Trauma may occur in relation to any significantly distressing event. What constitutes a traumatic event can vary for different people. This may include physical or emotional injuries, life threat, accidents, assault, violence, major loss, serious illness or medical trauma, acute or chronic pain, social turmoil, natural disasters, war, and other types of events. The level of distress in the aftermath of the event would typically be high enough that you feel overwhelmed, trapped, fearful, shameful, helpless, and powerless. Living through such an event can negatively impact a person’s relationships, sense of self, feelings of safety, and ability to regulate emotions. It also impacts mental health, physical health, emotional health, social well-being, and spiritual well-being. There is increasing recognition that trauma is not only an experience of the mind, but that it is also held in the body. However, not everyone who experiences a trauma will suffer negative symptoms in the aftermath. Protective factors that prevent the development of symptoms include having a strong social support system, no prior history of trauma, and a high degree of personal resilience..
Post-traumatic stress disorder (PTSD) are the symptoms that can develop after exposure to a traumatic event. This may involve personally experiencing the event, witnessing it happening, or hearing about it happening to close others. PTSD manifests as intense, disturbing thoughts and feelings related to the event, long after it is over. Symptoms can include nightmares or intrusive flashbacks that feel like a person is reliving the event. Other symptoms may involve sleep disturbance, sadness, irritability, anger, fear, guilt, dissociation, and a sense of isolation. Avoidance of people, places, objects, or situations that trigger distressing memories is another common feature. Nervous system dysregulation, exaggerated startle response, and ongoing hypervigilance is typical. Cognitive and mood disturbances may include forgetting details of the event, difficulty concentrating, maladaptive thoughts and feelings about self or others, and a loss of ability to experience positive emotions. PTSD is evident when symptoms linger more than a month after the event and cause significant distress or difficulty with daily functioning. Symptoms can also persist for months or years after the event has passed. Common co-occurring conditions may be depression, anxiety, substance use, and other physical and mental health issues.
This can result not only from distressing events, but also from abuse, neglect, and disrupted attachment with caregivers. Complex trauma is sometimes used to describe individuals who suffer symptoms in the aftermath of a chronic, traumatic childhood. However, this is not a formal diagnosis in the mental health world. Although adult survivors may meet the diagnostic criteria for PTSD, some may end up being diagnosed with a personality disorder instead. This can be a very stigmatizing since the entire concept of a personality disorder suggests inherent defectiveness. Such a label can imbue shame and judgment while smothering the possibility hope, compassion, and healing. This is where the mainstream clinical language can be an unhelpful and inaccurate description of a person’s contextual, lived-experience.
Compassion and compassionate language is needed. There is substantial evidence that childhood trauma can lead to adverse neurobiological effects including altered functioning in the neural circuitry, HPA axis, immune system, and cardiovascular system (Nusslock & Miller, 2016). The long-term negative effects of this can persist into adulthood, causing chronic mental and physical suffering. Impacts in adulthood may include higher rates of depression, substance-use, auto-immune conditions, metabolic syndrome, and heart disease (Nusslock & Miller, 2016). Another consequence can be abnormal brain development. Studies using fMRI scans confirm that maltreated youth exhibit increased amygdala reactivity and decreased volume in certain brain regions (Herringa, 2017). This promotes greater activation of the nervous system threat response, which leads to increased stress hormone output. The downstream effect of chronic stress hormones can show up as higher inflammatory biomarkers, as well as harmful immune dysregulation (Nusslock & Miller, 2016). Childhood trauma is also believed to lead to relational attachment difficulties later in life, as well as long-term emotional dysregulation and negative self-concept (Dagan & Yager, 2019). Survivors tend to exhibit avoidance, dissociation, negative assumptions, and feelings of unsafety (Dagan & Yager, 2019). These individuals have lived a life of shattering and labeling them with a personality disorder is problematic. This legacy and it’s rippling, destructive effects need to be brought further into cultural awareness.
Finally, it is important to keep in mind that any type of untreated trauma can result in a cascade of chronic, negative, mental and physical health consequences. Are you a survivor yourself? No matter how long you may have suffered with these symptoms, there is hope. Your brain still has the capacity for resiliency and neuroplasticity. Working with a trauma-informed therapist makes a big difference in the recovery process. The therapist should also have training in an approach that is designed to address this. There are many helpful modalities available today such as EMDR, cognitive processing therapy, somatic therapy, parts therapy, or brainspotting therapy. Ideally, it is helpful to work with a therapist who is skilled in using an integrative combination of somatic, cognitive, and experiential methods. It is never too late to begin the healing process, and reaching out for help is the first step.
Dagan, Y., & Yager, J. (2019). Posttraumatic growth in complex PTSD. Psychiatry, 82, 329–344.
Herringa, R. J. (2017). Trauma, PTSD, and the developing brain. Current psychiatry reports, 19(10), 1-9.
Nusslock, R., & Miller, G. E. (2016). Early-life adversity and physical and emotional health across the lifespan: A neuroimmune network hypothesis. Biological psychiatry, 80(1), 23-32.
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