Trauma 101: What is it, how it affects us, and how do we heal?

What is Trauma?

The word “trauma” is everywhere these days. The use of the word has skyrocketed on social media with everything from bad haircuts to everyday embarrassing moments being described as “traumatic.” The general sense of the word seems to describe experiences that surprise us, embarrass us, or overwhelm us. This is not necessarily incorrect, but let’s dive into what we mean by trauma from a therapy and mental health lens.

To begin with, trauma can be loosely defined as any event that occurs to a person in which they are caught off-guard, overwhelmed, and lack the coping skills to handle as the event is occurring. Much like a physical wound, trauma is characterized by an inability to protect oneself, feelings of helplessness, and a sudden quality to the event. Trauma is about what is outside of our control and the things we could not fight back against.

Big “T” and little “T” trauma

Therapeutically, it is important to distinguish between small traumas, which therapists call little “t” traumas and then large traumas, referred to as big “T” traumas. Little “t” traumas include things like bullying, emotional neglect, financial insecurity, and minor accidents. These events are often minimized, but if there is chronic exposure or several incidences in a lifetime they can add up and leave a lasting psychological scar.

Big “T” traumas include the typical horrific things that people tend to think of when we talk about trauma or post-traumatic stress disorder (PTSD). Big “T” traumas are things like rape, war, life-threatening violence, severe abuse or neglect, torture, major accidents, and natural disasters. These lists are not exhaustive. The differentiation between a little “t” trauma and a big “T” trauma is a personal one and really depends on the capacity an individual has to process what has occurred and also the support they receive. Time and length of exposure is also a factor that influences the development of trauma-related symptoms. Each person is equipped to handle things differently and experiences things differently, so the differentiation is a loose guideline and it is up to the client in therapy to distinguish the significance of the impact.

Identity and Intersectionality

Our identity plays a huge role in the support we receive and the types of traumas we experience. The list of specific data on identity and trauma is quite long and maybe I will continue to unpack this in further posts because it is 100% worth discussing!! In general, risk factors go along with broad social determinants: race, gender, sexuality, class, citizenship status, ability, and age. Each part of our identity intersects and shapes the way we do or do not receive support and care. Any of these factors can increase the likelihood that a person is targeted by a predator and exposed to trauma. In general, belonging to the culturally dominant and more powerful group (ex: adults vs. children) in any of the above-mentioned categories will reduce risk of exposure and also increase protection and support in the case a traumatic event does happen. Another issue that I’ve seen, is that folks who have multiple marginalized identities are more likely to have a stack of trauma and not just one event. Every social factor matters and plays a role.

A perfect example of how identity influences trauma is the not-often-discussed statistic that 61% of bisexual women experience some kind of intimate partner violence (IPV) in their lifetime versus only 35% of heterosexual women. Intimate partner violence includes rape, physical violence, and/or stalking. That is truly horrifying and is one of many reasons why as a therapist I always consider identity when working with my clients. People often don’t realize they have been targeted, but from a zoomed-out perspective it becomes clear that justice and safety are not the same for all individuals.

Many folks have little protection and are at an increased risk and yet the cultural narrative often frames survivors of violence as unstable or over-reacting. This leads to more shame and isolation which is the exact opposite climate for healing! Shame, othering, isolation, and victim-blaming can actually lead to further traumatic events as survivors find themselves side-lined to the margins more and more with compounding consequences like job loss, missed opportunities, and more exposure to trauma. Therapy should not be one more place to carry things alone and victims sometimes suffer from the mentality that “if all these bad things happened so many times, then maybe I’m the problem?” rather than the much sadder, but truer realization that they were victimized. No one wants to feel like a victim, but the reality is many people are harmed by others repeatedly and do not receive adequate support and protection.

The Role of The Nervous System

Let’s take a moment to discuss the role of the nervous system. As a reminder, our nervous system is made up of our brain, spinal cord, and nerves. It is the executive system of our bodies that governs how we think, feel, move, talk, etc. Every sensation and experience in our lives is coded into the brain via our nervous system. For your average experience, our nervous system takes in information via our 5 senses and encodes it into our brain. Our brain is then left to make sense of this data. Our brains encode experiences into memory and these memories are stored in our brain and integrated into our cognitive understanding (our thoughts). This is why our experiences influence our thought patterns so heavily. Repeated experiences create repeated thoughts and memories and we as humans weave these into stories, meaning, values, etc.

So, how are traumatic experiences different than the everyday ups and downs of life? In a traumatic event, let’s say a car crash, the sensory input we are receiving via our bodies is very unfamiliar and happening suddenly. For example, we might be in our car at peace one moment and the next moment the car is flipping over. Our bodies have never been in this situation before. The fight or flight system of the brain beginning in the amygdala is activated and our bodies release stress hormones, adrenaline and cortisol, automatically as a response. The effect is that our heart rates elevate, our pupils dilate, and our everyday systems such as digestion and memory formation are shut down to some extent. The brain and body only has so much energy and we are designed to jump into emergency mode when we are met with something our bodies perceive as a threat to survival. Some processes go out the window and the more immediate survival-related processes automatically take over.

