The experience of trauma can result in painful psychological symptoms for some people. Every person is unique, and what may be a traumatic experience for one person, may not result in symptoms for another. It’s important for people to understand the signs and symptoms of what is known as Post Traumatic Stress Disorder (PTSD), so that treatment can be received as soon as possible. The symptoms of PTSD can range from mild to severe, and can be brief in nature or more long-term, depending on the individual and the type of trauma they have experienced. Some symptoms of PTSD include:
- Re-experiencing or “re-living” the traumatic event
- Avoiding reminders of the trauma –including places, people, and even thoughts about the event
- General increase in overall anxiety and feeling edgy or anxious
- Intrusive and distressing memories of the event that are hard to push away
- Flashbacks – the sensation that the event is happening again
- Nightmares – of the actual event or with other frightening themes
- Feelings of severe distress and intense physical responses (sweating, tense muscles, rapid heart rate, upset stomach) when reminded of the traumatic event- can make it very difficult to talk about the event
- Amnesia or inability to remember all or part of the traumatic event
- Loss of interest in activities that used to be fun
- Feeling detached from other people and emotionally “numb” or flat
- Feeling like the future will be limited– feeling that life won’t be very long and normal events like marriage, having children, or retiring will never happen
- Sleep problems
- Irritable mood, including angry outbursts
- Difficulty concentrating on tasks
- Hyper-vigilance – always on guard and feeling jumpy (Post Traumatic Stress Disorder, 2014)
Having some distressing psychological symptoms after a trauma is not an abnormal occurrence, and does not mean the person is “crazy” or weak in any way. One way to think about the symptoms of PTSD is as symptoms of an injury. The brain/psyche has experienced a painful trauma, and symptoms are a reaction to this, much like swelling and redness results from a cut or bruise.
Trauma to the brain and psyche can result from experiencing events that threaten life or safety, or the life or safety of other people. It’s important to note that events that threaten emotional safety can also result in symptoms. These events may include thing like: military combat, accidents, serious illness or injury, being the victim of a crime, physical or sexual abuse, or witnessing violence.
In addition to the symptoms of PTSD listed above, there is a risk of developing symptoms of dissociation, or even a Dissociative Disorder, as a result of a traumatic experience. When something is painful, physically or emotionally, our first instinct is to withdraw and get away from the pain. This is very normal and rational. For example, if we accidently grasp a hot skillet handle, we immediately drop it to stop the pain. We can think about dissociation as a way to escape emotional pain, although it can become an unhealthy escape.
Dissociation and Dissociative Disorders can occur as a way to cope with the emotional pain of a traumatic event. Often, dissociative behavior begins during childhood after the experience of a trauma like physical, sexual, or emotional abuse. However, any significant traumatic event can potentially bring about the symptom of dissociation (e.g. a natural disaster). Dissociation can also result as a response to a chaotic or very unpredictable or unstable home life. Children may be more likely to dissociate in response to trauma because their personal identity is still developing (Dissociative Disorders, 2014). They are more able to detach from themselves and see the trauma as though it’s happening to someone else. The problem with using dissociation as a coping mechanism is that it can become habit that endures into adulthood. A person can develop the ability to automatically, and even unconsciously, dissociate during times of trauma or stress.
We can compare dissociation to emotionally and mentally detaching and escaping from stress or emotional pain. But, what actually happens when a person dissociates, and why is dissociation a potentially dangerous coping mechanism? Dissociation can be very mild, or is can be quite severe. When a person dissociates, they experience all of some of these symptoms and behaviors:
Disconnection with and lack of awareness about current reality
Thoughts, memories, surroundings, actions, and identity become confused
Loss of memory of events, people, or periods of time
Depression, anxiety, suicidal thoughts or attempts, or other mental health problems
A sense of being detached and unconnected from the self
Perceiving people and things in the environment as unreal or distorted
A blurred or confused sense of personal identity
Significant problems and stress in personal relationships, at work, parenting, and other areas of life stress or problems in your relationships, work or other important areas of life (Dissociative Disorders, 2014)
These symptoms can be very frightening and confusing for both the person and their loved ones. Dissociation is a real emotional response to trauma that can be debilitating and impair functioning in many areas of life.
Types of Dissociative Disorders
The Diagnostic and Statistical Manual of Mental Disorders (5th ed), published by the American Psychiatric Association, outlines three specific types of Dissociative Disorders. These include:
1.Dissociative Amnesia: This disorder is a type of amnesia that is more severe than the normal forgetfulness that many of us experience. This amnesia can’t be explained by a specific medical condition, and results in an inability to remember information about self, life events or other people, especially from a specific traumatic time. The episode of dissociative amnesia may last minutes or hours, and rarely months or years. It can also result is something called a dissociative fugue state, in which the person travels or wanders around in a confused state (Dissociative Disorders, 2014).
2. Dissociative Identity Disorder (DID): This disorder used to be known as Multiple Personality Disorder., and includes the symptom of “switching” to an alternate identity, or identities. The person may feel like there is more than one person inside themselves that talks to them, or even takes over. The different identities may or may not have awareness of each other, and may be different genders, have different voices, and different personalities and characteristics. For example, one may need to wear glasses, while another one does not. Dissociative identity disorder often also includes dissociative amnesia and dissociative fugue states. Over the years, this disorder has been the subject of movies and the subject of hot debate by behavioral health professionals. Can people really develop distinct and separate “personalities” that live within their psyche? If we accept that trauma can cause a person to dissociate--or psychically separate-- from reality, then we can see how this separation could create distinct parts of the personality.
