Psychological trauma and its consequences

What ‘s trauma?

According to the World Health Organization, trauma occurs when: The person has been exposed to a stressful event or situation (both brief and prolonged) of an exceptionally threatening or catastrophic nature, which could cause profound discomfort in almost everyone (W.H.O.: ICD-10).

Trauma is a psychological reaction, following a negative and highly stressful event that appears unexpectedly and uncontrollably. By compromising the physical or psychological integrity of the person who suffers it, and being unable to cope with it, it creates a very intense discomfort in him/her.

The high psychological impact of traumatic events occurs due to the intensity of the event along with the absence of adequate psychological responses to cope with something unknown and unexpected.

To consider an event as traumatic it has to be of a negative character, unexpected and sudden.

A large part of the individuals who face a traumatic situation suffer psychological consequences afterwards, which can be acute or chronic. In the first post-traumatic moments there are symptoms that can be considered normal and very often, these symptoms remit spontaneously, but sometimes the consequences last in time or increase affecting mental health.

Symptoms associated with trauma

Once the initial shock is overcome, responses to a traumatic event may vary. The most common responses are:

• Flashbacks and nightmares.
• Anxiety and constant nervousness.
• Anger.
• Denial of the event.
• Changes in thought patterns.
• Increased difficulty concentrating.
• Avoidance behaviors towards memories of the event.
• Intense fear of a recurrence of the traumatic event, especially on anniversaries of the event or when returning to the site of the original event.
• Withdrawal and isolation in daily activities.
• Decline in general health or worsening of an existing illness.
• Changes in mood.
• Dissociation.
• Irritability and sudden mood changes.
• Physical symptomatology of stress, such as sweating, headache and nausea.
• Sleep disturbance or inability to sleep (insomnia).

For the most part, those affected will not develop post-traumatic stress disorder (PTSD), anxiety or depressive disorders or dissociative identity disorder, but normal manifestations of post-traumatic syndrome, even in situations of high psychological impact.

Traumatic disorders

After exposure to a traumatic or stressful event, severe psychological reactions may develop, leading to one of the disorders related to trauma and stress.
The diagnoses included in this category of disorders are:

PTSD (Post Traumatic Stress Disorder)

Probably the most common and studied, with a prevalence of 1-4% of the population. It is especially common in people with professions that involve a risk of exposure to traumatic events (police, health, military…). Symptoms such as persistent and recurrent nightmares and insomnia, flashbacks, isolation and high reactivity (aggressiveness, hypervigilance…), irrational fears, derealization (feeling that the world is not real) and depersonalization (feeling like an external observer of oneself) and dazedness are common.

ASD (acute stress disorder)

It is characterized by PTSD-like symptoms that occur after the traumatic event. Such symptoms may last from two days to 4 weeks after the traumatic event. What differentiates it most from PTSD is that the symptoms must appear almost immediately after the event.

Adjustment disorder

Symptomatology appears after a clear and definite traumatic event, within three months of onset, but cannot be classified as PTSD. There is intense distress disproportionate to the severity or intensity of the stressor and significant impairment in normal functioning. Distress manifests with decreased work or school performance, changes in social relationships, complications in an existing illness, problems in a partner or family, and financial difficulties.

Reactive attachment disorder (RAD) (diagnosed only in children)

It is characterized by a distortion and lack of development in the ability to relate socially. Common symptoms include sadness or fearful reactions for no apparent reason, emotionally poor reactions to others, episodes of high irritability, and limited expression of positive affect.

Disinhibited social engagement disorder (DSED) (diagnosed only in children)

Appears a lack of selectivity to attachment figures of choice, being overly familiar with unfamiliar people and seeking affectionate contact outside the close social circle

Other specified disorder related to trauma and stress

Symptomatology characteristic of trauma- and stress-related disorders appears, causing significant distress and impairment in all areas, but criteria for any of the above diagnoses are not met. In this case, it is specified which other disorder might be influencing the symptomatology

Trauma and stress-related disorder not specified

The same as the previous disorder, but without specifying any other disorder.

