Just about everyone is stressed out these days, between the COVID-19 pandemic, back-to-school uncertainty, and rising unemployed rates. But in some cases, the emotions people experience are more than just a reaction to today’s troubling times. For some, their anxiety and fear are rooted in unresolved past trauma or current trauma due to loss or extreme circumstances.
Experiences become traumatic when they overwhelm our ability to cope. While the symptoms of situational stress – sadness, hopelessness, fear, anxiety, diminished interest in social activities or trouble sleeping – may mimic the symptoms of a response to unresolved trauma, they are far less likely to be associated with problems functioning at work, at school or other everyday situations. While a Post-Traumatic Stress Disorder (PTSD) diagnosis involves many of the same symptoms as situational stress, there are four categories of symptoms that are particular to PTSD: Intrusive memory and recall; avoidance; negative alterations in cognition and mood; and arousal and reactivity.
To receive a diagnosis of PTSD, these criteria must be present for at least a month, and they must cause significant distress or impairment in social, occupational, or other important areas of functioning. If the duration is less than a month, a person may instead have an acute stress disorder, which has similar symptoms but a shortened experience. Here, simple stress-busting techniques like exercise, meditation, healthy eating or counseling may help significantly.
Problems with intimacy, trust and control are tell-tale signs of trauma
People experiencing a trauma response often have difficulties in the areas of intimacy, trust, power and control, self-esteem and safety. In the pandemic, many of us had our sense of power and control ripped out from under us, and it has affected the way we parent, the groceries we purchase, how we approach spending and financial planning, and our need to connect with friends and family. But those who are experiencing the pandemic as stress are typically capable of shifting to other thoughts, easily finding activities where they can forget their concerns and relax. They may display some worry and irritability, but to some degree they can maintain a feeling of control in their lives.
However, for others, the pandemic may trigger adverse events or feelings from their past. For example, if a person experienced a sexual assault, the feelings around trust, control, self-esteem and safety brought up by the pandemic could contribute to a more intense experience of powerlessness.
The signs can be subtle, and people are often not thinking consciously about the trauma at the root of their behavior. They may have memories of a trauma that happened when they were 13, but they may not realize on a conscious level their response to the pandemic is triggering those prior emotions and experiences. That individual may perceive she is anxious because of back-to-school uncertainty, but when we take a closer look at her symptoms in a self-assessment, it becomes clear there is a connection to the past that must be addressed to help resolve her current symptoms.
Intrusive thoughts are common among those with a trauma response
One of the hallmarks of a trauma response is intrusive recall, where a thought or an image related to the trauma experience will suddenly intrude, even in the most unexpected moments. This can be debilitating. The thoughts can be about themselves or the person that was involved in the trauma, perhaps where it took place, or other details. For example, if a child was mocked or screamed at during dinner, the intrusive image may be what his plate looked like just before the rage escalated, or his father’s disgruntled face.
Intrusive recall also happens in the form of nightmares. It's not always a nightmare that involves that specific trauma, but it may have similar content or themes. Perhaps the trauma was sexual abuse, but the nightmares are not necessarily about sexual abuse but instead about being pinned down and not being able to get up, or not being able to move in a situation – the feeling of powerlessness. It could involve a general theme of trying to run away from somebody.
The other intrusive system we see frequently is dissociation, where a person is physically present but seems to have checked out mentally, like they are not even in the room. Often, they are visualizing and feeling as if they are in that experience all over again. The part of their brain that keeps track of “the here and now” is confused about whether what they are feeling is a memory or something happening in the present. In that situation we use grounding techniques, reorienting them to the room and their present environment to get them out of the dissociation. Trauma rewires the brain and people cannot just “snap out of it.” They need therapy and tools to help them safely manage their emotions and cope in a healthy way.
Many people are experiencing trauma for the first time during the pandemic. There are the harrowing experiences of healthcare professionals caring for COVID-19 patients, dealing with death day after day with no relief or loved ones unable to say goodbye when a family member passes away. The subsequent PTSD that can result from these experiences in recent months should not be minimized.
While I haven't treated anyone yet who's had a trauma diagnosis stemming from direct experience with COVID-19, I imagine several months from now we'll start seeing those individuals just as we did in the aftermath of 9/11. There’s no doubt we will continue to deal with the emotional after-effects of the pandemic for years. We want to validate people’s experiences and encourage them to address their trauma before it causes greater physical or emotional harm.
The health impact of unresolved trauma
Unresolved trauma can have a tremendous impact on a person’s health. And I say unresolved trauma because it is possible to heal and move beyond trauma. Just because someone had a traumatic experience in their past doesn’t mean they will automatically need treatment for it.
During stress, the body responds by stimulating the adrenal glands to produce cortisol, adrenaline and noradrenaline to help us prepare for action in times of danger. These hormones can even show up in times of worry. They play an important role in keeping you safe, but they are not meant to circulate in the bloodstream for long periods of time. Extreme, prolonged stress may diminish your body's ability to perform at its full capacity, which can lead to physical or mental health symptoms including burnout. Burnout can leave you disinterested in work, reckless, tense, and forgetful, with difficulty concentrating. Someone who has experienced trauma may have stronger and more frequent surges of adrenaline from their heightened responses and perception of danger, which causes wear and tear on the body. There are absolutely health impacts from unresolved trauma.
Unresolved trauma puts people at increased risk for mental health diagnoses, which run the gamut of anxiety, depression and PTSD. There are physical manifestations as well, such as cardiovascular problems like high blood pressure, stroke or heart attacks. There has been research to connect unresolved trauma to fibromyalgia and general inflammation in the body, which can lead to autoimmune disorders and organ fibrosis. Obesity and cancer are also associated with unresolved trauma. Finally, unresolved trauma puts people at higher risk of substance use disorder, as substance use is often initiated or increased after trauma.
Why it’s important to know that your symptoms could be trauma
These are challenging times for everyone, but if an individual is suffering or turning to substances as a way of coping, an assessment may be helpful to determine if unresolved trauma is contributing to problematic behavior. People can successfully recover from trauma, and distinguishing whether symptoms are trauma related vs. stress related is an important first step to prevent further impact and begin to heal.
In a future post, I will discuss different approaches to trauma treatment and the importance of ongoing support.
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