Trauma and Post Traumatic Stress Disorder

One’s physical safety or life is not threatened as a result of a “Small T” trauma, however unprocessed trauma can have a significant negative emotional impact on one’s quality of life. “Small T” trauma can be experienced during divorce, loss of employment, moving house, infidelity, personal conflict, financial troubles, work stress, legal battles, changing schools or loss of friends.

Also known as shock trauma. “Large T” traumas can be defined as experiences that elicit severe distress and helplessness, e.g. acts of terrorism, natural disasters, car accidents, war, child abuse, sexual assault, domestic violence or violence.

Developmental trauma is the result of abandonment, abuse, neglect or birth difficulties experienced between 0-3 years of age, which disrupts cognitive, neurological, and psychological development and attachment to adult caregivers.

Childhood trauma is experienced in childhood (prior to 18 years of age based on ACE research) and includes exposure to household dysfunction, including divorce, parental separation, mental illness, incarceration of a significant attachment figure, domestic violence or substance abuse.

Physical trauma such as bodily wounding or shock, accidents, experiencing physical abuse, disease, sickness, hospitalisation, surgery, physical neglect, and assault.

Sexual trauma relating to various experiences of sexual abuse, rape, sexual assault, and being taken advantage of in some sexual manner.

Emotional trauma including emotional abuse, emotional neglect, bullying, harassment, abandonment, rejection, invalidation, racial and discrimination trauma, workplace bullying and harassment, anxiety-related disorders, and panic attacks.

Relational trauma which occurs in one’s family or origin.

Psychological trauma including work burnout, work stress, and financial strain or stress.

Grief and loss including the experience of loss related to the death of a loved one, death of a pet, abortions, adoptions, abandonment, divorce, the ending of a relationship, end of employment, retirement, and financial loss.

War trauma including acts of terrorism and extreme violence.

Incarceration trauma trauma related to being in jail and associated experiences

Natural disasters related to experiencing floods, bush fires, cyclones and hurricanes.

Phobias such as phobias related to heights, confined spaces, spiders or being alone.

Cumulative trauma relating to ongoing, long term, “Small T” traumas (see below).

Trans-generational trauma where trauma is passed down from generation to generation in a family system.

First-responder trauma related to police, ambulance, emergency medical staff and firefighters

PTSD is a mental health disorder that can develop in some individuals who have experienced trauma.

Symptoms can include:

• Flashbacks
• Nightmares
• Sleep and concentration difficulties
• Depersonalization and derealization
• Inability to remember key features of the traumatic event
• Irritability and angry outbursts
• Exaggerated blame on self or others
• Avoidance of situations or people that are reminders of the traumatic event

You can have unresolved trauma and not have PTSD symptoms. It is important to note that PTSD is one of a number of mental health disorders that may result from exposure to a traumatic event. Depression, generalised anxiety and/or substance use are also risk factors that may develop in response to trauma.

Symptoms of PTSD can include:

• Re-experiencing the trauma
• flashbacks
• nightmares
• unwanted or intrusive thoughts
• hyper-vigilance/hyper arousal
• sleep difficulties
• irritability and anger outbursts
• numbing (eg. self-medicating)
• avoidance of anything that may remind you of the traumatic event

You can have unresolved trauma and not have PTSD symptoms.
It is important to note that PTSD is one of a number of mental health disorders that may result from exposure to a traumatic event.

Depression, generalised anxiety and/or substance use may also develop in response to trauma.

Research identifies that approximately one third of individuals who experience a severe traumatic event will develop posttraumatic stress disorder (PTSD). PubMed 2019 https://pubmed.ncbi.nlm.nih.gov/31520677/

Considerable research in this field suggests that predisposing factors which increase risk of PTSD include:

prior exposure to trauma
pre-existing high levels of stress
a lack of supportive social and family relationships.

Your therapist will gain an understanding of your history including any traumatic experiences. They will also want to know about your current mental and physical health, as well as your support network and goals for the therapy.

