What Is Trauma?
Trauma is any injury, physically or emotionally inflicted upon a person. Trauma has both a medical and a psychiatric definition. For the purposes of this site, we will focus primarily upon psychological trauma and its effects.
Emotional, or Psychological, Trauma is an intense, emotional reaction to a traumatic or severe situation. Trauma may be caused by stressful events such as natural disasters, incidences of abuse, assault, or death. Trauma can also be caused by more minor events, like a car accident or sports injuries.
A traumatic event involves a single event, or a repeating pattern of events that completely overwhelm an individual’s ability to cope or integrate the emotions involved in that experience. That feeling of being overwhelmed can last days, weeks, even years as the person struggles to cope.
Trauma can be caused by a number of events, but there are a few common aspects. There’s often a violation of the person’s familiar ideas about the world and of their rights, which puts the person into a state of extreme confusion and insecurity.
Psychological trauma may be accompanied by physical trauma or exist independently.
Trauma, while often involving a threat to life or safety, can also involve any situation that leaves you feeling stressed or alone, even if it didn’t involve physical harm. It’s not the objective facts that determine if an event is traumatic, but the subjective emotional experience of the event. The more frightened and helpless you felt at the time, the more likely that you will feel traumatized afterwards.
A traumatic event or situation creates psychological trauma when it overwhelms the individual’s ability to cope, and leaves that person fearing death, annihilation, mutilation, or psychosis. The individual may feel emotionally, cognitively, and physically overwhelmed. The circumstances of the event commonly include abuse of power, betrayal of trust, entrapment, helplessness, pain, confusion, and/or loss.
This definition of trauma is fairly broad. It includes responses to powerful one-time incidents like accidents, natural disasters, crimes, surgeries, deaths, and other violent events. It also includes responses to chronic or repetitive experiences such as child abuse, neglect, combat, urban violence, concentration camps, battering relationships, and enduring deprivation. This definition intentionally does not allow us to determine whether a particular event is traumatic; that is up to each survivor. This definition provides a guideline for our understanding of a survivor’s experience of the events and conditions of his/her life.
There are two components to a traumatic experience: the objective and the subjective:
It’s is the subjective experience of the objective events that constitutes the trauma. The more you believe you are endangered, the more traumatized you will be. Psychologically, the bottom line of trauma is overwhelming emotion and a feeling of utter helplessness. There may or may not be bodily injury, but psychological trauma is coupled with physiological upheaval that plays a leading role in the long-range effects.
In other words, trauma is defined by the experience of the survivor. Two people could undergo the same noxious event and one person might be traumatized while the other person remained relatively unscathed. It is not possible to make blanket generalizations such that “X is traumatic for all who go through it” or “event Y was not traumatic because no one was physically injured.” In addition, the specific aspects of an event that are traumatic will be different from one individual to the next. You cannot assume that the details or meaning of an event, such as a violent assault or rape, that are most distressing for one person will be same for another person.
Trauma comes in many forms, and there are vast differences among people who experience trauma. But the similarities and patterns of response cut across the variety of stressors and victims, so it is very useful to think broadly about trauma.
A stressful event may be traumatic if any or all of these apply:
Psychological effects are likely to be most severe if the trauma is:
- Undergone in childhood
- And perpetrated by a caregiver
- It was unexpected.
- You felt powerless to prevent it
- You were unprepared
- You had an intense emotional reaction
- You are unable to have emotions about the situation
What is the Difference Between Emotional Trauma and Stress?
Trauma is stress run amuck. Stress deregulates our nervous systems – but for only a relatively short period of time. Within a few days or weeks, our nervous systems calm down and we revert to a normal state of equilibrium. This return to normalcy is not the case when we have been traumatized. One way to tell the difference between stress and emotional trauma is by looking at the outcome – how much residual effect an upsetting event is having on our lives, relationships, and overall functioning. Traumatic distress can be distinguished from routine stress by assessing the following:
• how quickly upset is triggered
• how frequently upset is triggered
• how intensely threatening the source of upset is
• how long upset lasts
• how long it takes to calm down
If we can communicate our distress to people who care about us and can respond adequately, and if we return to a state of equilibrium following a stressful event, we are in the realm of stress. If we become frozen in a state of active emotional intensity, we are experiencing an emotional trauma – even though sometimes we may not be consciously aware of the level of distress we are experiencing
Situations That May Cause Psychological Trauma:
Single Blow vs. Repeated Trauma
Single shocking events can certainly produce trauma reactions in some people:
- Natural disasters such as earthquakes, hurricanes, floods, volcanoes, etc.