3. Depersonalization/De-realization Disorder: With this disorder, the person has a sense of detachment, or being outside of themselves. They may feel like they are just an observer of their actions, thoughts, or feelings. Others may notice that they seem to be detached or spacey. The world around them may seem unreal (de-realization). Again, these symptoms may last for a few minutes, or may come and go for months or years, and are very distressing for the person and their loved ones (Dissociative Disorders, 2014).
The symptoms of any type of dissociative disorder can be potentially dangerous. In a dissociative state, the person is not aware of what’s really happening or what they are doing. They may become so disoriented that they don’t know who they are or where they are or the date. They may do things that they don’t remember later, including traveling and spending money. The tendency to dissociate is a sign that a person needs help, and doesn’t know how to cope effectively with stress. A person may lack insight that they are having dissociative symptoms, so it’s important for loved ones to be aware of the signs and symptoms, and encourage the person to seek professional help. Some signs that a person may be struggling with symptoms related to trauma, including dissociation, include:
- Difficulty functioning ay home or work, or in social situations
- Experiencing episodes of extreme fear, anxiety or depression
- Inability to form close, satisfying relationships
- Experiencing terrifying nightmares, memories, or periods of re-experiencing (flashbacks)
- Avoiding things that remind them of the trauma (people, places, situations)
- Feeling emotionally numb or detached and disconnected from other people
- Using alcohol or drugs to cope with feelings
When distressing symptoms begin to interfere with life and relationships, it’s time to get help. There are effective treatments for the symptoms of PTSD, including dissociation.
Treatment for Trauma and Dissociation
Part of overcoming traumatic events includes the ability to face and resolve painful feelings and memories. During counseling, a skilled therapist can help people to process memories and feelings, while learning how to regulate powerful and painful emotions. Therapy can also help people start trust themselves and others again. Trauma takes away a sense of safety and control, which counseling can help people regain. Some effective therapeutic approaches for the treatment of psychological trauma-related symptoms include:
- EMDR (Eye Movement Desensitization and Reprocessing): This type of therapy uses side-to-side eye movement or other “bilateral” stimulation (sound or touch), along with cognitive –behavioral therapy. These “bilateral” eye movements are thought to work by “unfreezing”, or re-processing, traumatic memories, allowing them to be successfully resolved.
- Cognitive-Behavioral Therapy: This type of therapy helps people evaluate their thoughts and feelings about a traumatic event. It is often combined with body therapies like EMDR or somatic experiencing. This enables the treatment of both psychological and physiological symptoms of trauma.
- Somatic Experiencing: This therapy helps the body heal itself. Clients focus on their own bodily sensations, rather than specific memories or thoughts about a traumatic event. It allows the person to become aware of the effect of the trauma on their body in a safety, supportive environment. Some people experience natural physical releasing like crying or shaking during this kind of therapy (Emotional and Psychological Trauma, 2014).
After experiencing a trauma, it can help to be prepared for possible emotional and physical reactions. Recovering from trauma is a gradual process, and people heal in their own time and at their own pace. The important thing is to get help, when needed, and remember that symptoms are not a sign of weakness. In addition to talking with a counselor, there are other things people can do to help themselves recover and move beyond a traumatic experience.
1. Stay Connected: After a trauma, avoid withdrawing from others, even though the urge to isolate may be very strong. Staying connected to others can help with healing.
2. Keep Active: Trauma can cause us to shut down and withdraw from people and activities. It’s important to keep doing “normal” things with others people. Get back to doing previously enjoyable things, and try to stick with a routine.
3. Join a Support Group: It can be very helpful to spend time with others who are facing similar challenges. It helps to overcome isolation, and to learn coping skills from others.
4. Volunteer: Volunteering is a good way to reduce feelings of helplessness and powerless that often accompanies trauma. It is also empowering to be able to be helpful and comforting to others ((Emotional and Psychological Trauma, 2014).
5. Practice Good Self Care: Make sure to eat right, get enough sleep, and avoid drugs and alcohol. Getting some exercise and fresh air will help, too. As with a physical injury, the body and mind and spirit need these things to get well and fully recover. Spend time with people who are supportive, and do things that are enjoyable and relaxing.
Following these guidelines, and talking with as counselor, can help with recovery from trauma, and reduction of symptoms, including dissociation. Loved ones can help by being patient and understanding that healing takes time and everyone responds differently to trauma. It’s important to be non-judgmental and supportive, and understand that people sometimes don’t want to talk about the traumatic event or their feelings about it. Try not to take it too personally, and remember that recovering from any injury takes time and a lot of caring and compassion.
Dissociative disorders. (2014). Retrieved August 26, 2014, from http://www.mayoclinic.org/diseases-conditions/dissociative-disorders/basics/symptoms/CON-20031012
Emotional and psychological trauma. (2014). Retrieved August 26, 2014, from http://www.helpguide.org/mental/emotional_psychological_trauma.htm
Post-Traumatic Stress Disorder (PTSD). (2014). Retrieved August 26, 2014, from http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm