1. What is trauma?

The psychiatric definition of "trauma" is "an event outside normal human experience." Trauma generally leaves you feeling powerless, helpless, paralyzed. It tends to be sudden and overwhelming; it "owns" you. You cannot think clearly during and after a severe trauma; at the same time, you are forced to focus your consciousness in an attempt to deal. One author defines trauma as "any sudden and potentially life-threatening event."

This refers to one-time traumatic events, but most of it applies to prolonged, repeated trauma as well.



2. Some instances of one-time trauma.
3. Some instances of prolonged trauma.
4. What are the immediate effects of single-instance trauma?
  1. Emotional
  2. Cognitive
  3. Hyperarousal
  4. Body
  5. The inevitable review
    Trauma survivors spend a lot of time thinking about what they could have done differently. Truth is, they couldn't have done it differently -- the body takes over. And the important thing is not what you did -- it's that you survived.
5. What are the effects (immediate and long-term) of prolonged, repeated trauma?


The immediate effects of prolonged trauma are the same as for one-time trauma, only they recurs with each new wave of traumatic experience. The long-term effects include Post-traumatic Stress Disorder, Complex Post-traumatic Stress Disorder, and a variety of mental and physical illnesses.


6. What can be done to help survivors immediately after a trauma?


Crucial to helping someone survive trauma is realizing that you, too, are affected by the trauma, that deciding to help is a big commitment, and that you need helpers, too.

One of the best ways to help a traumatized person is simply to listen compassionately and actively, and make the person aware that you are willing to listen. Reassure the person that there are realistic ways to make it okay, that s/he can survive, that you are willing to help.

Offer practical assistance -- running errands, cooking, whatever needs to be done. Don't just ask; if you see that something needs doing, suggest that you do it. This is much more effective than simply saying, "If there's anything I can do..."

DO NOT criticize the person's reaction, minimize the trauma, suggest it was fate or God's doing, minimize the person's feelings, or say you know exactly how they feel (a very subtle way of minimizing feelings. Do not interfere with actions the person has chosen to take unless they are endangering self or others. If you think an action is too extreme, encourage the person to slow down and talk it through.



7. What is PTSD?


Post-Traumatic Stress Disorder (PTSD) is the name given to a cluster of symptoms often seen in trauma survivors. The more severe the trauma, the longer these symptoms will persist. In cases of major and/or repeated trauma, strong reactions may continue for years.

Symptoms of PTSD can include:


8. What causes PTSD to develop?


The simple answer, of course, is trauma. But it's more complicated than that. During a traumatic experience, you adapt and choose new approaches that are survival-oriented for the situation you're in. The problem comes after the trauma, when those approaches and response are no longer functional. Recovery involves recognizing what responses are and aren't functional, and getting rid of the ones that hurt you. In effect, trauma reprograms your reactions very quickly; recovery is a kind of process of deprogramming.

Some practitioners believe that trauma causes changes in brain chemistry, changes that are helpful in the short term by reducing the level of emotion to something bearable but that are harmful in the long term because they reinforce the PTSD symptoms.

9. What can be done for PTSD?


Healing begins when the survivor realizes that the trauma was real and had real effects on his/her life, not all of which are adaptive in terms of "ordinary" living.

Trauma creates overwhelming fear and leaves in its wake a feeling that the world is not a safe place. Many practitioners (Herman, Colodzin, Miller, Hybels-Steer, Dee) thus believe recovery begins with establishing a safe place, a situation within which the survivor can feel some sense of safety and predictability. This usually involves developing an honesty about and awareness of the fear. As the fear subsides, the survivor is able to focus on other feelings and symptoms, to recognize them, search them for meaning, and decide whether or not to act on them.



10. What is CPTSD?


Recommended DSM diagnostic criteria, per Trauma and Recovery by Judith Herman, c1992 by Basic Books.

