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Psychological trauma is damage to a person's
mind The mind is the set of faculties responsible for mental phenomena A phenomenon (; plural phenomena) is an observable fact or event. The term came into its modern philosophical Philosophy (from , ) is the study of general and fun ...

mind
as a result of one or more events that cause overwhelming amounts of stress that exceed the person's ability to cope or integrate the
emotion Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent with a proposition. Several of these states are a comb ...

emotion
s involved, eventually leading to serious, long-term negative consequences. Trauma is not the same as
mental distress Mental distress (or psychological distress) is a term used, by some mental health Mental health is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively ...
or
suffering Suffering, or pain in a broad sense, may be an experience of unpleasantness and aversion associated with the perception of harm or threat of harm in an individual. Suffering is the basic element that makes up the negative valence of affective ...

suffering
, both of which are universal human experiences. Given that subjective experiences differ between individuals, people will react to similar events differently. In other words, not all people who experience a potentially traumatic event will actually become psychologically traumatized (although they may all be distressed and experience suffering). However, some people will develop
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi ...
(
PTSD Post-traumatic stress disorder (PTSD)Acceptable variants of this term exist; see the '' Terminology'' section in this article. is a mental disorder that one can develop after exposure to a traumatic event, such as sexual assault, warfare, ...
) after being exposed to a major traumatic event. This discrepancy in risk rate can be attributed to
protective factor Protective factors are conditions or attributes (skills, strengths, resources, supports or coping strategies) in individuals, families, communities or the larger society that help people deal more effectively with stressful events and mitigate or ...
s some individuals may have that enable them to cope with difficult events; they are related to temperamental and environmental factors from among others. Some examples are
resilience Resilience, resilient, resiliency, or ''variation'', may refer to: Science Ecology * Ecological resilience In ecology, resilience is the capacity of an ecosystem to respond to a perturbation or disturbance by resisting damage and recovering ...
characteristics and active seeking of help.


Signs and symptoms

People who go through these types of extremely traumatic experiences often have certain symptoms and problems afterwards. The severity of these symptoms depends on the person, the type of trauma involved, and the emotional support they receive from others. The range of reactions to symptoms of trauma can be wide and varied, and differ in severity from person to person. A traumatized individual may experience one or several of them. After a traumatic experience, a person may re-experience the trauma mentally and physically. For example, the sound of a motorcycle engine may cause intrusive thoughts or a sense of re-experiencing a traumatic experience that involved a similar sound (e.g., gunfire). Sometimes a benign stimulus (e.g., noise from a motorcycle) may get connected in the mind with the traumatic experience. This process is called traumatic coupling. In this process, the benign stimulus becomes a trauma reminder, also called a
trauma triggerA trauma trigger is a Stimulus (psychology), psychological stimulus that prompts recall of a previous psychological trauma, traumatic experience. The stimulus itself need not be frightening or traumatic and may be only indirectly or superficially re ...
. These can produce uncomfortable and even painful feelings. Re-experiencing can damage people's sense of safety, self, self-efficacy, as well as their ability to regulate emotions and navigate relationships. They may turn to
psychoactive substances A psychoactive drug, psychopharmaceutical, or psychotropic drug is a chemical substance that changes nervous system function and results in alterations in perception, mood (psychology), mood, consciousness, cognition, or behavior. These substances ...
including
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...
to try to escape or dampen the feelings. These triggers cause flashbacks, which are dissociative experiences where the person feels as though the events are recurring. Flashbacks can range from distraction to complete dissociation or loss of awareness of the current context. Re-experiencing of symptoms is a sign that the body and mind are actively struggling to cope with the traumatic experience. Triggers and cues act as reminders of the trauma and can cause
anxiety Anxiety is an emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavioural responses, and a degree of pleasure or suffering, disp ...

anxiety
and other associated emotions. Often 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 behaviors or self-destructive coping mechanisms, often without being fully aware of the nature or causes of their own actions.
Panic attack Panic attacks are sudden periods of intense fear Fear is an intensely unpleasant emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feel ...

