#10: Trauma 101: Understanding the Basics, Symptoms, and Path to Healing
NOVEMBER 14, 2024
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In this episode, I'm excited to bring back the podcast with a broader focus on mental health topics beyond bipolar disorder.
We dive into exploring what trauma truly is, why it’s important to understand, and the powerful impact it has on our bodies, minds, and relationships.
I also answer some of the most common questions around trauma, including how to recognize it, why some people develop PTSD while others don’t, and effective methods for healing.
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Transcript
Anna: Hello, dear friends! It's great to be back from my unexpected hiatus. You may have noticed my absence or maybe not, but I am back to doing my podcast. Back to spreading awareness about mental health. As you know, the first nine episodes of this podcast were all about bipolar disorder. And I greatly enjoy talking about that topic and interviewing all of my guests. But now it's time for us to talk about more than just bipolar.
It's time to talk about other mental health topics like trauma, anxiety, going to therapy, dealing with toxic family members, using mindfulness, and much, much more.
I hope you will join me again on Thursdays, as we delve into all of these and today, I hope you will stick around for my episode on trauma. I'm calling this one Trauma 101. Because it contains the basics about what trauma is and what impact it has on us. So settle in and get comfortable. Let's spend the next half an hour together learning and connecting.
So to begin with, why should you care about trauma? Why is that an important topic for us to cover? Well 83 percent of Americans experience at least one traumatic event in their lifetime. That's over 280 million people. And 30 percent of Americans experience four or more traumatic events in their lifetime.
So that's a whole lot of people walking around with exposure to all of these distressing events. And I do want to say that worldwide, the average is a bit lower. It's like 70 percent of people are exposed to at least one traumatic event. And of course, it really depends on the country you live in.
You've probably heard about PTSD as one of the things that can happen after you experience a traumatic event. But that's really just the tip of the iceberg. Trauma also can result in damage to our gastrointestinal, reproductive, cardiovascular, and immune systems and our brain functions. And we're going to take a look at some of that today.
So, first off let's define trauma. What is trauma?
And before I even do that, let me do this. I will say that so many people minimize trauma. Survivors themselves who have lived through traumatic experiences have a tendency to minimize it. And I will always hear things like, “Oh, well, other people had it so much worse.” I've probably heard that from every single client who is a trauma survivor that I worked with, and I just want to say tonight, let's not minimize it.
Let's take an honest look at what it does to you. The seemingly obvious definition of trauma is that it's an event that is distressing in some way It's tempting to call the event itself trauma However, it's not the event itself. Rather, it's the impact it has on us that is the trauma.
Because the same event can be perceived as traumatic by some people and not by others. So a better definition of trauma is that it's something that overwhelms our capacity to cope with, process, and integrate what's happening to us. It's an injury to our nervous system that can result in somewhat near permanent damage.
It's a product of a response to stress that is that fight, flight, freeze, faint that you may have heard about. That I think is a more accurate definition of trauma.
So there are multiple ways to put trauma into categories. But I will talk about, I think, the simplest distinction out there. And that's putting trauma into type 1 trauma and type 2 trauma. And type 1 trauma is what happens after you have a single, unexpected, usually life threatening or violent episode in some way. So, it's also called single incident trauma.
Type 2 trauma is also called chronic or complex trauma. And that's what happens after an exposure to a prolonged series of traumatic experiences. So, that would be something like domestic violence or childhood abuse and neglect. That is Type 2 trauma.
Type 1 trauma examples would include something like a car accident or an assault, single incident.
Let's take a look at what happens to us when we undergo type 1 trauma. So during and immediately after something traumatic happens to you, you go through that fight, flight, freeze, faint response.
Fight is where you want to fight and confront the threat that's happening to you. Flight is where you want to run away from it. Freeze is you're kind of stuck between fight and flight and you can't do either. And then faint is you essentially play dead until the threat passes. And I want to say that a lot of people confuse freeze and faint.
But they are two different responses. And as a matter of fact, that whole response tends to come in a sequence.
So you usually start out with flight, trying to run away from threat, if we can't do anything else, we're going to try to run away from it. Then if you can't run away, it goes into fight, and if you can't fight it, it can result in that freeze state where your muscles are tense, your heart rate is high, your blood pressure is high, you're basically ready to fight or flee, but you can't do either one. You're stuck there. You're frozen and like deer in headlights.
