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Psychological trauma

Psychological trauma (also known as mental trauma, psychiatric trauma, emotional damage, or psychotrauma) is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.[1]

"Emotional damage" redirects here. For the Internet meme, see Steven He.

Psychological trauma

Therapy

Antidepressants,
antipsychotics,
antiemetics,
anticonvulsants,
benzodiazepines

Short-term reactions such as psychological shock and psychological denial are typically followed. Long-term reactions and effects include bipolar disorder, uncontrollable flashbacks, panic attacks, insomnia, nightmare disorder, difficulties with interpersonal relationships, and post-traumatic stress disorder (PTSD). Physical symptoms including migraines, hyperventilation, hyperhidrosis, and nausea are often developed.[2]


As subjective experiences differ between individuals, people react to similar events differently. Most people who experience a potentially traumatic event do not become psychologically traumatized, though they may be distressed and experience suffering.[3] Some will develop PTSD after exposure to a traumatic event, or series of events.[4][5] This discrepancy in risk rate can be attributed to protective factors some individuals have, that enable them to cope with difficult events, including temperamental and environmental factors, such as resilience and willingness to seek help.[6]


Psychotraumatology is the study of psychological trauma.

Signs and symptoms[edit]

People who experience trauma often have problems and difficulties afterwards. The severity of these symptoms depends on the person, the types of trauma involved, and the support and treatment they receive from others. The range of reactions to trauma can be wide and varied, and differ in severity from person to person.[7]


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.[8] In this process, the benign stimulus becomes a trauma reminder, also called a trauma trigger. 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 drugs, including alcohol, 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 and other associated emotions.[9] Often the person can be completely unaware of what these triggers are. In many cases, this may lead a person with a traumatic disorder 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 attacks are an example of a psychosomatic response to such emotional triggers.[10]


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 flashbacks may haunt the person, and nightmares may be frequent.[11] Insomnia may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night. A messy personal financial scene, as well as debt, are common features in trauma-affected people.[12] Trauma does not only cause changes in one's daily functions, but could also lead to morphological changes.[13] Such epigenetic changes can be passed on to the next generation, thus making genetics one of the components of psychological trauma.[14] However, some people are born with or later develop protective factors such as genetics that help lower their risk of psychological trauma.[15]


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). 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, prolonged grief disorder, somatic symptom disorder, conversion disorders, brief psychotic disorder, borderline personality disorder, adjustment disorder, etc.[16] Obsessive- compulsive disorder is another mental health disorder with symptoms similar to that of psychological trauma, such as hyper-vigilance and intrusive thoughts.[17] Research has indicated that individuals who have experienced a traumatic event have been known to use symptoms of obsessive- compulsive disorder, such as compulsive checking of safety, as a way to mitigate the symptoms associated with trauma.[18]


In time, emotional exhaustion may set in, leading to distraction, and clear thinking may be difficult or impossible. Emotional detachment, 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, profound emptiness, suicidality, and frequently, depression. If important aspects of the person's self and world understanding have been violated, the person may call their own identity into question.[7] 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.[19][20] In such instances, seeking counselling in appropriate mental health services is in the best interests of both the child and the parent(s).

Causes[edit]

Situational trauma[edit]

Trauma can be caused by human-made, technological and natural disasters,[21] including war, abuse, violence, vehicle collisions, 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.[21]


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.


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 child abuse. 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. 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.[22]

Effects[edit]

Evidence suggests that a minority of people who experience severe trauma in adulthood will experience enduring personality change. Personality changes include guilt, distrust, impulsiveness, aggression, avoidance, obsessive behaviour, emotional numbness, loss of interest, hopelessness and altered self-perception.[69]

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.)

processing: Visualization of achieved relief state and relaxation methods.

Experiential

A number of psychotherapy approaches have been designed with the treatment of trauma in mind—EMDR, progressive counting,[70] somatic experiencing, biofeedback, Internal Family Systems Therapy, and sensorimotor psychotherapy, and Emotional Freedom Technique (EFT) etc. Trauma informed care provides a framework for any person in any discipline or context to promote healing, or at least not re-traumatizing.


There is a large body of empirical support for the use of cognitive behavioral therapy[71][72] for the treatment of trauma-related symptoms,[73] including post-traumatic stress disorder. Institute of Medicine guidelines identify cognitive behavioral therapies as the most effective treatments for PTSD.[74] Two of these cognitive behavioral therapies, prolonged exposure[75] and cognitive processing therapy,[76] are being disseminated nationally by the Department of Veterans Affairs for the treatment of PTSD.[77][78] 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.[79] Seeking Safety is another type of cognitive behavioral therapy that focuses on learning safe coping skills for co-occurring PTSD and substance use problems.[80] While some sources highlight Seeking Safety as effective[81] with strong research support,[82] others have suggested that it did not lead to improvements beyond usual treatment.[80] 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.[15] 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.[83] 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.[84] Other options for pharmacotherapy include serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants and anti-psychotic medications, though none have been FDA approved.[85]


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.[86]


Processes involved in trauma therapy are:


A number of complementary approaches to trauma treatment have been implicated as well, including yoga and meditation.[87] There has been recent interest in developing trauma-sensitive yoga practices,[88] but the actual efficacy of yoga in reducing the effects of trauma needs more exploration.[89]


In health and social care settings, a trauma informed approach means that care is underpinned by understandings of trauma and its far-reaching implications.[90] Trauma is widespread. For example, 26% of participants in the Adverse Childhood Experiences (ACEs) study[91] 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.[90] Measurement of the effectiveness of a universal trauma informed approach is in early stages [92] and is largely based in theory and epidemiology.


Trauma informed teaching practice is an educative approach for migrant children from war-torn countries, who 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.[93][94] 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.[95] 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[96] was used to support newly arrived refugee students from war zones.[93] 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.[93]

Society and culture[edit]

Some people, and many 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.[97] 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.[97]

at Curlie

Psychological abuse

The International Society for Traumatic Stress Studies (ISTSS)

Archived 2021-01-15 at the Wayback Machine

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

National Child Traumatic Stress Network (NCTSN)

Trauma Information Pages