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Trauma

Am I experiencing trauma?

Trauma is not always easily recognizable in ourselves. How do we spot when we may be seeing or having a traumatic reaction?

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The cycle and stages of medical trauma

 

Stages of Medical Trauma

  1. The traumatic event: a skin cancer biopsy.

  2. This results in physical pain, mental stress, and emotional exhaustion.

  3. While recovering days after the biopsy, our tissues begin to heal, stress response hormones normalize, and emotional responses begin to fade.

  4. We return to “normal,” which may require hiding fears of pending biopsy results, downplaying insecurities of a change in physical appearance, and pretending like, “It’s all good… a skin biopsy is no big deal,” in an effort to make everyone around them feel better.

  5. Until one day, a new concerning spot is discovered and the person needs another biopsy. This time, the person notices that the physical, mental, and emotional responses are bigger and harder than the first time. This may leave the person questioning, “What’s wrong with me? I’ve been through this before, I know exactly what to expect.”

  6. It’s okay. As your treatment goes on, it makes sense that difficult emotions can compound. It doesn’t always get easier, and you don’t have to diminish your experience. Talk to your health care providers about treating your trauma, so that you can interrupt the cycle and strengthen your resilience as a survivor.

“Trauma reactions are incredibly boundaryless, so sometimes instead we try to control everything else” 

Jane McCampbell, Integrative Trauma Healer.
How to Spot Traumatic Reactions
  • Guiding question: Is or was your reaction out of proportion to the situation at hand?
    • Too big: Shrill, angry, defiant, fearful
    • Too small: Denied, ignored, belittled, shut down, or confusing
    • If it looks or feels confusing, it probably is - which is valid!

There are more clues you may be seeing or having a traumatic reaction which include denial or minimization, uncontrolled anxiety or hypervigilance, and desperate attempts to control one's environment and everyone in it.

Often when we're discussing controversial topics like politics, some may show traumatic reactions through knee jerk opposition. Notably if it’s one specific issue that triggers someone to shut down or become unreasonable to debate, that can be a sign of trauma.

We do need to be upset and outraged by a lot going on, but if there’s one thing that is particularly aggravating then it’s worth recognizing, “Maybe there’s a little bit of trauma there. I wonder what that is about. How does this impact my life and relationships with others?”

Read more about Medical Trauma Q & A with Social Worker, Vanessa Hausman, MSW, LICSW

  • The word “trauma” gets thrown around a lot. How is medical trauma defined?

    Trauma can be defined as one or more significant events that elicit noteable emotional distress. Trauma can occur to an acute or complex degree. One such example is a prolonged hospitalization in which an individual’s privacy may have been disrupted, they perceived a lack of control, and any sense of security was diminished.  Additionally, when there is no good answer to the age-old question, “Why did this happen to me?” our brains can start to feel like the world is unsafe, which can contribute to medical trauma.

  • How might the effects of medical trauma show up in a person?

    A hallmark indication of trauma is often hypervigilance. An individual’s brain may be constantly scanning the room to determine what they need to do to protect themselves. Frequent reminders of distressing events can cause distraction or avoidance. These symptoms can occur on a regular basis and other times are triggered by re-visiting the clinic or the anniversary of a procedure. Additionally, trauma can manifest into symptoms of anxiety or depression such as muscle tension, upset stomach, jittery or shaky knees, heart racing, irritability, the urge to shut down, low motivation, or decreased interest in previously enjoyable experiences.

  • Can caregivers experience second-hand trauma?

    Absolutely. Research has provided new insight into “secondary” or “vicarious” trauma. This phenomenon occurs when you are exposed to someone else’s trauma by way of watching and listening. Caregiver’s may experience a deeper sense of helplessness and are equally impacted.  In many ways, caregivers are at an increased risk of developing a mood disorder, due to their sole focus on caring for their loved one. They may find limited opportunities to engage in self-care, which contributes to vulnerability for altered functioning.

  • Do the effects of trauma show up right away or could it be months or years later?

    Commonly the effects of trauma may arise after the fact. When an individual is in the midst of treatment, they are in survival mode, just working hard to get through each day. Once remission is established, this may be the first opportunity to truly process complex emotions related to medical trauma. Caregivers, on the other hand, might not feel the impact until years later. Once their loved one is home from the hospital, their role as caregiver becomes even more hands-on and robust, as they provide care without the daily support of medical professionals.

  • What should a patient or caregiver do if they've experienced medical trauma?

    We all experience certain levels of anxiety at times, but when it starts to impact functioning, impedes your ability to get care, makes you unable to focus at school or work, or is keeping you from participating in relationships, it is important to talk to someone who can help. Contact your medical team and let them know how you’ve been feeling.

How to Spot Post Traumatic Stress Disorder (PTSD)

A person may have a traumatizing experience without developing PTSD. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines the symptoms that must be present for a diagnosis of PTSD. These are true for children over the age of 6 and adults. Often, PTSD related to medical trauma is missed or not diagnosed. This may be because healthcare teams are focused on caring for physical health diagnoses and forget to look for or ask about mental health diagnoses. Additionally, your healthcare team may not know enough about PTSD to bring it up, or how to help you if you screen positive for it. Consider the following symptoms that are present in a person with PTSD. If you think you might have PTSD, one way to start that conversation with your healthcare team is to print this PTSD screener, fill it out, and take it to your next appointment. It can be the first step in getting help for your trauma. Remember, you don’t have to qualify for a full PTSD diagnosis in order to get help.

