All About Trauma: What It Is, Short- and Long-Term Effects, How to Cope With It, and When to Get Help
Although she didn’t witness the event herself, Heidi Horsley, PsyD, found herself replaying the last moments of her brother’s life again and again in her mind. He died in a car accident after hydroplaning during a rainstorm.
“That narrative kept going over and over, and I couldn’t get the loop out of my head,” she says. With each replay, she recalls, she ruminated on whether her brother suffered before his death — and she became increasingly worried someone else was going to die. “The safe predictable world you once knew is gone. When my brother died, I didn’t feel like my parents could protect us. I felt my brother died, so I could die.”
Dr. Horsley’s younger brother died when she was 20 years old. Her experience as a young adult eventually prompted Horsley to become a therapist who specializes in grief and trauma. Now an adjunct assistant professor at the Columbia University School of Social Work in New York City and the executive director of the Open to Hope Foundation, Horsley says trauma, and its impact on mental health, is widely misunderstood.
Society often expects survivors of emotional trauma to recover much faster than is realistic — to stop talking about the event and move on in a matter of weeks.
“That’s where people get it wrong,” Horsley says. “[If, for example,] you were assaulted, it is normal to feel like the weight of the world is on you and you have no energy.”
Most people recover naturally from a traumatic event with time and good social support. In fact, a strong emotional response to trauma may be key to ensuring long-term recovery, Horsley says.
Other individuals develop mental health conditions like depression.
In both popular culture and the medical field, the term “trauma” can cover a vast array of experiences.
Psychological trauma generally stems from an experience that causes a person to believe, in the moment, that they or someone else is about to die, according to April Naturale, PhD, LCSW, the vice president of disaster services at Vibrant Emotional Health, who is based in Barnstable County, Massachusetts, and specializes in helping individuals and families cope with traumatic stress.
These kinds of events activate our fight-or-flight instinct, a stress response that triggers hormones to increase heart rate and prepare the body for action. This process also dials down activity in the parts of our brain that help us think critically and analytically (an energy-preserving mechanism to help us act more quickly in a moment of crisis).
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In some cases, Dr. Naturale says, the brain stays stuck in this threat mode for months or years after an incident, which may lead to problems with concentration, sleep, relaxation, and general enjoyment of life.
Genetics play a role in who will develop lasting symptoms after a traumatic experience — but so do the kind of events that caused the trauma.
It seems easier for people to comprehend events involving human error or that things like natural disasters are out of our control, Naturale says. Intentional violence tends to be tougher to accept, she says.
“What we don’t understand is when someone decides to randomly hurt, kill, or maim a group of people,” Naturale says. “We don’t like to think that anyone might kill us for no reason.” The randomness of certain traumas (whether they’re intentionally inflicted or not) can also be difficult to grapple with.
The number and duration of traumatic events a person experiences also significantly increases his or her mental health risk. Most people can cope with and recover from a single trauma. But when they experience multiple similar events, or when a single crisis persists for an extended period of time, the brain doesn’t have adequate opportunity to heal, Naturale says.
PTSD, however, is not the only mental health condition associated with trauma, says Arianna Galligher, the director of the STAR Program, a trauma recovery center at the Ohio State University College of Medicine in Columbus. Trauma may exacerbate mental health conditions that existed before the event, or people may develop symptoms of conditions such as depression or anxiety disorders for the first time in the aftermath of traumatic experiences.
“A lot of people who have experienced traumatic situations may develop a major depressive disorder or anxiety symptoms, rather than PTSD,” Galligher says. “What we really look for in terms of diagnosis is, what’s going on with you, and how do your symptoms impact day-to-day functioning?”
People who fall into a depressed state after a trauma, Horsley says, may feel as though “the world we once knew is over.” They may experience feelings of worthlessness or helplessness, believing there is nothing they can do to prevent future traumatic events, and that life is no longer worth living.
Other people may become so determined to prevent the trauma from happening again that they develop anxiety disorders. They may become extraordinarily cautious and may develop rituals that they feel will keep them safe, to the point where they may even appear to have obsessive-compulsive disorder (OCD), according to Dr. Ford.
Regardless of which direction the symptoms go, the root of the problem is typically control, Ford says. “The essence of trauma is it takes control away from you or someone you care about,” he says. How a person deals with that loss of control — giving up or redoubling their vigilance — may determine which set of symptoms they experience.
For emotional trauma that is not PTSD, psychologists have come up with several categories.
When a person is exposed to a prolonged human-caused trauma from which they cannot escape — as in situations such as child abuse, domestic violence, or discrimination — the brain often suppresses emotional reactions in order to remain in survival mode for an extended period of time, Ford says. Later in life when the threat is removed, these emotions begin to emerge, often in unexpected or overwhelming ways.
