dealing with trauma
Trauma Symptoms, Causes and Effects

Trauma is defined by the American Psychological Association (APA) as the emotional response someone has to an extremely negative event. While trauma is a normal reaction to a horrible event, the effects can be so severe that they interfere with an individual’s ability to live a normal life. In a case such as this, help may be needed to treat the stress and dysfunction caused by the traumatic event and to restore the individual to a state of emotional well-being.

What Are the Main Sources of Trauma?

Trauma can be caused by an overwhelmingly negative event that causes a lasting impact on the victim’s mental and emotional stability. While many sources of trauma are physically violent in nature, others are psychological. Some common sources of trauma include:
Domestic violence
Natural disasters
Severe illness or injury
The death of a loved one
Witnessing an act of violence

Trauma is often but not always associated with being present at the site of a trauma-inducing event. It is also possible to sustain trauma after witnessing something from a distance. Young children are especially vulnerable to trauma and should be psychologically examined after a traumatic event has occurred to ensure their emotional well-being.

What Are the Signs of a Person Suffering from Trauma?

While the causes and symptoms of trauma are various, there are some basic signs of trauma that you can look out for. People who have endured traumatic events will often appear shaken and disoriented. They may not respond to conversation as they normally would and will often appear withdrawn or not present even when speaking.

Another telltale sign of a trauma victim is anxiety. Anxiety due to trauma can manifest in problems such as night terrors, edginess, irritability, poor concentration and mood swings. While these symptoms of trauma are common, they are not exhaustive. Individuals respond to trauma in different ways. Sometimes trauma is virtually unnoticeable even to the victim’s closest friends and family. These cases illustrate the importance of talking to someone after a traumatic event has occurred, even if they show no initial signs of disturbance. Trauma can manifest days, months or even years after the actual event.

Emotional Symptoms of Trauma

Emotion is one of the most common ways in which trauma manifests. Some common emotional symptoms of trauma include denial, anger, sadness and emotional outbursts. Victim of trauma may redirect the overwhelming emotions they experience toward other sources, such as friends or family members. This is one of the reasons why trauma is difficult for loved ones as well. It is hard to help someone who pushes you away, but understanding the emotional symptoms that come after a traumatic event can help ease the process.

Physical Symptoms of Trauma

Trauma often manifests physically as well as emotionally. Some common physical signs of trauma include paleness, lethargy, fatigue, poor concentration and a racing heartbeat. The victim may have anxiety or panic attacks and be unable to cope in certain circumstances. The physical symptoms of trauma can be as real and alarming as those of physical injury or illness, and care should be taken to manage stress levels after a traumatic event.

Short-Term and Long-Term Effects of Trauma

All effects of trauma can take place either over a short period of time or over the course of weeks or even years. Any effects of trauma should be addressed immediately to prevent permanence. The sooner the trauma is addressed, the better chance a victim has of recovering successfully and fully.

Short-term and long-term effects of trauma can be similar, but long-term effects are generally more severe. Short-term mood changes are fairly normal after trauma, but if the shifts in mood last for longer than a few weeks, a long-term effect can occur.

Is There a Test or Self-Assessment I Can Do?

While there are online assessments available for trauma, professional assessment is recommended over self-assessment. The victim or loved one will be biased and predisposed to see certain things, while a professional is objective and trained to compensate for bias.

If you would like more information on getting a professional assessment for yourself or a loved one who has experienced trauma, call our hotline at 1-888-481-9687. Our friendly experts are available 24/7 to take your call and provide you with all the information you need to start your recovery.

Trauma Medication: Drug Options

While trauma, unlike some other mental disorders, is induced by an event or experience, it can be treated through the use of certain medications. Not all trauma requires medication, but it can be a useful tool in treating the symptoms of trauma, such as anxiety and depression. It is important to work with a healthcare professional to determine whether medication is necessary.

Trauma Drugs: Possible Options

Drug options will depend on the individual’s psychological and medical history as well as the severity of the symptoms. If depression is severe and felt over an extended period of time, it may be treated with common antidepressant drugs. Clinical depression is defined as any depressive episode lasting longer than three months. Many trauma victims fall under the category of anxiety sufferers who are eligible for anti-anxiety medication.

Medication Side Effects

One of the considerations in whether or not to medicate for the symptoms of trauma is the presence of medication side effects. All medications have side effects, and the severity varies widely depending on drug class and individual body chemistry. Some side effects are more manageable than others, and potential negative side effects should always be compared to the potential benefit to the patient.

Drug Addiction, Dependence and Withdrawal

Unfortunately, it is not uncommon for victims of trauma to turn to drugs as a means of self-medicating and coping with the effects of trauma. Government studies estimate that 25 percent of people experience trauma before the age of 16, and those individuals are much more likely to become addicted to drugs or alcohol.

Medication Overdose

Medication overdose occurs when someone ingests a significant enough amount of medication to cause physical harm. Overdose often occurs in conjunction with substance abuse, but it may be accidental and occur under regular circumstances. Any instance of overdose should be taken seriously, and professional help should be sought to ensure that an overdose does not reoccur and to determine if the cause is substance abuse.

Depression and Trauma

Depression and trauma have high comorbidity rates, and feelings of despair, malaise and sadness can last longer than a few days or even weeks. When a trauma occurs, post-traumatic stress disorder often occurs. The Department of Veteran Affairs estimates that depression is between three to five times more likely to occur in trauma victims who develop PTSD than in the general population.

Dual Diagnosis: Addiction and Trauma

When the symptoms of PTSD, depression and anxiety become too much to cope with through normal means, many victims of trauma turn to substance abuse. As mentioned, victims are much more likely to develop addictions than other members of the general population. It is essential for the loved ones of a trauma victim to look out for the symptoms of addiction after trauma, even if the addiction is the only outward sign of PTSD.

Getting Help for Trauma-Related Issues

If you or a loved one is suffering from trauma, there is help available. With a variety of Trauma treatment options and caring professionals willing to help, the outlook for recovery is good. Often, people just need a little help with taking the first step. Our friendly representatives are available 24/7 to take your call and speak with you about getting help for trauma-related issues. Call our hotline to start the journey toward recovery today.

How to Find Help Treating a Trauma-Related Problem

Trauma is how the mind responds to mental injury. Mental trauma involves painful feelings and frightening thoughts invoked by witnessing or experiencing a traumatic event. While most people process and deal with these feelings after a short time, some people are unable to do so. Understanding Trauma The belief is that greater harm is done when a person is more directly exposed to traumatic experiences. Secondhand exposure can also be traumatic, according to the National…
Emotional and Psychological Trauma: Symptoms, Treatment, and Recovery

Authors: Lawrence Robinson, Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: May 2016.

Emotional and Psychological Trauma

If you’ve experienced trauma, you may be struggling with upsetting emotions, frightening memories, or a sense of constant danger. Or you may feel numb, disconnected, and unable to trust other people. When bad things happen, it can take a while to get over the pain and feel safe again. But with the right self-help strategies and support, you can speed your recovery. Whether the trauma happened years ago or yesterday, you can heal and move on.

What is emotional and psychological trauma?

Emotional and psychological trauma is the result of extraordinarily stressful events that shatter your sense of security, making you feel helpless in a dangerous world.
Traumatic experiences often involve a threat to life but any situation that leaves you feeling overwhelmed can be traumatic, even if it doesn’t involve physical harm.
It’s not the objective facts that determine whether an event is traumatic, but your subjective emotional experience.
The more frightened and helpless you feel, the more likely you are to be traumatized.

Causes of emotional or psychological trauma

Emotional and psychological trauma can be caused by:
One-time events, such as an accident, injury, natural disaster, or violent attack
Ongoing, relentless stress, such as living in a crime-ridden neighborhood or battling a life-threatening illness
Commonly overlooked causes, such as surgery (especially in the first 3 years of life), the sudden death of someone close, the breakup of a significant relationship, or a humiliating or deeply disappointing experience

An event will most likely lead to emotional or psychological trauma if:
It happened unexpectedly.
You were unprepared for it.
You felt powerless to prevent it.
It happened repeatedly.
Someone was intentionally cruel.
It happened in childhood.

Risk factors that increase your vulnerability to trauma

A number of risk factors make people more susceptible to emotional and psychological trauma. You’re more likely to be traumatized by a stressful experience if:
You’re already under a heavy stress load or have recently suffered a series of losses
You’ve been traumatized before-especially if the earlier trauma occurred in childhood

Childhood trauma increases the risk of future trauma

Experiencing trauma in childhood can have a severe and long-lasting effect. When childhood trauma is not resolved, a sense of fear and helplessness carries over into adulthood, setting the stage for further trauma.

Childhood trauma results from anything that disrupts a child’s sense of safety, including:
An unstable or unsafe environment
Separation from a parent
Serious illness
Intrusive medical procedures
Sexual, physical, or verbal abuse
Domestic violence

Symptoms of emotional and psychological trauma

People react in different ways to trauma, experiencing a wide range of physical and emotional reactions. There is no “right” or “wrong” way to think, feel, or respond, so don’t judge your own reactions or those of other people. Your responses are NORMAL reactions to ABNORMAL events.

Emotional and psychological symptoms of trauma:
Shock, denial, or disbelief
Anger, irritability, mood swings
Guilt, shame, self-blame
Feeling sad or hopeless
Confusion, difficulty concentrating
Anxiety and fear
Withdrawing from others
Feeling disconnected or numb

Physical symptoms of trauma:
Insomnia or nightmares
Being startled easily
Racing heartbeat
Aches and pains
Difficulty concentrating
Edginess and agitation
Muscle tension

Symptoms typically last from a few days to a few months, gradually fading as you process the trauma. But even when you’re feeling better, you may be troubled from time to time by painful memories or emotions-especially in response to triggers such as an anniversary of the event or something that reminds you of the trauma.

Grieving is normal following trauma

Whether or not a traumatic event involves death, survivors must cope with the loss, at least temporarily, of their sense of safety. The natural reaction to this loss is grief. Like people who have lost a loved one, trauma survivors go through a grieving process, which is easier if you turn to others for support and take care of yourself.