If you have experienced any amount of trauma, mental health services can help decrease your symptoms and improve your quality of life. The Veterans Administration has some of the best developed tools for helping with PTSD. Though medical trauma is different from war trauma, there are many similarities. To learn more about PTSD and to explore additional resources for you and your family, check out the National Center for PTSD. 

 

PTSD Diagnosis

A person must have exposure to trauma in ONE of the following ways:

  1. Directly experience the traumatic event
  2. Witness the event occurring in person to another (seeing pictures or watching bad things happen on TV doesn’t count)
  3. Hear about a traumatic event happening to a loved one, close family member, or friend
  4. Have repeat exposure to something traumatic happening (like in the example of the skin biopsy described in the diagram above) 

 

A person must also have ONE or more of the following symptoms that feels related to the traumatic event and begins after the event:

  1. Distressing memories of the traumatic event. These may happen out of the blue or be triggered by the occurrence of a similar event. They tend to come on without the person consciously trying to remember an event, and they can be quite disruptive. 
  2. Recurring bad dreams or nightmares about the traumatic event or in some way related to it.
  3. Flashbacks to the traumatic event or feeling as though the mind and body are disconnected. A person may feel “spacey” or “zoned out” when triggered by trauma. They may forget large chunks of time as a way to protect themselves from trauma. 
  4. Intense or long lasting psychological distress when something reminds them of the traumatic event, or they are feeling retraumatized. This could include anxiety or panic.
  5. Psychological reactions to symbols or reminders of the traumatic event(s). 

 

A person must have the desire to avoid things associated with the traumatic event. This often results in either or both of the following: 

  • Trying to avoid the memories associated with the traumatic event 
  • Trying to avoid things that remind them of the event such as anniversary dates, places such as the hospital, or even people associated with the trauma. 

 

A person must have negative changes in mood and thoughts because of the traumatic event(s). These changes in mood must start or worsen after the traumatic event(s). A person must experience at least TWO of the following:

  • Forgetting important parts of the traumatic event
  • Ongoing and extreme negative thoughts, believes or expectations about themselves or certain situations

Ongoing negative emotional state:

  • Decreased interest in activities that were previously seen as important or enjoyable
  • Feeling detached or disconnected from others
  • Ongoing lack of positive emotions

A person must also have changes in their behavior and the way they react to certain things associated with the trauma. A person must experience TWO of the following:

  1. Irritability or anger, which may be expressed as verbal or physical aggression
  2. Reckless or dangerous behavior
  3. Hypervigilance, or the feeling that the person always has to be “on alert”
  4. Becomes more easily startled by sounds or other stimulus
  5. Difficulty concentrating
  6. Difficulty sleeping, staying asleep, or falling asleep 

 

For a diagnosis of PTSD, the symptoms described above must last more than one month. They must cause distress that is significant or impair functioning in various areas of life, such as relationships, work, ability to care for oneself, and the symptoms must not be related to outside influences, such as drug or alcohol use, or the underlying medical diagnosis. For example, if a person has a brain tumor in a part of their brain that changes their emotions or reactions to events, that would not be considered PTSD. Drug or alcohol use does not mean that a person doesn’t have a diagnosis of PTSD. The important thing is making sure the symptoms started before the drug or alcohol use, or continued after stopping it. It is common for people who experience PTSD to self medicate with prescription medication, non-prescription drugs, or alcohol. 

In many ways, PTSD shows the same signs of trauma that are discussed above: Hypervigilance, minimization, or out of proportion emotional reactions. Other signs include dissociation from our body or unexplained physiological reactions like hives or panic attacks.

Looking at our sleep can be a helpful way to spot PTSD specifically. It might be PTSD if there are troubles with "busy brain" when quieting our mind for bed, or if we are dependent on the sound of radio or TV to fall asleep. Along these lines, another hint could be if we experience frequent "twilight jerks" due to nightmares.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th Edition. DSM-5.

Covid-19 and reemerging Trauma

We know traumatic events are when something happened, and traumatic reactions are how we respond later on over time. What is important to realize is that not all traumatic events lead to ongoing traumatic reactions.

In fact, the first triggering event is usually easy to handle. We can frame an event to its specifics. We carry that traumatic event with us and often forget about it until something reminds us of it.

Anything can remind us of a traumatic event - a sound, feeling, or smell - and when we experience that sensation, it can send us reeling back to the first traumatic event. We start to notice our ongoing traumatic reactions to triggers when those sensations continually cause us to feel like the traumatic event is happening all over again. 

How does Covid-19 affect trauma?

This is a widespread traumatic event. For some it’s their first experience with medical trauma, but for many others this is a reawakening. If you have difficulty breathing, a compromised immune system, or need routine testing - Covid-19 is providing a second traumatic event that becomes increasingly hard to ignore. To a certain extent - everyone is dealing with the aftermath and trauma that Covid-19 has caused.

If it feels like we all have trauma - you’re right! The world has been rapidly changing since 2020, and there is widespread trauma that feels overwhelming.

So what can we do about it? The first step is engaging and understanding your own trauma, and you’re already here. Let’s take another deep breath here, and look at practices to help cope.

If it feels like we all have trauma - you’re right! The world has been rapidly changing since 2020, and there is widespread trauma that feels overwhelming.

So what can we do about it? The first step is engaging and understanding your own trauma, and you’re already here. Let’s take another deep breath here, then let's learn more about practices to help cope with trauma.

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