What is Trauma?
Trauma is not a trigger, event, or incident that occurred externally to one’s self. It is the internal response to a situation or perceived threat, which overwhelms the individual’s ability to cope and can elicit fear, terror, powerlessness and helplessness, rejection, betrayal, invalidation, shock, distress, disturbance, and emotional, physical and/or spiritual pain.
“Trauma is a normal response to abnormal circumstances.”
Dr Tom Flewett, Psychiatrist
Trauma is stored in the body, and ingrained in the nervous system (Bessel van der Kolk, The Body Keeps the Score, 2015). We can experience adverse events directly or witness them indirectly (e.g. seeing a family member being physically abused) however the response in the body and mind can be the same.
PTSD and unresolved past traumas are treatable.
Generally speaking, the assumption is that everyone is doing the best they can with the knowledge and skills that they have at the time. However, we are human. And because we are human we are perfectly imperfect; we are flawed. We may not mean to hurt people but we do. Everyone has trauma. Everyone experiences trauma. There is nothing wrong with you and you don’t have to be ashamed. It is the severity of traumatic experiences and the amount of intervention and support systems that vary between people.
Normal responses to Trauma
Physical illness, mental illness, disease of all kinds, even a ‘successful workaholic’ can all be signs of a traumatised individual.
Normal responses to trauma vary quite dramatically from person to person. It is very subjective, individualised, and manifests in many different ways.
Flashbacks or intrusive memories
Nightmares
Insomnia
Easily startled
Sleep difficulties
Hyper vigilance
Dysfunctional adult relationships
Anxiety and/or depression
Obesity
Co-dependency in relationships
Impulsivity
Poor emotional regulation/emotional outbursts
Unhealthy relationship with sex
Gastrointestinal problems
Panic Attacks
Disability
Lack of physical activity
Numbing/shutting down
Decreased concentration/lack of focus
Avoidance of people, places or situations that remind you of past traumatic events
Dissociation
Addictions (of all kinds)
Suicidal thoughts or feelings and/or attempts
Self-harm
Eating disorders (anorexia, bulimia, food addiction, binge/restrict cycles)
Auto-immune diseases
Personality Disorders
All types of physical illness (heart disease, cancer, stroke, COPD, thyroid issues)
All types of mental illness
Poor boundaries
Difficulty tolerating distress
Nausea
Dizziness
Depression
Social problems
Shame and worthlessness
Feeling unreal or out of body
Feelings of helplessness and hopelessness
Low/poor energy levels
Types of Trauma
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Post Traumatic Stress Disorder (PTSD)
Symptoms of PTSD can include re-experiencing the trauma, flashbacks, nightmares, unwanted or intrusive thoughts, hypervigilance, hyperarousal, sleep difficulties, irritability and anger outbursts, numbing (eg. self-medicating), and avoidance of anything that may remind you of the traumatic event.
You can have unresolved trauma and not have PTSD symptoms.
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Complex PTSD
Complex PTSD generally applies to PTSD and related symptoms including depression and dissociation that originate in childhood from multiple and severe traumas, and/or from a breakdown in attachment.
Sufferers of complex PTSD may experience levels of dissociation or numbness which serves as a way to cope with threatening situations.
People with Complex PTSD will usually experience all of the PTSD symptoms outlined above as well as many of the responses mentioned further above.
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Complex Trauma
Usually, Complex Trauma involves insecure attachment in early childhood in combination with abuse or trauma later in childhood (Brown and Elliot, 2018). For example, a dysfunctional relationship with the mother or father.
This means you can still have a lot of unresolved trauma affecting your life in many different ways but not experience PTSD symptoms (nightmares, flashbacks, hyper-vigilance) as suggested above.
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Developmental Trauma
Developmental trauma is the result of abandonment, abuse, neglect or serious illness, birth difficulties or complications experienced between 0-3 years of age, which disrupts cognitive, neurological, and psychological development and attachment to adult caregivers.
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Childhood Trauma
Childhood trauma is experienced in childhood (prior to 18 years of age based on ACE research) and includes household dysfunction, including divorce, parental separation, mental illness, incarceration of a relative, violent treatment of the mother, and substance abuse.
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Physical Trauma
Physical trauma such as bodily wounding or shock, accidents, experiencing physical abuse, disease, sickness, hospitalisation, surgery, physical neglect, and assault.
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Sexual Trauma
Sexual trauma relating to various experiences of sexual abuse, rape, sexual assault, and being taken advantage of in some way.
