How to Think About Trauma


The language of trauma is everywhere these days.

Unfortunately, how we talk about trauma is often not especially thoughtful or clear. And from the dining room table to the psychiatrist’s office, this lack of clarity frequently leads to a lot of confusion and conflict.

Here are a few suggestions for thinking more clearly about trauma so that we can have more productive conversations about it, and ultimately, deal with it better—for ourselves, our loved ones, and our broader communities.


A traumatic event is different than a trauma response

A traumatic event is when you are exposed to actual or threatened death, serious injury, or sexual violence. For example: a car accident, sexual violence, or witnessing someone being killed.

A trauma response is how you respond to a traumatic event and can include:

  • Behaviors. For example: avoiding the place where the trauma occurred or drinking to numb yourself.
  • Thoughts. For example: memories of the traumatic event, nightmares, or mentally trying to distract yourself from thinking about the traumatic event.
  • Physical sensations. For example: night sweats, exaggerated startle response, or chest tightness.
  • Emotions. For example: Fear and anxiety, anger, shame, etc.

Importantly, some trauma responses are involuntary—like having a nightmare about the traumatic event or feeling fear when something reminds you of the traumatic event—and some are voluntary like worrying or avoiding people and places associated with the traumatic event.

What’s more, trauma responses can be relatively acute—for example, having a single nightmare about the traumatic event 3 days later—or they can be chronic—recurring nightmares for months or years after the traumatic event.


Not all trauma responses lead to post-traumatic stress disorder

There’s enormous variety in how people respond to traumatic events.

Anyone exposed to a traumatic event will likely have some trauma response…

  • Feeling scared or angry
  • Having a nightmare about it
  • Trying not to think about the event too much

But some people go on to develop post-traumatic stress disorder (PTSD) which is when the trauma response becomes chronic, severe, and significantly interferes with their daily functioning.

Common symptoms of PTSD include chronic:

  • Re-experiencing. For example: nightmares, flashbacks, or intrusive thoughts.
  • Avoidance. For example: deliberately staying away from places or people associated with the traumatic event, or trying to distract yourself from thoughts or emotions associated with the event.
  • Hyperarousal. For example: an exaggerated startle response or reckless/destructive behavior.
  • Cognitive/Mood Changes. For example: excessive guilt or shame toward oneself or others, intense loneliness, emotional numbing, or extreme negative self-talk

According to the latest research, approximately 5% of people who are exposed to a traumatic event go on to develop PTSD.

Which leads to my next point…


Traumatic events don’t cause PTSD

Two different people could be involved in two nearly identical car crashes. And while both would find the experience scary and challenging in a variety of ways, it’s perfectly possible for one of them to develop PTSD while the other does not.

This illustrates a critical idea when it comes to trauma…

Traumatic events are triggers for but not causes of PTSD.

PTSD develops as a result of an unhealthy trauma response driven largely by experiential avoidance.

That’s pretty technical sounding so let’s break it down…

An unhealthy trauma response means that the way you respond to a traumatic event or anything associated with it makes things worse for you in the long run.

Here’s an example:

  • When you wake up in the middle of the night having just had a nightmare about your traumatic event, you then immediately wake up your spouse and tell them about it.
  • This seems natural enough. And getting some support and reassurance from your spouse probably feels good in the moment.
  • But long-term, you’re unintentionally making the problem worse because elaborating on the nightmare increases the odds of it happening again in the future.

The technical term for this process is experiential avoidance which means trying to avoid or get rid of an unpleasant inner experience like a painful memory, uncomfortable emotion, or scary thought.

For example:

  • A memory of being abused as a child pops into mind and you immediately distract yourself by watching TV.
  • You feel guilty about how you handled the unexpected death of your mother, so you pour yourself a couple extra glasses of wine to numb out the pain.
  • You get tense and anxious any time you drive by the scene of the car crash you were in, so you avoid taking that route to work anymore.

While experiential avoidance often leads to some short-term relief, it happens at the expense of long-term suffering. When you immediately avoid a painful thought or emotion, it signals to your brain that it’s dangerous. Which means you’re unintentionally training your brain to be more sensitive to thoughts or emotions like that in the future and also to be afraid of them which only magnifies their emotional intensity the next time.

In short…

Traumatic events are triggers for PTSD but experiential avoidance is the cause.


Complex post-traumatic stress disorder (C-PTSD) is a new and evolving concept

The term complex post-traumatic stress disorder is increasingly common but not well-understood and far from universally agreed upon.

