Both visible and invisible experiences of trauma can have a profound impact on our lives. Whether enduring physical or emotional pain, the lasting effects of overwhelming experiences can be long-lasting, leading to mental health disorders such as Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD). If you are living with a nervous system impacted by trauma, it is important to understand the nature of these disorders and the available treatment options that may help you come closer to living in alignment with the life you want. This post explores what you need to know about trauma, the disorders it can cause, and the role of healing through psychodynamic therapy.

What is Trauma and What Causes it

Trauma refers to a distressing or disturbing event or experience that exceeds one’s abilities to cope. Notably, this means that trauma is not defined by the event itself, but rather by our felt sense of whether we can bear it. We all have varying capacities to cope and varying degrees of resilience; this means that the same event may prove traumatic for one person, and merely troubling for another. The alterations in our emotional, psychological, physiological, and behavioral responses can have a profound impact on mental health and well-being. 

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Trauma can result from a wide range of experiences, such as physical or sexual assault, natural disasters, accidents, combat, and witnessing violence or death. Trauma can also be the result of damaged relationships with caregivers, ongoing stress, and continued exposure to difficult circumstances, such as poverty, discrimination, or abuse. While everyone experiences trauma differently, common reactions can include anxiety, depression, trauma-induced disorders, and difficulty with social relationships and daily activities. A compassionate and supportive approach to recovery can help people affected by trauma regain a sense of safety, control, and healing.

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Different Kinds of Trauma Disorders

Trauma disorders can manifest in many different ways and can touch individuals from all walks of life. Some of the most common types of trauma disorders include post-traumatic stress disorder (PTSD), acute stress disorder, adjustment disorder, and complex trauma. While these disorders have their own constellation of defining features, the circumstances that trigger them will vary widely. While these disorders can be challenging to live with, effective treatment is available and recovery is possible. It is important to seek professional help if you or a loved one is struggling with the impact of trauma, as early intervention can make a significant difference in improving outcomes. We’ll review all of the current trauma disorders from the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). 

Reactive Attachment Disorder

Reactive Attachment Disorder is a serious condition that can develop in children who experience a lack of consistent care and nurturing in their early years. As a result of this neglect, these children struggle to form healthy, secure attachments with their caregivers or other individuals. This disorder is characterized by  a pattern of markedly disturbed and developmentally inappropriate attachment behaviors. This is evident in a child’s rare or minimal seeking of support from their primary caregiver for comfort, support, protection, or nurturance. In addition, when distressed, the child responds minimally or not at all to the comforting efforts of their parent or caregiver. Not only do these individuals tend to evidence minimal positive emotion during routine activities with caregivers, their ability to regulate their emotions is compromised. Thus, they may show fear, sadness, or irritability that are not readily explained. Notably, this disorder can only be given to children over the age of 9 months and before they reach 5 years old.

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Disinhibited Social Engagement Disorder

Similar to Reactive Attachment Disorder, Disinhibited Social Engagement Disorder is a condition that affects children who have experienced neglect from caregivers or other forms of trauma in their early years. This can include a persistent lack of having basic emotional needs for comfort, stimulation, and affection met, or by repeated changes of primary caregivers such that the chances to form stable attachments are severely curtailed. The disorder is characterized by a lack of fear toward strangers, a willingness to go with unfamiliar people, and a tendency to seek attention from anyone who is willing to provide it. While some level of social inhibition is expected in young children, those with Disinhibited Social Engagement Disorder display an extreme lack of caution around adults they do not know. This overly familiar behavior toward strangers would violate the expected social boundaries of the child’s culture. Disinhibited Social Engagement Disorder would only be given to a child older than 9 months.

Adjustment Disorders

Adjustment disorders occur when someone is having trouble coping with an identifiable stressor, perhaps a major life change, transition, or difficulty. These changes can include anything from moving to a new city, losing a loved one, or losing one’s job. The events that provoke Adjustment Disorder can be singular or occur in concert; recurrent or continuous. While it's normal to feel sad or anxious during these times, Adjustment Disorders are seen when the intensity, quality, or persistence of the distress is out of proportion to the intensity of the stressor. Understandably, these reactions can easily interfere with daily life. Adjustment Disorders are classified by the predominance of depressed mood, anxiety, or mixed anxiety and depression. Disturbance of conduct can be present as well, either on its own or in the context of anxiety or depression. Once the event in question or its consequences have resolved, the features of Adjustment Disorder should not last more than an additional six months.

