Psychological trauma is defined by the experience of an extremely stressful event, which is perceived to be life-threatening, and overwhelms our psychological coping mechanisms (APA, DSM 5). This can be accidents, natural catastrophes, loss or bereavement, or experiences of violence or abuse. It can also involve witnessing others having those experiences. It is not necessary that the event is objectively stressful or life-threatening, but that it is subjectively perceived as such.
Normally, in stressful events, our body triggers the so-called ‘fight or flight response’ (Siegel, 2015; Cozolino, 2010). This equips us to either fight the threat, or to outrun it. When the situation has passed, our stress-levels return to normal. This process is in itself not problematic. However, when an event is perceived as extremely threatening, but we cannot either fight it or flee from it, our system becomes overwhelmed and responds by a ‘short'-circuit’ response, also called ‘dissociation’, or ‘freeze response’. This is referred to as psychological trauma. The key to it is the experience of extreme threat combined with powerlessness and helplessness.
A classic diagnosis for this is PTSD (DSM 5), which includes symptoms such as distressing memories/flashbacks, dreams, high levels of anxiety, irritability, insomnia, depression, lack of concentration, and a strong desire to avoid situations reminiscent of the traumatic event.
It is of course possible to recover from this response, and many people manage this without psychological help. However, if you are struggling with these symptoms, therapy can be an effective support.
A diagnosis of PTSD is usually applied to symptoms following a discernible event, often in adulthood.
However, research is increasingly focusing on the effects of trauma during childhood (van der Kolk, 2014). It is shown that children are psychologically more vulnerable to trauma than adults, as their psyche is only just developing. Particularly relational trauma, i.e. maltreatment in the form of abuse or neglect, can have a strong impact on the emerging psychology of a child, and can have effects lasting into adulthood (Fonagy et al, 2002; van der Hart et al, 2006; Ruppert, 2013).
This can be referred to as Complex PTSD, among other things (DSM 5).
It is thought that many psychological and relationship problems people bring to therapy as adults can be related to traumatic experiences during childhood, even if these have been forgotten, or not been consciously perceived as traumatic at the time (van der Kolk, 2014).
There is also mounting evidence that many physical health problems, such as hypertension, or obesity, can be related to childhood traumatic events (Felitti et al, 2000':ACEs).
Also psychological problems and behaviours related to addiction, such as drinking, smoking, overeating, or gambling are increasingly linked to childhood trauma, and it is thought that they can be compensation behaviours to try and manage emotional distress (Felitti et al, ACE; Mate, 2018).
It is being shown that psychotherapy can be an an effective intervention with complex PTSD and childhood trauma, and related distress and disorders. Depending on the severity of the traumatic history, sometimes longer-term therapy can be indicated.
references:
Adverse Childhood Experiences Study (ACE): https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html
American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Washington, D.C.: American Psychiatric Association.
Cozolino, L. (2010) The Neuroscience of Psychotherapy: Healing the Social Brain. New York: Norton & Company.
Fonagy, P., Gergely, G., Jurist, E. L. & Target, M. (2002) Affect Regulation, Mentalization and the Development of the Self. New York: Other Press.
Mate, G. (2018) In the Realm of Hungry Ghosts: Close Encounters with Addiction. London: Vermillion.
Ruppert, F. (2013) Trauma, Fear and Love. Hove: Green Balloon Publishing.
Siegel, D. (2015) The Developing Mind (2nd Edn): How Relationships and the Brain Interact to Shape Who We Are. New York: Guildford Press.
Van der Hart, O., Nijenhuis, R. S. and Steele, K. (2006) The Haunted Self. New York: Norton.
Van der Kolk, B. (2014) The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. London: Penguin.