“That narrative kept going over and over, and I couldn’t get the loop out of my head,” she says. With each replay, she recalls, she ruminated on whether her brother suffered before his death — and she became increasingly worried someone else was going to die. “The safe predictable world you once knew is gone. When my brother died, I didn’t feel like my parents could protect us. I felt my brother died, so I could die.” Dr. Horsley’s younger brother died when she was 20 years old. Her experience as a young adult eventually prompted Horsley to become a therapist who specializes in grief and trauma. Now an adjunct professor at Columbia University in New York City and the executive director of the Open to Hope Foundation, Horsley says trauma, and its impact on mental health, is widely misunderstood. Society often expects survivors of emotional trauma to recover much faster than is realistic — to stop talking about the event and move on in a matter of weeks or months. As a result, many individuals come to believe they are suffering from a mental health condition like post-traumatic stress disorder (PTSD) when their reaction may be not only normal but healthy, she explains. “That’s where people get it wrong,” Horsley says. “[If, for example,] you were assaulted, it is normal to feel like the weight of the world is on you and you have no energy.” While a certain percentage of individuals do develop mental health conditions, especially PTSD and depression, after a traumatic event, most people recover naturally with time and good social support. In fact, a strong emotional response to trauma may be key to ensuring long-term recovery, Horsley says. Psychological trauma generally stems from an experience that causes a person to believe in that moment that they, or someone else, is about to die, according to April Naturale, PhD, the assistant vice president of national crisis and wellness programs at Vibrant Emotional Health in New York City, who specializes in helping individuals and families cope with traumatic stress.
These kinds of events activate our fight-or-flight instinct, a stress response that triggers hormones to increase heart rate and prepare the body for action. This process also dials down activity in the parts of our brain that help us think critically and analytically (an energy-preserving mechanism to help us act more quickly in a moment of crisis). RELATED: How Stress Affects Your Body, From Your Brain to Your Digestive System In some cases, Dr. Naturale says, the brain stays stuck in this threat mode for months or years after an incident, which may lead to problems with concentration, sleep, relaxation, and general enjoyment of life. Genetics and an individual’s natural risk of mental illness appear to play a role in who will develop lasting symptoms after a traumatic experience — but so does the kind of event that caused the trauma. It seems easier for people to comprehend events involving human error or that things like natural disasters are out of our control, Naturale says. Intentional violence tends to be tougher to accept, she explains. “What we don’t understand is when someone decides to randomly hurt, kill, or maim a group of people,” Naturale says. “We don’t like to think that anyone might kill us for no reason.” The randomness of certain traumas (whether they’re intentionally inflicted or not) can also be difficult to grapple with. The number and duration of traumatic events a person experiences also significantly increases his or her mental health risk. Most people can cope with and recover from a single trauma. But when they experience multiple similar events, or when a single crisis persists for an extended period of time, the brain doesn’t have adequate opportunity to heal, Naturale says. PTSD, however, is not the only mental health condition associated with trauma, says Arianna Galligher, the associate director of the stress, trauma, and resilience trauma recovery center at the Ohio State University Wexner Medical Center in Columbus. Trauma may exacerbate mental health conditions that existed before the event, or people may develop symptoms of conditions such as depression or anxiety disorders for the first time in the aftermath of traumatic experiences. “A lot of people who have experienced traumatic situations may develop a major depressive disorder or anxiety symptoms, rather than PTSD,” Galligher says. “What we really look for in terms of diagnosis is, what’s going on with you, and how do your symptoms impact day-to-day functioning?” People who fall into a depressed state after a trauma, Horsley says, may feel as though “the world we once knew is over.” They may experience feelings of worthlessness or helplessness, believing there is nothing they can do to prevent future traumatic events, and that life is no longer worth living. Other people may become so determined to prevent the trauma from happening again that they develop anxiety disorders. They may become extraordinarily cautious and even may develop rituals that they feel will keep them safe, to the point where they may even appear to have obsessive-compulsive disorder (OCD), according to Dr. Ford. Regardless of which direction the symptoms go, the root of the problem is typically control, Ford says. “The essence of trauma is it takes control away from you or someone you care about,” he says. How a person deals with that loss of control — giving up or redoubling their vigilance — may determine which set of symptoms they experience.
