Psychological Traumatic-Stress Disorders: Types, Symptoms, Causes, & Treatments
Psychological or emotional trauma can occur when one experiences an event (or several events) in which death, serious injury, or sexual assault, are threatened— or actually occur. A person can also be traumatized by hearing of these events happening to a loved one. First responders and soldiers can experience psychological trauma as a result of repeated exposure to these types of events.
Traumatic-Stress Disorders manifest as either Acute Stress Disorder or Post-Traumatic Stress Disorder, depending on several factors, including how long symptoms last. With medical support and psychotherapy, survivors of trauma can learn ways to manage, reduce, or eliminate their symptoms and reclaim their lives.
What Causes Traumatic Stress Disorders?
Types of experiences that might be perceived as emotionally traumatic include, but are not limited to:
- Childhood physical, emotional, sexual abuse, or neglect
- Domestic violence
- Car accidents or other types of accidents resulting in serious injury or death
- Racism
- Robbery
- Witnessed suicide or violent death
- Medical trauma
- Death of a child
Traumatic stress disorders can develop based on a complex set of personal and trauma-specific risk factors. These include age at the time of trauma, previous exposure to trauma, family history of mental illness, and stress level prior to the trauma. Factors specific to the traumatic event also play a role in whether people are more likely to develop a traumatic stress disorder.
These factors include:
- how intense the traumatic event is and how long it lasts
- whether a person received adequate emotional and social support after the trauma
- whether the person dissociated during the event (this happens most often with the freeze or submit response).2,3
How Trauma Can Affect the Mind and Body
Trauma can have a significant effect on both the body and the mind. Symptoms during the trauma are responses by the part of the brain focused on survival, while after experiencing trauma the symptoms may vary greatly.
During the Trauma
During an emotionally traumatic event, the survival part of the brain initiates the release of stress hormones to prepare the body physically to respond to the perceived threat. Responses during a traumatic event are not conscious decisions, but rather are based on a subconscious assessment of what response (i.e., fight, flight, freeze, submit) will maximize one’s chances for survival.
Following the Trauma
Following psychologically traumatic events, trauma-related stress symptoms will occur in 6-50% of people (depending on the nature of the trauma). For the majority of people, these symptoms will disappear within four weeks. When symptoms persist beyond four weeks, one should be assessed for Post-Traumatic Stress Disorder (PTSD).
Symptoms can be physical, emotional, behavioural, and spiritual in nature. They can also impact thinking, causing problems with memory, concentration, problem-solving and decision-making. Symptoms might emerge within hours or days of a traumatic experience. When symptoms are extreme, include thoughts of suicide, interfere with aspects of daily life, and/or last for more than four weeks, one should seek medical and/or counselling assistance.
Types of Psychological Trauma-Related Disorders
Types of psychological trauma-related disorders include Acute Stress Disorder and Post-Traumatic Stress Disorder.
Acute Stress Disorder
Acute Stress Disorder is characterized by symptoms that persist for at least 3 days and last up to a month following exposure to a traumatic event. These distressing and recurrent symptoms could include:
- Reliving the trauma (nightmares, flashbacks)
- Avoidance of reminders of the trauma
- Dissociation (being in a daze, forgetting parts or all of the trauma)
- Negative mood
- Hyperarousal (sleep problems; irritability; concentration problems)
Following a traumatic event, the incidence of Acute Stress Disorder varies from 6-50% depending on the nature of the trauma.
Post-Traumatic Stress Disorder (PTSD)
PTSD is characterized by significant distress as a result of symptoms that persist for more than four weeks and make it difficult to function in one or more areas of one’s life.
Symptoms of PTSD can include:
- Reliving the trauma (nightmares, flashbacks)
- Active avoidance of reminders of the trauma
- Negative changes in thinking and mood
- Hyperarousal (irritability; reduced concentration; sleep issues)
While more than half of Americans report having experienced a traumatic event in their lifetimes, only 8.7% of the civilian population are projected to develop PTSD by 75 years of age. The rates of PTSD among soldiers and first responders are much higher.
