Understanding Complex Trauma & PTSD
“Some people’s lives seem to flow in a narrative; mine had many stops and starts. That’s what trauma does. It interrupts the plot…It just happens, and then life goes on. No one prepares you for it.”
- Jessica Stern, Denial: A Memoir of Terror
What is trauma?
Trauma is defined not by the event(s) that happened to us, but by the response our nervous system has to those event(s). By this definition, what is experienced as traumatic for one person may not be experienced as traumatic for another person.
Stress is an experience that every person is familiar with to varying degrees, and stress and trauma exist along a continuum.
“A stressful event becomes a trauma when we feel overwhelmed and powerless.”
-Dr. Hillary McBride, The Wisdom of Your Body
Trauma can include what we may normally think of as a traumatic event, such as a natural disaster, war, sexual assault, a tragic car accident, etc. However, trauma can also include non-life-threatening injuries, emotional and spiritual abuse, racism, bullying, loss of a significant person, unplanned expenses, job change, divorce, death of a pet, moving, etc.
“Trauma occurs when something negative and unexpected happens, and it leaves us feeling confused, overwhelmed, and powerless.”
-Dr. Rick Bradshaw
Complex Trauma
Trauma can be a one-time event; but it can also be an event that occurs repeatedly.
“When hurts occur repeatedly at the hands of those who are supposed to protect us, or when there is no safe place to return to, we call this complex trauma…It often means that we never learned it was safe to trust, which leaves us feeling desperately alone inside without knowing how to be connected.”
-Dr. Hillary McBride, The Wisdom of Your Body
Because trauma, by definition, makes one feel out of control and powerless, children, especially in the pre-verbal years (ages 0-2 years old), are especially vulnerable to experiences of trauma, both singular traumatic events as well as on-going complex trauma. During the ages of 0-2, the brain and body are developing at an extremely rapid rate, and trauma has an especially potent impact on the developing brain.
For more information about the long-term effects of trauma in children, check out the groundbreaking research done on Adverse Childhood Experiences.
“Trauma…almost always makes it difficult to engage in intimate relationships…affects the imagination…It changes not only how we think and what we think about, but also our very capacity to think.”
-Dr. Bessel van der Kolk, The Body Keeps The Score
Lasting Impacts of Trauma
Trauma can lead to both serious mental mental health conditions as well as serious physical health conditions. Trauma can sometimes, but not always, lead to a diagnosis of Post-Traumatic Stress Disorder, which includes specific criteria such as flashbacks and/or nightmares. Trauma can also be a contributing factor in the development of personality disorders, eating disorders, anxiety disorders, depression, mood disorders, behavioral difficulties, and many other mental health conditions. People who experience trauma may use substances or other addictive things (such as gambling, video games, food, sex, etc.) to cope.
These things in and of themselves are not inherently bad.
However, when an individual becomes addicted, it can lead to substance use (and other addictive) disorders that can be incredibly disruptive to one’s life and relationships.
Individuals who experience trauma may also try to cope with self-harming behaviors and suicide. If you are experiencing self-injurious behavior or are having suicidal thoughts, please contact the National Suicide Hotline at 988 (text or call) or go to your nearest emergency room.
Trauma and Your Body
Trauma is always an experience in your physical body and your nervous system, and trauma can sometimes cause or exacerbate physical health conditions, such as chronic pain, high blood pressure, migraine disorder, fibromyalgia, diminished immune response/frequent sickness, and autoimmune disorders (just to name a few).
Trauma Responses
Fight, Flight, Freeze, Fawn
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“Fight” is defined as facing a perceived threat with aggression. A fight response can take the following forms: tight jaw or grinding of the teeth; urge to punch someone or something; feeling intense anger or killing someone, even yourself; desire to stomp or kick; crying; glaring at people; upset stomach (feels like knots or burning); and attacking the source of the danger.
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“Flight” is defined as running away from the danger. The following emotional and physiological responses indicate you may be in flight mode: excessively exercising, feeling fidgety or tense or trapped, restless body that will not stop moving, sensation of numbness in extremities, and dilated or darting eyes.
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“Freeze” is defined as being unable to move or act against a threat. The following may be indicators that you are having a freeze response: pale skin; sense of dread; feeling stiff, heavy, cold, numb; loud, pounding heart; and decreasing heart rate. This is also where dissociation, a very common trauma response, comes in. Dissociation is defined as disconnecting from one’s thoughts, feelings, memory, or sense of identity. Dissociation may have developed if you were in a traumatic situation that you were unable to escape (such as an abusive home, repeated sexual assault(s), or a tragic accident). In the moment, you may have used dissociation as a very adaptive coping mechanism to prevent yourself from needing to be present within the experience. However, just like all trauma responses, what began as an adaptive response that likely saved your life, when utilized over and over again when a threat isn’t actually present, can become unhelpful and even harmful. Dissociation may have helped you survive the traumatic event (or series of events in the case of complex trauma), however, when it is utilized too often, it creates a sense of disconnect from the people and world around you, and yourself, which prevents you from living life to its fullest and developing new memories.
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“Fawn” is defined as immediately acting to try to please in order to avoid a conflict or threat. The fawn response is often found in people who grew up in abusive families or in individuals who experienced complex trauma. You may recognize a fawn response in yourself by noticing that, despite being treated poorly by a person, you continue to prioritize their needs over your own.
When a fight/flight/freeze/fawn response has been activated, the following physiological symptoms may occur:
Eyes: the pupils dilate. Allowing your eyes to take in more light improves your eyesight so that more attention can be dedicated to danger. You might notice a "tunnel vision" or realize that your vision becomes "sharper."
Ears: the same concept for the eyes applies to the ears. You will notice that your ears essentially "perk up" and your hearing can become "sharper."
Heart: heart rate increases, and there is a dilation of coronary blood vessels. A faster heart can feed more blood, oxygen, and energy into the body, enhancing your power to run away or fight.
Lungs: breathing quickens and becomes shallower. Again, this quicker breathing takes in more oxygen for your muscles.
Skin: you become pale, and your face gets flushed. Blood vessels in the skin contract, directing more blood where it is needed - the muscles, brain, legs, and arms. Your hands and feet get cold because of this too.
Muscles: your muscles tense up all over the body, becoming primed for action. Because of this, your muscles might shake or tremble, particularly if you are not moving.
Stomach: you may get nausea or "butterflies" - blood is diverted away from the digestive system, which can cause these feelings.
Mind: thoughts begin to race. This quicker thinking can help you evaluate your environment and make rapid decisions, if necessary. Hence, it can be challenging to concentrate on anything other than the danger you perceive. You may also feel dizzy or lightheaded if one does not actually run or fight under the trigger.
Pain: your perception of pain temporarily reduces while under the fight or flight or freeze or fawn trigger.
