Traumatic responses: the signs and symptoms of trauma

Trauma can look different in each individual. We take a broad understanding of traumatic responses, rather than one specific mental disorder or syndrome (for example, post-traumatic stress disorder, or PTSD). Instead we focus on a range of symptoms, adaptations and difficulties that are often present in individuals who have been traumatized – and, specifically, those who have experienced interpersonal forms of trauma. We understand that interpersonal forms of trauma can impact many aspects of a woman’s life, identity, relationships, feelings, thoughts and behaviours. Common reactions, adaptations and difficulties include:

• acute traumatic response 
• changes in thinking due to trauma
• emotional impact of trauma
• body-related impacts of trauma
• problems in relationships with others
• difficulty managing emotions
• avoidance behaviours and responses
• revictimization

Acute traumatic response

Women who have experienced trauma can develop symptoms of post-traumatic stress disorder (PTSD). There are three categories of PTSD symptoms:

1. Intrusive re-experiencing 
   • Flashbacks and nightmares fall under this category: symptoms in which the trauma victim re-experiences traumatic events or feelings in ways that intrude on everyday life.
   • Flashbacks are vivid recollections of the trauma or an aspect of the trauma. During a flashback, one may see, hear or smell aspects of the trauma, or may have bodily sensations or body memories connected to the trauma. People who have flashbacks can feel as if they are going crazy or are out of control. Flashbacks are actually the brain’s attempt to integrate the traumatic material. Until this is accomplished, flashbacks can be extremely disruptive to one’s daily life.
   • Traumatic nightmares can be overwhelming and intrusive. They may include details of the traumatic event, or they may reflect the emotions connected to the trauma. For example, the nightmare might involve feelings of entrapment or terror, without any storyline.
2. Avoidance
   • Emotional numbing – Individuals may experience a lack of feeling altogether following a trauma. Some feel numb, disconnected or “emotionally dead.”
   • Avoiding things or situations associated with the trauma – Following a trauma, individuals may avoid certain things that have become associated with the trauma; for example, a place or an activity. This can generalize to other things and leave someone feeling quite constricted in their life.
3. Hyperarousal
   • “Hyperarousal” means being overly aroused or alert.
   • Insomnia or persistent restlessness – Individuals may have difficulty sleeping or relaxing.
   • Heightened startle response – Individuals may always feel on edge or as if they have to be aware of everything around them.

Changes in thinking due to trauma

Traumatic events can lead to changes in one’s thinking. Core beliefs about one’s self, others and the world are formed out of one’s early experiences with caregivers. When someone’s early experiences are characterized by abuse or neglect, she is likely to try to make sense of the abuse by adapting her thinking and her beliefs. There are five important areas of belief that are most likely to be disrupted by trauma: safety; trust; esteem; intimacy and connection; and power and control. Here are some examples of these trauma-disrupted beliefs:

• Safety
  • I am vulnerable to being hurt and abused by others
  • to protect myself I must always be vigilant against the possibility of threat
  • the world is full of danger
  • I am a magnet for danger and harm
  • maintaining my own safety requires extreme measures (e.g. sleeping with a weapon near by)
  • I must avoid situations that have been connected to danger in the past (e.g. my bed)
• Trust
  • I will be betrayed and abandoned by others
  • others always disappoint me
  • if I am vulnerable to others they will make a fool out of me, or humiliate me
  • depending on someone means I am needy or demanding and I will be rejected
  • if given the opportunity, others will hurt me
• Esteem
  • I am bad, damaged, flawed, or evil
  • I am responsible for bad things happening
  • I am guilty
  • I am worthless
  • bad things have happened because I deserve them
  • others are bad, evil, and malevolent
• Intimacy and connection
  • I will always be alone and alienated from others
  • the good part of me has died
  • I will always be disconnected form others
  • I am different from everyone else
• Power and control
  • I must be in control of myself and others or else others will control me
  • I have no control over myself or my relationships
  • power is about dominating others or being dominated
  • being in control is terrifying
  • being out of control is terrifying

Emotional impact of trauma

Trauma impacts one’s mood and feelings. In fact, anxiety and depressive disorders are common conditions for people who have experienced trauma. Common feelings associated with trauma include:

• fear
• confusion
• anxiety
• sadness
• grief
• loss
• guilt
• denial
• disbelief
• shock
• blame
• shame
• anger
• irritability

Body-related (“somatic”) impacts of trauma

Trauma impacts the body. Research has shown a relationship between a history of trauma and physical complaints (e.g. chronic pelvic pain, genitourinary problems, gastrointestinal distress). Survivors of trauma also have higher rates of somatization disorder.

Somatization disorder is characterized by a combination of pain, gastrointestinal, sexual and neurological symptoms, lasting for a number of years and with no known medical cause.

One study found that over 90 per cent of women with somatization disorder reported a history of abuse.

Common physical symptoms of trauma include:

• aches and pains
• racing heart
• fatigue
• muscle tension
• numbness
• feeling jumpy or edgy

There is also strong evidence supporting the relationship between a history of childhood trauma and health problems in adulthood. Adverse experiences in childhood increase the risk for:

• alcoholism
• drug abuse
• depression
• suicide attempts
• risky sexual behaviour
• obesity
• heart disease
• cancer
• lung disease
• skeletal fractures
• diabetes

Problems in relationships with others

Trauma that is interpersonal in nature can affect how you experience other relationships later in life. Abused children will often come to believe that what is happening to them is their fault. They may feel that there is something wrong with them and that they are inherently “bad.” This distorted view can persist into adulthood, affecting how the survivor feels about herself. Survivors of abuse can be plagued with feelings of self-hate, self-blame, shame and guilt.