After a while, you start to fold and fade. And that means that you go limp, your muscle tension goes down, your heart rate and blood pressure go down. And like I said, you basically play dead until the threat passes. That's your stress response cycle.
And I want to say that for a lot of people after they go through that cycle, during and immediately after the traumatic event, they go on to live normal lives and don't develop any further issues. But up to 33 percent end up developing what's called Acute Stress Disorder. And Acute Stress Disorder has the exact same symptoms as PTSD, but the symptoms are only present for one month.
So if you have the symptoms that I'm about to tell you about, for one month or less, it's Acute Stress Disorder. If it's for more than one month, then it's considered to be PTSD. And only up to 20 percent of people who go through some kind of traumatic event develop PTSD. But out of those people who do develop the Acute Stress Disorder first, about 80 percent go on to develop full-blown PTSD.
So, in other words, if you have these symptoms soon after a traumatic event and you have them for a couple of weeks or a month, you are pretty likely to then go on to develop full blown PTSD. So, people either recover completely before that or they don't, 80 percent don't, and go on to develop PTSD.
Before I give you the symptoms of PTSD, I just want to say that the framework I am using tonight is the DSM 5, which stands for Diagnostic and Statistical Manual of Mental Disorders, 5th edition, and it's basically the framework that's used to diagnose mental conditions in the United States.
Internationally, a different system, a different framework is used, and that's going to become important later. But, according to the DSM 5, to be diagnosed with either Acute Stress Disorder or PTSD, you have to have, first of all you have to be exposed to death or threatened death, actual or threatened violence or serious injury, or actual or threatened sexual violence in some way.
And that exposure can be direct, meaning it's happening to you. It can be witnessed, meaning you're watching somebody else go through it. It can be you learning that a loved one was exposed to such an event. Or it can be indirect, which is like a first responder who helps the victim of that event get better.
And after you are exposed to that event, these are the symptoms that come.
Symptom number one is intrusion. Intrusion means having flashbacks, intrusive thoughts, images feelings. And, and I think I said thoughts already that basically come back from the past and intrude into the present moment. That's where the word comes from.
And then the second symptom that you have with Acute Stress Disorder or PTSD is hypervigilance. Hypervigilance is like high-stress anxiety. It means you are constantly on edge. You are constantly dreading that something bad like the trauma is going to happen to you again. So your nervous system is scanning the environment for danger, seeing danger where there is none.
Oh, and something I will mention with hypervigilance is that a lot of trauma survivors have what's called an exaggerated startle response, which means they're easily startled and then it's hard for them to settle back down. And hypervigilance can also mean being quick to anger for no reason.
The third symptom of acute stress disorder or PTSD is avoidance. And avoidance exactly like the name implies means that you're trying to avoid these painful reminders of what you went through. And that includes trying to push away those memories, those thoughts and images that come up or actually avoiding, like, let's say, for example, if you were in a car accident, avoiding driving again. If you were assaulted, avoiding going to the place where you were assaulted. So just various avoidance of reminders, intrusive thoughts, images, et cetera.
And then the fourth symptom, the last symptom, is negative changes in mood, and that's very similar to depression, where you basically have the inability to feel happy, feel successful, feel love.
So those are the four symptoms according to the DSM 5: intrusion, hypervigilance, avoidance, and negative changes in mood. And I'm going to add a fifth symptom that I see in basically all trauma survivors, but it's not part of the official diagnosis, and that's dissociation.
Dissociation means you are detached from self and emotions. You're basically detaching yourself from reality to avoid those painful reminders. So I think the DSM 5 sort of mentions it under avoidance, but it's not a stand-alone category for symptoms. And dissociation exists on a spectrum ranging from mild dissociation, which is things like zoning out, daydreaming, not trauma survivors have this mild dissociation sometimes too.
It ranges to very severe, which includes things like dissociative amnesia, where you blackout for long periods of time, sometimes weeks or months. and you don't know where you've been, what you've said, what you've done, and also dissociative identity disorder where that used to be called multiple personalities disorder, so you dissociate to the point where you start forming these separate identities within you.
Okay, so we took a look at type 1 trauma. Let's take a look at type 2 trauma. So with type 2 trauma, again, just to remind you, those are that chronic trauma, those prolonged experiences that you're exposed to over and over again that are repeated, and I don't think I mentioned it before with type 2 trauma, these experiences are often anticipated too.
