Emotional Trauma

Trauma's Many Faces - Recognizing Trauma

If you've ever felt overwhelmingly helpless and alone in the face of distress, fear, or sadness, you've experienced a traumatic event. Thousands of people suffered devastating personal losses in the terrorist attacks of Sept. 11, 2001. Yet countless millions of us who did not lose a friend or loved one in the tragedy nonetheless felt the pain of unresolved trauma returning to haunt us.

During the 1990s, experts recognized that "normal" events can trigger traumatic reactions. Everyday happenings such as falls, medical and dental procedures, disappointments, betrayals, hospitalizations, difficult births, and minor car accidents can impact the body and brain with lingering effects on behavior, mood, and attitude-no differently than extreme or violent events would. Traumatic experiences can produce feelings of anxiety, depression, despair, hopelessness, reoccurring anger, self-blame, guilt, and shame, as well as sexual dysfunction, compulsive or aggressive behaviors, sleep disorders, concentration problems, disconnection from others, loss of interest in outside activities, and psychosomatic complaints. The severity of the symptoms depends on the perceived severity of the traumatic event, your trauma history, the level of stress in your life, and the quality of support available to you from family, friends, and professionals.

Not surprisingly, given how little awareness there is about traumatic aftermath, many people don't realize that their symptoms may be rooted in the past. Although we recognize a problem and seek a variety of solutions, we achieve temporary or limited benefits. The following portraits are typical:

Laura slams her brakes as a van runs a red light, missing her car by inches. Heart racing, she feels grateful that she isn't hurt and her car isn't damaged. "Everything's fine," she tells herself. "Stop making more out of nothing." Back home, Laura cries and shakes watching America at War on TV, suddenly fearful for her life. Weeks later she considers asking her doctor for anti-anxiety medication.

Alex is 35 and terrified of needles. He doesn't get medical help until it's unavoidable. He's tired of hearing his dentist say, "This would have been a lot easier to fix six months ago." He had successful eye surgery when he was 2 but doesn't feel disturbed by the ancient memory. Now he might skip a planned overseas trip-not because of the required vaccine, he says, but because "it isn't safe to travel."

David is a "career" therapy patient. He's tried most forms of therapy to get over a persistent backache with no identifiable cause, and he can't figure out why he can't hold a good job. He's been on medications, tried energy, talk, and physical therapies. He gets hope and temporary relief with each start, but before long he senses that he's "stuck" again. "Maybe I just have to live with it," he thinks, but inside he wonders if it's even worth living.

Christina sees her 3-year-old daughter tumble down a short flight of stairs. Christina can barely breathe as she rushes to Hannah, who wails but isn't seriously hurt. Afterward, Christina-understandably-won't let Hannah out of her sight. But three months later, the only way Christina can get any rest is with sleeping pills.

Adam loves everything about golf, being outdoors with friends, the sight of a shot arcing onto the green-not to mention the great business deals he's cut on the fairways. Every so often, though, after one too many shots he doesn't like, he smashes his titanium driver, snapping the shaft. Embarrassed, he wonders why he gets so damn mad that he loses control.

The past year of Evan's life bears little resemblance to how he lived before he was fired. Eating, sleeping, and watching TV fill his days. He rarely sees family or friends and has dropped out of the soccer league. His bicycle gathers dust in the basement. He's addicted to the evening news, served with Scotch and soda. Even when his wife threatens, Evan can't mobilize to look for a job.

No one is immune to traumatic experiences; anyone can become traumatized. To develop symptoms in response to trauma does not mean that you are incompetent, sick, weak, or psychologically maladjusted. Just as pain thresholds differ, researchers now recognize that trauma thresholds differ. One person may come through a terrible accident with no emotional scars while another might struggle for years with traumatic residue under the exact circumstances. Properly detected and treated, symptoms that develop and linger for days, months, or years can nevertheless be resolved, even long after the precipitating event.

"Trauma" is a response and should
not be defined by the event itself.

Certainly, the most catastrophic events could cause anyone to be traumatized. But what of a fender bender? Disappointment in love? A mild financial setback? The world experienced on TV the attacks on the World Trade Center; many witnesses became traumatized as a result. Traumatic aftermath results when an individual can't naturally resolve feelings unleashed.

