Trauma  by Dr Elizabeth McCardell, M. Couns., PhD

 

     It is timely to write about trauma. After all, we have experienced horrendous floods this year and fires three years prior and many people suffered directly and indirectly the effects of these. On social media many were saying that everybody affected have Post Traumatic Stress Disorder (PTSD). It needs to be said right here, that this isn’t true. Not all who went through these experiences are affected in this way.

     Our responses to threat are primarily instinctive and biological, and secondarily psychological and cognitive. We go into fight, flight, and freeze mode, common to all mammals. First, we enter the arousal cycle. Our muscles tense, as we identify the source of possible danger. Then we enter the mobilization stage where  our bodies begin to produce adrenaline and cortisol, the two primary chemicals that energize us to fight or flee. In the third stage, we discharge this energy by completing the appropriate defensive actions (fighting or fleeing). The fourth and final stage happens when the nervous system, no longer aroused, returns to a state of equilibrium. If we are overwhelmed by the threat and are unable to fight or flee, we instinctively employ the third action plan, the "freezing response”. Here we are in a dissociative state where our minds seem to separate from our body, but we are still highly aroused, setting the stage for high anxiety which may continue for awhile.

     I note here that PTSD is identified as the ongoing experience of trauma lasting more than three months. Less than three months, and this trauma response is identified as Acute Stress Disorder (ASD).  Not all experiences of stressful events become disorders (a very important point here). 

 

     According to the DSM-IV (a bible of psychiatric diagnoses), for trauma disorder to be diagnosed, the person must experience at least one of five cluster symptoms: recurrent and intrusive distressing recollections, nightmares, flashbacks, intense psychological distress in response to memories or reminders of the trauma, and physiological arousal cued by memories or reminders of the trauma);  three or more of seven  symptoms of persistent avoidance (of memories or reminders of the trauma) and emotional numbing (dissociative or psychogenic amnesia for important parts of the trauma, loss of interest in important activities, feelings of detachment or estrangement from others, restricted range of affect, and a sense of a foreshortened future); and two or more symptoms of increased arousal (sleep difficulties, irritability or outbursts of anger, concentration difficulties, hypervigilance, and an exaggerated startle response).

 

     PTSD doesn’t necessarily occur after ASD and ASD doesn’t necessarily occur after a stress event. Why is this so?  Length of duration may be a consideration, as frequency could be also, but the data is inconclusive. The anxiety response is not the same across all potentially traumatic events. Some events, such as random rape, are transient, while domestic abuse is usually repeated. Hand to hand combat can be transient, but can be repeated many times. Floods and their ongoing destruction go on for a long time, but the time factor isn’t necessarily sufficient to bring on an ongoing trauma response. Other things are at work, and we still really don’t understand everything about this stress response. Some people are more resilient than others, some have better networks and can express their feelings more openly, perhaps.

 

     Several studies have found that low cortisol levels in the acute aftermath of the stressful event and an elevated resting heart rate shortly afterwards tend to result in a stronger and more sustained stress reaction, which is hypothesized to contribute to the development of PTSD. Also an extensive prior history of psychiatric problems and/or substance abuse may make  a person  particularly vulnerable to the development of PTSD. Prior traumatic history also contributes to the development of a stress disorder.

 

     So how we live our life now matters in terms of how we respond to stressful events. Now is the time to communicate and connect with others and learn to manage our issues without abusing alcohol and drugs. Working through our anxieties and concerns through counselling is really useful in preventing the development of the debilitating conditions of ASD and PTSD because they are not inevitable. Therapy for existing trauma really does matter.