Because of this activated state our memory formation process in the hippocampus is interrupted. This leaves us with unintegrated memories. The event of a car crash becomes a fragmented memory in our thoughts. We find ourselves disoriented, for example this might look like vividly remembering the moment before the crash, then having a memory block for some parts of it, and then having other vivid and discombobulated memories of the aftermath.

The overwhelming feelings we feel during these events characterize our memory instead. Our body physically remembers panic, overwhelm, fear, helplessness, and our survival instinct kicking in. From this event, our mind and body might form a core memory and belief system related to the trauma. This might sound something like “I am never really safe” or “I always have to be scanning for threats." These core beliefs become problematic when they subconsciously impact our choices and behavior long after the traumatic event. For example, developing a fear of highway driving or even leaving your house. We are often unaware of our distorted core beliefs and therapy can help us shed light on these processes and name them.

Specifics on Relational Trauma

Relational trauma such as interpersonal violence, rape, and emotional abuse are very problematic to our well-being, but unlike the aftermath of a natural disaster or car crash, the scars are sometimes not visible to others and can go buried and unrecognized. However, these events do leave scars. They deform our ability to feel safe around other people, safe in our own bodies, experience pleasure, and form healthy connections. The effects of relational trauma on the brain can include difficulty telling the difference between safety and danger, lack of trust in your decisions, difficulty planning, memory issues, being attracted to emotionally unavailable or unsafe people, reliving the event in nightmares or daydreams, and dysregulated emotions.

Symptomatically, the hallmark of all trauma is dysregulated emotions. Some people experience over-regulation in which they become rigid, strict with themselves and others, numbed out, overly independent, argumentative, and/or defensive. Others experience under-regulation which can look like being extremely sensitive, fragile, tearful, prone to emotional overwhelm, fixated on others, easily influenced by other people’s emotional states, and stuck in a cycle of constant worrying. Many people who have survived relational trauma experience both extremes often swinging from one to the other in an exhausting cycle.

Dissociation and Escape

This pattern of emotional polarity eventually leads to mental burnout and dissociation to avoid feeling the overwhelming feelings. Dissociation is like taking a break from it all. It is a numbing experience that allows you to escape from the cycle. Common forms of dissociation include: mindless scrolling on social media, zoning out, fixating on other people, working in excess, always being busy, needing to be moving or doing something constantly, and addictions. Dissociation in small doses, like bed rotting on tik tok, is a normal part of everyone’s life, but for the traumatized person dissociation feels urgently needed on a regular basis. Sometimes, it is so bad that people can hardly even control it.

Many folks with Post-Traumatic Stress Disorder (PTSD) report dissociative episodes that might come with uncharacteristic substance use, high risk behavior, and increased suicidal thoughts or plans. Other folks experience passive suicidal ideation, which is like a low-simmer background of suicidal thoughts, as the new normal after a traumatic event. This is especially true for individuals who were traumatized when they were helpless as many survivors of sexual assault and abuse can relate to. This type of relational trauma is rooted in violence, predatory behavior, and victims are often selected by their abuser due to vulnerabilities and access. This can leave survivors reeling in blame and shame as well as confusion about what occurred. No one is to blame for the shameful behavior of a predator and I hope every survivor knows that they are not to blame for what happened no matter their reaction or the circumstances and no matter how many times it happened. Period!

Healing and Post-Traumatic Stress Disorder (PTSD)

As an optimistic reminder, only 10-20% of people that experience a traumatic incident (think big “T”) end up developing PTSD. That is not as high as you might expect! That being said, you do not need to have full-blown PTSD to feel the impact of trauma on your nervous system.

Healing from trauma is a process of unburying and reprocessing the traumatic incident(s) and then gaining awareness of residual symptoms and the way they continue to show up. All symptoms were once survival strategies, but life moves on and you don’t have to remain stuck in the painful loops of the past.

As a survivor of sexual assault and a therapist, I have spent much of my professional life studying specifically sexual assault and abuse in order to understand my own past and help heal others. I understand from both ends of the experience. Therapists need and go to therapy too! We are all humans. It can be painful to come forward in therapy. It can feel confusing and awkward to talk about what happened and some folks even bury it so deeply it takes years to even identify and name the harm. It is critical to get support and always know you are not alone! It is my hope that with more understanding of the physical processes that happen during trauma we can all learn how to better support ourselves and others. We never know the hidden scars that those around us are carrying.

I hope this post helped explain and I will continue writing and breaking things down. It is impossible to cover everything in one post, but there will be more to come. I am sending love and healing to anyone reading! You are not alone.

Sources:

Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. Sage Publications, Inc.

Corey, J., Duggan, M., & Travers, Á. (2023). Risk and Protective Factors for Intimate Partner Violence Against Bisexual Victims: A Systematic Scoping Review. Trauma, violence & abuse, 24(4), 2130–2142. https://doi.org/10.1177/15248380221084749

Levine, P. A., & Frederick, A. (1997). Waking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. North Atlantic Books. [1, 2,3]

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

Zohar, J., Amital, D., Cropp, H. D., Cohen-Rappaport, G., Zinger, Y., & Sasson, Y. (2000). Update on the epidemiology, diagnosis, and treatment of posttraumatic stress disorder. Dialogues in clinical neuroscience, 2(1), 37–43. https://doi.org/10.31887/DCNS.2000.2.1/jzohar