Trauma recovery tip 1: Get moving

Trauma disrupts the body’s natural equilibrium, freezing you in a state of hyperarousal and fear. In essence, your nervous system gets “stuck.” As well as burning off adrenaline and releasing endorphins, exercise and movement can actually help your nervous system become unstuck.
Instead of focusing on your thoughts or distracting yourself while you exercise, really focus on your body and how it feels as you move.
Exercise that is rhythmic and engages both your arms and legs-such as walking, running, swimming, basketball, or even dancing-works best.
Notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of wind on your skin.
Rock climbing, boxing, weight training, or martial arts can make it easier to focus on your body movements-after all, if you don’t, you could get hurt.
Try to exercise for 30 minutes or more-or if it’s easier, three 10-minute spurts of exercise per day are just as good. Move as often as you can throughout the day.

Trauma recovery tip 2: Don’t isolate

Following a trauma, you may want to withdraw from others, but isolation makes things worse. Connecting to others face to face will help you heal, so make an effort to maintain your relationships and avoid spending too much time alone.
You don’t have to talk about the trauma. Connecting with others doesn’t have to mean talking about the trauma. In fact, for some people, that can just make things worse. Comfort comes from feeling engaged and accepted by others.
Ask for support. While you don’t have to talk about the trauma itself, it is important you have someone to share your feelings with face to face, someone who will listen attentively without judging you. Turn to a trusted family member, friend, counselor, or clergyman.
Participate in social activities, even if you don’t feel like it. Do “normal” things with other people, things that have nothing to do with the traumatic experience.
Reconnect with old friends. If you’ve retreated from relationships that were once important to you, make the effort to reconnect.
Join a support group for trauma survivors. Being with others who are facing the same problems can help reduce your sense of isolation and hearing how others cope can help inspire you.
Volunteer. As well as helping others, volunteering can be a great way to challenge the sense of helplessness that often accompanies trauma. Remind yourself of your strengths and reclaim your sense of power by comforting or helping others.
Make new friends. If you live alone or far from family and friends, it’s important to reach out and make new friends. Take a class or join a club to meet people with similar interests, connect to an alumni association, or reach out to neighbors or work colleagues.

If connecting to others is difficult

Many people who have experienced trauma feel disconnected, withdrawn and find it difficult to connect with other people. If that describes you, there are some things you can do before you next sit down with a friend:
Exercise or move. Jump up and down, swing your arms and legs, or just flail around. Your head will feel clearer and you’ll find it easier to connect.
Vocal toning. As strange as it sounds, vocal toning is a great way to open up to social engagement. Sit straight and simply make “mmmm” sounds. Change the pitch and volume until you experience a pleasant vibration in your face.

Trauma recovery tip 3: Self-regulate your nervous system

No matter how agitated, anxious, or out of control you feel, it’s important to know that you can change your arousal system and calm yourself.
Mindful breathing. If you are feeling disoriented, confused, or upset, a quick way to calm yourself is through mindful breathing. Simply take 60 breaths, focusing your attention on each out breath.
Sensory input. Does a specific sight, smell or taste quickly make you feel calm? Or maybe petting an animal or listening to music works to quickly soothe you? Everyone responds to sensory input a little differently, so experiment to find what works best for you. See Stress Relief in the Moment.
Staying grounded. To feel in the present and more grounded sit on a chair, feel your feet on the ground and your back against the chair. Look around you and pick six objects that have red or blue in them. Notice how your breathing gets deeper and calmer.
Allow yourself to feel what you feel when you feel it. Acknowledge your feelings about the trauma as they arise and accept them. Our emotional intelligence toolkit can help.

Trauma recovery tip 4: Take care of your health

A healthy body increases your ability to cope with stress from a trauma.
Get plenty of sleep. After a traumatic experience, worry or fear may disturb your sleep patterns. A lack of sleep can make your trauma symptoms worse and make it harder to maintain your emotional balance. Go to sleep and get up at the same time each day and aim for 7 to 9 hours of sleep each night.
Avoid alcohol and drugs as their use can worsen your trauma symptoms and exacerbate feelings of depression, anxiety, and isolation.
Eat a well-balanced diet. Eating small, well-balanced meals throughout the day will help you keep your energy up and minimize mood swings. Avoid sugary and fried and eat plenty of omega-3 fats-such as salmon, walnuts, soybeans, and flaxseeds-to give your mood a boost.
Reduce stress. Try relaxation techniques such as meditation, yoga, or deep breathing exercises. Schedule time for activities that bring you joy such as favorite hobbies.

When to seek professional help for emotional or psychological trauma

Recovering from a traumatic event takes time, and everyone heals at his or her own pace. But if months have passed and your symptoms aren’t letting up, you may need professional help from a trauma expert.

Seek help for emotional or psychological trauma if you’re:
Having trouble functioning at home or work
Suffering from severe fear, anxiety, or depression
Unable to form close, satisfying relationships
Experiencing terrifying memories, nightmares, or flashbacks
Avoiding more and more things that remind you of the trauma
Emotionally numb and disconnected from others
Using alcohol or drugs to feel better

Finding a trauma specialist

Working through trauma can be scary, painful, and potentially retraumatizing. Therefore, this healing work is best done with the help of an experienced trauma specialist.
Finding the right therapist may take some time. It’s very important that the therapist you choose has experience treating trauma.
Choose a trauma specialist you feel comfortable with. If you don’t feel safe, respected, or understood, find another therapist. There should be a sense of trust and warmth between you.

After meeting a potential trauma therapist, ask yourself these questions:
Did you feel comfortable discussing your problems with the therapist?
Did you feel like the therapist understood what you were talking about?
Were your concerns taken seriously or were they minimized or dismissed?
Were you treated with compassion and respect?
Do you believe that you could grow to trust the therapist?

Treatment for psychological and emotional trauma

In order to heal from psychological and emotional trauma, you must face and resolve the unbearable feelings and memories you’ve long avoided. Trauma treatment and healing involves:
Processing trauma-related memories and feelings
Discharging pent-up “fight-or-flight” energy
Learning how to regulate strong emotions
Building or rebuilding the ability to trust other people

Trauma therapy treatment approaches

The following therapies are commonly used in the treatment of emotional and psychological trauma:
Somatic experiencing focuses on bodily sensations, rather than thoughts and memories about the traumatic event. By concentrating on what’s happening in your body, you can release pent-up trauma-related energy through shaking, crying, and other forms of physical release.
EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation that can “unfreeze” traumatic memories.
Cognitive-behavioral therapy helps you process and evaluate your thoughts and feelings about a trauma.

Helping a loved one deal with emotional and psychological trauma

It can be difficult to know how to help a loved one who’s suffered trauma, but your support can be a crucial factor in their recovery.
Be patient and understanding. Healing from trauma takes time. Be patient with the pace of recovery and remember that everyone’s response to trauma is different. Don’t judge your loved one’s reaction against your own response or anyone else’s.
Offer practical support to help your loved one get back into a normal routine. That may mean help with collecting groceries or housework, for example, or simply being available to talk or listen.
Don’t pressure your loved one into talking but be available if they want to talk. Some trauma survivors find it difficult to talk about what happened. Don’t force your loved one to open up but let them know you are there to listen if they want to talk, or available to just hang out if they don’t.
Help your loved one to socialize and relax. Encourage them to participate in physical exercise, seek out friends, and pursue hobbies and other activities that bring them pleasure. Take a fitness class together or set a regular lunch date with friends.
Don’t take the trauma symptoms personally. Your loved one may become angry, irritable, withdrawn, or emotionally distant. Remember that this is a result of the trauma and may not have anything to do with you or your relationship.

Helping a child recover from trauma

It’s important to communicate openly with children following trauma. Let them know that it’s normal to feel scared or upset. Your children may also look to you for cues on how they should respond to trauma so let them see you dealing with symptoms in a positive way.
How children react to emotional and psychological trauma

Some common reactions to trauma and ways to help your child deal with them:
Regression. Many children need to return to an earlier stage when they felt safer. Younger children may wet the bed or want a bottle; older children may fear being alone. It’s important to be understanding, patient and comforting if your child responds this way.
Thinking the event is their fault. Children younger than 8 tend to think that if something goes wrong, it must be their fault. Be sure your child understands that he or she did not cause the event.
Sleep disorders. Some children have difficulty falling to sleep; others wake frequently or have troubling dreams. Give your child a stuffed animal, soft blanket, or flashlight to take to bed. Try spending extra time together in the evening, doing quiet activities or reading. Be patient. It may take a while before your child can sleep through the night again.
Feeling helpless. Being active in a campaign to prevent an event from happening again, writing thank you letters to people who have helped, and caring for others can bring a sense of hope and control to everyone in the family.
Source: Sidran Institute

Related HelpGuide articles
PTSD in Military Veterans: Symptoms, Treatment, and Self-Help: Helping Yourself on the Road to Recovery for Post-Traumatic Stress Disorder
How to Help Someone with PTSD: Helping a Loved One, Friend, or Family Member with Post-Traumatic Stress Disorder
PTSD: Symptoms, Self-Help, and Treatment: How to Overcome PTSD and Move On with Your Life

Resources and references

General information about emotional and psychological trauma
Common Reactions After Trauma – Guide to the common symptoms, effects, and problems that can result from emotional or psychological trauma. (National Center for PTSD)
What is Psychological Trauma? – In-depth introduction to emotional or psychological trauma, including the causes, symptoms, treatments, and effects. (Sidran Institute)

Trauma treatment and therapy
How to Choose a Therapist for Post-Traumatic Stress and Dissociative Conditions – Advice on how to choose a trauma therapist. (Sidran Institute)
A Brief Description of EMDR Therapy – Covers the eight phases of EMDR therapy involved in the treatment of trauma. (EMDR Network)

Trauma recovery and self-help
Recovering from Trauma – Article on the necessity of processing emotional trauma in treatment if we are to recover and heal. (Psychology Today)
Dealing With the Effects of Trauma: A Self-Help Guide (PDF) – Guide to the healing journey, including coping strategies, where to find help for emotional trauma, and how to support recovery. (SAMHSA’s National Mental Health Information Center)

