Trauma

Trauma is an emotional response to a terrible event like an accident, rape or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives. Psychologists can help these individuals find constructive ways of managing their emotions.

Psychological trauma
Psychological trauma may accompany physical trauma or exist independently of it. Typical causes and dangers of psychological trauma are sexual abuse, employment discrimination, police brutality, bullying, domestic violence, indoctrination, being the victim of an alcoholic parent, the threat of either, or the witnessing of either, particularly in childhood, life threatening medical conditions, medication induced trauma.!"# $atastrophic events such as earth%uakes and volcanic eruptions, war or other mass violence can also cause psychological trauma. Long term exposure to situations such as extreme poverty or milder forms of abuse, such as verbal abuse, can be traumatic &though verbal abuse can also potentially be traumatic as a single event'. (owever, different people will react differently to similar events. )ne person may experience an event as traumatic while another person would not suffer trauma as a result of the same event. In other words, not all people who experience a potentially traumatic event will actually become psychologically traumati*ed.!+# ,ome theories suggest childhood trauma can lead to violent behavior, possibly as extreme as serial murder. -or example, (ickey.s Trauma $ontrol /odel suggests that 0childhood trauma for serial murderers may serve as a triggering mechanism resulting in an individual.s inability to cope with the stress of certain events.0!1#

TRIGGER
2fter a traumatic experience, a person may re-experience the trauma mentally and physically, hence avoiding trauma reminders, also called triggers, as this can be uncomfortable and even painful. They may turn to psychoactive substances including alcohol to try to escape the feelings. 3e experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience.!4# Triggers and cues act as reminders of the trauma, and can cause anxiety and other associated emotions. )ften 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 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. $onse%uently, intense feelings of anger may surface fre%uently, sometimes in very inappropriate or unexpected situations, as danger may always seem to be present, as much as it is actually

present and experienced from past events. 5psetting memories such as images, thoughts, or flashbacks may haunt the person, and nightmares may be fre%uent.!6# Insomnia may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night. The person may not remember what actually happened while emotions experienced during the trauma may be reexperienced without the person understanding why &see 3epressed memory'. This can lead to the traumatic events being constantly experienced as if they were happening in the present, preventing the sub7ect 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.!8# In time, emotional exhaustion may set in, leading to distraction, and clear thinking may be difficult or impossible. 9motional detachment, as well as dissociation or 0numbing out0, can fre%uently occur. :issociating from the painful emotion includes numbing all emotion, and the person may seem emotionally flat, preoccupied, distant, or cold. The person can become confused in ordinary situations and have memory problems. ,ome traumati*ed 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, loss of self esteem, and fre%uently depression. If important aspects of the person.s self and world understanding have been violated, the person may call their own identity into %uestion.!4# )ften despite their best efforts, traumati*ed parents may have difficulty assisting their child with emotion regulation, attribution of meaning, and containment of post traumatic fear in the wake of the child.s traumati*ation, leading to adverse conse%uences for the child.!;#!<=# In such instances, it is in the interest of the parent&s' and child for the parent&s' to seek consultation as well as to have their child receive appropriate mental health services.
Self-medication Main article: Self medication

,elf medication is the use of drugs, alcohol, or other self soothing forms of behavior to treat mental distress, stress, anxiety,!<<# mental illnesses and>or other effects of psychological trauma.
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Situational trauma
Trauma can be caused by man made and natural disasters, including war, abuse, violence, earth%uakes, mechani*ed accidents &car, train, or plane crashes, etc.' or medical emergencies. 3esponses to psychological trauma@ There are several behavioral responses common towards stressors including the proactive, reactive, and passive responses. Proactive responses include attempts to address and correct a stressor before it has a noticeable effect on lifestyle. 3eactive responses occur after the stress and possible trauma has occurred, and are aimed more at correcting or minimi*ing the damage of a stressful event. 2 passive response is often characteri*ed by an emotional numbness or ignorance of a stressor. Those who are able to be proactive can often overcome stressors and are more likely to be able to cope well with unexpected situations. )n the other hand, those who are more reactive will often experience more noticeable effects from an unexpected stressor. In the case of those who are

passive, victims of a stressful event are more likely to suffer from long term traumatic effects and often enact no intentional coping actions. These observations may suggest that the level of trauma associated with a victim is related to such independent coping abilities. There is also a distinction between trauma induced by recent situations and long term trauma which may have been buried in the unconscious from past situations such as childhood abuse. Trauma is often overcome through healingA in some cases this can be achieved by recreating or revisiting the origin of the trauma under more psychologically safe circumstances, such as with a therapist.

