Effects of Traumatic Experiences

A National Center for PTSD Fact Sheet  by Eve B. Carlson, Ph.D. &  Josef Ruzek, Ph.D.

When people find themselves suddenly in danger, sometimes they are overcome w/feelings of fear, helplessness, or horror. These events are called traumatic experiences.

Some common traumatic experiences include:

• being physically attacked
• being in a serious accident
• being in combat
• being sexually assaulted
• being in a fire or a disaster like a hurricane or a tornado

After traumatic experiences, people may have problems that they didn't have before the event.

If these problems are severe & the survivor doesn't get help for them, they can begin to cause problems in the survivor's family.

In thinking about mental health it's important to realize how traumas can affect those who experience them as well as family members' reactions to the traumatic event. The family of the survivor must learn to cope w/the survivor's symptoms & behaviors. Finally, suggestions are made about what a survivor & his or her family can do to get help for PTSD.

How do traumatic experiences affect people?    People who go thru traumatic experiences often have symptoms & problems afterward. How serious the symptoms & problems are depends on many things including:

• a person's life experiences before the trauma
• a person's own natural ability to cope w/stress
• how serious the trauma was
• what kind of help & support a person gets from family & friends & professionals immediately following the trauma

Because most trauma survivors aren't familiar w/how trauma affects people, they often have trouble understanding what is happening to them.

They may think the trauma is their fault, that they're going crazy, or that there is something wrong w/them because other people who experienced the trauma don't appear to have the same problems.

Survivors may turn to drugs or alcohol to make themselves feel better. They may turn away from friends & family who don't seem to understand. They may not know what to do to get better.

a terrible question
Every year thousands of drivers experience the trauma of knowing that they've caused the death of another person. For many of them, says Kelly Connor, the nature of this trauma is too vast, too unknown & too dreadful to contemplate

What do trauma survivors need to know?

·       Traumas happen to many competent, healthy, strong, good people. No one can completely protect him or herself from traumatic experiences.

·        Many people have long-lasting problems following exposure to trauma. Up to 8% of individuals will have PTSD at some time in their lives.

·        People who react to traumas are not going crazy. They're experiencing symptoms & problems that are connected w/having been in a traumatic situation.

·        Having symptoms after a traumatic event is not a sign of personal weakness. Many psychologically well-adjusted & physically healthy people develop PTSD. Probably everyone would develop PTSD if they were exposed to a severe enough trauma.

·        When a person understands trauma symptoms better, he or she can become less fearful of them & better able to manage them.

·        By recognizing the effects of trauma & knowing more about symptoms, a person is better able to decide about getting treatment.

What are the common effects of trauma?

During a trauma, survivors often become overwhelmed w/fear. Soon after the traumatic experience, they may re-experience the trauma mentally & physically.  Because this can be uncomfortable & sometimes painful, survivors tend to avoid reminders of the trauma. 

These symptoms create a problem that is called posttraumatic stress disorder (PTSD). PTSD is a specific set of problems resulting from a traumatic experience & is recognized by medical & mental-health professionals. 

Re-experiencing Symptoms:

Trauma survivors commonly re-experience their traumas. This means that the survivor experiences again the same mental, emotional & physical experiences that occurred during or just after the trauma.

These include:

• thinking about the trauma
• seeing images of the event
• feeling agitated
• having physical sensations like those that occurred during the trauma

Trauma survivors find themselves:

• feeling as if they're in danger
• experiencing panic sensations
• wanting to escape
• getting angry
• thinking about attacking or harming someone else

Because they're anxious & physically agitated, they may have trouble sleeping & concentrating. The survivor usually can't control these symptoms or stop them from happening.

Mentally re-experiencing the trauma can include:

·        Upsetting memories such as images or thoughts about the trauma

·        Feeling as if the trauma is happening again (flashbacks)

·        Bad dreams & 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 & 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 & sweaty

·        Having your heart pound or having trouble breathing

Because trauma survivors have these upsetting feelings when they feel stress or are reminded of their trauma, they often act as if they're in danger again. They might get overly concerned about staying safe in situations that aren't truly dangerous.

i.e., a person living in a safe neighborhood might still feel that he has to have an alarm system, double locks on the door, a locked fence & a guard dog.

Because traumatized people often feel like they're in danger even when they're not, they may be overly aggressive & lash out to protect themselves when there's no need.

i.e., a person who was attacked might be quick to yell at or hit someone who seems to be threatening.                    