Prolonged Trauma
When a person is exposed to a prolonged human-caused trauma from which they cannot escape — as in situations such as child abuse, domestic violence, or discrimination — the brain often suppresses emotional reactions in order to remain in survival mode for an extended period of time, Ford says. Later in life when the threat is removed, these emotions begin to emerge, often in unexpected or overwhelming ways. This can lead people to experience panic attacks or fits of rage. In other cases, Ford says, people exposed to prolonged trauma develop dissociative episodes where they feel disconnected from their own lives. They may experience a sense that things happening to them are not real, or repeatedly zone out and lose track of time. Waves of seemingly inexplicable emotions may drive some people to self-medicate and develop addictions; others may face social rejection in response to their outbursts, essentially adding new traumas to the old one, Ford says.
Complex Trauma
Developmental Trauma
Intergenerational Trauma
Its effects may be felt across cultures of people who have been displaced, enslaved, or subjected to genocide, according to Ford. Stories of these events may be passed down through the generations, transmitting the long-term effects of systemic disadvantages that result from the loss of homes and homelands, poverty, and discrimination.
“You distract yourself for a while, but you think about it again,” she says. “That’s going to continue,” she adds, but should start to diminish over the course of a few weeks. This acute response, Galligher says, can cause:
Difficulty concentratingTrouble relaxingStruggling to fall or stay asleepIntense emotions, like anger, anxiety, sadness, or shameEmotional numbnessFeeling detached or estranged from others
Nausea or gastrointestinal distressSweating or shiveringFaintnessMuscle tremors or shakingElevated heart rate or blood pressureFatigue or exhaustion
Most survivors report that symptoms periodically return around significant milestones after the event, such as anniversaries. But for most people who experience trauma, initial symptoms subside after a few months to a year. “It’s often a struggle to get through the first holiday or the first birthday [after a trauma] — after that, symptoms drop significantly,” Naturale says. Naturale noted that in her experience working with survivors after 9/11, just sharing this information about normal responses to trauma significantly reduced the incidence of mental health symptoms. But not all social interactions are helpful. If an individual’s social network is not supportive and is dismissive of their experience and feelings, Horsley recommends the person find a safe place to talk — which may include therapy or a specialized support group for individuals with similar experiences. Many of these groups are available online, and many are open to survivors free of cost.
Healthy Coping Strategies
It’s important for survivors to give themselves permission to take additional time for self-care, and seek out fun activities that can give them a “break” from the intensity of their emotions, Horsley says. This means covering the basics by getting enough sleep, staying hydrated, and maintaining a good diet. But also looking for hope. Many people find a new sense of meaning or purpose when they engage with healthy coping mechanisms, Horsley says. Additionally, attending memorials for the lost may fill a need to pay tribute to loved ones. Support groups can lead to new understanding or even advocacy.
Potentially Unhealthy Coping Strategies
Horsley cautions that not everything that technically qualifies as coping leads to positive outcomes. Comfort foods may help us get through a difficult time, for example, but excessive reliance on food as a sole coping mechanism may lead to other negative long-term health consequences. Similarly, Horsley says, individuals who turn to drugs and alcohol as a means of self-medicating for trauma are technically coping — but creating more problems for themselves down the road. “Alcohol is a depressant; it will make you more sad and upset,” she says.
Social Support
Though healthy coping strategies can vary from person to person, social support is important for everyone, Naturale says. Isolation, unemployment, or a lack of access to supportive resources represent significant risk factors for developing mental illness following a traumatic event. “Ninety percent of people get better in a reasonable amount of time with good social support and good coping,” she says. If you’re unsure whether the people in your social network would be supportive, Naturale says, it never hurts to err on the side of caution and speak to a licensed therapist. A few educational sessions to focus on what to expect after trauma and how to cope may go a long way to promote recovery. While she does not believe therapy is necessary for everyone who experiences a traumatic event, survivors should seek professional help if they feel as though they cannot connect with others and must isolate themselves; if they are experiencing thoughts of suicide; or if they find ongoing depression or anxiety is interfering with their day-to-day life months after a traumatic event, Naturale says. If you are actively in crisis and need immediate support, call 911. You can also call the National Suicide Prevention Lifeline at 800-273-8255 or text 741-741 to reach a trained counselor with Crisis Text Line.