Trauma in children and adolescents
Helping a Child Manage Fears – Article on helping a child cope with traumatic events. Includes tips for helping your child and a list of common childhood reactions to trauma. (Sidran Institute)
Understanding Child Traumatic Stress – Learn how emotional or psychological trauma in children differs from trauma in adult. Includes causes, symptoms, and recovery factors. (The National Child Traumatic Stress Network)

Delving deeper into psychological and emotional trauma
Trauma, Attachment, and Stress Disorders: Rethinking and Reworking Developmental Issues – Explains the brain-based view of emotional trauma and how it affects child development. (Trauma Resources)

What other readers are saying

“I suffered abuse in my life during childhood and have just begun to face the fear and anxiety through therapy. Reading the article made me feel okay about the feelings I was having, and whenever I get really anxious I can come to this site and know that what I’m experiencing is completely normal. Where I live, mental health is not really an acknowledged thing and I did not even know about seeking help until I went to college in a large city. This resource is invaluable.” ~ New York

“I was recently in a car accident and . . . there has been an obvious deterioration in my behavioral and emotional functioning. I could not understand why the feelings weren’t going away, or why I seemed to be getting worse, not better. A couple of friends suggested I was traumatized, which I initially pooh-poohed, but then I started to really consider it and finally decided to research trauma. Your article spoke to me, and clarified a great deal. I am particularly grateful for the suggestions about how to self-help and what to expect going forward.” ~ Canada
Traumatic Events
Written by Jacquelyn Cafasso

Medically Reviewed by Steve Kim, MD on January 28, 2016

Responses to Trauma
Seeking Help
Read This Next

What Are Traumatic Events?

Experiencing a traumatic event can cause physical, emotional, or psychological harm.
Traumatic events can be a variety of experiences, from the death of a loved one to illness or divorce.
Strategies such as seeking support, giving yourself time, and keeping a journal can help you manage your symptoms after a traumatic event.

A traumatic event is an incident that causes physical, emotional, spiritual, or psychological harm. The person experiencing the distressing event may feel threatened, anxious, or frightened as a result. In some cases, they may not know how to respond, or may be in denial about the effect such an event has had. The person will need support and time to recover from the traumatic event and regain emotional and mental stability.

Examples of traumatic events include:
death of family member, lover, friend, teacher, or pet
physical pain or injury (e.g. severe car accident)
serious illness
natural disasters
moving to a new location
parental abandonment
witnessing a death
domestic abuse
prison stay

How Do People Respond to Traumatic Events?

People respond to traumatic events in different ways. Often there are no visible signs, but people may have serious emotional reactions. Shock and denial shortly after the event is a normal reaction. Shock and denial are often used to protect oneself from the emotional impact of the event. You may feel numb or detached. You may not feel the event’s full intensity right away.

Once you have moved past the initial shock, responses to a traumatic event may vary. Common responses include:
sudden, dramatic mood changes
anxiety and nervousness
flashbacks or repeated memories of the event
difficulty concentrating
altered sleeping or insomnia
changes in appetite
intense fear that the traumatic event will recur, particularly around anniversaries of the event (or when going back to the scene of the original event)
withdrawal and isolation from day-to-day activities
physical symptoms of stress, such as headaches and nausea
worsening of an existing medical condition

A condition known as post-traumatic stress disorder (PTSD) can sometimes occur after you experience a life-threatening event or witness a death. PTSD is a type of anxiety disorder that affects stress hormones and changes the body’s response to stress. People with this disorder require strong social support and ongoing therapy. Many veterans returning from war suffer from PTSD.

PTSD can cause an intense physical and emotional response to any thought or memory of the event. It can last for months or years following trauma. Experts do not know why some people experience PTSD after a traumatic event while others do not. A history of trauma, along with other physical, genetic, psychological, and social factors may play a role in developing PTSD.

How Can You Manage Traumatic Stress?

There are several ways to help restore your emotional stability after a traumatic event:
Communicate the experience with family or close friends or in a diary or online journal.
Give yourself time and recognize that you can’t control everything.
Ask for support from people who care about you or attend a local support group for people who have had a similar experience.
Find a support group led by a trained professional who can facilitate discussions.
Eat a well-balanced diet, exercise, get adequate rest, and avoid alcohol and drugs.
Maintain a daily routine with structured activities.
Avoid major life decisions, such as changing careers or moving soon after the event.
Pursue hobbies or other interests, but do not overdo it.
Spend time with others to avoid becoming withdrawn, even if you do not feel up to it.

When Should You Contact a Professional?

You should seek professional help if symptoms persist and interfere with day-to-day activities, school or work performance, or personal relationships.

Signs that a child may need professional help to cope with a traumatic event include:
emotional outbursts
aggressive behavior
persistent difficulty in sleeping
continued obsession with the traumatic event
serious problems at school

Psychologists and mental health providers can work with people to find ways to cope with stress. They can help both children and their parents understand how to cope with the emotional impact of a traumatic event.

Trauma is defined by the way a person reacts to events. So a trauma to one person may not be a trauma to another. And some people can cope with the trauma and move forward quickly. Others, though, may not be able to cope.

It is important to remember that some children might see an event as traumatic even when the adults around them do not. For example, after a house fire, adults are busy working with the insurance company and rebuilding. Children only know that their toys and room – the things that made them feel safe – were destroyed.

Any time a child does not feel safe and protected, the event could be seen as a trauma. Because trauma is defined by the person who experiences it, no single list can include all the causes of trauma for children. The following list, though, will explain some of the more common traumas children face.

Surgery or Serious Illness – The child is in the hospital for a serious illness or surgery.

Accidents – The child has experienced an automobile accident, a serious fall or sports injury, a house fire or other major accident that threatens his or her feelings of safety and security.

Constant and Intense Bullying – The child is bullied by one or more people over a period of time. The bullies could be classmates, teammates, neighbors or others in the child’s life. Bullying can begin as early as preschool.

Separation from Loved Ones – A child might be separated from loved ones due to military deployment, a divorce, a prison sentence or even removal of a child from home due to an investigation of abuse or neglect.

Natural Disasters – A child is affected by a severe event such as a tornado, hurricane, forest fire, flooding.

Emotional Abuse – A parent or other adult in the household often swears at the child, insults the child or humiliates the child. Emotional abuse might include the adult acting in a way that makes the child afraid that he or she might be hurt physically.

Physical Abuse – A parent or other adult in the household often pushes, grabs, slaps or throws something at the child. Physical abuse can also include hitting a child so hard it leaves marks or causes injuries.

Sexual Abuse – Any sexual activity between an adult and a child. Sexual abuse can also occur between children. This sexual activity can include obscene phone calls, fondling, exposure, pornography, prostitution or rape. Specific legal definitions can be found in the Texas Penal Code.

Neglect – The child does not have enough to eat, has to wear dirty clothes and has no one to protect him or her. Parents might be too drunk or high to take care of the child or take the child to the doctor when needed.

Loss/Abandonment – The child loses a biological parent through divorce, abandonment, death or other reason.

Isolation within the Family – No one in the family appears to love the child or consider the child to be important or special. The family does not look out for each other, feel close or support each other.

Domestic Violence – Domestic violence is a behavior used by one person in a relationship to gain power over or control the other. Abuse includes physical, sexual, emotional, economic or psychological actions or threats. This includes any behaviors that frighten, intimidate, terrorize, manipulate, hurt, humiliate, blame, injure or wound someone.

Community Violence – A child either is hurt by violence or witnesses it. Sometimes a child only needs to hear about violence to experience trauma.

Substance Abuse – Someone in the child’s household abuses alcohol, street drugs or prescription drugs.

Mental Illness – Someone in the child’s household is depressed, has another mental illness and/or has attempted suicide.

Terrorism – A child either experiences or hears about terrorism, especially when it happens in a place the child believes should be safe. The child could experience even more traumatic stress if there are children among those who are injured or killed.

Flight from Home as a Refugee – A child has been uprooted from home, often after experiencing violence or intense fear of harm.
Understanding and managing psychological trauma

The word ‘trauma’ is derived from the Greek term for ‘wound’. Very frightening or distressing events may result in a psychological wound or injury – a difficulty in coping or functioning normally following a particular event or experience. Everyone’s reaction is different, but most people who experience a potentially traumatic event will recover well with the help of family and friends and will not experience any long-term problems. If people do develop problems, they may appear directly after the traumatic event or they may not emerge until much later.

What is a potentially traumatic event?
What are the symptoms of psychological trauma?
Tips on managing psychological trauma
When to seek professional assistance
How is psychological trauma treated?
Posttraumatic Stress Disorder (PTSD)
Other resources on psychological trauma and PTSD
Seeking professional assistance

What is a potentially traumatic event?

Potentially traumatic events are powerful and upsetting incidents that intrude into daily life. They are usually defined as experiences which are life threatening, or where there is a significant threat to one’s physical or psychological wellbeing.

The same event may have little impact on one person but cause severe distress in another individual. The impact that an event has may be related to the person’s mental and physical health, level of available support at the time of the event, and past experience and coping skills.

Situations and events that can lead a person to experience psychological trauma include:
Acts of violence such as an armed robbery, war or terrorism
Natural disasters such as bushfire, earthquake or floods
Interpersonal violence such as rape, child abuse, or suicide of a family member or friend
Involvement in a serious motor vehicle or workplace accident.

Other less severe but still stressful situations can also trigger traumatic reactions in some people.

What are the symptoms of psychological trauma?

Many people have strong emotional or physical reactions following experience of a traumatic event. For most, these reactions subside over a few days or weeks. For some, the symptoms may last longer and be more severe. This may be due to several factors such as the nature of the traumatic event, the level of available support, previous and current life stress, personality, and coping resources.

Symptoms of trauma can be described as physical, cognitive (thinking), behavioural (things we do) and emotional.

