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Trauma: Recognizing It and Treating It

LukeNotes Winter 2012

“That was a long time ago.” “You need to move on.” “The same thing happened to me and I got over it.” Have you ever wondered why some old injuries or hurts seem to stick with some people for such a long time? Have you observed some people react to new hurts with the same intensity as if they were older and more dangerous experiences? A better understanding of trauma may help clarify these questions.

What is a trauma? Experiences that overwhelm our coping ability can be described as potentially traumatic. Being overwhelmed occurs not so much from our weakness, but instead from the limits of our being human. In PosttraumaticStress Disorder (PTSD), a trauma is defined as an experience where one fears death or serious injury or experiences a profound violation of physical integrity. Some experiences can be inherently overwhelming, such as natural disasters, potentially lethal accidents, assaults, and abuse against which we cannot defend ourselves. However, research is also clear that even events that overwhelm our coping ability but are not life threatening can still have traumatizing effects. Trauma can be one life-threatening experience or recurrent emotionally overwhelming experiences.

Many people experience the intensity of a trauma, but without later developing any apparent posttraumatic problems. Some who develop posttraumatic symptoms will recover “on their own” after a period of time. This can lead to a false conclusion that continuing to struggle with past trauma is simply weakness, a failure of will, a lack of knowledge, a refusal to“get over it,” or simply an excuse. Individuals might then wonder if psychological disorders in reaction to traumatic experiences are even legitimate conditions. After all, even mental health experts have areas of disagreement around such disorders. Therefore, it may be helpful to note areas of expert agreement around potential effects of trauma.

Psychological Effects of Trauma

The psychological effects of traumatic experiences are often diverse, long-lasting and very disruptive. They may develop even months or years after the trauma. There is not a single type of trauma reaction, but common “clusters” of symptoms.These clusters include re-experiencing, avoidance or numbing, and hyper-arousal or irritability. Re-experiencing involves intrusive thoughts, nightmares, flashbacks, and intense emotional or physical reactions to things that remind one of the trauma. Avoidance or numbing includes avoiding thoughts about or reminders of the trauma, specific amnesia (loss of memory) around the trauma, separation from awareness of current experiences (dissociation), loss of interest in pleasurable things, feeling distant from others or from one’s emotions, or lacking future plans. Arousal and irritability can be seen in difficulty sleeping, angry outbursts, concentration difficulties, being chronically alert for potential danger (hypervigilance), and very strong startle reactions. These clusters may vary somewhat, depending upon the nature of the traumatic experience and the manner in which the symptoms are assessed. In addition to these clusters, additional psychological symptoms may emerge, such as depressed mood, anxiety difficulties, alcohol or substance abuse, or problematic sexual behaviors. Traumatic experiences can disrupt memory, beliefs about the world, coping skills, and social support. Early traumas may affect long-standing personality styles. People can become avoidant, dependent, or interpersonally chaotic and intense. Some develop the potential for intentionally hurting themselves or attempting suicide. These symptoms obviously cause distress and pain both for the trauma survivors and for those around them.

Why then do some trauma survivors stay stuck in their problematic reactions? Memories of trauma are often acontextual, which means the ability to sense that the trauma occurred the past is impaired and survivors may react as though the trauma is recurring in the present. Common posttraumatic symptoms reflect a person’s best attempt to survive the trauma. The survivor experiences these symptoms as protective and therefore will resist efforts to change them, despite the evidence that these“solutions” are self-defeating.

What Can Be Done About Trauma

Understanding and professional assessment and treatment are the most helpful responses. Realizing that trauma reactions, even frightening or trying ones, make sense from the survivor’s perspective can help one to take a survivor’s problematic behavior less personally and to feel less responsible for creating a solution. Increased education on trauma is highly encouraged. Recognizing signs of trauma should prompt one to help a survivor seek a professional mental health assessment. Some who struggle with posttraumatic symptoms will recover “on their own,” but the consequences of misjudging that possibility are serious. If one does not have formal training in trauma assessment and treatment, there is a real risk for creating unintended harm; good intentions are no substitute for good training. Fortunately, a wide range of psychological and psychopharmacological treatments do exist to heal the psychological wounds of trauma. While trauma recovery is sometimes lifelong work, the tools needed to engage that work are available, effective, and reasonably quick to acquire with professional help.

Jeff Martens, PhD, is a psychologist in the residential program of Saint Luke Institute.