What is trauma? Signs and symptoms of PTSD
PTSD stands for Post Traumatic Stress Disorder and is defined by both incident AND impact. Mental health professionals think of trauma and PTSD as being a psychological injury in the sense that an outside event has occurred, and it has caused a shift in the way our brain perceives the world and physiologically activates or deactivates certain things in the body.
In the last episode, I outlined the definition of trauma and how we separate it into 3 different categories: traumatic exposure, trauma responses (fight, flight, or freeze), or ongoing trauma symptoms.
When people say, “I have trauma,” they typically mean ongoing trauma symptoms, which are actually pretty rare.
This is essentially when the brain gets stuck in the trauma response (fight, flight, or freeze) for a prolonged period and hasn’t resolved, and the symptoms have persisted for at least 30 days or more after they began.
PTSD is widespread trauma symptoms that affect many survivors.
This blog post is dedicated to PTSD, what it is, how it happens, what it can look like for different people, and how it affects survivors specifically.
Let’s dive in!
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PTSD stands for Post Traumatic Stress Disorder and is defined by both incident AND impact.
This is important to understand because many people who argue about trauma only focus on the impact of an incident and whether it causes specific symptoms without regard to the actual incident.
However, the mental health field has developed its definition of PTSD over decades of research and clinical interventions, so it’s essential to look at both the incident and the impact.
Mental health professionals think of trauma and PTSD as being a psychological injury in the sense that an outside event has occurred, and it has caused a shift in the way our brain perceives the world and physiologically activates or deactivates certain things in the body.
This is very different from being overwhelmed by the nervous system.
Nervous system overwhelm can also be referred to as distress, which can be heightened emotion, emotional activation, etc. This has a different impact on the brain and won’t necessarily create that fundamental shift in how our brain now operates and perceives the world.
Distress is normal and common in the face of stressful events.
It’s important to establish that the psychological and mental health fields do know a lot about trauma. We have researched trauma up and down and inside and out, and we only continue to get more in-depth and specific.
This also means we have precise definitions supported by our research.
Unfortunately, we’ve seen many people in the mental health community stray from this path of rigor and science/evidence-based engagement of psychology and mental health services. There has been a shift toward a more personal ideological approach where these individuals reinforce what they believe to be trauma vs. what we know trauma to be based on our definition.
PTSD, however, fundamentally changes the way the brain operates and is one of the more common ways that trauma can manifest.
When working under the incident and impact approach, a traumatic incident is exposure to actual or threatened death, serious injury, or sexual violence. This can either be our own direct experience, witnessing this happen to someone else, hearing that this happened to a close friend or family member, or experiencing repeated or extreme exposure to details and information about the traumatic event that occurred.
This definition immediately rules out a lot of experiences that people would apply the word “trauma” or “traumatizing” to.
I believe this generalization of trauma has come about from our efforts to validate people’s pain and to demonstrate that all pain warrants attention, care, and support.
While that is absolutely true, pain doesn’t have to be trauma to warrant care and support. Pain and distress are always valid.
When we talk about learning that trauma happened to a close family member or friend, it has to specifically be either violent or accidental death, sexual violence, or severe injury. It’s not an incident that we’d refer to as a common or normal experience like death from natural causes or even death due to terminal or chronic illness.
Some other things that I’ve heard people refer to as traumatic include major breakups, divorces, or intense fights with loved ones. Again, I would say that those are transformative experiences but don’t meet the criteria for trauma.
That said, they don’t need to meet the criteria for trauma for them to matter.
Trauma is a specific thing that happens to the brain, a specific psychological injury that is not the same as what happens in the experiences mentioned above.
With PTSD, we see the symptoms clustered. We think of it as persistent re-experiencing of the trauma, avoidance of stimuli, alterations to thoughts and mood, and/or alterations to arousal and reactivity.
Let’s unpack each of these!
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What Are Flashbacks?
Re-experiencing the traumatic event
Flashbacks are one of the key signs of PTSD.
Re-experiencing the trauma can also be called flashbacks. It is where your body, brain, or both believe it is back in the traumatic event.
This can look like seeing visualizations of the trauma, your body thinking the trauma is happening again because a trigger has occurred, or intrusive/involuntary memories.
With children, they sometimes engage in what’s called “traumatic play,” where they engage in some sort of narrative play around the incident and keep repeating the incident over and over again.
It is common for re-experiencing to happen while sleeping through nightmares and dreams. We might also have dissociative reactions, where we’re not entirely in touch with what’s happening around us but actually think we’re back in the event. Or we can dissociate from the world outside of us and have a dissociative response when we are not completely in touch with our body, present moment, or awareness.
