Trauma is more common than we think, yet its effects can be deeply isolating and often misunderstood. There are many definitions of what constitutes “trauma,” but a broad definition is a response to an event or series of events that disrupt an individuals’ felt sense of safety, well-being, and functioning. Trauma can negatively impact all aspects of our lives, from tasks of daily living like sleeping and eating, to how we interact in our relationships, and how we feel about ourselves. Understanding the different types of trauma, its impacts on the brain and body, and how symptoms may manifest following trauma will be explored in this blog.
Understanding Trauma and Its Impact on Mental Health
There are many different types of trauma one can experience:
- Acute trauma: Acute trauma occurs when one experiences a single, isolated event that is overwhelming and distressing. This may include incidents such as a car accident, robbery, sexual assault, natural disaster, or the sudden death of a loved one.
- Chronic trauma: This kind of trauma entails prolonged, repeated exposure to a series of distressing events. Examples of chronic trauma include exposure to domestic abuse or violence or living in a war zone with repeated exposure to violence.
- Childhood trauma: Childhood trauma occurs when a child or adolescent has experienced single or repeated exposure to distressing events during childhood, often at the hands of their caregivers and/or peers. Examples of this include physical abuse, sexual abuse, emotional abuse or neglect, abandonment, witnessing parental substance use or domestic violence, or severe bullying and social rejection.
- Complex trauma: Complex trauma occurs when an individual has been exposed to multiple traumatic events. They have likely experienced prolonged childhood trauma as well as other traumatic events in adulthood. These individuals often experienced severe emotional dysregulation, attachment issues, low self-worth, and identity issues.
- Vicarious (Secondary) Trauma: Vicarious trauma happens when an individual is indirectly exposed to a traumatic event, such as by hearing about an event or repeatedly seeing images of an event. Therapists and counselors can experience vicarious trauma through repeated exposure to the stories they hear from their clients who are processing trauma. Vicarious trauma is also common in first responders, paramedics, and firefighters who arrive at the scene of accidents or disasters.
- Cultural or Collective Trauma: Cultural or collective trauma refers to trauma that impacts a specific community or group of people, often due to historical or societal events. Examples of this include the impact of the Holocaust on Jewish communities or slavery and its impacts on its descendants.
- Intergenerational Trauma: This kind of trauma occurs when the trauma experienced by one generation is unresolved and therefore impacts subsequent generations through both genetic and environmental factors. Children of parents who have experienced trauma and its impacts are more likely to experience childhood trauma and may go on to develop mental health difficulties if left unresolved.
- Betrayal Trauma: Betrayal trauma occurs when someone who is meant to be a trustworthy, safe individual betrays the trust of another in a severe or damaging way. Individuals may experience betrayal trauma from a parent or caregiver, coach, religious figure, teacher, spouse or friend. Examples of this can include infidelity in romantic relationships or sexual assault or molestation by a trusted adult.
How Trauma Impacts the Brain
Trauma is subjective, meaning one person may perceive an event to be traumatic while another person may perceive that same event differently. During a traumatic event, the brain’s stress response system, which includes the limbic system and in particular, the amygdala, becomes active. This system produces cortisol and adrenaline which helps the body either flee from the threat or fight it off. If fleeing or fighting are not feasible options, the body will go into a temporary freeze response as its last defense for survival. Simultaneously, the prefrontal cortex (PFC), responsible for logic, reasoning, and decision-making goes offline. This makes it harder for the individual to think clearly and rationally during the event.
After someone experiences a traumatic event, the brain typically responds in one of two ways:
Pathway 1: In some cases, the brain returns to a baseline level of activity following the traumatic event. The sympathetic nervous system is turned off, while the parasympathetic nervous system, responsible for rest and digestion, is turned on. Additionally, the PFC comes back online which helps the individual process and make sense of the trauma. The hippocampus, which is responsible for memory formation, helps to encode the trauma into long-term memory. This path is more likely when the individual has access to a strong social support network and has adequate coping skills. Having someone to talk to about the traumatic event helps lessen the intensity and distress related to the event as well as helps integrate the memory into a cohesive narrative.
Pathway 2: Many individuals do not have adequate social support or coping skills following trauma which means they may not be able to fully process the event. When the trauma is unable to be fully processed, parts of the memory become fragmented into different parts of the brain. The hippocampus becomes less active and is unable to integrate and move the event into long-term memory. Oftentimes, individuals experience triggers related to the trauma where the past feels present. Triggers can be sounds, smells, tastes, images, places, or people that remind them of the trauma. When a person experiences a trigger, their bodies will go into fight, flight, or freeze mode because the brain is perceiving that trigger as a signal for threat or danger. The amygdala remains on overdrive meaning the individual will become hypervigilant for signs of danger and the body will be in a prolonged state of fight, flight, or freeze mode. Additionally, the PFC is less active, meaning the individual will have more difficulty making decisions, concentrating, managing impulses, and regulating emotions. This can cause significant disruptions in relationships, daily functioning, and overall well-being. The individual may go on to develop a variety of mental health problems that stem from the trauma, including PTSD or CPTSD.