Symptoms
The symptoms of Acute Stress Disorder and Post-Traumatic Stress Disorder may be similar but have some specific differences.
Acute Stress Disorder
Acute Stress Disorder is characterized by symptoms that last between 3 days and 1 month following exposure to a traumatic event, cause disruption in one or more areas of a person’s life, and are not the result of a medical issue, substance or alcohol use, or other injuries. Symptoms that last beyond a month could be indicative of PTSD.
Symptoms of Acute Stress Disorder might include:
- Flashbacks
- Emotional or physical distress triggered by reminders of the trauma
- Nightmares or night terrors
- Memory loss regarding parts or all of the traumatic event
- Inability to feel positive emotions
- Feeling dazed
- Feeling like you are in a dream or your body isn’t yours
- Avoiding memories or reminders of the trauma
- Problems getting to sleep or staying asleep
- Irritability and being easily angered
- Being unable to relax
- Always assessing your surroundings for possible threats
- Concentration problems
- Being easily startled
Post-Traumatic Stress Disorder (PTSD)
PTSD is characterized by symptoms that last longer than 1 month following exposure to a traumatic event, cause disruption in one or more areas of a person’s life, and are not the result of a medical issue, substance or alcohol use, or other injuries. These symptoms might begin within hours or days of the traumatic event or might not become active until decades following the event.
Symptoms of PTSD might include:
- Flashbacks (Note: In children, this might show itself in the form of serious repetitive play in which they reenact parts of the trauma)
- Emotional or physical distress triggered by reminders of the trauma
- Nightmares or night terrors (Note: In children, this might present as nightmares or night terrors in which they don’t remember what their dreams were about)
- Memory loss regarding parts or all of the traumatic event
- Inability to feel positive emotions (joy, hope, peace)
- Feeling dazed
- Feeling like you are in a dream or your body isn’t yours
- Avoiding memories or reminders of the trauma
- Problems getting to sleep or staying asleep
- Irritability and being easily angered
- Being unable to relax
- Concentration problems
- Always assessing your surroundings for possible threats
- Being easily startled
- Having ongoing negative beliefs about oneself, other people, or the world
- Persistent fear, terror, guilt, rage, shame, or other distressing emotions
- Feeling disconnected from other people
- Engaging in high-risk behaviour (getting into fights, driving while intoxicated) or self-destructive behaviour (self-injuring, increased alcohol or substance use)
Complex Trauma Symptoms
While not a diagnosis, Complex Trauma symptoms refer to a unique set of symptoms that have been observed, in addition to PTSD symptoms, among children and adults who experienced prolonged repeated trauma (possibly over months or years), while living in a state of captivity and under the control of the perpetrator(s) of the trauma. It usually involves betrayal by someone in a position of power. The following are examples of traumatic experiences that might give rise to complex trauma symptoms: domestic violence; child abuse or neglect; concentration camps; war; prisoner of war camps; sex trafficking; systemic racism.
The following are symptoms of complex trauma (some or all may be present):
- Repeated self-inflicted harming behaviours (self-injury, eating disorders, substance abuse)
- Increased victimization at the hands of others
- Loss of, or injury to, one’s sense of self— seeing oneself as “damaged,” less than human, shameful
- Ongoing physical pain (headaches, stomach pain, body aches) without an obvious physiological cause
- Difficulty managing emotional distress and not having the ability to calm oneself when upset
- May also suffer from diagnosed anxiety and/or depression
- Inability to trust or feel close to others
- Lack of purpose or meaning in life
- Feeling of ongoing connection to the abuser/perpetrator
Treatment of Psychological Trauma-Related Disorders
Treatment of psychological trauma-related disorders typically includes therapy, medication, or a combination of the two.
Therapy for Trauma-Related Disorders
The therapies that are most commonly used to treat Post-Traumatic Stress Disorder (PTSD) are Cognitive Behavioral Therapies (CBT) and Exposure Therapies.