Panic attack
s are an example of a psychosomatic response to such emotional triggers. Consequently, intense feelings of anger may frequently surface, sometimes in inappropriate or unexpected situations, as danger may always seem to be present due to re-experiencing past events. Upsetting memories such as images, thoughts, or
flashback Flashback or flashbacks may refer to: * Flashback (narrative), in literature and dramatic media, an interjected scene or point that takes the narrative back in time from the current point * Flashback (psychology), in which a memory is suddenly and ...
s may haunt the person, and
nightmare A nightmare, also known as a bad dream, Retrieved 11 July 2016. is an unpleasant dream A dream is a succession of image An image (from la, imago) is an artifact that depicts visual perception Visual perception is the abi ...

nightmare
s may be frequent.
Insomnia Insomnia, also known as sleeplessness, is a sleep disorder A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and ...

Insomnia
may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night. Trauma doesn't only cause changes in one's daily functions, but could also lead to morphological changes. Such epigenetic changes can be passed on to the next generation, thus making genetics one of the components of psychological trauma. However, some people are born with or later develop protective factors such as genetics that help lower their risk of psychological trauma. The person may not remember what actually happened, while emotions experienced during the trauma may be re-experienced without the person understanding why (see
Repressed Memory Repressed memory is a controversial, and largely unproven claim, that memory, memories for traumatic events may be stored in the unconscious mind and blocked from normal conscious recall. As originally postulated by Sigmund Freud, repressed memo ...
). This can lead to the traumatic events being constantly experienced as if they were happening in the present, preventing the subject 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. This can lead to mental health disorders like acute stress and anxiety disorder,
traumatic grief Prolonged grief disorder (PGD) is a disorder consisting of a distinct set of symptoms following the death of a loved one. PGD is experienced by about 10 percent of bereaved survivors, though rates vary depending on the circumstances. The affected ...
,
undifferentiated somatoform disorder Somatization disorder is a mental disorder, mental and Abnormal behavior, behavioral disease#disorder, disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic nervous system, somatic symptoms. It ...
,
conversion disorder Conversion disorder (CD), or functional neurologic symptom disorder, is a diagnostic category used in some psychiatric classification systems. It is sometimes applied to patients who present with neurological Neurology (from el, νεῦρ ...
s,
brief psychotic disorder Brief psychotic disorder ⁠— according to the classifications of mental disorders DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5 The ''Diagnostic and Statistical Manual of Mental Dis ...
,
borderline personality disorder Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a mental illness A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that ...
, adjustment disorder, etc. In time, emotional exhaustion may set in, leading to distraction, and clear thinking may be difficult or impossible.
Emotional detachment In psychology Psychology is the scientific Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or something, such as facts A fact is an occurrence in ...
, as well as dissociation or "numbing out" can frequently occur. Dissociating from the painful emotion includes numbing all emotion, and the person may seem emotionally flat, preoccupied, distant, or cold. Dissociation includes depersonalisation disorder, dissociative amnesia, dissociative fugue, dissociative identity disorder, etc. Exposure to and re-experiencing trauma can cause neurophysiological changes like slowed myelination, abnormalities in synaptic pruning, shrinking of the hippocampus, cognitive and affective impairment. This is significant in brain scan studies done regarding higher-order function assessment with children and youth who were in vulnerable environments. Some traumatized 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, transient paranoid ideation, loss of
self-esteem Self-esteem is an individual's subjective evaluation of their own worth. Self-esteem encompasses beliefs about oneself (for example, "I am unloved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith an ...
, profound emptiness, suicidality, and frequently,
depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
. If important aspects of the person's self and world understanding have been violated, the person may call their own identity into question. Often despite their best efforts, traumatized 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 traumatization, leading to adverse consequences for the child. In such instances, seeking counselling in appropriate mental health services is in the best interests of both the child and the parent(s).


Causes


Situational trauma

Trauma can be caused by human-made, technological and natural disasters, including war, abuse, violence, mechanized accidents (such as vehicle accidents) or medical emergencies. An individual's response to psychological trauma can be varied based on the type of trauma, as well as socio-demographic and background factors. There are several behavioral responses commonly used 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. Reactive responses occur after the stress and possible trauma has occurred and is aimed more at correcting or minimizing the damage of a stressful event. A passive response is often characterized 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. On 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 Child abuse or child maltreatment is physical Physical may refer to: *Physical examination, a regular overall check-up with a doctor *Physical (album), ''Physical'' (album), a 1981 album by Olivia Newton-John **Physical (Olivia Newton-John so ...
. Trauma is sometimes overcome through healing; 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 A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a problem, usually following a . As a rule, each therapy has and s. There are many different types of therapy. Not all therapies are . Many ...
. More recently, awareness of the consequences of climate change is seen as a source of trauma as individuals contemplate future events as well as experience climate change related disasters. Emotional experiences within these contexts are increasing, and collective processing and engagement with these emotions can lead to increased resilience and post traumatic growth, as well as a greater sense of belongingness. These outcomes are protective against the devastating impacts of psychological trauma.


