What Is Traumatic Stress?

Traumatic stress
Traumatic events are shocking and emotionally overwhelming situations. It is natural for people who experience or witness them to have many reactions. Some of these are intense fear, horror, numbness, or helplessness. These events might involve actual or threatened death, serious injury, or sexual or other physical assault. They can be one-time occurrences, such as a natural disaster, house fire, violent crime, or airplane accident, or they can be ongoing, repeated, and relentless, as is often the case in combat or war. Child abuse and neglect, and other forms of domestic violence are additional examples of this. Most often trauma is accompanied by many losses. Unfortunately, traumatic events are quite common.

Reactions to traumatic events vary considerably, ranging from relatively mild, creating minor disruptions in the person's life, to severe and debilitating. It is very common for people to experience anxiety, terror, shock, and upset, as well as emotional numbness and personal or social disconnection. People often cannot remember significant parts of what happened, yet may be plagued by parts of memories that return in physical and psychological flashbacks. Nightmares of the traumatic event are common, as are depression, irritability, sleep disturbance, dissociation, and feeling jumpy.

Some of the problems people encounter after traumatic events are part of the diagnosis of acute stress disorder (ASD). ASD describes experiences of dissociation (e.g., feelings of unreality or disconnection), intrusive thoughts and images, efforts to avoid reminders of the traumatic experiences, and anxiety that may occur in the month following the end of the events. When these experiences last more than a month after traumatic experiences have stopped, they are described by the diagnosis of post-traumatic stress disorder (PTSD).

Other equally uncomfortable problems or symptoms may exist with or instead of PTSD. For example, a traumatic event often challenges the person's sense of personal safety and control, leaving him or her feeling less secure and more vulnerable. Physical health may suffer as well, and individuals may notice increased feelings of fatigue, headaches, and other physical symptoms. Many people traumatized in childhood also experience revictimization (being harmed again) or aggression, identity disturbance (a feeling that you don't know who you are), bodily problems such as illnesses or aches and pains without detectable physical cause (somatization), difficulty staying on an even keel emotionally, and relationship problems.

What can be helpful after trauma?
It can be helpful to stay connected to natural support systems, whether they are friends, coworkers, family, neighbors, other familiar groups, personal beliefs, or community. Taking care of basic needs is important after trauma. This includes trying to get enough sleep, eating well, exercising, drinking enough water and juice, and avoiding alcohol and caffeine. Keeping to routines and activities if possible, and finding ways to assist someone else, can be helpful for many. And it is particularly important to know you can ask for help.

How to decide whether you need help
People who have had traumatic life experiences cope the best way they can with their memories and painful effects. For many people, reactions gradually diminish. Some find it helpful to talk about what happened and their feelings, to get support from people who can be trusted, or to be involved in other activities that help them to reconnect with people and find meaning in their lives. But for some people, the symptoms and disturbing reactions persist or even worsen. This can lead people to find ways to cope that are not so helpful, such as withdrawing from friends and family, using drugs or alcohol, or avoiding activities that are empowering. It is important to consider seeking help if important areas of life, such as relationships, work, or school, are being affected by traumatic stress. Likewise, people who become more and more depressed or anxious or for whom the use of alcohol or other drugs increases significantly may need treatment. Some traumatized people speak over and over about traumatic events without relief of symptoms. These people may benefit from treatment.

Treatment options
There are many types of treatment for traumatic stress, from individual therapy to support groups. Interpersonal, relational, and psychodynamic psychotherapies, which focus on the meaning of trauma and how it has affected relationships, may help people understand the source of their current problems and how these relate to their traumatic experiences. For some, medication can be effective. Also, anxiety management, cognitive therapy (focusing on thoughts and beliefs), and exposure therapy (helping the person confront painful memories and situations that are realistically safe although still frightening, through talking about or imagining them) are helpful for reducing PTSD and related reactions. A combination of psychotherapy and medication is often helpful for depression and anxiety following traumatic experiences.

No single treatment is effective for everyone, and it may take time to find the right treatment. There also may be difficult periods in any treatment. Therefore, it is important to find a trained psychotherapist or physician, preferably one with experience treating people with traumatic stress, who can work together with the survivor to find a treatment approach that makes sense for the individual. A comfort with language, cultural considerations, and style of expression may enhance rapport in treatment.

Where to go for help
For people who wish to consider psychotherapy, a family doctor, clergy person, local mental health association, state psychiatric, psychological, or social work association, or health insurer may be helpful in providing a referral to a counselor or therapist with experience in treating people affected by traumatic stress.

© 2005 International Society For Traumatic Stress Studies. All rights reserved.