Cognitive Behavioral Therapies
These include Cognitive Therapy (CT), individual or group Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT).
In these types of therapies, the therapist works with the client to focus on trying to change the negative, distorted beliefs that developed during trauma and continue to cause significant distress. During experiences of intense horror, fear, or pain, the lens through which one sees the world is distorted by the trauma. This can lead to the development of inaccurate subconscious beliefs ( “I am damaged,” “I will never be safe”) that continue to cause distress in daily life.
This distress is usually experienced physically and emotionally due to the fact that one’s thoughts and beliefs are connected to physical sensations and emotions. The experienced distress can also impact one’s behaviours and lead to social withdrawal or substance use to try to numb the pain. It is only by becoming aware of these thoughts, and evaluating them through a different lens of safety and compassion, that one can then adapt these beliefs so that they are more accurate and positive, thereby reducing distress.
Exposure Therapies
These include Prolonged Exposure Therapy (PET), Eye Movement Desensitization and Reprocessing (EMDR).
After ensuring that the client has the means to manage emotional distress that might be triggered by recalling trauma-related images, the therapist and client work together in a safe environment to face these images. Following the guidelines that define the specific exposure therapy being used, the client continues to recall these images and might also begin to confront reminders of the trauma, until their body and mind become desensitized to them and they no longer trigger distress.
Medication for Trauma-Related Disorders
Medication might be prescribed by a physician or psychiatrist to help manage the symptoms of trauma-related disorders. Some medications that are commonly used to treat anxiety or depression have been found to also be effective at treating PTSD symptoms. These include, but are not limited to fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor XR).
Intended Treatment Outcomes & Timelines
Treatment outcomes and timelines often depend on the severity of the trauma and may be different depending on the specific trauma disorder.
Acute Stress Disorder Treatments
Treatment of Acute Stress Disorder is typically geared toward symptom management and enhancing coping strategies, as well as providing education and access to support. Acute stress disorder typically resolves on its own within four weeks.
Post Traumatic Stress Disorder Treatments
Treatment outcomes for therapy to address PTSD are dependent upon client goals. For some clients, the goal is symptom management and stabilization. They want to learn how to cope with and manage the symptoms so they can get on with their life, without dealing directly with the trauma.
Other clients will want to go beyond symptom management and do more in-depth work of trauma processing. For these clients, the goal is to come to a place where they are no longer reacting to the trauma in everyday life, but rather have found a way, through therapy, to place the trauma in their past (as part of their history), so that they can reclaim their present and future.
Generally, potential treatment outcomes when addressing PTSD might include:
- Symptom management, reduction, or elimination
- Enhanced access to support professionals, peers, supportive family and friends) and resources (supportive books, websites, associations)
- Understanding how trauma affects the mind and body, normal responses to trauma, and the phases of healing
- Creation of an individualized coping strategy toolkit
- Improved functioning at school, work, and socially
- Enhanced awareness of one’s strengths, resiliency, and courage
- The ability to live in the present moment, free from being involuntarily pulled into reliving parts of the trauma over and over again
How to Get Help for Psychological Trauma-Related Disorders
The best sources of help for psychological trauma-related disorders can depend on a number of factors:
- Type of trauma experienced: Depending on the type of trauma experienced, (domestic violence, sexual assault, military service, first responders), there may be specific associations, agencies, or groups that offer therapy services or peer support services. Therapists might also specialize in providing trauma therapy to survivors of specific types of trauma.
- Developmental stage: Some mental health professionals will have expertise with specific age groups (children, families, youth, adults, seniors)
- Presence of other mental illnesses: Trauma-related disorders sometimes occur with other illnesses such as addictions, depression, or anxiety. Some therapists or therapy programs are specifically geared toward survivors of trauma who are dealing with PTSD and another of these illnesses.
- Access to health insurance: Whether you have it, and if it covers specific medical, psychological, or counselling services.
