What is Trauma?
Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that can have lasting adverse effects on the individual’s functioning and physical, social, emotional well-being.
There are three main types of trauma: Acute, Chronic, or Complex
- Acute trauma results from a single incident.
- Chronic trauma is repeated and prolonged such as domestic violence or abuse.
- Complex trauma is exposure to varied and multiple traumatic events, often of an invasive, interpersonal nature.
Early childhood trauma generally refers to the traumatic experiences that occur to children ages 0-6. Children can experience various types of trauma including:
- Natural disasters
- Sexual abuse
- Physical abuse
- Domestic violence
- Medical injury, illness, or procedures
- Community violence
- Neglect, deprivation
- Traumatic grief
- Victim of crime
- Kidnapping
- Accidents
- School violence
- Loss
Trauma and Brain Development
Research has shown that children are particularly vulnerable to trauma because of their rapidly developing brain. During traumatic experiences, a child’s brain is in heightened state of stress and fear-related hormones are activated. Although, stress is a normal part of life, when a child is exposed to chronic trauma, like abuse or neglect, the child’s brain remains in this heightened pattern. Remaining in this heightened state can change the emotional, behavioral and cognitive functioning of the child in order to maintain and promote survival. Over time, these traumatic experiences can have a significant impact on a child’s future behavior, emotional development, mental and physical health.
Adverse Childhood Experiences Study
The Adverse Childhood Experiences Study (ACEs) underscores the impact of trauma on physical and mental health over time.
The ACEs is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego. More than 17,000 Health Maintenance Organization (HMO) members who underwent a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction.
The study uses the ACE score, which is a total count of the number of adverse childhood experiences reported by respondents to assess the total amount of stress during childhood. The greater the number of ACEs the greater the risk for the following problems later in life including alcoholism, depression, multiple sexual partners, suicide attempts, smoking and liver disease among other negative health related issues.
Read more on the ACE Study from The Centers for Disease Control
Information on Assessing and Treating Children who have Experienced Trauma
The National Child Traumatic Stress Network notes that, “children suffering from traumatic stress symptoms generally have difficulty regulating their behaviors and emotions. They may be clingy and fearful of new situations, easily frightened, difficult to console, and/or aggressive or impulsive. They many have difficulty sleeping, lose recently acquired developmental skills, and show regression in functioning and behavior.”
It is essential that children who have suffered trauma be identified and treated. The National Child Traumatic Stress Network has resources for mental health professionals, early childhood providers, and primary care physicians to help identify, assess, and treat children who have suffered traumatic stress.
Read more about Early Childhood Trauma from The National Child Traumatic Stress Network
Trauma can be experienced in a number of different settings. Settings might include home life, at school, the work place, in the wider community or in a war zone.
Whether an event is deemed traumatic is defined by the ‘subjective experience’ of it rather than the event itself.
We have provided a breakdown of experiences which might typify a traumatic experience.
There are two main categories of trauma. Types 1 and type 2.
Type 1 Trauma
Type 1 refers to single-incident traumas which are unexpected and come out of the blue. They can be referred to as big T trauma, shock or acute trauma. A condition related to big T trauma or Type 1 trauma is Post Traumatic Stress Disorder.
Examples of type 1 trauma might include:
- Severe illness or injury
- Violent assault
- Sexual assault
- Traumatic loss
- Mugging or robbery
- Being a victim of or witness to violence
- Witnessing a terrorist attack
- Witnessing a natural disaster
- Road accident
- Military combat incident
- Hospitalisation
- Psychiatric hospitalisation
- Childbirth
- Medical trauma
- Post suicide attempt trauma
- Life threatening illness or diagnosis
Type 2 Trauma
Complex trauma describes trauma which may have been experienced as part of childhood or early stages of development.
Repetitive trauma refers to trauma which has been repeated over a period of time and is often part of an interpersonal relationship where someone might feel trapped emotionally or physically. They may also feel as if they have been coerced or powerless to prevent the trauma.
A condition related to type 2 trauma is Complex Post Traumatic Stress Disorder.
Examples of type 2 trauma include:
- Sibling abuse
- Childhood emotional abuse
- Domestic violence
- Emotional neglect and attachment trauma
- Abandonment
- Verbal abuse
- Coercion
- Domestic physical abuse
- Long term misdiagnosis of a health problem
- Bullying at home at school or in a work setting
- Sexual abuse
- Emotional abuse
- Physical neglect
- Overly strict upbringing sometimes religious
Historical, Collective or Intergenerational Trauma
This trauma is characterized by psychological or emotional difficulties which can affect different communities, cultural groups and generations. Adaptive coping patterns can be passed intergenerationally. Examples might include:
- Racism
- Slavery
- Forcible removal from a family or community
- Genocide
- War
Vicarious or Secondary Trauma
This type of trauma can occur when someone speaks to someone who has experienced a trauma or witnessed a trauma first hand. The person listening can experience secondary trauma and experience symptoms experienced by the person explaining the trauma.
