In treating survivors of a traumatic event (or series of events) I am often asked if I can explain why they are still suffering after the event has ended. Generally speaking, the question is really posed to the survivor by their support system: the survivor’s family and friends. Confused as to how to answer, the survivor comes to me for help in forming their reply. It has been repeatedly proven that psychological support from family and friends is critical to reduce the intensity of posttraumatic stress and other psychological symptoms, which is why I am always ready to talk with a survivor’s support system and educate them about what is helpful and what is not. Many survivors receive well-intentioned but harmful feedback from their social support such as pushing them to “get over it.” Unfortunately for all too many survivors this is easier said than done.
Briere, Ph.D. & Scott, M.D. (2006) define trauma as “the event, not the reaction, and should be reserved for major events that are psychologically overwhelming for an individual.” I’m sure we can all come up with examples of trauma for adults, but I also want to include an overview of childhood trauma because sometimes these examples are overlooked.
According to RAINN (2009), childhood trauma results from anything that disrupts a child’s sense of safety and security, including: An unstable or unsafe environment, separation from a parent, serious illness, intrusive medical procedures, domestic violence—sexual, physical, financial, spiritual, or verbal abuse (frequent yelling, name-calling, blaming, shaming, isolation, intimidation, and controlling behavior are examples of verbal abuse, which deteriorates self-esteem), neglect, and bullying.
Get Understanding In Order to Give It
To have the wisdom of knowing what to say to a survivor requires understanding and empathizing with their experience. I'm not talking about knowing every detail of what happened during the traumatic experience, rather understanding their current distress. What triggers them? What feelings arise? What negative thoughts are running through their head?
According to Briere, Ph.D. & Scott, M.D. (2006), the type of symptomatology and the degree to which it’s expressed in a person depends on variables specific to the survivor (i.e. the survivor’s gender, age/perceived vulnerability, race, etc.), characteristics of the traumatic event (was it life threatening, did the survivor sustain a physical injury, sexual victimization, etc.) and how those around the survivor responded to the survivor. Ideally, loved ones respond to the survivor with nonblaming, nonstigmatizing statements and are able to care, nurture and offer immediate physical aid. Every survivor’s experience and resulting reaction is unique, however, there are a number of common responses.
Psychological responses include:
Low self-esteem or self-hatred, i.e. “Why did I survive the earthquake when others did not?” or “This happened to me because I was born defective in some way, I’m worthless.”
Guilt/shame, i.e. “I didn’t do enough to prevent this, it’s my fault,” or in the case of sexual abuse, “I experience physical pleasure, so I must have wanted it to happen,” and it is normal for survivors of sexual assault to feel guilty for disclosing the abuse and for the fallout it causes in their families (Hagood, 2000; RAINN, 2009).
Anxiety and depression often go hand-in-hand. Think of depression as one side of a coin where the survivor’s emotions (usually anger expressed inwardly because it’s not safe to be angry in the environment) and energy are pushed down, being so low that at times they feel hopeless.
On the other side of the coin you have anxiety, where the emotions and energy are riled up and the person feels a hypersensitivity to everything, danger is lurking around every corner and they feel an impending sense of doom. Both anxiety and depression cause despair and confusion. A survivor may logically know that there is no reason to feel sad or scared in the present moment; but their body has been hijacked in a way, they can’t help but feel something is wrong (Hagood, 2000; RAINN, 2009).
Sleep disturbances, lack of trust in others (even previously close relationships), flashbacks, dissociation, and intimacy problems are all common reactions to trauma and they are all rooted in anxiety and depression. Flashbacks and dissociation are especially common for children who have suffered a traumatic experience because developmentally their psyche was not mature enough to process the experience at the time. As these survivors get older, flashbacks may increase and memories from when they dissociated may resurface as the mind’s way of processing and clearing the trauma.
Robinson, L., Smith, M. M.A., & Segal, J. Ph.D.(2015) also note shock, denial or disbelief, anger, irritability, mood swings, confusion, difficulty concentrating, withdrawing from others, and feeling disconnected or numb as common psychological responses to trauma.
Physical symptoms can include: Insomnia or nightmares, being startled easily, racing heartbeat, aches and pains, fatigue, difficulty concentrating, edginess and agitation, and muscle tension (Robinson, L., Smith, M. M.A., & Segal, J. Ph.D., 2015).
