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What is trauma?

(This is an article directly copied from  Psychology Today magazine.)

Trauma

What Is Trauma?

Trauma is a person’s emotional response to a distressing experience. Few people can go through life without encountering some kind of trauma. Unlike ordinary hardships, traumatic events tend to be sudden and unpredictable, involve a serious threat to life—like bodily injury or death—and feel beyond a person’s control. Most importantly, events are traumatic to the degree that they undermine a person's sense of safety in the world and create a sense that catastrophe could strike at any time.  

Some common traumatic events include:

  • Parental loss in childhood
  • Auto accidents
  • Physical violence
  • Sexual assault
  • Military combat experiences
  • Unexpected loss of a loved one

Contents

Types of Trauma

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Acute trauma reflects intense distress in the immediate aftermath of a one-time event and the reaction is of relatively short duration. Common examples include a car crash, physical or sexual assault, or the sudden death of a loved one.

Chronic trauma can arise from harmful events that are repeated or prolonged. It can develop in response to persistent bullying, neglect, abuse (emotional, physical, or sexual), and domestic violence.

Complex trauma can arise from experiencing repeated or multiple traumatic events from which there is no possibility of escape. The sense of being trapped is a feature of the experience. Like other types of trauma, it can undermine a sense of safety in the world and beget hypervigilance, constant (and exhausting!) monitoring of the environment for the possibility of threat.

Secondary or vicarious trauma arises from exposure to other people’s suffering and can strike those in professions that are called on to respond to injury and mayhem, notably physicians, first responders, and law enforcement. Over time, such individuals are at risk for compassion fatigue, whereby they avoid investing emotionally in other people in an attempt to protect themselves from experiencing distress.

Adverse Childhood Experiences (ACE) cover a wide range of difficult situations that children either directly face or witness while growing up, before they have developed effective coping skills. ACEs can disrupt the normal course of development and the emotional injury can last long into adulthood. The loss of a parent; neglect; emotional, physical, or sexual abuse; and divorce are among the most common types of Adverse Childhood Experiences.

Effects of Trauma

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Disturbing events activate the amygdala, a structure in the brain responsible for detecting threats.  It is the anxiety center of the brain and is what kept us alive on the savannah when tigers wanted to eat us!  It responds by sending out an alarm to multiple body systems to prepare for defense. The (sympathetic) nervous system jumps into action, causing the release of chemicals that cause us to feel anxiety and stress hormones that prepare the body for a fight-flight-or-freeze response. Short-term fear, anxiety, shock, and anger/aggression are all normal responses to trauma. Such negative feelings tend to fade away as the crisis abates and the experience fades from memory but, for some people, the distressing feelings can be long term and interfere with day-to-day life for days, weeks, or decades.

Sufferers of long-term trauma may develop emotional disturbances, such as 

  • Extreme anxiety 
  • Anger
  • Sadness
  • Survivor’s guilt
  • Disassociation (feeling disconnected from yourself and the world around you)
  • Anhedonia (the inability to feel pleasure)
  • PTSI (post-traumatic stress injury)

The amygdala (anxiety center of the brain) becomes hyperactive, its over-reaction to minor disturbances lead to an outpouring of stress hormones and anxiety. Living in a "ready to react to danger" mode, and being ever-watchful for the possibility of threat (vigilant), people may experience ongoing problems with sleep or physical pain, encounter turbulence in their personal and professional relationships, and feel a diminished sense of self-worth. Their bodies may develop mild to chronic illness such as migraines, IBS, diabetes, heart problems and more.  The more severe illnesses usually result from experiences multiple and severe stressors through the developmental years.  

Positive psychological changes after trauma are also possible when people acknowledge their difficulties and see themselves as survivors rather than victims of unfortunate experience. These can include building resilience, the development of effective coping skills, and development of a sense of self.-efficacy. Some people may undergo post-traumatic growth, forging stronger relationships, redefining their relationship with new meaning and/or spiritual purpose, and gaining a deeper appreciation for life. It may sound contradictory, but post-traumatic growth can exist right alongside PTSI.

Treatment for Trauma

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Left unaddressed or untreated, trauma can undermine relationships and wreak havoc on personal and professional lives. There are multiple avenues of treatment available for people experiencing from short- or long-term trauma symptoms.

Lifestyle changes are an early treatment option to consider. Eating healthy, exercising, avoiding alcohol and drugs, getting enough sleep, seeing loved ones regularly, and emphasizing self-care can help relieve trauma symptoms.

Psychotherapy can help a person build resilience, develop coping skills, and address unresolved feelings that are keeping them stuck. Exposure therapy and cognitive reappraisal therapy are two of the more reliable treatments for trauma and PTSD.

Trauma-informed care treats the whole person, recognizes past trauma and the maladaptive coping mechanisms that the individual may have adopted to survive their distressing experience.. Trauma-focused cognitive behavioral therapy is frequently used to address the destructive effects of early trauma, proving particularly helpful to youth with PTSI and mood disorders resulting from abuse, violence, or unresolved grief.

Psychedelic-assisted psychotherapy with MDMA (aka Ecstasy or Molly) is a promising form of treatment for deep-seated trauma. Under a therapist’s supervision and support, PTSI patients are given MDMA to help them talk in depth about disturbing traumatic experiences and learn to control their reactivity. The MDMA appears to speed up the therapeutic process for patients.

Ketamine (special Kmay also be used to expedite recovery. It is injected under a therapist’s supervision prior to a talk therapy session. Research has shown it to be effective.

Controversies About Trauma

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There are many myths about trauma that impede understanding and care. For example, there is a popular assumption that all childhoods are traumatic, which causes people to mistake ordinary hardship or distress for genuine trauma. While this view of trauma may seem initially validating of a difficult experience, it can quickly lead individuals to question their own experiences growing up and the adequacy of their caretakers.

Another common misconception about trauma is that it will destroy your life forever. Some people who experience trauma assume the identity of a victim, expecting the world to harm them and seeing slights where they don't exist; this tendency has helped to create a culture of victimhood that does more harm than good by ignoring people's capacity for growth through challenge. Letting go of the victim label can enable people to see themselves instead as survivors, allowing them to grow and feel optimistic about the future.

It is generally assumed that talking about negative emotions and experiences leads to healing. However, with traumatic events, especially large-scale disasters or wars that impact thousands of people, data show that rehashing painful memories can be dangerous. As a result, treatments such as psychological debriefing are best deployed carefully and on a case-by-case basis. Everyone’s journey through trauma will be different.

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