When looking for a provider of trauma therapy, in addition to the above considerations, it is important to ensure that therapists are licensed or registered in your area and that they have taken trauma-specific therapy training. Trauma therapy is different from other types of therapy and requires specialized knowledge and clinical skills.
How to Get Help for Yourself
For some, asking for help might be one of the hardest things you have to do (beyond surviving the trauma you have already lived through). It is important to remember that psychological trauma-related disorders are real illnesses. Trauma can change the way the mind and body function, which is why you are experiencing such distressing symptoms. It’s not about weakness or character flaws. It takes strength and courage to recognize and ask for help when you need it.
Some people choose to talk to their doctor, or to speak to a trauma counsellor before they talk to their family or friends about what they are going through. Others are more comfortable talking to a spiritual advisor. Still, others would rather talk to other people who have gone through a similar experience, either in a formal therapy or peer support group, or informally by talking to people you know.
However you choose to start, the important thing is that you start to take the first steps to getting the help you need, and don’t give up until you get what you need. If it feels too overwhelming, you might want to ask your doctor or a loved one to advocate for you to get the care you need.
How to Get Help for a Loved One
If an adult loved one wants help, it’s usually best to ask how you can help, rather than assume that you know what they need. They might want your help to research therapists, groups, and other services available in your area. They might want you to go with them to an appointment if they are nervous or need your help to free them up from responsibilities (e.g., childcare) so that they can attend an appointment. They might also need your help to advocate for services for them, if they are too overwhelmed by trauma symptoms to do this on their own behalf.
If an adult loved one doesn’t appear to be aware of their trauma-related symptoms, or are denying that they are experiencing symptoms, and you are worried about them, it is important to be respectful. It might be helpful to let them know what behaviours you have noticed that have caused you to be concerned.
If they are open to information on the topic, you might want to share books, websites, etc. related to traumatic stress symptoms and resources with them. If they are not open to getting help and you continue to be concerned, it might be helpful for you to obtain counselling support for yourself to better understand your loved one and how to support yourself through this.
If your loved one is a child, it will be important to find a therapist who specializes in working with children who are survivors of trauma. Depending on the age of the child, you and your family might have some involvement in therapy so that you can learn how to help your child through this. If the trauma was experienced by the members of the same family, family therapy might also be appropriate.
Living with Psychological Trauma-Related Stress Disorders: Coping and Managing Symptoms
There are a number of strategies you can use to help to manage the symptoms of an emotional trauma-related disorder.
Here are nine things that may help:
- Seek Counseling with a qualified professional
- Seek Medical Support or medication prescribed by your doctor to treat symptoms/pain, if appropriate
- Distraction strategies can give you a break from negative thought spirals by directing your attention to something neutral or more positive (going for a walk, listening to uplifting music, watching a movie, playing with an animal)
- Self-soothing strategies using your senses (taste, touch, smell, sight and sound) can help to calm and/or energize you (having a hot soothing drink, wearing comfortable clothes, baking cookies, looking at nature, listening to music)
- Mindfulness strategies redirect your focus away from reliving the trauma, back to the present moment. There are two types of mindfulness strategies that you may find helpful: 1) mindful attention using your senses to what is currently happening around you in your environment ( what can you see, hear, touch and smell in the present moment); and 2) mindful attention to what is really being asked of you in this moment (to focus on one task, to go to sleep)
- Accepting Support from Others: This might mean sharing your challenges with them, or accepting their offers of help with things you need to get done in your daily life. It might mean accepting help from local organizations who are able to provide you with respite from children when you are feeling overwhelmed, or some type of financial, housework, or other supports if needed. It also might mean talking with other people who have been through something similar to reduce your sense of isolation and allow you to connect with people who really understand.
- Education: Understanding how trauma affects the mind and body, normal responses to trauma, and things you can do to help yourself, can help to reduce unnecessary distress caused by fear of the unknown.
- Prayer or meditation may be helpful for some.
- Physical activity (specifically yoga) can be helpful to reduce stress and help you to feel back in your body, if this is something you are physically able to do.
