What is Trauma?
Dr. Salih Murat Paker – Clinical Psychologist – Psychotherapist – December 2021
Traumatic Event and Traumatization
What we generally call “traumatic events” are events that overwhelm the physical and mental integrity, balance, and coping capacity of the person in a sudden and harsh way. These events are caused by natural disasters, accidents, war, torture, rape, harassment, etc. They could be human-made or not. The risk for trauma survivors to suffer from more long-term and more intense psychological difficulties is increased IF:
- the events are more sudden,
- the risk of physical and psychological death or injury is greater,
- the losses are greater and multiple,
- the events are more continuous,
- the perpetrators are more unexpected (for example, incest),
- the survivor is mentally less prepared,
- the social support for the survivor is less,
- the survivor is younger or older (children and older age are more at risk),
- the survivor’s personality is less resilient and flexible,
- the survivor’s sense of vulnerability and insecurity is greater.
And, of course, there may be traumatizing events that the person is not directly exposed to but witnessed. For example, witnessing brutal accidents or murder. Sudden and dramatic death of a loved one could be a traumatic event. Or, being exposed to heavy slander, psychological lynching, or cancel culture in the age of social media can create traumatic effects. There are also situations such as learning the details of the events experienced by victims, visualizing them and being traumatized over this, which we call “vicarious traumatization”, which is mostly seen in those who work in disaster areas, emergency situations, or in mental health professionals or volunteers who work with trauma survivors. As you can see, we are talking about a complex process with many factors and many subtypes.
Almost everyone who has been exposed to a traumatic event may experience various psychological difficulties in the weeks or even months following the event. This is normal. Because there has been an abnormal, unusual, extraordinary event, our body and mind, which have the capacity to cope with a certain amount of stress, are overwhelmed and give normal stress responses to this abnormal event. In most cases, these psychological difficulties will subside significantly on their own within weeks or months. But depending on the many risk factors mentioned above, in some cases these difficulties persist. In cases where war and other chronic forms of political violence are ongoing, anxiety mechanisms work much more and continuously, since a minimum safe environment cannot be reached unless the war and violence process end.
Possible Psychological Difficulties
The most common psychological difficulty as a result of exposure to traumatic events is post-traumatic stress disorder, followed by depression and other anxiety disorders. The risk of developing serious personality problems also increases if traumatization is experienced at an early age and in a repeated manner. Traumatic events do not produce only negative effects, but when the appropriate factors come together, “post-traumatic growth” could also be possible. The survivor’s capacity to endure and cope could develop, their sense of self could evolve to a more positive one, and they could be able to look at the world and their environment in a more constructive way.
Post-traumatic stress disorder
The main axis of the clinical picture, which we call post-traumatic stress disorder, is the mental difficulties of digestion and processing of the traumatic events that overwhelm the person’s capacity to endure stress. What was experienced or is being experienced is so heavy, so incredible and unexpected that it cannot be integrated into normal consciousness and memory systems. Therefore, post-traumatic re-experiencing reactions are given. All or part of the traumatic event, or a very associative, indirect dimension—even a scent or color—is remembered in the form of dreams, nightmares or anxiety responses while awake. The second group of difficulties is avoidance reactions. The person may want to avoid emotions, thoughts and environments that remind of the traumatic event. The third group of reactions is some changes that may occur in the person’s feeling and thinking abilities. There may be difficulties such as forgetfulness, pessimism, hopelessness, blaming oneself or others, depressed mood, decreased interest, and social isolation. The fourth group of difficulties is changes in the areas of excitation and reactivity. Restlessness, anger, risky, destructive behaviors, increased alertness and startle reactions, sleep and concentration difficulties can be seen. Undoubtedly, in most cases, some but not all these symptoms occur and the distress they cause can range from very mild to severely affecting all areas of life.
In what situations is it necessary to seek professional help?
The psychological effects of traumatic events will be different types and at varying degrees depending on the risk factors mentioned above and characteristics of the traumatic event. In most cases, psychological difficulties will subside spontaneously or with appropriate social support within a few weeks or months after the traumatic event. If there is no significant reduction in distress even after months, it may be necessary to consult a psychotherapist who specializes in trauma and start therapy. Of course, if there are risky situations, such as thoughts of harming oneself or others, severe depressive or anxious states, then it will be necessary to consult a professional regardless of the stage after the traumatic event.