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Emotional Trauma
Emotional trauma including emotional abuse, emotional neglect, bullying, harassment, abandonment, rejection, invalidation, racial and discrimination trauma, workplace bullying and harassment, anxiety-related disorders, and panic attacks.
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Grief and Loss
Grief and loss, including the experience of loss related to the death of a loved one, death of a pet, abortions, adoptions, abandonment, divorce, the ending of a relationship, end of employment, retirement, and financial loss.
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Relational trauma occurs in one’s family or origin.
Psychological trauma including work burnout, work stress, and financial strain or stress.
War trauma including acts of terrorism and extreme violence.
Incarceration trauma related to being imprisoned and associated experiences
Natural disasters related to experiencing floods, bushfires, cyclones and hurricanes.
Phobias, such as phobias related to heights, confined spaces, spiders, nighttime or being alone.
Cumulative trauma, relating to ongoing, long-term, “Small T” traumas (see below).
Trans-generational trauma, which occurs from generation to generation in a family system.
First-responder trauma, related to police, ambulance, emergency medical staff and firefighters
‘Small T’ Traumas
One’s physical safety or life is not threatened as a result of a “Small T” trauma, however, unprocessed trauma can have a negative emotional impact on one’s quality of life. “Small T” trauma can be experienced during divorce, loss of employment, moving house, infidelity, personal conflict, financial troubles, work stress, legal battles, changing schools, and loss of friends.
‘Large T’ Traumas
Also known as shock trauma. “Large T” traumas can be defined as experiences that elicit severe distress and helplessness, e.g. acts of terrorism, natural disasters, car accidents, war, child abuse, sexual assault, domestic violence or violence.
Dissociation or ‘Parts’
When we experience something that is too much for our system to cope with, we can ‘split’ into parts, referred to as dissociation.
Dissociation can often be the ultimate defense mechanism in being able to protect the system from the pain and trauma associated with past memories.
We actually talk about ‘parts’ all the time. For example, part of us wants to go out to dinner with friends, and part of us wants to stay home and watch a movie. Part of us is angry about something, but part of us understands the bigger picture. More commonly we may talk about our ‘inner child’ or our ‘inner critic’.
Just like trauma itself, there is a wide spectrum on the dissociative scale ranging from some separation of emotional parts to extreme separation of the personality and we now call this Dissociative Identity Disorder (formerly known as Multiple Personality Disorder). The more severe and chronic the trauma, the more dissociative parts can be expected to exist (Solomon, Hart, Nijenhuis, 2010).
Some common symptoms of dissociation include:
A sense of losing time
Confusion
Exhibition of two or more personalities (alter egos or ‘alters’)
Feelings of detachment (dissociation)
Memory gaps, and
Out-of-character behaviour
Another symptom can be depersonalisation, which is marked by periods of feeling disconnected or detached from one’s own body and thoughts. Depersonalisation can be described as feeling like you are observing yourself from outside your body or like being in a dream.
EMDR Therapy and combined Structural Dissociation
EMDR Therapy talks about:
The ‘Apparantly Normal Part’, which is usually the adult part of us that is involved in and responsible for everyday living and functioning, and
‘Emotional Parts’, which are the parts of ourselves stuck in trauma time (in the past). Emotional Parts are usually younger than the Apparently Normal Part (ANP) and sometimes hold onto memories the ANP doesn’t have.
When working with Dissociation, the aim of the game, so to speak, is integration across all levels. Through therapy, clients work on unifying their separate parts, helping the parts to share their separate memories and work together rather than against each other to eventually achieve ‘harmony in the house’. Validation and compassion for all personalities or all parts is a crucial component in this work as well as helping the different personalities or parts orientate to the present moment time.
How traumatic memories are stored in the brain
Normal memories are stored by a part of the brain called the hippocampus. You can think of the hippocampus as a librarian who catalogues (processes) events and stores them in the right place.
However, some traumatic events (such as accidents, abuse, disasters, or violence) are so overwhelming the hippocampus doesn’t do its job properly. When this occurs, memories are stored in their raw, unprocessed, form. These traumatic memories are easily triggered, leading them to replay and generate distress over and over again.
According to the Adaptive Information Processing Model (EMDR, Shapiro, 1995, 2001) these experiences can be so emotionally and physiologically arousing they become dysfunctionally stored in state-specific form, unable to be processed.
These memories live in “trauma time” and when there is a reminder (either internal or external), the images, thoughts, emotions, sensations, mental and behavioural actions experienced at the time of the trauma may be re-experienced. Hence, current problems are the result of past, dysfunctionally stored memories.