Trauma: An Overview

What is psychological trauma?

• A mental condition resulting from a challenge that shatters two core beliefs: Our ability to care for ourselves and our certainty that the world is safe
• Note that trauma refers to the mental condition and not to the challenge. The challenge is extrinsic and the trauma is intrinsic.

What are some challenges that can result in trauma?

• Being subjected to distant, rejecting, and self-absorbed parenting during childhood and adolescence
• Personally experiencing near death or witnessing the death or near death of another
• Personally experiencing serious injury or the threat of such; similarly witnessing serious injury or the threat of such to another
• Experiencing sexual violence or witnessing sexual violence to another (Note: The threat of sexual violence is in itself sexual violence.)
• Experiencing microaggressions based on externally imposed membership in a less privileged category of society
• Experiencing infidelity in an intimate relationship
• Loss of social status (through change of relationship status, job loss, ageing, etc.)

How long can trauma last?

• From twenty-four hours to a lifetime
• The duration of a trauma is affected by the duration of the challenge.
  • A trauma can result from a discrete challenge such as a motor vehicle accident (MVA) or
  • from a long-term challenge (e.g., ongoing parental maltreatment or the aggressions and microaggressions perpetrated  by societal groups with economic and political power against members of communities with less access to such powers.)

Can trauma ever have  positive outcomes?

• Yes, under the following conditions:
  • The trauma is induced by a discrete challenge.
  • The trauma reaction lasts less than 30 days.
  • The target of the challenge has adequate skills of emotional regulation.
  • The target of the challenge has adequate social support.
• As a result, the target of the challenge:
  • heals back stronger and smarter, and
  • experiences joy, the reward of having negotiated the trauma successfully.

Does vulnerability to trauma have individual differences?

• Yes, some people demonstrate two overlapping qualities when challenges confront them:
  • Hardiness: The ability to place distress in context while determining the appropriate response
  • Resilience: The ability to regain confidence in the ability to care for the self
• Psychological science has identified three attitudes of people who demonstrate hardiness and resilience:
  • Commitment: Joining with others rather than isolating
  • Control: Actively working to change what is happening rather than passively accepting the outcome
  • Incorporation: Being open to new learning and establishing a new normal regardless of the final outcome of the challenge
• People are born with more or less hardiness and resilience, but everyone can proactively work to increase these two skill sets through psychotherapy and other mentoring.

Can trauma ever have negative outcomes?

• Yes,
  • When constant or quickly repeating challenges do not permit recovery
  • When sufficient skills of distress tolerance are lacking
  • When a caring social network is lacking
• Sadly, Nietzsche’s aphorism, “That what does not kill me makes me stronger,” is not reliably true.

What are some negative outcomes of trauma?

• Shame: Feeling public disapproval because “I should have been smarter and stronger.”
•  Depression
  • Uncontrolled rumination or catastrophizing
  • Lethargy
  • No longer enjoying what was once pleasurable (anhedonia)
• Anxiety
  • Generalized anxiety disorder (GAD)
  • Social anxiety: Significant ongoing negative comparisons with others
  • Separation anxiety disorder
• Dissociation: Depersonalization, derealization, or both
• Unwanted, intrusive memories
• Phobias
• Emotional dysregulation resulting from insufficient resilience
• Distress intolerance from insufficient hardiness
• Poor impulse control and high risk behaviors (e.g., spending binges, alcohol and other substance use, gambling, promiscuous sex, etc.)
• Posttraumatic stress disorder (PTSD)
• Attention-deficit/hyperactivity disorder (ADHD or ADD)

Dear Readers,

This is the first of two posts on psychological trauma. The second post will offer more detail about posttraumatic stress disorder (PTSD).

Good mental health,

Dr. Michael

(Featured image is in the Netherlands: A potato farm in North Holland province as seen from the North Sea Canal. Photograph by the author)