  1. A history of subjection to totalitarian control over a prolonged period (months to years). Examples include hostages, prisoners of war, concentration-camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and organized sexual exploitation.
  2. Alterations in affect regulation, including:
    • persistent dysphoria
    • chronic suicidal preoccupation
    • self-injury
    • explosive or extremely inhibited anger (may alternate)
    • compulsive or extremely inhibited sexuality (may alternate)

  3. Alterations in consciousness, including:
    • amnesia or hypermnesia for traumatic events
    • transient dissociative episodes
    • depersonalization/derealization
    • reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

  4. Alterations in self-perception, including:
    • sense of helplessness or paralysis of initiative
    • shame, guilt, and self-blame
    • sense of defilement or stigma
    • sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

  5. Alterations in perception of perpetrator, including:
    • preoccupation with relationship with perpetrator (includes preoccupation with revenge)
    • unrealistic attribution of total power to perpetrator (caution: victim's assessment of power realities may be more realistic than clinician's)
    • idealization or paradoxical gratitude
    • sense of special or supernatural relationship
    • acceptance of belief system or rationalizations of perpetrator

  6. Alterations in relations with others, including:
    • isolation and withdrawal
    • disruption in intimate relationships
    • repeated search for rescuer (may alternate with isolation and withdrawal)
    • persistent distrust
    • repeated failures of self-protection

  7. Alterations in systems of meaning:
    • loss of sustaining faith
    • sense of hopelessness and despair

11. What are the steps to recovery from prolonged trauma?


According to Herman and Miller, survivors of prolonged trauma must first create a safe place. Herman considers the remaining steps to be remembrance and mourning and reconnecting with the world, accepting the changes that the trauma has made in your life. Remembrance and mourning involves grieving both actualities and potentials that were lost; reconnection is a time of "I know I have myself" -- a time for seeing the positive changes wrought by the traumas, celebrating the survivor self, and reconnecting/deepening intimacy with others in ways that were not possible before.

Miller sees recovery in three stages, too: the outer, middle, and inner circles. The outer circle is a time for building safety and rapport and gathering basic information. Middle circle work involves focusing on current symptoms and how to handle them. Inner circle work, when trust is deepest, involves the sharing of shameful secrets and resolving the issues behind the trauma.




12. How do I control and manage the symptoms while recovering?


Many symptoms can be reduced and controlled simply by getting sufficient sleep and eating healthy, balanced meals. Nightmares can sometimes be controlled by use of a dream journal; rage and flashbacks can be prevented or reduced by recognizing triggers and avoiding them. Reducing your general stress level and finding self-soothing methods can also help.

Depression and anxiety can sometimes be helped through medication (antidepressants, anxiolytics, mood stabilizers). Hyperarousal can also be helped by medication, and older tricyclic antidepressant are frequently used for insomnia.

Ways to soothe yourself when anxious:

Ritual: for example, a going-to-sleep ritual. Take a long, relaxing bath, put on comfortable clothing (if you sleep in clothes, and light a candle by your bed. Turn off the other lights. Stretch slowly across your bed, feeling your movements, feeling the sheets. Slowly open a book of poetry and read a page, meditating on the wisdom and beauty of the poem. Blow out the candle and go to sleep.

Hide under the covers. Take the day off, make a nest of pillows and blankets somewhere. Turn off the phone. Scent the room. Make a tray of munchies, using your prettiest dishes, and find a good book. Do whatever makes you feel refreshed and relaxed, even if it's just huddling in your nest with munchies for a few hours. Allow the anxiety to bleed away.

Ways to self-soothe when you are depressed:

Hiding under the covers.

Herbal baths:either make an infusion of herbs (like a very very strong tea) or put the herbs in small muslin bags you hang in the water stream or just drop in the tub.

Suggested combinations:


For more suggestions, see The Woman's Comfort Book.


Bibliography
Colodzin, B. (1993). How to Survive Trauma. Barrytown, New York: Station Hill Press.
Dee, E. (1993). War Against the Silence After Trauma: Unmasking and managing the stress of change. Sioux City, Iowa: Loess Hills Press.
Herman, J. L. (1992). Trauma and Recovery: The aftermath of violence -- from domestic abuse to political terror. New York: Basic Books.
Hybels-Steer, M. (1995). Aftermath: Survive and overcome trauma. New York: Fireside.
Louden, J. (1992). The Woman's Comfort Book: A self-nurturing guide for restoring balance in your life. San Francisco: HarperCollins.
Miller, D. (1994). Women Who Hurt Themselves: A book of hope and understanding. New York: Basic Books.
Shengold, L. (1989). Soul Murder:The effects of childhood abuse and deprivation. New York: Ballantine.

Resources on the web for PTSD

David Baldwin's Trauma Pages

mentalhealth.com

http://www.long-beach.va.gov/ptsd/stress.html

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