Defining Trauma

Psychological trauma is damage to a person's mind as a result of one or more events that cause overwhelming amounts of stress that exceed the person's ability to cope or integrate the emotions involved, eventually leading to serious, long-term negative consequences. Trauma is not the same as mental distress or suffering, both of which are universal human experiences.

Introduction

Given that subjective experiences differ between individuals, people will react to similar events differently. In other words, not all people who experience a potentially traumatic event will actually become psychologically traumatized (although they may all be distressed and experience suffering). However, some people will develop post-traumatic stress disorder (PTSD) after being exposed to a major traumatic event.

People who go through these types of extremely traumatic experiences often have certain symptoms and problems afterwards. The severity of these symptoms depends on the person, the type of trauma involved, and the emotional support they receive from others. The range of reactions to symptoms of trauma can be wide and varied, and differ in severity from person to person. A traumatized individual may experience one or several of them.

After a traumatic experience, a person may re-experience the trauma mentally and physically. For example, the sound of a motorcycle engine may cause intrusive thoughts or a sense of re-experiencing a traumatic experience that involved a similar sound (e.g., gunfire). Sometimes a benign stimulus (e.g., noise from a motorcycle) may get connected in the mind with the traumatic experience. This process is called traumatic coupling.

In this process, the benign stimulus becomes a trauma reminder, also called a trauma trigger. These can produce uncomfortable and even painful feelings. Re-experiencing can damage people's sense of safety, self, self-efficacy, as well as their ability to regulate emotions and navigate relationships. These triggers cause flashbacks, which are dissociative experiences where the person feels as though the events are recurring. Flashbacks can range from distraction to complete dissociation or loss of awareness of the current context.

“Re-experiencing of symptoms is a sign that the body and mind are actively struggling to cope with the traumatic experience.”.

Triggers and cues act as reminders of the trauma and can cause anxiety and other associated emotions. Often the person can be completely unaware of what these triggers are. In many cases this may lead a person suffering from traumatic disorders to engage in disruptive behaviors or self-destructive coping mechanisms, often without being fully aware of the nature or causes of their own actions. Panic attacks are an example of a psychosomatic response to such emotional triggers.

Consequently, intense feelings of anger may frequently surface, sometimes in inappropriate or unexpected situations, as danger may always seem to be present due to re-experiencing past events. Upsetting memories such as images, thoughts, or flashbacks may haunt the person, and nightmares may be frequent. Insomnia may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night. Trauma doesn't only cause changes in one's daily functions, but could also lead to morphological changes.

“Epigenetic changes can be passed on to the next generation, thus making genetics one of the components of psychological trauma”.

The person may not remember what actually happened, while emotions experienced during the trauma may be re-experienced without the person understanding why (see Repressed Memory). This can lead to the traumatic events being constantly experienced as if they were happening in the present, preventing the subject from gaining perspective on the experience.

This can produce a pattern of prolonged periods of acute arousal punctuated by periods of physical and mental exhaustion. This can lead to mental health disorders like acute stress and anxiety disorder, traumatic grief, undifferentiated somatoform disorder, conversion disorders, brief psychotic disorder, borderline personality disorder, adjustment disorder, etc.

In time, emotional exhaustion may set in, leading to distraction, and clear thinking may be difficult or impossible. Emotional detachment, as well as dissociation or "numbing out" can frequently occur. Dissociating from the painful emotion includes numbing all emotion, and the person may seem emotionally flat, preoccupied, distant, or cold. Dissociation includes depersonalisation disorder, dissociative amnesia, dissociative fugue, dissociative identity disorder, etc. Exposure to and re-experiencing trauma can cause neurophysiological changes like slowed myelination, abnormalities in synaptic pruning, shrinking of the hippocampus, cognitive and affective impairment.

Some traumatized people may feel permanently damaged when trauma symptoms do not go away and they do not believe their situation will improve. This can lead to feelings of despair, transient paranoid ideation, loss of self-esteem, profound emptiness, suicidality, and frequently, depression. If important aspects of the person's self and world understanding have been violated, the person may call their own identity into question.

Complex post-traumatic stress disorder

Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that can develop in response to exposure to an extremely traumatic event or series of events in a context in which the individual perceives little or no chance of escape, and particularly where the exposure is prolonged or repetitive. In addition to the symptoms of post-traumatic stress disorder, an individual with C-PTSD experiences emotional dysregulation, negative self-beliefs and feelings of shame, guilt or failure regarding the trauma, and interpersonal difficulties.

