Understanding Your Response to Trauma
What is a traumatic event?
Among the many stressful events of living, we can be faced with
extraordinary circumstances that leave us feeling terrified,
powerless, and/or horrified in the face of threatened or actual
injury or death. Examples of traumatic events may include:
- natural disaster
- catastrophe caused by human error
- catastrophe caused by failed equipment
- physical or sexual assault; rape
- serious motor vehicle accident
- witnessed violence, injury or death
- combat, torture or imprisonment
- threats of harm to self or loved ones; stalkings
- domestic violence and physical abuse
- fire and burn survivors
- destruction of one's home
- life-threatening illnesses and treatments
How do we usually respond to a traumatic event?
Sometimes immediately, and sometimes after brief or even extended
delay, most of us will experience intense feelings and symptoms
related to the traumatic event. Not every person experiences the
same aftermath to the same trauma. However, you are likely to
bounce back and forth between periods during which you relive the
trauma and other periods during which you are benumbed of feeling
and avoidant of any thought or reminder of the traumatic event.
This is entirely normal. This normal, acute response
to trauma is not called "post-traumatic stress disorder" unless it
is persistent over time and does not gradually heal.
What effects might I experience?
1) Reexperiencing the Trauma
- "flashbacks" or intrusive memories of the trauma: You
may experience flashbacks in which you intensely relive the trauma,
as if it were really happening again. You may feel all the same
emotions and sensory experiences again. You do not lose
consciousness during a flashback, but you may have difficulty
distinguishing here-and-now reality when a flashback consumes you.
This can be a frightening experience, especially since you may see,
hear, smell, taste or feel things related to the past traumatic
event that are not actually there in your current reality. This
does not mean that you are "losing your mind." Such
flashbacks are an entirely normal part of the response to
trauma as you struggle to rework and integrate the experience. If
you had another traumatic experience years before this one, you may
even find that sudden flashbacks about that previous experience get
mixed up with flashbacks about your more recent traumatic
- nightmares about the trauma or other scary content: You
may have nightmares that vividly replay the traumatic event or that
just replay fragments of your experience. You may have nightmares
that repeatedly replay themes of helplessness, horror, anger, or
other feelings related to the trauma. You may awaken very upset and
sweating profusely, without remembering any nightmare.
- insomnia: You may often feel "too wired" to sleep. Your
nightmares may be so alarming that you become fearful of sleep. You
may associate darkness with danger. Being left alone with your own
thoughts, without the distractions of your daytime activities, may
prompt memories of the trauma which make it difficult to sleep.
Coffee or alcohol may interfere with your sleep like never before.
Persistent insomnia or awakenings during the night could also be a
sign of developing depression which can be treated with
- intense response to reminders or symbols of the trauma:
You may experience sudden panic, irritability, anger, grief, horror
or vague "sinking" feelings that sometimes seem to come "out of the
blue." Sometimes you may recognize at the time, or later, that your
feelings are in response to a reminder of the trauma. Such
reminders can be obvious or they can be so subtle that you may not
easily recognize them as connected with the trauma. You may also
experience strong feelings when faced with a monthly or annual
anniversary of the traumatic event. You may find that, quite
unpredictably, you dissolve under ordinary stress that you would
usually take in stride. You might find that music is intolerable,
that children's behavior or noise is hard to take, or that you
can't watch television because the feelings come.
2) Numbing of Emotions and Avoidance of
- periodic numbing of emotions: Although your emotions may
be very intense at some times, at other times they may be so much
the opposite that you may feel dull, empty, numb or completely shut
down. You may feel emotionally dead or like a robot without
feelings. You may feel remarkably detached and estranged from
others. You may feel that you can't even generate feelings of love
in your most treasured relationships. You may lose interest or
feelings of enjoyment for your favorite pastimes, eating or sex.
Even though others may think you are doing better at these times
compared to periods when you are intensely reliving the trauma, it
may alarm you to feel so benumbed and lacking in feeling. Again,
this is a part of the normal response to trauma. Just as the iris
controls the amount of light entering your eye in order to protect
the retina, or, just as the body secretes natural anesthetic after
a physical injury, so, too, does your system mobilize to protect
you from being overwhelmed after trauma by numbing your
- avoidance of "triggers" or reminders of the trauma:
Given the intensity of your feelings when you are reminded of the
trauma, it is only natural that you will often strive to avoid such
triggers. You may also find that your memory fails you in recalling
certain important aspects of the trauma. Such avoidance or memory
lapses can be self-protective in the aftermath of trauma. However,
if too persistent or too generalized, such responses may hinder
- wishes or attempts to ignore, forget or bury the trauma:
You may find that you go through periods during which you strive to
keep the trauma out of your thoughts and don't want to discuss it.
For example, you might throw yourself into your work so that you're
so busy you can't hardly stop to think. This is the opposite
extreme from periods during which the trauma consumes your thoughts
and you desperately want to talk about it over and over. You may
find that the harder you try to keep thoughts of the trauma out of
your awareness, the more they intrude in other forms (e.g.,
nightmares or periodic flashbacks).