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing an actual or threatened death, serious injury, or sexual violence. One can also learn of a traumatic event befalling a family member or close friend and develop PTSD. When the nervous system is taxed beyond its ability to regulate us, we see intrusive symptoms (e.g. distressing memories, recurrent dreams or nightmares, flashbacks, or prolonged stress at exposure to reminders of the trauma), and avoidance of things that remind one of the traumatic event. This can take the form of avoiding both memories, thoughts, or feelings about the event, and also avoid external reminders such as people, places, conversations, activities, and objects linked with the trauma. This disorder can also result in negative alterations in thinking and mood, such as not being able to remember important aspects of the event, or persistent and exaggerated negative beliefs about oneself, others, and the world. Feelings like fear, horror, anger, and shame may linger, and the individual may show diminished interest in activities they once enjoyed. I

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It is not uncommon to note feelings of detachment from others, or the inability to feel happiness, satisfaction, or joy. Finally, PTSD can also manifest in changes to arousal and reactivity of the nervous system. This is reflected in irritable and angry outbursts without provocation, reckless or self-destructive behavior, and problems with concentration. The individual may also show hypervigilance, exaggerated startle response, and problems with sleep. Depersonalization (feeling detached from one’s own body) and derealization (experiencing the world as unreal, dreamlike, or distant) may be seen.

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In some individuals, the fear-based re-experiencing or emotional changes may predominate; in others, the lack of pleasure, depressive mood, and negative beliefs may be more pronounced. Still others may show mostly problematic arousal, heightened reactivity, and dissociation. Any combination of these experiences can result from exposure to trauma, making day-to-day life extraordinarily challenging to navigate. To meet criteria for PTSD, these disturbances should be present for at least one month following the traumatic event.

Acute Stress Disorder

Acute stress disorder looks much like PTSD. The difference is that the changes in mood, behavior, and arousal are seen in the span of days and up to a month following the traumatic event. Beyond this duration, the individual would be considered to have PTSD. As above, this is disorder resulting from experiencing or witnessing a traumatic event, or learning that a loved one had exposure to actual or threatened death, serious injury, or sexual violation. Experiencing repeated or extreme exposure to aversive details of trauma can lead to Acute Distress or PTSD as well, placing people like first responders, police officers, or soldiers at risk. Individuals experiencing Acute Distress Disorder may experience any combination of intrusive symptoms (distressing and involuntary memories, dreams, flashbacks), negative mood, dissociation, avoidance, and changes in arousal (sleep disturbance, angry outbursts, hypervigilance, and concentration problems). Ideally, these experiences can usher one to treatment and prevent prolonged disturbance. With the right care and support, it is possible to recover from Acute Stress Disorder and regain a sense of control and well-being.

Complex Posttraumatic Stress Disorder

Complex Posttraumatic Stress Disorder (CPTSD) is a mental health condition that can develop after experiencing prolonged relational trauma–that is, the connection with one’s caregivers was marked by repeated instances of abuse or neglect. Individuals with CPTSD might recall childhood as a time when they never felt safe with anyone, felt abandoned, were shuttled from place to place, and were left to their own devices. 

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According to the trauma specialist Bessel Van Der Kolk, having the memory of feeling safe and secure with someone during our childhood can become reactivated years later in caring and attuned relationships. This could be a friendship, a romantic partnership, or in therapy. If one lacks the experience of such a connection, of feeling safe and loved, the parts of us that respond to human kindness remain underdeveloped; it becomes highly challenging to form meaningful connections and to feel grounded within one’s own body. Van Der Volk goes on to describe the experience of those living with the sequelae of interpersonal trauma from early caregivers: “Adults who had been abused as children often had trouble concentrating, complained of always being on edge, and were filled with self-loathing. They had enormous trouble negotiating intimate relationships, often veering from indiscriminate, high-risk, and unsatisfying sexual involvements to total shutdown. They also had large gaps in their memories, often engaged in self-destructive behaviors, and had a host of medical problems. These symptoms were relatively rare in the survivors of natural disasters.”

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The impact of traumatic experiences have markedly different effects on young children versus fully formed adults, and the roots of the disturbance in CPTSD are less obvious than the discrete events linked with PTSD. Following a combination of trauma and compromised attachment, individuals with CPTSD are likely to show pronounced patterns of dysregulation, problems with attention and concentration, and difficulties in their relationships with themselves and others. Using most of their energy to stay in control of a body pumped full of stress hormones, they often experience challenges in sustaining attention for things not directly relevant to survival. Being ignored or abandoned leaves them understandably needy, even for their abusers. Having been chronically mistreated or abused, they cannot but see themselves as somehow defective or worthless. With this as the bedrock of their developmental experience, trust in others is hard to come by. Feeling loathsome while also overreacting to minor frustrations make making and keeping friends a significant challenge.

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As bleak as this is, there is reason to hope. If abusive and neglectful relationships can damage one’s sense of self and ability to connect with others, relationships can also act as a font of healing. It can take time to undo the damage of chronic relational trauma, but new ways of being with self and other are possible in the context of a caring therapeutic relationship.

