Trauma: What Is It? (Part 1)

As we think about what we have witnessed in our country over the past year, the word trauma continues to come up repeatedly. No matter where you lived or what you did for a living, it seemed that no one could escape the results of what was happening. The effects of a world-wide pandemic, political and social unrest, devastating riots across the nation, and the closure of schools were felt by everyone across the country. 2020 was anything but normal and what you did for a living and where you lived perhaps played the largest role in how you experienced 2020 and the impacts you felt.

Over the last year, our therapy practice has almost doubled in size and for the first time in our 15+ years we have a waitlist for clients. With 40+ therapists across four locations offering both in-person or online counseling, we are struggling keeping up with the demand we see in the communities that we serve.

In addition to my own training and clinical experience, two specific sources that I used in writing this article were the book titled, The Body Keeps the Score by Bessel Van Der Kolk, M.D. This book is all about the impact of trauma on our brains and our bodies. The other was an article written by Seth J. Gillihan, Ph.D, Clinical Assistant Professor of psychology in the Psychiatry Department at the University of Pennsylvania back in 2016.

Part one of this mini-series is all about providing education on the complexity of what trauma is and our body and brain’s response to it. There are three specific topics that are addressed in this article:  First, what is trauma? Second, what are some common responses to trauma? Third, what is secondary crisis in response to trauma?

What is Trauma?

The word “trauma” in the behavioral health setting refers to an individual’s exposure to death or threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Exposure can occur in four different ways and there are four types of response categories.

• Direct exposure: Being attacked, sexual assault, or being involved in a car accident.
• Witnessing the trauma: Watching an attack take place or a car accident in front of you.
• Learning about the trauma: Hearing from a loved one someone has died or been injured.
• Indirect aversive exposure to trauma: Responding to the scene as a firefighter or paramedic.

The Response to Trauma?

When an individual goes through a traumatic situation there is often physical and emotional responses the individual experiences that are outside of their control. These responses can be categorized into four different groups. The onset of any of these responses can vary depending on the circumstance. Sometimes these symptoms can set in hours after exposure and other time it can take days or weeks for some of these symptoms to emerge. Under each category, you will be able to see some common symptoms in response to trauma.

Dr. Seth J. Gillihan’s, Ph.D, Clinical Assistant Professor of psychology in the Psychiatry Department at the University of Pennsylvania, article published in Psychology Today titled 21 Common Reactions to Trauma in September 2016 was used to help categorize and bring greater understanding to how our bodies respond to trauma in this next section of the article.

Category 1: Re-experiencing the trauma.

• Replaying the memory: The brain replays the memory over and over even when you try to stop it.
• Nightmares: The nightmares do not have to be of the exact trauma but can have similar themes such as fear and anxiety.
• Flashbacks: When the brain is triggered and brings back the memories of the trauma to the forefront of the brain. This is often accompanied by physical sensations felt during the trauma.
• Feeling fear, anxiety, and anger: Anxiety and fear are the most common responses to trauma. Irritability is also part of anger.
• Sadness: Crying often comes along with sadness and it is our body’s response when coming down from the fight-flight-freeze response.
• Feeling numb: Feeling out of touch with one’s own body either emotionally and/or physically.

Category 2: Avoiding triggers related to the trauma.

• Trying not to think about the event(s): The mind tends to replay the traumatic memory and it can be difficult to keep it out of your mind for long.
• Avoiding things related to the event(s): Avoid stations that remind us of the traumatic event such as TV show or a road where the accident took place.

Category 3: Changes in how you view yourself & the world around you.

• Difficulty trusting people: Becoming suspicious of others. Asking, “If that person hurt me, why not someone else?”
• Blaming yourself for the trauma: Guilt is a common emotion after trauma. We repeatedly ask questions in our heads like; “Why didn’t I…” or “If only I…”.
• Criticizing yourself for your reaction to the trauma: Thinking you should get over the trauma already or comparing your recovery to others. A question you might ask yourself is, “How come everyone else has gotten over it and I can’t?”
• Seeing yourself as weak or inadequate: Thinking that you were weak for allowing the trauma to happen. This is a response to seeing ourselves as “less than.”
• Believing the world is extremely dangerous: Immediately after the trauma, our brains see the world as dangerous. You believe there is danger around every corner. You might have many “false alarms” because your nervous system is highly attuned for danger and looking for threats.

Secondary Crisis:

A secondary crisis can be understood as a side-effect of trauma. In other words, physical trauma leads to emotional distress. Emotional distress can often set in hours or days following exposure to trauma. The secondary crisis often impacts multiple aspects of one’s life. For the sake of clarity, I will call these different aspects of life “life domains”.  There are six life domains that are often affected after a traumatic situation. Not all these life domains are equal in importance.

• Developmental Life Domain – The developmental life domain is impacted when the trauma causes an individual to miss a milestone event in his life. Examples of developmental miles stones include graduations, starting a new job, starting college, or moving out on your own.

• Physical Life Domain – The physical life domain is impacted when a traumatic experience leaves a person with physical limitations that require fundamental changes in how they participate in life. The more basic the physical limitation, the greater the distress. An example of a basic physical limitation is the ability to feed oneself, ability to bathe or go the bathroom, or walk.

• Existential / Spiritual Life Domain – The existential/spiritual life domain is impacted when the traumatic event causes the individual to question the meaning of life. This often occurs when the experience brought the individual close to death. They might ask many different “why” questions.

• Occupational Life Domain – The degree of impact from trauma can affect one’s occupational life domain. A common example is work. The nature of the injury and time out of work might impact one’s ability to return to the workplace after the physical injury has healed. Perhaps the individual can no longer perform the same work-related tasks, or their job is no longer available to go back to due to the amount of time that was taken off. This can lead to a sense of loss.

• Relational Life Domain – Relationships are often impacted by trauma. People can grow closer together or drift apart.  In other words, the amount of time spent with others changes. Some become isolated and withdraw and others can become dependent on others. Sometimes physical trauma to the brain can cause changes to a person’s attitude and demeaner.

• Self-Life Domain – Traumatic situations can cause an individual to question and redefine themselves. A person who once was assertive and independent prior to a traumatic situation might later view themselves as more dependent, passive, and less confident. This shift in self-perception could have further implications in other area of life, such as relationships.

Always remember that understanding and awareness is the first part of healing from trauma. I often use the following analogy with my clients who have experienced trauma in their life. I compare the healing process from trauma to camping and hiking in the wild. One of the most basic rules to follow when you first realize you are lost in the wild is to familiarize yourself with where you are. You stop and use whatever possible around you to orient yourself to your location. You will need to actively fight the urge to panic and wonder around, for this will make you more disoriented. I hope this article can help orient you in your experience to help guide you in the direction you need to begin your healing.