A child who has been abused is likely to struggle with trusting others. After all, when your caregivers do not take good care of you, it is difficult to believe anyone else will. These feelings of distrust can last into adulthood and affect a woman’s relationships, including intimate relationships. She may long for connection and intimacy and yet be afraid to let someone get close to her. Women who have experienced abuse can be sensitive to rejection, fear abandonment and can often find themselves in unstable or chaotic relationships.

Difficulty managing emotions

Being able to tolerate strong emotions and soothe yourself when distressed are skills called affect regulation. These skills are learned early in life through relationships with caring and attuned attachment figures.

Affect regulation is the ability to experience, tolerate and manage one’s feelings.
Self-soothing means strategies used to calm oneself when upset.
Attachment figures are, typically, the primary caregivers of the infant, such as parents. The attachment relationship influences the development of the core aspects of the individual – identity, feelings, core beliefs, and relationships.

A child who is abused by her primary caregiver, or attachment figure, is often left scared and unsoothed.

Difficulties self-soothing and managing feelings as a child can persist into adulthood, and leave someone feeling as if she goes from being totally overwhelmed (hyperaroused) to completely numb (hypoaroused).When overwhelmed, a woman may feel as if her feelings are intolerable or scary. She may feel as if she is continually on the verge of being overwhelmed or “losing it.” This is a chronic state of hyperarousal. The other extreme is hypoarousal. In this state, a woman may feel disconnected or numb. This state is a protective strategy to manage overwhelming emotions.

Avoidance behaviours and responses

Trauma survivors often engage in avoidance behaviours as a way to cope with difficult feelings, sensations, thoughts and memories. Avoidance behaviours are especially useful when someone feels overwhelmed or does not know how to self-soothe. Some examples of avoidance behaviours and responses are tension reducing behaviours and dissociation.

Tension-reducing behaviours
In order to avoid intolerable or uncomfortable feelings, people who have experienced trauma may use different behavioural strategies. These behaviours are called “tension-reducing behaviours” because they help reduce the level of distress or tension the person is feeling. Tension-reducing behaviours include:

• substance use
• thoughts of suicide
• engaging in risky sexual behaviour
• binge eating
• spending sprees
• self-harming (e.g. cutting, banging)

While these behaviours may appear unhealthy or problematic, it is important to understand their adaptive and coping function. These tension-reducing behaviours are often used to avoid or cope with the intolerable effects of trauma. Ideally, over time and with help, those who have experienced trauma will learn alternative self-care strategies that offer more choice and are less self-harming in nature.

Dissociation
Dissociation is a coping strategy to manage overwhelming experiences. In the absence of stress, the mind is able to collect all the information around us – sensations, feelings, thoughts, behaviours and identity – and use it to make sense of one’s experience. This means that at any given moment we know who we are, where we are, what we are thinking and feeling, and so on. However, in an overwhelming or unbearable situation, a person may dissociate, or protect herself by disconnecting from aspects of what she is experiencing. This makes the situation momentarily tolerable. For example, a rape victim might feel as though she has left her body and is on the ceiling looking down at what is happening to her. Or, she might not be able to feel her emotions, but feels numb instead.

When one dissociates, one or more of these pieces of information is cut off from the self, resulting in a fragmented or confusing sense of oneself or of the experience. When this happens the person might:

• not remember part or all of what happened
• not have any feeling about the event
• lack any sensory memory despite knowing it must have physically hurt

This information and these memories may or may not be recalled later in life. When there is chronic traumatization, dissociation may become a well-practiced strategy that can lead to problems in daily life and/or increase one’s vulnerability to additional harm. For example, individuals who dissociate regularly may:

• feel as though there are large periods of time when they don’t know what happened
• find themselves in places without any memory of how they got there
• find evidence that they have engaged in some activity – for example, gone shopping – but not have any memory of it
• be told they were acting different or strange
• have others insist they know them from somewhere, but have no memory of meeting this person

Revictimization
People who have experienced trauma are at an increased risk for being revictimized in the future. In fact, it is reported that approximately two out of every three people who are sexually victimized are revictimized later in life. Also, when someone who experienced childhood trauma is victimized again later in life, they may have more severe and complicated responses to the new trauma.

People who have been traumatized repeatedly throughout their lives may wonder why it continues to happen to them. This is a complex issue that we will continue to address on this website. For now, here are some theories about why traumatized people are vulnerable to being revictimized:

• One of the effects of trauma can be difficulty hearing one’s internal messages about potential danger. This disconnection may have developed as a way for the individual to survive when traumatic experiences were unavoidable (for example, child abuse), but now leave the individual vulnerable to revictimization later in life.
• Another effect of trauma can be the core belief that one does not deserve to be treated with respect. Instead, someone may believe she deserves to be hurt, is bad, and worthless.
• Some individuals may also, consciously or unconsciously, feel compelled to repeat the traumatic situation or relationship in an attempt to “make it right.” They may then engage in similar relationship dynamics with the hope of resolving an inherently abusive situation.
• Some individuals who have histories of chronic abuse may have shaped their beliefs of relationships and self-worth around the abuse. For example, if violence has been paired with love, they may understand violence to be part of loving relationships. Or, if the only way they received care was to be victimized, then they may believe this is the cost of receiving care.