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As a note, CPTSD is not an official diagnosis in the DSM, and it is more commonly coded as “Other specified trauma- and stressor-related disorder, persistent complex disorder.”

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Living with Trauma

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A close friend describes her experience of living with the aftermath of traumatic experiences. (Trigger warning: Physical and sexual assault, self harm thoughts)

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The most powerful way I was affected by my trauma was a negative impact on my experience of life in general. I had a heavier sense of this during the traumatic experiences themselves, though I couldn’t have pointed my finger at it–that lingering sense of depression and disconnection, and where it was rooted–until years later. It was years into therapy that I began to identify what I had been through was “traumatic.” Initially when others reflected that what I had been through was in fact trauma, it didn’t seem like it to me. 

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Some of the less obvious ways I was affected by my trauma was an inability to validate myself or my emotional experiences. I also struggled with dissociation and depersonalization, and less than healthy ways of engaging my emotions. My ability to trust was badly damaged, and I became unreachable to the people around me.

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My history holds multiple traumatic events. The physical abuse was perpetrated by an ex-romantic partner. When I was a young adult, I was in an abusive relationship that involved psychological and verbal abuse, as well as physical abuse. In that relationship, I was often gaslit and manipulated. It felt like I was  treated as a puppet. I was isolated from my other friendships. Some of what he said to me feels burned into my memory. That relationship took me to the brink of what I could experience. It got scary–he got physically violent and volatile. He was an athlete, and I was a skinny girl. I felt like I had no chance, like if I resisted it would only be worse, so I shut my mouth and took it. I had so much shame over that, my reaction to the abuse: like I was weak, I was a pansy for not talking back, fighting back. I’ve come to understand at last that this is a valid response in the face of real danger.

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I have one memory in my mind in particular, when my then-romantic partner was getting physically violent. I entered this state of fight or flight. I remember a sense of shock, as if my thoughts simply would not process, would not move. Afterward there was also depression, denial, and avoidance. I couldn’t believe that this was happening to me both in the moment and after, and I was left wondering how it came to be this way. I felt an anxious sadness–that is, I could sense that deep down I was despairing, but was horrified of giving it any air time, of facing it. I couldn’t talk about it. This way of being felt hopeless, despairing–I went numb. I felt apathetic, dead inside. That was when I spent more and more time dissociating, alienated from my own life. 

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I was sexually assaulted numerous times. There were instances of not giving consent, not being conscious, being stuck in very unsafe situations. My boundaries have been violated. I was an object, a body–not a human being, someone’s daughter, someone’s loved one. It was disgusting. During the events, I shut down and left my body. It was too terrible to bear. It felt like it killed me inside. 

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Initially, I didn’t realize I was dissociating; it was not a fun way of living. I felt so disconnected from my body, from reality. It was like living in a dream, like floating. I was a witness to things happening rather than “me” being in the driver’s seat. I was a walking ghost. It might sound dramatic, but at its depth I felt almost dead. I would fade out for a long time, and then come back to my body. It was only when a friend of mine with a trauma history mentioned that she struggled with dissociating and described her experience that I realized “that’s been me…for a very long time.”

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It’s so hard to remember exactly what I was thinking during the traumatic experiences, because your whole being is being tested beyond its limits. Fear floods your brain, and it felt like my thinking simply would not function, like it was jammed. It was like this during the physical assault, and later for the sexual assaults, too. My memories of the events have heightened emotional impact for me, and it’s hard to know what happened in my mind at the time. That’s really common. I remember thinking as my partner held me against the wall “how is this my life? How is this real?” feeling utter disbelief and terror. 

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It really affected my romantic relationships for a long time. I had no capacity to trust, and I no longer wanted to be physically intimate with partners. In my last relationship, I felt only one-third “in” the relationship. I never again wanted to be in a position where I could lose my power, my control. I felt almost constantly in fight-or-flight, ready to run. I know in hindsight that it was really hard on my partner, and that he didn’t fully understand what was happening. I think too I had a lot of anger as the years moved forward–at the world, at the universe for allowing all that to happen. I became hopeless, and turned my back on my spiritual faith. 

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In my friendships, I was at a distance and quick to leave. I wasn’t heartless, but I just couldn’t bring myself to really love. It didn’t feel safe to connect to others. I couldn’t let myself get hurt. People that probably were not great to keep around–those I could not trust–were precisely the ones I wound up keeping around. In a sense, this meant that I was justified in not really liking or connecting more deeply with them; in another sense, it validated how I felt about myself in the aftermath of the abuse: not ever quite worthy of people who would treat me well, or who would be reliable. If I couldn’t be happy or feel trust, at least I could feel right in that odd logic. It spared me the effort of building deep or lasting bonds.

