Trauma and stressor-related disorders
"My psychologist described PTSD like a bottle: when I start, my bottle's pretty much empty, and every job is represented by a drip of water in that bottle. And my bottle had just overflowed, hence why I just couldn't manage anything."
Many of us have experienced threatening or traumatic situations at some time in our lives. Some people—like defence members, first responders and refugees may face repeated traumatic situations. Repeated events like these can happen to others as well.
Complex trauma occurs when someone faces a traumatic situation they can't escape from, over and over, or over a long period of time. Examples include child abuse or neglect, ongoing domestic violence, torture, and being a refugee.
Trauma carries more risks of serious and ongoing mental health issues if it happens repeatedly, especially if it occurs as a child. But the good news is that with the right support it is possible to recover from trauma, including its complex forms.
Some people even find positive changes in their attitude to life and their relationships (posttraumatic growth) as they recover from effects of trauma. Life may seem even more precious, and if we have people who we love and trust, they may be even more special.
Living with a mental health condition can be challenging, but you are never alone. It’s important to take the first steps in getting support.
Trauma can change how we view the world
Trauma overwhelms our ability to protect ourselves and others. It can make us feel the world isn’t safe or that we can’t trust others or take risks. If this happens early in life, this can have a particularly profound impact that may take some time and ongoing support to fully reverse.
Our bodies have a survival mechanism that helps us react quickly to threatening situations. When we are afraid, our adrenal glands release hormones like adrenaline and cortisol. This gets the heart beating faster and leads to deeper breathing, tighter muscles, and more oxygen to the brain. This response helps us deal with threats by fighting them, running away or staying still. We can get this kind of response in any stressful situation, but it is much stronger when the situation is experienced as traumatic.
When we come across something that reminds us of a trauma, our body can react as if the trauma is happening again. This can even happen if we come across something that is safe, but is perceived to be like the event (so a car backfiring can lead to this response for someone whose prior trauma related to gunfire). The response can take people by surprise, and it may feel as if nowhere is safe. If we stay on high alert, we easily go back into ‘fight, fight, or freeze’.
If it comes out of the blue, our fast heartbeat can make us think we are having a heart attack, and when our muscles are tight, it may seem like we can’t breathe. Our overbreathing makes us lightheaded, and things may seem unreal. After a few minutes, the body usually reverses most of these reactions. But if we keep feeling under threat, some of them (like tight muscles) may keep going. At the end of the day, we feel both anxious and worn out.
Common effects of trauma include:
- being hyper-alert
- feeling numb
- having disturbed sleep or nightmares
- having intrusive thoughts or images about the event/s
- avoiding reminders of the event.
At first, people often have difficulty piecing together what happened, and it is common to have memory fragments rather than a complete picture.
All of these are normal responses to a traumatic experience.
For many people who encountered one trauma, the effects gradually happen less often and may even go away altogether after a few weeks.
Mild or temporary effects can even happen for some people who repeatedly experience trauma as part of their job, even if they think they have some control over the threat or its effects. However, people exposed to trauma at work are not immune from effects of traumas. Some experiences may affect them especially deeply, and the ways they cope with trauma may cause other problems.
For both of these groups, digital apps and programs may help with recovery. However, healthy connections are also important.
Even after one trauma, some people will have effects that continue and may become worse. More severe or long-lasting traumas, and more of them, make that more likely to happen. If the effects interfere a lot with daily life, the person may have Post-Traumatic Stress Disorder (PTSD).
But that is not the only way people react to trauma. Some may never have PTSD, but do have other mental health problems that have a big impact on their lives:
- They may feel deeply ashamed or guilty about the trauma, even though it wasn’t their fault.
- They may think they are worthless or dirty.
- They may be depressed or angry, have difficulty with relationships, problems with substance use, or suicidal thoughts.
- They may space out and shut down their emotions (dissociate), so it’s hard to have good feelings at all.
- If they had another a mental health issue in the past, that may get worse.
- Even their physical health and wellbeing may suffer.
Complex trauma increases the risk of effects that are more severe, complex and long-lasting. People with complex trauma often have trouble experiencing or managing emotions. They often struggle to feel safe and trust others, and find it hard to make and keep close relationships.
