Trauma is an almost universal part of the human experience.

There are many types and causes of trauma. The latest definition of Trauma is Physical harm, emotional harm and/or life-threatening harm. [Importantly] the event or circumstance has lasting adverse effects on the individual’s mental, physical and emotional health, social well-being and/or spiritual well-being.
_{-SAMHSA, (2022).}

We usually think of trauma as a thing that happens in very extreme circumstances – rape, molestation, physical abuse, extreme neglect, assault, domestic violence, or natural disasters. But this is acute trauma, which is not the only kind. 

Even acute trauma is common.

Abuse and Neglect

Research has shown that such abuse and neglect can be just as devastating as physical abuse and sexual molestation.

Karlen Lyons-Ruth, who in the 1980s at Harvard University, conducted an influential study that followed children from birth to 20 years old. Their hypothesis was that hostile or intrusive behaviour on the part of mothers would be the strongest indicator of mental instability in their adult children. 

Instead, they found that a mother’s emotional withdrawal had the most profound and long-lasting impact. 

If your caregivers regularly ignore your needs, you learn to anticipate rejection and withdrawal. You cope by blocking out their hostility or neglect and acting as if it doesn’t matter.

But the body keeps the score: it remains in a state of high alert, prepared to ward off blows, deprivation, or abandonment.

A child who has been ignored or chronically humiliated is likely to lack self-respect. Children who have not been allowed to assert themselves will have trouble standing up for themselves. And many adults who were brutalised as children carry a smouldering rage they can barely contain.

Types of Trauma are often subdivided into:

It is not uncommon for people to experience both types of trauma during their lives.

Single-incident trauma

Single-incident trauma includes specific events that are recognised as falling outside of normal human experience and include natural and manmade disasters, sexual and/or physical violence either towards oneself or a loved one.

Single-incident trauma can impact not only the victim but also those who care for, or work, with them (e.g., paramedics and therapists).

Complex trauma

In contrast, experiences leading to complex trauma are so distressing to an individual on an emotional level that they can have lasting negative impacts on those affected. The events themselves, such as being ostracised, may not be sufficiently distressing to many people that it would cause long term harm but to others, who likely lack protective factors, this impact can be severe and long lasting. This is particularly the case where an individual experiences a number of traumatic experiences.

Complex trauma then is not identified by the objective severity of any specific event but instead by the emotional suffering that results from it.

Complex trauma experiences can be seen as the building blocks that make up a traumatising environment (Wekerle & Kerig, 2017).

Although post-traumatic stress disorder (PTSD) is widely understood as a reaction to a traumatic event such as a car accident or terrorist attack, known as single-incident trauma, less is known about complex trauma.

Both single-incident trauma and complex trauma can cause chronic and even life-long distress; however, the latter has received little attention.

Traumatic experiences can compound

Though single-incident trauma may seem more severe at first glance, experiences leading to complex trauma should not be overlooked. Emerging evidence suggests that exposure to a chronically traumatising environment can be more psychologically damaging that a single-trauma event, particularly when the traumatising environments are experienced at critical neurological and interpersonal time points in human development.

An added exacerbating factor for complex trauma sufferers is that the lack of a specific objectively awful event can result in a lack of awareness of and/or sympathy for the sufferer’s exposure. Both complex and single-incident trauma appear to respond to interventions designed to manage PTSD, such as eye movement desensitisation and reprocessing (EMDR) therapy (Cvetek, 2008; Frustaci et al., 2010).

The three E’s of trauma framework

The three ‘E’s of trauma – event, experience, and effects – form a comprehensive framework for understanding the profound impact of traumatic events on individuals.

Understanding the three ‘e’s of trauma provides a holistic perspective on the complex and multidimensional nature of its effects. It highlights that trauma encompasses not only the initial event but also the subjective experiences and subsequent consequences that individuals endure.

The first ‘E’

The first ‘e’ represents the traumatic event itself. Events and circumstances may include the actual or perceived threat of extreme physical or psychological harm (ie natural disasters, violence, etc.) or severe neglect for a child that imperils healthy development. These events and circumstances may occur as a single occurrence or repeatedly over time. Traumatic events can vary widely in their nature and intensity, but they all share the potential to profoundly disrupt an individual’s sense of safety and well-being.

The second ‘E’

The second ‘e’ refers to the individual’s subjective experience of the traumatic event. The individual’s experience of these events or circumstances, such as the internal, emotional, and cognitive responses that occur during and after the trauma, helps to determine whether it is a traumatic event. A particular event may be experienced as traumatic for one individual and not for another (eg a child removed from an abusive home may experience this differently than their sibling).

