Dr. Angela Hanford
What are your initial thoughts when you hear the words trauma or Post-Traumatic Stress Disorder (PTSD)? These words may conjure up images of soldiers on the battlefield or of a young woman who has been raped. But what actually constitutes trauma and what does trauma look like?Traumatic experiences are all around us. In a survey conducted by the World Health Organization (WHO), 70.4% of those responding reported having experienced trauma at some point in their lifetime (Keller, et al., 2017). However, not all cases of trauma resulted in the development of PTSD. PTSD was most highly associated with trauma that was interpersonal in nature (e.g., the unexpected death of a loved one, sexual assault).
What is trauma? Merriam-Webster defines trauma as: (a) “an injury…”, (b) “a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury,” or (c) “an emotional upset.”
When most people think of trauma, it is often situations such as rape, sexual abuse, physical abuse, war exposure, or a near death experience (e.g., shooting). However, someone may have trauma reactions to major surgery, neglect, abandonment, an accident, loss of a loved one, divorce, any break in relationship, or a major move. These events may also produce a host of overwhelming emotions that impact one’s spiritual, emotional, relational, and work or academic functioning.
According to the U.S. Department of Veterans Affairs (2015), common symptoms of trauma include:
- Feeling disconnected
- Anxiety and fear
- Difficulty concentrating or making decisions
- Easily startled
- Sadness or hopelessness
- Mood swings, irritability, or anger outbursts
- Nightmares or flashbacks
- Racing heart
- Easily agitated
- Headache, stomach ache, difficulty eating
Post-Traumatic Stress Disorder
Sometimes people who experience trauma develop PTSD. PTSD, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (American Psychiatric Association, 2013), may occur after someone has experienced or was threatened with serious physical harm (including death) or sexual trauma. These events can be either directly experienced, witnessed, learning of a close connection experiencing such trauma, or experiencing repeated exposure to severe details of traumatic events (e.g., first responders).
Symptoms people experience a range from disturbing memories and dreams to feeling as though the event is occurring again to feeling a variety of distressing emotional, cognitive, and physical reactions (e.g., mood swings, hyperarousal). In addition, someone with PTSD may attempt to avoid situations or environments where they will be reminded of the traumatic event.
Although PTSD is a widely known consequence of trauma, it is not the only, or even necessarily the most common, diagnosis associated with certain types of trauma (Scheeringa, Zeanah, Myers, & Putnam, 2003).
For example, one set of researchers found that, in their sample of child abuse victims, the most common diagnoses reported were separation anxiety disorder, oppositional defiant disorder, phobic disorders, PTSD, and attention-deficit/hyperactivity disorder (Ackerman, Newton, McPherson, Jones, & Dykman, 1998).
Furthermore, van der Kolk (2005) reported that early childhood trauma results in difficulty regulating emotions, and that trauma during childhood disrupts the attachment system.
Unlike a single episode traumatic event, complex trauma occurs when there are multiple traumatic events, with the effects building on each event, and over a time span (van der Kolk, 2005, Courtiois, 2008). Complex trauma typically occurs in a specific interpersonal context and often during childhood. This could be repeated sexual abuse as a child, chronic neglect, or a host of other forms of maltreatment that occur over a period of time.
You may have heard of the relatively well-known ACE (adverse childhood experiences) study that was conducted by Kaiser Permanente and the Centers for Disease Control and Prevention (Feletti, et al., 1998).
The ACE’s examined in this study included: childhood abuse (psychological, physical, sexual), neglect, domestic violence, having a household member with mental illness or substance abuse, having a caregiver incarcerated, or separation from a caregiver.
The results of the ACE study demonstrated that there was a significant relationship between the ACE’s and an increased risk in factors such as substance abuse, depression, suicide attempts, sexual promiscuity, obesity, and cigarette smoking.
Furthermore, the more ACE’s, the higher the association with negative outcomes. The authors concluded that exposure to these adverse experiences during childhood were associated with risk factors for some common causes of death in adults (e.g., liver disease, cancer).
When complex trauma occurs in children, it has an impact on development, including brain development. For example, Bessel van der Kolk (2005) stated that “the brain-based stress response systems of these children appear to become permanently changed as they focus attention on the need to ensure safety rather than on the many growth-promoting interests and activities that secure children find attractive and stimulating.”
Another trauma researcher, Bruce Perry (2006), stated that when children are traumatized, their arousal level is at a heightened state at all times, versus only when there is an actual threat.
It should be noted that hyperacoursal can also occur in adults who experience trauma. For example, Ganzel et al. (2007) discovered that five years after the 9/11 attacks, those who were nearby during the attacks still had overactivity in their threat arousal system.
Healing From Trauma
Healing from trauma takes time, so it is important to have patience. If you or a loved one has experienced trauma, there are ways to promote effective coping. For example, Bath (2008) wrote about “three pillars” or areas that need attention when someone has been traumatized. These areas are “safety, connections, and managing emotions.”
Creating a safe place is important for anyone who has experienced trauma. Along with physical safety, the traumatized individual needs to have a safe place where he or she can express emotions and process the trauma. Creating a safe environment can be especially complicated when the perpetrator of the trauma is a caregiver or trusted loved one.
Two examples for creating safety for children include making sure that there is consistency in life and ensuring that the child feels that he or she has a sense of control in decisions being made (Bath, 2008).
2) ConnectionsAlthough trauma symptoms may result in someone wanting to isolate, this is not the most conducive environment for any type of emotional healing. Rather, it can lead to loneliness and depression.
Furthermore, part of healing from a trauma is talking about it. However, this needs to be done when the traumatized individual is ready. Telling the story helps us to heal and to develop a coherent narrative of the events.
