Problems like depression, substance abuse, and post-traumatic stress disorder (PTSD) are common among those who have been traumatized – especially if those traumas happened to the person early and repetitively in his or her life. But first, it’s important to know what is meant by the word trauma. Sometimes people discount their traumas because they mistakenly believe that what they endured wasn’t severe or dramatic enough. For instance, a person may not have been in a war zone or may not have been sexually assaulted; therefore, she says to herself some version of, “It wasn’t that big of a deal.” But objectively high drama doesn’t always equal trauma. Similarly, enduring seemingly-small, repetitive traumas, like being bullied, neglected or impoverished, can leave a lasting psychological mark.
So, trauma is less about objective distress and more about subjective distress. This is a fancy way of saying that trauma, like beauty, is in the eye of the beholder. I still remember some things from my childhood that – at the time – were subjectively a big deal …. even though my objective, adult brain now claims to know better. “Small” traumas from our past, if never acknowledged, can snowball and refuse to heal – no matter how much time passes ₁. It turns out that discounting your pain doesn’t actually make your pain go away. In fact, discounting trauma is just another avoidance strategy; something we do unconsciously to escape thinking or feeling something unpleasant. Nevertheless, ignoring, minimizing or discounting the past usually gives more – not less – power to long-dead ghosts that continue to haunt us.
While many people who endured trauma may not qualify for a full diagnosis of PTSD, understanding how PTSD is diagnosed can help us effectively cope with our own traumas – regardless of whether or not our adult brains insist our traumas are little, big, or somewhere in between. We can always compare our hurts to others and find someone who had it worse (or better) than us. But – one word of warning when treating trauma – such comparisons are usually not helpful.
Symptoms of PTSD
Trauma symptoms are symptoms of survival – not symptoms of being “crazy” or “weak.” The symptoms of PTSD, for instance, are the body’s normal physiological and psychological response when coping with something that doesn’t fit our perceptions of how the world “should” work:
- “I should be safe with my family…but I’m not.”
- “I shouldn’t feel threatened at work or school…but I do.”
- “I should feel accepted by others…but I don’t.”
Experiencing trauma means we feel threatened, and PTSD symptoms are our brain’s instinctual way of re-establishing or seeking safety. Think of trauma symptoms as normal survival responses to abnormal survival-threatening events. (Again, threat is a subjective, eye-of-the-beholder experience: you only have to perceive you or someone you loved were threatened in some way; it makes little difference whether or not the threat was real.)
To receive a full diagnosis of PTSD, a person must meet all four criteria below for more than a month. Additionally, these symptoms must impair the person in some way and be related to experiencing one or more traumatic events:
- Re-experiencing: The person re-experiences the trauma through nightmares that may or may not have anything to do with the trauma. Even if the person is fully awake, he or she may experience flashbacks where they relive portions of the trauma. The person is usually very reactive to triggers that remind him or her of the trauma, such as the sound of a car backfiring.
- Hyperarousal: The person has a strong fight, flight, or freeze response. For instance, because they feel like they’re going to be attacked at any moment, they may be jittery or always on the lookout for danger. It may be understandably difficult for such persons to sleep, relax or concentrate. When going into a public place, like a restaurant, instead of looking for a comfortable seat, the person might automatically find a quick exit route.
- Avoidance: The person avoids anything that reminds him or her of the traumatic event. This includes both external reminders of the trauma (e.g., being in a crowd, seeing a person that reminds you of your abuser) or experiencing internal stimuli, like feelings, memories, or sensations that have now become threatening. The person might avoid talking or may stay very busy, so there isn’t an opportunity to think about what happened. Avoidance can take the form of using distraction techniques excessively, like being online all the time or becoming a “workaholic.”
- Negative changes in beliefs: The person’s perception of the world – and him- or herself in it – may change. The person might not experience as positive or loving feelings toward others, or she may stay away from relationships entirely. It’s almost as if the trauma has caused her to have a universally pessimistic outlook about life and relationships. The person might even experience a foreshortened perspective about the future, like feelings of hopelessness. (“What difference does anything make?”; “Why bother?”)
Associated Problems Related to Trauma
These symptoms can impair the survivors of trauma in many ways. The person may not be able to keep a job, stay close to family, or remain sober. The person may use alcohol or physician-prescribed drugs – including opioids and benzodiazepines, like Oxycodone, Valium and Xanax — to “numb out”. If the person experienced early and repetitive childhood abuse, such a history can increase the likelihood of experiencing other psychological disorders. Statistically speaking, there’s a higher likelihood of PTSD, depression, and/or substance abuse if the person came from what is called an “invalidating environment,” where he or she was ignored or abused for speaking up as a young child (to read more about how someone can feel invalidated see https://blogs.psychcentral.com/emotionally-sensitive/2012/02/reasons-you-and-others-invalidate-your-emotional-experience/). Persons who grow up in an invalidating environment may have been shamed for experiencing normal human feelings, like anger. They may have been told – in word or in deed – that they were “selfish” or “bad” simply for feeling an emotion (see my blog Why Does My Child Feel so Bad? for more information).
Yet, even those who were raised in validating environments can develop PTSD symptoms. Typically, such persons experience high levels of fear, along with being restrained from getting away or fighting back. The feelings of intense fear coupled with being unable to escape produce a state of shock or what trauma-expert Peter Levine called a “fear immobility” response (Levine, 2010). The person becomes frozen between an unstoppable force (the urge to flee or fight) and an immovable object (the inability to flee or fight). In order to avoid such fear immobility in the future, the traumatized person unconsciously learns to numb out or ignore his or her feelings whenever an uncomfortable emotion, like rage, anger or fear, is starting to be experienced. Even positive emotions can become threatening. The original enemy may have been an actual person, who would pounce inexplicably (such as the Viet Cong in Vietnam) or was impossible to escape (such as a Viet Cong-like parent, neighborhood or peer group). Eventually, however, the enemy becomes the self. The feelings of immobility, rage and terror the returning soldier or trauma victim experiences become threatening in and of themselves. This is true even after the original enemy has been vanquished or is no longer around. Our personal ghosts die hard.
Once the self becomes the enemy, the survivor of trauma is vulnerable to ongoing victimization. If a survivor becomes numb to her internal experience, she is essentially cut off from the wisdom of the body. This wisdom is often called intuition. A woman, for instance, may fall for yet another predator or participate in risky behaviors as a way to feel something. Like seeing a puppy on the side of the highway, all of the woman’s friends know that this too will end in tears, but numbness is both oppressive and – as it turns out – immune to good advice. Allow me to emphasize that this is not said to “blame the victim”; they do that to themselves quite enough already. Perpetrators certainly need to be held accountable. But knowing how perpetual numbness creates perpetual problems is an important concept to understand. Otherwise, we mistakenly believe that the goal is to not feel. This is an impossible – and ultimately costly – expectation to maintain.
Now that we understand a little more about trauma and the symptoms of PTSD, the next blog entry in this series (Coping Effectively with Trauma: Part II) will discuss ways to treat trauma – both in ourselves and get help for those we love.
₁ Many examples of childhood trauma were included on the Adverse Childhood Experiences Study (ACES), which is one of the largest studies connecting childhood traumas with developing medical problems. To easily assess your own ACES score and determine whether or not you experienced some childhood traumas, go to https://acestoohigh.com/got-your-ace-score/
Levine, P. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness