Traumatic Events and Post-Traumatic Stress Syndromes

Earthquakes, floods, bombings -- the media brings horrific images of tragedy touching the lives of innocents throughout the world into our daily consciousness. We most often associate trauma with natural disasters (hurricanes, fires, floods, earthquakes), crime and victimization (rape, robbery, kidnappings, bombings) and catastrophic accidents (car wrecks, train derailments, airline crashes). But trauma is equally often attached to ordinary life events, such as the death of a parent or another significant person, personal illness or threat of disability, or even witnessing tragedy directly or on television. At some point, each of us experiences an event in our lives which can be potentially traumatic.

Responses to trauma vary depending on the event, the individual's pre-existing ability to cope, and the availability of support for the crisis. Trauma can be embedded in the unique personal meaning of an event, so that two people experiencing the same event may have very different responses. Some events, such as sudden unexpected bereavement or rape, almost invariably result in trauma. The degree to which individuals can effectively cope with the aftermath of traumatic events determines whether or not they will experience dysfunction in their daily lives beyond a "normal" adjustment period, and whether or not they will develop a post-traumatic stress syndrome. The experience of a traumatic event does not automatically lead to developing post-traumatic stress disorder.

If an event has been experienced as traumatic, most individuals will progress through a series of responses which lead gradually to a return to pre-trauma functioning. The initial response to the event may be a combination of surprise, fear, sadness, or anger. This initial recognition or emotional awareness response is typically followed by one of two alternating phases: the denial phase and the intrusion phase. In the denial phase, the individual's most prominent feeling is disbelief that the event has actually occurred, often experienced as refusal to face the memory of the trauma. Individuals may have vivid dreams of life before the traumatic loss, or may find themselves forgetting during the course of the day that a profound change has occurred. Conversely, during the intrusion phase, the individual experiences difficulties concentrating on material other than the traumatic event. Thoughts surrounding the event return repeatedly, and individuals may feel powerless to direct their thoughts or feelings. Nightmares of the traumatic event or of events evoking similar emotional responses may appear. The two phases of intrusion and denial occur over a period, often alternating, until gradually the individual reaches the next phase, in which he or she is able to face the reality of what has occurred. This acceptance phase is usually followed by the completion phase, which is characterized by the individual integrating the changes brought on by the traumatic event and moving forward in life.

While progressing through the phases of a post-stress response, a number of themes commonly occur and are entirely normal. One prominent theme is the fear of recurrence of the event or strong feelings associated with the event, such as panic or terror. Many people experience shame and rage over feelings of vulnerability engendered by the event ("If I wasn't incompetent I would have been able to prevent the accident"). Rage or irrational anger directed at the source or cause of the event is common ("How could you die and leave me now when I needed you most?"). Many find themselves feeling irrational rage or envy directed at those who were exempted from the event ("It's not fair that my best friend has died and yours is still living"). Aggressive impulses can be attached to feelings. Guilt or shame over surviving when others have been killed or injured is yet another common theme.

For most people, these thoughts and feelings gradually fade as normal functioning and daily routines return. A crucial aspect of post-stress recovery is the ability to talk about the traumatic event and its personal meaning. Individuals who are able to recount the details of the event and to reveal to others the emotional impact of the experience are more likely to discover that many of their responses, including fear, anger, shame and guilt are shared by others with similar traumatic experiences. Venting these strong emotions and normalizing these reactions eases the emotional integration of the traumatic event, and allows individuals to face the reality of events and to consider how events have altered their future plans.

The progression through the typical phases of the post-stress response is sometimes disrupted, leading to the symptoms which define post-traumatic stress syndromes. The initial phase of recognition or emotional awareness may be experienced as overwhelming panic, or may result in an emotionally paralyzed state experienced as exhaustion. The denial phase may escalate to extreme avoidance, and the individual may resort to addictive behaviors such as substance abuse to block the experience and awareness of pain. The intrusion phase may intensify into obsessive, disturbing, persistent thoughts and images of the event, and the individual may develop compulsive behaviors to attempt to block the unbidden intrusive thoughts. The failure to progress to the acceptance and completion phases may result in individuals permanently altering their beliefs and expectations regarding their ability to engage in normal life activities, to engage in productive work, to enjoy their leisure hours, and to develop meaningful, satisfying interpersonal and intimate relationships.

Post-traumatic stress syndromes are characterized by (1) a re-experiencing of the trauma, through recurrent and intrusive memories, recurrent dreams, or sudden acting or feeling as if the trauma were recurring in response to an environmental trigger or thought; (2) emotional numbing, manifested by loss of interest in significant activities, social detachment, or constricted emotional expression; and (3) a combination of hyper-alertness, sleep disturbance, survival guilt, difficulty concentrating or remembering, or avoiding activities that evoke memories of the trauma.

Many people who have experienced trauma remain susceptible to developing post-traumatic symptoms long after the occurrence of the event. For some, the recovery from trauma can be a prolonged process, while for others, simply sharing reactions to traumatic events in a non-threatening atmosphere is sufficient to relieve symptoms. Therapeutic interventions for post-traumatic stress often focus on gradual reintegration of avoided thoughts and activities and effective future planning. Many individuals experiencing post-traumatic symptoms have found that support groups whose members have experienced similar traumas are particularly effective.

The Counseling Center offers confidential individual and group services for students who have experienced traumatic events.