6p Trauma

[Wesley Godinez]

Childrenas well as adults are susceptible to trauma. Shock, fear, anger, sadness, difficulty concentrating, and a sense of helplessness are common features of the immediate trauma response. Children may suddenly develop behavioral problems and exhibit clinginess. However, the effects usually abate over time, and the vast majority of people recover from trauma. Active coping skills and strong social support are important in mitigating symptoms and preventing the longer-term effects of trauma on mental health. It is estimated that only 3 percent to 10 percent of people who undergo a traumatic experience have persistent mental health difficulties known as post-traumatic stress disorder (PTSD).

Acute trauma reflects intense distress in the immediate aftermath of a one-time event of short duration. The reaction itself is short-term, resolving on its own or with the help of counseling. A car crash, physical or sexual assault, the sudden death of a loved one, or even a medical emergency can create acute trauma.

Chronic trauma refers to the harmful effects of events that are repeated or prolonged. It can develop in response to persistent bullying, neglect, abuse (emotional, physical, or sexual), and domestic violence. Because of its repeated nature and inescapability, chronic trauma often has serious mental health consequences for individuals.

Complex trauma can arise from experiencing repeated or multiple traumatic events of differing types from which there is no possibility of escape, such as repeated child abuse. 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, and constant (and exhausting!) monitoring of the environment for the possibility of threat. Complex trauma experienced in childhood has been associated with the development of borderline personality disorder as well as PTSD.

Disturbing events activate the amygdala, a structure in the brain responsible for detecting threats. It responds by sending out an alarm to multiple body systems to prepare for defense. The sympathetic nervous system jumps into action, stimulating the release of adrenaline, noradrenaline, 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 dissipate as the crisis abates and the experience fades from memory, but for some people, the distressing feelings can linger, interfering with day-to-day life.

Positive psychological changes after trauma are also possible when people acknowledge their difficulties and see themselves as survivors rather than victims of unfortunate experiences. These can include building resilience, the development of effective coping skills, and the development of a sense of self-efficacy. Some people may undergo post-traumatic growth, forging stronger relationships, redefining their relationships 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 PTSD.

Many factors are associated with resilience to trauma. Researchers have identified attributes of individuals that prevent the development of PTSD, and they have also found that various features of social context can provide important protections. Studies show that six psychosocial factors promote resilience in individuals: optimism, cognitive flexibility, active coping skills, maintaining a supportive social network, attending to one's physical well-being, and embracing a personal moral compass and sense of purpose. In addition, establishing a sense of safety is critical for overcoming the effects of trauma.

In addition, lifestyle factors can promote recovery. Eating healthy, exercising, avoiding alcohol and drugs, getting enough sleep, seeing loved ones regularly, and engaging in self-care can help relieve trauma symptoms. Talking about the event, especially sharing feelings with others who underwent the experience, may also be helpful.

Often in the immediate wake of catastrophes and other traumatic events, the desire to help people manage their distress and to prevent future psychological problems has led to the practice of psychological debriefing, in which individuals are encouraged to recollect the event. However, research finds that debriefing is not only not effective, it can actually be harmful, increasing the risk for eventual depression and PTSD. It is not considered an appropriate mental health intervention in the immediate aftermath of trauma.

Psychological intervention can be helpful for some people in the wake of trauma. Those who stand to benefit are individuals whose symptoms of distress show no signs of abating after one month or whose symptoms become so severe they interfere with everyday functioning. 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.

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. Viewing ordinary, if imperfect, childhood experiences as examples of trauma not only misunderstands the nature of experience but misstates the capacity for resilience that most people have.

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.

Psychological trauma (also known as mental trauma, psychiatric trauma, emotional damage, or psychotrauma) is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.[1]

Short-term reactions such as psychological shock and psychological denial are typically followed. Long-term reactions and effects include bipolar disorder, uncontrollable flashbacks, panic attacks, insomnia, nightmare disorder, difficulties with interpersonal relationships, and post-traumatic stress disorder (PTSD). Physical symptoms including migraines, hyperventilation, hyperhidrosis, and nausea are often developed.[2]

As subjective experiences differ between individuals, people react to similar events differently. Most people who experience a potentially traumatic event do not become psychologically traumatized, though they may be distressed and experience suffering.[3] Some will develop PTSD after exposure to a traumatic event, or series of events.[4][5] This discrepancy in risk rate can be attributed to protective factors some individuals have, that enable them to cope with difficult events, including temperamental and environmental factors, such as resilience and willingness to seek help.[6]

People who experience trauma often have problems and difficulties afterwards. The severity of these symptoms depends on the person, the types of trauma involved, and the support and treatment they receive from others. The range of reactions to trauma can be wide and varied, and differ in severity from person to person.[7]

After a traumatic experience, a person may re-experience the trauma mentally and physically. For example, the sound of a motorcycle engine may cause intrusive thoughts or a sense of re-experiencing a traumatic experience that involved a similar sound e.g. gunfire. Sometimes a benign stimulus (e.g. noise from a motorcycle) may get connected in the mind with the traumatic experience. This process is called traumatic coupling.[8] In this process, the benign stimulus becomes a trauma reminder, also called a trauma trigger. These can produce uncomfortable and even painful feelings. Re-experiencing can damage people's sense of safety, self, self-efficacy, as well as their ability to regulate emotions and navigate relationships. They may turn to psychoactive drugs, including alcohol, to try to escape or dampen the feelings. These triggers cause flashbacks, which are dissociative experiences where the person feels as though the events are recurring. Flashbacks can range from distraction to complete dissociation or loss of awareness of the current context. Re-experiencing of symptoms is a sign that the body and mind are actively struggling to cope with the traumatic experience.

Triggers and cues act as reminders of the trauma and can cause anxiety and other associated emotions.[9] Often the person can be completely unaware of what these triggers are. In many cases, this may lead a person with a traumatic disorder to engage in disruptive behaviors or self-destructive coping mechanisms, often without being fully aware of the nature or causes of their own actions. Panic attacks are an example of a psychosomatic response to such emotional triggers.[10]

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