Excessive alertness, on the look-out for signs of danger
Easily startled
Disturbed sleep
General aches and pains

Cognitive (thinking)
Intrusive thoughts and memories of the event
Visual images of the event
Poor concentration and memory

Avoidance of places or activities that are reminders of the event
Social withdrawal and isolation
Loss of interest in normal activities

Numbness and detachment
Anger and irritability
Anxiety and panic

As long as they are not too severe or last for too long, the symptoms described above are normal reactions to trauma. Although these symptoms can be distressing, they will settle quickly in most people. They are part of the natural healing process of adjusting to a very powerful event, making some sense out of what happened, and putting it into perspective. With understanding and support from family, friends and colleagues the stress symptoms usually resolve more rapidly. A minority of people will develop more serious conditions such as depression, posttraumatic stress disorder, anxiety disorders, or alcohol and drug problems.

Tips on managing psychological trauma

There are several things you can do to look after yourself and promote recovery from a traumatic event or situation. The following points provide some general advice.
Recognise that you have been through a distressing experience and give yourself permission to experience some reaction to it. Don’t be angry with yourself for being upset.
Remind yourself that you are not abnormal and that you can and are coping.
Avoid overuse of alcohol or other drugs to cope.
Avoid making any major decisions or big life changes.
Do not try to block out thoughts of what has happened. Gradually confronting what has happened will assist in coming to terms with the traumatic experience.
Don’t ‘bottle up’ your feelings – share your experiences with others when opportunities arise. This may feel uncomfortable at times, but talking to understanding people that you trust is helpful in dealing with trauma.
Try to maintain a normal routine. Keep busy and structure your day.
Make sure you do not unnecessarily avoid certain activities or places.
Allow yourself time to rest if you are feeling tired, and remember that regular exercise is important.
Let your friends and family know of your needs. Help them to help you by letting them know when you are tired, need time out, or need a chance to talk or just be with someone.
Make time to practise relaxation. You can use a formal technique such as progressive muscle relaxation, or just make time to absorb yourself in a relaxing activity such as gardening or listening to music. This will help your body and nervous system to settle and readjust.
If the trauma that you experience stirs up other memories or feelings from a past unrelated stressful occurrence, or even childhood experiences, try not to let the memories all blur together. Keep the memories separate and deal with them separately.
Express your feelings as they arise. Whether you discuss them with someone else or write them down in a diary, expressing feelings in some way often helps the healing process.

When to seek professional assistance

You should seek professional assistance if the symptoms resulting from the trauma are too distressing or last for more than a couple of weeks. Warning signs may include:
Being unable to handle the intense feelings or physical sensations
Feeling numb and empty
Continuing to experience strong distressing emotions
Continuing to have physical symptoms of being tense, agitated, and on edge
Continuing to have disturbed sleep and/ or nightmares
Having no-one to support you and with whom you can share your feelings and emotions
Having relationship problems with friends, family and colleagues
Increasing your use of alcohol or drugs.

How is psychological trauma treated?

Most people who experience a traumatic event will not require treatment. Most will work through their anxiety with support from close friends and family. However, for some people the response to the trauma can be debilitating and treatment from a trained mental health professional will be needed to help the person to recover.

Treatments for a severe trauma response include trauma-focused psychological interventions. These focus on providing education, stress management techniques, and helping the person to confront feared situations and distressing memories. Medication, particularly some of the new antidepressant drugs, can often be useful alongside trauma-focused psychological approaches.

Posttraumatic Stress Disorder (PTSD)

PTSD is a clinical condition that may develop in some people following exposure to a traumatic event. PTSD involves three main groups of symptoms:
Re-experiencing the trauma in the form of intrusive memories, nightmares or flashbacks
Avoidance of reminders and numbing of emotional responsiveness
Hyperarousal – feeling jumpy and on edge.

PTSD is very distressing and can lead to serious ongoing problems with social relationships and the ability to work or carry out normal daily activities. PTSD usually requires professional assistance as these problems tend not to resolve by themselves with the passage of time.

Depression, anxiety disorders (such as panic, phobias, and general anxiety) and alcohol or drug disorders may also develop following trauma in some people. These conditions may occur with, or in the absence of, PTSD.

Other resources on psychological trauma and PTSD

The Australian Centre for Posttraumatic Mental Health ( website contains useful information for trauma survivors, their families, and health practitioners. Free copies of consumer and practitioner versions of the Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder can be downloaded. (These guidelines are also available from

The US National Center for PTSD ( ) website also contains a range of useful resources for consumers and practitioners, as well as links to several other useful sites.

Seeking professional assistance

If you feel unable to cope following a trauma you can seek help from an APS psychologist. An APS psychologist is trained to assess trauma and to help the person to better understand and manage their responses to the trauma by developing effective coping strategies and techniques. An APS psychologist can also help a person to manage other problems that may be associated with the trauma, such as depression, stress, drug and alcohol use, or personal relationships.

To talk to an APS psychologist, speak to your GP about a referral or phone the APS Find a Psychologist service on 1800 333 497. Alternatively, you can locate a psychologist in your area by visiting the APS Find a Psychologist website.

Causes of Trauma

Causes of Trauma
By Rochelle Suri Ph.D, Reprinted with Author’s Permission

Dr. Rochelle Suri is a licensed Marriage and Family Therapist from California. She received her Doctoral degree from the California Institute of Integral Studies, in the specialized field of East-West Psychology. She currently lives in Mumbai, India, where she has a private practice, working with adults, children, and families.

Trauma can be caused by several factors and experiences, some more obvious than others. To fully understand and help an individual who is experiencing trauma, one must go beyond the experience and fully investigate and understand the cause(s) of an individual’s trauma. Understanding the cause or causes might provide vital clues in developing ways and tools for working with the trauma itself, enabling a person to manage his or her symptoms of trauma, as well as bringing to the person’s awareness the original causes that may result in retraumatization.
This entry introduces the causes of trauma, focusing on the following areas: conceptualization of the causes of trauma, emotional and psychological trauma, spiritual trauma, and cultural trauma. Also provided is an overview of other causes of trauma that may be generally overlooked.


All causes of trauma have three aspects in common:
An external cause: It is generally believed that trauma is not inflicted on oneself by oneself. It has to be inflicted by another person or by something else. The suddenness and the unpredictability of the situation or experience are key components in experiencing something as traumatic.
Violation: This refers to the sense of experiencing something or someone as an intrusion in the individual’s life. In other words, the individual may experience his or her physical, emotional, and psychological self as being invaded by an unwelcomed and unexpected person or thing that presents itself as a major source of distress.
Loss of control: Because the traumatic experience is unexpected and sudden, individuals, more often than not, are unprepared for the situation. This can then result in a sense of feeling overwhelmed and helpless, leaving the individual feeling extremely vulnerable and exposed to the cause of trauma.

The causes of trauma may differ from one individual to another-that is, what is perceived as a traumatic experience for one person may not necessarily be the same for someone else. However, it could be stated that some causes of trauma may be generalized to a larger population. These causes may be considered universal because of their tendency to affect individuals from various cultural, social, political, religious, spiritual, economic, and psychological backgrounds. The following section discusses what are believed to be universal causes or sources of trauma.

Emotional and Psychological Trauma

This type of trauma directly affects the individual’s psychological and emotional makeup and functioning. In other words, emotional and psychological trauma may interfere with the way an individual processes emotions, perceives situations, expresses feelings, and responds to circumstances (known and unknown), as well as the manner in which the person will deal with the trauma.
The causes of this kind of trauma include but are not limited to sexual abuse, emotional abuse, physical abuse, verbal abuse, financial abuse, physical neglect, emotional neglect, intense exposure to poverty, domestic violence, loss of a loved one (sudden or gradual), exposure to war, acts of violence, insomnia, exposure to alcoholism and substance abuse, intense torture (as in wars), being a victim of theft or robbery, and being diagnosed with a lifethreatening illness or life condition.
Another cause of emotional and/or psychological trauma is the diagnosis of a mental or psychiatric illness, which can deeply impair an individual’s emotional and psychological well-being. All of these causes can affect an individual in ways that interrupt or interfere with his or her daily functioning.

Spiritual Trauma

This kind of trauma, increasingly gaining recognition as an important area in traumatology, is related to the spiritual beliefs and frameworks of an individual and how these are affected, challenged, modified, or betrayed by another person or thing. The causes of spiritual trauma include but are not limited to the following: spiritual emergency (refers to a type of spiritual crisis that leads to sudden spiritual and mystical experiences that a person may not be able to deal with in the moment), religious dogmatization, deep loss of faith, and forced conversion of religious faith. Sexual and/or emotional abuse by religious officials (such as clergy, religious preachers and teachers, religious gurus, or masters) is also another possible cause of spiritual trauma, resulting in a sense of betrayal in one’s faith.

Cultural Trauma

This category of trauma relates to situations or experiences that individuals experience together, either as a collective or social group. This group may play the role of perpetrators, victims, or spectators. Whatever the role, the group is affected by the experience in some form or another, and the residual effect of the experience may be passed on to several generations, thus resulting in future generations experiencing an innate sense of trauma even though it was not directly inflicted on them.
An example of cultural trauma is that experienced by current generations or peoples of Germany whose Nazi ancestors perpetrated heinous and deplorable acts of violence against the Jews. Some of the causes of cultural trauma include but are not limited to racism and apartheid, colonialism, and political and economic discrimination. The oppression of minorities, either in a domestic or foreign country, could also be a significant cause of cultural trauma.
For instance, the oppression of certain races or tribes, the oppression of religious faiths or denominations, and the oppression of or discrimination against a particular sex are some examples of the causes of cultural trauma.

Neglected Causes of Trauma

Although emotional, psychological, spiritual, and cultural causes of trauma are universally considered and understood, some causes of trauma tend to be overlooked or neglected. It is not clear why this is the case, although these causes are now coming to light and are being given more attention. More research and exploratory studies are being conducted in the following areas that are believed to be possible causes of trauma:
physical falls or injuries, sport injuries, surgery (minor or major), automobile accidents, sudden or planned termination of a relationship, humiliating or deeply disappointing experiences, social isolation (involuntary), natural disasters, exposure to extreme climatic conditions, childbirth stress (for mother and/or child) and chronic pain, to name a few. It is hoped that, with further studies and exploration, more light will be shed on how these causes of trauma affect an individual’s life.