In psychodynamics

Psychodynamic Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces that underlie human behavior, feelings, and emotions and how they might relate ...
viewpoints are controversial, but have been shown to have utility therapeutically. French neurologist,
Jean-Martin Charcot Jean-Martin Charcot (; 29 November 1825 – 16 August 1893) was a French neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine Medicine is the Art (skill), ...

Jean-Martin Charcot
, argued in the 1890s that psychological trauma was the origin of all instances of the mental illness known as
hysteria Hysteria is a pejorative term used colloquially to mean ungovernable emotional Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a rela ...

hysteria
. Charcot's "traumatic hysteria" often manifested as paralysis that followed a physical trauma, typically years later after what Charcot described as a period of "incubation".
Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine M ...

Sigmund Freud
, Charcot's student and the father of
psychoanalysis Psychoanalysis (from Greek language, Greek: + ) is a set of Theory, theories and Therapy, therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a bo ...

psychoanalysis
, examined the concept of psychological trauma throughout his career.
Jean Laplanche Jean Laplanche (; 21 June 1924 – 6 May 2012) was a French author An author is the creator or originator of any written work such as a book or play, and is also considered a writer. More broadly defined, an author is "the person who ori ...
has given a general description of Freud's understanding of trauma, which varied significantly over the course of Freud's career: "An event in the subject's life, defined by its intensity, by the subject's incapacity to respond adequately to it and by the upheaval and long-lasting effects that it brings about in the psychical organization". The French psychoanalyst
Jacques Lacan Jacques Marie Émile Lacan (, , ; 13 April 1901 – 9 September 1981) was a French psychoanalyst Psychoanalysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, ...

Jacques Lacan
claimed that what he called "
The Real ''The'' () is a grammatical article Article often refers to: * Article (grammar) An article is any member of a class of dedicated words that are used with noun phrases to mark the identifiability of the referents of the noun phrases. The c ...

The Real
" had a traumatic quality external to symbolization. As an object of anxiety, Lacan maintained that The Real is "the essential object which isn't an object any longer, but this something faced with which all words cease and all categories fail, the object of anxiety ''par excellence''".Lacan, J., ''The Seminar of Jacques Lacan: Book II: The Ego in Freud's Theory and in the Technique of Psychoanalysis 1954–1955'' , p.164 (W. W. Norton & Company, 1991), Fred Alford, citing the work of object relations theorist
Donald Winnicott Donald Woods Winnicott (7 April 1896 – 25 January 1971) was an English paediatrician Pediatrics ( also spelled paediatrics or pædiatrics) is the branch of medicine Medicine is the Art (skill), art, science, and Praxis (process) , pra ...
, uses the concept of inner other, and internal representation of the social world, with which one converses internally and which is generated through interactions with others. He posits that the inner other is damaged by trauma but can be repaired by conversations with others such as therapists. He relates the concept of the inner other to the work of
Albert Camus Albert Camus ( , ; ; 7 November 1913 – 4 January 1960) was a French philosopher, author, and journalist. He won the Nobel Prize in Literature ) , image = Nobel Prize.png , caption = , awarded_for = Outstanding contributions in ...

Albert Camus
viewing the inner other as that which removes the absurd. Alford notes how trauma damages trust in social relations due to fear of exploitation and argues that culture and social relations can help people recover from trauma. Diana Fosha, a pioneer of modern psychodynamic perspective, also argues that social relations can help people recover from trauma, but specifically refers to attachment theory and the attachment dynamic of the therapeutic relationship. Fosha argues that the sense of emotional safety and co-regulation that occurs in a psychodynamically-oriented therapeutic relationship acts as the secure attachment that is necessary to allow a client to experience and process through their trauma safely and effectively.