- Closely related are technological disasters such as auto and plane crashes, chemical spills, nuclear failures, etc. Technological disasters are more socially divisive because there is always energy given towards finding fault and blaming.
- Criminal violence often involves single blow traumas such as robbery, rape and homicide, which not only have a great impact on the victims, but also on witnesses, loved ones of victims, etc. (Interestingly, there is often overlap between single blow and repeated trauma, because a substantial majority of victimized women have experienced more than one crime.)
- Unfortunately, traumatic effects are often cumulative.
There are many situations that have the potential to cause psychological trauma (although not every person exposed to the same stressors will develop a traumatic reaction). Here are a few of the known situations that can cause psychological trauma:
- Sexual Abuse
- Domestic Violence
- Children of Alcoholics (and addicts)
- Long-term exposure to verbal abuse
- Car Accidents
- Natural disasters
- Humiliating experiences
- Fall or sports injury
- Sudden, unexpected death of someone close
- Diagnosis of life-threatening illness or disabling condition
What Are The Types of Trauma?
Natural Trauma vs. Human-Made Trauma
Prolonged stressors, deliberately inflicted by people, are far harder to deal with than accidents or natural disasters. Most people who seek mental health treatment for trauma have been victims of violently inflicted wounds dealt by a person. If this was done deliberately, in the context of an ongoing relationship, the problems are increased. The worst situation is when the injury is caused deliberately in a relationship with a person on whom the victim is dependent – most specifically a parent-child relationship.
Types of Man-Made Violence
- War/political violence – Massive in scale, severe, repeated, prolonged, and unpredictable. Also multiple: witnessing, life threatening, but also doing violence to others. Embracing the identity of a killer.
- Human rights abuses – kidnapping, torture, etc.
- Criminal violence – discussed above.
- Rape – The largest group of people with post-traumatic stress disorder in this country. A national survey of 4000 women found that 1 in 8 reported being the victim of a forcible rape. Nearly half had been raped more than once. Nearly 1/3 was younger than 11 and over 60% were under 18. Women with a history of incest were at significantly higher risk for rape in later life (68% incest history, 38% no incest).
- Domestic Violence – recent studies show that between 21% and 34% of women will be assaulted by an intimate male partner. 20-30% of adults in the US, approved of hitting a spouse.
- Child Abuse – the scope of childhood trauma is staggering. Everyday children are beaten, burned, slapped, whipped, thrown, shaken, kicked, and raped. According to Dr. Bruce Perry, a conservative estimate of children at risk for PTSD exceeds 15 million.
- Sexual abuse – 40% of all psychiatric inpatients have histories of sexual abuse in childhood. Sexual abuse doesn’t occur in a vacuum: is most often accompanied by other forms of stress and trauma-generally within a family.
We must be careful about generalizations about child sexual abuse: research shows that about 1/3 of sexually abused children have no symptoms, and a large proportion that do become symptomatic, are able to recover. Fewer than 1/5 of adults who were abused in childhood show serious psychological disturbance
More disturbance is associated with more severe abuse: longer duration, forced penetration, helplessness, fear of injury or death, perpetration by a close relative or caregiver, coupled with lack of support or negative consequences from disclosure.
- Physical abuse often results in violence toward others, abuse of one’s own children, substance abuse, self-injurious behavior, suicide attempts, and a variety of emotional problems.
- Emotional/verbal abuse
- Witnessing. Seeing anyone beaten is stressful; the greater your attachment to the victim, the greater the stress. Especially painful is watching violence directed towards a caregiver, leaving the child to fear losing the primary source of security in the family.
- Sadistic abuse – we generally think about interpersonal violence as an eruption of passions, but the severest forms are those inflicted deliberately. Calculated cruelty can be far more terrifying than impulsive violence. Coercive control is used in settings like concentration camps, prostitution and pornography rings, and in some families.
One of the best-documented research findings in the field of trauma is the DOSE-RESPONSE relationship –the higher the dose of trauma, the more potentially damaging the effects; the greater the stressor, the more likely the development of PTSD.