Little t trauma
Little t trauma is less prominent and discussed less often. Little t traumas are experiences which are part of the everyday and are an expected part of life. They may however be very traumatic. Examples might include:
- Loss of a loved one (not traumatic bereavement)
- Moving to a new house
- Losing a job
Psychological trauma is a response to an event that a person finds highly stressful. Examples include being in a war zone, a natural disaster, or an accident. Trauma can cause a wide range of physical and emotional symptoms.
Not everyone who experiences a stressful event will develop trauma. There are also various types of trauma. Some people will develop symptoms that resolve after a few weeks, while others will have more long-term effects.
With treatment, people can address the root cause of the trauma and find constructive ways to manage their symptoms.
In this article, we discuss the various types of trauma, trauma symptoms, and the available treatment options.
What is trauma?
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According to the American Psychological Association (APA), trauma is “an emotional response to a terrible event like an accident, rape, or natural disaster.”
However, a person may experience trauma as a response to any event they find physically or emotionally threatening or harmful.
A traumatized person can feel a range of emotions both immediately after the event and in the long term. They may feel overwhelmed, helpless, shocked, or have difficulty processing their experiences. Trauma can also cause physical symptoms.
Trauma can have long-term effects on the person’s well-being. If symptoms persist and do not decrease in severity, it can indicate that the trauma has developed into a mental health disorder called post-traumatic stress disorder (PTSD).
There are several types of trauma, including:
- Acute trauma: This results from a single stressful or dangerous event.
- Chronic trauma: This results from repeated and prolonged exposure to highly stressful events. Examples include cases of child abuse, bullying, or domestic violence.
- Complex trauma: This results from exposure to multiple traumatic events.
Secondary trauma, or vicarious trauma, is another form of trauma. With this form of trauma, a person develops trauma symptoms from close contact with someone who has experienced a traumatic event.
Family members, mental health professionals, and others who care for those who have experienced a traumatic event are at risk of vicarious trauma. The symptoms often mirror those of PTSD.
Symptoms
The symptoms of trauma range from mild to severe. Many factors determine how a traumatic event affects a person, including:
- their characteristics
- the presence of other mental health conditions
- previous exposure to traumatic events
- the type and characteristics of the event or events
- their background and approach to handling emotions
Emotional and psychological responses
A person who has experienced trauma may feel:
- denial
- anger
- fear
- sadness
- shame
- confusion
- anxiety
- depression
- numbness
- guilt
- hopelessness
- irritability
- difficulty concentrating
They may have emotional outbursts, find it difficult to cope with how they feel, or withdraw from others. Flashbacks, where a person relives the traumatic event in their mind, are common, as are nightmares.
Physical responses
Along with an emotional reaction, trauma can cause physical symptoms, such as:
- headaches
- digestive symptoms
- fatigue
- racing heart
- sweating
- feeling jumpy
Sometimes, a person will also experience hyperarousal, or when someone feels as though they are in a constant state of alertness. This may make it difficult to sleep.
Individuals may also go on to develop other mental health issues, such as depression, anxiety, and substance abuse problems.
Traumatic experiences
Some research estimates that 60–75% of people in North America experience a traumatic event at some point. The charity Mind in the United Kingdom lists the following as potential causes of trauma:
- bullying
- harassment
- physical, psychological, or sexual abuse
- sexual assault
- traffic collisions
- childbirth
- life threatening illnesses
- sudden loss of a loved one
- being attacked
- being kidnapped
- acts of terrorism
- natural disasters
- war
Traumatic events can be isolated or repeated, ongoing events. A person can also experience trauma after witnessing something traumatic happening to someone else.
People have different reactions to traumatic events. For example, those who live through the same natural disaster can respond very differently despite experiencing the same event.
PTSD
PTSD develops when the symptoms of trauma persist or get worse in the weeks and months after the stressful event. PTSD is distressing and interferes with a person’s daily life and relationships.
Symptoms include severe anxiety, flashbacks, and persistent memories of the event.
Another symptom of PTSD is avoidance behaviors. If a person tries to avoid thinking about the traumatic event, visiting the place where it occurred, or avoiding its triggers, it can be a sign of PTSD.
PTSD may last for years, although treatment can help people to manage their symptoms and improve their quality of life.