Stress disorders

All psychological traumas originate from stress, a physiological response to an unpleasant stimulus. Long-term stress increases the risk of poor mental health and mental disorders, which can be attributed to secretion of glucocorticoids for a long period of time. Such prolonged exposure causes many physiological dysfunctions such as the suppression of the immune system and increase in blood pressure. Not only does it affect the body physiologically, but a morphological change in the hippocampus also takes place. Studies showed that extreme stress early in life can disrupt normal development of hippocampus and impact its functions in adulthood. Studies surely show a correlation between the size of hippocampus and one's susceptibility to stress disorders. In times of war, psychological trauma has been known as shell shock or
combat stress reaction Combat stress reaction (CSR) is a term used within the military to describe acute behavioral disorganization seen by medical personnel as a direct result of the trauma of war. Also known as "combat fatigue" or "battle neurosis", it has some overla ...
. Psychological trauma may cause an
acute stress reaction Acute stress disorder (ASD, also known as acute stress reaction, psychological shock, mental shock, or simply shock) is a psychological Psychology is the scientific Science () is a systematic enterprise that Scientific method, b ...
which may lead to posttraumatic stress disorder (PTSD). PTSD emerged as the label for this condition after the
Vietnam War {{Infobox military conflict , conflict = Vietnam War , partof = the Indochina Wars The Indochina Wars ( vi, Chiến tranh Đông Dương) were a series of wars fought in Southeast Asia Southeast Asia, also spelled ...
in which many veterans returned to their respective countries demoralized, and sometimes, addicted to psychoactive substances. The symptoms of PTSD must persist for at least one month for diagnosis to be made. The main symptoms of PTSD consist of four main categories: trauma (i.e. intense fear), reliving (i.e. flashbacks), avoidance behavior (i.e. emotional numbing), and hypervigilance (i.e. continuous scanning of the environment for danger). Research shows that about 60% of the US population reported as having experienced at least one traumatic symptom in their lives, but only a small proportion actually develops PTSD. There is a correlation between the risk of PTSD and whether or not the act was inflicted deliberately by the offender. Psychological trauma is treated with therapy and, if indicated, psychotropic medications. The term ''continuous posttraumatic stress disorder'' (CTSD) was introduced into the trauma literature by Gill Straker (1987). It was originally used by South African clinicians to describe the effects of exposure to frequent, 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. As one of the processes of treatment, confrontation with their sources of trauma plays a crucial role. While debriefing people immediately after a critical incident has not been shown to reduce incidence of PTSD, coming alongside people experiencing trauma in a supportive way has become standard practice.


Vicarious trauma

Vicarious trauma affects workers who witness their clients' trauma. It is more likely to occur in situations where trauma related work is the norm rather than the exception. Listening with empathy to the clients generates feeling, and seeing oneself in clients' trauma may compound the risk for developing trauma symptoms. Trauma may also result if workers witness situations that happen in the course of their work (e.g. violence in the workplace, reviewing violent video tapes.) Risk increases with exposure and with the absence of help seeking protective factors and pre-preparation of preventive strategies. Individuals who have a personal history of trauma are also at increased risk for developing vicarious trauma. Vicarious trauma can lead workers to develop more negative views of themselves, others, and the world as a whole, which can compromise their quality of life and ability to work effectively.