Childhood Trauma

Another area that has recently been focused on, although hitherto neglected, is that of childhood trauma. Recent studies and research have established that trauma experienced in childhood can have severe and long-lasting effects into adulthood, especially when not resolved. Some of the causes of childhood trauma include the following: an unstable or unsafe environment; separation from a parent; debilitating illness; intrusive medical and dental procedures; sexual, physical, emotional, and verbal abuse; emotional and physical neglect; domestic violence; bullying; and the pressure to excel (e.g., in academics, sports, or extracurricular activities).


Finally, it is important to keep in mind that what one person perceives to be traumatic or life threatening (either consciously or unconsciously) may not necessarily be the same for another. As Peter Levine has noted, an individual’s perception of trauma is based on the person’s age, life experience, and constitutional temperament. Therefore, when assessing or investigating the causes of trauma, one should not assume that a certain cause or factor will necessarily be experienced as traumatic in an individual’s life. This is especially the case when working with individuals from different cultural, religious, socioeconomic, spiritual, and racial backgrounds.
Types of Traumatic Stress

Children can be exposed to a range of traumatic experiences.

Community Violence
Complex Trauma
Domestic Violence
Early Childhood Trauma
Medical Trauma
Natural Disasters
Physical Abuse
Refugee Trauma
School Violence
Sexual Abuse
Traumatic Grief

Community Violence

Community violence includes predatory violence (robbery, for example) and violence that comes from personal conflicts between people who are not family members. It may include brutal acts such as shootings, rapes, stabbings, and beatings. Children may experience trauma as victims, witnesses, or perpetrators.

Complex Trauma

The term complex trauma describes the problem of children’s exposure to multiple or prolonged traumatic events and the impact of this exposure on their development. Typically, complex trauma exposure involves the simultaneous or sequential occurrence of child maltreatment-including psychological maltreatment, neglect, physical and sexual abuse, and domestic violence-that is chronic, begins in early childhood, and occurs within the primary caregiving system.
Exposure to these initial traumatic experiences-and the resulting emotional dysregulation and the loss of safety, direction, and the ability to detect or respond to danger cues-often sets off a chain of events leading to subsequent or repeated trauma exposure in adolescence and adulthood.

Domestic Violence

Domestic violence-sometimes called intimate partner violence, domestic abuse, or battering-includes actual or threatened physical or sexual violence or emotional abuse between adults in an intimate relationship. This clinical definition is broader than the legal definition, which may be restricted to acts of physical harm. Domestic violence can be directed toward a current or former spouse or partner, whether they are heterosexual or same-sex partners.

Anywhere from 3 to 10 million children are exposed to domestic violence in the United States every year. Studies suggest that the majority of children who are exposed to domestic violence are young-under the age of 8.

Early Childhood Trauma

Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. These traumas can be the result of intentional violence-such as child physical or sexual abuse, or domestic violence-or the result of natural disaster, accidents, or war. Young children also may experience traumatic stress in response to painful medical procedures or the sudden loss of a parent/caregiver.

Medical Trauma

Pediatric medical traumatic stress refers to reactions that children and their families may have to pain, injury, and serious illness; or to “invasive” medical procedures (such as surgery) or treatments (such as burn care) that are sometimes frightening. Reactions can affect the mind as well as the body. For example, children and their families may become anxious, irritable, or on edge.
They may have unwanted thoughts or nightmares about the illness, injury, or the hospital. Some people may avoid going to the doctor or the hospital, or lose interest in being with friends and family and in things they used to enjoy. As a result, they may not do well at school, work, or home. How children and families cope with these changes is related to the person’s own thoughts and feelings about the illness, injury, or the hospital; reactions can vary, even within the same family.

Natural Disasters

A disaster is any natural catastrophe (for example, tornadoes, hurricanes, and earthquakes) or any fire, flood, or explosion that causes enough damage that local, state, or federal agencies and disaster relief organizations are called into action. Disasters can result from a man-made event (such as a nuclear reactor explosion), but if the damage is caused intentionally, it is classified as an act of terrorism.


Child neglect occurs when a parent or caregiver does not give a child the care he or she needs according to its age, even though that adult can afford to give that care or is offered help to give that care. Neglect can mean not giving food, clothing, and shelter. It can mean that a parent or caregiver is not providing a child with medical or mental health treatment or not giving prescribed medicines the child needs.
Neglect can also mean neglecting the child’s education. Keeping a child from school or from special education can be neglect. Neglect also includes exposing a child to dangerous environments. It can mean poor supervision for a child, including putting the child in the care of someone incapable of caring for children. It can also mean abandoning a child or expelling it from home. Neglect is the most common form of abuse reported to child welfare authorities.

Physical Abuse

Physical abuse means causing or attempting to cause physical pain or injury. It can result from punching, beating, kicking, burning, or harming a child in other ways. Sometimes, an injury occurs when a punishment is not appropriate for a child’s age or condition. Physical abuse can consist of a single act or several acts. In extreme cases, it can result in death.

Refugee Trauma

Refugee trauma include exposure to war, political violence, or torture. Refugee trauma can be the result of living in a region affected by bombing, shooting, or looting, as well as forced displacement to a new home due to political reasons. Some young refugees have served as soldiers, guerrillas, or other combatants in their home countries, and their traumatic experiences may closely resemble those of combat veterans.

School Violence

School violence includes fatal and nonfatal student or teacher victimization, threats to or injury of students, fights at school, and students carrying weapons to school. Formal definitions of school violence range from very narrow to very broad. The Center for the Prevention of School Violence, for example, defines it broadly as “any behavior that violates a school’s educational mission or climate of respect or jeopardizes the intent of the school to be free of aggression against persons or property, drugs, weapons, disruptions, and disorder.” Click here for more information on community violence.

Sexual Abuse

Child sexual abuse includes a wide range of sexual behaviors that take place between a child and an older person or alternatively between a child and another child/adolescent. Behaviors that are sexually abusive often involve bodily contact, such as sexual kissing, touching, fondling of genitals, and intercourse. However, behaviors may be sexually abusive even if they do not involve contact, such as of genital exposure (“flashing”), verbal pressure for sex, and sexual exploitation for purposes of prostitution or pornography.


Terrorism is defined in a variety of formal, legal ways, but the essential element is the intent to inflict psychological damage on an adversary. The US Department of Defense defines terrorism as “the calculated use of violence or the threat of violence to inculcate fear, intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological.” Terrorism includes attacks by individuals acting in isolation (for example, sniper attacks) as well as attacks by groups or people acting for groups.

Traumatic Grief

Childhood traumatic grief may occur following a death of someone important to the child when the child perceives the experience as traumatic. The death may have been sudden and unexpected (e.g., through violence or an accident), or anticipated (e.g., illness or other natural causes).

The distinguishing feature of childhood traumatic grief is that the trauma symptoms interfere with the child’s ability to go through the typical process of bereavement. The child experiences a combination of trauma and grief symptoms so severe that any thoughts or reminders, even happy ones, about the person who died can lead to frightening thoughts, images, and/or memories of how the person died.
Emotional and Psychological Trauma: Causes and Effects, Symptoms and Treatment

Psychological or Emotional Trauma is Much Broader Than Current Definitions of PTSD; it has many faces.

On this page: What is psychological or emotional trauma? | What causes emotional or psychological trauma? | What is the difference between stress and emotional or psychological trauma? | What causes psychological trauma? | Why can an event cause an emotionally traumatic response in one person and not in another? | What are the symptoms of emotional trauma? | What are the possible effects of emotional trauma? | What if symptoms don’t go away, or appear at a later time? | How is emotional trauma treated? | Online Resources for Emotional or Psychological Trauma

What is psychological or emotional trauma?

The ability to recognize emotional trauma has changed radically over the course of history. Until recently psychological trauma was noted only in men after catastrophic wars. The women’s movement in the sixties broadened the definition of emotional trauma to include physically and sexually abused women and children. Now, because of the discoveries made in the nineties – known as the decade of the brain – psychological trauma has further broadened its definition.

Recent research has revealed that emotional trauma can result from such common occurrences as an auto accident, the breakup of a significant relationship, a humiliating or deeply disappointing experience, the discovery of a life-threatening illness or disabling condition, or other similar situations. Traumatizing events can take a serious emotional toll on those involved, even if the event did not cause physical damage.

Regardless of its source, an emotional trauma contains three common elements:
• it was unexpected;
• the person was unprepared; and
• there was nothing the person could do to prevent it from happening.

It is not the event that determines whether something is traumatic to someone, but the individual’s experience of the event. And it is not predictable how a given person will react to a particular event. For someone who is used to being in control of emotions and events, it may be surprising – even embarrassing – to discover that something like an accident or job loss can be so debilitating.

What causes emotional or psychological trauma?

Our brains are structured into three main parts, long observed in autopsies:
• the cortex (the outer surface, where higher thinking skills arise; includes the frontal cortex, the most recently evolved portion of the brain)
• the limbic system (the center of the brain, where emotions evolve)
• the brain stem (the reptilian brain that controls basic survival functions)

Because of the development of brain scan technology, scientists can now observe the brain in action, without waiting for an autopsy. These scans reveal that trauma actually changes the structure and function of the brain, at the point where the frontal cortex, the emotional brain and the survival brain converge. A significant finding is that brain scans of people with relationship or developmental problems, learning problems, and social problems related to emotional intelligence reveal similar structural and functional irregularities as is the case resulting from PTSD.

What is the difference between stress and emotional or psychological trauma?

Trauma is stress run amuck. Stress dis-regulates our nervous systems – but for only a relatively short period of time. Within a few days or weeks, our nervous systems calm down and we revert to a normal state of equilibrium. This return to normalcy is not the case when we have been traumatized. One way to tell the difference between stress and emotional trauma is by looking at the outcome – how much residual effect an upsetting event is having on our lives, relationships, and overall functioning.
Traumatic distress can be distinguished from routine stress by assessing the following:
• how quickly upset is triggered
• how frequently upset is triggered
• how intensely threatening the source of upset is
• how long upset lasts
• how long it takes to calm down

If we can communicate our distress to people who care about us and can respond adequately, and if we return to a state of equilibrium following a stressful event, we are in the realm of stress. If we become frozen in a state of active emotional intensity, we are experiencing an emotional trauma – even though sometimes we may not be consciously aware of the level of distress we are experiencing

What causes psychological trauma?