- sense of a foreshortened future or of future
catastrophe: You may find that you experience either
hopelessness or fatalism when you consider the future. You may
become preoccupied with ideas that you won't retain your health,
that you won't have the love of others, that you will die young, or
that you or loved ones will be especially vulnerable to future
catastrophe. Once the proverbial one-in-a-million traumatic event
has happened to you, it can feel like all other disasters are
likely to happen to you, too.
3) Symptoms of Increased Arousal
- trouble falling or staying asleep
- difficulty deciding anything
- difficulty concentrating
- outbursts of anger
- spasms of grief
- hypervigilance about safety
- startle reactions
- bodily reactions to triggers (e.g., sweating, nausea,
trembling, pain, hyperventilation)
- knot in stomach or headache
4) Possible Effects on Beliefs, Attitudes and Sense of
Depending on the nature of your traumatic experience and how it was
caused, you may notice any of the following changes:
- the world feels unsafe, unfair, unpredictable and out of
- sense of separation from the rest of humanity
- loss of autonomy, mobility or freedom
- sense of betrayal, unfairness or mistrust
- self-blame and diminished self-respect
- sense of degradation, humiliation or personal weakness
- indifference, fatalism or cynicism
- guilt or shame about surviving, especially if others did
- rage, thoughts of revenge, and aggressive impulses (guilt)
- anger at people who have not been affected
- sadness over losses
- spiritual crisis or loss of faith
How can this all be just "in my head?"
It's not. Researchers have demonstrated that exposure
to severe trauma often results in persistent alterations in bodily
functions. For example, levels of several neurotransmitters in your
brain may be affected by trauma, which can contribute to your
symptoms. Trauma can render parts of the brain overactive or
underactive, also contributing to your symptoms. Disruption of your
sleep cycle after trauma may also contribute to your symptoms. Your
baseline level of arousal, as measured by resting heart rate and
blood pressure, may be persistently elevated after trauma.
How might my family be affected?
When something traumatic happens to one person in a family, often
everyone is affected. Different people's trauma reactions may vary
considerably. It may seem that some are "over" or "under" reacting.
Often this is because one person is in a period of being benumbed
while another may be in a period of over-arousal. Family members
often experience changes in their world view or a spiritual crisis
of their own. They may also have intense feelings of guilt, anger,
or sorrow about what has happened to you, which can sometimes make
it difficult for them to be helpful to you.
Why am I so upset about the responses of others?
Unfortunately, the police, the justice system, reporters, medical
personnel, the clergy, and others can respond to you in ways that
compound your feelings. This is sometimes called "secondary trauma"
or "secondary wounding." Ignorant, patronizing, impatient or
insensitive responses of others may leave you feeling ignored,
blamed, or treated like a child. Even well-intentioned loved ones
who care for you and are eager to see you recover may respond to
you in ways that compound your feelings. Sometimes your upset about
such reactions from others may seem worse than the trauma itself,
or you may become very preoccupied by it. Remember that sometimes
people may avoid you or even blame you because they don't like to
be reminded that bad things can happen unpredictably to good
What can I do to help myself?
- Learn more about your response to trauma by reading from
materials listed below.
- You and your loved ones must understand that you may well have
a very intense need to discuss the traumatic event repeatedly and
in much detail. This can be a natural part of the recovery process
as you struggle to integrate the experience. If this proves to be
too upsetting for your loved ones, or if you feel you cannot talk
to them about parts of the incident or certain feelings that you
have, then you may need to find other confidants (e.g., mental
health professional, minister or support group), who can understand
and tolerate such a need.
- Sometimes it is helpful to write down your memories of your
traumatic experience, or to keep a journal of what you are going
through as you recover. Sometimes it is helpful to look at
photographs or other reminders of, or to establish a memorial to,
someone or something that is lost. Tears can be healing. Give
yourself permission to feel all your feelings, even those that
don't make sense or go together.
- Strive to identify the "triggers" for your reliving of the
trauma so that you can better predict and ready yourself for upset
rather than being taken by surprise, which only adds to your sense
of alarm. Allow yourself to lean on others a bit when you know
something will be difficult.
- Be extremely cautious about your use of alcohol. Many people
who have experienced trauma try to control or diminish their
symptoms with alcohol, only to have their drinking compound their
- Strive not to isolate yourself more than briefly. Even if you
do not feel like actively relating to others, find ways to be in
the vicinity of others. Occasionally, you may need to withdraw for
a day or two to "regroup" and come out again.
- Remind yourself that your reactions are real and expected
reactions to trauma, rather than evidence of personal weakness.
Remind yourself that it will take patience and effort to recover,
but that you won't stay stuck in your worst feelings. Remember that
you can't make yourself recover quickly by sheer force of will.
Give yourself the latitude to have good days and bad days. "Trauma"
means "wound." Deep wounds take time to heal, even if you do
everything you can.
- If your intrusive symptoms (e.g., flashbacks, sleep
disturbance, nightmares, startle responses) are especially
disruptive, or, if you are really struggling with anxiety or
depression, consult your family physician or a psychiatrist about
whether medication may be useful.