This can lead people to experience panic attacks or fits of rage. In other cases, Ford says, people exposed to prolonged trauma develop dissociative episodes where they feel disconnected from their own lives. They may experience a sense that things happening to them are not real, or repeatedly zone out and lose track of time.
Waves of seemingly inexplicable emotions may drive some people to self-medicate and develop addictions; others may face social rejection in response to their outbursts, essentially adding new traumas to the old one, Ford says.
Its effects may be felt across cultures of people who have been displaced, enslaved, or subjected to genocide, according to Ford. Stories of these events may be passed down through the generations, transmitting the long-term effects of systemic disadvantages that result from the loss of homes and homelands, poverty, and discrimination.
A strong emotional response in the immediate aftermath of a traumatic event is not only normal, it’s to be expected, Naturale says. Many people will experience what she calls an “acute stress response,” so severe that they may become unaware of their surroundings or act out of character or inappropriately. The fight, flight, or freeze response, she says, will suppress the brain’s ability to think and function normally for a short period of time as a way of coping with a crisis.
This means the first few moments after a traumatic event tend to be chaotic, and individuals may not be able to remember everything they did or experienced during the event, Galligher says. But within a few hours, most people begin to experience intrusive thoughts associated with the trauma and find that they’re unable to stop thinking about what just happened.
“You distract yourself for a while, but you think about it again,” she says. “That’s going to continue,” she adds, but that approach typically starts to diminish over the course of a few weeks.
This acute response, Galligher says, can cause:
Most survivors report that symptoms periodically return around significant milestones after the event, such as anniversaries. But for most people who experience trauma, initial symptoms subside after a few months to a year.
“It’s often a struggle to get through the first holiday or the first birthday [after a trauma] — after that, symptoms drop significantly,” Naturale says.
Naturale noted that in her experience working with survivors after 9/11, just sharing this information about normal responses to trauma significantly reduced the incidence of mental health symptoms.
In some cases, a traumatic event may have longer-term implications, particularly if the trauma took place during childhood.
A common and healthy way to cope with trauma is to reach out to others to talk through and process what happened.
But not all social interactions are helpful. If an individual’s social network is not supportive and is dismissive of their experience and feelings, Horsley recommends the person find a safe place to talk — which may include therapy or a specialized support group for individuals with similar experiences. Many of these groups are available online, and many are open to survivors free of cost.
It’s important for survivors to give themselves permission to take additional time for self-care, and seek out fun activities that can give them a “break” from the intensity of their emotions, Horsley says. This means covering the basics by getting enough sleep, staying hydrated, and maintaining a good diet — but also looking for hope.
For example, Horsley says, if someone has experienced a significant loss, as she did, they might feel deprived of touch and closeness. A massage or acupuncture session may help fill this need. A new hobby or a class in an old interest might be just what’s needed — and activities involving movement, such as yoga or dance, may be especially helpful, Horsley says.
Many people find a new sense of meaning or purpose when they engage with healthy coping mechanisms, Horsley says. Additionally, attending memorials for the lost may fill a need to pay tribute to loved ones. Support groups can also be helpful.
Horsley cautions that not everything that technically qualifies as coping leads to positive outcomes. Comfort foods may help us get through a difficult time, for example, but excessive reliance on food as a sole coping mechanism may lead to other negative long-term health consequences. Similarly, Horsley says, individuals who turn to drugs and alcohol as a means of self-medicating for trauma are technically coping — but creating more problems for themselves down the road.
“Alcohol is a depressant; it will make you more sad and upset,” she says.
Though healthy coping strategies can vary from person to person, social support is important for everyone, Naturale says. Isolation, unemployment, or a lack of access to supportive resources represent significant risk factors for developing mental illness following a traumatic event.
“Ninety percent of people get better in a reasonable amount of time with good social support and good coping,” she says.
If you’re coping with trauma, it may be beneficial to identify the people in your life you can turn to when you feel like you need to talk. These may be individuals with similar experiences, or who can otherwise help you feel seen and heard by validating your emotional response as a normal reaction to trauma, rather than dismissing your experience or suggesting the reaction is somehow inappropriate or disordered, according to Naturale and other experts.
If you’re unsure whether the people in your social network would be supportive, Naturale says, it never hurts to err on the side of caution and speak to a licensed therapist. A few educational sessions to focus on what to expect after trauma and how to cope may go a long way to promote recovery.
While she does not believe therapy is necessary for everyone who experiences a traumatic event, survivors should seek professional help if they feel as though they cannot connect with others and must isolate themselves; if they are experiencing thoughts of suicide; or if they find ongoing depression or anxiety is interfering with their day-to-day life months after a traumatic event, Naturale says.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.
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