Assessment[14]
The experience and outcomes of psychological trauma can be assessed in a number of ways. Within the context of a clinical interview, the risk for imminent danger to the self or others is the initial focus of assessment. That is, it is necessary to assess the physical safety of both the individual and others by considering the individualBs physical and mental functioning as well as immediate environment. In many cases, ensuring the individualBs safety may involve contacting emergency services &e.g., medical, psychiatric, law enforcement' as well as members of the individualBs social support network. Cefore assessing an individualBs psychological symptoms, it is necessary to determine whether the individual has returned to a state of psychological stability. If an individual remains in a state of crisis &i.e., overwhelmed with emotion, experiencing cognitive disorgani*ation', it may not be appropriate or possible to conduct a psychological assessment until intervention has been provided. If deemed appropriate, the assessing clinician may proceed by in%uiring about both the traumatic event and the outcomes experienced &e.g., posttraumatic symptoms, dissociation, substance abuse, somatic symptoms, psychotic reactions'. ,uch in%uiry occurs within the context of established rapport and is completed in an empathic, sensitive, and supportive manner. The clinician may also in%uire about possible relational disturbance, such as alertness to interpersonal danger, abandonment issues, and the need for self protection via interpersonal control. Through discussion of interpersonal relationships, the clinician is better able to assess the individualBs ability to enter and sustain a clinical relationship. :uring assessment, individuals may exhibit activation responses in which reminders of the traumatic event trigger sudden feelings &e.g., distress, anxiety, anger', memories, or thoughts relating to the event. Cecause individuals may not yet be capable of managing this distress, it is necessary to determine how the event can be discussed in such a way that will not Dretraumati*eE the individual. It is also important to take note of such responses, as these responses may aid the clinician in determining the intensity and severity of possible posttraumatic stress as well as the ease with which responses are triggered. -urther, it is important to note the presence of possible avoidance responses. 2voidance responses may involve the absence of expected activation or emotional reactivity as well as the use of avoidance mechanisms &e.g., substance use, effortful avoidance of cues associated with the event, dissociation'. In addition to monitoring activation and avoidance responses, clinicians carefully observe the individualBs strengths or difficulties with affect regulation &i.e., affect tolerance and affect modulation'. ,uch difficulties may be evidenced by mood swings, brief yet intense depressive episodes, or self mutilation. The information gathered through observation of affect regulation will guide the clinicianBs decisions regarding the individualBs readiness to partake in various therapeutic activities.

Though assessment of psychological trauma may be conducted in an unstructured manner, assessment may also involve the use of a structured interview. ,uch interviews might include the $linician 2dministered PT,: ,cale &$2P,A Clake et al., <;;1', 2cute ,tress :isorder Interview &2,:IA Cryant, (arvey, :ang, F ,ackville, <;;8', ,tructured Interview for :isorders of 9xtreme ,tress &,I:9,A Pelcovit* et al., <;;6', ,tructured $linical Interview for :,/ IG :issociative :isorders 3evised &,$I: :A ,teinberg, <;;+', and Crief Interview for Posttraumatic :isorders &CIP:A Criere, <;;8'. Lastly, assessment of psychological trauma might include the use of self administered psychological tests. IndividualsB scores on such tests are compared to normative data in order to determine how the individualBs level of functioning compares to others in a sample representative of the general population. Psychological testing might include the use of generic tests &e.g., //PI ?, /$/I III, ,$L ;= 3' to assess non trauma specific symptoms as well as difficulties related to personality. In addition, psychological testing might include the use of trauma specific tests to assess posttraumatic outcomes. ,uch tests might include the Posttraumatic ,tress :iagnostic ,cale &P:,A -oa, <;;1', :avidson Trauma ,cale &:T,@ :avidson et al., <;;6', :etailed 2ssessment of Posttraumatic ,tress &:2P,A Criere, ?==<', Trauma ,ymptom Inventory &T,I@ Criere, <;;1', and Trauma ,ymptom $hecklist for $hildren &T,$$A Criere, <;;4'.

Treatment
2 number of psychotherapy approaches have been designed with the treatment of trauma in mind H9/:3, ,omatic 9xperiencing, Ciofeedback, Internal -amily ,ystems Therapy, and ,ensorimotor psychotherapy. There is a large body of empirical support for the use of cognitive behavioral therapy !<1#!<4# for the treatment of trauma related symptoms,!<6# including Posttraumatic ,tress :isorder.!<8# Institute of /edicine guidelines identify cognitive behavioral therapies as the most effective treatments for PT,:.!<;# Two of these cognitive behavioral therapies, Prolonged 9xposure !?=# and $ognitive Processing Therapy,!?<# are being disseminated nationally by the :epartment of Geterans 2ffairs for the treatment of PT,:.!??#!?"#