- Consider joining a support group if an appropriate choice is
available. Your doctor or a mental health agency may be able to
direct you to an appropriate group or internet web site. If no
group is available, you may find it useful to make individual
contact with someone who has survived a similar experience.
- At some point in your recovery, it may feel important for you
to revisit the scene of the traumatic event or to make contact with
certain symbols of the trauma. It may be important for you to seek
further information about the event, (e.g., talking with witnesses,
reading news stories or police reports, or contacting other
authorities for details about the event or its aftermath). Don't
rush into this. You may find this easier if you ask a loved one
to accompany you. Others may feel that you are needlessly torturing
yourself; but, sometimes details, however terrible, provide relief.
If in doubt, seek a consultation before proceeding.
- Take time to learn and practice muscle relaxation, imagery and
breathing skills to help calm yourself. Consult the references
noted below or seek assistance from an expert who can help you
develop such skills.
- If your symptoms are especially upsetting or especially
persistent, you may decide to seek professional help. Do not assume
that all mental health professionals understand post-traumatic
responses and appropriate treatment. If you need a referral,
discuss it with your family physician to see if there are special
resources in your community, (e.g., experts in trauma response,
rape crisis centers, domestic violence clinics), call the
psychology or psychiatry department of the nearest university
medical center or contact the Anxiety Disorders Association of America
for a referral in your area. If you are unsure about a name you've
been given, ask about the nature of the mental health
professional's experience in working with people after trauma.
Locally, the Anxiety and
Stress Disorders Institute of Maryland offers treatment
specialized for post-traumatic responses.
Can medication help?
There are several medications that may be helpful in treating
post-traumatic symptoms, but there is no single, consensus choice.
For example, several of the anti-depressants may diminish your
sleep disturbance, nightmares and flashbacks, even if you are not
particularly depressed. Some drugs that are ordinarily used to
lower blood pressure may help with startle responses and intense
reliving experiences. The class of anti-anxiety drugs called the
benzodiazepines may also be useful as a short-term means of
diminishing your symptoms and helping you sleep. Some of these
choices may not be appropriate for you and others may have
uncomfortable side effects. More than one drug trial or
combinations of drugs may be necessary before you get satisfactory
results. A particular drug trial might require many weeks before
its effectiveness can be evaluated. The choices should be discussed
with your family physician or with a psychiatrist who specializes
in treating patients with post-traumatic symptoms. It is especially
important to consider medication if you are completely exhausted
from lack of sleep or if you are developing significant
Other reading for you and your family:
- Excellent overview of post-traumatic response, with emphasis
on self-help and chapters focused on survivors of crime, rape,
abuse, natural catastrophes, vehicular accidents and combat:
Matsakis, A. I Can't Get Over It: A Handbook for Trauma
Survivors. Oakland, CA: New Harbinger Publications,
- Sexual assault: Fay, J. and Adams, C. Free of the
Shadows: Recovering From Sexual Violence. Oakland, CA: New
Harbinger Publications, 1989.
- Survivors of a Suddenly Killed Loved One: Lord, J.H.
No Time for Goodbyes: Coping with Sorrow, Anger and Injustice
After a Tragic Death. Ventura, CA: Pathfinder Publishing,
- Relaxation and stress reduction skills: Davis, M.,
Eshelman, E.R., and McKay, M. The Relaxation and Stress
Reduction Workbook. Oakland, CA: New Harbinger Publications,
1982. Budzynski, T. Relaxation exercises on cassette tape. (
Guilford Press, 1-800-365-7006)
Posttraumatic Stress Disorder: A
State-of-the-Science Review (2006)
Bremner JD, Foa EB, Mayberg HS, North CS, Stein MB.
Journal of Psychiatric Research, 2006 Feb;40(1):1-21.
This article reviews the state-of-the-art research in posttraumatic
stress disorder (PTSD) from several perspectives: (1) Sex
differences: PTSD is more frequent among women, who tend to have
different types of precipitating traumas and higher rates of
comorbid panic disorder and agoraphobia than do men. (2) Risk and
resilience: The presence of Group C symptoms after exposure to a
disaster or act of terrorism may predict the development of PTSD as
well as comorbid diagnoses. (3) Impact of trauma in early life:
Persistent increases in CRF concentration are associated with early
life trauma and PTSD, and may be reversed with paroxetine
treatment. (4) Imaging studies: Intriguing findings in treated and
untreated depressed patients may serve as a paradigm of failed
brain adaptation to chronic emotional stress and anxiety disorders.
(5) Neural circuits and memory: Hippocampal volume appears to be
selectively decreased and hippocampal function impaired among PTSD
patients. (6) Cognitive behavioral approaches: Prolonged exposure
therapy, a readily disseminated treatment modality, is effective in
modifying the negative cognitions that are frequent among PTSD
patients. In the future, it would be useful to assess the validity
of the PTSD construct, elucidate genetic and experiential
contributing factors (and their complex interrelationships),
clarify the mechanisms of action for different treatments used in
PTSD, discover ways to predict which treatments (or treatment
combinations) will be successful for a given individual, develop an
operational definition of remission in PTSD, and explore ways to
disseminate effective evidence-based treatments for this
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