Unpacking the meaning of emotional trauma

What do you think of when you read the word trauma? Head injuries, car accidents, earthquakes, child abuse? These may be some of the things that you associate with trauma or traumatic events. However, if the word leaves you confused or unsure about what trauma is, you are not alone. Trauma has a layered and complex meaning, and it can even go unnoticed and unrecognized for long periods of time.

Trauma or traumatic stress (stress directly due to trauma) may be understood in the context of PTSD (Post-Traumatic Stress Disorder) but the impact of trauma is not always fully captured with this diagnosis, as many individuals who have suffered something traumatic do not meet the full criteria for PTSD. However, most individuals find that at some point the traumatic or distressing event overwhelmed their ability to cope for a period of time.

As a psychologist, I often see patients who tell me that they have experienced something quite difficult or distressing in their lives. When I ask about what they experienced, they will sometimes say things like “my uncle was inappropriate with me” or “my last relationship was very messy” or “my sister ended her life but it was a long time ago.” On exploring this in more detail, I typically find that the event has had a far-reaching impact on their relationships, their self-worth, anxiety, and their overall health although they don't identify the event as having been traumatic. The elements of what they experienced however were quite traumatic –they overwhelmed their resources for coping–and they reacted with fear, horror, or helplessness, even after the stressor was no longer ongoing in their lives.

Exposure to something traumatic or severely distressing to the individual, is rather a universal phenomenon across one’s lifespan. Individuals can display a range of responses after exposure to trauma, due to their past experiences, their biological make-up, and their environment. In my clinical experience, some people show resilience rather quickly after a traumatic experience with minimal impact to their personal, physical, and emotional well-being. Others may find themselves impacted moderately, where they may avoid certain reminders of the event, feel scared or sad more frequently, find it difficult to focus or concentrate, and may begin to view others and the world a bit differently. These individuals typically benefit from short-term professional help or counseling to learn skills to develop the resilience and growth that they would like to achieve.

Some go on to develop a more severe response, where something like PTSD may be the appropriate diagnosis.  They may:

• Experience depressed, anxious, and angry mood shifts

• See flashbacks of the traumatic event

• Find it difficult to feel safe

• Have disturbed sleep or nightmares

• Feel on edge

• Drink alcohol excessively to cope

• Feel somewhat disconnected from themselves and others

• And have difficulties in their interpersonal relationships.

In traumas that are interpersonal in nature such as child sexual abuse and sexual assault or long-term emotional abuse, individuals can also develop complex trauma, or C-PTSD, where it may feel difficult to trust others and engage in meaningful relationships, see oneself as worthy of being loved,or have difficulty in regulate their feelings and tolerating day-to-day stressors.

Another distinction to make when thinking about the impact of trauma, is whether the exposure to the traumatic event is a one-time event, or whether it is occurring repeatedly. The impact of trauma can be cumulative, which means that the more incidents of trauma one is exposed to, the greater the impact of the second, third, and fourth incident, over time.  It is also important to note that while you may not be experiencing all the symptoms of PTSD, you may be trying to understand or cope with what has happened. I always have patients who tell me, “but what I experienced is not as bad as what others have experienced or what you see in the news these days.” I tell them that there does not have to be a certain level of “extreme” before help is warranted. For example, an individual who has recently begun a new romantic relationship, starts to find that their partner is starting to show some controlling behaviors in the relationship. While this may not immediately lead to a set of PTSD symptoms, there can still be a significant impact on the individual’s identity and how they feel about themselves, particularly if a situation such as this is ongoing.

Being able to recognize the early signs of your emotional health declining after a distressing event, particularly if it has been over a month after the event has occurred, and seeking a professional who can guide you about whether this is something to be concerned about, can be an effective way of taking charge of your mental health. It is also important to remember your strengths and support system and be able to utilize them during the process of trauma recovery. This includes reaching out to loved ones, pets, exercise, self-care, being in environments where you feel safe, and using other outlets that you might use to cope with stress.

Dr Divya Kannan is a clinical psychologist recently relocated to Bangalore from Vanderbilt University in Nashville, USA, where she has spent the last several years working with adult survivors of violence. She is currently a practicing clinician in Bangalore.