For example: the World Health Organization lists C-PTSD as a recognized disorder in the ICD-11 whereas the American Psychiatric Association who publishes the DSM-V does not.

The basic idea is that while C-PTSD and PTSD both involve traditional symptoms like hypervigilance, avoidance, and re-experiencing, people with C-PTSD also struggle significantly with emotional dysregulation, identity/self-esteem issues, and relationship dysfunction.

There’s also thought to be significant overlap between C-PTSD and borderline personality disorder.


Be thoughtful about “everyday trauma” and concept creep

As discussions about mental health become more common and accepted in our culture, concepts like trauma tend to expand not only in frequency of usage but also in meaning.

For example:

  • A doctor might ask a new patient whether they’ve ever experienced any trauma. And in their mind, they’re thinking about trauma in a relatively narrow clinical sense of post-traumatic stress disorder with its fairly structured and prescribed symptoms.
  • That doctor’s teenage son, however, might be overheard at school describing how “traumatic” it was getting a B- on his Biology test last week.

This is a phenomenon known as concept creep which is when the meaning of harm-related concepts like trauma becomes progressively expansive and inclusive as they become less academic and more mainstream.

The way to think about this is not so much that it’s good or bad if concepts become more expansive and inclusive, but rather, that there are tradeoffs that need to be considered carefully.

For example:

  • If you tend to casually throw around the term trauma or traumatized, how might that be experienced by someone who’s been through a life-threatening traumatic event like sexual abuse or violence and still suffers with PTSD?
  • If you’re a therapist, doctor, coach, or other helping professional and you use the term trauma to mean at different times a traumatic event, a non-pathological trauma response, and PTSD, that’s going to be quite confusing and potentially anti-therapeutic for your clients.
  • If you struggle with PTSD and your therapist tells you that you have C-PTSD, does the additional label/diagnosis actually help you overcome your PTSD or merely feel validating? Both? Neither?

So be thoughtful about trauma-related terminology and how you use them. In particular, try not to conflate or confuse superficially similar but substantively different terms like traumatic event, post-traumatic stress disorder, or trauma response.

If you really want a challenge, try this: Avoid using the term trauma at all and confine yourself only to more specific terms like PTSD, traumatic event, trauma response, etc.


Not all emotional struggles come from trauma

In the late 1800s, Sigmund Freud popularized the idea that most emotional struggles originate in negative events from childhood. Whether it was penis envy, oral fixations, or the Oedipal complex, Freud was fascinated with the idea that the solution to emotional problems in the present was insight into their origins in the past.

Recently, there’s been a resurgence of this idea in popular culture and the broader social dialogue around mental health. Not that you hear people talking about Electra complexes and phallic stages all that often. Rather, it’s increasingly common for people—both lay people and mental health professionals—to conceptualize nearly every type of emotional struggle in terms of trauma.

And while it’s true that many of our present struggles do have origins in the past, to assume that that’s always the case—or that spending a lot of time and energy exploring the past is always productive—is neither true nor helpful.

For one thing, the vast majority of people who develop emotional struggles like anxiety or depression and have no history of a traumatic event or experience at all.

But also, just because an emotional struggle has its origin in a past traumatic event doesn’t mean that event is what’s maintaining the struggle now.

For example:

  • The death of your father and the resulting traumatic response may have triggered your insomnia 15 years ago.
  • But it’s your current sleep habits that are maintaining your insomnia, not the death of your father.
  • And overcoming that insomnia will have much more to do with rebuilding good sleep habits in the present than “processing” the death of your father.

The past matters. Freud was a smart—arguably brilliant—man. And trauma is of course a very real thing with devastating consequences.

But not everything is about trauma.


When it comes to dealing with trauma, control is key

Perhaps the biggest thing I see holding people back from working through their struggles with trauma is confusion about what they can control and what they want to control but can’t.

For example:

  • Understandably, many people who struggle with PTSD desperately want to feel more control over injuries that happened to them in the past. Which makes sense given how much helplessness people often feel during and after a traumatic event.
  • And while they may not realize it, this desire to feel in control over the past frequently manifests in counterproductive behavior like a compulsive need to understand why their victimizer did what they did or spending years in therapy analyzing how terrible their parents were and how much it screwed them up.
  • The problem here is opportunity cost: All that time and energy we pour into our past is all time and energy that we’re not using to address our struggles in the present—to practice tolerating anger and shame instead of numbing them out, learning to control our rumination habit instead of dwelling on how other people hurt us, pursuing meaningful activities despite feeling afraid and anxious.