A intervention plan for the therapy is explored together, any concerns and questions addressed and a safe therapeutic alliance between you and your therapist progressively developed. Building skills and resources to support the trauma counselling will also be an important feature of this phase.

This block of work is generally focused on desensitising the past trauma memory/ies, reprocessing the maladaptive beliefs underpinning the traumatic event/s and resolving any somatic elements.

This phase addresses present triggers as well as templates for any future challenging situations which may be encountered as it relates to the trauma

The number of EMDR sessions required to address your symptoms will vary depending on the complexity of your psychopathology and the degree of protective factors available to you.For example, EMDR treatment can work very rapidly for the client who has only experienced a single incident trauma. A psychologically healthy person who has had a supportive childhood, no history of drug or alcohol abuse, and generally happy, intimate and supportive relationships with loved ones, is likely to respond to treatment very quickly.

However people who have been exposed to multiple, often interrelated forms of traumatic experiences, as in complex trauma, will generally require longer treatment. Adults presenting with trauma that began in childhood, who were perpetrated by persons within formative attachment relationships and whose trauma was compounded by co-morbidities of mental illness, addiction, domestic violence, poverty, racism and a host of other stresses are likely to need longer therapy.

Good therapy helps your brain and nervous system learn non-reactive ways of responding to triggers via connection to adaptive neural networks. But a brain that is dealing with a multitude of long established stressors will usually take much longer to achieve this.

Our experiences in childhood shape the lens through which we view the world. If our experience in childhood was generally positive, safe, and consistent, then underlying beliefs about ourself, important others and the world in general will be shaped by resilience and optimism and our ability to navigate life’s adversities is likely to be more robust.

Conversely, if we experienced trauma in childhood, then those overwhelming experiences are inclined to remain partially or un-processed and maladaptive beliefs about ourselves and the world around us may have formed as a result. If these experiences have not been adequately addressed, they will remain active in adulthood, impacting negatively on our mental health and our choices in the external world.

Some ways childhood trauma may impact us as adults:

Low self esteem.

Much of our sense of self is derived from the blueprint that develops out of the repeated experience with our caregivers. If our attachment experience was neglectful or abusive, our sense of self worth is likely to be negatively impacted.

Trust Issues.

Those who endured trauma perpetrated by persons within formative attachment relationships learned early that people are not to be trusted.

A Belief of Unlovability.

Beliefs that the child did something to deserve the trauma they were subjected to is common.

Fear of abandonment.

Based on actual early experiences of neglect or abandonment, this overwhelming experience may be wired up in the brain as a threat to look out for.

Trauma symptoms.

Untreated symptoms arising from early trauma may continue to be triggered.

Attachment Issues.

Avoidant, anxious or chaotic attachment styles shaped by early attachment experiences become templates for all future relationships. See Attachment styles in Family of Origin Difficulties

Emotional Regulation difficulties.

Children learn their emotional regulation skills through their experience of how their caregivers soothed them. These skills may be poorly developed in childhood trauma survivors.

Poor relationship choices.

Unprocessed beliefs of unworthiness may shape future romantic choices. If the initial attachment was with toxic caregivers, this love template may also influence the choices of future partners. (Please see Family of Origin Difficulties on website for more information on how early family of origin difficulties impact on adult mental health)

Increased vulnerability to psychiatric disorders.

Early exposure to stress and trauma is known to have physical effects on neurodevelopment which may lead to changes in the individual’s long-term response to stress as well as vulnerability to psychiatric disorders including depression. ( Source: https://pubmed.ncbi.nlm.nih.gov/15985923/ )

Increased vulnerability to physical health issues.

Research has identified complex trauma in childhood as dramatically increasing risk for some of the leading causes of death in the western world. These include autoimmune diseases, high blood pressure, heart disease and cancer. ( Source: https://www.hsph.harvard.edu/news/hsph-in-the-news/childhood-traumas-devastating-impact-on-health/ )