Seventy percent of adults in the United States — or more than 223 million people — have experienced a traumatic event at least once in their lives, according to the National Council for Mental Wellbeing.
And while the impact is different for each person, experts say talking about it, seeking treatment when needed and being there for each other can make a difference.
“The brain can heal itself in the right environment with the conditions of supportive relationships,” says Dr. Jessica Gomez, a bilingual clinical psychologist and executive director of the Momentous Institute in Dallas.
What is Trauma?
When discussing trauma, traumatic events and post-traumatic stress disorder, it’s important to make distinctions among terms, experts advise.
The term trauma is used to refer to an event, and the term traumatization refers to the negative emotional reaction to the event, according to Dr. Steven Gold, a licensed clinical psychologist who served as editor-in-chief for the American Psychological Association’s “Handbook of Trauma Psychology.”
“This is especially important because not everyone who encounters a traumatic event will be traumatized by it,” he notes, explaining that 12% to 15% of combat veterans will be traumatized by the experience, while almost 50% of rape survivors will suffer traumatization. As a result, the term “potentially traumatic event” is often used.
“The most commonly used definition of trauma in the sense of traumatic events is experiencing or witnessing potential or actual death, serious physical injury or sexual assault,” Gold says.
Traumatization is more widely discussed in recent years, he explains. The diagnosis of post-traumatic stress disorder was officially recognized in 1980, but was met with skepticism for many years.
“Over time, there has been growing interest in and wide-ranging discussion of trauma, including in the popular media, so few people, either professionals or members of the general public, question the reality of trauma and traumatization,” Gold says. “If anything, the term trauma is used too broadly and indiscriminately to refer to anything that someone finds disturbing.”
What is PTSD?
If someone experiences or witnesses a traumatic event or series of events, they may develop post-traumatic stress disorder, says Anna Deibel, a licensed clinical professional counselor at Grow Therapy.
“Someone may experience these events or circumstances in emotionally, physically harmful or life-threatening ways,” she says. “As a result, the person can be left with an impacted mental, physical, social and/or spiritual well-being long after the trauma has taken place.”
Experts note PTSD and trauma are not interchangeable. To be considered for a PTSD diagnosis, signs and symptoms must last for more than a month and be severe enough to interfere with school, work or relationships.
Risk factors for PTSD, according to the National Institute of Mental Health, include exposure to previous traumatic experiences, especially as a child, getting hurt or seeing people hurt or killed, feeling horror, helplessness or extreme fear, having little to no social support after the event, facing pain, injury or other stress after the event, and having a personal or family history of mental illness or substance abuse.
PTSD can affect anyone, but Deibel notes the U.S. Department of Veterans Affairs says about 5% of adults in the U.S. have it in any given year. Women are more likely to develop PTSD than men, partly due to the types of traumatic events, including sexual assault, women are more likely to experience.
What Causes Traumatization?
Gold explains that when the ‘fight-flight-freeze’ reflex is triggered, it increases the likelihood of surviving life-threatening situations. Freezing is set off when the other two options are not possible.
“It can easily be misunderstood by outside observers as reflecting that the person was unaffected by the traumatic event, or even disturbingly unmoved by it,” Gold says. “When the FFF response continues to be activated, or is triggered by cues that are in some way reminiscent of the event a month or more after the traumatic event has ended, this is the mechanism driving PTSD.”
Gold notes depression, substance abuse or dissociative disorders can also be responses to traumatization.
Trauma can come in different forms, Deibel says, including a single overwhelming incident, chronic or complex trauma, as well as insidious trauma, which can be gradual and subtle, but still harmful. This includes racism and homophobia, for example. Vicarious trauma may impact health care professionals, social workers, caregivers and therapists. A large-scale natural disaster may cause mass trauma, affecting many people. Intergenerational trauma is trauma that may be passed from one generation to the next.
“This is because trauma can actually change a person’s DNA, which is then passed on to biological children,” Deibel explains.
Historical trauma — including genocide, slavery, colonialism and war — can last many years and span multiple generations.