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My goal became to navigate life without needing another soul. If Armageddon took place, I would face it on my own. I just figured that people are dangerous, and it was the safer bet to try to learn how to survive completely and utterly alone. I was very different then than I am now. I was still a kind person, but there was a distance to me. In conflict, I couldn’t bring myself to go there. People experienced me as robotic, cold. Not mean, but deeply guarded and mistrusting. I feel like I was underneath it all the same person I’ve always been, but with a profoundly high wall up at all times, with all people. 

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I would go on dates, and just could not connect with a single person. I was so guarded, so fiercely protective of myself. Nothing ever developed from them. I was simply too burned, too traumatized to enter relationships. I remember hurting people because of it. There were probably good, kind, and safe people I met, but I just could not let the wall down. I pushed people away who likely would have been very good for me. 

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My sense of self was shattered. I did not like myself. I thought I was worthless. I thought I just wasn’t a very good person. Sometimes I didn’t like to be alone with myself. Other times, sitting alone in the depression and misery felt almost like a high: sitting in the anguish felt self-punitive, and I’d internalized the messages I learned from the trauma. The only thing I seemed to have control over whipping myself with my pain. 

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These things finally began to shift because of some deeply loyal, long-term friendships and encouragement to seek professional help in therapy. At first, I reacted to my friends as if my struggles were not all that serious, that reaching out for help would be “dramatic.” But I felt like I was withering away. I was not sleeping. I was so stressed and emotionally burnt out, deadened. My appetite disappeared, and I lost a lot of weight. My jeans got baggy, and still I thought that my pain was exaggerated, not quite legitimate. It felt like my friends were humoring me. I thought I was being too sensitive. I thought that their encouragement to get help was pointing out what a pansy I was. I would get nauseous–it felt like my body was rebelling. I was in such extraordinary pain. I began to think of hurting myself. From this point, I felt that I had a year to at least try to help myself, to give it a shot. I made an appointment with my doctor. I was having these surges of dread and discomfort–I didn’t know they were panic attacks, but that was it. My doctor recommended an antidepressant and therapy. I hadn’t considered therapy, and was resistant at first. Then a trusted family member provided a few referrals. From there, it all began to slowly change for the better in ways I could never have dreamt. 

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To the reader, it doesn’t matter whether your experience is categorized by others as a trauma; what matters is how you experience it, what you feel, your gut sense. To be with another human who just wants to listen, to validate, to bear witness to your experience is to become alive again, to heal, to exist again. You didn’t deserve what happened to you. You don’t have to live like you have, just surviving. You deserve to feel better, to feel joy. To live in color. It can get better. You are human, you matter, and there is hope.

Psychodynamic Therapy and Healing from Trauma

Psychodynamic therapy is an approach to healing from trauma while at the same time learning to carry the pieces of our experience that never leave us. This avenue of therapy uses an exploration of the therapeutic relationship to glimpse unconscious processes, assumptions, and ways of being–especially the ways in which these have been impacted by a traumatic experience. An empathic, non-judgmental space in which to air out and examine the thoughts, feelings, and memories of our most painful experiences can be deeply validating. 

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As you work with trauma in psychodynamic therapy, the goal is not symptom reduction alone, but the resolution of the pain that gives rise to the symptoms. This is a deeper and more lasting work. Freely exploring any memory, wish, or feeling that arises in the context of your relationship with your therapist, you might uncover defenses–ways of being to keep you protected from being hurt again as you were in the trauma. These ways of staying defended, whether chosen or non-conscious, can come at a steep cost: in the effort to protect ourselves, we can become emotionally numb, unwilling to trust others, or find that our relationship with ourselves has become damaged. In psychodynamic therapy, such processes can be gently unearthed and examined. With greater awareness of our unconscious processes, patterns of relating, and sense of self comes the capacity for intentional choice in these matters. Psychodynamic therapy is an arena in which you can slowly, safely try on new ways of being while setting down the constricting burdens of the past.

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In the course of psychodynamic therapy, you might process both hidden and overt emotional wounds. By exploring your past experiences and relationships and attending to how they resonate in the relationship with your therapist, you better understand the root causes of your pain and to heal through the relationship you forge together. This is especially useful in the case of relational traumas that leave us feeling unable to emotionally connect or trust others. Together, new intellectual understanding and corrective emotional experience help people affected by trauma to live more openly, more fully, and less bound by the impact of their painful experiences.

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Trauma is a unique and highly personal experience, as is the process of healing. The aftermath of trauma does not have to be your destiny. Although navigating these experiences can be taxing and intimidating, there is hope for recovery. Whether you have been diagnosed with a trauma disorder or have experienced an event that was beyond your capacity to cope, your pain is valid. Embark on your healing journey by scheduling a consultation with a professional therapist to best determine how to meet your needs. 

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Resources:

Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York.

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