Trauma and Post-Traumatic Stress Disorder
Table of Contents
Trauma is an emotional response to a frightening or upsetting event like an accident, rape, assault, or natural disaster. Everyone reacts differently to different situations—an event such as an accident may impact one person very strongly and not affect another person at all. There are complex reasons for people having different reactions to potentially traumatic events, including their personal history, personality, how much or little control they had during the event, and other factors.
Immediately after a potentially traumatic event, shock and denial are typical. Longer-term reactions include unpredictable emotions, flashbacks, and physical symptoms like headaches or nausea. While a wide range of reactions to trauma are normal, some people have more severe or long-lasting reactions that may interfere with their day-to-day lives or well-being.
Following a traumatic event, people frequently feel stunned, disoriented, or unable to integrate distressing information. Once these initial reactions subside, people can experience a variety of thoughts and behaviors. Common responses include:
- Intense or unpredictable feelings. You may be anxious, nervous, overwhelmed, or grief-stricken. You may also feel more irritable or moody than usual.
- Changes to thoughts and behavior patterns. You might have repeated and vivid memories of the event. These memories may occur for no apparent reason and may lead to physical reactions such as rapid heartbeat or sweating. You may have trouble concentrating or making decisions. Sleep and eating patterns also can be disrupted—some people overeat and oversleep, while others experience trouble falling or staying asleep and loss of appetite.
- Sensitivity to environmental factors. Sirens, loud noises, burning smells, or other environmental sensations may stimulate memories of the event, creating heightened anxiety. These “triggers” may be accompanied by fears that the stressful event will be repeated. You may find yourself trying to avoid these stimuli.
- Strained interpersonal relationships. Increased conflict, such as more frequent disagreements with family members and coworkers, can occur. You might also become withdrawn, isolated, or disengaged from your usual social activities.
- Stress-related physical symptoms. Tension and fatigue are common. You may have headaches, nausea, and chest pain; these symptoms could require medical attention. Pre-existing medical conditions could be affected by the stress.
- Reliving the traumatic event through nightmares or flashbacks
- Feeling strongly triggered by stimuli (e.g., a car backfiring, the smell of smoke, seeing a person who resembles someone who assaulted you) that remind you consciously or unconsciously of the event
- A strong desire to avoid stimuli that may trigger your trauma feelings; you may actually avoid these stimuli and also avoid thinking or talking about your trauma
- Memory lapses (e.g., not remembering parts of the traumatic event)
- Losing the ability to have feelings of connection with other people
- Feeling numb or dissociated (not fully connected with your body)
- Feeling the world is completely dangerous and that no one can be trusted
- Being hypervigilant (constantly anxious and tense, overly watchful for danger, easily startled)
- Having trouble sleeping
- Feeling helpless
- Feeling hopeless
Fortunately, research shows that most people are resilient and over time are able to bounce back from traumatic events. It is common for people to experience stress in the immediate aftermath, but within a few months, most people are able to resume functioning as they did before. It is important to remember that resilience and recovery, not prolonged distress, are the norm. That said, different people may take more or less time to feel OK again after a traumatic incident has occurred.
Coping in the First 24 to 48 Hours
- Call emergency services (911) if needed
- Ensure that you are in a safe place with safe people
- Alternate between periods of physical activity (e.g., a brisk walk) and rest to release stress chemicals that build up in the body (e.g., adrenaline, cortisol)
Longer-Term Coping Strategies
- Give yourself time to adjust. Anticipate that this will be a difficult time in your life. Allow yourself to mourn the losses you have experienced and try to be patient with changes in your emotional state.
- Ask for support when needed. Social support is a key component to recovery. Family and friends can be an important resource. Ask someone to be with you if you don't want to be alone or if you feel afraid. Ask a friend to text or call you every day to check in. You can also find support and understanding from others who've survived a trauma. You may want to seek help from a religious or spiritual community, medical clinician, or mental health providers.
- Ask for practical help if needed. Ask friends and family to help out with tasks you may not feel up to doing yourself, such as going to the grocery store or driving to a doctor's appointment.
- Communicate your experience. Express what you are feeling in whatever ways feel comfortable to you, such as talking with family or close friends, keeping a diary, blogging, or engaging in a creative activity (e.g., drawing, dancing, making crafts).
- Find a local support group led by trained professionals. Support groups are frequently available to address a variety of traumas. Group discussions, facilitated by a professional counselor, can help you realize that you are not alone in your reactions and emotions and get support.
- Engage in healthy behaviors. Eat well-balanced meals and get plenty of rest. If you experience ongoing difficulties with sleep, you may be able to find some relief through relaxation techniques. Avoid relying on alcohol and other drugs to cope or "check out," because they can delay active coping and moving forward; they can also cause additional problems.
- Establish or re-establish routines. This can include eating meals at regular times, sleeping and waking on a regular schedule, going back to school or work, or following an exercise program. Plan to have something to look forward to, like pursuing a hobby, walking in the park or on the beach, seeing a friend, or reading a good book. Find a balance between doing too much and not doing enough—it's important not to push yourself too hard but also not to allow yourself to spend all your time alone and inactive.
- Avoid making major life decisions. Switching careers or jobs and making other important decisions can be highly stressful even when you haven't gone through a trauma; they are even harder to take on when you're recovering.
- Be kind to yourself. Recognize that you are going through a tough time and that having various reactions is normal and expected.
It's normal to have a variety of emotional, cogitive, and physical reactions to a trauma that may last for days, weeks, or months following a traumatic incident. Typically, symptoms gradually improve over time. However, if your reactions are very intense, get worse rather than better, persist for a very long time, and/or interfere with your ability to function, you may have Post-Traumatic Stress Disorder (PTSD), clinical depression, or another psychological condition that requires professional assessment and treatment. If you experience persistent feelings of distress or hopelessness and you feel like you are barely able to get through your daily responsibilities and activities, see a licensed mental health professional or medical clinician. It's especially important to ask for help if you are having thoughts of harming or killing yourself or someone else.
- Express that you care and want to help.
- Spend time with the person, but give them space and private time when needed.
- Listen attentively to what the person says; don't jump in with advice, opinions, or demands.
- Don't tell the person how they “should” be feeling
- Offer help and support without waiting to be asked, but do check in to make sure the help is wanted.
- Reassure the person of their safety.
- Offer to help with tasks like cooking, shopping, cleaning, and going to appointments, if needed.
- Encourage (but don't pressure) the person to spend time with you or other people.
- Encourage (but don't pressure) the person to engage in some normal activities (e.g., going to class, going out to lunch) but not to push themselves too hard.
- Offer to go for a walk or work out with the person to help them stay active.
- Be patient: Don't pressure them to “be OK” faster than is possible for them.
- Don't take on too much responsibility for the person's recovery, or you may feel overwhelmed or burned out; seek support for yourself if needed.
- Encourage them to get professional help if needed. This should be their choice, unless you believe the person is at imminent risk of killing themselves or another person. In these emergency situations, call 911.
Information adapted from the American Psychological Association website.