Intense, prolonged distress when exposed to specific cues or triggers can also happen with PTSD.
What is a Trauma Trigger?
A trauma trigger is something associated with a traumatic event that activates a trauma response. Unfortunately, the word trigger has also been expanded to anything that causes an emotional reaction, however that is not entirely accurate.
For me, certain smells were triggering. The scent of a specific laundry detergent was present during my assault, and every time I smell it, I feel intensely afraid. I notice myself getting hypervigilant, which can often cause intrusive memories.
Certain music and songs that remind me of my assailant or mannerisms and clothing can also trigger responses for me. Again, these are specific triggers for me. Every individual is different.
Through my recovery work, I’ve learned skills to help get me through these moments, but some of these symptoms still linger.
Being triggered comes with physiological reactions: heart racing, breath getting shallow, feeling cold or hot, feeling like your body is getting ready to fight, flee, or dissociate so you can detach from your body to deal with what your brain believes is about to happen.
All of this falls under the re-experiencing cluster of PTSD symptoms.
Trauma Avoidance
Trauma avoidance is avoidant behaviors activated by traumatic experiences and ongoing trauma symptoms. Trauma avoidance can impact our ability to attend work, spend time with friends and family, and pursue meaningful goals and activities.
Persistent Avoidance:
Whether consciously or unconsciously, trauma survivors begin to avoid things in their lives that remind them of the trauma. This is also a symptom that can generalize quickly, meaning we avoid several things that may be somewhat related or even unrelated, but we just avoid in general.
External avoidance is when we avoid leaving home, avoid crowds, avoid meeting up with friends, avoid certain locations, or avoid certain experiences that evoke similar experiences to your trauma.
Internal avoidance is when we avoid things that would trigger memories or a re-experiencing of the trauma.
A personal example is that I noticed very quickly after my assault that I started isolating. The isolation was very unconscious. I was always “too busy” or “too tired” to go out and explore the world or hang out with people.
I was never a huge extrovert before my assault, but I definitely enjoyed socializing and being a part of my community. After my trauma, I didn’t make time for anything. The only things I did outside my home and work were near my home or work.
This is what I mean by generalization. It’s not that the entire world reminded me of my assault or caused triggering memories, but I started to isolate myself, and it kept getting worse and worse.
I think the origin of this was that any type of large group setting would cause a lot of fear for me. It made me feel more exposed. My trauma also included stalking, so I had a fear that he was going to show up anywhere I went.
The isolation was around me trying to control that fear, but it ultimately led me to stop going anywhere or seeing anyone. I lost a few relationships because I simply was not engaging in them.
We may also see people start to use substances as a means of avoidance. When we’re drunk or high, we’re not able to think back on some of these things in the same way we do when we’re sober and entirely in touch with the world.
Substance abuse is one of the more common ways people avoid or cope with their symptoms. It isn’t necessarily healthy or safe, but it is a standard means of avoidance.
Trauma and Mood Swings
Trauma and mood swings, negative alterations in thoughts and mood due to ongoing trauma symptoms.
With this cluster, looking at how this differentiates from other experiences or disorders is essential.
Because we’re stuck in a survival mechanism, our senses can get fixated or focused during fight, flight, or freeze, making it difficult to provide information to law enforcement when they ask questions about the incident.
We see this inability to remember important aspects of the event as part of PTSD because we’re still kind of locked in that constricted space.
We may also have persistent and exaggerated negative beliefs or expectations about ourselves and the world.
This can include engaging in self-blame, especially when we fixate on blaming ourselves and have difficulty letting go despite knowing that we did not cause the situation.
Our rape culture world does not help alleviate self-blame as it has a tendency to blame survivors for their assault and regularly pins on us that it’s our responsibility to prevent assault. We cannot control the behavior of others, but after something has happened, we may have a persistent belief that we should have done something differently, and it’s our fault that we didn’t make it stop.
We can also have other persistent beliefs like feeling broken, damaged, crazy, or feeling like the world is an inherently dangerous place.
We can see that our brain is attempting to make sense of what happened but also going to out-of-balance extremes. Yes, there is a lot of danger in the world, but there are also many good things that happen.
In my personal experience, the feeling of being broken was something that I definitely struggled with after my assault. My brain felt stuck in mud and slow-moving.
These persistent feelings are indicators of PTSD. These thoughts aren’t necessarily crazy or inaccurate, but the thought isn’t complete.
The world obviously has a lot of danger, but there are also a lot of good, mundane, safe, and joyful things that happen in it as well. When we see someone has a specific focus and cannot alter that belief, something may not be getting repaired.