Our understanding of the range of traumatic aftermath is in its infancy. In 1966, trauma was characterized as "the neglected disease of modern society." Only since 1980 has the American Psychiatric Association included a classification for post-traumatic stress disorder (PTSD) in the industry handbook, Diagnostic and Statistical Manual of Mental Disorders. PTSD defines the most severe effects seen in Vietnam War veterans, victims of natural disasters or violent crime, or other life-threatening events. Yet those diagnosed with PTSD represent a tiny portion of the total population affected by trauma.

In our culture, historically intolerant of emotional vulnerability, we allot little time to recognize the depth of an emotional event. Few of us are permitted-or permit ourselves-after a significant physical or emotional shock to withdraw from routines and let feelings run their course. Even people who lose a loved one typically return to work immediately after the funeral. What too many of us fail to realize is that, when it comes to deep emotional or physical shocks, attempts to "get over it" too quickly ensure that you never really do.

What Kind of Experience Produces Trauma?

Emotional trauma can result from one extreme and deeply felt experience, from a series of such experiences, or from a series of low-intensity events when we are especially vulnerable. A car accident, sexual or physical abuse, and poor primary relationships early in life are examples of experiences that create emotional trauma. Trauma, like pain, isn't objective. Filtered through our emotional and cognitive processes, an event's impact depends on one's perception of it.

Your perception may be at odds with your thoughts. For example, you might intellectually understand the need for heightened security at airports, but your nervous system feels threatened by the sight of armed soldiers in the terminal. You can say to yourself, "This is a good precaution," but at a core level you're experiencing danger. When the mind delivers one message-"good"-and the body another-"threatening"-the conflict can leave you feeling and disconnected for months or years. Logic and instinct have diverged.

Because emotional reactions activate more rapidly than rational thoughts do, our conflicted response can be even more confusing. Although emotions are first out of our internal gates, they take much longer to run their full course. A person seeing a car careening in her direction feels the adrenaline rush faster than she can formulate the thought, "A car is going to hit me." It's the adrenaline that allows her to move out of harm's way even before her conscious mind has intellectually assessed the danger.

After the danger has passed, although she understands that she's safe, the physiological response is still in process. Most people feel like shaking, sweating, crying, laughing, or shuddering after such a near miss. Bringing the threatened body back to equilibrium is an essential part of our natural cycle to cope with a trauma. Once the car is gone, most people believe the cycle is over, but internal recovery is still in process. Recovery may take a few minutes, a few hours, or days.

If we halt the process by ignoring the emotional and physical sensations that continue after a traumatizing event, we short-circuit our natural ability to heal. We disconnect ourselves from recovery and set the stage for traumatic aftermath. Have you ever noticed that most people who fall try to get up immediately? Perhaps embarrassed or upset, they override the natural shock of unexpectedly hitting the ground when, in fact, body and mind would have a greater chance of coping-of processing the shock-if the person just stayed put for a few minutes.

Conditions for traumatic aftermath

You can be traumatized by things that happen to you, to someone close to you, or even to strangers. Those who care for traumatized people are also more prone to being traumatized. It is common for a caregiver to become anxious, depressed, or ill. Mental health professionals in crisis settings quickly burn out a phenomenon known as vicarious or secondary traumatization unless they, too, receive ongoing emotional support.

The lasting consequences of any traumatic event are tied to the perception-not the reality-of feeling helpless and alone when the event occurs. A child nearly hit by a car will feel a traumatic wound if his terrified father screams at him for being in the street instead of hugging him in relief. The child feels both frightened and alone-a ripe opportunity for traumatic aftermath to develop.

Sometimes the absence of experiences creates the same neurological byproducts of trauma as overt traumatic experiences do. Recent research shows that the lack of a mutually attuned nonverbal relationship between mother and infant can impact the child's developing brain as surely as if he had been repeatedly abused. For example, Michael's mother loved him when he was a baby, but her depression absorbed her attention; she rarely played with or had eye contact with her son. A quiet "good" baby-unquestionably loved by his parents-Michael was nothing less than a content, well-parented infant. Many years passed before Michael exhibited recognizable symptoms of trauma.

