Post-traumatic Stress Disorders
Post-traumatic stress refers to a collection of symptoms and a specific style of coping with those symptoms that emerge in response to trauma. Here, a trauma refers to an actual or threatened death, serious injury, or sexual violence.* In the initial aftermath of a trauma (defined in this way), it’s very normal for people to have strong negative emotions. For some people, these experiences resolve naturally and the experience becomes a memory, filed away among many others. For other people, the symptoms continue, trigger one another, and the memory does not get neatly filed away. When these symptoms and an individual’s attempts at coping with them and cause significant distress or get in the way of living life, we call this post-traumatic stress disorder or PTSD.
Core features
Intrusion symptoms. This includes involuntary and distressing memories, flashbacks or nightmares about or related to the trauma.
Avoidance. People tend to avoid from situations, people, activities or things that 1) remind them of the trauma itself, 2) trigger similar feelings to how they felt during the trauma, or 3) they no longer have interest in since and because of the trauma. People often find themselves overfocused on reducing fear that trauma could reoccur through things like checking locks, practicing self-defense, and scanning the environment.
Changes in mood, beliefs, and information processing. Trauma can change how we make sense of ourselves, other people or the world leading to strong painful emotions. Sometimes the beliefs we had before the trauma distort our understanding of the events we survived and we form beliefs about what happened that increase fear, anger, guilt and shame. Memory and attention changes are common too.
Heightened Reactivity. Our nervous systems can get stuck in a state of anticipation for future threats. This can look like being easily startled, irritability, angry outbursts, being reckless or making snap decisions, being on the lookout for danger, and difficulty sleeping or concentrating.
*This very narrow definition may not capture your experiences, so be sure to scroll down and check out this blog article.
Complex PTSD
Complex PTSD refers to the when prolonged and repeated exposure to trauma brings on challenges in addition to those associated with PTSD. When traumatic stress is so cumulative, people often do not have time to recover naturally before another major stressor overwhelms them, so they can get stuck in a heightened state of expectation that the world is fundamentally dangerous or people are untrustworthy. When this happens very early on in life, people often struggle to regulate their emotions well into adulthood, long after they are out of the environment in which they were repeatedly harmed.
The experience of chronic and inescapable of traumatic events can also lead to other expressions of distress, like difficulties with intimacy, emotional flashbacks, chronic pain or physical illness, and challenges with sense of self and identity. It’s also common for people to feel compelled to engage in activities that mirror some of the traumas they survived, often in the hopes of attaining a different, corrective outcome. People can experience strong feelings of shame and guilt for engaging in these efforts to write a new ending to their story. Like lightning striking a power grid, a reminder of one trauma can trigger a host of reminders about different events, requiring a more nuanced and relationship-based approach to treatment.
Coping with Emotional Abuse and Neglect
Though emotional abuse and chronic invalidation do not meet the strictest diagnostic definition of a traumatic event, these experiences can still produce deep. long-lasting changes in mood, thinking, and behavior. Some examples of emotional abuse and neglect include chronic invalidation, repeated belittling, gaslighting, shaming, and persistent dismissal or questioning of a person’s experiences. This form of abuse often occurs alongside the types of traumas that result in a PTSD diagnosis but can also occur without those kinds of events and deserve acknowledgment and treatment despite not fitting the classical definition for PTSD. These are the bruises we can’t see but very much feel. The nature of invisible wounds begets the coping style of many emotional abuse survivors, who deal may deal with low-self worth, excessive guilt and shame, and self-doubt by people-pleasing, isolating, self-criticism, anticipating rejection, and second-guessing themselves. It’s not uncommon to struggle with naming your emotions, while placing extra focus on the internal experiences of others.
Moral Injury
Moral injury refers to the psychological impact of acting in a way that breaches your own values, especially in a situation where your ability to make choices was restricted. This can show up alongside traditional PTSD symptoms or separately and can look like guilt about the actions you did or did not take, anger toward individuals or institutions for betrayals of duty or morality, and shame about who believe you have become in the aftermath.
Institutional Trauma
When the source of danger or threat is an institution or system rather than a single, series or group of individuals, we call the impact institutional trauma. This includes adverse religious experiences, racial trauma, and any experiences of identity-based discrimination or systemic oppression.