Trauma

Overview
A trauma is any significantly distressing event outside your normal means of coping or the normal range of human experience. A trauma may involve a perceived threat to your physical integrity or that of someone close to you. Some traumas involve threatened or actual violence.
An estimated 90 percent of Americans will be exposed to a traumatic stressor during their lifetime. Most people who experience a trauma recover without developing severe psychological distress or impairment. The prognosis tends to be better with natural disasters (such as floods, tornadoes and earthquakes) than "human" disasters (such as car accidents, school shootings and bombings).

In some cases, being involved in a trauma or witnessing a traumatic event triggers depression, substance abuse, domestic abuse, acute stress disorder or post-traumatic stress disorder (PTSD). Acute stress disorder may last up to one month. The condition is characterized by heightened alertness or arousal, avoiding situations related to the trauma, and repeatedly experiencing the trauma through recurring thoughts, dreams or flashbacks. When the symptoms last for more than one month, it may be considered post-traumatic stress disorder. "Human" disasters are more likely to cause PTSD than natural disasters. The likelihood of developing PTSD may be affected by the availability of social support, a person's family history and mental health history, and experience with prior traumatic events.

Family members can also be affected by a loved one's trauma. For example, they may become targets of displaced anger or experience anger, depression, guilt, frustration, insecurity or confusion of their own.


Characteristics
A trauma can affect you in many ways. Physically, you may notice a change in your appetite or energy level. Emotionally, you may feel anxious, afraid or helpless. You may also be confused, ashamed or have temporary feelings of shock. You may have a decreased ability to think and make decisions. Emotional numbness, grief and guilt -- including survivor guilt -- are also common. Some people experience nightmares, flashbacks, terrifying memories, panic attacks or recurrent intrusive thoughts about the event.
Socially, you may blame certain people or groups for not preventing the trauma. You may become less productive or experience difficulties in family functioning. You may withdraw or avoid certain situations or the trauma site. Some people experience an inability to talk about the trauma, become judgmental, or use dark humor.

Sometimes, a traumatic event can be more than you're able to handle at the time. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult a medical doctor to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
Four separate phases of coping with trauma are common during a disaster. The heroic phase begins immediately with efforts to protect lives and property. The next phase, the honeymoon phase, is characterized by optimism, feelings of thanks and relief at survival. The disillusionment phase, in which you realize something disastrous has taken place, typically develops about three to four weeks after the disaster. This phase is characterized by anger, frustration, placing blame, questioning "Why?" and second-guessing your actions before or during the disaster. The disillusionment phase can last for months or years -- in some cases, indefinitely. During the fourth phase, the reconstruction phase, there is a restoration of the "normal" routine. The memories of the disaster are not erased, but life goes on.
For adult trauma survivors
Early intervention after a trauma can help prevent or mitigate the effects of traumatic stress and restore you to normal functioning as soon as possible. Consider the following steps:

Protect. Find a safe haven that provides shelter, food, privacy, and an opportunity to relax and sleep. Avoid using stimulants such as caffeinated beverages, tobacco, diet pills and ADHD medications because they can heighten or aggravate the effects of stress. Drinking alcohol or using illicit drugs can also hinder your recovery by disrupting REM sleep, which is needed to help the brain process stressful and traumatic events.

Select. Identify useful basic emergency assistance resources, such as the Federal Emergency Management Agency (FEMA), the Red Cross and the Salvation Army.

Direct. Begin working on immediate family and personal priorities to help regain a sense of hope. Do not try to fight off or avoid recurring thoughts, dreams or flashbacks. They are normal reactions to trauma and will decrease and become less painful over time. Try to resume your normal activities as soon as possible, even if you do it slowly or gradually. Within the first 24 to 48 hours after a trauma, alternating periods of appropriate physical exercise with relaxation can be especially helpful in alleviating some of the physical stress.

Connect. Maintain or reestablish communication with loved ones and peers. Talk about the traumatic experience as appropriate and listen to others tell their stories. Also, be supportive and patient with those close to you. They may be experiencing a reaction to the trauma as well, even if they weren't directly affected by the event.

You may want to seek counseling with a mental health professional for additional support. Relaxation training such as meditation, imagery or biofeedback may also be useful. In some cases, individual or group debriefing may also be recommended. With this type of intervention, the affected person has the opportunity to discuss the event with a trained professional. By retelling the experience, the perceived power of the event typically diminishes. Education on normal reactions to traumatic events is often a part of the debriefing. It may also help to remember that most people who experience a trauma recover without developing severe psychological distress or impairment.

Medications, specifically selective serotonin reuptake inhibitors (SSRIs), are often the most helpful in treating mental health issues associated with traumatic stress. Avoid alcohol and mind-altering substances.

For children
Gently encourage children to talk about their feelings and reactions to the event. Older children may be more able to talk about the event; younger children may need to express their feelings through drawings or play. Answer children's questions as honestly as possible, using words and concepts they can understand and age-appropriate facts. Assure children of their own safety, and allow them to grieve and mourn. If the event is heavily covered in the media, you may want to limit TV time. Help children resume a normal routine as soon as possible -- children benefit from a sense of normalcy and stability. Seek counseling if symptoms such as abnormal behavior, nightmares, avoidance or intense anxiety last more than three to four weeks.

For loved ones
Encourage loved ones to seek counseling, but don't pressure them. Listen to your loved ones, spend time with them, and offer assistance without forcing the issue. Reassure them of their safety. Help with everyday tasks such as cooking, cleaning and caring for children. Do not take their anger or other feelings personally. Be careful to avoid statements such as, "You're lucky it wasn't worse." Instead, tell your loved ones you're sorry the event has occurred and you're there to help in any way you can.

You may also want to seek individual, couple or family counseling if you or anyone in your family is experiencing secondary trauma reactions, such as anxiety, fear, anger, addiction, school or work problems, or difficulties with intimacy. Classes on stress and anger management, couple's communication or parenting may also be helpful. Finally, stay involved in positive relationships, productive work and enjoyable activities.