• Traumas happen to many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences.
• Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives.
• People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation.
• Having symptoms after a traumatic event is not a sign of personal weakness. Many psychologically well-adjusted and physically healthy people develop PTSD. Given exposure to a trauma that is bad enough, probably all people would develop PTSD.
• By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them.
• By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment.

Most of this information is written by Eve B. Carlson, Ph.D. and Joseph Ruzek, Ph.D for a website by the National Center for PTSD. Visit them online at www.ncptsd.org.

What are Common Basic Effects of Trauma?

Because they get overwhelmed with fear during a trauma, survivors often have particular symptoms that begin soon after the traumatic experience. The main symptoms are re-experiencing of the trauma - mentally and physically - and avoidance of trauma reminders. Together, these symptoms create a problem that is called Posttraumatic Stress Disorder (PTSD). PTSD is a specific set of problems resulting from a traumatic experience that is recognized by medical and mental health professionals.

Re-experiencing Symptoms:

Trauma survivors commonly continue re-experiencing their traumas. Re-experiencing means that the survivor continues to have the same mental, emotional, and physical experiences that occurred during or just after the trauma. This includes thinking about the trauma, seeing images of the event, feeling agitated, and having physical sensations like those that occurred during the trauma. Trauma survivors find themselves feeling and acting as if the trauma is happening again: feeling as if they are in danger, experiencing panic sensations, wanting to escape, getting angry, thinking about attacking or harming someone else. Because they are anxious and physically agitated, they may have trouble sleeping and trouble concentrating. These experiences are not usually voluntary; the survivor usually can't control them or stop them from happening.

Mentally re-experiencing the trauma can include:

• Upsetting memories such as images or other thoughts about the trauma.
• Feeling as if it the trauma is happening again ("Flashbacks").
• Bad dreams and nightmares.
• Getting upset when reminded about the trauma (by something the person sees, hears, feels, smells, or tastes).
• Anxiety or fear - feeling in danger again.
• Anger or aggressive feelings – feeling the need to defend oneself.
• Trouble controlling emotions because reminders lead to sudden anxiety, anger, or upset.
• Trouble concentrating or thinking clearly.

People also can have physical reactions to trauma reminders such as:

• Trouble falling or staying asleep.
• Feeling agitated and constantly on the lookout for danger.
• Getting very startled by loud noises or something or someone coming up on you from behind when you don't expect it.
• Feeling shaky and sweaty.
• Having your heart pound or having trouble breathing.

Because they have these upsetting feelings, trauma survivors often act as if they are in danger again when they get stressed or reminded of their trauma. They might get overly concerned about keeping safe in situations that really aren't very dangerous. For example, a person living in a good neighborhood might still feel that he has to have an alarm system, double locks on the door, a locked fence, and a guard dog. Because traumatized people often feel like they are in danger even when they aren't, they may be overly aggressive, lashing out to protect themselves when there is no need. For example, a person who was attacked might be quick to yell at or hit someone who seems to be threatening. This happens because, when threatened, people have a natural physical "fight or flight" reaction that prepares them to respond to them danger.

Although reexperiencing symptoms are unpleasant, they are a sign that the body and mind are actively struggling to cope with the traumatic experience. These symptoms are automatic, learned responses to trauma reminders: trauma has become associated with lots of things so that they remind the person of the trauma and give them feeling that they are in danger again. It is also possible that reexperiencing symptoms are actually part of the mind’s attempt to make sense of what has happened.

Some Important Trauma Links:

Victim Emotional Health
Emotional health issues for victims, from the American Red Cross.

Warning Signs
Warning signs of trauma-related stress, from the American Psychological Association.

Critical Incident (pdf)
Critical incident stress information sheet, from the Los Angeles County Department of Mental Health.

Normalizing Emotions
You are not alone! A description of normal emotions following a disaster, from the American Red Cross.

Coping Suggestions
Coping suggestions from the Los Angeles County Department of Mental Health.

Steps to Take
After a disaster: Steps you can take, from the Los Angeles County Department of Mental Health.

• Ways of avoiding thoughts, feelings, and sensations associated with the trauma can include:
• Actively avoiding trauma-related thoughts and memories.
• Avoiding conversations and staying away from places, activities, or people that might remind you of trauma.
• Trouble remembering important parts of what happened during the trauma.
• "Shutting down" emotionally or feeling emotionally numb.
• Trouble having loving feelings or feeling any strong emotions.
• Finding that things around you seem strange or unreal.
• Feeling strange or "not yourself".
• Feeling disconnected from the world around you and things that happen to you.
• Avoiding situations that might make you have a strong emotional reaction.
• Feeling weird physical sensations.
• Feeling physically numb.
• Not feeling pain or other sensations.
• Losing interest in things you used to enjoy doing.