The third ‘E’

The third ‘e’ denotes the effects of trauma on an individual’s functioning and well-being. The long-lasting adverse effects of the event are a critical component of trauma. These adverse effects may occur immediately or may have a delayed onset. The duration of the effects can be short to long-term. In some situations, the individual may not recognize the connection between the traumatic events and the effects, and the effects can present differently depending on the person

Early development

Our early environment contributes heavily to our development, including how we are calibrated to respond to events that happen later on in life.

Very early life trauma refers to traumatic experiences that occur in infancy or early childhood, during a critical period of neurodevelopment when the brain is rapidly forming connections and organising its functioning. Early traumatic experiences in this period can have a profound impact on various aspects of development.

It typically refers to events that occur in early infancy or during the prenatal period when language skills have not yet developed or are still in their early stages of development.

Pre-verbal trauma

Pre-verbal traumas are traumatic experiences that occur before an individual has developed the ability to express their thoughts, emotions, or memories using language.

During the pre-verbal period, infants and young children rely heavily on non-verbal cues, sensory experiences, and their emotional responses to communicate and process their experiences.

Pre-verbal trauma can result from various experiences, including accidents, medical procedures, exposure to violence or traumatic events, abuse, or neglect.

For example, insensitive and/or irresponsible caregiving experiences can create an early environment for children to experience trauma. In this case, the child may learn that the world is unpredictable and threatening and the child may not know where to find safety or sanctuary.

This environment may occur before children can use formal language to communicate (around age 2-3), or before they can create stable memories (around age 4). Additionally, pre-verbal trauma can also occur in people with an intellectual disability who function at a younger developmental level. Nonetheless, these experiences still contribute to a persons’s long-lasting understanding of what their world and relationships within it are like.

Pre-verbal trauma: manifestation

The impact of pre-verbal trauma can manifest in a range of ways, including disrupted attachment relationships, developmental delays, emotional dysregulation, behavioural difficulties, and challenges in forming trusting relationships later in life.

The long-term effects can extend into adulthood, impacting mental health, interpersonal relationships, and overall well-being.

Impact of pre-verbal trauma

While pre-verbal trauma may lack explicit verbal memories, it is essential to recognise and address its impact. Trauma-informed approaches that focus on non-verbal communication, sensory integration, and regulation of emotions can be particularly valuable in supporting individuals who have experienced pre-verbal trauma.

Intergenerational trauma

Intergenerational trauma refers to the transmission of trauma across generations. It occurs when the effects of trauma experienced by previous generations impact the mental, emotional, and relational well-being of subsequent generations. This can include historical trauma related to colonisation, genocide, slavery, or other collective traumas that continue to have lasting effects on affected communities.

Cultural and systemic trauma

Cultural and systemic trauma refers to trauma experienced within specific cultural, ethnic, or marginalized communities due to systemic oppression, discrimination, or historical injustices. This form of trauma can result from racism, sexism, homophobia, transphobia, or other forms of institutionalized oppression that perpetuate ongoing harm and marginalization. We’ll delve further into cultural and systemic trauma in future weeks.

Vicarious trauma

Vicarious trauma refers to the emotional and psychological impact experienced by individuals who are regularly exposed to the trauma of others. This commonly affects professionals working in helping or caregiving roles, such as therapists, social workers, or first responders. Continual exposure to traumatic stories and experiences can lead to secondary trauma and impact the well-being of these individuals.

System-induced trauma

System-induced trauma encompasses trauma resulting from interactions with various systems, such as the criminal justice system, immigration system, or child welfare system. Experiences within these systems, such as incarceration, detention, family separations, or unfair treatment, can cause significant trauma and have long-term effects on individuals and communities.

Trauma-informed approaches involve re-evaluating, adapting, and transforming systems to be more responsive to the needs and experiences of those affected by trauma.

We’ll explore this in more depth in our final course week.

It’s essential to recognise that trauma is a complex and multifaceted phenomenon, and individuals may experience trauma in different ways and contexts. Understanding the broad range of trauma experiences is crucial for providing appropriate support, intervention, and healing for those affected by trauma.

Neurodiversity and trauma

When considering neurodiversity within the context of complex trauma, it is crucial to acknowledge that individuals with neurodivergent traits may be more vulnerable to experiencing trauma or may respond to trauma in unique ways.

Neurodivergent individuals, such as those with autism, ADHD, or other neurological differences, may have distinct sensory sensitivities, social challenges, or difficulty with emotional regulation.

These traits can influence how people perceive, process, and respond to traumatic events.

Shame and trauma

Shame can be closely connected to trauma and is often experienced by individuals who have gone through traumatic events.

When someone goes through a traumatic event, they may develop feelings of shame in relation to what happened to them. This shame can arise from a variety of sources, including self-blame, guilt, or societal attitudes and judgments about the event.

