Archive for

The Impact of Psychological Trauma

I’ve written previously about what therapists mean when we talk about trauma. Now I’d like to elaborate on it’s impact and why you might want to seek therapy for help in the aftermath of traumatic experiences. How does it impact a person and what can be done about it?

Trauma impacts many and has further reaching consequences than is usually understood. Kessler et al. (1995) found that 60% of men and 51% of women in the general population reported at least one traumatic event at some time in their lives. Almost 17% of men and 13% of women who had some trauma exposure had actually experienced more than three such events. As a therapist, I expect that most people seeking help will have experienced some sort of trauma in their lives.

What follows is an overview. Every individual is different and context can intensify or ameliorate the impact a traumatic event will have. Do you have a support system? Was your family relatively healthy and able to meet your emotional needs? Was this one in a series of traumatic events? Were you able to talk about it and receive help right away? All these factors and more play a role.

Approximately 73% of individuals exposed to a traumatic incident will experience dissociative states during the incident or in the hours, days, and weeks following. However, for most of those people these dissociative incidents will subside on their own within a few weeks after the traumatic incident subsides.  -International Society for the Study of Trauma and Dissociation

Sometimes traumatic events lead to a particular constellations of reactions and symptoms that are called Post-Traumatic Stress Disorder. This is defined as and recognized as caused by a traumatic event. It is my understanding that the impact of trauma is even broader than commonly understood and is also  a component underlying many psychological diagnoses.  
Reactions to a traumatic event may include any or all of the following:

  • Anxiety
  • Eating Disturbances
  • Sleep Disturbances
  • Sexual Dysfunction
  • Low energy
  • Chronic, unexplained pain
  • Depression, spontaneous crying, despair, and hopelessness
  • Memory Disturbance
  • Panic Attacks
  • Fearfulness
  • Compulsive and Impulsive Behaviors
  • Irritability, angry outbursts
  • Emotional numbness

In my practice I understand many diagnostic categories as trauma related and best seen as complex trauma aftermath. Especially when we take into account the breadth of traumatic experiences (big T and little t) it becomes clearer that things like anxiety, panic attacks,  depression, substance abuse, compulsive behaviors, eating disorders , dissociative disorders and personality disorders can all be related to trauma. Individuals with complex trauma histories are also often misdiagnosed! Just a couple of examples: some children diagnosed with ADHD may actually be dealing with unresolved trauma and research shows that people with Dissociative Disorders spend an average of seven years in the mental health system before getting the correct diagnosis. Without the awareness of the role that trauma plays, standard approaches to mental heath and substance abuse treatment and other human services may re-traumatize individuals who have experienced violence.  This can interfere with getting useful treatment of even lead to giving up on seeking help at all!

Appropriate treatment for a person who has experienced violence must be both trauma-specific and trauma-informed.  Trauma-specific services are those designed to directly address the effects of trauma, with the goal of healing and recovery.  EMDR is an example of such an approach. 

Tips for Coping With Trauma–What to do to Survive and Thrive Again After Disaster Strikes

What do you do at three thirty in the morning when you can’t sleep after a tragedy has occurred? First, you acknowledge that it is affecting you, and then you do what you can. Early in the morning after the shootings at Columbine High School in Littleton, Colorado on April 21, 1999, I woke up and couldn’t go back to sleep. It hit too close to home. I had moved to a house less than a mile from Columbine High School two months before the shooting, and I had two sons in high school, albeit a different one. I couldn’t get my mind off of what had happened, and how it must be affecting the people directly involved.

Instead of tossing and turning, I got up and started to write. As I typed on my laptop in the wee hours of the morning, it calmed, encouraged and empowered me to remember what trauma and tragedy is, how humans normally react to it, as well as how to cope with it. Later, I realized that people in other situations of trauma and tragedy might also find this information useful, so I have revised it to be more generally applicable. I hope you find it helpful.

What is trauma?

Trauma is any life threatening experience, outside the range of normal human experience. Anyone who is in a life threatening situation experiences it. Everyone who is near enough to see or hear traumatic events, and is empathetic to those who were actually there, experiences vicarious trauma; they FEEL AS IF they were involved, even when they were not. This includes those who listen to the radio or watch the news, and feel compassion for those who were involved.
People experiencing trauma are, and feel, helpless in the face of what has happened. Trauma also brings loss, for nothing is ever again the same. People are injured; property is destroyed. People die. We lose our sense of safety, our trust in other people, our beliefs about control, predictability, and on and on. This profound loss of the familiar is a hallmark of trauma.

Why learn about this?

