Trauma and Responses to Trauma

What is Trauma?

Trauma is an event that is experienced as:

outside the range of normal human experience
causes emotional/physical distress
involves a threat to the life of the person or others and
feelings of intense fear, helplessness or horror

*not breaking your nail or spilling a drink on your designer outfit before going out to a black tie function!

What is the difference between trauma and crisis:

trauma is the incident, the event whilst
crisis is the process of emotional turmoil the individual is subjected to following the trauma (nb individual’s perception defines the crisis)

Examples of Traumatic Events common in South Africa:

witnessing someone being killed
surviving sexual assault
surviving natural disasters (floods, major storm, bush fires)
motor vehicle accident
armed robbery or hijacking
physical/ threatened violence (war, politically-motivated marches etc)

Types of Traumatic Exposure:

For many of us, surviving one traumatic event is a huge accomplishment. However, there are others who have experienced repeat trauma. There are a variety of types of traumatic exposure, and the type of trauma a person may experience can affect how he/she deals with it afterwards.

Simple/Once-off trauma (eg car accident, aggravated assault, hijacking, rape, shooting – random with little chance of repeat)
Man-made (eg bombs as in Manchester terror attack in the UK – direct result of human intervention) versus natural disasters (eg fires such as the recent fires in Knysna, floods, earthquakes, tsunamis)
Repeat trauma (eg domestic violence where assault is ongoing, members of police services who are exposed to violence on an ongoing basis)
Continuous trauma (repeated exposure to varying types of trauma eg a car accident, followed by the death of a loved one, followed by police brutality etc)
Vicarious trauma (witness to trauma by repeated actions/stories, need not be directly involved, absorbing the pain – often affects those around the primary survivor of trauma eg psychologists, counsellors, medical personnel, family members)
Secondary victimisation (trauma extends beyond the event eg victim blaming behaviours, ineffective and insensitive handling by medical staff, police, courts or could also be when a survivor is forced to relive the event they are effectively being re-traumatised)

Response determinants - factors influencing the response to trauma:

Every person reacts differently to traumatic events, because each person has different resources for coping with trauma. The following factors influence whether a person manages to deal with the trauma and move on with his/her life within an average time or not:

individual characteristics of the survivor eg age, gender, personality, psychological strength
person’s perception of the event
How much stress the person was under before the traumatic event
Type of trauma (see above)
proximity, length and severity of event
Number of prior traumatic experiences
How safe the person is from being exposed to more trauma
The support that he/she gets (family, friends, other survivors, professionals)

Phases of Trauma Impact:

When a person goes through a traumatic experience there are 3 defined stages:

Impact: Shock, numb, disorganized, confused, sometimes “high” excited feeling from adrenalin
Recoil: Realisation of the trauma, re-experiencing the trauma, avoidance of things that remind her/her of trauma, physical arousal (jumpy, anxious etc)
Re-integration: Processing the trauma: Spiritual questioning (Why me? Why does this happen?), gradually returning to previous functioning, starting to feel empowered again

Normal Responses to Trauma:

Every person who has been traumatised will show at least some of the common emotional, physical and psychological reactions to trauma. It is important to realise that these reactions are a normal response to an abnormal event.

Re-experiencing the event: nightmares or strange dreams; having strong memories of the event as if it were happening again (flashbacks); seeing, hearing or smelling things from the event; constantly talking about the event; becoming anxious and upset when reminded of the trauma
Avoidance: anything that reminds the person of the event may be avoided eg pretending it did not happen or refusing to talk about it; forgetting parts of the event; avoiding clothes they were wearing, the place it happened, smells that trigger the memory etc; drug or alcohol abuse; isolating him/herself from family and friends
Physical arousal: sleeping/eating problems; poor concentration and memory (eg forgetful, daydreaming, in a daze); hyper vigilance; panic attacks; physical pain such as headaches, back pain, stomach pain etc; anger, irritability, aggressive, frustration
Other feelings: sadness and crying; feelings of guilt; wanting to take revenge; anger with God; question of faith; feeling hopeless and helpless; emotional numbness; lack of interest in things that they normally liked

These normal responses can be expected to occur from shortly after the trauma happens until about one month after the event, and they will gradually disappear. However sometimes people do not cope well after a traumatic event due to other factors discussed above, and they can develop abnormal reactions to the traumatic event.

Abnormal Responses to Trauma:

Acute Stress Disorder
Intrusive symptoms - re-experiencing a traumatic event through recurrent and intrusive memories and dreams, reliving the experience
Avoids thoughts of event and to remain emotionally detached from the event eg may refuse to travel in a car after an accident
Increased arousal manifested by sleep disturbances, temper outbursts, concentration difficulties and exaggerated startle responses (being “jumpy”)
Duration for ASD is two to 30 days:
Post Traumatic Stress Disorder
Intrusive symptoms – recurrent, involuntary, and intrusive distressing memories of the traumatic event; recurrent distressing dreams, dissociative reactions (eg flashbacks of the traumatic event); intense psychological distress at exposure to cues that resemble aspect of the traumatic event
Negative thoughts and mood – fear, guilt, sadness, shame, loss of interest, withdrawal, inability to express positive emotions
Avoids thoughts of event and to remain emotionally detached from the event
Alterations in arousal manifested by sleep disturbances, temper outbursts, concentration difficulties and exaggerated startle responses
Duration for ASD is two to 30 days:
Major Depressive Disorder
depressed mood
loss of interest or pleasure
weight loss or gain; decrease or increase in appetite
sleep problems: insomnia or hypersomnia
psychomotor agitation or retardation
fatigue or loss of energy
feelings of worthlessness or inappropriate guilt
diminished ability to think or concentrate, indecisiveness
suicide ideation (thoughts of suicide)