Diagnosis

As "trauma" adopted a more widely defined scope, traumatology as a field developed a more interdisciplinary approach. This is in part due to the field's diverse professional representation including: psychologists, medical professionals, and lawyers. As a result, findings in this field are adapted for various applications, from individual psychiatric treatments to sociological large-scale trauma management. While the field has adopted a number of diverse methodological approaches, many pose their own limitations in practical application. The experience and outcomes of psychological trauma can be assessed in a number of ways. Within the context of a clinical interview, the risk of imminent danger to the self or others is important to address but is not the focus of assessment. In most cases, it will not be necessary to involve contacting emergency services (e.g., medical, psychiatric, law enforcement) to ensure the individuals safety; members of the individual's
social support Social support is the perception and actuality that one is cared for, has assistance available from other people, and most popularly, that one is part of a supportive social network A social network is a social structure made up of a set of s ...
network are much more critical. Understanding and accepting the psychological state of an individual is paramount. There are many misconceptions of what it means for a traumatized individual to be in psychological crisis. These are times when an individual is in inordinate amounts of pain and incapable of self-comfort. If treated humanely and respectfully the individual is less likely to resort to self harm. In these situations it is best to provide a supportive, caring environment and to communicate to the individual that no matter the circumstance, the individual will be taken seriously rather than being treated as delusional. It is vital for the assessor to understand that what is going on in the traumatized person's head is valid and real. If deemed appropriate, the assessing clinician may proceed by inquiring about both the traumatic event and the outcomes experienced (e.g., post-traumatic symptoms, dissociation,
substance abuse Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder Substance-related disorders, also known as substance use disord ...
, somatic symptoms, psychotic reactions). Such inquiry occurs within the context of established
rapport Rapport () is a close and harmonious relationship in which the people or groups concerned are "in sync" with each other, understand each other's feelings or ideas, and communicate smoothly. The word stems from the French verb which means literal ...
and is completed in an empathic, sensitive, and supportive manner. The clinician may also inquire about possible relational disturbance, such as alertness to interpersonal danger,
abandonment issues Emotional abandonment is a subjective emotional state in which people feel undesired, left behind, insecure, or discarded. People experiencing emotional abandonment may feel at a loss, cut off from a crucial source of sustenance that has been wi ...
, and the need for self-protection via interpersonal control. Through discussion of interpersonal relationships, the clinician is better able to assess the individual's ability to enter and sustain a clinical relationship. During assessment, individuals may exhibit activation responses in which reminders of the traumatic event trigger sudden feelings (e.g., distress, anxiety,
anger Anger, also known as wrath or rage, is an intense emotion Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects ...

anger
), memories, or thoughts relating to the event. Because 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 "retraumatize" 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 post traumatic stress as well as the ease with which responses are triggered. Further, it is important to note the presence of possible avoidance responses. Avoidance 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 individual's strengths or difficulties with affect regulation (i.e., affect tolerance and affect modulation). Such difficulties may be evidenced by mood swings, brief yet intense depressive episodes, or
self-mutilation Self-harm or self-injury is intentional behaviour that is considered harmful to oneself. This is most commonly regarded as direct injury of one's own skin Tissue (biology), tissues usually without a suicide, suicidal intention. Other terms such ...
. The information gathered through observation of affect regulation will guide the clinician's decisions regarding the individual's 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. Such interviews might include the Clinician-Administered PTSD Scale, Acute Stress Disorder Interview, Structured Interview for Disorders of Extreme Stress, Structured Clinical Interview for DSM-IV Dissociative Disorders- Revised, and Brief Interview for post-traumatic Disorders. Lastly, assessment of psychological trauma might include the use of self-administered psychological tests. Individual scores on such tests are compared to normative data in order to determine how the individual's 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., MMPI-2, MCMI-III, SCL-90-R) 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 post-traumatic outcomes. Such tests might include the post-traumatic Stress Diagnostic Scale, Davidson Trauma Scale, Detailed Assessment of post-traumatic Stress, Trauma Symptom Inventory, Trauma Symptom Checklist for Children, Traumatic Life Events Questionnaire, and Trauma-related Guilt Inventory. Children are assessed through activities and therapeutic relationship, some of the activities are play genogram, sand worlds, coloring feelings, self and kinetic family drawing, symbol work, dramatic-puppet play, story telling, Briere's TSCC, etc.