Re-experiencing symptoms are a sign that the body & mind are actively struggling to cope w/the traumatic experience. These symptoms are automatic, learned responses to trauma reminders. 

The trauma has become associated w/many things so that when the person experiences these things, he or she is reminded of the trauma & feels that he or she is in danger again. It's also possible that re-experiencing symptoms are actually a part of the minds attempt to make sense of what has happened.

Avoidance Symptoms:

Because thinking about the trauma & feeling as if you're in danger is upsetting, people who have been thru traumas often try to avoid reminders of the trauma. Sometimes survivors are aware that they're avoiding reminders, but other times survivors don't realize that their behavior is motivated by the need to avoid reminders of the trauma.

Ways of avoiding thoughts, feelings & sensations associated with the trauma can include:

·        Actively avoiding trauma-related thoughts & memories

·        Avoiding conversations & staying away from places, activities, or people that might remind you of the 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

·        Feeling disconnected from the world around you & 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

Trying to avoid thinking about the trauma & avoiding treatment for trauma-related problems may keep a person from feeling upset in the short term, but avoiding treatment means that in the long term, trauma symptoms will persist.

What are common secondary & associated posttraumatic symptoms?

Secondary symptoms are problems that arise because of the posttraumatic re-experiencing & avoidance symptoms. For example, because a person wants to avoid talking about a traumatic event, she might cut off from friends, which would eventually cause her to feel lonely & depressed. As time passes after a traumatic experience, more secondary symptoms may develop. Over time, secondary symptoms can become more troubling & disabling than the original re-experiencing & avoidance symptoms.

Associated symptoms don't come directly from being overwhelmed with fear; they occur because of other things that were going on at the time of the trauma. For example, a person who is psychologically traumatized in a car accident might also be physically injured & then get depressed because he can't work or leave the house.

All of these problems can be secondary or associated trauma symptoms:

Depression can develop when a person has losses connected with the trauma or when a person avoids other people & becomes isolated.

Despair & hopelessness can result when a person is afraid that he or she will never feel better again.

Survivors may lose important beliefs when a traumatic event makes them lose faith that the world is a good & safe place.

Aggressive behavior toward oneself or others can result from frustration over the inability to control PTSD symptoms (feeling that PTSD symptoms run your life). People may also become aggressive when other things that happened at the time of trauma make the person angry (the unfairness of the situation). Some people are aggressive because they grew up with people who lashed out & they were never taught other ways to cope with angry feelings.

Because angry feelings may keep others at a distance, they may stop a person from having positive connections & getting help. Anger & aggression can cause job problems, marital & relationship problems & loss of friendships.

Self-blame, guilt & shame can arise when PTSD symptoms make it hard to fulfill current responsibilities. They can also occur 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 unwarranted & fails to hold accountable those who may have actually been responsible for the event. Self-blame causes a lot of distress & can prevent a person from reaching out for help. Sometimes society also blames the victim of a trauma.  Unfortunately, this may reinforce the survivors hesitation to seek help.

People who have experienced traumas may have problems in relationships with others because they often have a hard time feeling close to people or trusting people. This is especially likely to happen when the trauma was caused or worsened by other people (as opposed to an accident or natural disaster).

Trauma survivors may feel detached or disconnected from others because they have difficulty feeling or expressing positive feelings. After traumas, people can become overwhelmed by their problems or become numb & stop putting energy into their relationships with friends & family.

Survivors may get into arguments & fights with other people 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 create hurt feelings or animosity in the survivors relationships.

Less interest or participation in things the person used to like to do may result from depression following a trauma. When a person spends less time doing fun things & being with people, he or she has fewer chances to feel good & have pleasant interactions.

Social isolation can happen because of social withdrawal & a lack of trust in others. This often leads to the loss of support, friendships & intimacy & it increases fears & worries.

Survivors may have problems with identity when PTSD symptoms change important aspects of a person's life such as relationships or whether the person can do his or her work well. A person may also question his or her identity because of the way he or she acted during a trauma.

e.g., 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 really is who he thought he was.

Feeling permanently damaged can result when trauma symptoms don't go away & a person doesn't believe they will get better.

Survivors may develop problems with self-esteem because PTSD symptoms make it hard for a person to feel good about him or herself. Sometimes, because of how they behaved at the time of the trauma, survivors feel that they're bad, worthless, stupid, incompetent, evil, etc.