With all of these negative reactions to trauma, it is natural for the survivor to employ coping mechanisms. Unfortunately, the following coping mechanisms are not healthy and can cause further damage:
The survivor may get stuck in a deep sadness, jealousy, anger, or emptiness when thinking of the things non-traumatized people take for granted. They may grieve the things they lost or never had such as: positive childhood experiences, trust, innocence, relationships with family members, a sense of safety/feeling carefree (RAINN, 2009).
Alcohol or substance abuse are often a survivor’s attempt to escape the intense waves of feelings, terror, and helplessness.
Eating disorders are a common expression of taking back control over the body in a way that was denied during the traumatic event.
Self-injury, such as burning or cutting, can be a way for the survivor to relieve intense anxiety that is triggered by memories of the traumatic event. However, this coping mechanism often results in reinforcing the survivors guilt, shame, self-hatred, low self-esteem and other psychological symptoms (RAINN, 2009).
Again, the most important thing you can do for the survivor is offer them nonblaming nurturing support. Being there is enough. Listening when the survivor is ready to talk is enough. This kind of unconditional positive regard can literally help the survivor heal the psychological wounds.
Patience is key. If the survivor is open to it, offer practical support to help them get back into a normal routine (i.e. grocery shopping, cleaning the house, being available to regularly meet with them). Help them relax by encouraging physical exercise, seeking out friends, pursuing hobbies, and engaging in calming behaviors like reading before bed. Encourage, but don’t force the issue. Offer helpful educational information such as the fact that watching television, being on a smart phone, or using a computer two hours before bedtime prevents the body from achieving deep sleep, which exacerbates symptoms (Harvard Health Publications, 2015).
Robinson, L., Smith, M. M.A., & Segal, J. Ph.D. (2015) advise, “Don’t pressure your loved one into talking but be available when they want to talk. Some trauma survivors find it difficult to talk about what happened. Don’t force your loved one to open up but let them know you are there to listen whenever they feel ready.”
In regards to children, they state that it’s important to communicate openly following the traumatic event. Let them know that it’s normal to feel scared or upset. A child survivor may look to you for cues on how they should respond to the traumatic event so let the child see you dealing with trauma in a positive way (Robinson, L., Smith, M. M.A., & Segal, J. Ph.D., 2015).
Finally, don’t take the trauma reactions personally. Your survivor may become angry, irritable, withdrawn, or emotionally distant. Remember that this is probably a result of the trauma and likely has nothing to do with your relationship (Robinson, L., Smith, M. M.A., & Segal, J. Ph.D., 2015). Want a more extensive explanation of trauma responses, how to support your loved one, or instructions for trauma survivors on how to cope and heal? Check out the resources below (after the references)!
Karen Ulep is a Registered Marriage and Family Therapist Intern who works at The Place Within Folsom under the supervision of Suzy Lee, Licensed Marriage and Family Therapist #52675. The wife of a veteran who has served for over 25 years in the Marine Corps, Karen is EMDR-trained and specializes in treating trauma survivors, their families, and those who are suffering due to difficult life transitions, grief and loss, anxiety, and depression.
Briere, J. & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation, and
While this resource was made specifically for transgender sexual abuse survivors and their friends and family, I have found it to be an excellent guide for anyone who has suffered trauma. Specifically, this guide gives practical tools for coping with strong emotions and helping survivors heal. It also has a an excellent section about the brain and trauma: http://forge-forward.org/wp-content/docs/self-help-guide-to-healing-2015-FINAL.pdf
This site was created for survivors of child abuse, incest, sexual assault, rape, domestic violence, ritual abuse, or psychological and verbal abuse and offers a “playroom” with grounding techniques and soothing activities: http://fortrefuge.com/hotlines.html
The International Society for Traumatic Stress Studies offers free downloadable pamphlets for trauma survivors and their loved ones. Be sure to check out all of their public resources and note that many of their fact sheets and pamphlets are available for download in Spanish, Arabic and Chinese.https://www.istss.org/public-resources/public-education-pamphlets.aspx
David Bladwin’s Trauma Pages offer an extensive definitions of the different types of trauma, support for trauma survivors, types of treatment, and related issues such as sleep disturbances: http://www.trauma-pages.com/pg4.htm
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