Gomez and other experts make a distinction as well between “Big T” events, such as an assault or a natural disaster that can bring on an overwhelming sense of helplessness, and “small t” events that may include divorce, financial difficulties or personal conflict. But a cumulative effect of smaller traumas can also bring on distress and difficulties. Gomez stresses trauma looks different for different people.
“It just depends on the individual, how they’re going to react to it,” she says.
Gomez also notes more than 60% of adults have experienced adverse childhood experiences, with 16% experiencing four or more ACEs, according to the Centers for Disease Control and Prevention.
These are potentially traumatic events that may include violence, abuse or growing up in a family with mental illness or substance use problems, says the CDC. The “toxic stress” can alter brain development and stress responses. Chronic health problems, mental illness and substance abuse can be linked.
“We know that the more adverse experiences you have, they stack,” Gomez says.
How Is It Treated?
Symptoms of traumatization may include anxiety and depression, flashbacks, hypervigilance, sleep disorders, and the inability to accept positive emotions. Symptoms of PTSD may include intrusive thoughts, reliving traumatic events, avoidance, changes in thinking, mood, sleep patterns and concentration, as well as self-destructive behavior.
Ongoing trauma can also affect and shape entire communities, Gold says.
“Entire communities, and in the case of war, entire generations, can be affected by these forms of traumatizing danger and shape the cultural and social frameworks shared by the affected community,” he explains. “For example, gun violence and the commonplace occurrence of gun-related killings in the U.S. fosters a sense of vulnerability, alertness and looming danger that are noticeably absent in other countries where gun ownership is an exceedingly rare phenomenon.”
Gold says treatment may include revisiting the original event through describing it, writing about it or picturing it mentally. But this may not be effective or may increase traumatization, especially for those subjected to repeated or prolonged traumatic events. Treatment, says Gold, is instead generally started with distress-reduction techniques and coping strategies.
“Much like working out physically, where regular exercise leads to noticeable changes in the body, engaging in distress-reduction methods regularly can lead to lasting changes in one’s mental state,” Gold says.
Identifying cues related to the traumatic event and gradually approaching them also can be effective, he notes.
Gomez stresses there is no “cookie-cutter treatment.” For some, it may be cognitive behavior therapy, but others may use play therapy or dance and other movements. She stresses the importance of relationships, as well as being mindful of what is consumed, especially at a time when constant news and information can be overwhelming.
“I think you have to monitor the impact and give yourself permission to disconnect,” she says.
Deibel notes not all people who experience PTSD need treatment, especially if a strong support system is available. But when treatment is needed, the sooner it is accessed, the better chance for recovery. Deibel says this may include therapy, medication and support groups.
“While support groups haven’t been shown to reduce PTSD symptoms, they can help in other ways, such as giving you a feeling of connection to other people who have been through similar circumstances,” she says. “Sharing the challenges that occur in daily life might diminish any feelings of isolation and help you learn new perspectives on how others deal with it.”
How Can We Help?
Gold says those close to someone who has experienced traumatization can help by “having the humility to understand that you cannot fully grasp what your loved one affected by trauma is going through, and simply listening without giving advice. Above all, understanding that traumatization is not a choice. When it occurs, it is the expression of the fight-flight-freeze reflex that was triggered by the original traumatic event.”
Gomez says she has seen “an elevation of these themes” both during and following the COVID-19 pandemic, and “an explosion of need” among youth, especially those of color. The effects also filter to educators and other adults in caregiving roles. She says significant interventions are needed, both for children and adults.
“We have a real opportunity to really destigmatize mental health and trauma,” she stresses, noting teaching children as early as kindergarten about their brain and its functions can help, as well as not separating mental health from general health.
“We have to stop treating these two separately,” she says. “They’re interwoven.”
Gomez also stresses the “right” words aren’t necessarily needed when providing comfort to a loved one.
“If you don’t have the words, there is nothing more important than the presence of being,” she says. “I think it’s one of the biggest gifts we can give each other.”
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