We can also see distorted cognitions about the cause, self-blame, or magical thinking.
Magical Thinking and Trauma
Magical thinking is more common in children who experienced trauma and is also a normal developmental trait. In part, this is because children’s brains work in a very concrete way and, at times, very imaginal, using symbolism and magical thinking as a way of understanding things. So when something outside of the realm of our understanding, like trauma, happens as a child, the child might engage magical thinking as a way of making sense of it.
An example can be, “I somehow have the power to control my parents' behavior, so it must be my fault that they were abusive to me, and if I just try to be a good kid, then maybe I can prevent them from hurting me.”
Depression, Anxiety, and Trauma
Signs of depression and anxiety are often present during active symptoms of trauma and PTSD. We can also see persistent negative emotional states where there’s a lingering sense of fear, horror, anger, guilt, or shame. Shame is predominantly an emotion that lingers and continues without explaining why it won’t go away.
Diminished interest in activities also comes up. This symptom is particularly upsetting because these activities can often help us recover quicker. But when our brains are activated in such a way, they don’t have time, space, or energy to allow for creative processes, imagination, or playfulness.
Often, activities we used to enjoy are ones we don't connect with anymore.
There are several deeply meaningful activities I engage in, and early on in my recovery, I wasn’t doing much of anything outside of work. I was doing what I had to do to stay alive, but that was about it. I wanted to do more and noticed the absence of these life-giving activities, but I simply didn’t have the capacity.
This is another example of how the brain has shifted in its functioning. When we’re in a survival system, our brain prioritizes survival over creativity. That means we may not be able to engage in those meaningful activities that can actually be the road back to ourselves.
Relationships and Trauma
Relationships are greatly affected by trauma symptoms and traumatic experiences. Detachment and estrangement from friends, family, community members, etc. often arise.
Detachment is especially common if the trauma is one where community members are not entirely supportive of the survivor. This symptom happens frequently around sexual assault, sexual abuse, family-based abuse, and intimate partner violence. Because our culture and community tend to victim-blame, gaslight, and invalidate survivors, it creates a culture of secrecy that puts the burden on the survivor to manage the issue.
This is where that estrangement and isolation stems from.
In many ways, this is also a product of shame. When we feel intense shame, we don’t want to connect with other people as we think we’re terrible to be around, so we don’t want to be around the people we love.
We can also feel like the people around us just don’t know, they can’t relate, they don’t understand, etc. Issues that existed in this relationship prior may have created a barrier to trusting somebody with this kind of information.
Survivors often don’t want to burden others or fear how others might react, so they withhold the information and become detached because they can’t share what’s happening.
The part of ourselves that feels the sense of connection and that rush of oxytocin we get from our close relationships doesn’t happen because our brain has shifted fundamentally. That feeling and sense of connection we get isn’t happening as much or at all when we’re active in our trauma symptoms. This can also cause disconnection from relationships because we’re not being “fed” by them in a way.
How To Overcome Isolation
One of the interventions to help overcome isolation can be getting support from a therapist practicing interpersonal skills to maintain safe and structured relationships so you don’t lose your relationships while also going through and engaging in recovery.
You could also offer yourself compassion and acceptance to help overcome isolation. Sometimes, relationships get lost in the process, and that’s okay, too. Ultimately, whatever you need to do to survive, get through, get on the other side of your recovery, and get back on your feet is whatever you need to do.
We also see a persistent inability to experience positive emotions. It’s challenging to access experiences of joy, satisfaction, or happiness.
Those experiences of pleasure or positive emotions are diminished, and it has a lot to do with our brain chemicals of serotonin and oxytocin and how, when stuck in a survival response, our brain won’t activate those chemicals. It only activates the parts of our brain that keep us alive and safe.
What to Do When Emotionally Overwhelmed
Emotional Overwhelm and Alterations in arousal and reactivity is a perceptual change and is a defining characteristic of trauma.
Alterations in arousal and reactivity are different from other types of experiences like high distress or attachment ruptures. We see that people, especially children in their adolescence who suffered trauma, experience a lot of irritability or reactivity.
Kids can often get misdiagnosed as simply being irritable, obstinate, or having anger management issues, but it is also possible that they could be intensely afraid, suffering trauma, dealing with anxiety, etc.
Sometimes, self-destructive behavior comes from that place of shame, anger, and rage. It can also come from an inability to perceive threats and danger effectively.