You kind of know that they're coming, which makes sense. If you are in an abusive relationship or you're a child that's being abused or neglected, you kind of know that it's coming again. You just don’t know exactly when. So they are anticipated to some extent. And what people who go through complex or chronic trauma develop quite often is called complex PTSD.
So complex post-traumatic stress disorder, also referred to as CPTSD. And with complex PTSD, what's really interesting is it's not an official diagnosis in the United States. You will not find it in the DSM 5. But it is an official diagnosis in over 130 countries that use the ICD 11, which is the international classification for diseases. So I find it very interesting that here in the United States, we don't have that diagnosis, but it definitely exists elsewhere. And with complex PTSD, you have all of the symptoms of PTSD that I mentioned already. So intrusion, hypervigilance, avoidance, and negative changes in mood, and then some.
On top of that, you also struggle with emotional regulation, which means you have a really hard time controlling your emotions. You struggle with starting and maintaining healthy relationships, which really makes sense because type 2 trauma is often relational, meaning it's one person harming another person. So, of course, if you learn that people are a source of danger, it kind of makes sense to me that you're going to struggle maintaining healthy relationships with people.
And then the third additional symptom of complex PTSD is having a negative self-image or self-concept. And that goes beyond those negative changes to mood to where you're basically feeling worthless or shameful or bad in some way. Like you can't do anything right. You're fundamentally flawed somehow. That's a negative self-concept.
And I'm also going to mention some stuff that's not part of the official diagnosis. But again, we see it a lot with type 2 trauma survivors. And that's that they are more likely to have unexplained aches and pains, and in general more somatic symptoms, like fibromyalgia, autoimmune diseases, chronic pain in general. They are more likely to be suicidal and to engage in self-harming behaviors, and finally, they are more likely to struggle with addiction.
So, far what we've talked about, all of those symptoms, they are mostly mental. Some of them have those body, those somatic components, but they're mostly mental. So let's take a look at what trauma does to our bodies directly. First, let's talk about hormones. So, you probably have heard of the hormone cortisol.
It's also known as the stress hormone because along with adrenaline, it's responsible for our stress response, that fight, flight, freeze, faint response that I talked about. And what we know about trauma survivors is they typically have really elevated levels of cortisol, especially during stressful events.
In one study, they took women who grew up with childhood abuse and they exposed them to reminders of that abuse by, they basically wrote a script that was one minute in length and then read the script to the woman. So while they were reading that script to the woman, she would have cortisol levels upwards of 120 percent over what the healthy control who was read the same script had.
120 percent higher. And right after they were read that script, when they were recovering from it, their cortisol levels were 69 percent higher. Even beforehand, when they knew that the script was coming, but it still wasn't read to them, they were just anticipating it, it was 60 percent higher. So in other words, their levels of cortisol were elevated before, during, and after the reminder of the traumatic event.
Cortisol levels in people with PTSD tend to be higher at night. So they are already higher during the day. But at night, what happens is all of our cortisol levels peak around 3am in preparation for us becoming alert for the morning, right around 3am is where they peak. And then they diminish throughout the day.
So what you see in people with PTSD is they already have those elevated levels. So at 3 a. m. their cup overflows, so to speak, and they tend to wake up and they tend to not be able to go back to sleep. So that of course can make symptoms like hypervigilance worse. It can make them more irritable. It can make them more anxious as well as more distractible. All kinds of things that come with having poor sleep.
And then there's this paradox with cortisol, which I'm still researching myself, but we know that in some survivors of complex trauma, with complex PTSD, those cortisol levels are actually suppressed. So, in some people, they're really elevated and some people they're only elevated during stressful events, more so than in healthy people.
And in others, they're suppressed to where you're not getting that normal stress response, which might sound like a positive thing, but it's not because what it means is the whole stress response system is not working the way it's intended to.
It's completely dysregulated and all this cortisol dysregulation can lead to autoimmune issues like lupus, rheumatoid arthritis, multiple sclerosis, IBS or inflammatory bowel syndrome, and I think Crohn's disease as well, and also thyroid issues.
And it can also lead to things like weight gain and diabetes. Cortisol is really associated with weight gain because it actually releases glucose into our bloodstreams when it comes online. So people who have too much cortisol in them tend to gain weight around the midsection and tend to develop diabetes.
So if you think that you have something wrong with your cortisol levels, you can get them measured. You just need to talk to your doctor. It's a pretty simple analysis to do.