The most challenging clients are those who have experienced repeated intentional violence, abuse, and neglect from childhood onward. These clients have experienced tremendous loss, the absence of control, violations of safety, and betrayal of trust. The resulting emotions are overwhelming: grief, terror, horror, rage, and anguish.
Their whole experience of identity and of the world is based upon expectations of harm and abuse. When betrayal and damage is done by a loved one who says that what he or she is doing is good and is for the child’s good, the seeds of lifelong mistrust and fear are planted. Thus, the survivor of repetitive childhood abuse and neglect expects to be harmed in any helping relationship and may interact with us as though we have already harmed him or her.
Why Do Traumatic Responses Occur In Some People And Not Others?
Not all traumatic events lead to lasting emotional and psychological damage. Certain people rebound quickly from the most devastating of experiences, while others may be devastated by experiences that may seem superficially less upsetting.
Anyone can become traumatized – even those who work with trauma victims can develop symptoms of vicarious or secondary traumatization. Symptoms, no matter the precipitating event, should always be taken seriously and steps should be taken to heal from the trauma. Like other physical illnesses, the amount of time it takes to heal can vary wildly from one person to the next.
There’s no clear-cut answer to why some traumatic events elicit emotional trauma for some, but there are likely contributing factors. A number of risk factors make people more susceptible to emotional psychological trauma. These are some of the contributing factors to developing lasting emotional and psychological damage:
- Heavy stress
- Prior losses, especially in childhood
- Those who have recently experienced a number of losses
- Poor coping skills
- Substance abuse
- Extreme conditions
- Total devastation
Symptoms of Emotional and Psychological Trauma:
Following a traumatic event – or repeated trauma – people react in many different ways, experiencing a wide array of physical and emotional reactions. It’s important to remember that there’s not a “right” or “wrong” way to respond to trauma, so don’t judge your reactions against those of others. Your responses are normal reactions to abnormal events.
Symptoms and feelings following a trauma can last a few days to a few months and will gradually fade as the trauma is processed. Certain sights, sounds, images or situations may always remind you of the trauma.
After a traumatic event, a person may go through a number of emotions. Typical symptoms are broken down into categories.
Emotional and Psychological Symptoms of Trauma:
- Denial or disbelief
- Emotional Numbness
- Social Isolation
- Difficulties in concentration and/or memory problems
- Anxiety, edginess, or hyper-vigilance
Physical Symptoms of Trauma:
- Racing heartbeat
- Numbness, withdrawing from people
- Insomnia or nightmares
- Muscle aches and pains
- Sexual difficulties
- Muscle tension
Problems Associated with Trauma
In addition to the initial trauma, symptoms do not always go away easily. It is not uncommon for someone to have recurring issues after trauma. These recurring issues, if not managed well, can cause additional trauma.
- Re-experiencing of events through flashbacks, intrusive thoughts, and floods of emotion; these symptoms are often quite disruptive to everyday life.
- Mood Disorders
- Anxiety Disorders
- Depressive Disorders
- Post-Traumatic Stress Disorder
- Substance Abuse
- Eating Disorders
- Attachment Disorders
- Sleep Disorders
What Happens When Trauma Is Repeated and Sustained?
Repeated traumatic events can result in what is known as Complex Post-Traumatic Stress Disorder (it may also be called Disorders of Extreme Stress Not Otherwise Specified or DES-NOS). Due to the difficulty in finding control groups to study those who have suffered multiple traumas and because most of those who suffer from Complex PTSD also qualify for diagnosis of PTSD, it has not been added to the Diagnostic and Statistical Manual of Mental Disorders (the DSM). Information can be difficult to come by for this issue but even so, it is recognized by many medical professionals/therapists as a disorder linked to repeated or long-term incidences of trauma.
Complex PTSD differs from the typical PTSD because repeated traumas can cause the individual to question their own self-concept and can alter adaptive abilities. According to the National Center for PTSD, symptoms may include:
- Alterations in emotional regulation; may include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
- Alterations in consciousness; includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body.
- Changes in self-perception; may include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
- Alterations in how the perpetrator is perceived. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
- Alterations in relations with others. Examples include isolation, distrust, or a repeated search for a rescuer.