Avoiding thinking about trauma or avoiding treatment for your trauma-related problems may keep a person from feeling upset in the short run. But avoiding treatment of continuing trauma symptoms prevents progress on coping with trauma so that people's trauma symptoms don't go away.

What are Common Secondary and Associated Post-Traumatic Symptoms?

Secondary symptoms are problems that result from post-traumatic re-experiencing and avoidance symptoms . For example: because a person wants to avoid talking about a trauamatic event that happened, she might get cut off from friends and begin to feel lonely and depressed. As time passes after a traumatic experience, more and more secondary symptoms may develop. Over time, secondary symptoms can become more troubling and disabling than the original re-experiencing and avoidance symptoms.

Depression: can happen when a person has losses connected with the trauma situation or when a person avoids other people and becomes isolated.

Despair and hopelessness: can happen when a person is afraid that he or she will never feel better again.

Loss of important beliefs: can happen when a traumatic event makes a person lose faith that the world is a good and safe place.

Aggressive behavior toward oneself or others: can happen due to frustration over the inability to control PTSD symptoms (feeling that PTSD symptoms "run your life"). It can also happen when other things that happened at the time of trauma made the person angry (the unfairness of the situation). Some people are aggressive because they grew up with people who lashed out when they were angry and never taught them how to cope with angry feelings. Because angry feelings keep people away, they also stop a person from having positive connections and getting help. Anger and aggression can cause job problems, marital and relationship problems, and loss of friendships.

Self-blame, guilt, and shame: can happen when PTSD symptoms make it hard to fulfill current responsibilities. It can also happen when people fall into the common trap of second-guessing what they did or didn't do at the time of a trauma. Many people, in trying to make sense of their experience, blame themselves. This is usually completely unfair. At best, it fails to take into account the other reasons why the events occurred. Self-blame causes a lot of distress and can prevent a person from reaching out for help. Society sometimes takes a "blame-the-victim" attitude, and this is wrong.

Getting into arguments and fights: can happen because of the angry or aggressive feelings that are common after a trauma. Also, a person's constant avoidance of social situations (such as family gatherings) may annoy family members.

Less interest or participation in things the person used to like to do: can happen because of depression following a trauma. Spending less time doing fun things and being with people means a person has less of a chance to feel good and have pleasant interactions.

Social isolation: can happen because of social withdrawal and a lack of trust in others. This often leads to loss of support, friendship, and intimacy, and grows fears and worries.

Problems with identity: can happen when PTSD symptoms change important things in a person's life, like relationships or whether a person can do your work well. It can also happen when other things that happened at the time of trauma make a person confused about their own identity. For instance a person who thinks of himself as unselfish might think he acted selfishly by saving himself during a disaster. This might make him question whether he is really who he thought he was.

Feeling permanently damaged: can happen when trauma symptoms don't go away and a person doesn't think they will get better.

Problems with self-esteem: can happen because PTSD symptoms make it hard for a person to feel good about him or herself. Sometimes, because of things they did or didn't do at the time of trauma, survivors feel that they are bad, worthless, stupid, incompetent, evil, and so on.

Physical health symptoms and problems: can happen because of long periods of physical agitation or arousal from anxiety. Trauma survivors may also avoid medical care because it reminds them of their trauma and causes anxiety, and this may lead to poorer health. Habits used to cope with post-traumatic stress, like alcohol use, can also cause health problems. Also, other things that happened at the time of trauma may cause health problems (for example, an injury).

Alcohol and/or drug abuse: can happen when a person wants to avoid bad feelings that come with PTSD symptoms, or when other things that happened at the time of trauma lead a person to take drugs. This is a common way to cope with upsetting trauma symptoms, but it actually leads to more problems.

Remember:

Although PTSD symptoms and other trauma-related problems may take up most of a person's attention when they are suffering, people who have PTSD also have strengths, interests, commitments, relationships with others, past experiences that were not traumatic, desires, and hopes for the future.

Treatments are available for individuals with PTSD and associated trauma-related symptoms.

Understanding the effects of trauma on relationships can also be an important step for family members or friends.