate it.  But trauma therapy can help to rebalance this natural reaction to stress.

Additionally, the indirect effects of trauma on the body can be subtle yet dangerous.  Traumatized people who live in a state of emotional “dysregulation” often look for ways to regain emotional control.  Often, trauma'sphysical and emotional pain can make it hard to cope, leading to unhealthy tendencies like smoking or drinking. These things are coping mechanisms.  Although these can be seemingly effective strategies in the short term, they only numb the emotions and prolong the trauma’s impact on the body and mind.  We never learn how to deal with the underlying emotions effectively.

Psychological Effects

Frequently, trauma’s psychological effects are noticed first and can disrupt the individual’s day-to-day life with depression, anxiety, anger, intense fear, flashbacks, and paranoia. The traumatic experience could also affect and alter perceptions.  This can lead to the belief that the world around them is unsafe and other people are dangerous, or in extreme cases, create altered personalities to help them cope with the trauma.  This leads us to the diagnosis of post-traumatic stress disorder (PTSD), merely a classification for people to understand what is wrong.  “However, symptoms may not appear until several months or even years later,” according to the Anxiety and Depression Association of America. There are several leading indicators:

Complex PTSD vs PTSD

Typical PTSD can arise after a traumatic episode, such as a car collision, an earthquake, or a sexual assault.  It is generally related to a single traumatic event.

Complex PTSD, on the other hand, is related to a series of traumatic events over time or one prolonged event.  The symptoms of complex PTSD can be similar but more enduring and extreme than those of PTSD.

Is complex PTSD a separate condition?

Some mental health professionals are beginning to distinguish between the two conditions, despite the lack of guidance from the DSM-5 (the manual of mental health diagnoses)

Symptoms of complex PTSD

A person with complex PTSD may experience symptoms in addition to those that characterize PTSD.

Common symptoms of PTSD and complex PTSD include:

•      avoiding situations that remind a person of the trauma

•      dizziness or nausea when remembering the trauma

•      hyperarousal, which means being in a continual state of high alert

•      the belief that the world is a dangerous place

•      a loss of trust in the self or others

•      difficulty sleeping or concentrating

•           

People with PTSD or complex PTSD may also experience:

A negative self-view: Complex PTSD can cause a person to view themselves negatively and feel helpless, guilty, or ashamed.  They often consider themselves to be different from other people.

•      Changes in beliefs and worldview: People with either condition may hold a negative view of the world and the people in it or lose faith in previously held beliefs.

•      Emotional regulation difficulties: These conditions can cause people to lose control over their emotions.  They may experience intense anger or sadness or have thoughts of suicide.

•      Relationship issues: Relationships may suffer due to difficulties trusting and interacting, and because of a negative self-view.  A person with either condition may also tend to develop unhealthy relationships if they are what the person has known in the past.

•      Detachment from the trauma: Some survivors may experience complete amnesia of the trauma.

•      Preoccupation with an abuser: It is common to fixate on the abuser, the relationship with the abuser, or getting revenge for the abuse.

Symptoms of complex PTSD can vary, and they may change over time.  People with the condition may also experience symptoms other than the above.

Triggers of complex PTSD

People who have PTSD or complex PTSD can react to different life situations as if they are reliving their trauma.

The particular situation that triggers a person can be random and varies depending on their specific trauma history.  A person can be triggered by situations, images, smells, conversations with others, and more.  This triggering can manifest as a fight-or-flight response triggered by the amygdala, responsible for processing emotions in the brain.  When this happens, a person’s brain can perceive that they are in danger, even if they are not.  This is known as an amygdala hijack and can also result in things like flashbacks, nightmares, or being easily startled.

Since complex trauma is prolonged, it can often begin in early childhood. Traumatic childhood experiences, also known as adverse childhood experiences (ACEs), can include:

•      childhood exposure to violence, abuse, or neglect

•      a death by suicide in the family

•      substance dependence in the family

•      mental health disorders in the family

•      having incarcerated family members

•      chronic poverty or neglect

•      housing instability

•      growing up in an unsafe or crime-heavy environment

Treatment of complex PTSD

Research shows that people with PTSD and complex PTSD may need personalized treatment.

Options for treatment include:

Psychotherapy

Psychotherapy may take place on a one-to-one basis or in a group setting.

Initially, therapy will focus on stabilizing the person so that they can:

•      address their feelings, including distrust and negative world views

•      improve their connections with others

• deal adaptively with flashbacks and anxiety