Psychological trauma can result from events we have long recognized as traumatic, including:
• natural disasters (earthquakes, fires, floods, hurricanes, etc.)
• physical assault, including rape, incest, molestation, domestic abuse
• serious bodily harm
• serious accidents such as automobile or other high-impact scenarios
• experiencing or witnessing horrific injury, carnage or fatalities

Other potential sources of psychological trauma are often overlooked including:
• falls or sports injuries
• surgery, particularly emergency, and especially in first 3 years of life
• serious illness, especially when accompanied by very high fever
• birth trauma
• hearing about violence to or sudden death of someone close

In addition, traumatic stress in childhood that influences the brain is caused by poor or inadequate relationship with a primary caretaker. Sources of this developmental or relational trauma include the following:
• orced separation very early in life from primary caregiver;
• chronic mis-attunement of caregiver to child’s attachment signals (“mal-attachment”) or reasons such as physical or mental illness, depression or grief.

It is acknowledged that early life trauma creates a vulnerability for experiencing future traumatic responses. For a fuller insights on the causes of psychological/emotional trauma see our adult trauma history questionnaire.

Why can an event cause an emotionally traumatic response in one person and not in another?

There is no clear answer to this question, but it is likely that one or more of these factors are involved:
• the severity of the event;
• the individual’s personal history (which may not even be recalled);
• the larger meaning the event represents for the individual (which may not be immediately evident);
• coping skills, values and beliefs held by the individual (some of which may have never been identified); and
• the reactions and support from family, friends, and/or professionals.

Anyone can become traumatized. Even professionals who work with trauma, or other people close to a traumatized person, can develop symptoms of “vicarious” or “secondary” traumatization. Developing symptoms is never a sign of weakness. Symptoms should be taken seriously and steps should be taken to heal, just as one would take action to heal from a physical ailment. And just as with a physical condition, the amount of time or assistance needed to recover from emotional trauma will vary from one person to another.

What are the symptoms of emotional trauma?

There are common effects or conditions that may occur following a traumatic event. Sometimes these responses can be delayed, for months or even years after the event. Often, people do not even initially associate their symptoms with the precipitating trauma. The following are symptoms that may result from a more commonplace, unresolved trauma, especially if there were earlier, overwhelming life experiences:

• Eating disturbances (more or less than usual)
• Sleep disturbances (more or less than usual)
• Sexual dysfunction
• Low energy
• Chronic, unexplained pain

• Depression, spontaneous crying, despair and hopelessness
• Anxiety
• Panic attacks
• Fearfulness
• Compulsive and obsessive behaviors
• Feeling out of control
• Irritability, angry and resentment
• Emotional numbness
• Withdrawal from normal routine and relationships

• Memory lapses, especially about the trauma
• Difficulty making decisions
• Decreased ability to concentrate
• Feeling distracted
• ADHD symptoms

The following additional symptoms of emotional trauma are commonly associated with a severe precipitating event, such as a natural disaster, exposure to war, rape, assault, violent crime, major car or airplane crashes, or child abuse. Extreme symptoms can also occur as a delayed reaction to the traumatic event.

Re-experiencing the Trauma
• intrusive thoughts
• flashbacks or nightmares
• sudden floods of emotions or images related to the traumatic event

Emotional Numbing and Avoidance
• amnesia
• avoidance of situations that resemble the initial event
• detachment
• depression
• guilt feelings
• grief reactions
• an altered sense of time Increased Arousal
• hyper-vigilance, jumpiness, an extreme sense of being “on guard”
• overreactions, including sudden unprovoked anger
• general anxiety
• insomnia
• obsessions with death

What are the possible effects of emotional trauma?

Even when unrecognized, emotional trauma can create lasting difficulties in an individual’s life. One way to determine whether an emotional or psychological trauma has occurred, perhaps even early in life before language or conscious awareness were in place, is to look at the kinds of recurring problems one might be experiencing. These can serve as clues to an earlier situation that caused a dysregulation in the structure or function of the brain.

Common personal and behavioral effects of emotional trauma:
• substance abuse
• compulsive behavior patterns
• self-destructive and impulsive behavior
• uncontrollable reactive thoughts
• inability to make healthy professional or lifestyle choices
• dissociative symptoms (“splitting off” parts of the self)
• feelings of ineffectiveness, shame, despair, hopelessness
• feeling permanently damaged
• a loss of previously sustained beliefs

Common effects of emotional trauma on interpersonal relationships:
• inability to maintain close relationships or choose appropriate friends and mates
• sexual problems
• hostility
• arguments with family members, employers or co-workers
• social withdrawal
• feeling constantly threatened

What if symptoms don’t go away, or appear at a later time?

Over time, even without professional treatment, symptoms of an emotional trauma generally subside, and normal daily functioning gradually returns. However, even after time has passed, sometimes the symptoms don’t go away. Or they may appear to be gone, but surface again in another stressful situation. When a person’s daily life functioning or life choices continue to be affected, a post-traumatic stress disorder may be the problem, requiring professional assistance.

How is emotional trauma treated?

Traditional approaches to treating emotional trauma include talk therapies, Cognitive-Behavioral Therapy (CBT) – intentionally changing one’s thoughts and actions – and systematic desensitization to reduce reactivity to a traumatic stressor. These approaches to healing trauma were developed without brain science information, and therefore have varying degrees of success.

Recent developments in the treatment of emotional trauma include new, effective forms of psychotherapy and somatic (body) therapies that were developed with new brain science information in mind. Although often intensely interpersonal, these therapies are also psychological and neurological in their focus and application. This group of therapies relies on innate instinctual resources, rather than medications, to bring about healing.
They differ in some ways, but the one thing they have in common is combining talk therapy with a focus on the body. As with any therapy, but especially due to the intensity of the emotions involved, it is important to find a therapist with whom one feels trust and a strong bond. They include:

Eye Movement Desensitization/Reprocessing (EMDR) was developed by psychologist, Francine Shapiro, after she noticed her own stress reactions diminishing when her eyes swept back and forth as she walked through a park. It is conducted by licensed mental health professionals who have taken specific training in this complex approach.
It combines elements of a range of therapeutic approaches with eye movements or other forms of rhythmical stimulation, such as hand taps or sounds. Theories as to why EMDR is effective are still evolving. Some speculate that the rapid unique therapeutic element of EMDR – the eye movements or other rhythmical stimulation – might help the brain access and process traumatic material.

EMDR has been most effective with single-incident trauma, but its uses continue to evolve in addressing longer histories of emotional or physical trauma, and in balancing other aspects of a person’s life.

Somatic Psychotherapies The term somatic, coined by Tomas Hanna, means mind/body or more precisely brain/body. The idea is that to change the body, we have to engage the brain and change the brain – not only how we think and feel, but also the neurological connections themselves. The body, its sensations, and direct sensory experience are referenced throughout the therapeutic process. Somatic therapies include:

• Somatic Experiencing: developed by Peter Levine, this approach evolved in part from observations of how animals literally “shake off” traumatic experiences, allowing the body to process stress chemicals completely until they return to normal levels. The SE therapist may be a licensed professional or unlicensed but with some mental health training. All SE therapists complete an extensive training program, in which they learn to observe the body, facial expressions and gestures carefully and to help the person “thaw” a response that was “frozen” in a traumatic situation (illustration: the person might be observed to make short gestures that almost appear to be a “pushing” motion, but that stop abruptly – the therapist might have the person complete the gesture in full, and notice how the body’s tension level changes).

• Hakomi Method: originated by Ron Kurtz, this system is based on five therapeutic principles – Mindfulness, Organicity, Non-Violence, the Mind-Body Connection, and Unity. It is a body-centered approach for which, in part, the therapist helps the client experiment with small changes in gesture or other movements, to see what differences occur in the processing of emotionally charged content (illustration: the person might be observed to always make a certain gesture or have a certain posture when talking about the attacker – the therapist might suggest the gesture or posture be changed to a different one as an experiment, and then to notice the changes in feelings or thoughts).

• Somatic Psychology: developed by Pat Ogden, this treatment merges somatic therapies, neuroscience, attachment theory, and cognitive approaches, as well Hakomi Method. The approach often uses physical expression to process the energy stored in the body following a trauma, to reset the neurological system into better balance (illustration: the person might be asked to push the attacker away by forcefully pushing against a wall or against a pillow held by the therapist, to allow the body’s neurological and musculature systems to reset themselves to a more normal level).

• AEDP (Accelerated Experiential Dynamic Psychotherapy): developed by Diana Fosha, New York based psychoanalyst, this approach brings the elements of secure attachment into her work with adults. The talk therapy she practices focuses on the mutual exchange of all deeply-seated emotions, bodily awareness and joyous playful exchange.

We gratefully acknowledge the role of in providing us with information that has been used on this page.

Online Resources for Emotional or Psychological Trauma

General Information
This noncommercial site offers a thorough description of the causes and symptoms of trauma.
is a non- commercial website that describes the relationship between emotional intelligence and emotional trauma.
This popular non-commercial site by David Baldwin does a thorough job of defining and describing PTSD.
Is an educational institution that focuses on violent traumatic events and fears in children’s lives. Especially helpful is the distinction made between trauma and grief.
is a noncommercial site that focuses on the societal as well as personal impact of trauma
Trauma Pages – Supportive Information – A comprehensive list of links related to various types of trauma, treatments, support, and related issues.
Managing Traumatic Stress – A factsheet provided by from the American Psychological Association.

Trauma information for helping children and adolescents
National Institute of Mental Health – Lists reactions of children and adolescents to traumatic events (which may differ from adult reactions), and ways adults can help young trauma survivors.
Psychological Trauma Center – Cedars-Sinai Medical Center provides information for parents, including tips on helping children and adolescents deal with traumatic events.
National Mental Health Association – Offers ways to help children handle disaster-related anxiety (relevant to any anxiety), listed by age from pre-school through adolescence.
Academy of Cognitive Therapy – Has a section on help for children, which describes children’s reactions to trauma and offers guidelines for parents and teachers.