The following are some ways in which shame and trauma are interconnected. Note that these factors also make retraumatisation more likely:

Self-blame

Trauma survivors may internalize the belief that they are responsible for what happened to them, leading to feelings of shame. This self-blame can stem from a distorted perception of the event or from societal messages that blame victims.

Violation of personal boundaries

Traumatic experiences often involve a breach of personal boundaries, which can trigger intense shame. Survivors may feel deeply embarrassed, humiliated, or degraded by the violation, leading to a profound sense of shame.

Stigmatisation and societal judgment

In some cases, societal attitudes and judgments about certain types of trauma, such as sexual assault, can contribute to feelings of shame in survivors. Negative stereotypes, victim-blaming, or a lack of support can intensify the shame experienced by individuals who have endured trauma.

Fragmented self-image

Trauma can disrupt a person’s sense of self and lead to a fragmented self-image. This fragmentation can result in feelings of shame and inadequacy as individuals struggle to reconcile their pre-trauma and post-trauma identities.

Interpersonal relationships

Shame can significantly impact relationships, as individuals may struggle with feelings of unworthiness or fear of being judged or rejected. They may have difficulty trusting others or expressing their needs and emotions. These challenges can lead to unhealthy or abusive relationships.

Shame can create a vulnerability that perpetrators or abusive individuals may exploit. Perpetrators may use shame as a tool to maintain control or manipulate survivors into re-engaging in harmful situations. The shame-based beliefs and low self-esteem can make individuals more susceptible to abusive dynamics.

Avoidance and isolation

Shame often compels individuals to hide or keep their traumatic experiences secret, further isolating them from support networks. This isolation can reinforce the shame they feel and hinder their healing process. Let’s explore some other shame coping strategies next.

Shame and trauma are intimately linked, so it is important to not only conceptualise shame but also understand what it involves.

Shame is such a complex and kind of mecurial experience, it has so many different ways it manifests.
_{– Prof Luna Dolezal, (2023).}

The effect of Trauma

The memory of the trauma acts like a splinter in the mind – it is the body’s response to the foreign object that becomes the problem rather than the object itself.

From a neuroscience lens, brain-imaging studies of trauma patients usually find abnormal activation of the insula. The insula integrates and interprets information from sensory organs, and transmits fight-or-flight signals to the amygdala when necessary.

In people with trauma, these signals are firing all the time. It doesn’t require any conscious influence – you just constantly feel on edge, for no apparent reason. You may have a sense that something has gone wrong, or of imminent doom. These powerful feelings are generated deep inside the brain and cannot be eliminated by reason or understanding.

Suppressing one’s core feelings takes a tremendous amount of energy. This leaves less energy for pursuing meaningful goals, making you feel bored and shut down. But at the same time, stress hormones are flooding your body, leading to headaches, muscle aches, bowel problems, sexual dysfunction, or aggressive behaviour toward people around you.

Trauma becomes physical symptoms

When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other kinds of pain. 

Other common conditions which often have no clear physical cause include chronic neck pain, digestive problems, spastic colon/irritable bowel syndrome, chronic fatigue, and some forms of asthma. Traumatized children have fifty times the rate of asthma as their non-traumatized peers.

These individuals may visit multiple specialists, undergo extensive diagnostic tests, and be prescribed medications. These measures may provide temporary relief, but none of them address the underlying cause. 

Another common symptom is alexithymia, in which a person reports feeling physically uncomfortable without being able to describe exactly what the problem is. This comes from self-numbing, which keeps them from responding to the ordinary needs of their bodies in quiet, mindful ways – shifting in their chair, stretching, drinking water, or going for a walk, for example.

If you’re not aware of what your body needs, you’re unable to take care of it. If you don’t feel hunger, you can’t nourish yourself. If you mistake anxiety for hunger, you may eat too much. And if you can’t feel satiated, you’ll keep eating.

References

_{Cvetek, R., 2008. EMDR treatment of distressful experiences that fail to meet the criteria for PTSD. Journal of EMDR Practice and Research, 2(1), pp.2-14.}

_{Frustaci, A., Lanza, G.A., Fernandez, I., di Giannantonio, M. and Pozzi, G., 2010. Changes in psychological symptoms and heart rate variability during EMDR treatment: a case series of subthreshold PTSD. Journal of EMDR Practice and Research, 4(1), p.3.}

_{Huang, L.N., Flatow, R., Biggs, T., Afayee, S., Smith, K., Clark, T. and Blake, M., 2014. SAMHSA’s Concept of Truama and Guidance for a Trauma-Informed Approach.}

_{Wekerle, C. and Kerig, P.K., 2017. Sexual and Non-sexual Violence Against Children and Youth: Continuing Conversations. Journal of Child & Adolescent Trauma, 10, pp.95-96.}