January 09th, 2024

Trauma: Let's Talk About It

Today I wanted to take a moment to discuss trauma. I'll define what it is (and isn't), describe how it affects our brains and, as a result, our lives. Finally, I'll make some recommendations on what to do with your trauma. Strap in because I'm bringing lots of useful info. Here we go!

• Definition: 
  
  • Merriam-Webster (2023) tells us that the word trauma is Greek for 'wound'. It defines trauma as "1. An injury (such as a wound) to living tissue caused by an extrinsic agent. 2. A disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury. 3. An emotional upset. 4. An agent, force, or mechanism that causes trauma" (Merriam-Webster, 2023). These definitions speak for themselves. Whether physical or mental, a trauma is a wound. Yes, your brain and mental state can be wounded (we'll get to more on that in a moment). Many people don't even know what trauma is. I can't tell you how many times I've heard a patient tell me that they've never had the experiences that they've lived through described as trauma. So what is and isn't a trauma? Let's talk about it. 

• What It IS:
  
  • The Diagnostic and Statistical Manual, 5th Edition (aka DSM-5, aka, the psychological bible) lists the following types of experiences as trauma: "exposure to war as a combatant or civilian, threatened or actual physical assault (e.g., physical attack, robbery, mugging, childhood physical abuse), threatened or actual sexual violence, being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war, natural or human-made disasters, and severe motor vehicle accidents. For children, sexually violent events may include developmentally inappropriate sexual experiences without physical violence or injury. Medical incidents that qualify as traumatic events involve sudden, catastrophic events (e.g., waking during surgery, anaphylactic shock). Witnessed events include, but are not limited to, observing threatened or serious injury, unnatural death, physical or sexual abuse of another person due to violent assault, domestic violence, accident, war or disaster, or a medical catastrophe in one's child (e.g., a life-threatening hemorrhage). Indirect exposure through learning about an event is limited to experiences affecting close relatives or friends and experiences that are violent or accidental" (2013).

• What It AIN'T: 
  • Whew...that was a lot of information. However, I think it is important to understand what trauma is so that we don't get it confused with what it isn't. Trauma isn't everyday stress. Anything not involving an immediate threat to life or physical injury isn't considered a trauma (i.e.: breakups, loss of job) (National Library of Medicine, 2017).     

• It's Trauma and The Brain:
  • So now that we know what it is and isn't, why the hell does it seem like trauma has such a stronghold on our lives? Well, the short answer is that trauma literally changes the way your brain operates. I'll spare you the ENTIRE science lesson but feel free to see the resources section at the end of this email if you want more details. Here's the most important part: 
    
    • There's a section of your brain where your amygdala and hippocampus live (raise your hand if you just imagined hippos on a college campus...sorry...I...I got distracted). The amygdala plays a big part in controlling the 'fight, flight, or freeze' response that we all have on our factory default settings (Cleveland Clinic, 2023). The hippocampus's "largest job is to hold short-term memories and transfer them to long-term storage in our brains. It also plays a role in emotional processing, including anxiety and avoidance behaviors" (Wendt, T., Baby, M.D., D.P., 2022). When we experience trauma, the amygdala gets stuck in the 'on' position, making us feel flooded with all sorts of emotions. The hippocampus reacts by making sure you remember the trauma in as many ways as possible so that it can make sense of it all. However, since trauma is typically horrible, there is often no making sense of it,  causing our brains to go a bit haywire (Brainline, 2019). So, what does that look like? 
      
    • Symptoms: With a brain that isn't working like it normally would, there's going to be some negative effects. The DSM-5 lists intrusion symptoms such as "recurrent involuntary, and intrusive distressing memories of the event" (these are kind of like someone butting into your discussion with someone else). This can occur in the form of dreams, flashbacks, or in memories that just pop into your head without warning. Another sign of having been traumatized is avoidance of things that remind us of the trauma. Negative beliefs that make it difficult to trust others or to experience positive emotions may arise. Significant changes in how reactive we are to triggers might include irritability or angry outbursts, problems with concentration, or reckless behavior (i.e.: drug abuse or risky sexual behaviors) (American Psychiatric Association, 2013). 

• Treatment Options: Treatment is not a 'one size fits all' sort of thing. Sometimes multiple interventions are needed in order to get to a place of healing. Here are some of the interventions that are available to treat trauma: 
  
  • Psychotherapy: A licensed therapist or social worker with experience and training in treating trauma is one route. In therapy, a person can learn tools to cope with negative emotions and triggers. Therapy typically involves discussing the details of the trauma and 'making sense' of it so that your brain can heal. Types of therapy that are known to be helpful with treating trauma include but aren't limited to Accelerated Resolution Therapy (ART), Trauma Focused Cognitive Behavioral Therapy (TF-CBT), Internal Family Systems (IFS), EMDR (Eye Movement Reprocessing and Desensitization), Brain Spotting, and others. Group therapy may also be included. 
    
  • Medication Management: A licensed physician or nurse practitioner can prescribe medications known to assist with decreasing negative symptoms associated with trauma. 
    
  • Body Focused Therapies: Physiotherapy, osteopathy, massage, acupuncture, reflexology, yoga, meditation, and tai chi can all be useful in treating or coping with symptoms associated with trauma by focusing on relaxation of the body. 

I hope that this information was informative and useful. Maybe you've learned that what you or someone you know has ACTUALLY been dealing with symptoms associated with trauma instead of just having a 'bad attitude' or many of the other assumptions that we sometimes make. If so, the next step is to begin your healing. Healing is a process, and it takes time and grace. Be kind to yourselves as you embark on your own journey. 
 

Resources:

• Merriam-Webster, Incorporated. (2023). Trauma. https://www.merriam-webster.com/dictionary/trauma
• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Disorders, 5th Edition.
• National Library of Medicine. (2017, Feb. 13). Posttraumatic Stress Disorder in the DSM-5: Controversy, Change, and Conceptual Considerations. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371751/#:~:text=Stressful%20events%20not%20involving%20an,considered%20trauma%20in%20this%20definition
• Cleveland Clinic. (2023). Amygdala: What It Is And What It Controls. https://my.clevelandclinic.org/health/body/24894-amygdala 
• Wendt, T., Baby, M.D., D.P. (2022, Sept. 1). The Hippocampus: What To Know. https://www.webmd.com/brain/hippocampus-what-to-know
• BrainLine. (2019, May 6). How PTSD Affects the Brain. https://www.brainline.org/article/how-ptsd-affects-brain#:~:text=Your%20hippocampus%20is%20a%20lot,doesn't%20get%20coded%20correctly.