Emotional and Psychological Trauma

Contents of the chapter

Types of Trauma

Effects of Trauma

Treatment for Trauma

What Is Trauma?

Trauma is a person’s emotional response to a distressing experience. Few people can go through
life without encountering some kind of trauma. Unlike ordinary hardships, traumatic events tend
to be sudden and unpredictable, involve a serious threat to life—like bodily injury or death—and
feel beyond a person’s control. Most important, events are traumatic to the degree that they
undermine a person's sense of safety in the world and create a sense that catastrophe could strike
at any time. Parental loss in childhood, auto accidents, physical violence, sexual assault, military
combat experiences, the unexpected loss of a loved one are commonly traumatic events.

Types of Trauma

Acute trauma reflects intense distress in the immediate aftermath of a one-time event and the
reaction is of short duration. Common examples include a car crash, physical or sexual assault, or
the sudden death of a loved one.

Chronic trauma can arise from harmful events that are repeated or prolonged. It can develop in
response to persistent bullying, neglect, abuse (emotional, physical, or sexual), and domestic
violence.

Complex trauma can arise from experiencing repeated or multiple traumatic events from which
there is no possibility of escape. 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,
constant (and exhausting!) monitoring of the environment for the possibility of threat.
Secondary or vicarious trauma arises from exposure to other people’s suffering and can strike
those in professions that are called on to respond to injury and mayhem, notably physicians, first
responders, and law enforcement. Over time, such individuals are at risk for compassion fatigue,
whereby they avoid investing emotionally in other people in an attempt to protect themselves from
experiencing distress.

Adverse Childhood Experiences (ACE) cover a wide range of difficult situations that children
either directly face or witness while growing up, before they have developed effective coping
skills. ACEs can disrupt the normal course of development and the emotional injury can last long
into adulthood. The loss of a parent; neglect; emotional, physical, or sexual abuse; and divorce are
among the most common types of Adverse Childhood Experiences.

Effects of Trauma

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 and
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.

Sufferers of long-term trauma may develop emotional disturbances, such as extreme anxiety,
anger, sadness, survivor’s guilt, disassociation, the inability to feel pleasure (anhedonia), or PTSD
(post-traumatic stress disorder). The amygdala become hyperactive, its over-reaction to minor
perturbations leading to an outpouring of stress hormones. Living in defense mode, and ever-
vigilant to the possibility of threat, people may experience ongoing problems with sleep or physical
pain, encounter turbulence in their personal and professional relationships, and feel a diminished
sense of self-worth.

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

Emotional and psychological trauma can be caused by:

• One-time events, such as an accident, injury, or a violent attack, especially if it was

unexpected or happened in childhood.

• Ongoing, relentless stress, such as living in a crime-ridden neighborhood, battling a

life-threatening illness or experiencing traumatic events that occur repeatedly, such as
bullying, domestic violence, or childhood neglect.

• Commonly overlooked causes, such as surgery (especially in the first 3 years of life),
the sudden death of someone close, the breakup of a significant relationship, or a
humiliating or deeply disappointing experience, especially if someone was deliberately
cruel.

Coping with the trauma of a natural or manmade disaster can present unique challenges—even if
you weren’t directly involved in the event. In fact, while it’s highly unlikely any of us will ever be
the direct victims of a terrorist attack, plane crash, or mass shooting, for example, we’re all
regularly bombarded by horrific images on social media and news sources of those people who
have been. Viewing these images over and over can overwhelm your nervous system and
create traumatic stress. Whatever the cause of your trauma, and whether it happened years ago or
yesterday, you can make healing changes and move on with your life.

Childhood trauma and the risk of future trauma

While traumatic events can happen to anyone, you’re more likely to be traumatized by an event if
you’re already under a heavy stress load, have recently suffered a series of losses, or have been
traumatized before—especially if the earlier trauma occurred in childhood. Childhood trauma can
result from anything that disrupts a child’s sense of safety, including:
 • An unstable or unsafe environment

• Separation from a parent

• Serious illness

• Intrusive medical procedures

• Sexual, physical, or verbal abuse

• Domestic violence

• Neglect

Experiencing trauma in childhood can result in a severe and long-lasting effect. When childhood
trauma is not resolved, a sense of fear and helplessness carries over into adulthood, setting the
stage for further trauma. However, even if your trauma happened many years ago, there are steps
you can take to overcome the pain, learn to trust and connect to others again, and regain your sense
of emotional balance.

Symptoms of psychological trauma

We all react to trauma in different ways, experiencing a wide range of physical and emotional
reactions. There is no “right” or “wrong” way to think, feel, or respond, so don’t judge your own
reactions or those of other people. Your responses are NORMAL reactions to ABNORMAL
events.