Definition

The Diagnostic and Statistical Manual of Mental Disorders, ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5) defines trauma as the symptoms that occur following exposure to an event (i.e., traumatic event) that involves actual or threatened death, serious injury, or sexual violence. This exposure could come in the form of experiencing the event, witnessing the event, or learning that the event was experienced by a family member or close associate. Trauma symptoms may come in the form of intrusive memories, dreams, or flashbacks; avoidance of reminders of the traumatic event; negative thoughts and feelings; or increased alertness or reactivity. Memories associated with trauma are typically explicit, coherent, and difficult to forget. Due to the complexity of the interaction between traumatic event occurrence and trauma symptomatology, a person's distress response to aversive details of a traumatic event may involve intense fear or helplessness but ranges according to the context. In children, trauma symptoms can be manifested in the form of disorganized or agitative behaviors. Trauma can be caused by a wide variety of events, but there are a few common aspects. There is frequently a violation of the person's core assumptions about the world and their human rights, putting the person in a state of extreme Mental confusion, confusion and insecurity. This is seen when institutions depended upon for survival violate, humiliate, Betrayal Trauma, betray, or cause major losses or separations instead of evoking aspects like positive self worth, safe boundaries and personal freedom. Psychologically traumatic experiences often involve physical trauma that threatens one's survival and sense of security. Typical causes and dangers of psychological trauma include harassment, embarrassment, abandonment, abusive relationships, rejection, co-dependence, physical assault, sexual abuse, partner battery, employment discrimination, police brutality, corruption#Judicial corruption, judicial corruption and Judicial misconduct, misconduct, bullying, paternalism, domestic violence, indoctrination, being the victim of an alcoholism, alcoholic parent, the threat or the witnessing of violence (particularly in childhood), life-threatening medical conditions, and medication-induced trauma. Catastrophic natural disasters such as earthquakes and volcanic eruptions, large scale transportation accidents, Structure fire, house or domestic fire, motor vehicle accident, mass interpersonal violence like war, terrorist attacks or other mass victimization like sex trafficking, being taken as a hostage or being Kidnapping, kidnapped can also cause psychological trauma. Long-term exposure to situations such as extreme poverty or other forms of abuse, such as verbal abuse, exist independently of physical trauma but still generate psychological trauma. Some theories suggest childhood trauma can increase one's risk for mental disorders including
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi ...
(PTSD), depression, and substance abuse. Childhood trauma, Childhood adversity is associated with neuroticism during adulthood. Parts of the brain in a growing child are developing in a sequential and hierarchical order, from least complex to most complex. The brain's neurons change in response to the constant external signals and stimulation, receiving and storing new information. This allows the brain to continually respond to its surroundings and promote survival. Sense#Five "traditional" senses, The five traditional signals (sight, hearing, taste, smell, and touch) contribute to the developing brain structure and its function. Infants and children begin to create internal representations of their external environment, and in particular, key attachment relationships, shortly after birth. Violent and victimization, victimizing attachment figures impact infants' and young children's internal representations. The more frequently a specific pattern of brain neurons is activated, the more permanent the internal representation associated with the pattern becomes. This causes sensitization in the brain towards the specific neural network. Because of this sensitization, the neural pattern can be activated by decreasingly less external stimuli. Childhood abuse tends to have the most complications with long-term effects out of all forms of trauma because it occurs during the most sensitive and critical stages of psychological development. It could also lead to violent behavior, possibly as extreme as serial murder. For example, Hickey's Trauma-Control Model suggests that "childhood trauma for serial murderers may serve as a triggering mechanism resulting in an individual's inability to cope with the stress of certain events." Often Psychodynamics, psychodynamic aspects of trauma are overlooked even by health professionals: "If clinicians fail to look through a trauma lens and to conceptualize client problems as related possibly to current or past trauma, they may fail to see that trauma victims, young and old, organize much of their lives around repetitive patterns of reliving and warding off traumatic memories, reminders, and affects."