If we do not recognize and address trauma or vicarious trauma, we run the risk of all our relationships being permanently affected, our sense of safety, trust and hope being permanently impaired, rather than only temporarily affected. We can also develop physical and emotional symptoms or turn to drugs, alcohol or other substances or adrenalin producing activities to numb the pain that we are afraid of.

Trauma affects our sense of self at the deepest level. It shakes our sense of who we are, our very identity. It changes our view of the world; our ability to respond emotionally to other events and to people close to us. It affects our sense of safety and hope about the world. It affects our spirituality–we may find ourselves angry at God, no longer able to believe in a loving, powerful God who would let such things happen; or we may find ourselves turning to God for solace when we had not believed in a deity before this happened.

New trauma also re-activates old traumas. People who have experienced other traumatic events, such as war, child abuse, auto accidents, etc., may find themselves remembering and/or re-experiencing those old traumas again. They may have flashbacks, or find themselves engulfed with a flood of memories or feelings from those experiences. They may have difficulty knowing if they are responding to the current situation or previous ones.

How do people usually react to trauma?

Trauma response is a process, not an event. It includes our physical (biological) and emotional (psychological) responses to what has happened, and it recurs whenever we hear more about what has happened. These are normal, predictable responses to both trauma and vicarious trauma. Others include:

  1. hyperarousal: increased heartbeat and breathing, agitation, difficulty breathing, muscular jitteriness, racing thoughts, high anxiety levels, even anxiety attacks.
  2. constriction: not being able to feel normally, physically or emotionally. This is the brain’s way of protecting us from what is too much to bear all at once, and of focusing the brain and body to defend or protect ourselves.
  3. dissociation: Feeling disconnected from what has happened and from other people can be normal in the beginning, but should gradually subside as time passes and as we process physically and emotionally what has happened. The reality sinks in gradually, a little at a time, as we are able to cope with it. Denial is part of this. We hear ourselves saying, This can’t be happening. Not here, not to me, not to our community. Disconnecting from our bodily senses can be a part of it. We may feel like we are somewhere else, watching this happen to someone else. We may be ‘spacey’ or forgetful. We may feel physical symptoms when the cause is not physical, but displacement of emotions.
  4. freezing, immobility, connected with a feeling of helplessness: This is the ‘deer in the headlights’ syndrome, or like pressing both the accelerator and the brake in an automobile at the same time. It involves a sense of complete immobilization; the body cannot move, a paralysis so complete that a person cannot move or make a sound. This response is likely only for those whose lives were actually threatened in the incident, and can sometimes also be experienced in a delayed manner.

Our responses come from our fight or flight response being activated, our nervous system being signaled to energize our survival response. This includes physical responses of increase in heart rate, difficulty breathing (shallow, rapid, panting, etc) cold sweats, tingling muscular tension, and mental responses of increase in thoughts, mind racing and worrying.

Other normal responses to trauma are:

These things are all normal and natural in response to trauma. How does healing happen? The healing of trauma depends on the recognition of its symptoms. Knowing about the cycle of trauma can help us cooperate with nature, and resolve our responses to it faster. One important principle is: In abnormal circumstances, abnormal feelings are normal. We do not need to be afraid of the trauma response. It is the brain and body’s natural way of taking care of things. Healing from trauma requires us to allow the process to take place–to allow the physical and emotional and mental responses to come and to go. And if we do not block them, they will come and go. If we try to block them, if we fight them, they will come and stay because the process does not get completed.

It can help to view emotions like waves in the ocean. Ocean waves are caused by ongoing earth processes, like the electro-magnetic waves emitted by the moon, etc. They are also caused by weather and events such as earthquakes. Emotions are much like these waves: they come without our request or permission, and they are reactive to internal and external events. And if we allow them to take their course, they come and they go. When we fight ocean waves, they have much more power over us than they do when we learn to flow with them. Ditto with our emotions. Traumatic events and tragedy in our lives cause emotions that are roughly equivalent to Tsunami waves in the ocean. Extraordinary events and and the emotions they bring in their wake require extraordinary responses on our part.

Coping and containment are crucial skills for resolving trauma. Coping involves soothing yourself when your traumatic arousal levels start to get too high. What calms us (that is not self-destructive)? Things such as taking a warm bath, getting physical exercise, lighting scented candles, making or listening to music, taking a walk, going bowling, petting a purring cat, shooting hoops, playing with a child, doing repetitive tasks such as gardening or housework, chopping wood, shoveling snow, journaling, doing heavy yard work, drawing, painting, whittling or knitting; talking about what we are experiencing to a caring, accepting listener, are among the things that can be soothing. Different things are soothing to different people; it is also common for something that calms one person to be irritating or troublesome to others close by. It is important to do what we need to do, and to allow others to do what they need to do, without judging each other about what they need to do.