Six clusters of symptoms have been suggested for diagnosis of C-PTSD:

• Alterations in regulation of affect and impulses
• Alterations in attention or consciousness
• Alterations in self-perception
• Alterations in relations with others
• Somatization
• Alterations in systems of meaning

Experiences in these areas may include:

• Changes in emotional regulation, including experiences such as persistent dysphoria, chronic suicidal preoccupation, self-injury, explosive or extremely inhibited anger (may alternate), and compulsive or extremely inhibited sexuality (may alternate).
• Variations in consciousness, such as amnesia or improved recall for traumatic events, episodes of dissociation, depersonalization/derealization, and reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation).
• Changes in self-perception, such as a sense of helplessness or paralysis of initiative, shame, guilt and self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings (may include a sense of specialness, utter aloneness, a belief that no other person can understand, or a feeling of nonhuman identity).
• Varied changes in perception of the perpetrators, such as a preoccupation with the relationship with a perpetrator (including a preoccupation with revenge), an unrealistic attribution of total power to a perpetrator (though the individual's assessment may be more realistic than the clinician's), idealization or paradoxical gratitude, a sense of a special or supernatural relationship with a perpetrator, and acceptance of a perpetrator's belief system or rationalizations.
• Alterations in relations with others, such as isolation and withdrawal, disruption in intimate relationships, a repeated search for a rescuer (may alternate with isolation and withdrawal), persistent distrust, and repeated failures of self-protection.
• Changes in systems of meaning, such as a loss of sustaining faith and a sense of hopelessness and despair.

Some researchers believe that C-PTSD is distinct from, but similar to, post-traumatic stress disorder (PTSD), somatization disorder, dissociative identity disorder, and borderline personality disorder. Its main distinctions are a distortion of the person's core identity and significant emotional dysregulation. Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization beginning in childhood, rather than, or as well as, in adulthood. These early injuries interrupt the development of a robust sense of self and of others.

Hypervigilance

Hypervigilance is when the nervous system is inaccurately filtering sensory information and the individual is in an enhanced state of sensory sensitivity. This appears to be linked to a dysregulated nervous system which can often be caused by traumatic events or PTSD. Normally, the nervous system releases stress signals in certain situations as a defense mechanism to protect people from perceived dangers. In some cases, the nervous system becomes chronically dysregulated, causing a release of stress signals that are inappropriate to the situation and create inappropriate and exaggerated responses.

In hypervigilance, there is a perpetual scanning of the environment to search for sights, sounds, people, behaviors, smells, or anything else that is reminiscent of activity, threat or trauma. The individual is placed on high alert in order to be certain danger is not near. Hypervigilance can lead to a variety of obsessive behavior patterns, as well as producing difficulties with social interaction and relationships. Hypervigilance is differentiated from dysphoric hyperarousal in that the person remains cogent and aware of their surroundings. In dysphoric hyperarousal, a person with PTSD may lose contact with reality and re-experience the traumatic event verbatim.

Where there have been multiple traumas, a person may become hypervigilant and suffer severe anxiety attacks intense enough to induce a delusional state where the effects of related traumas overlap. This can result in the thousand-yard stare (a phrase often used to describe the blank, unfocused gaze of combatants who have become emotionally detached from the horrors around them). Hypervigilance can be a symptom of post-traumatic stress disorder (PTSD) and various types of anxiety disorders. It is distinguished from paranoia. Paranoid diagnoses, such as can occur in schizophrenia, can seem superficially similar, but are characteristically different.

People suffering from hypervigilance may become preoccupied with scanning their environment for possible threats. They might 'overreact' to loud and unexpected noises or become agitated in highly crowded or noisy environments. Sustained states of hypervigilance, lasting for a decade or more, lead to higher sensitivity to disturbances in their local environment, and an inability to tolerate very small or large groups. After resolution of the situation demanding their attention, people are exhausted and are often unable to function in normal society.

Trauma trigger

A trauma trigger is a psychological stimulus that prompts involuntary recall of a previous traumatic experience. The stimulus itself need not be frightening or traumatic and may be only indirectly or superficially reminiscent of an earlier traumatic incident, such as a scent or a piece of clothing. Triggers can be subtle and difficult to anticipate. A trauma trigger may also be called a trauma stimulus, a trauma stressor or a trauma reminder. When trauma is "triggered", the involuntary response goes far beyond feeling uncomfortable and can feel overwhelming and uncontrollable, such as a panic attack or a strong impulse to flee to a safe place.