Treatment

A number of psychotherapy approaches have been designed with the treatment of trauma in mind—Eye movement desensitization and reprocessing, EMDR, progressive counting (PC), somatic experiencing, biofeedback, Internal Family Systems Model, Internal Family Systems Therapy, and sensorimotor psychotherapy, and Emotional Freedom Techniques, Emotional Freedom Technique (EFT) etc. There is a large body of empirical support for the use of cognitive behavioral therapy for the treatment of trauma-related symptoms, including
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi ...
. Institute of Medicine guidelines identify cognitive behavioral therapies as the most effective treatments for PTSD. Two of these cognitive behavioral therapies, prolonged exposure and cognitive processing therapy, are being disseminated nationally by the Department of Veterans Affairs for the treatment of PTSD. A 2010 Cochrane review found that trauma-focused cognitive behavioral therapy was effective for individuals with acute traumatic stress symptoms when compared to waiting list and supportive counseling. Seeking Safety is another type of cognitive behavioral therapy that focuses on learning safe coping skills for co-occurring PTSD and substance use problems. While some sources highlight Seeking Safety as effective with strong research support, others have suggested that it did not lead to improvements beyond usual treatment. Recent studies show that a combination of treatments involving dialectical behavior therapy (DBT), often used for borderline personality disorder, and exposure therapy is highly effective in treating psychological trauma. If, however, psychological trauma has caused dissociative disorders or complex PTSD, the trauma model approach (also known as phase-oriented treatment of structural dissociation) has been proven to work better than the simple cognitive approach. Studies funded by pharmaceuticals have also shown that medications such as the new anti-depressants are effective when used in combination with other psychological approaches. At present, the selective serotonin reuptake inhibitor (SSRI) antidepressants sertraline (Zoloft) and paroxetine (Paxil) are the only medications that have been approved by the Food and Drug Administration (FDA) in the United States to treat PTSD. Other options for pharmacotherapy include serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants and anti-psychotic medications, though none have been FDA approved. Trauma therapy allows processing trauma-related memories and allows growth towards more adaptive psychological functioning. It helps to develop positive coping instead of negative coping and allows the individual to integrate upsetting-distressing material (thoughts, feelings and memories) and to resolve these internally. It also aids in the growth of personal skills like resilience, ego regulation, empathy, etc. Processes involved in trauma therapy are: * Psychoeducation: Information dissemination and educating in vulnerabilities and adoptable coping mechanisms. * Emotional regulation: Identifying, countering discriminating, grounding thoughts and emotions from internal construction to an external representation. * Cognitive processing: Transforming negative perceptions and beliefs about self, others and environment to positive ones through cognitive reconsideration or re-framing. * Trauma processing: Systematic desensitization, response activation and counter-conditioning, titrated extinction of emotional response, deconstructing disparity (emotional vs. reality state), resolution of traumatic material (in theory, to a state in which triggers no longer produce harmful distress and the individual is able to express relief.) * Emotional processing: Reconstructing perceptions, beliefs and erroneous expectations, habituating new life contexts for auto-activated trauma-related fears, and providing crisis cards with coded emotions and appropriate cognition. (This stage is only initiated in pre-termination phase from clinical assessment and judgement of the mental health professional.) * Gestalt therapy, Experiential processing: Visualization of achieved relief state and relaxation methods. A number of complementary approaches to trauma treatment have been implicated as well, including yoga and meditation. There has been recent interest in developing trauma-sensitive yoga practices, but the actual efficacy of yoga in reducing the effects of trauma needs more exploration. In health and social care settings, a trauma informed approach means that care is underpinned by understandings of trauma and its far-reaching implications. Trauma is widespread. For example, 26% of participants in the Adverse childhood experiences, Adverse Childhood Experiences (ACEs) study were survivors of one ACE and 12.5% were survivors of four or more ACEs. A trauma-informed approach acknowledges the high rates of trauma and means that care providers treat every person as if they might be a survivor of trauma. Measurement of the effectiveness of a universal trauma informed approach is in early stages and is largely based in theory and epidemiology. Trauma informed teaching practice is an educative approach for migrant children from war-torn countries have typically experienced complex trauma, and the number of such children entering Canadian schools has led some school jurisdictions to consider new classroom approaches to assist these pupils. Along with complex trauma, these students often have experienced interrupted schooling due to the migration process, and as a consequence may have limited literacy skills in their first language. One study of a Canadian secondary school classroom, as told through journal entries of a student teacher, showed how Blaustein and Kinniburgh's ARC (attachment, regulation and competency) framework was used to support newly-arrived refugee students from war zones. Tweedie et al. (2017) describe how key components of the ARC framework, such as establishing consistency in classroom routines; assisting students to identify and self-regulate emotional responses; and enabling student personal goal achievement, are practically applied in one classroom where students have experienced complex trauma. The authors encourage teachers and schools to avoid a deficit lens to view such pupils, and suggest ways schools can structure teaching and learning environments which take into account the extreme stresses these students have encountered.


Society and culture

Some people, and many Self-help book, self-help books, use the word ''trauma'' broadly, to refer to any unpleasant experience, even if the affected person has a psychologically healthy response to the experience. This imprecise language may promote the medicalization of normal human behaviors (e.g., grief after a death) and make discussions of psychological trauma more complex, but it might also encourage people to respond with compassion to the distress and suffering of others.


See also


References


Further reading

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External links

*
The International Society for Traumatic Stress Studies (ISTSS)

Trauma-Focused Cognitive Behavioral Therapy – Medical University of South Carolina

National Child Traumatic Stress Network (NCTSN)

Trauma Information Pages
{{Authority control Psychological stress Abuse Bullying Counseling Anxiety disorders Post-traumatic stress disorder Victimology Trauma types Adverse childhood experiences