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What is trauma and how do I know if I have it?

Updated: Jul 13

According to the American Psychological Association trauma is "an emotional response to terrible event like an accident, rape, or a natural disaster" (APA, 2022). In plain language, trauma is a stress response to an emotionally overwhelming event. It is typically associated with life threat and can often coincide with feelings of being helpless and powerless. Traumatic events can overwhelm our ability to cope.


However, just because an event falls into the category of trauma does not necessarily mean that a person will be "traumatized." Actually, 70% of respondents surveyed in a study reported experiencing a trauma in their lifetime (BU, 2013). Added to this, respondents of a Kaiser Permanente study conducted from 1995 to 1997 assessing abuse, household dysfunction, emotional abuse, physical abuse, sexual abuse, emotional neglect, etc. found that 2/3rds of respondents experienced some type of trauma/adverse childhood experience. So, traumatic experiences are actually more common than we think they are. Experiencing a potentially traumatic event (PTE) does not guarantee that it will lead to disorders such as acute stress disorder or posttraumatic stress disorder (for simplicity, trauma and PTSD will be used interchangeably here). Most people will go on to experience recovery from symptoms. In fact, PTSD is considered a disorder of non-recovery, or something got in the way of the individual's natural recovery process.


What happens to an individual when life threatening events occur include physiological processes, conditioned learning, cognitive processes, emotional processes, etc.


On the physiological level, when our brain detects danger our body experiences a number of chemical changes resulting in what we know as the fight-flight-freeze response (fawning to be talked about in another post). Specifically, a small almond shaped organ in the limbic system of the brain called the amygdala detects danger and sends signals that activates the hypothalamus-pituitary gland, and adrenal glands, or HPA axis, that in turn set off a chemical response in the body (adrenaline, cortisol). These chemical changes prepare the body for an attack by getting it ready to run, flee, or freeze. Blood is diverted from extremities, the gut, and sex organs. It is diverted to larger muscle groups allowing for said running, fleeing and sometimes freezing. The diversion in resources is felt in the form of butterflies in the stomach, loss of control of bowels at extreme levels of stress, loss of libido, loss of fine motor coordination, tunnel vision, shifts in attention away from peripheral information, rapid heart rate, and increased breathing to name a few changes. One may experience terror, numbness, anger, etc.


While these chemical changes are happening, conditioned learning is also taking place. Conditioned learning can be summed up as learning through association. Let's take a quick detour in learning to understand this a bit better. Ivan Pavlov was a Russian physiologist who realized that pairing certain stimuli in time could create learning that would result in a link in the brain among paired items (an unconditioned stimuli and a neutral stimuli) and a reflexive response (unconditioned response). Pavlov predicted that dogs in his experiment would salivate to food and he measured their salivation when presented with said food. However, he noticed that his dogs salivated to the footsteps of his assistants. Salivation to food is a reflex, but this didn't explain why the dogs were salivating to his assistants' foot steps. He realzied that something else was happening. The dogs somehow learned that the sound of the assistants' footsteps became associated with food and could then elicit a reflexive response on their own after several pairings in time with the food. How then does this relate to trauma? Well, fortunately and unfortunately, conditioning is at play. Our brains pair sight, sounds, smells, time of day, people, places, things, thoughts, sensations, anniversaries, etc. with the trauma. So, our brain then associates the things present in the environment with trauma. These associations then serve as "triggers", which activate the amygdala and set of the fight-flight-freeze (FFF) response. We then experience this as anxiety or panic in the here-and-now. If you are not aware of what your triggers are, this can be a very distressing event. You may feel like you are going to die without understanding why. In hunter gather times, it was an important response. You needed to remember the sensation of fear to a lake where you witnessed a peer being eaten by an alligator. That fear memory likely kept people safe through hypervigilant behaviors and heightened startle responses. However, that response doesn't always work so well in industrialized societies.


In terms of cognitive changes, two different processes can happen. If you grew up in a relatively safe, stable, supportive and nurturing environment, when trauma occurs it can defy what you know about trust, safety, power/control, intimacy and esteem (Resick, Monson, Chard, 2014). In other words, the way you know how to organize and perceive the world has been shattered. If you grew up with chaos, trauma, abuse of any kind, you may have learned unhelpful and distorted ways to view yourself, others, the world, trust, safety, power/control, intimacy and esteem. A trauma may only serve to cement your early trauma beliefs. In response to trauma beliefs in general, you may feel "stuck" in emotions like anger, sadness, shame, blame, guilt, and fear because said trauma thoughts are functioning as fuel for your feelings.


After experiencing a trauma, a trained mental health provider can assess if you have PTSD by evaluating your symptoms with diagnostic criteria. PTSD is a diagnosis that correlates to a cluster of symptoms including re-experiencing symptoms, hyperarousal symptoms, changes in mood and thinking, and avoidance symptoms. As a field, we know that trauma is fairly responsive to cognitive-behavioral inspired methods (CPT) that heal trauma beliefs and exposure-related methods (Penn Arts & Science, 2022; EMDRIA, 2022) that heal FFF reactivity (Prolonged Exposure and EMDR: google Watson/"Little Albert/Fear conditioning to better understand fear conditioning/generalizing fear and breaking conditioned fear responses. Also, google Foa/exposure therapy to better understand how fear conditioning can be broken). If you suspect that you have trauma/PTSD, schedule an evaluation with a trained mental health provider to assess your symptoms. Trauma can be treatable with the right tools and providers in your corner.





Citations


American Psychological Association. (2022, June 13). Trauma. Retrieved from https://www.apa.org/topics/trauma#:~:text=Trauma%20is%20an%20emotional%20response,symptoms%20like%20headaches%20or%20nausea.


EMDRIA. About EMDR Therapy. (2022, June 13). Retrieved from https://www.emdria.org/about-emdr-therapy/


Boston University School of Public Health. (2018, July 13). Trauma and its aftermath. Retrieved from https://www.bu.edu/sph/news/articles/2018/trauma-and-its-aftermath/#:~:text=A%20general%20population%20survey%20conducted,unexpected%20death%20of%20loved%20ones.


Penn Arts & Science. (2022, July 13). Edna Foa. Retrieved from https://psychology.sas.upenn.edu/people/edna-foa


Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive processing therapy: Veteran/military version: Therapist’s manual. Washington, DC: Department of Veterans Affairs.

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