Trauma

Trauma

Traumatic events, such as being assaulted or experiencing a natural disaster, can seriously affect a person’s physical and mental health. These one-off experiences of trauma are called single-incident trauma.

Complex trauma is something different and usually occurs as a result of repeated trauma experienced by a child or young person, although it can also occur as a result of experiences as an adult and some people experience trauma across their lives. 

Not all people who experience single-incident or complex trauma will go on to develop Post Traumatic Stress Disorder (PTSD) or Complex PTSD, but those who do experience ongoing trauma reactions need professional help and treatment.

CATEGORY: Life Events

SOURCES: APS | verywellmind.com | BMD | blueknot.org.au

Number: #5

 

Philippine Tarsier Looking Scared
Border Collie Peeks Out With One Eye 1 1
Hippo Has Head Burried In Green Pond 1
Hissing Cat 2

 

A study released by the Australian Bureau of Statistics’ National Study of Mental Health and Wellbeing in 2023 (5,500 people aged 16 to 85 years old during 2020-2021) showed that more than two in five Australians experience a mental health issue in their lifetime. In 2020–21 more than 3.4 million Australians sought help from a health care professional for their mental health.

The study is published at https://abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/2020-21

Ageneral explanation of trauma might be this:

 

Trauma is any type of distressing event or experience that can have an impact on a person’s ability to cope and function. Trauma can result in emotional, physical, and psychological harm. Many people will experience some kind of traumatic event—from the unexpected death of a loved one to a motor vehicle accident—at some point in their lifetime. But not everyone who experiences trauma will go on to develop PTSD or Complex PTSD.

Single Incident Trauma

People can experience single incident trauma from a car accident, the death of loved one, imprisonment, job loss, divorce, a bushfire, flood, sexual or physical assault in adulthood, traumatic birth experiences, or from fighting in a war, for example. Single incident traumas can be experienced at any age, and affect people differently. 

Whether someone is able to work through the traumatic event afterwards depends on lots of variables, including the provision of support at the time of the event and afterwards.

Complex Trauma

Repeated trauma can be experienced as a child or young person, or as an adult, and it is the chronic and repetitive nature of the trauma that makes it complex. Complex trauma often happens between people, is often planned, extreme ongoing and/or repeated, and often has long lasting impacts.

Some people do not appear to be affected badly by repeated trauma experiences and may not be, others might not recognise the effects of their trauma until much later.

Experiencing repeated trauma as a child:

If you are not protected or cared for as a child or young person, or are hurt or betrayed, it can affect you badly.

People who were emotionally, physically or sexually abused or physically or emotionally neglected, bullied, cyberbullied, exploited, trafficked or subjected to forced adoption practices as a child or young person often experience complex trauma. So can people who experienced or witnessed violence in the community or in the home and family when they were growing up.

Being culturally dislocated such as occurs with young refugees or asylum seekers and many of our own First Nations children and young people, as well as being discriminated against such as often occurs for children and young people with disability, those from the LGBTIQ+ community and from multicultural communities are other causes.

There are lot of possible ways in which children and young people can experience repeated trauma.

Experiencing repeated trauma as an adult:

Experience of violence in the home, family, neighbourhood and workplace can be causes of complex trauma in adults. The trauma can be physical, sexual, emotional, verbal, financial or spiritual. Other causes in adulthood are violence in the community such as civil unrest, war trauma or genocide, refugee and asylum seeker trauma, sexual exploitation and trafficking, extreme medical trauma and repeated deployments such as for emergency personnel, armed forces.

PTSD & Complex PTSD

Experiencing trauma, even repeated trauma, does not always lead to the development of PTSD or Complex PTSD for people.

When someone is ‘stuck’ in their trauma response, endlessly reliving it and experiencing debilitating symptoms that impair their daily functioning, they may have PTSD and/or Complex PTSD and will require help and treatment. It’s important to note that people with experiences of complex trauma may also experience PTSD, in addition to the impacts caused by their complex trauma experiences.