Compassionate support immediately after a traumatic event can dramatically decrease the risk of traumatic symptoms. When skier Jamie hit a tree, the rescue team spoke soothingly to him for 15 minutes before putting him on a stretcher. Jamie's broken leg healed rapidly, and he had no trouble getting back on his skis. Jamie later learned that the ski patrol's calming words were relatively new to procedure, having been found to minimize injuries and lasting emotional scars.

Bearable experiences become
unbearable if you feel helpless and alone.

An event is more traumatic if it violates deeply held convictions or moral values. U.S. soldiers in Vietnam, who felt a deep sense of right and wrong but nevertheless killed civilians in the line of duty, suffered the most intense forms of PTSD. In everyday life, as on the battlefield, chances of being traumatized increase dramatically when we act contrary to our basic beliefs. Divorce, for example, may be a difficult yet manageable sorrow for one person, yet devastating for someone who believes in the sanctity of marriage.

Many current traumas are actually internal re-enactments of old, even forgotten events not yet resolved. A girl falls from a tree and is, amazingly, unhurt. As an adult, she is unduly terrified whenever she trips. For days after, she feels stiff, anxious, and depressed. Remember Michael the "good" baby whose mother was emotionally unavailable. As a child, he felt lonely and isolated and had trouble making friends. In adulthood, Michael was continually drawn to people who excited, then abandoned, him. He was repeatedly attracted to emotionally unfulfilling relationships that felt somehow familiar.

Unresolved traumatic aftermath can accumulate over years. New experiences link to a chain that stretches back indefinitely, and the current experience becomes weighted with the emotions of present and past threats.

In some cases, traumatic experience can move us toward health and new life. Bessel A. Van Der Kolk, a leading authority in the field, points out that "a traumatic experience can become the center around which a victim reorganizes a previously disorganized life, reorienting values and goals." John F. Kennedy was traumatized by WWII combat and used his experience to rethink and restructure his life toward the common good. Before her brain-tumor crisis, Carolyn, whom you met in the introduction, worked 100 hours a week and identified herself and her self-worth through her accomplishments. Now she centers her life around her relationships.

Our bodies and minds really are hardwired to survive and thrive. Nowhere is this so apparent as when we are traumatized. Peter Levine, author of Waking the Tiger, writes that "the same immense energies that create the symptoms of trauma, when properly engaged and mobilized, can transform the trauma and propel us into new heights of healing, mastery and even wisdom." This has certainly been my experience. Each new traumatic event exposes old wounds and offers the opportunity to repair and truly heal the past rather than just treat its symptoms.

How many people live with traumatic aftermath?

The number of people living with traumatic aftermath is elusive. The range of symptoms is not fully understood, and diagnosis is often missed, because emotional trauma isn't a disease. Though it produces symptoms indistinguishable from some mental disorders, it isn't a state of illness. It is a normal response that results in a debilitating aftermath only when interrupted. People with less obvious traumatic symptoms find ways to compensate for, hide, or ignore them. Without an obvious link to a traumatic onset, people may be treated with anti-depressants and anti-anxiety medications, which mask symptoms and have numbing side-effects but don't cure the problem.

Traumatic diagnosis is typically limited to the most serious and obvious cases of PTSD. Unless symptoms fall into the specific and complex range specified in DSM-1V: Diagnostic and Statistical Manual of Mental Disorders, they are commonly misdiagnosed as faulty brain chemistry or missed altogether.

Statistics capture only the small percentage of sufferers who neatly fit this PTSD diagnosis. A closer look at such widely circulated information as The Surgeon General's Report, The US Department of Health and Human Services Report, and updates from The National Institute of Mental Health paints a broader picture of the impact of emotional trauma. An additional 17 percent of the population is victim to physical assault but not diagnosed with PTSD; 40 percent more have witnessed serious violence. Among adolescents 12-17, an estimated 8 percent are victims of serious sexual abuse. Millions more suffer from a far less obvious condition-the aftermath of trauma that stems from poor parental attachment in infancy.