Trauma in psychoanalysis
Main article: Psychoanalysis

-rench neurologist Iean /artin $harcot argued!when?# that psychological trauma was the origin of all instances of the mental illness known as hysteria. $harcot.s 0traumatic hysteria0 often manifested as a paralysis that followed a physical trauma, typically years later after what $harcot described as a period of 0incubation0. ,igmund -reud, $harcot.s student and the father of psychoanalysis, examined the concept of psychological trauma throughout his career. Iean Laplanche has given a general description of -reud.s understanding of trauma, which varied significantly over the course of -reud.s career@ 02n event in the sub7ect.s life, defined by its intensity, by the sub7ect.s incapacity to respond ade%uately to it and by the upheaval and long lasting effects that it brings about in the psychical organi*ation0.!?+# The -rench psychoanalyst Iac%ues Lacan claimed that what he called 0The 3eal0 had a traumatic %uality external to symboli*ation. 2s an ob7ect of anxiety, Lacan maintained that The 3eal is 0the

essential ob7ect which isn.t an ob7ect any longer, but this something faced with which all words cease and all categories fail, the ob7ect of anxiety par excellence0.!?1#

Trauma and stress disorders

Main articles: Posttraumatic stress disorder and Complex post-traumatic stress disorder

In times of war, psychological trauma has been known as shell shock or combat stress reaction. Psychological trauma may cause an acute stress reaction which may lead on to posttraumatic stress disorder &PT,:'. PT,: emerged as the label for this condition after the Gietnam War in which many veterans returned to their respective countries demorali*ed, and sometimes, addicted to psychoactive substances. Psychological trauma is treated with therapy and, if indicated, psychotropic medications. The term $ontinuous Post Traumatic ,tress :isorder &$T,:' was introduced into the trauma literature by Jill ,traker &<;86'.!?4# It was originally used by ,outh 2frican clinicians to describe the effects of exposure to fre%uent, high levels of violence usually associated with civil conflict and political repression. The term is also applicable to the effects of exposure to contexts in which gang violence and crime are endemic as well as to the effects of ongoing exposure to life threats in high risk occupations such as police, fire and emergency services. -ollowing traumatic events, persons involved are often asked to talk about the events soon after, sometimes even immediately after the event occurred in order to start a healing process. While debriefing people immediately after an event has not been shown to reduce incidence of post traumatic stress, coming alongside people experiencing trauma in a supportive way has become standard practice.
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What causes emotional or psychological traumaK )ur brains are structured into three main parts, long observed in autopsies@ L the cortex &the outer surface, where higher thinking skills ariseA includes the frontal cortex, the most recently evolved portion of the brain' L the limbic system &the center of the brain, where emotions evolve' L the brain stem &the reptilian brain that controls basic survival functions' Cecause of the development of brain scan technology, scientists can now observe the brain in action, without waiting for an autopsy. These scans reveal that trauma actually changes the structure and function of the brain, at the point where the frontal cortex, the emotional brain and the survival brain converge. 2 significant finding is that brain scans of people with relationship or developmental problems, learning problems, and social problems related to emotional intelligence reveal similar structural and functional irregularities as is the case resulting from PT,:. & Post Traumatic ,tress :isorder ' What is the difference between stress and emotional or psychological traumaK Trauma is stress run amuck. ,tress dis regulates our nervous systems but for only a relatively short period of time. Within a few days or weeks, our nervous systems calm down and we revert to a normal state of e%uilibrium. This return to normalcy is not the case when we have been traumati*ed. )ne way to tell the difference between stress and emotional trauma is by looking at the outcome how much residual effect an upsetting event is having on our lives, relationships,

and overall functioning. Traumatic distress can be distinguished from routine stress by assessing the following@ L how %uickly upset is triggered L how fre%uently upset is triggered L how intensely threatening the source of upset is L how long upset lasts L how long it takes to calm down If we can communicate our distress to people who care about us and can respond ade%uately, and if we return to a state of e%uilibrium following a stressful event, we are in the realm of stress. If we become fro*en in a state of active emotional intensity, we are experiencing an emotional trauma even though sometimes we may not be consciously aware of the level of distress we are experiencing What causes psychological traumaK Psychological trauma can result from events we have long recogni*ed as traumatic, including@ L natural disasters &earth%uakes, fires, floods, hurricanes, etc.' L physical assault, including rape, incest, molestation, domestic abuse L serious bodily harm L serious accidents such as automobile or other high impact scenarios L experiencing or witnessing horrific in7ury, carnage or fatalities )ther potential sources of psychological trauma are often overlooked including@ L falls or sports in7uries L surgery, particularly emergency, and especially in first " years of life L serious illness, especially when accompanied by very high fever L birth trauma L hearing about violence to or sudden death of someone close
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