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Psychological Trauma

Special Reports

by Joanna Beazley Richards MSc.

The study of psychological trauma has been accompanied by an explosion of knowledge about how experience shapes the central nervous system and the sense of the self. Developments in the neurosciences, developmental psychopathology and information processing have contributed to our understanding of how brain function is shaped by experience and that life itself can continually transform perception and biology. The study of psychological trauma has probably been the single most fertile area in helping to develop a deeper understanding of the relationship among the emotional, cognitive, social and biological forces that shape human functioning.

What is emotional and psychological trauma?

Different experts in the field of psychology define psychological trauma in different ways. Emotional and psychological trauma is the result of extraordinarily stressful events that shatter our sense of security, making us feel helpless and vulnerable in a dangerous world. A traumatic event or situation creates psychological trauma when it overwhelms the individual's perceived ability to cope, and leaves that person fearing death, annihilation, mutilation, or psychosis. The individual feels emotionally, cognitively, and physically overwhelmed. The circumstances of the event commonly include abuse of power, betrayal of trust, entrapment, helplessness, pain, confusion, and/or loss.

Traumatic experiences often involve a threat to life or safety, but any situation that leaves us feeling overwhelmed and alone can be traumatic, even if it doesn’t involve physical harm. Trauma Article for Expert Witness By Joanna Beazley Richards MSc 2 It’s not the objective facts that determine whether an event is traumatic, but our subjective emotional experience of the event. The more frightened and helpless we feel, the more likely we are to be traumatized.

There are vast differences among people who experience trauma, but the similarities and patterns of response cut across the variety of stressors and victims, so it is very useful to think broadly about trauma. It is an individual's subjective experience that determines whether an event is or is not traumatic. Psychological trauma is the unique individual experience of an event or enduring conditions, in which the individual's ability to integrate his/her emotional experience is overwhelmed or the individual experiences (subjectively) a threat to life, bodily integrity, or sanity. (Pearlman & Saakvitne, 1995, p. 60)

Trauma has the same neurological effects on everyone, leaving the part of the brain usually involved in problem solving, analysis and clear thinking severely compromised. (Van der Kolk, 2014).

A psychological trauma can occur when a person has experienced either a single event or long lasting or repeated events that are so overwhelming that one’s ability to cope or make sense of what happened is affected. (Seigel, 1999).

Everyone has different ways of responding to events. What one individual finds traumatic another person may not find distressing.

Examples of traumatic events include:

• Serious accidents, e.g. road traffic collisions.

• Being threatened with violence, or actually experiencing violent attack.

• Being betrayed.

• Loss and grief.

• Someone being told they have a life threatening (terminal) illness.

• Physical, emotional, spiritual or sexual abuse.

• Neglect.

• Natural or man made disasters.

• Being taken hostage.

• Bullying.

A stressful event is most likely to be traumatic if:

• It happened unexpectedly.

• We were unprepared for it.

• We felt powerless to prevent it.

• It happened repeatedly.

• Someone was intentionally cruel.

• It happened in childhood.

• Emotional and psychological trauma can be caused by single-blow, one-time events, such as a horrible accident, a natural disaster, or a violent attack.

• Trauma can also stem from ongoing, relentless stress, such as living in a crime-ridden neighbourhood or struggling with cancer.

Commonly overlooked sources of emotional and psychological trauma.

• Being burgled or robbed.

• Falls or sports injuries.

• Surgery (especially in the first 3 years of life).

• The sudden death of someone close.

• The breakup of a significant relationship.

• A humiliating or deeply disappointing experience.

• The discovery of a life-threatening illness or disabling condition.

Outcomes of traumatic events.

• Successful motor response (flight/fight/freeze) returns the person to homeostasis.

• Failed response (immobilization), results in conditioned hormonal response, dissociated from effective physical action

• When our own resources fail, social support can restore homeostasis. Many of the clients we see will have lacked social support at the time of their traumatic experiences. (Rothschild, 2000)

How people may feel when they have experienced a traumatic event.

Typical reactions that people may feel after a traumatic event include:

• Constantly thinking about the event.

• Images of the events keep coming into their mind.

• Difficulty sleeping and/or nightmares.

• Changes in how someone feels emotionally, i.e. frightened, sad, anxious, angry.

• Avoiding certain situations that remind the person of the event.

• Feeling numb, stunned, shocked or dazed and have difficulties connecting with life around them.

• Denial that the event actually happened.

It is very common to experience distress following a traumatic event. In most cases, the emotional reactions get better over the days and weeks that follow a trauma. (Browne, 1993).

People may feel a wide range of emotions, including:

Anger – in relation to what happened to the person and with other people involved.

Guilt – When the person thinks they could or should have done something to prevent what happened (they may feel they were to blame), or that they survived when others suffered or died.

Frightened – that the same event may happen again or they feel they are unable to cope with their feelings. They may feel that they are not in control of what is going on.

Helpless – feeling that they were unable to do something about what happened.

Sad – that the trauma happened or that someone was injured or killed, especially if you knew them.

Ashamed or Embarrassed – by what had happened and they feel they cannot tell anyone about it.