Acute Stress Disorder
A diagnosis of Acute Stress Disorder would be made by a psychiatrist, psychologist, or other qualified medical or mental health professional. They would be assessing whether at least nine of the following symptoms are present:1
- Involuntary, repeated, and distressing memories of the traumatic event (Note: In children, this might show itself in the form of serious, repetitive play in which they reenact parts of the trauma.)
- Recurring distressing trauma-related dreams
- Flashbacks (reliving of parts of the traumatic event— physical, emotional, visual, auditory, or olfactory memories of the trauma) where the person responds as though the trauma is occurring in the present. (Note: In children, this might show itself in the form of serious, repetitive play in which they reenact parts of the trauma.)
- Significant physical or emotional distress related to reminders of the traumatic event
- Continuing inability to feel joy or other positive emotions
- A change in the way one experiences the world or oneself (feeling dazed, experiencing the world as in a dream, feeling like one is not in one’s body)
- Unable to remember important parts of the traumatic event (not due to physical injury, or alcohol or substance use)
- Avoidance of distressing thoughts, emotions, or memories that are related to the traumatic event
- Avoidance of people, places, things, situations, etc. that remind one of the traumatic event and trigger distress
- Sleep problems (getting to sleep, staying asleep)
- Irritability and unprovoked angry outbursts
- Constantly on guard and looking for threats. Not able to relax. Feeling unsafe.
- Problems with concentration and focus
- Getting startled easily and having an intense reaction when startled.
Post Traumatic Stress Disorder
PTSD is characterized by symptoms that have lasted for at least 4 weeks following exposure to a traumatic event. These symptoms might begin within hours or days of the traumatic event or might not become active until decades following the event. These symptoms will be causing significant disruption in one or more areas of a person’s life and are not the result of a medical issue or substance/alcohol use.
Criteria for a diagnosis includes one of more of the following intrusive symptoms:1
- Involuntary, repeated, and distressing memories of the traumatic event.
- Recurring distressing trauma-related dreams. (Note: In children, this might present as nightmares or night terrors in which they don’t remember what their dreams were about.)
- Flashbacks (reliving of parts of the traumatic event— physical, emotional, visual, auditory, or olfactory memories of the trauma) to which the person responds as though the trauma is occurring in the present. (Note: In children, this might show itself in the form of serious, repetitive play in which they reenact parts of the trauma.)
- Intense emotional distress caused by reminders of the traumatic event (feelings, thoughts, memories, people, places, things, etc.).
- Physical distress or reactions caused by reminders of the traumatic event.
AND
One or both of the following avoidance symptoms:
- Avoidance of distressing thoughts, emotions, or memories that are related to the traumatic event.
- Avoidance of people, places, things, situations, etc., that remind one of the traumatic event and trigger distress.
AND
Two or more of the following changes in mood and cognition types of symptoms:
- Unable to remember parts or all of the traumatic event.
- Ongoing, extreme negative beliefs about oneself, other people, the world.
- Ongoing, inaccurate beliefs about the traumatic event that cause the person to blame themselves or others for what happened.
- Persistent negative emotions (of fear, terror, guilt, rage, shame).
- Much less interested in activities that were important to them.
- Feeling disconnected or alienated from other people.
- Inability to feel joy, love, happiness, or other positive emotions.
AND
Two or more of the following arousal and reactivity changes:
- Increased irritability and unprovoked angry outbursts.
- Increased high-risk or self-destructive behaviour.
- Sleep issues (falling asleep, staying asleep).
- Constantly on guard and looking for threats; not able to relax; feeling unsafe.
- Problems with concentration or focus.
- Getting startled easily and having an intense reaction when startled.
What’s Wrong with Me??? Just Tell Me!
People I work with often tell me they are worried they are going “crazy.” When I ask clients what that looks like, they typically describe being permanently disassociated from reality along with a complete loss of dignity. They imagine what the loss of their mental faculties would look like, which often resembles things falsely and harmfully depicted in the movies. They worry that the content of their obsessive thoughts may be evidence of something additional going on, perhaps something more sinister that could possibly lead to harming someone.