Emotional & psychological symptoms:

• Shock, denial, or disbelief

• Confusion, difficulty concentrating

• Anger, irritability, mood swings

• Anxiety and fear

 • Guilt, shame, self-blame

• Withdrawing from others

• Feeling sad or hopeless

• Feeling disconnected or numb

Physical symptoms:

• Insomnia or nightmares

• Fatigue

• Being startled easily

• Difficulty concentrating

• Racing heartbeat

• Edginess and agitation

• Aches and pains

• Muscle tension

Causes of Psychological Trauma

1. Natural disasters such as earthquakes, hurricanes, floods, volcanoes, etc.

Closely related are technological disasters such as auto and plane crashes, chemical spills, nuclear
failures, etc. Technological disasters are more socially divisive because there is always energy
given towards finding fault and blaming.

2.Criminal violence often involves single blow traumas such as robbery, rape and homicide,
which not only have a great impact on the victims, but also on witnesses, loved ones of victims,
etc. (Interestingly, there is often overlap between single blow and repeated trauma, because a
substantial majority of victimized women have experienced more than one crime.) Unfortunately,
traumatic effects are often cumulative.

As traumatic as single-blow traumas are, the traumatic experiences that result in the most
serious mental health problems are prolonged and repeated, sometimes extending over years of a
person’s life.

3. War/political violence – Massive in scale, severe, repeated, prolonged and unpredictable. Also
multiple: witnessing, life threatening, but also doing violence to others. Embracing the identity of
a killer.

4. Human rights abuses – kidnapping, torture, etc.

5. Rape – The largest group of people with posttraumatic stress disorder in this country. A national
survey of 4000 women found that 1 in 8 reported being the victim of a forcible rape. Nearly half
had been raped more than once. Nearly 1/3 was younger than 11 and over 60% were under 18.
Diana Russell’s research showed that women with a history of incest were at significantly higher
risk for rape in later life (68% incest history, 38% no incest).

6. Domestic Violence – recent studies show that between 21% and 34% of women will be
assaulted by an intimate male partner. Deborah Rose’s study found that 20-30% of adults in the
US, approved of hitting a spouse.

7. Child Abuse – the scope of childhood trauma is staggering. Everyday children are beaten,
burned, slapped, whipped, thrown, shaken, kicked and raped. According to Dr. Bruce Perry, a
conservative estimate of children at risk for PTSD exceeds 15 million.

8. Sexual abuse – According to Dr. Frank Putnam of NIMH, at least 40% of all psychiatric
inpatients have histories of sexual abuse in childhood. Sexual abuse doesn’t occur in a vacuum: is
most often accompanied by other forms of stress and trauma-generally within a family.

Physical abuse often results in violence toward others, abuse of one’s own children, substance
abuse, self-injurious behavior, suicide attempts, and a variety of emotional problems.

9. Emotional/verbal abuse
10. Witnessing. Seeing anyone beaten is stressful; the greater your attachment to the victim, the
greater the stress. Especially painful is watching violence directed towards a caregiver, leaving the
child to fear losing the primary source of security in the family.

11. Sadistic abuse – we generally think about interpersonal violence as an eruption of passions,
but the severest forms are those inflicted deliberately. Calculated cruelty can be far more terrifying
than impulsive violence. Coercive control is used in settings like concentration camps, prostitution
and pornography rings, and in some families.

Effects of Long-Term Trauma on Health

• High blood pressure which can lead to stroke, enlarged heart and kidney disease.

• Coronary artery disease.

• Increased risk of drug use and addictions

• General anxiety and depression.

• Sleep interruption and insomnia.

• Chronic fatigue.

• Impaired memory.

• Heart burn, ulcers and irritable bowel.

• Increased risk of infections and cancer.

• Obesity and increased risk of diabetes.

• Worsening of all forms of pain.

• Worsening of PMS and infertility.

• Worsening of certain skin diseases.

• Sexual dysfunction.
• Premature aging.

• Worsening of certain auto immune disorders such as arthritis.

When to seek professional therapy for trauma

Recovering from trauma takes time, and everyone heals at their own pace. But if months have
passed and your symptoms aren’t letting up, you may need professional help from a trauma expert.

Seek help for trauma if you’re:

• Having trouble functioning at home or work

• Suffering from severe fear, anxiety, or depression

• Unable to form close, satisfying relationships

• Experiencing terrifying memories, nightmares, or flashbacks

• Avoiding more and more anything that reminds you of the trauma

• Emotionally numb and disconnected from others

• Using alcohol or drugs to feel better

Working through trauma can be scary, painful, and potentially re-traumatizing, so this healing
work is best undertaken with the help of an experienced trauma specialist. Finding the right
therapist may take some time. It’s very important that the therapist you choose has experience
treating trauma. But the quality of the relationship with your therapist is equally important.
Choose a trauma specialist you feel comfortable with. If you don’t feel safe, respected, or
understood, find another therapist.