Emotional symptoms of trauma may include:

• Shock, denial, or disbelief.

• Anger, irritability, mood swings.

• Guilt, shame, self-blame.

• Feeling sad or hopeless.

• Confusion, difficulty concentrating.

• Anxiety and fear.

• Withdrawing from others.

• Feeling disconnected or numb.

Physical symptoms of trauma may include:

• Insomnia or nightmares.

• Being startled easily.

• Racing heartbeat.

• Aches and pains.

• Fatigue.

• Difficulty concentrating.

• Edginess and agitation.

• Muscle tension.

The traumatic event is over, but the person's reaction to it is not. The intrusion of the past into the present is one of the main problems confronting the trauma survivor. Often referred to as re-experiencing, this is the key to many of the psychological symptoms and psychiatric disorders that result from traumatic experiences. This intrusion may present as distressing intrusive memories, flashbacks, nightmares, or overwhelming emotional states.

Post Traumatic Stress Disorder (PTSD).

PTSD is the most severe form of emotional and psychological trauma. Its primary symptoms include intrusive memories or flashbacks, avoiding things that remind them of the traumatic event, and living in a constant state of “red alert”.

If someone has PTSD, it’s important to see a trauma specialist.

PTSD is the only diagnostic category in the DSM that is based on aetiology. In order for a person to be diagnosed with PTSD, there has to have been to be a traumatic event. Because most diagnoses are descriptive and not explanatory, they focus on symptoms or behaviours without a context: they do not explain how or why a person may have developed those behaviours (e.g., to cope with traumatic stress).

DSM-5 Criteria for PTSD.

MSc 6 In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (1). The DSM 5 says: “Diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and, the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition. Two specifications are noted including delayed expression and a dissociative subtype of PTSD, the latter of which is new to DSM-5.”

Risk factors that increase our vulnerability to trauma.

Not all potentially traumatic events lead to lasting emotional and psychological damage. Some people rebound quickly from even the most tragic and shocking experiences. Others are devastated by experiences that, on the surface, may appear to be less upsetting.

A number of risk factors make people susceptible to emotional and psychological trauma. People are more likely to be traumatized by a stressful experience if they’re already under a heavy stress load or have recently suffered a series of losses. People are also more likely to be traumatized by a new situation if they’ve been traumatized before – especially if the earlier trauma occurred in childhood. (Herman, 1992).

Trauma Treatment.

Some people recover from a trauma with no or little additional support, especially if symptoms are mild. However, many people can develop chronic symptoms that can be long lasting. Post Traumatic Stress Disorder (PTSD) is the name given to describe these symptoms. (Allen, 1995)

However, in some cases the effects of a trauma can be longer lasting and continue for months and even years after the event. Receiving the appropriate type of support can help the person come to terms with the traumatic experience so that it does not continue to affect them for the rest of their life.

Psychological support can be very effective in helping people with PTSD. Therapies available on the NHS include Eye Movement Desensitisation and Reprocessing (EMDR) and trauma focused Cognitive Behavioural Therapy (tf-CBT).

It is important you visit your GP as soon after a trauma as possible. They can help to signpost you to the most appropriate early support or more specialist psychological services if symptoms persist.

A typical Trauma Treatment Involves:

• Establishing a therapeutic alliance.

• Establishing safety and empowerment.

• Learning how to regulate strong emotions.

• Processing trauma-related memories and then feelings.

• Discharging pent-up “fight-or-flight” energy.

• Building or rebuilding the ability to trust other people.

• Reconnecting with life and relationships.

• Having a sense of a positive future.

References

Allen, J. G. (1995). Coping with Trauma: A Guide to Self-Understanding. Washington, DC: American Psychiatric Press.

Browne, A. (1993). Violence against Women by Male Partners: prevention, outcomes and policy implications. Am Psychol 48:1077-1087.

Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (2013) American Psychiatric Association, Washington.

Herman, J. L. (1992). Trauma and Recovery, New York: Basic Books.

Pearlman, L. A. and Saakvitne, K. W. (1995). Trauma and the Therapist. New York: Norton.

Rothschild, B. (2000). The Body Remembers: The psychophysiology of trauma and trauma treatment. New York: W. W. Norton & Company.

Siegel, D. (1999). The Developing Mind. New York: The Guildford Press.

The National Institute for Clinical Excellence Guidelines Clinical guideline [CG26] Published date: March 2005 https://www.nice.org.uk/guidance/cg26/chapter/1- Guidance#the-treatment-of-ptsd

Van der Kolk, B. (2014). The Body Keeps the Score. London: Allen Lane.

The Author.

Joanna Beazley Richards is the Principal of Wealden Psychology Institute, Crowborough,which was established in 1986. Joanna is an HCPC registered Clinical Psychologist and Practitioner Psychologist, BPS Chartered Psychologist and UKCP Registered Psychotherapist, offering clinical, forensic and organisational consultancy, training, supervision and psychotherapy.

Joanna is a Registered Expert Witness, preparing psychological reports for the legal profession; currently filing on average one a week in relation to personal injury, family, and criminal matters.