It is important to know what works for us. We might want to make a list so we can have it available when we are getting too upset to think clearly. It’s also important to avoid caffeine, nicotine, alcohol, and excesses with food, which we many times turn to without thinking, because they usually make things worse in the long run. However, it is important to eat healthy meals at regular times as much as possible, so blood sugar doesn’t drop too low. Coping also does not mean that we vent or spew our emotions on those around us, verbally or physically.

Containment involves the skill of separating ourselves from overwhelming physical or emotional reactions temporarily, putting them in a box, so to speak, until we are more able to take them out and deal with them. It is different from ‘sweeping things under the rug’. In Containment, we put them away temporarily, and we choose what to take out, and when to do it; we don’t put them away forever and hope to forget them. Many people find that making or using a physical container to symbolically contain their emotions helps to keep them under control until they feel more able to deal with them. The emotions connected to trauma can be buried, but they will always come out later in some way. If we do not take them out, they affect the body through illness, the mind through bitterness, and the soul through fearfulness, among other things.

What can we do to help affected by trauma?
People can by very helpful to each other. The first thing most people need to remember is simple: BREATHE. Yes, our instinctive response is often to hold our breath, or to take tiny, shallow breaths. It can be helpful to actively hold our breath at first, to remind us that we DO have control over this one thing, and then when we’re ready, to breathe–long, slow, deep breaths from the lower part of the lungs. If we find ourselves hyperventilating, then breathing into a bag can help.

Other things that can be helpful are to: listen to each other tell the stories over and over again; help each other identify the emotions we are feeling, and to release them; hold each other, help each other to identify when we need to use other coping or containment techniques, when we need to take a break, when we need to allow ourselves to feel and cry or scream (into a pillow, in a closed car, etc), or otherwise allow ourselves to release the emotions we are feeling. Again, it’s important to make sure that we release our emotions in ways that are not harmful to those around us and don’t get us into the proverbial kicking the dog syndrome. Many people find that

What if these things don’t bring relief? We also need to help each other identify when we are getting stuck, and need some professional help to provide the safety, support and guidance we need to deal with this. People with previous traumas and losses are likely to need more support and help to effectively cope with this than others will, but we all need each other at a time like this. People need professional help when

  • they have done all of these things, but they are not getting relief.
  • they are still experiencing trauma related symptoms after others in the same circumstances have ceased to, and have returned to a more normal life.
  • their symptoms are interfering with their ability to function in their daily lives.

Another important thing to help us all recover is for everyone to do what we can. Each of us notices different things that can be done, and has different abilities to offer. Giving blood, helping with the clean-up, making donations, attending memorial services, sending cards of support to the victims and their families, writing music, painting pictures, making quilts or gardens; there are endless ways to show our support and to process our own trauma at the same time. This information is offered in the hope that it can support you in coping with trauma or tragedy that has happened in your community. Permission is granted to copy and share this article in its entirety, with complete contact information as it is below. For permission to quote from this article, please contact me.

Why Everyone in Recovery Must Be Trauma-Informed – For Women and Children’s Sake (Part 3)

My passion in looking at men and trauma comes primarily from my personal experience as a young boy, first growing up in a violent alcoholic home and then having to deal with the impact of that trauma long into my thirties – and long into my sobriety. I still have vivid memories sitting on the top stair outside of my parents’ bedroom, hearing my mother screaming and crying as I was trying to get up the nerve to open the door or bang on it, once they/he had finally gotten smart enough to lock it. Or crying myself to sleep through the only slightly muffled sound of my parents yelling, cursing, and belittling each other – only to pretend like nothing had happened the next day. Or my Dad grabbing me by my leg as I was trying to get away from him,pulling me down the stairs and then proceeding to hit me. I could go on.

Believe it or not, I had a lot of confusion as to whether what I had grown up in was actually violent. It was only until I got into relationships with people who did know the difference that I began to see that how I grew up was far from normal – even though, sadly, far too many children experience the same thing and even worse. With that in mind, it would be completely irresponsible of me not to talk about the effect that men’s trauma has on women and children. While compassion for men is essential, we have to be careful that compassion does not become enabling or minimizing of the horrific violence that women and children are enduring on a daily basis because of men acting out due to unaddressed trauma.

Here are some sobering statistics that are important to always keep in mind when we are talking about men and trauma:
• Approximately 1.5 million women are raped or physically assaulted by an intimate partner each year in the United States. Because many are victimized more than once, approximately 4.8 million intimate-partner rapes and physical assaults against women are committed annually (Bureau of Justice Statistics, 2000).

