Other Reactions to Trauma
Common Reactions After Trauma
After going through a trauma, survivors often say that their first feeling is relief to be alive. This may be followed by stress, fear, and anger. Trauma survivors may also find they are unable to stop thinking about what happened. Many survivors will show a high level of arousal, which causes them to react strongly to sounds and sights around them.
Most people have some kind of stress reaction after a trauma. Having such a reaction has nothing to do with personal weakness. Stress reactions may last for several days or even a few weeks. For most people, if symptoms occur, they will slowly decrease over time.
What are common reactions to trauma?
All kinds of trauma survivors commonly experience stress reactions. This is true for veterans, children, and disaster rescue or relief workers. If you understand what is happening when you or someone you know reacts to a traumatic event, you may be less fearful and better able to handle things.
Reactions to a trauma may include:
- Feeling hopeless about the future
- Feeling detached or unconcerned about others
- Having trouble concentrating or making decisions
- Feeling jumpy and getting startled easily at sudden noises
- Feeling on guard and constantly alert
- Having disturbing dreams and memories or flashbacks
- Having work or school problems
You may also experience more physical reactions such as:
- Stomach upset and trouble eating
- Trouble sleeping and feeling very tired
- Pounding heart, rapid breathing, feeling edgy
- Severe headache if thinking of the event
- Failure to engage in exercise, diet, safe sex, regular health care
- Excess smoking, alcohol, drugs, food
- Having your ongoing medical problems get worse
You may have more emotional troubles such as:
- Feeling nervous, helpless, fearful, sad
- Feeling shocked, numb, and not able to feel love or joy
- Avoiding people, places, and things related to the event
- Being irritable or having outbursts of anger
- Becoming easily upset or agitated
- Blaming yourself or having negative views of oneself or the world
- Distrust of others, getting into conflicts, being over-controlling
- Being withdrawn, feeling rejected, or abandoned
- Loss of intimacy or feeling detached
Recovery from stress reactions
Turn to your family and friends when you are ready to talk. They are your personal support system. Recovery is an ongoing gradual process. It doesn’t happen through suddenly being “cured” and it doesn’t mean that you will forget what happened. Most people will recover from trauma naturally. If your stress reactions are getting in the way of your relationships, work, or other important activities, you may want to talk to a counsellor or your doctor. Good treatments are available.
Common problems that can occur after a trauma
Post-Traumatic Stress Disorder (PTSD). PTSD is a condition that can develop after you have gone through a life-threatening event. If you have PTSD, you may have trouble keeping yourself from thinking over and over about what happened to you. You may try to avoid people and places that remind you of the trauma. You may feel numb. Lastly, if you have PTSD, you might find that you have trouble relaxing. You may startle easily and you may feel on guard most of the time.
Depression. Depression involves feeling down or sad more days than not. If you are depressed, you may lose interest in activities that used to be enjoyable or fun. You may feel low in energy and be overly tired. You may feel hopeless or in despair, and you may think that things will never get better. Depression is more likely when you have had losses such as the death of close friends. If you are depressed, at times you might think about hurting or killing yourself. For this reason, getting help for depression is very important.
Self-blame, guilt and shame. Sometimes in trying to make sense of a traumatic event, you may blame yourself in some way. You may think you are responsible for bad things that happened, or for surviving when others didn’t. You may feel guilty for what you did or did not do. Remember, we all tend to be our own worst critics. Most of the time, that guilt, shame, or self-blame is not justified.
Suicidal thoughts. Trauma and personal loss can lead a depressed person to think about hurting or killing themselves. If you think someone you know may be feeling suicidal, you should directly ask them. You will NOT put the idea in their head.
Anger or aggressive behaviour. Trauma can be connected with anger in many ways. After a trauma, you might think that what happened to you was unfair or unjust. You might not understand why the event happened and why it happened to you. These thoughts can result in intense anger. Although anger is a natural and healthy emotion, intense feelings of anger and aggressive behaviour can cause problems with family, friends, or co-workers. If you become violent when angry, you just make the situation worse. Violence can lead to people being injured, and there may be legal consequences.