As researchers uncover information about trauma's neurobiological components, our understanding grows. Experts recognize that, from many perspectives, emotional trauma plays an ongoing role in our lives. This recognition leads to our seeing new possibilities as we interpret statistics. For example:

• Mental disorders account for more than 15 percent of the overall burden of disease, slightly more than the burden associated with all forms of cancer and second only to cardiovascular disease. One in five Americans is affected by mental illness.
• According to the National Institute of Mental Health, 11 million Americans become depressed every year. Twice as many women as men suffer depression.
• Twelve million Americans under age 18 suffer from some form of mental illness, with lifetime prevalence rates as high as 17 percent.
• More than 16 million adults in the United States ages 18-54 have anxiety disorders.
• The number of Americans encountering suicidal depression some time in their lives has increased from under 10 percent for Baby Boomers and their parents to as much as 25 percent for the post-Baby Boom generations.
• Although the United States is the world's largest market for anti-depressants, with estimated annual sales of $7.2 billion, these medications aren't reducing mental health problems. After an individual's first episode of depression, there is a 50 percent chance of recurrence; after the second episode, 70 percent; after the third, 95 percent.

Why do I feel this way? Why can't I get over it?

The immobility response

A gazelle running for its life is about to be pounced on by a tiger. A split second before the tiger strikes, the gazelle enters an altered state of consciousness, goes limp and collapses, unable to move. This response may save the animal's life. The tiger may lose interest in what appears to be dead meat. Once the danger has passed, the immobility response completes, and the gazelle regains its normal state of awareness, shakes and trembles, stands, and returns to the herd.

Human physiological response is like that of animals in the wild. We are born with survival mechanisms. When we feel endangered, a stress response commonly known as "the fight or flight response" triggers a set of physiological and neurological actions that supply the energy to confront the situation or run from it. Another reaction to danger that has received much less attention from researchers is the immobility response.

The immobility or freeze response occurs when fighting and fleeing aren't possible--it's like flooring the gas pedal and slamming on the brake at the same time. Though we are highly activated, we can't move. If we go into shock as the result of a traumatic experience, we lose touch with sensation and emotion. We feel confused, numb, and immobilized. What distinguishes the human response from that of an animal is that humans can get stuck, unable to complete the immobility response.

For nearly 40 years Helen had a perfect driving record. In a moment of confusion, she hit the accelerator and ran into a parked car. She wasn't hurt and the two cars suffered only minor damage, but Helen was visibly shaken. She lost her appetite and slept poorly. Weeks later, on the way home from the auto repair shop, she narrowly missed another automobile. She has not driven since.

Healing from trauma is a process of
completing the immobility response.

A gazelle that escapes from a tiger doesn't suffer nightmares or migraines. Once the traumatic event is over, the animal's physiological processes run their course and return to a state of equilibrium. Humans, to avoid painful or frightening feelings, short-circuit the process by mentally recounting what happened. In effect, we interrupt the return to equilibrium. As a result, we are left feeling frozen-stuck in hyperactivity, anxiety, fearful alertness-or the opposite, depression and inertia. Michael, whom we met earlier, became immobilized when his wife left him. Because the marriage was bad, Michael was surprised that her departure was so devastating to him. He withdrew from family and friends, spending most the next six months in front of the TV.

Core emotions

When we perceive a threat, biological emotions are evoked that connect us to our instincts, our intuition, and the motivation to act on our own behalf. However, if we feel overwhelmed, the immobility response shorts-circuits these core emotions before they have run their course. Active, time-limited core emotions such as fear, anger, sadness, or joy get numbed or subverted into look-alike secondary emotions that consume us when we become traumatized. This is why we often express sadness when we really feel angry or anger when we're afraid.

Healing from trauma cannot occur until we replace these secondary emotions with core feelings. After her accident, Helen replaced short-term fear with long-term anxiety. If she had not, she could have healed from the incident and moved on. But it's not too late. Even now, if Helen is willing to face the fear that she experienced at the time of her accident, she might soon be driving and feeling better than she has in years.

If we were connected to our core feelings at all
times, we could avoid traumatic aftermath.

Traumas Many Faces: Recognizing and Healing Emotional Trauma:

Recognizing Trauma is the first part of Traumas Many Faces and describes the symptoms and causes of emotional trauma.

Healing Trauma is the final part of Traumas Many Faces and is a description of how trauma is healed.

Quiz & Overview of Trauma Symptomotology:

Is Emotional Trauma a Factor in Your Life? Quizzes you on symptoms that may suggest you are living with unresolved trauma.

Types of Emotional Trauma is a breakdown of trauma symptomology.

Return to home page for Emotional Trauma.