So we talked about the stress hormone, cortisol. Now let's talk about the love hormone, oxytocin. Oxytocin is called the love hormone because it promotes social bonds between people.
It also helps with emotional regulation, and it promotes the bonds between mother and child and between romantic partners. We know that early life stress causes levels of oxytocin to be lower in brain regions responsible for that emotional regulation, like the amygdala and the hypothalamus. We also know that, in general, the levels are suppressed elsewhere in the body.
And what does that mean? Well, that usually means having a higher anxiety, because oxytocin helps lower anxiety. And it also means having a greater susceptibility to drug dependence. We know that oxytocin levels, low oxytocin levels cause that. And of course, that is also something that leads us to have difficulty developing those connections and social bonds with other people.
So again, going back to why do complex trauma survivors have difficulty developing relationships with people? Maybe this is another reason. It's because their oxytocin levels are out of whack.
The last thing that's a biological aspect of trauma that I'm going to mention tonight is a neurotransmitter called substance P.
And this is a neurotransmitter that plays a role in several important functions like regulating pain and inflammation, regulating the respiratory and cardiovascular systems, regulating the gastrointestinal tract, and regulating our response to stress. So, a really important neurotransmitter that's kind of tends to be lesser known.
And in trauma survivors, what we see is we see elevated levels of substance P. And that again can lead to autoimmune issues that I already mentioned. It can lead to heart conditions. And it also can lead to issues like eczema and psoriasis too.
So there you go. Here's these three naturally occurring substances, the hormones cortisol and oxytocin, and then a neurotransmitter called substance P.
And they're all dysregulated because of trauma. So to summarize, people with PTSD and complex PTSD have damages to the systems that are responsible for controlling stress and responding to stress. And that can lead to autoimmune issues, like lupus, rheumatoid arthritis, multiple sclerosis; to gastrointestinal issues like IBS, Crohn's disease, and even celiac disease.
It can lead to diabetes. It can lead to cardiovascular issues like coronary heart disease. It can lead to psychiatric disorders. That's one thing I didn't mention about substance P. Elevated levels can also lead to psychiatric disorders like anxiety, bipolar disorder, schizophrenia, and also skin issues like psoriasis and eczema.
There are also studies that show that PTSD can lead to infertility and there are studies linking PTSD to cancer. There's one study that showed that in women who have PTSD, they have a higher chance of developing ovarian cancer.
And I feel like I should mention the ACE study here, and those of you who are therapists will definitely know what I'm talking about immediately.
But ACE stands for Adverse Childhood Experiences. And the ACE study was this huge study done by Kaiser Permanente. Really the largest of its kind, where they asked over 17, 000 people if they had any of the following 10 experiences happen to them when they were children.
And those experiences are emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, mother was treated violently, there was substance abuse in the household, there was mental illness in the household, there was parental separation or divorce, or there was an incarcerated household member.
So those are the 10 ACEs, 10 Adverse Childhood Experiences. And what they found was really astounding because at first, they found that two thirds of the study participants had at least one ACE. And one in five, or even more than one in five, had three or more ACEs happen to them.
If I remember correctly, 20 percent of participants reported childhood sexual abuse. So that tells us that these ACEs are much more prevalent than we think they are, and than we want to believe they are. And then they also link the presence of these ACEs to many of the leading causes of death, like heart disease, diabetes, stroke, cancer, and many others.
They also link them to things like mental health disorders and risky behaviors and poor social and economic outcomes like unemployment. For example, a person with an ACE score of four or more, so if you had four or more of those experiences as a child they were 460 percent more likely to develop depression and 1,200 percent more likely to attempt suicide.
460 percent more likely to develop depression and 1, 200 percent more likely to attempt suicide than a person with an A score of 0. So again, really mind-boggling numbers that show just how profoundly trauma can impact us.
If you want to learn more about the ACE study. Study. I have a detailed blog post about it. I will make sure to link it in the show notes.
Let me tell you about another type of trauma.
So this trauma can be type one or type two. It's just like another little category and it's called vicarious trauma. And vicarious trauma happens when you simply listen to somebody tell you the story of their trauma. So you weren't exposed to a traumatic experience yourself, you were just listening to the story of somebody who was.