Posttraumatic Stress Disorder (PTSD)
PTSD is one disorder an individual may develop following a traumatic event and is characterized by the following symptoms:
- Intrusion Symptoms: Following a traumatic event, the individual may experience intrusion symptoms in the form of flashbacks, nightmares, intrusive thoughts or memories related to the event, or any form of distress when the individual is exposed to reminders of the event (i.e., sights, sounds, smells).
- Avoidance Symptoms: Avoidance is a common reaction to trauma due to the distress and fear related to thinking about the event. Individuals will tend to avoid encountering anything that reminds them of the trauma, including people, places, activities, and objects. It is also common for individuals to try to avoid thinking about the trauma or feeling the emotions related to it.
- Negative Alterations in Mood and Cognitions: This symptom category includes a variety of changes in how one feels and thinks following a traumatic event. An individual may experience:
- Dissociative amnesia: This is an inability to remember certain aspects of the event. This is a protective mechanism meant to shield an individual from the distressing and overwhelming aspects of traumatic events.
- Negative thought or beliefs: An individual may have negative beliefs about themselves and the world attached to the trauma, including beliefs such as “this was my fault,” “I am bad,” “the world is dangerous,” and “I am powerless.” It is common for individuals to have distorted beliefs about the cause of the trauma, often blaming themselves and believing they could have done something differently to prevent the trauma from happening. This is an individual’s way of trying to gain some control over what happened to them.
- Negative emotionality: It is common for individuals to experience negative emotions such as helplessness, hopelessness, guilt, shame, anger, anxiety, and irritability related to trauma.
- Emotional numbness: It is also common for individuals to feel emotionally numb and detached from themselves and others. This is the body’s mechanism of placing the individual in a prolonged “freeze” state to protect against further threats to survival.
- Difficulty experiencing positive emotions: The individual may have difficulty experiencing positive emotions, like joy, happiness, or a sense of ease and calm. When the body is in a prolonged state of fight, flight, or freeze, the part of the brain responsible for feelings of connection, engagement, and calm is less active.
- Arousal and reactivity symptoms: These symptoms include hypervigilance, or a feeling of being on alert for threats in the environment. Individuals may be hyperreactive to stimuli and experience angry outbursts or difficulty controlling their emotions. Sleep difficulties, like difficulty falling or staying asleep, are also common. Individuals may also have difficulty concentrating and staying on task due to prolonged hypervigilance and intrusive ideation.
Complex Posttraumatic Stress Disorder (CPTSD)
PTSD is more common when an individual has experienced an isolated, acute traumatic event. Chronic and prolonged trauma can result in symptoms of complex PTSD (CPTSD). CPTSD includes the core symptoms of PTSD mentioned above, but also includes other symptoms and impacts associated with the prolonged nature of the trauma. These impacts include:
- Affective dysregulation: Chronic difficulty managing emotions like intense anger, sadness, or emotional numbness. These individuals may experience more intense fluctuations in mood in response to trauma triggers.
- Negative self-concept: Chronic exposure to traumatic events can have a profound negative impact on self-esteem, often resulting in feelings of worthlessness, shame, and believing one to be broken or damaged in some way.
- Interpersonal difficulties: Individuals with CPTSD often have difficulty forming and maintaining relationships due to a pervasive fear or mistrust of others. They may fear abandonment, have difficulties with intimacy, and prefer to remain isolated and withdrawn from others for fear of getting hurt.
- Intrapersonal difficulties: CPTSD can also impact one’s identity formation, leaving these individuals without a clear sense of who they are. This can also negatively impact how they relate to others.
- Dissociation: Individuals with CPTSD may commonly feel emotionally numb and disconnected from themselves and others. They may experience a feeling of depersonalization, which involves feeling disconnected from one’s body, or derealization, which involves perceiving the environment around them as not real.
Trauma in any form can leave one feeling helpless, alone, and scared. Acknowledging that you have been impacted by trauma is the first step toward healing and recovery. While the effects of trauma can be devastating and have grave impacts on one’s physical and emotional health, there is hope. There are a variety of evidence-based treatments for trauma recovery that can help in alleviating trauma symptoms, processing traumatic memories, and reengaging with the world in a way that feels meaningful and connected.
If you or someone you know is struggling with symptoms of PTSD or CPTSD, reach out for help. Our team of mental health professionals at Integrated Care Clinic have specialized training in the treatment of trauma and are dedicated to helping individuals heal from trauma and regain a sense of connection, joy, and thriving in their lives.
