Managing Trauma Symptoms

Persons who are coping with the aftermath of traumatic life events tend to find themselves overwhelmed with intrusive thoughts, images, or memories of the event, as well as difficulties in managing strong emotions. Common symptoms that individuals may experience include repeated intrusive memories, images, or flashbacks of the trauma; nightmares or bad dreams; and feelings of anxiety, panic attacks, and physical reactions associated with anxiety (e.g., racing heart, muscle tension, shortness of breath). Additional symptoms that may occur include numbing of emotions (e.g., an absence of loving feelings toward others), sleep disturbance, irritability or anger, concentration problems, and jumpiness.

Certain behaviors are common after traumatic events, including avoidance of anything that reminds the person of the trauma (e.g., thoughts, images, memories, feelings, places, activities, situations), distancing from other people, constantly being on the lookout for danger, and angry outbursts. Avoidance behaviors may generalize to other areas that were not associated with the traumatic event. For example, individuals who avoid the physical location of where a traumatic event occurred may find that they begin to avoid more and more physical locations that were not associated with the traumatic event, such that they end up not going out of the home and they isolate themselves from sources of support. Depression commonly co-occurs with posttraumatic stress. Individuals may have traumatic grief reactions after a traumatic event because many traumatic events are associated with losses. Some individuals may find that they reenact aspects of the trauma—that is, they repeat parts of the traumatic events in their actions.

Persons may engage in certain behaviors that were originally intended to help them manage their symptoms, but these behaviors themselves become symptoms that typically require treatment. This includes behaviors such as self-injury, substance abuse or dependence, risk-taking behaviors (including sexual risk-taking), suicide attempts, aggression, eating disorders, and others.

Dissociation may occur at the time of the traumatic event (peritraumatic dissociation) and after the event. Trauma-specific dissociation is that which occurs in the aftermath of the traumatic event and may disrupt the person's ability to function, particularly when memories or feelings of distress have been triggered or activated. People may feel “spaced out,” be unaware of what is happening around them, may feel the environment around them is unreal, may feel their body or parts of their bodies are not theirs, or have “out of body” experiences. Dissociative processes, particularly in cases of severe childhood trauma, may lead to entire parts of the personality becoming split off or completely separate from other parts of the personality. In some cases, individuals may develop amnesia for large parts of their lives or a dissociative identity disorder (DID). Individuals who have experienced chronic traumatic life experiences may have problems with their sense of self (e.g., altered self-perceptions, lowered self-esteem), which may lead to dysfunctional behaviors. Somatoform symptoms or disorders are often seen in the aftermath of trauma. Many clinicians believe that memories may take the form of physical sensations (body memories) without conscious memory of the traumatic incident(s), and there is scientific evidence for somatoform dissociation, particularly after chronic childhood abuse.

...