Ask yourself:

• Did you feel comfortable discussing your problems with the therapist?

• Did you feel like the therapist understood what you were talking about?
• Were your concerns taken seriously or were they minimized or dismissed?

• Were you treated with compassion and respect?

• Do you believe that you could grow to trust the therapist?

Treatment for Trauma

Left unaddressed or untreated, trauma can undermine relationships and wreak havoc on personal
and professional lives. There are multiple avenues of treatment available for people experiencing
from short- or long-term trauma symptoms.

Healing from trauma

Trauma symptoms typically last from a few days to a few months, gradually fading as you process
the unsettling event. But even when you’re feeling better, you may be troubled from time to time
by painful memories or emotions—especially in response to triggers such as an anniversary of the
event or something that reminds you of the trauma.

If your psychological trauma symptoms don’t ease up—or if they become even worse—and
you find that you’re unable to move on from the event for a prolonged period of time, you may be
experiencing Post-Traumatic Stress Disorder (PTSD). While emotional trauma is a normal
response to a disturbing event, it becomes PTSD when your nervous system gets “stuck” and
you remain in psychological shock, unable to make sense of what happened or process your
emotions.

Whether or not a traumatic event involves death, you as a survivor must cope with the loss, at
least temporarily, of your sense of safety. The natural reaction to this loss is grief. Like people who
have lost a loved one, you need to go through a grieving process. The following tips can help you
cope with the sense of grief, heal from the trauma, and move on with your life.

1) Lifestyle changes are an early treatment option to consider. Eating healthy, exercising,
avoiding alcohol and drugs, getting enough sleep, seeing loved ones regularly, and emphasizing
self-care can help relieve trauma symptoms.
Trauma recovery tip 1: Get moving

Trauma disrupts your body’s natural equilibrium, freezing you in a state of hyperarousal and fear.
As well as burning off adrenaline and releasing endorphins, exercise and movement can actually
help repair your nervous system.

Try to exercise for 30 minutes or more on most days. Or if it’s easier, three 10-minute spurts of
exercise per day are just as good.

Exercise that is rhythmic and engages both your arms and legs—such as walking, running,
swimming, basketball, or even dancing—works best.

Add a mindfulness element. Instead of focusing on your thoughts or distracting yourself while
you exercise, really focus on your body and how it feels as you move. Notice the sensation of your
feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of wind on
your skin. Rock climbing, boxing, weight training, or martial arts can make this easier—after all,
you need to focus on your body movements during these activities in order to avoid injury.

Tip 2: Don’t isolate

Following a trauma, you may want to withdraw from others, but isolation only makes things worse.
Connecting to others face to face will help you heal, so make an effort to maintain your
relationships and avoid spending too much time alone.

You don’t have to talk about the trauma. Connecting with others doesn’t have to involve talking
about the trauma. In fact, for some people, that can just make things worse. Comfort comes from
feeling engaged and accepted by others.

Ask for support. While you don’t have to talk about the trauma itself, it is important that you have
someone to share your feelings with face to face, someone who will listen attentively without
judging you. Turn to a trusted family member, friend, counselor, or clergyman.

Participate in social activities, even if you don’t feel like it. Do “normal” activities with other
people, activities that have nothing to do with the traumatic experience.
Reconnect with old friends. If you’ve retreated from relationships that were once important to
you, make the effort to reconnect.

Join a support group for trauma survivors. Connecting with others who are facing the same
problems can help reduce your sense of isolation, and hearing how others cope can help inspire
you in your own recovery.

Volunteer. As well as helping others, volunteering can be a great way to challenge the sense of
helplessness that often accompanies trauma. Remind yourself of your strengths and reclaim your
sense of power by helping others.

Make new friends. If you live alone or far from family and friends, it’s important to reach out and
make new friends. Take a class or join a club to meet people with similar interests, connect to an
alumni association, or reach out to neighbors or work colleagues.

If connecting to others is difficult…

Many people who have experienced trauma feel disconnected, withdrawn and find it difficult to
connect with other people. If that describes you, there are some actions you can take before you
next meet with a friend:

Exercise or move. Jump up and down, swing your arms and legs, or just flail around. Your head
will feel clearer and you’ll find it easier to connect.

Vocal toning. As strange as it sounds, vocal toning is a great way to open up to social engagement.
Sit up straight and simply make “mmmm” sounds. Change the pitch and volume until you
experience a pleasant vibration in your face.

Tip 3: Self-regulate your nervous system

No matter how agitated, anxious, or out of control you feel, it’s important to know that you can
change your arousal system and calm yourself. Not only will it help relieve the anxiety associated
with trauma, but it will also engender a greater sense of control.
Mindful breathing. If you are feeling disoriented, confused, or upset, practicing mindful
breathing is a quick way to calm yourself. Simply take 60 breaths, focusing your attention on each
‘out’ breath.