Risk factors for developing PTSD include:
- previous trauma
- physical pain or injury
- having little support after the trauma
- dealing with other stressors at the same time, such as financial difficulty
- previous anxiety or depression
Most people who experience a traumatic event do not develop PTSD. The National Institute of Mental Health estimate that the lifetime prevalence of PTSD in the United States is 6.8%.
Childhood trauma
Research indicates that children are especially vulnerable to trauma because their brains are still developing.
Children experience a heightened state of stress during terrible events, and their bodies release hormones related to stress and fear.
This type of developmental trauma can disrupt normal brain development. As a result, trauma, especially ongoing trauma, can significantly affect a child’s long-term emotional development, mental health, physical health, and behavior.
The sense of fear and helplessness may persist into adulthood. It leaves the person at a significantly higher risk of the effects of future trauma.
Treatment
Several treatments can help people with trauma to cope with their symptoms and improve their quality of life.
Therapy
Therapy is a first-line treatment for trauma. Ideally, an individual will work with a trauma informed or trauma focused therapist.
Types of therapy a person with trauma could benefit from include:
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) helps people to change their thought patterns in order to influence their behaviors and emotions. Evidence supports CBT as the most effective approach for PTSD.
Learn more about CBT here.
Eye movement desensitization and reprocessing
Eye movement desensitization and reprocessing, or EMDR, is another common trauma therapy.
During EMDR, individuals briefly relive specific traumatic experiences while the therapist directs their eye movements. EMDR aims to help people process and integrate traumatic memories.
Several randomized controlled trials have demonstrated that EMDR is an effective treatment for PTSD.
Learn more about EDMR here.
Somatic therapies
Some therapists use somatic or body-based techniques to help the mind and the body process trauma.
A review of the literature in the Psychotherapy and Counselling Journal of Australia found that body-based therapies could help a range of people. These therapies include:
- Somatic experiencing: This approach involves a therapist helping a person to relive traumatic memories in a safe space.
- Sensorimotor psychotherapy: This type of therapy combines psychotherapy with body-based techniques to turn traumatic memories into sources of strength.
- Acupoint stimulation: This involves a practitioner applying pressure to specific points on the body, which induces a state of relaxation.
- Touch therapies: Other touch therapies include Reiki, healing touch, and therapeutic touch therapy.
At present, there is not as much evidence to prove the effectiveness of somatic therapies as there is for CBT and EDMR. Researchers note that more data on these methods will help to determine how they work.
Medications
Medication alone cannot cure trauma or PTSD, but it can help a person manage symptoms such as anxiety, depression, and sleep disturbances. A person should talk to their doctor about their options.
Self-care
Practicing self-care can help individuals to cope with the emotional, psychological, and physical symptoms of trauma. Examples of self-care for trauma include:
Exercise
Trauma can activate the body’s fight-or-flight response. Exercise may help mitigate some of these effects.
Research suggests that aerobic exercise may be an effective therapy for people with PTSD.
Individuals can aim to exercise for at least 30 minutes a day on most days of the week.
Mindfulness
Mindful breathing and other mindfulness-based exercises can ground people in the present, which can stop them from reliving the traumatic event.
Studies suggest that mindfulness-based treatments are a promising intervention for PTSD, whether alone or in conjunction with other treatments.
Connection with others
Withdrawal from others is a common symptom of trauma. However, connecting with friends and family is important.
According to the Anxiety and Depression Association of America, staying in contact with people can help to prevent trauma from becoming PTSD.
It is not necessary to talk about the trauma with other people if it is too difficult. Simply engaging with others can improve mood and well-being. Some people feel a benefit from disclosing the trauma with people they trust.
A balanced lifestyle
A person with trauma may find it difficult to relax or to sleep well. However, sleep, relaxation, and diet all play a role in mental health. If possible, a person should try to:
- sleep for 7–9 hours a night
- eat a balanced diet
- avoid alcohol and drugs
- relieve stress with mindful or enjoyable activities
Support
If necessary, people can ask for support from others. This includes talking to trusted loved ones or joining a support group for trauma survivors.
When to seek help
People who experience persistent or severe symptoms of trauma should seek help from a mental health professional. It is especially important to seek help if the trauma symptoms interfere with daily functioning or relationships with others.
Even those with mild symptoms can feel better once they talk to someone.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Click here for more links and local resources.
Summary
Most people will experience a traumatic event at some point in their lives. Some may experience symptoms of shock and distress, and most will recover within a short period.
A minority will experience more long-term traumatic effects, such as the development of PTSD. Therapy and self-care can help those with persistent trauma symptoms to manage these symptoms and improve their quality of life.
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