By Shelley Bradley-Scholey
Trauma is a complex experience that can leave lasting imprints on an individual's mind, body, and spirit. It can surpass the boundaries of time, with an event or series of events from the past impacting how someone experiences the present and the shape of their future. Trauma can be a single event, a series of pervasive events and importantly, is identified as traumatic based on how the individual experiences it, not necessarily the nature of the event itself.
The effects of trauma manifest in various ways, influencing mental health, relationships, parenting, occupation, and overall well-being. In this article, we delve into the multifaceted nature of trauma, touching on Post-Traumatic Stress Disorder (PTSD), Complex PTSD, and the interconnected web of difficulties that often accompany trauma, such as low self-esteem, depression, anxiety, and coping mechanisms like substance use and self-harm. We will explore the ripple effect of trauma and how that can manifest in many ways beyond the typical mental health difficulties you might expect to see, for example, perfectionism, burnt out, problematic relationships and blocks to being the person you want to be.
What is Trauma?
At its core, trauma refers to a distressing or disturbing event that overwhelms an individual's ability to cope, leaving them feeling helpless, frightened, ashamed, responsible, or emotionally devastated. Trauma can be categorised into "small t" and "big T" trauma, although I am a little on the fence about this distinction, whilst it is helpful in terms of categorising events it can also feel like we are labelling some experiences as less traumatic than others and in my experience the nature of the event isn’t always a good predictor of how it might impact the individual. The term “big T” trauma typically involves severe and universally acknowledged traumatic events such as physical or sexual abuse, combat experiences, natural disasters, or traumatic grief (this is not an all-encompassing list) while “little t” trauma encompasses more subtle but still impactful events like pervasive criticism, bullying, illness, loss, or other difficult memories.
The way I prefer to explain the difference between “big T and little t” is like the filling of a sink, the trauma might be a huge bucket full of water that instantly fills the sink to overflowing, a discrete event that causes the trauma in one large measure, or it can be like the dripping of a tap, whereby one or two drips don’t seem to fill the sink but if the dripping goes on for long enough the sink will be full to overflowing – it is the same result but a different mode of delivery. Of course, people can also experience a series of huge events – filling their sink with buckets full repeatedly over a period of time.
Understanding the impact and consequences of traumatic events
The symptoms of trauma are wide-ranging and can manifest in cognitive, physical, emotional, and behavioural domains. Individuals who have experienced trauma may struggle with flashbacks, nightmares, and intrusive memories, often reliving the traumatic event. Emotional responses can include heightened anxiety, depression, and intense feelings of guilt or shame. Physiological symptoms like insomnia, irritability, and hypervigilance are also common. People tend to try and manage these difficulties by avoiding things that may remind them of the event or engaging in ways of coping with the distress such as using alcohol, food, or self-harm. Trauma can also manifest in other ways that are less clearly linked to the traumatic experience, it can influence our internal narrative of how we view ourselves, other people, and the world – this can then subsequently impact how we lead our life, the choices we make, the relationships we choose, the way we manage our emotions and how we treat ourselves.
Post-Traumatic Stress Disorder (PTSD)
PTSD is a specific form of trauma-related mental health disorder that can develop after exposure to a traumatic event. It is characterised by symptoms such as re-experiencing the trauma through intrusive thoughts or nightmares, avoiding reminders of the trauma, negative changes in mood and cognition, and increased arousal and reactivity. PTSD can significantly impair an individual's daily functioning and quality of life, requiring professional intervention and support.
Complex PTSD (CPTSD)
While PTSD focuses on an individual’s response to a specific traumatic event, Complex PTSD is a term used to describe the enduring psychological impact of chronic trauma or repeated interpersonal trauma, often occurring in childhood or over an extended period. Complex trauma can result from situations like ongoing emotional, physical, and sexual abuse, neglect, or living in an environment of constant threat. It can also occur because of repeated or chronic C-PTSD is characterized by additional symptoms, including difficulties in regulating emotions, challenges in forming and maintaining relationships, and a distorted sense of self. CPTSD might make it difficult to tolerate feeling difficult emotions, it can feel overwhelming and unbearable and a person with CPTSD may not have learnt or be unable to use the skills to manage these distressing emotions. A highly critical view of self can exist, this might include feeling bad about who you are, shameful and a persistent sense of being unworthy or to blame for events that have occurred – this in turn might then impact how we act in relationships and the types of attachments we have to people.
The Interconnected Difficulties of Trauma
Trauma seldom travels alone; it brings with it a host of interconnected difficulties that permeate various aspects of an individual's life, the fall out of trauma can be so much more than PTSD. Low self-esteem is a common companion, as the traumatic experience often shatters one's sense of worth and self-perception. Depression may arise from the overwhelming weight of the trauma, casting a shadow on one's ability to find joy or meaning in life, avoidance can lead to isolation and a reduction of social connection. Anxiety, with its pervasive worry and fear, can further compound the challenges of navigating daily existence. The way we relate to others can be impacted as trauma can often occur as a result of the actions and omissions of others, this can lead to difficulty in forming and sustaining healthy relationships. Trauma can lie at the root of many common problems such as unrelenting standards, perfectionism, burn out, self-sabotage, and recurrent unhelpful patterns of behaviour - it has a ripple effect.
Coping Mechanisms
Facing the aftermath of trauma, and living with the fall out of it, individuals may resort to coping mechanisms that, while initially providing relief, can escalate into separate issues. Alcohol and substance use are common avenues for self-medication, offering a temporary escape from the pain. However, these substances can lead to dependency and exacerbate the underlying problems. Self-harm, often a desperate attempt to regain control or numb emotional pain, can become a coping strategy that serves a multitude of functions such as meeting the need to feel something, externalising the pain, or punishing self. Additionally, using food as a source of comfort or control can manifest in eating disorders, further complicating the journey towards healing. People might develop hostile or aggressive behaviours in a bid to keep themselves safe or be overly appeasing in relationships to keep the other party happy.
Subtle Trauma
Not all trauma is overt; some wounds are inflicted subtly, leaving scars that are not immediately visible. Experiences from early life shape the individual’s inner narrative in both positive and negative ways. The way we are parented is one of those key experiences and psychological impact can occur from parental high standards, criticism, a lack of nurturing, or an environment where emotions are suppressed. Some of the experiences we have would not appear to be traumatic to a bystander if they were considered in isolation, but the repetitive nature of criticism or bullying can slowly chip away at someone’s sense of self over time. These subtle forms of trauma may go unnoticed or minimized, yet their impact can be enduring and insidious. Issues like family breakdowns, the ill health of parents and care givers, can also lead to difficulties alter in life.
Grief, a natural response to loss, can become a source of profound pain when left unprocessed. There is no timeline on grief, particularly if the circumstances are traumatic or the relationship with the bereaved is complex, grief can sometimes be overlooked as a trauma because it is part of the natural human condition. Grief can be a significant source of trauma, the nature of the bereavement and the manner in which we manage our emotions a grief reaction can impact the processing of a loss and whether this becomes a traumatic memory.
Summary
Understanding trauma requires a nuanced perspective that acknowledges the diverse ways it manifests in individuals' lives. From the battlefield to the home, trauma leaves an indelible mark on the human experience. Whether it's the acute distress of a singular event or the chronic erosion of repeated traumas, the consequences can be profound. Recognising the interconnected difficulties that accompany trauma, exploring the distinctions between PTSD and Complex PTSD, and acknowledging the varied coping mechanisms individuals employ are crucial steps toward fostering compassion, empathy, and effective support for those on the path to healing.