Symptoms

dropcap]S[/dropcap]ymptoms people experience after trauma are, at least initially, actually an expected and normal response to the trauma experience, and while they are distressing, they are not an indicator that you have PTSD or Complex PTSD, nor that you will go on to develop PTSD or Complex PTSD.

Usually the symptoms experienced by someone in the days and weeks after a single-incident trauma experience are less severe and less intense than those experienced by someone with PTSD or Complex PTSD.

PTSD cannot be diagnosed until at least 30 days have passed since the trauma, as many PTSD-like symptoms in that periods are actually part of your body’s natural response to a traumatic event, and for many people, these symptoms will gradually reduce over time.

Single Incident Trauma

Expected responses to trauma, primarily single-incident trauma, in the initial days and weeks include:

Intrusive thoughts and memories: After a traumatic event, it is common to experience some intrusive thoughts and memories of the traumatic event. This is especially likely to occur when you encounter something (for example, a person, place, or image) that reminds you of the traumatic event.

Hypervigilance: It is also very natural to feel more on-guard and aware of your surroundings after a traumatic event. This is actually a very protective symptom as your body is attempting to keep you safe by making you more aware of potential sources of threat and danger. This natural safety mechanism is going to be more sensitive following a traumatic event.

Hyperarousal: Just as you are going to likely be more on-guard, you are also likely going to feel more keyed-up and on edge following a traumatic event. This is again part of your body’s natural protection system. Fear and anxiety tell us that there is some kind of danger present, and all the bodily sensations that go along with fear and anxiety are essentially designed to help us respond to that danger. They are preparing us to flee, freeze, or to fight. Following a traumatic event, your body’s alarm system is going to be more sensitive in an attempt to protect you from future traumatic events.

Feeling unsafe: After a traumatic event, our assumptions about the world being a safe and secure place are understandably shattered. Consequently, people may feel as though any situation or place is potentially dangerous. Places or situations you once felt secure in may now feel threatening and be anxiety-provoking. This is especially likely to occur in situations or places that remind you of your traumatic event.

Symptoms that can be a sign that you may be at risk for developing PTSD are listed below, and if you experience these, you need to keep an eye on this. They may cause the expected trauma symptoms listed above to become worse, eventually leading to PTSD:

Loss of interest: It is important to keep an eye out for a loss of interest in activities that you used to once enjoy, as well as feelings of being detached from others. This symptom can be a sign that you are ​at risk of becoming depressed. This symptom may also cause you to isolate yourself from others, including important sources of social support.

Avoidance: After a traumatic event, it is very common to avoid certain situations, activities, or people. However, you must pay attention to avoidance behaviors. Avoidance usually leads to more avoidance as it reinforces the belief that the world is not a safe place. This avoidance can then lead to a worsening of symptoms and eventually PTSD.

Unhealthy coping behaviors: Just as avoidance of activities, situations, or people can be problematic, so can the avoidance of thoughts and feelings. The symptoms people experience after a traumatic event can be very distressing. As a result, people may rely on unhealthy coping strategies (for example, using substances) as a way of avoiding these symptoms. Avoidance is only a short-term solution, and in the long-run, it can actually cause your feelings and thoughts to become more intense.

If you are still experiencing symptoms for some time after the single-incident trauma experience and these symptoms have a significant impact on your daily living, it will pay to have a GP or psychologist check to see if you meet the diagnostic criteria for a trauma- or stressor-related disorder or possibly an adjustment disorder, depending on the exact nature of your symptoms.

Complex Trauma

Complex trauma symptoms may be better conceptualised as impacts, as they tend to be long-lasting and pervasive. They can overlap with those described above and often include things like:

  • difficulties in relationships and interactions with people
  • ‘being or feeling’ trapped
  • feeling ashamed
  • unable to feel safe
  • unable to trust
  • feeling bad about yourself
  • problems managing your feelings
  • use of unhelpful or unhealthy coping strategies such as alcohol and drugs, self-harm, over- or under-eating or over-working
  • compromised physical and mental health and wellbeing
  • impacts ability to manage your daily life

Diagnosis

 

With the update of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, PTSD and OCD were removed from the anxiety disorders and each given a category of their own. PTSD is now in a category called trauma and stressor related disorders, and this category also includes other disorders, such as adjustment disorders.