Children are especially vulnerable. When faced with threat, children often can’t fight or flee. They may ‘freeze’, unable to move, or too frightened to do anything. They may pretend that the situation isn’t happening or space out—a response that may be missed by adults who are around them.
Children are especially likely to blame themselves for abuse. If they can’t develop reliable attachments with their primary caregivers, they may find it hard to learn how to connect with others. They may not seek affection or respond to comfort, and may withdraw, become anxious or depressed, or seem naughty.
Traumas in childhood may not be remembered as an adult, or memories may later emerge, when something reminds them of a trauma. If a person hasn’t made a connection between their early experience and their current problems, that can make it harder for them to recover.
Any serious and ongoing problem is a sign to get help. See the section below on taking action for change for ways to get started.
Some ways of coping with trauma are soothing at first, but make it harder to recover in the longer term. Examples include:
- using alcohol and drugs
- risk taking
- physically hurting ourselves
- spacing out (dissociating)
- avoiding reminders of the trauma, or trying not to think about it
- overusing other activities that give relief or distraction, like overworking or over-exercising.
Debriefing in a group after traumas used to be common, but we now know that this can make people worse, especially if they hear others’ horrible experiences and see how distressed they are.
There are other things that can help:
- Learning about trauma, and how recovery can happen. You are already doing that now!
- If avoiding reminders of the trauma causes problems for everyday life, facing them safely step-by-step. People with mild reactions to a single event can often do this by themselves or with help from a friend. For people with severe trauma reactions, reducing avoidance will often need to be part of broader treatment with a therapist.
- Learning healthy ways to deal with negative thoughts and lower distress. Meditation, relaxation, yoga or Tai Chi can help. So can other activities you enjoy.
- Building stronger relationships with people you can trust, who make you feel safe and support your recovery. This is especially important in complex trauma, or when someone you trusted and relied on was responsible for it. But it’s also important for anyone who is struggling with trauma.
- Exercising regularly, eating well and dealing with sleep problems.
Taking action for change
People can and do recover, even if their trauma was very severe, happened repeatedly, or occurred early in life. It may just take longer in those cases.
Recovery from trauma is not about willpower or trying to 'forget the past'. It is about teaching your body to reduce ‘fight, flight or freeze’, and learn new ways to deal with the trauma—ways that can make you feel free to grow and live more fully.
Each person’s experience is different, and people may have different paths to recovery. For some who experience one trauma it may be like a sprint through some hurdles. If you have had more severe or repeated experiences it may sometimes feel like climbing a sandhill—two steps up, and a slip back. Recovery may seem slow…and if you have experienced complex trauma, you may find it hard to manage because your strong emotions may feel overwhelming. Reaching out to seek support may be especially difficult.
Be gentle and patient with yourself. Looking after yourself can be a challenge. Take small steps and try to seek help and support when you need it. Focusing on how far you have come will help you keep going.
If you decide you need professional support, there are also apps and programs that have trained therapists to a guide you through an online course. There are also phone, chat, email services and crisis liens that offer counselling.
Helping someone affected by past or current trauma
There is a lot that family and friends can do to support a person affected by trauma.
- Learn more about trauma, the effects it can have, and how people recover from different types of trauma.
- Help them feel safe. If others have hurt them, they may be reluctant to trust you, and may push you away if they feel threatened.
- Recognise that they have undergone overwhelming experiences and are doing their best to cope. Notice their effort, and any ways that things seem to be getting better.
- If they want to talk, take time to listen without passing judgment…but understand if they don’t want to discuss the trauma at the moment. If they just want to chat about something else, that can be helpful too.
- Ask what they need and how you can help.
- If you are in a close relationship with the person, it’s especially important to be patient and let them know that things can get better. They may sometimes be irritable or just want to be by themselves. Be patient—they are dealing with a lot.
- Support them if they decide to use a digital tool and/or seek professional help.
- Accept that progress will take time.
Looking after yourself
While caring for someone is rewarding, it can be physically and emotionally challenging. Don’t forget to take some time to look after your own mental health and wellbeing.