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Trauma

Accidents and other distressing events happen to all of us at some time in our lives. Sometimes we take these in our stride and live through them unscathed, but some events can leave a residue that continues to affect us years later.

In attempting to write this article I seem to have ended up with nothing but a series of lists. The problem is that the causes and effects of trauma are so diverse and widespread that it's hard to do justice to it in any other way. So there seems to be no option but to bow to the inevitable, and present the lists. These have been culled from a range of sources, and although they are lengthy I make no guarantee that they are complete.

Causes of trauma

Our brains are immensely complex pieces of machinery, vastly more complex than the computer you might have on your desk. As a complex and delicate machine the brain is vulnerable to damage or trauma.

The brain is in fact extremely well protected - it is encased in a hard skull and surrounded by fluid to cushion it from shocks. The blood-brain barrier serves to protect it from chemical damage from substances in our blood stream, and there are mechanisms for filtering out information which threatens to overload it. Nevertheless events can occur which overwhelm these protective mechanisms, and trauma occurs.

The list below shows some of the events that can cause trauma. It's possible to divide the list into three groups - human causes which are intentional (deliberate and malicious), human causes which are unintentional (accidents, unintended consequences) and those with natural causes. Generally events in the first list are the most traumatic.

You will notice that it is very diverse, and it covers events that can happen to most people in their lives. Yet not everyone develops symptoms of trauma. This is because the likelihood of having an adverse reaction to trauma depends on many factors. One is the nature of the trauma (the degree of threat, how long it lasted, whether it was a single event or repeated, the degree of powerlessness the individual felt). The age at which a traumatic event occurred can be significant, as well as any previous traumatic experiences, how well we were able to cope, our ability to take action to protect ourselves, and the availability of post-trauma support.

List 1 - causes of trauma

  • War
  • Physical, sexual and emotional abuse
  • Torture
  • Violent crime, robbery, mugging, domestic violence
  • Sexual assault, rape
  • Terrorism, hostage-taking, hijacking
  • Arrest and imprisonment
  • Abandonment, neglect
  • Bullying, harassment, humiliation 
  • Accidents in cars, trains, planes, etc
  • Medical procedures, operations
  • Bankruptcy
  • Loss of home, property, status
  • Family breakup, divorce 
  • Natural disasters, such as earthquake, extreme weather, fire, flood, tsunami, avalanche, volcanic eruption..
  • Stressful conditions before, during or after birth
  • Sudden life-threatening illness
  • Death of an important caregiver
  • Death of a child
  • Attack by an animal 

Symptoms of trauma

The second list shows some of the symptoms of trauma:

List 2 - symptoms of trauma

  • Panic attacks
  • Anxiety
  • Anger and aggression
  • Sleep disturbances, nightmares
  • Vertigo
  • Flashbacks
  • Depression
  • Memory impairment
  • Intrusive thoughts
  • Dissociation, fugue states
  • Confusion, distraction
  • Hypervigilance
  • Bruxing (grinding teeth)
  • Feeling numb
  • Eating disorders, bulimia
  • Self harm
  • Pain - neck, shoulder, arms, etc
  • Muscle spasm
  • Nausea and vomiting
  • Fainting
  • Blurred or distorted vision
  • Hypersensitivity to light, sound,
  • Sensitivity to chemicals
  • Sensory loss
  • Speech disorders, e.g. stammering
  • Tremors, twitches, tics
  • Fibromyalgia, ME
  • IBS, gastrointestinal problems
  • Skin rash, acne
  • Bladder problems
  • Acid reflux

This list list covers a very wide variety of symptoms and many people will identify with one or more of these. Experiencing a single symptom does not necessarily identify trauma as the cause, but if a number of these are present, combined with having experienced some of the events in List 1, then a picture of stress due to trauma starts to emerge.

Treatment of trauma

Because of the wide variety of symptoms that can arise from trauma, there is no one particular model of therapy that can claim to have all the answers. Among the psychological therapies there can be a place for counselling, cognitive behaviour therapy (CBT) and psychotherapy. When there are strong somatic effects, some form of bodywork may be helpful, such as therapeutic massage, Bowen technique, and reflexology.

Some of the components of the psychological treatment of trauma which have been found helpful are:

  • explanation and education about how the body and mind respond to trauma
  • anxiety management techniques, including relaxation, thought stopping and regulated breathing
  • working on unhelpful fear-related beliefs which may be maintaining the problem
  • graduated step-by-step revisiting of traumatic memories in imagination
  • exposure to situations that are being avoided in real life

Post-traumatic stress disorder (PTSD)

So far in this article I have been referring to trauma in general. PTSD is a specific diagnosis of severe trauma, for which certain criteria need to be met. I feel that the distinction is artificial, and some people may be excluded from a diagnosis of PTSD who are nevertheless suffering from the after-effects of trauma.

Full details of the PTSD diagnosis from the American Psychiatric Association's manuals DSM-IV is given at this website and many others on the web. The table opposite gives an abbreviated summary:

Whether or not a full diagnosis of PTSD is made, the elements of treatment remain the same.

Summary of PTSD Criteria

  • The person has been exposed to a traumatic event involving actual death, threat of death or serious injury, and responded with intense fear, helplessness or horror
  • The event is persistently re-experienced as intrusive thoughts, images, perceptions, distressing dreams, flashbacks, or realistic memories.
  • Triggers associated with the trauma are avoided and there is a numbing of general responsiveness
  • Symptoms of increased arousal are present, such as sleeping problems, anger, irritiability, concentration problems, hypervigilance, exaggerated startle response
  • Disturbance has persisted for more than one month
  • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

The Hope Street Centre is an independent centre located in the attractive rural market town of Sandbach in South Cheshire, with easy access to the M6 motorway and the railway network at Crewe.  The centre is readily accessible from the neighbouring towns of Congleton, Alsager, Middlewich, Holmes Chapel, Knutsford, Crewe, Kidsgrove, Winsford, Northwich, Warrington and Stoke on Trent.

 
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