There are several factors that can make traumatic experiences more negative. On the one hand, factors associated with the person him/herself such as the way he/she perceives and experiences the situation, resilience or mental health history. On the other hand, there are the factors associated with the situation itself: human and material losses, extension in time or chronicity, age at which it begins (in case of abuse). Finally, factors associated with the place where the event occurs; the presence of social support, the existence of preventive measures, the community culture itself, or the existing mental health care in that society.

Trauma in childhood

Considering that during childhood a child is dependent on his or her caregivers, any abusive or neglectful behavior can have a traumatic effect, being experienced as a threat to his or her own integrity.

In addition, in childhood it is common for mistreatment to be continuous, being a chronic situation for them. It is important to highlight that abandonment is another form of maltreatment, being as psychologically harmful as physical or sexual abuse.

Consequences of childhood trauma: When to seek professional help?

The reactions shown by children and adolescents who have been exposed to traumatic events can be summarized as:

1. Development of new fears.
2. Separation anxiety (especially in young children).
3. Sleep disturbances.
4. Nightmares.
5. Sadness.
6. Loss of interest in normal activities.
7. Decreased concentration.
8. Deterioration of school work.
9. Anger.
10. Somatic complaints.
11. Irritability.

The functioning in the family, group of friends or school can be affected by these symptoms, putting at risk the mental stability of the youngest.

Dissociative disorders: response to chronic trauma

What is dissociation?

The term dissociation refers to a disconnection between mind and body; a disruption in the way the mind handles information. You may feel disconnected from your feelings, thoughts, memories and the environment around you and it can affect your sense of identity and perception of time.

Dissociation is a human defense mechanism against trauma, which allows us to blur and even eliminate experiences that are too painful to assimilate, especially when we are children and we are developing. Thus, in the face of abuse or maltreatment (especially in childhood and adolescence), dissociative symptoms are a lifesaver for many victims; the problem is that this reaction, in principle adaptive, becomes dysfunctional very quickly, affecting the mental health of the victims.

Dissociative symptoms

Dissociative symptoms are divided into three blocks: amnesia, derealization/depersonalization and confusion/alteration of identity (Steinberg, 1995).

Amnesia serves the function of allowing the patient to go on with life by selectively forgetting the distressing situation and intolerable emotion; in Dissociative Identity Disorder for example, the parts dealing with everyday life situations usually present amnesia for previous traumas.

Depersonalization disconnects the body from consciousness so that the individual can detach the traumatic experience from his or her own emotions; often when there is severe trauma we do not perceive the emotional part of the experience to defend ourselves against the degree of emotional arousal it provokes.

The alteration of identity alternates one mental state with another without creating a meta-consciousness that encompasses both.

Dissociative disorders

Dissociative disorders include several syndromes with the common core of an alteration in consciousness that affects both identity and memory:

• Dissociative amnesia, in which patients lose autobiographical memory of certain events, usually events of a traumatic or stressful nature.
• Dissociative Fugue, in which amnesia covers all (or at least a very large part) of the patient’s life and is accompanied by loss of personal identity and in many cases a physical relocation (hence the name). Dissociative amnesia can be diagnosed with or without dissociative fugue.
• Dissociative identity disorder or DID (formerly multiple personality disorder), in which the patient appears to possess and manifest two or more identities (a «host» personality and one or more «alter egos» ) that alternate control over conscious experience, thought and action and are usually separated by some degree of amnesia.
• Depersonalization disorder, in which patients feel that they have changed in some way or are somehow no longer real.
• Dissociative disorders not otherwise specified, in which the patient manifests some dissociative symptoms to some degree but falls short of qualifying for a diagnosis of the above.

Although the effects of trauma can impact areas of functioning that seem remote from the trauma, considering trauma as the primary causal influence of symptoms can help empower individuals to heal themselves with support, and validation in a safe environment.