PTSD Reckless Behavior
Engaging in reckless behavior is because the alarm system in our body that would typically tell us we need to be careful is constantly fired up and active for those people. When that happens, we don’t recognize when it will get fired up because something in our present moment is dangerous.
For example, if your car alarm constantly goes off, you won’t run outside to turn it off whenever it goes again, even though someone might be trying to break in. We just ignore the alarm because we’ve gotten used to it.
We’re in such an active state of sensitivity to our environment that we may miss the signs that there is actually a threat and engage in damaging or destructive behavior.
Hypervigilance After Trauma
Hypervigilance after trauma is also a standard behavior. It’s this constant scanning of our environment, trying to see where the threat could come from.
When I experienced hypervigilance after trauma, I noticed myself constantly watching the door in public. Whenever I heard the door open or close, my eyes would shoot over to it, making it hard to follow conversations.
We also see exaggerated startle responses as hypervigilance after trauma. This is when somebody is more sensitive to being startled or surprised. Their response might also be more prolonged or larger than that of a non-traumatized individual.
ADHD or Trauma
Difficulty with concentration and attention occurs frequently, especially with children. Trauma can easily be misdiagnosed as ADHD.
We also frequently see sleep disturbances. The individual may not be sleeping, their sleep may be shallow, or they could be sleeping too much. This is our physiological system struggling to become stable and consistent.
Signs of PTSD and Trauma
Ultimately, signs of PTSD and ongoing trauma is when any of these symptoms occur longer than a month after the incident.
It’s normal for us, in response to a traumatic event, to have symptoms occur over a couple of weeks. They typically lessen over time, and we see resolution, but when it persists for a month or longer, that’s when we’re looking at PTSD. The brain hasn’t resolved in the way it is designed to. It usually indicates a psychological injury.
For us to properly diagnose somebody with PTSD, they must also have significant distress and impairment in critical areas of functioning. This ultimately means that these symptoms are causing problems for you in your life.
One thing I want to make clear is that you shouldn’t diagnose yourself with PTSD. If you believe you may have PTSD, please seek out a mental health professional to get an adequate diagnosis.
PTSD with Survivors Specifically
When discussing PTSD among survivors, we use the general population as the benchmark.
In the face of a traumatic event or even an adverse experience, it’s highly common that we’ll have a fight, flight, or freeze response, but it’s not very uncommon that we’ll have persisting trauma symptoms.
In fact, lingering trauma symptoms occur in less than 10% of people in the general population who experienced a traumatic event.
With survivors of sexual assault or sexual violence, we see that 94% of survivors have symptoms of PTSD within two weeks of the assault, and 30% still have PTSD 9 months after the incident.
33% of survivors - at some point - contemplate suicide, and 13% actually attempt it.
13% following through with attempting suicide may seem like a low number, but it’s a startling statistic, considering the general population is typically less than 3%.
We also see that 70% of survivors report moderate to severe distress after their assault, which is far more significant than survivors of any other crime.
There are heightened rates of substance abuse occurring for survivors of sexual assault. Survivors are 3.4x more likely to use marijuana, 6x more likely to use cocaine, and 10x more likely to use any other major substance.
38% of survivors report having problems at work or school, and 37% report problems with family and friends (increased arguments, not feeling like they can trust, feeling less connected/close in the relationships).
These numbers are paramount to observe because when discussing the cost of rape or sexual assault, most people believe it’s “not that bad,” and many people believe that rapists should be allowed a second chance.
Ultimately, when we say this, we’re saying survivors don’t matter, but also that surviving sexual assault is commonplace and isn’t something that should be cared about.
These statistics show us a lot.
We see that sexual assault is a unique experience, and the rates at which it affects and causes a substantial impact on a survivor's life is so much higher than most other traumatic incidents or violent crimes.
A few years ago, I was a professor at a graduate school for mental health professionals, and I used to teach a class on trauma. There was one statistic that always surprised my students.
Most people think of combat veterans or people who have survived an attempted murder or attack when they think of PTSD, but in reality, 60-70% of people who have PTSD are survivors of sexual assault and rape.
The majority of people who suffer from PTSD and need intervention are survivors.
That is a massive part of why I’m creating a healing community for us.
If you take anything away from this blog post, let it be this: see a mental health professional if you think there’s a chance you may have PTSD.
All survivors know what’s best for themselves at any given time, and that includes recovery intervention methods. I can assure you that there are many interventions out there to help.
It’s all about coming back to what feels suitable for you.
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You can listen to this episode on my podcast, “Initiated Survivor.” The episode is titled “Trauma: PTSD (part 2)” and is available on Apple Podcasts and Spotify!
Thank you for reading. Until next time!
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