Therapeutic approaches for emotional and other trauma

(Note: because many of these therapies are relatively recent in development, much of the information about them appears on sites that offer training or products and thus are designated by * as a commercial site)

EMDR Institute* EMDR is an acronym for Eye Movement Desensitization and Reprocessing. It integrates many of elements of a range of therapeutic approaches in combination with eye movements or other forms of rhythmical stimulation in ways that stimulate the brain’s information processing system. This site provides information on related publications as well as referrals to EMDR-trained clinicians

Somatic Therapies

Somatic Psychology* The term somatics has evolved to mean “the experienced body,” “experiencing the body from within,” and “one’s experience of one’s own body.” This webpage explores some of the meanings behind somatic psychology and the training involved.

Trauma Healing with Somatic Experiencing* Somatic experiencing is a short-term naturalistic approach to the resolution and healing of trauma. It employs the awareness of body sensation to help people renegotiate and heal their traumas rather than relive them. This website also has related articles and a practitioner directory.

Hakomi Method* describes the theory and practice of one of the first body-centered therapies. Includes links to an entire training manual and other readings.

Sensorimotor Psychotherapy Institute* Describes the certification program for trauma work, combining body work and psychotherapy.

Integrative Body Psychotherapy* In Integrative Body Psychotherapy, verbal and cognitive methods are integrated with a somatic body orientation and breath work. This site provides information about this type of psychotherapy, as well as a directory of certified therapists.

Reprinted with permission from © 2005. For information on over 125 Mental Health and Lifelong Wellness topics visit

10 Causes Of Post Traumatic Stress Disorder In Children

10 Causes Of Post Traumatic Stress Disorder In Children
Jolene, 2013/01/08

No one wants the words “post-traumatic stress disorder” and “children” to appear in the same sentence. But recent events like the Sandy Hook elementary school shooting are reminders that children as well as adults can be exposed to events that cause this debilitating but highly treatable mental illness.

Previous posts in this series explained why I advocate for children with post-traumatic stress disorder (PTSD), explored 5 myths and misconceptions about PTSD in children, and defined both trauma and PTSD from a child’s point of view.

The Causes Of PTSD In Children

Today’s post explores some of the causes of PTSD in kids. While you read through the list, keep in mind the definition of trauma given by Margaret Vasquez, a clinical traumatologist who was traumatized in childhood and treated as a young adult. In the third post in this series, she defined trauma as “the the scary, painful and yucky stuff that happens.”

Consider the trauma from a child’s perspective. While some items on the list are “scary, painful, and yucky” for children and adults alike, others would create barely a blip on an adult’s radar screen. But for kids who are small in stature, who often have little control over their environment, and who have fewer ways to escape trauma than adults, they can be “scary, painful, and yucky.”

1. Medical Intervention:
This includes, surgeries, tests, and procedures. Though such interventions are for a child’s future good, from their perspective the event is scary. It hurts. The environment is unfamiliar.
As an adult, our son gave this description of being wheeled into surgery when he was four. “I was laying on a hard gurney. They opened these big doors and wheeled me into this huge, cold, white room with glaring lights. I went a little crazy, so people kept leaning over and saying, ‘It’s okay. You’re all right.’ All I could think was, ‘They don’t have faces. None of the people have faces.’ It was years before I realized they were wearing masks that covered their mouths and noses.”

2. Abuse:
Any kind of abuse, whether physical, sexual, or emotional, as well as any behavior perceived as abuse by a child, can be traumatic. This includes bullying by adults or a child’s peers.

3. Neglect:
Think about the horrendous stories of children kept in boxes, or rows and rows of babies confined to cribs in foreign orphanages. We now know that many of these children develop radical attachment disorder (RAD). But neglect at a very early age is also a cause of trauma.

4. Disasters:
Name your disaster-tornado, hurricane, earthquake, tsunamis, flood, volcano, a house fire, a bridge collapse-any natural event where a child feels he or the adults around them are helpless can be a source of trauma.

5. Violent Acts:
The Sandy Hook school shooting is one example of a violent act. Others include war, gang violence, witnessing a parent being abused, or children who are kidnapped.

6. Accidents:
Car, plane or train accidents are a cause of trauma for children who experience the event. Even a playground accident or accidents in the home or on a farm can cause trauma.

7. Divorce:
The break up of a marriage (or a long-term relationship between unmarried partners) is often much more traumatic than adults may realize. The greater the animosity between the parents and the less parents address the issue directly with children, the more likely it is to cause trauma.

8. The Death of a Significant Loved One:
Whenever someone important to child’s security dies, the event can cause trauma.

9. Moving:
Remember to look at moving from a child’s perspective. A child usually has no control over the move. Friends are gone. The familiar environment is gone. Parents are preoccupied. New school. New neighborhood. Having to make new friends. That can be pretty traumatic.

10. Adoption:
Yes, even this wonderful, loving act can be traumatic for kids. Adoption is a big change for a child. Even for newborns, the mothers’ voices and body rhythms that were synced for nine months are no longer there. For older children, their whole life changes. For the most part they have no control over what’s happening.

Trauma Doesn’t = PTSD

Before you throw your hands up in despair, remember that trauma and PTSD are not the same thing. Only when symptoms of trauma remain more than three months after the initial event is it classified as PTSD. And if a child is diagnosed with PTSD, it can be treated easily and effectively. So breathe easy until the next post in this series, which identifies symptoms of PTSD in kids.
Psychological trauma

Psychological trauma is a type of damage to the psyche that occurs as a result of a severely distressing event. Trauma is often the result of an overwhelming amount of stress that exceeds one’s ability to cope, or integrate the emotions involved with that experience. A traumatic event involves one experience, or repeating events with the sense of being overwhelmed that can be delayed by weeks, years, or even decades as the person struggles to cope with the immediate circumstances, eventually leading to serious, long-term negative consequences.

However, the definition of trauma differs among individuals by their subjective experiences, not the objective facts. People will react to similar events differently. In other words, not all people who experience a potentially traumatic event will actually become psychologically traumatized. This discrepancy in risk rate can be attributed to protective factors some individuals may have that enable them to cope with trauma. Some examples are mild exposure to stress early in life, resilience characteristics, and active seeking of help.


DSM-IV-TR defines trauma as direct personal experience of an event that involves actual or threatened death or serious injury, threat to one’s physical integrity; or witnessing an event that involves the the above experience or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member of close associate. Memories associated with trauma are implicit, pre-verbal and cannot be recalled, but can be triggered by stimuli from the in vivo environment. The person’s response to aversive details of traumatic event involve intense fear, helplessness or horror. In children it is manifested as disorganized or agitative behaviors.

Trauma can be caused by a wide variety of events, but there are a few common aspects. There is frequently a violation of the person’s familiar ideas about the world and of their human rights, putting the person in a state of extreme confusion and insecurity. This is also seen when institutions that are depended upon for survival, violate, humiliations, betrayal, major loses or separations.

Psychologically traumatic experiences often involve physical trauma that threatens one’s survival and sense of security. Typical causes and dangers of psychological trauma include harassment, embarrassment, abandonment, abusive relationships, rejection, co-dependence, physical assault, sexual abuse, partner battery, employment discrimination, police brutality, judicial corruption and misconduct, bullying, paternalism, domestic violence, indoctrination, being the victim of an alcoholic parent, the threat or the witnessing of violence (particularly in childhood), life-threatening medical conditions, medication-induced trauma.
Catastrophic natural disasters such as earthquakes and volcanic eruptions, large scale transportation accidents, house or domestic fire, motor vehicle accident, mass interpersonal violence like war, terrorist attacks or other mass tortures like sex trafficking, taken as hostages or kidnapped can also cause psychological trauma. Long-term exposure to situations such as extreme poverty or milder forms of abuse, such as verbal abuse, exist independently of physical trauma but still generate psychological trauma.

Some theories suggest childhood trauma can increase one’s risk for mental disorders including posttraumatic stress disorder (PTSD), depression, and substance abuse. Childhood adversity is associated with neuroticism during adulthood. Parts of the brain in a growing child are developing in a sequential and hierarchical order, from least complex to most complex.
The brain’s neurons are designed to change in response to the constant external signals and stimulation, receiving and storing new information. This allows the brain to continually respond to its surroundings and promote survival. Our five main sensory signals contribute to the developing brain structure and its function.[10] Infants and children begin to create internal representations of their external environment, and in particular, key attachment relationships, shortly after birth.
Violent and victimized attachment figures impact infants’ and young children’s internal representations. The more frequent a specific pattern of brain neurons is activated, the more permanent the internal representation associated with the pattern becomes. This causes sensitization in the brain towards the specific neural network. Because of this sensitization, the neural pattern can be activated by decreasingly less external stimuli.
Childhood abuse tends to have the most complications with long-term effects out of all forms of trauma because it occurs during the most sensitive and critical stages of psychological development. It could also lead to violent behavior, possibly as extreme as serial murder. For example, Hickey’s Trauma-Control Model suggests that “childhood trauma for serial murderers may serve as a triggering mechanism resulting in an individual’s inability to cope with the stress of certain events.”

Often psychodynamic aspect of trauma is overlooked even by health professionals: “If clinicians fail to look through a trauma lens and to conceptualize client problems as related possibly to current or past trauma, they may fail to see that trauma victims, young and old, organize much of their lives around repetitive patterns of reliving and warding off traumatic memories, reminders, and affects.”


People who go through these types of extremely traumatic experiences often have certain symptoms and problems afterward. The severity of these symptoms depends on the person, the type of trauma involved, and the emotional support they receive from others. Reactions to and symptoms of trauma can be wide and varied, and differ in severity from person to person. A traumatized individual may experience one or several of them.

After a traumatic experience, a person may re-experience the trauma mentally and physically, hence avoiding trauma reminders, also called triggers, as this can be uncomfortable and even painful. They may turn to psychoactive substances including alcohol to try to escape the feelings. Re-experiencing symptoms are 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. Often the person can be completely unaware of what these triggers are. In many cases this may lead a person suffering from traumatic disorders to engage in disruptive 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.