Alcohol/Drug abuse. Drinking or “self-medicating” with drugs is a common, and unhealthy, way of coping with upsetting events. You may drink too much or use drugs to numb yourself and to try to deal with difficult thoughts, feelings, and memories related to the trauma. While using alcohol or drugs may offer a quick solution, it can actually lead to more problems. If someone close begins to lose control of drinking or drug use, you should try to get them to see a health care provider about managing their drinking or drug use.
Summing it all up
Right after a trauma, almost every survivor will find himself or herself unable to stop thinking about what happened. Stress reactions, such as increased fear, nervousness, jumpiness, upsetting memories, and efforts to avoid reminders, will gradually decrease over time for most people.
Use your personal support systems, family and friends, when you are ready to talk. Recovery is an ongoing gradual process. It doesn’t happen through suddenly being “cured” and it doesn’t mean that you will forget what happened. Most people will recover from trauma naturally over time. If your emotional reactions are getting in the way of your relationships, work, or other important activities, you may want to talk to a counsellor or your doctor. Good treatments are available.
Acute Stress Disorder
Acute stress disorder (ASD) is a mental disorder that can occur in the first month following a trauma. The symptoms that define ASD overlap with those for PTSD. One difference, though, is that a PTSD diagnosis cannot be given until symptoms have lasted for one month. Also, compared to PTSD, ASD is more likely to involve feelings such as not knowing where you are, or feeling as if you are outside of your body.
How common is ASD?
Studies of ASD vary in terms of the tools used and the rates of ASD found. Overall, within one month of a trauma, survivors show rates of ASD ranging from 6% to 33%. Rates differ for different types of trauma. For example, survivors of accidents or disasters such as typhoons show lower rates of ASD. Survivors of violence such as robbery, assaults, and mass shootings show rates at the higher end of that range.
Who is at risk for ASD as a result of trauma?
Several factors can place you at higher risk for developing ASD after a trauma:
- Having gone through other traumatic events
- Having had PTSD in the past
- Having had prior mental health problems
- Tending to have symptoms, such as not knowing who or where you are, when confronted with trauma
Does ASD predict PTSD?
If you have ASD, you are very likely to get PTSD. Research has found that over 80% of people with ASD have PTSD six months later. Not everyone with ASD will get PTSD, though.
Also, those who do not get ASD can still develop PTSD later on. Studies indicate that a small number (4% to 13%) of survivors who do not get ASD in the first month after a trauma will get PTSD in later months or years.
Are there effective treatments for ASD?
Yes, a type of treatment called cognitive behavioural therapy (CBT) has been shown to have positive results. Research shows that survivors who get CBT soon after going through a trauma are less likely to get PTSD symptoms later. A mental health care provider trained in treatment for trauma can judge whether CBT may be useful for a trauma survivor.
Another treatment called psychological debriefing (PD) has sometimes been used in the wake of a traumatic event. However, there is little research to back its use for effectively treating ASD or PTSD. It should also be noted that with more severe trauma or reactions such as PTSD, debriefing is not recommended.
Anger and Trauma
Why is anger a common response to trauma?
Anger is often a large part of a survivor’s response to trauma. It is a core piece of the survival response in human beings. Anger helps us cope with life’s stresses by giving us energy to keep going in the face of trouble or blocks. Yet anger can create major problems in the personal lives of those who have experienced trauma and those who suffer from PTSD.
One way of thinking is that high levels of anger are related to a natural survival instinct. When faced with extreme threat, people often respond with anger. Anger can help a person survive by shifting his or her focus. The person focuses all of his or her attention, thought, and action toward survival.
Anger is also a common response to events that seem unfair or in which you have been made a victim. Research shows that anger can be especially common if you have been betrayed by others. This may be most often seen in cases of trauma that involve exploitation or violence.
The trauma and shock of early childhood abuse often affects how well the survivor learns to control his or her emotions. Problems in this area lead to frequent outbursts of extreme emotions, including anger and rage.
How can anger after a trauma become a problem?