No matter what happened in your past you are responsible for building a better future for yourself. And that means being crystal clear about what you can actually control that will help and what you desperately wish you could control but can’t.


Final thoughts

Experiencing a traumatic event is terrible. It’s even more terrible when a trauma response develops into chronic suffering in the form of PTSD. And it’s especially tragic when this happens to children—potentially setting them up for a lifetime of psychological, emotional, social, and even physical suffering.

Which is why it’s critical that we do everything we can not only to help those suffering from trauma but to move toward a world where fewer traumatic events happen in the first place.

Of course, this is an enormous goal that means going well beyond the domains of mental health into everything from politics and public policy to education and parenting.

And if we’re going to do that well—in a convincing and compelling way—we need to be thoughtful and clear in the way we think and talk about trauma.


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Your point about behavioural responses to trauma causing PTSD is controversial but true.

It’s a tough pill to swallow as a sufferer because it implies a certain degree of blame is on us for our ongoing suffering.

I grappled with “what ifs” for a long time — what if I had responded differently?

But I try to have compassion for myself and understand that in those circumstances where I was filled with fear and uncertainty and had few resources, seeking short-term relief through avoidance was the easiest option open to me. The important part is that I’m now actively working on re-writing history.

This topic is so important for me. I suffered from trauma of my parents divorce when I was 6. An only child, my world fell apart. My mother had a nervous breakdown when I was 16.
Inner child work greatly helped. My wife of 50 years is an emotional abuser. Thanks to my therapist and a ton of study about emotional abuse, I very much suffer from C-PTSD b/c of the long term nature of abuse. She now feels it’s PTSD. I have no choice now but to leave and it’s very difficult after so long. No choice.

Excellent . This one blew my mind: “Traumatic events are triggers for PTSD but experiential avoidance is the cause”.
This is what came to mind: Avoidance gives life and power to PTSD.
Thanks

I read a very good book on trauma that pointed out that the one thing every sufferer of PTSD has in common is emotional trauma, neglect, and / or abuse that happened at a very young age, from anywhere from infancy to three years old. During this stage, a child’s brain hasn’t fully developed, especially the part of the brain that handles emotions. Thus, a traumatic event that happens at such a vulnerable age is likely to flood the child’s brain with emotions that will feel terrifying. When that same child grows up and goes through another traumatic event, the person’s brain will respond in the same way it did as a child.

This made sense to me. My sister who is eight years older than me said that I was constantly yelled at when I was toddler. I was a very sickly child and my mother can be horribly narcistic at times. My guess is she resented taking care of a sickly child. But as a toddler I wouldn’t have understood what was going on. All I probably knew at the time was that my mother was always angry at me and I assumed I was at fault. I was doing something wrong. Or I was a “bad” person, worthy of being despised.

Between having parents who were poor caregivers and poor role models when it came to emotional vulnerability, (I remember being yelled at for being scared and having my happiness continually being sabotaged) I simply didn’t know how to care for my own emotional mental health. But I intuitively knew at least part of my problem was bad mental health habits. When helpless, I would catch myself obsessively worrying, renumerating, blaming myself for things that don’t go according to plan, etc. I am now 50 years old and I’m finally discovering what it means to be emotionally mature!

Hi Nick, I agree with everything you have said and I think you are right that concept creep is a real problem with many mental health and psychological issues losing their meaning and becoming misused.
However, I think that characterising therapy/psychotherapy in CPTSD as focusing purely on the past in an almost ruminative way is just not true. My experience of psychotherapy is that we focus on the past just enough to identify possible causes of maladaptive thinking and behaviours in order to focus on how this is affecting me in the present. Most of therapy is about developing healthier coping mechanisms in the present. We definitely do not spend our time raking over the past in the way you describe.
I also think it would be helpful to expand on what you mean by the “overlap” between trauma and so called “Borderline Personality Disorder”. Some people who have identified this this similarity believe it means that BPD is a stigmatised misdiagnosis of CPTSD. Others think that CPTSD does not really exist and BPD is a valid diagnosis. I believe the former, that it is a stigmatised diagnosis mainly directed at women. I guess it is outside of the scope this article but maybe it would be worth clarifying?
Thanks for all your clear and helpful articles 🙂

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