The trigger can be anything that provokes fear or distressing memories in the affected person, and which the affected person associates with a traumatic experience. Some common triggers are:

• a particular smell – such as freshly mown grass, the fragrance of an aftershave product, or perfume. The sense of smell, olfaction, has been claimed as more closely connected to traumatic reminders than other sensory experience, given the proximity of the olfactory bulb to the limbic system.
• a particular taste – such as the food eaten during or shortly before a traumatic experience
• a particular sound – such as a helicopter or a song
• a particular texture
• certain times of day – for example, sunset or sunrise
• certain times of year or specific dates – for example, autumn weather that resembles the affected person's experience of the weather during the September 11 attacks, or the anniversary of a traumatic experience
• sights – (real, photo, film or video) for examples, a fallen tree or a light shining at a particular angle
• places – for example, a bathroom, or all bathrooms
• a person, especially a person who was present during a traumatic event or resembles someone involved in that event in some respect
• an argument
• a sensation on the skin – such as the feeling of a wristwatch resembling the feeling of handcuffs, or sexual touching for victims of sexual assault
• the position of the body
• physical pain
• emotions – such as feeling overwhelmed, vulnerable, or not in control
• a particular situation – for example, being in a crowded place

The trigger is usually personal and specific. However, it need not be closely related to the actual experience. For example, after the Gulf War, some Israelis experienced the sound of an accelerating motorbike as a trigger, which they associated with the sound of sirens they heard during the war, even though the resemblance between the two sounds is limited. The realistic portrayal of graphic violence in visual media may expose some affected people to triggers while watching movies or television.

Emotional dysregulation

Emotional dysregulation is a term used in the mental health community that refers to emotional responses that are poorly modulated and do not lie within the accepted range of emotive response. Emotional dysregulation can be associated with an experience of early psychological trauma, brain injury, or chronic maltreatment (such as child abuse, child neglect, or institutional neglect/abuse), and associated disorders such as reactive attachment disorder.

Emotional dysregulation may be present in people with psychiatric disorders such as attention deficit hyperactivity disorder,] autism spectrum disorders, bipolar disorder, borderline personality disorder, complex post-traumatic stress disorder, and fetal alcohol spectrum disorders.

“In such cases as borderline personality disorder and complex post-traumatic stress disorder, hypersensitivity to emotional stimuli causes a slower return to a normal emotional state. This is manifested biologically by deficits in the frontal cortices of the brain”.

Possible manifestations of emotional dysregulation include extreme tearfulness, angry outbursts or behavioral outbursts such as destroying or throwing objects, aggression towards self or others, and threats to kill oneself. Emotional dysregulation can lead to behavioral problems and can interfere with a person's social interactions and relationships at home, in school, or at place of employment. Smoking, self-harm, eating disorders, and addiction have all been associated with emotional dysregulation.

Somatoform disorders may be caused by a decreased ability to regulate and experience emotions or an inability to express emotions in a positive way. Individuals who have difficulty regulating emotions are at risk for eating disorders and substance abuse as they use food or substances as a way to regulate their emotions. Emotional dysregulation is also found in people who have an increased risk of developing a mental disorder, in particularly an affective disorder such as depression or bipolar disorder.

While cognitive behavioral therapy is the most widely prescribed treatment for such psychiatric disorders, a commonly prescribed psychotherapeutic treatment for emotional dysregulation is dialectical behavioral therapy, a psychotherapy which promotes the use of mindfulness, a concept called dialectics, and emphasizes the importance of validation and maintaining healthy behavioral habits.

Existential crisis

Existential crisis, also known as existential dread, are moments when individuals question whether their lives have meaning, purpose, or value, and are negatively impacted by the contemplation. It may be commonly, but not necessarily, tied to depression or inevitably negative speculations on purpose in life such as the futility of all effort (e.g., "if one day I will be forgotten, what is the point of all of my work?"). This issue of the meaning and purpose of human existence is a major focus of the philosophical tradition of existentialism.

An existential crisis may often be provoked by a significant event in the person's life—psychological trauma, marriage, separation, major loss, the death of a loved one, a life-threatening experience, a new love partner, psychoactive drug use, adult children leaving home, reaching a personally significant age (turning 18, turning 40, etc.), etc. Usually, it provokes the sufferer's introspection about personal mortality, thus revealing the psychological repression of said awareness. Existential crisis can be similar to anxiety and depression.