In people with PTSD, their response to extreme threat can become “stuck.” This may lead to responding to all stress in survival mode. If you have PTSD, you may be more likely to react to any stress with “full activation.” You may react as if your life or self were threatened. This automatic response of irritability and anger in those with PTSD can create serious problems in the workplace and in family life. It can also affect your feelings about yourself and your role in society.
Researchers have broken down Post-Traumatic anger into three key aspects, discussed below. These three factors can lead someone with PTSD to react with anger, even in situations that do not involve extreme threat:
Anger is marked by certain reactions in the body. The systems most closely linked to emotion and survival — heart, circulation, glands and brain — are called into action. Anger is also marked by the muscles becoming tense. If you have PTSD, this higher level of tension and arousal can become your normal state. That means the emotional and physical feelings of anger are more intense. If you have PTSD, you may often feel on edge, keyed up, or irritable. You may be easily provoked. This high level of arousal may cause you to actually seek out situations that require you to stay alert and ward off danger. On the other hand, you may also be tempted to use alcohol or drugs to reduce the level of tension you’re feeling.
Often the best response to extreme threat is to act aggressively to protect yourself. Many trauma survivors, especially those who went through trauma at a young age, never learn any other way of handling threat. They tend to become stuck in their ways of reacting when they feel threatened. They may be impulsive, acting before they think. Aggressive behaviours also include complaining, “backstabbing,” being late or doing a poor job on purpose, self-blame, or even self-injury. Many people with PTSD only use aggressive responses to threat. They are not able to use other responses that could be more positive.
Thoughts and Beliefs
Everyone has thoughts or beliefs that help them understand and make sense of their surroundings. After trauma, a person with PTSD may think or believe that threat is all around, even when this is not true. He or she may not be fully aware of these thoughts and beliefs.
For example, a combat Veteran may become angry when his wife, children, or co-workers don’t “follow the rules.” He doesn’t realise that his strong belief is actually related to how important it was for him to follow rules during the war in order to prevent deaths.
If you have PTSD, you may not be aware of how your thoughts and beliefs have been affected by trauma. For instance, since the trauma you may feel a greater need to control your surroundings. This may lead you to act inflexibly toward others. Your actions then provoke others into becoming hostile towards you. Their hostile behaviour then feeds into and reinforces your beliefs about others. Some common thoughts of people with PTSD are:
- “You can’t trust anyone.”
- “If I got out of control, it would be horrible, life-threatening, or could not be tolerated.”
- “After all I’ve been through, I deserve to be treated better than this.”
- “Others are out to get me,” or “They won’t protect me.”
How can you get help with anger?
In anger management treatment, problems with arousal, behaviour, and beliefs are all addressed in different ways. Cognitive-behavioural treatment (CBT), a commonly used therapy, uses many techniques to manage these three anger problem areas:
For increased arousal
The goal of treatment is to help the person learn skills that will reduce overall arousal. He or she may learn how to relax, use self-hypnosis, and use physical exercises that release tension.
The goal is first to look at how a person usually behaves when he or she feels threat or stress. The next goal is to help him or her expand the range of possible responses. More adaptive responses include:
- Taking a time out
- Writing thoughts down when angry
- Talking with someone instead of acting
- Changing the pattern “act first, think later” to “think first, act later“
Clients are given help in becoming more aware of their own thoughts leading up to becoming angry. They are then asked to come up with more positive thoughts to replace their negative, angry thoughts.
For example, they may learn to say to themselves, “Even if I don’t have control here, I won’t be threatened in this situation.” Another example would be, “Others do not have to be perfect in order for me to survive or be comfortable.” Role-play is often used so you can practice recognizing the thoughts that make you angry and applying more positive thoughts instead.
There are many ways to help people with PTSD deal with the high levels of anger they may feel. Many people have all three of the anger problem areas listed above. Treatment aims to help with all aspects of anger. One important goal of treatment is to improve your sense of flexibility and control. In this way, you do not have to feel as if you’re going through trauma again each time you react to a trigger with explosive or excessive anger. Treatment may also have a positive impact on personal and work relationships.
Chemtob, C.M., Novaco, R.W., Hamada, R.S., Gross, D.M., & Smith, G. (1997). Anger regulation deficits in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 10(1), 17-35.