And that vicarious trauma can be serious enough to result in what's called secondary PTSD, where you actually start to experience the PTSD symptoms that I mentioned, which again were intrusion, hypervigilance, avoidance, and negative changes in mood. And dissociation, since it's the unofficial symptom that I added on there.
And vicarious trauma happens a lot to people in helping professions, like psychotherapists are a primary target for that. But also loved ones of survivors of trauma. So this is not to say that survivors shouldn't share their stories, quite the opposite, they should. But this is to say that if you listen to those stories often, just take care of yourself.
Make sure that you're engaging in self-care. Make sure you're being kind to yourself. And then the last kind of trauma I will mention today is so called little “t” trauma. So, so far what we've talked about are like violent things, you know, threatened death or actual death, things like that.
They're all called big “T” or capital letter “T” traumas. But then there's such a thing as little “t” traumas that are experienced that may seem like not a big deal, but they also can result in PTSD like symptoms, especially if they happen to you over and over again. And little “t” traumas can include things like losing your job or losing your housing, death of a pet, financial difficulties like filing for bankruptcy and even infidelity can all result in PTSD-like symptoms.
Okay, so to summarize, I gave you a relatively quick overview of what trauma is, how to place it into categories, what the symptoms of PTSD, acute stress disorder, and complex PTSD are, and we also mentioned vicarious trauma and little “t” trauma.
If you want to know what impact trauma had on you. I've got just the thing for you. You can download my free trauma checklist. It lists some of the most common causes of trauma along with five categories of symptoms that you can just check off as you go. It's a great resource to learn more about the specific impact trauma had on you. I will put the link to it in the show notes.
Okay, I'm going to tell you what the most common questions I encounter are. The most common question is, “How do I know that what happened to me is trauma?” And to that, I say, well, remember, trauma is not the event itself.
It's that overwhelm of our capacity to cope with it and process it and integrate it. So, if you have any of the symptoms I mentioned, if you struggle with maybe different symptoms that aren't part of the DSM 5 or ICD 11, but you're like, yeah, I didn't have this before I went through this event and now I do, then it's probably trauma.
The second most common question I get is, “Why do some people develop PTSD and others don't?” So let's take a look at some of the risk factors for PTSD. Number one is going to be identifying as a woman. Women have twice the rate of PTSD as men.
Another one is going to be having an intellectual disability. And then also having a history of prior traumatic events or PTSD. So in other words, if you get into, let's say, a car accident three times, each time your chance of developing PTSD is going to go up. Another risk factor is a history of psychiatric illness or personality disorders.
There's also some genetical factors that we just don't exactly understand, but we do know that some people are just more predisposed to it. I will briefly mention the field of epigenetics, which is the study of how our environment affects our genes. So it's not all about nurture, it's very much also about nature.
And epigenetics showed in research that we are affected by at least two generations that came before us. So, in other words, if your parents or grandparents were exposed to trauma in their lives, you are more likely to develop some kind of trauma symptoms in your lifetime if you are exposed to trauma. It increases your risk.
And then another risk factor is the severity of the trauma. For example, if there is physical injury or a sexual assault, that is going to skyrocket your chances of developing PTSD. And then finally, there are factors that happen after the trauma, like brain injury, prolonged physical pain, poor socioeconomic status, and just subsequent life stress.
So if you live a stressful life and you go through something traumatic, you are more likely to develop PTSD afterwards.
The third most common question I get is, “Okay, so I have trauma. What's the best way to heal from it?” And while there is not one way that works best for everybody, of course, I can tell you what works for my clients.
And that's the combination of EMDR therapy, which that's eye movement desensitization and reprocessing therapy. IFS therapy, which stands for internal family systems, mindfulness, and somatic work. People really discount mindfulness, but it's actually really important in PTSD recovery. And I want to be very clear that these are not the only methods of working with trauma and recovering from trauma.
There are many more. These are just the ones that I tend to use. And I do want to say that traditional talk therapy, where you just sit there and talk about the trauma, is kind of limited when it comes to processing it. You can do some processing that way, but generally you have to do something that involves the body as well.
Before I let you go. I want to remind you once again about that trauma symptom checklist you can download in my show notes. Grab it for free and find out if you have signs of trauma
Next week, I will be talking about the role of mindfulness in trauma recovery, which like I mentioned is a very important topic. I hope that you leave today feeling a little more empowered on your journey. Remember, healing takes time. And you are right where you need to be. Take care of yourselves.
And until we meet again, be kind to your heart.