OCD may trick you into believing that any shift in mood, thought, or perception may be an indicator of their descent to “losing their mind.” Stress (like a pandemic) or significant changes (like being isolated from family and friends) exacerbate OCD symptoms and naturally lead to increased irritability and moodiness, which in turn may reinforce one’s fear that their mental health is declining.
Hyperawareness in Mental Health Anxiety
Having anxiety about mental health is like having an OCD hall monitor in your mind. The sole purpose of the OCD hall monitor is to watch out for brain activity that might be an indicator of a potential danger which should be promptly evaluated.
In mental health anxiety, OCD manifests as hyperawareness of mental processes that keep you embroiled in anxiety about mental health. Here are some ways OCD uses hyperawareness to keep you on the lookout for signs of feared mental illnesses.
Hyperawareness of Moods
- What if my mood swings are evidence of having manic episodes during which I could lose control of myself?
- What if my feelings of sadness and frustration are a sign of clinical depression that could lead me to harm myself?
- What if I feel terrible forever?
Hyperawareness of Perception
- What if my feelings of depersonalization are indicators of losing touch with reality?
- What if my obsessive thoughts are delusions and I am psychotic?
- What if taking medication altered my brain permanently?
Hyperawareness of Thought
- What if my racing thoughts are a symptom of another disorder which might ruin my life?
- What if my false memories are delusions?
- What if my obsessive thoughts are not OCD, but rather signs of being a sociopath?
While seeking appropriate treatment for your mental health needs is important, it is equally important to distinguish self-care from compulsive certainty-seeking in OCD.
Common Compulsions in Mental Health Anxiety
Once OCD has identified what it deems to be an unauthorized thought, feeling, or experience, the investigation ensues. In health anxiety one scans the body for physical symptoms while in mental health anxiety one scans the mind for irregular patterns of thoughts and feelings.
- Mental review of conversations with mental health practitioners
- Excessive mental evaluation of mood
- Reassurance seeking from mental health professionals
- Researching mental health disorders to ensure an accurate diagnosis
- Researching feared symptoms to try to be certain they do not apply to you
- Reassurance seeking from family members about family psychiatric history
- Staring at objects to check for feelings of derealization
- Checking to see if you feel real
- Mental review of experiences to assess if they were symptoms
- Avoiding media that depicts mental health issues
Mindful Awareness and Mental Health
It may seem counterintuitive to suggest practising mindful awareness when you are already acutely aware of the inner workings of your mind. It is important to note the distinction between being hyperaware and being mindfully aware. Hyperawareness of one’s mind is a state of being excessively, painfully aware of mental processes through vigilantly checking in on them. The excessive awareness then leads to rumination, overestimation of threat, and misattribution of mental experiences as signs of mental illness.
On the other hand, mindful awareness allows one to be aware of one’s thought patterns and emotional responses, without the element of judgment. When one can mindfully observe mood changes, thought patterns, and emotional responses without evaluating their significance, they can be transient experiences much like a weather pattern.
Living Dangerously? (Only Not Really)
I once had a client tell me that she was one step away from total disaster; I remember thinking to myself, “aren’t we all one step away from disaster?” The idea that something bad could happen at any time has always been true, regardless of your awareness of it. We all know this, but it is not at the forefront of one’s mind unless of course, you are living through a pandemic. Living with OCD means you have a brain that is aware of all possibilities, which makes your awareness of them feel risky. Acknowledging potentially disastrous outcomes does not make them more likely.
I sometimes describe OCD as being like a well-meaning friend who desperately wants to be helpful, but often ends up being unhelpful. Viewing OCD as trying to protect you in its weird way can help you to back away from self-judgment and allow you to view your obsessive thoughts about your mental health with a sense of humour, rather than treating the thoughts like threatening information. Remember OCD is not the arbiter of your mental health or anything else for that matter.
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