Sensory input. Does a specific sight, smell or taste quickly make you feel calm? Or maybe petting
an animal or listening to music works to quickly soothe you? Everyone responds to sensory input
a little differently, so experiment with different quick stress relief techniques to find what works
best for you.

Staying grounded. To feel in the present and more grounded, sit on a chair. Feel your feet on the
ground and your back against the chair. Look around you and pick six objects that have red or blue
in them. Notice how your breathing gets deeper and calmer.

Allow yourself to feel what you feel when you feel it. Acknowledge your feelings about the
trauma as they arise and accept them.

Tip 4: Take care of your health

It’s true: having a healthy body can increase your ability to cope with the stress of trauma.

Get plenty of sleep. After a traumatic experience, worry or fear may disturb your sleep patterns.
But a lack of quality sleep can exacerbate your trauma symptoms and make it harder to maintain
your emotional balance. Go to sleep and get up at the same time each day and aim for 7 to 9 hours
of sleep each night.

Avoid alcohol and drugs. Their use can worsen your trauma symptoms and increase feelings of
depression, anxiety, and isolation.

Eat a well-balanced diet. Eating small, well-balanced meals throughout the day will help you
keep your energy up and minimize mood swings. Avoid sugary and fried foods and eat plenty of
omega-3 fats—such as salmon, walnuts, soybeans, and flaxseeds—to give your mood a boost.

Reduce stress. Try relaxation techniques such as meditation, yoga, or deep breathing exercises.
Schedule time for activities that bring you joy such as your favorite hobbies.
Helping a loved one deal with trauma

When a loved one has suffered trauma, your support can play a crucial role in their recovery.

Be patient and understanding. Healing from trauma takes time. Be patient with the pace of
recovery and remember that everyone’s response to trauma is different. Don’t judge your loved
one’s reaction against your own response or anyone else’s.

Offer practical support to help your loved one get back into a normal routine. That may mean
helping with collecting groceries or doing housework, for example, or simply being available to
talk or listen.

Don’t pressure your loved one into talking but be available if they want to talk. Some trauma
survivors find it difficult to talk about what happened. Don’t force your loved one to open up but
let them know you are there to listen if they want to talk, or available to just hang out if they don’t.

Help your loved one to socialize and relax. Encourage them to participate in physical exercise,
seek out friends, and pursue hobbies and other activities that bring them pleasure. Take a fitness
class together or set a regular lunch date with friends.

Don’t take the trauma symptoms personally. Your loved one may become angry, irritable,
withdrawn, or emotionally distant. Remember that this is a result of the trauma and may not have
anything to do with you or your relationship.

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5) 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.

6) Trauma-informed care treats the whole person, recognizes past trauma and the maladaptive
coping mechanisms that the individual may have adopted to survive their distressing experience..
Trauma-focused cognitive behavioral therapy is frequently used to address the destructive effects
of early trauma, proving particularly helpful to youth with PTSD and mood disorders resulting
from abuse, violence, or unresolved grief.

7) Psychedelic-assisted psychotherapy with MDMA (aka Ecstasy or Molly) is a promising form

of treatment for deep-seated trauma. Under a therapist’s supervision and support, PTSD patients
are given MDMA to help them talk in depth about disturbing traumatic experiences and learn to
control their reactivity. The MDMA appears to speed up the therapeutic process for patients.

8) Ketamine (special K) may also be used to expedite recovery. It is injected under a therapist’s
supervision prior to a talk therapy session. Research has shown it to be effective.

To help a child recover from trauma, it’s important to communicate openly. Let them know that
it’s normal to feel scared or upset. Your child may also look to you for cues on how they should
respond to trauma, so let them see you dealing with your symptoms in a positive way.

How children react to emotional and psychological trauma

Some common reactions to trauma and ways to help your child deal with them:

• Regression. Many children need to return to an earlier stage where they felt safer. Younger
children may wet the bed or want a bottle; older children may fear being alone. It’s important to
be understanding, patient and comforting if your child responds this way.

• Thinking the event is their fault. Children younger than 8 tend to think that if something
goes wrong, it must be their fault. Be sure your child understands that he or she did not cause the
event.
• Sleep disorders. Some children have difficulty falling asleep; others wake frequently or
have troubling dreams. Give your child a stuffed animal, soft blanket, or flashlight to take to bed.
Try spending extra time together in the evening, doing quiet activities or reading. Be patient. It
may take a while before your child can sleep through the night again.

• Feeling helpless. Being active in a campaign to prevent an event from happening again,
writing thank you letters to people who have helped, and caring for others can bring a sense of
hope and control to everyone in the family.