Consequently, intense feelings of anger may frequently surface, sometimes in inappropriate or unexpected situations, as danger may always seem to be present, as much as it is actually present and experienced from past events. Upsetting memories such as images, thoughts, or flashbacks may haunt the person, and nightmares may be frequent.
Insomnia may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night. Trauma doesn’t only cause changes in one’s daily functions but could also lead to morphological changes. Such epigenetic changes can be passed on to the next generations, thus making genetics as one of the components of the causes of psychological trauma. However, some people are born or later develop protective factors such as genetics and sex that help lower their risk of psychological trauma.

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, traumatic grief, undifferentiated somatoform disorder, conversion disorders, brief psychotic disorder, borderline personality disorder, adjustment disorder…etc.

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 include depersonalisation disorder, dissociative amnesia, dissociative fugue, dissociative fugue, dissociative identity disorder…etc.

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.
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. In such instances, it is in the interest of the parent(s) and child for the parent(s) to seek consultation as well as to have their child receive appropriate mental health services.


The experience and outcomes of psychological trauma can be assessed in a number of ways. Within the context of a clinical interview, the risk for imminent danger to the self or others is important to address but is not the focus of assessment. In most cases, it will not be necessary to involve contacting emergency services (e.g., medical, psychiatric, law enforcement) to ensure the individuals safety; members of the individual’s social support network are much more critical.

Understanding and accepting the psychological state an individual is in is paramount. There are many mis-conceptions of what it means for a traumatized individual to be in crisis or ‘psychosis.’ These are times when an individual is in inordinate amounts of pain and cannot comfort themselves, if treated humanely and respectfully they will not get to a state in which they are a danger.
In these situations it is best to provide a supportive, caring environment and communicate to the individual that no matter the circumstance they will be taken seriously and not just as a sick, delusional individual. It is vital for the assessor to understand that what is going on in the traumatized persons head is valid and real. If deemed appropriate, the assessing clinician may proceed by inquiring about both the traumatic event and the outcomes experienced (e.g., posttraumatic symptoms, dissociation, substance abuse, somatic symptoms, psychotic reactions).
Such inquiry occurs within the context of established rapport and is completed in an empathic, sensitive, and supportive manner. The clinician may also inquire about possible relational disturbance, such as alertness to interpersonal danger, abandonment issues, and the need for self-protection via interpersonal control. Through discussion of interpersonal relationships, the clinician is better able to assess the individual’s ability to enter and sustain a clinical relationship.

During assessment, individuals may exhibit activation responses in which reminders of the traumatic event trigger sudden feelings (e.g., distress, anxiety, anger), memories, or thoughts relating to the event. Because individuals may not yet be capable of managing this distress, it is necessary to determine how the event can be discussed in such a way that will not “retraumatize” the individual.
It is also important to take note of such responses, as these responses may aid the clinician in determining the intensity and severity of possible posttraumatic stress as well as the ease with which responses are triggered. Further, it is important to note the presence of possible avoidance responses. Avoidance responses may involve the absence of expected activation or emotional reactivity as well as the use of avoidance mechanisms (e.g., substance use, effortful avoidance of cues associated with the event, dissociation).

In addition to monitoring activation and avoidance responses, clinicians carefully observe the individual’s strengths or difficulties with affect regulation (i.e., affect tolerance and affect modulation). Such difficulties may be evidenced by mood swings, brief yet intense depressive episodes, or self-mutilation. The information gathered through observation of affect regulation will guide the clinician’s decisions regarding the individual’s readiness to partake in various therapeutic activities.

Though assessment of psychological trauma may be conducted in an unstructured manner, assessment may also involve the use of a structured interview. Such interviews might include the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995), Acute Stress Disorder Interview (ASDI; Bryant, Harvey, Dang, & Sackville, 1998), Structured Interview for Disorders of Extreme Stress (SIDES; Pelcovitz et al., 1997), Structured Clinical Interview for DSM-IV Dissociative Disorders- Revised (SCID-D; Steinberg, 1994), and Brief Interview for Posttraumatic Disorders (BIPD; Briere, 1998).

Lastly, assessment of psychological trauma might include the use of self-administered psychological tests. Individuals’ scores on such tests are compared to normative data in order to determine how the individual’s level of functioning compares to others in a sample representative of the general population. Psychological testing might include the use of generic tests (e.g., MMPI-2, MCMI-III, SCL-90-R) to assess non-trauma-specific symptoms as well as difficulties related to personality.
In addition, psychological testing might include the use of trauma-specific tests to assess posttraumatic outcomes. Such tests might include the Posttraumatic Stress Diagnostic Scale (PDS; Foa, 1995), Davidson Trauma Scale (DTS: Davidson et al., 1997), Detailed Assessment of Posttraumatic Stress (DAPS; Briere, 2001), Trauma Symptom Inventory (TSI: Briere, 1995), Trauma Symptom Checklist for Children (TSCC; Briere, 1996), Traumatic Life Events Questionnaire (TLEQ: Kubany et al., 2000), and Trauma-related Guilt Inventory (TRGI: Kubany et al., 1996).


A number of psychotherapy approaches have been designed with the treatment of trauma in mind-EMDR, Somatic Experiencing, biofeedback, Internal Family Systems Therapy, and sensorimotor psychotherapy.

There is a large body of empirical support for the use of cognitive behavioral therapy for the treatment of trauma-related symptoms, including posttraumatic stress disorder. Institute of Medicine guidelines identify cognitive behavioral therapies as the most effective treatments for PTSD. Two of these cognitive behavioral therapies, prolonged exposure and cognitive processing therapy, are being disseminated nationally by the Department of Veterans Affairs for the treatment of PTSD.
Recent studies show that a combination of treatments involving the dialectical behavior therapy (DBT), often used for borderline personality disorder, and exposure therapy is highly effective in treating psychological trauma. 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 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.

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) resolve internally. It also aids in growth of personal skills like resilience, ego regulation, empathy…etc.

Process’ involved in Trauma therapy are:
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 to positive ones about self, others and environment 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 (state in which triggers don’t produce the harmful distress and able to express relief.)
Emotional processing: Reconstructing perceptions, beliefs and erroneous expectations like trauma-related fears are auto-activated and habituated in new life contexts, providing crisis cards with coded emotions and appropriate cognition’s. (This stage is only initiated in pre-termination phase from clinical assessment & judgement of the mental health professional.)
Experiential processing: Visualization of achieved relief state and relaxation methods.

Causative discourses

Situational trauma

Trauma can be caused by man-made and natural disasters, including war, abuse, violence, mechanized accidents (car, train, or plane crashes, etc.) or medical emergencies.

Responses to psychological trauma: There are several behavioral responses common 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 are 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.

Those who are able to be proactive can often overcome stressors and are more likely to be able to cope well with unexpected situations. On the other hand, those who are more reactive will often experience more noticeable effects from an unexpected stressor. In the case of those who are passive, victims of a stressful event are more likely to suffer from long-term traumatic effects and often enact no intentional coping actions. These observations may suggest that the level of trauma associated with a victim is related to such independent coping abilities.

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 childhood abuse. Trauma is often 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.

In psychoanalysis

French neurologist Jean-Martin Charcot argued in the 1890s that psychological trauma was the origin of all instances of the mental illness known as hysteria. Charcot’s “traumatic hysteria” often manifested as a paralysis that followed a physical trauma, typically years later after what Charcot described as a period of “incubation”. Sigmund Freud, Charcot’s student and the father of psychoanalysis, examined the concept of psychological trauma throughout his career.
Jean Laplanche has given a general description of Freud’s understanding of trauma, which varied significantly over the course of Freud’s career: “An event in the subject’s life, defined by its intensity, by the subject’s incapacity to respond adequately to it and by the upheaval and long-lasting effects that it brings about in the psychical organization”.

The French psychoanalyst Jacques Lacan claimed that what he called “The Real” had a traumatic quality external to symbolization. As an object of anxiety, Lacan maintained that The Real is “the essential object which isn’t an object any longer, but this something faced with which all words cease and all categories fail, the object of anxiety par excellence”.

Stress disorders

All psychological traumas originate from stress, a physiological response to an unpleasant stimulus. Long term stress increases the risk of poor mental health and mental disorders, which can be attributed to secretion of glucocorticoids for a long period of time. Such prolonged exposure causes many physiological dysfunctions such as the suppression of the immune system and increase in blood pressure.
Not only does it affect the body physiologically, but a morphological change in the hippocampus also takes place. Studies showed that extreme stress early in life can disrupt normal development of hippocampus and impact its functions in adulthood. Studies surely show a correlation between the size of hippocampus and one’s susceptibility to stress disorders.
In times of war, psychological trauma has been known as shell shock or combat stress reaction. Psychological trauma may cause an acute stress reaction which may lead on to posttraumatic stress disorder (PTSD). PTSD emerged as the label for this condition after the Vietnam War in which many veterans returned to their respective countries demoralized, and sometimes, addicted to psychoactive substances.
The symptoms of PTSD must persist for at least a month for diagnosis. The main symptoms of PTSD consist of four main categories: Trauma (i.e. intense fear), reliving (i.e. flashbacks), avoidance behavior (i.e. emotional numbing), and hypervigilance (i.e. irritability). Research shows that about 60% of the US population reported as having experienced at least one traumatic symptom in their lives but only a small proportion actually develops PTSD.
There is a correlation between the risk of PTSD and whether or not the act was inflicted deliberately by the offender. Psychological trauma is treated with therapy and, if indicated, psychotropic medications.

The term continuous post traumatic stress disorder (CTSD) was introduced into the trauma literature by Gill Straker (1987). It was originally used by South African clinicians to describe the effects of exposure to frequent, high levels of violence usually associated with civil conflict and political repression. The term is also applicable to the effects of exposure to contexts in which gang violence and crime are endemic as well as to the effects of ongoing exposure to life threats in high-risk occupations such as police, fire and emergency services.

As one of the processes of treatment, confrontation with their sources of trauma plays a crucial role. While debriefing people immediately after an event has not been shown to reduce incidence of post-traumatic stress, coming alongside people experiencing trauma in a supportive way has become standard practice.