- Changes in one’s system of meanings; may include a loss of sustaining faith or a sense of hopelessness and despair.
Treatment for Trauma Disorders
Medications are prescribed to manage symptoms, often while undergoing cognitive-behavioral therapy, in treatment of trauma. Additionally, some trauma survivors may choose to undergo hypnotherapy. Two very successful and commonly used therapies are described below.
Eye Movement Desensitization and Reprocessing – EMDR treatment is growing in popularity. It has been shown to be highly effective in a short period of time and is typically less intrusive and disruptive than more traditional therapies (i.e. exposure therapy). EMDR involves trauma processing with the help of a therapist who uses a machine that emits a combination of vibrations and beeping noises to stimulate parts of the brain that have been affected by trauma.
Exposure Therapy – Exposure therapy is a more widely-used treatment for trauma that focuses on desensitizing the individual to traumatic events through repeated exposure to feared objects or retelling of traumatic incidences. This process is guided by a trained psychotherapist in a safe, controlled environment.
How Do I Help Myself Heal From Trauma?
Healing from traumatic events is not something that will happen overnight. It takes months, even years, to work through all of the feelings associated with trauma. In addition to a therapy plan, these are some things you can do to help yourself heal from a trauma.
Give yourself time to adjust – it’s a difficult time in your life, so feel free to mourn your losses and be patient with yourself as you heal from your experiences.
Ask for help from people who love you and care about you – remember, though, that if those closest to you have experienced the same trauma, your support system may be weakened.
Talk about your experience – write for us, The Band. Keep a private journal. Talk to friends. Talk to a counselor. Just talk to others.
Participate in social activities, even if you don’t want to. You may find that doing things that “normal people” who have not experienced the trauma do may inspire you.
Join a local support group for trauma survivors in your area – finding people who understand your feelings and feel like you do is invaluable. It can help you learn, grow, and heal from your trauma. If you cannot locate a local support group, see if you can find an online support group to join.
Healthy behaviors to manage stress are key – eat well. Drink lots of water. Get enough sleep. Meditate. Make sure to exercise.
Volunteer – while helping others, volunteering can be a great way to challenge the feelings of helplessness brought about by the trauma and remind you of your strengths.
Reestablish (or establish new) routines to restore some feelings of normalcy into your life.
Break larger jobs into smaller, more manageable tasks to take pleasure from accomplishing even the smallest of things.
Find and do activities that make you feel better while occupying your mind. That way, you’re not dedicating all your time, energy and attention to the traumatic experience.
Allow yourself your feelings. Acknowledge them. Accept them. They are normal and must be accepted to heal.
Avoid major life decisions – moving across the country, changing jobs, buying a new car – without taking a time-out first to make sure this is a wise choice.
Avoid self-medication with drugs, alcohol or food. These can worsen symptoms and exacerbate feelings of depression, isolation, and anxiety.
Reduce stress. Meditate. Do yoga. Spend time with friends. Enjoy a hobby. Anything that brings you joy.
How To Help Someone Else Deal With Emotional Trauma:
It’s really hard to know how to help someone else who has suffered a traumatic, distressing experience. Your support, however, can be critical in their recovery. Here are some tips:
Be patient and understanding. There’s no time-frame on recovery from trauma and healing cannot be rushed.
Don’t judge. Remember that everyone’s reaction to a trauma is different.
Offer practical support (housework help, getting groceries) to help your loved one get back into a normal routine. While dealing with a trauma, normal routines often go by the wayside.
Don’t pressure your loved one into talking about it, but be there if they do want to talk. Some people who have been through traumatic experiences don’t want to talk about it, while others may want to rehash the event over and over. They are both normal reactions.
Help your loved one to socialize and relax. Encourage physical exercise, activities that allow them to de-stress, and hobbies they enjoy. Make time each week to spend time with your friend.
Don’t take it personally – some of the trauma symptoms can be hard for others to handle. When your loved one becomes angry, irritable, grouchy, distant or withdrawn, remember that this is a normal reaction to the trauma and not indicative of your relationship.
Additional Resources For Trauma:
David Baldwin’s Trauma Information Pages offers support for various traumas – psychological trauma, violent crime victims, veteran/combat trauma and many others.
The Survivor Manual provides a large collection of resources for those who have suffered from sexual trauma.
Page last audited 8/2018