Have you ever wondered what it actually means to be traumatized? People casually use the word "traumatic" to refer to everything from a moment of public embarrassment to a disappointing TV show finale. We all know that mental health professionals mean something different than what our friends mean when they use the term, but what exactly do they mean by it? How can we figure out if we have actually experienced trauma? If we have, what should we do about it?
Trauma refers to physical or psychological wounds that are so severe they overwhelm our normal coping and healing mechanisms. Physical trauma can include everything from bullet wounds to impact injuries from car accidents, while psychological trauma is a prolonged stress reaction to circumstances that threaten a person's life or well-being.
While post-traumatic stress disorder (PTSD) was not added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the primary reference guide for mental health professionals, until 1980, and the word trauma was not coined until the 17th century, people have observed traumatic psychological reactions and called them by different names for most of human history.
The earliest recorded cases of traumatic stress reactions are descriptions of soldiers' responses to battle in Greek histories from the 5th century BCE. Modern terms used to refer to battle trauma have progressed from "soldier's heart" during the Civil War to "shell shock" during World War I and "battle fatigue" in World War II. The first edition of the DSM, which was published in 1952, included a "gross stress reaction" diagnosis, which was changed to the familiar post-traumatic stress disorder diagnosis when the third edition of the DSM was published in 1980.
While we've long been aware that prolonged exposure to war trauma takes a psychological toll, it's only in recent decades that we've recognized that other circumstances can produce the same psychological reaction. We now know that symptoms similar to shell shock arise in response to a range of traumatic experiences, including sexual assault, natural disasters, and being a victim or witness to acts of personal or collective violence.
The DSM defines trauma as "direct or indirect exposure to actual or threatened death, serious injury, or sexual violence." Direct exposure occurs when a person is directly threatened with or victimized by violence. Indirect exposure to trauma occurs when someone:
Trauma can arise as an acute response to a single incident or as a cumulative response to a series of events. When first responders repeatedly witness the aftermath of violence, they may suffer cumulative trauma in response to the full scale of what they've seen.
Movies and television shows often dramatize the effects of trauma by showing characters having flashbacks. During flashbacks, people recall traumatic events so vividly that they feel as if they are reliving them. Flashbacks are one of the symptoms of PTSD, but not everyone who has PTSD experiences them. Other intrusive PTSD symptoms include nightmares and unwanted memories.
Trauma impacts mood and cognition in ways that can resemble the effects of depression. People with unresolved trauma often have difficulty experiencing the full range of emotion they had before the trauma. Some people become hypervigilant after a traumatic event, or more easily startled by sudden environmental changes and more reactive to them. Others experience emotional numbing and have minimal or no reaction to emotional events that would have affected them before. Many people feel irrational guilt or shame about what happened to them.
People who have experienced a traumatic event typically avoid places or situations where they fear a similar trauma could occur or that could trigger memories, thoughts, or feelings related to the trauma. People with trauma histories may use substances to blunt their emotions or block traumatic memories, which can cause them to develop co-occurring substance use disorders.
Dissociative symptoms are common across a range of trauma-related conditions. People who suffer repeated trauma may learn how to remove themselves psychologically from what they are experiencing. When people dissociate, they detach from their thoughts, feelings, or sense of self. They may escape into their imaginations or disconnect from their experience to the extent they feel as if they are observing themselves from a distance.
"Spacing out" or escaping into a steady stream of distractions are dissociative strategies we all use to counter boredom or anxiety; people who have trauma-related symptoms or disorders may engage in these behaviors to excess or may experience more severe forms of dissociation, like periods of dissociative amnesia, or "blackouts."
Conditions listed as trauma-related conditions in the DSM include PTSD; acute stress disorder, which is similar to PTSD but slightly less severe; adjustment disorders, which are caused by stress rather than trauma; and two traumatic disorders of childhood, reactive attachment disorder and disinhibited social engagement disorder.
Many disorders that are not specifically listed as trauma-related disorders in the DSM are now better understood as being rooted in trauma, especially personality disorders. Research suggests that trauma, especially childhood trauma, increases the risk of nearly every kind of mental health condition. Trauma has been linked with higher rates of:
Not everyone who experiences trauma will develop a mental health condition as a result of that trauma. Some people experience a few isolated symptoms or are able to resolve the trauma before symptoms arise. However, many people experience trauma-related changes in their emotional health that require therapy to resolve.
If you know or suspect that you have been exposed to trauma and have experienced any of the symptoms described in this article, consider reaching out to a therapist. Symptoms of trauma can compound over time and lead to complications like co-occurring mood, anxiety, or substance use disorders; conflicts with loved ones; and problems at work or home.
Therapy provides a safe place for people who have experienced trauma to explore and confront what happened. In therapy, traumatized individuals can process feelings that are overwhelming to engage on their own. This helps them regain a sense of power and safety and overcome the sense of helplessness traumatic events often cause.
Several promising interventions for trauma-related disorders or symptoms have emerged in the last couple of decades, and a growing body of research supports their efficacy. Evidence-based interventions for traumatic stress have been shown to help people who struggle with treatment-resistant depression, borderline personality disorder, and substance use disorders. Some of the most well-supported evidence-based interventions for trauma include:
Both EMDR and PET are forms of exposure therapy that use different techniques to help people gradually explore and process memories, feelings, thoughts, and bodily sensations related to the trauma. Cognitive processing therapy helps people understand how trauma changed the ways they think and feel and to learn new ways to think about what happened.
Dialectical behavior therapy was originally developed to treat borderline personality disorder but works well for most trauma-related conditions. It is especially effective in treating symptoms of dissociation or emotional dysregulation, as it provides tools to help people accept and reconnect to their inner states in a healthy way.
Improved understanding of trauma has revolutionized the field of mental health. New insights into the effects of trauma have led to effective new therapies for trauma-related conditions and initiatives to train more therapists in them. Clinicians now understand that trauma is a factor in mental health conditions other than PTSD and that evidence-based treatments for trauma can resolve previously treatment-resistant symptoms or disorders. The revolution in trauma-informed care brings renewed hope for people who bear trauma's hidden wounds.
It is possible to heal from trauma. If you have unresolved trauma or suspect that you might, consider looking for a qualified therapist. An increasing number of therapists are certified in trauma-informed care and trained in specific treatments for trauma-related conditions. You can search for local counselors that provide trauma-informed care on OpenCounseling or look for trauma-certified providers online at BetterHelp (a sponsor). With a therapist's help, you can reclaim your sense of hope and safety and connect to yourself and your life again.
Another Labor Day has come and gone and most kids are back in school. As summer ends and a new academic year begins, the focus shifts from planning...
Ever since Consumer Reports tested different types of therapy in the 1990s and found marriage counseling to be the least effective of all of...
Like everyone else, children may certainly be in need of counseling at some point in their young lives. Unfortunately, children often lack the...
Therapy has the potential to be profoundly healing. A good therapist gives you a safe space where you can talk about things you've never...
There are times in life when everything is going smoothly, then suddenly comes to a stop. After long periods of growth and progress, it's...
Good therapy can seem like magic. You sit in your therapist's office and talk and things in your life start to get better. You don't...
The last article in the "Making Therapy Successful" series explored how to set goals for therapy. By thinking about what you want...