There may also be support groups available that address your particular trauma situation.
3) Managing Emotions
Along with having safety and the needed safe relationships, there are also ways in which we can learn to better manage emotions. Some examples include:
- Breathing: When we are anxious, we tend to breathe in a more shallow manner. This results in less oxygen and more carbon dioxide in our bodies. This ratio makes anxiety worse.
When you hear, “take a few deep breaths,” it might be helpful to give it a try. There are many different breathing exercises and even apps for your smartphone that will take you through different breathing exercises. Find something that works for you.
- Mindfulness: Learning to take control of your thoughts rather than letting your thoughts (including anxious thoughts!) take control of you, is very helpful. Daniel Siegel has written a lot on the practice of mindfulness.
- Relaxation: With a hyperaroused body, there is an increased level of cortisol. Prolonged exposure to high levels of cortisol have been associated with negative health consequences. Besides breathing exercises, you might try activities such as yoga, stretching, or progressive muscle relaxation.
- Sleep: Try to obtain the amount of sleep that your body needs.
- Healthy eating
- Physical activity (with your doctor’s consent)
- Journaling: Emotions do not heal by keeping them internally.
- Managing everyday stress: Taking time off from work, if needed; Asking others to help carry some of your responsibilities.
- Grounding: If you are panicking or do not feel in touch with yourself or your surroundings, feel your feet on the ground, look around at your surroundings, say aloud where you are.
- Avoid using alcohol or other substances to try to numb emotions or escape. These substances do not allow you to actually process the trauma. In addition, these substances can actually result in an increase in negative mood states (e.g., depression and anxiety).
Many people who have experienced trauma will heal over time, without professional help. However, if the trauma symptoms are overwhelming, interfere with life, or if suicidal and/or homicidal feelings are present, it is important to seek professional help for healing from trauma.
Treatment for Healing from Trauma
If you or someone you know has experienced trauma and the subsequent negative impacts of the experiences, it is important to know that there are effective treatments available. Two such approaches for trauma treatment include EMDR and trauma-focused cognitive behavioral therapy.
Eye Movement Desensitization and Reprocessing (EMDR)
The theory behind EMDR is that sometimes memories are stored in an unprocessed and, therefore, non-adaptive, state (Francine Shapiro, 2012). This could be due to extreme stress at the time of the trauma, a lack of developmental capacity to process the trauma, or other situation that prevents complete healthy processing of the traumatic event.
The memories are stored in their original states with all the thoughts, feelings, images, and body sensations that occurred with the traumatic event. What research (see the EMDR Research Foundation) has shown is that by applying bilateral stimulation (e.g., left to right pattern of eye movements, tapping, or auditory stimulation), using the standard EMDR protocol, that it allows the memories to become “unstuck” and reprocessed into an adaptive memory. EMDR is considered an empirically validated treatment for PTSD.
EMDR has recent event protocols that are used when the trauma occurred more recently (e.g., a day or a few months). The reason that these are different protocols is that it takes time for a memory to become consolidated. Sometimes people say this timeframe is three months or six months, but this is debated.
Trauma-Focused Cognitive-Behavior Therapy (TF-CBT)
TF-CBT is a type of therapy that helps someone who has been traumatized to process the thoughts and feelings associated with the trauma. Some components of TF-CT include relaxation training, learning to regulate emotions, pressing the thoughts associated with the trauma, and developing a narrative of the trauma.
Treatment may include individual, family, couples, and/or group psychotherapy. In addition, you may be referred to a medical doctor of a medical evaluation.
If you or someone you know is struggling to move past a trauma or multiple traumas, help is available to promote lasting healing from trauma. Reach out to a therapist who understands trauma and is ready to walk with you on your journey toward healing and growth.
Ackerman, P.T., Newton, J.E., McPherson, W.B., Jones, J.G., & Dykman, R.A. (1998). Prevalence of post traumatic stress disorder and other psychiatric diagnoses in three groups of abused children (sexual, physical, and both). Child Abuse and Neglect. 22(3), 759-774.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming Children and Youth, 17(3), 17-21.
Courtois, C. A. (2008). Complex trauma, complex reactions: Assessment and treatment. Psychological Trauma: Theory, Research, Practice, and Policy, S(1), 86-100.
Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., & Marks, J.S. (1998). Relationship of childhood abuse and household dysfunciton to many of the leading cases of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4). 245-258.
Ganzel, B., Casey, B., Glover, G., Voss, H., & Temple, E. (2007). The aftermath of 9/11: Effect of the intensity and recency of trauma on outcome and emotion. Emotion 7(2), 227-238.
Kessler, R.C., Aguliar-Gaxiola, S., Aloso, J., Benjet, C., Bromet, E.J., & Cardoso, G., et al. On behalf of the WHO World Mental Health Survey Collaborators, K.C. (2017). Trauma and PTSD in the WHO world ental health surveys. European Journal of Psychotraumatology. 8(sup5), 1353383.
Perry, B. (2006). Applying principles of neurodevelopment to clinical work with maltreated and traumatized children. In N. Webb (Ed.), working with traumatized youth in child welfare (pp. 27-52). New York: The Guilford Press.
Scheeringa, M.S., Zeanah, C.H., Myers, L., & Putnam, F.W. (2003). New finding s on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(5), 561-570.
Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR therapy. New York: Rodale Books.
U.S. Department of Veterans Affairs (2015). Common Reactions After Trauma. https://www.ptsd.va.gov/public/problems/common-reactions-after-trauma.asp. Retrieved 4/27/18.
van der Kolk, B. (2005). Developmental Trauma Disorder: Towards a rational diagnosis fro children with complex trauma histories. Psychiatric Annals, 33 (5), 401-408.
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