• Women aged sixteen to twenty-four experience the highest per capita rates of intimate violence (19.6 victimizations per 1,000 women) (Bureau of Justice Statistics, 2003; National Coalition Against Domestic Violence, 2009).

• One in every four women will experience domestic violence in her lifetime. Eighty-five percent of domestic violence victims are women. Most cases are never reported to the police. (National Coalition Against Domestic Violence, 2009)

• In 2007, approximately 5.8 million children were involved in an estimated 3.2 million child abuse reports and allegations. [Most cases are never reported to the police.] (National Child Abuse Statistics, 2010)

• About 30% of abused and neglected children will later abuse their own children, continuing the horrible cycle of abuse. (National Child Abuse Statistics, 2010) [My uneducated guess is that this number is actually much higher when we think about how much violence and abuse still lives in the shadows.]

The first thing that needed to happen in order for me to better see and understand my behavior was that I had to realize that violence was so much more than what I thought it was. I was often so focused on my internal experience that I did not look at my external behavior. “How can I be scaring anyone when I feel so afraid?” I would say, angrily yelling, after having been confronted. Or maybe I would laugh that patronizing laugh that we, men, can have that essentially says: “Stop being such a baby” (echoed from the mouths of so many who we had followed into manhood). Like my alcoholism, so long as I maintained a fixed definition of violence then it meant that I was not violent. But, in fairness, I was not shown what love and peace really looked like – or better, felt like. I did not understand what it really meant to feel safe. I did not realize that punching a wall was an act of violence – I thought it was avoiding violence!

Here are some other examples of violence that many may not consider to be technically abusive but that create an environment of fear for loved ones:
• Raising your voice at your partner in an effort to intimidate or silence.
• Using your physical body to intimidate in any way by size and strength alone. Most men are intimidating to women and children, and few men understand this.
• Slamming doors.
• Threatening harm to yourself or to your partner.
• Punching or kicking a wall or door with someone else in the room.
• Taking car keys or doing anything else to prevent your partner from leaving your presence or your home, or doing any other act that prevents your partner from seeking safety.
• Chasing your partner as he or she tries to leave or escape from you and your threatening behavior.

The last thing I ever wanted to do was continue the cycle of abuse. I hate violence, have a pure heart, and never wanted to see anyone in pain. Yet, I found the same words coming out of my mouth with the same anger and violence from which I used to cower. I behaved in ways towards others that were exactly the same kind of behavior that still had me afraid of being in the dark as a goddamn grown man! While it is hard to write these words, I feel as though I must, because until we men begin to truly own our behavior and call it what it really is nothing is going to change. We must shine an honest and compassionate light on this topic. Nobody wants to be an addict; to become that which so many of us swore we would never be. And, maybe that is the same fear that gets in the way for so many of us men in acknowledging the impact of abuse on our lives: the fear of being our fathers (or whoever it was that abused us.)

Of course, with all the junk we have about being a man in our society, a man acknowledging the pain of abuse sometimes feels comparable to admitting he is not a man at all. There is still a part of me that feels like a [fill in the epithet] for writing these words. There is no question that at the heart of the vast majority of abuse is a stagnant well of toxic shame corroding the spirits of some very good men.

There is so much to discuss on this topic alone but I am only able to hit the tip of the iceberg here. The reality is that it is not unreasonable to assume that most men, especially those of us in recovery from any addiction, have had some experience of trauma. I believe this should be an expectation, not considered an exception as it often is now. But nothing guarantees that sobriety will stop a man’s violence or heal the trauma destroying so many people’s lives. Helping a man to understand that his experience was indeed traumatic is not easy. The way we still raise boys to be men overlaps far too much with violence and abuse, which leads many of us to confuse that kind of mentality and behavior with Love. With that in mind, we should also assume that most men in recovery do not have a full understanding of violence, and so it is incumbent upon those of us who have come to a different understanding to share it, and to even take an unwavering stand against violence against women and children – and men! One of the greatest ways for me to heal has been the commitment to peace and safety I have made to my wife and my daughter – and even our little Shih Tzu, Haley. The more I am able to be the man I always hoped to be, the more I can see that is who I have always been.

In the field of recovery, we make one thing clear throughout – even strongly encouraging clinicians to put this message up in their offices and their group rooms: Whatever happened to you as a child – no matter what you did – was not your fault; and, whatever you do or have done as an adult that has harmed another – no matter what someone else has done – it is your responsibility and it needs to stop.