PTSD is not diagnosed until at least 30 days have passed since the experience of a single-incident traumatic event. It is possible to consider a particular event that has occurred within the context of repeated traumatic events as a single-incident trauma in terms of understanding someone’s presentation around that event. It is important to also consider the context however, as there will be other impacts not necessarily common to single incident traumas that happen to someone who does not have a history or repeated exposure to traumatic events as well.

Complex PTSD has not been formally recognised as a diagnosable disorder in the two most common classification systems used for mental health disorders, the DSM and the ICD, until recently. The ICD will be adding the diagnosis of Complex PTSD to it’s 2022 revision. While this diagnosis does perhaps not fully describe complex trauma, this is seen by many as an important step in part because the treatment of complex PTSD is different to that of PTSD alone.

Therapy | Treatment

Let’s make a distinction between treatment of ‘normal’ responses to traumatic events and PTSD/Complex PTSD treatment.

Things that can be helpful and can improve recovery after experiencing a traumatic event include:

  • Accept that you have had a distressing experience and it is natural to react to it. Denying or refusing to do so can hinder recovery.
  • Remind yourself daily that your reactions are normal and that you can and are coping; don’t be angry with yourself for being upset.
  • Avoid overusing alcohol or drugs to cope.
  • Avoid making any major decisions or big life changes, as distress can affect your judgement.
  • Do not block out thoughts of the event. Gradually confronting it will help you move on from the experience.
  • Don’t ‘bottle up’ your feelings. Talking or writing about the trauma helps deal with it, even though this may feel uncomfortable.
  • Maintain a normal routine. Keep busy, structure your day and try not to unnecessarily avoid certain activities or places.
  • Rest, exercise regularly, relax and become involved with a group or hobby. These activities help you to settle and readjust.
  • If the trauma stirs up other memories or feelings from past, or unrelated stressful events, try to separate the feelings and deal with the experiences individually.
  • Finally, tell friends and family about your needs and reactions and spend time with loved ones. Their support will help speed up recovery.

If you are struggling to recover, and/or have developed PTSD or Complex PTSD, treatment will need to involve a professional, and treatment will depend on the symptoms you are experiencing as a result of the trauma.

It may involve psychotherapy, medication, self-care, or a combination of these approaches. Treatments often focus on helping people integrate their emotional response to the trauma as well as addressing any resulting mental health conditions such as anxiety, depression, or PTSD.

Psychotherapy

Treatment may involve the use of cognitive behavioral therapy (CBT) to help people evaluate thoughts and feelings related to trauma and replace negative thinking with more realistic thoughts.

Eye movement desensitization and reprocessing (EMDR) is another approach that utilises elements of CBT combined with eye or body movements.

In treating someone with chronic experiences of trauma it is important to assess and understand all the ways in which their daily and interpersonal functioning is affected, and how their sense of themselves has been compromised. Understandable but debilitating impacts likely  to be present and needing treatment may include entrenched mistrust of others, a sense of the world as an unsafe place, of themselves as damaged, broken, unworthy, and unfixable and impacts are likely rippling into all areas of their lives, including relationships, friendships, family dynamics, work environments, coping strategies, and mental and physical health more generally.

Medications

If you have been diagnosed with PTSD as a result of trauma, or have complex trauma experiences, there are medications that may also be helpful as a part of your treatment. These medications may include:

Antidepressants, including serotonin reuptake inhibitors (SSRIs) such as Lexapro and Zoloft (sertraline), both of which have been approved for the treatment of PTSD.

Anti-anxiety medications, such as benzodiazepines including Valium (diazepam) and lorazepam.