Physical health symptoms & 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 & causes anxiety & this may lead to poorer health.

i.e., a rape survivor may not visit a gynecologist & an injured motor vehicle accident survivor may avoid doctors because they remind him or her that a trauma occurred.  Habits used to cope with posttraumatic stress, like alcohol use, can also cause health problems. In addition, other things that happened at the time of the trauma may cause health problems (for example, an injury).

Survivors may turn to alcohol & drug abuse when they want to avoid the bad feelings that come with PTSD symptoms. Many people use alcohol & drugs as a way to try to cope with upsetting trauma symptoms, but it actually leads to more problems.       

PTSD & the Family

A National Center for PTSD Fact Sheet
By Eve B. Carlson, Ph.D. & Joseph Ruzek, Ph.D.

How does PTSD affect family members?

Because the symptoms of PTSD & other trauma reactions change how a trauma survivor feels & acts, traumatic experiences that happen to one member of a family can affect everyone else in the family.

When trauma reactions are severe & go on for some time w/out treatment, they can cause major problems in a family. Here we'll describe family members' reactions to the traumatic event & to the survivor's symptoms & behaviors.

It's no wonder that family members react to the fact that their loved one has gone through a trauma. It's upsetting when someone you care about goes through a terrible ordeal. And it's no wonder that people react to the way a traumatized family member feels & acts.

Trauma symptoms can make a family member hard to get along w/or cause him or her to withdraw from the rest of the family. It can be very difficult for everyone when these changes occur. Just as people have different reactions to traumatic experiences, families also react differently when a loved one is traumatized.

In the section below, many different types of reactions are described. A family may experience many of these reactions, or only a few. All of the reactions described are common in families who've had to deal w/trauma.

Sympathy

One of the first reactions many family members have is sympathy for their loved one. People feel very sorry that someone they care about has had to suffer thru a terrifying experience. They feel sorry when the person continues to suffer from symptoms of PTSD & other trauma responses.

It can be helpful for the person who has experienced the trauma to know that his or her family members sympathize with him or her, especially just after the traumatic event occurs.

Sympathy from family members can have a negative effect, though. When family members' sympathy leads them to "baby" a trauma survivor & have low expectations of him or her, it may send a message that the family doesn't believe the trauma survivor is strong enough to overcome the ordeal.

For example, if a wife has so much sympathy for her husband that she doesn't expect him to work after a traumatic experience, the husband may think that she doesn't have any confidence in his ability to recover & go back to work.

Depression

One source of depression for family members can be the traumatic event itself. All traumas involve events where people suddenly find themselves in danger. When this happens in a situation or place where people are used to feeling safe, just knowing the event happened could cause a person to lose faith in the safety & predictability of life.

For example, if a woman gets mugged in the parking lot of a neighborhood shopping center, her family may find they feel depressed by the idea that they're not really as safe as they thought they were, even in their own neighborhood.

It can also be very depressing when a traumatic event threatens a person's ideals about the world. For instance, if a man gets traumatized in combat by seeing someone tortured, it can be very depressing to know that people are capable of doing such cruel things to each other.

Before the man was faced with that event, he may have been able to believe that people are basically good & kind.

Depression is also common among family members when the traumatized person acts in a way that causes feelings of pain or loss. There may be changes in family life when a member has PTSD or other symptoms after trauma.

The traumatized person may feel too anxious to go out on family outings as he or she did in the past. The traumatized person may not be able to work because of PTSD symptoms.

As a result, the family income may decrease & the family may be unable to buy things & do things the way they did before the traumatic event. A husband may feel unloved or abandoned when, because of her depression, his traumatized wife withdraws emotionally & avoids being intimate or sexual.

Children whose father can't be in crowds because of combat trauma may feel hurt that their father won't come to see them play sports.

When PTSD lasts for a long time, family members can begin to lose hope that their loved one or their family will ever get "back to normal."

Fear & Worry

Knowing that something terrible can happen "out of the blue" can make people very fearful. This is especially true when a family member feels unsafe & often reminds others about possible dangers.

Very often, trauma survivors feel "on edge" & become preoccupied with trying to stay safe. They may want to get a guard dog, put up security lights, have weapons in the house in order to protect themselves & their family members.

When one person in a family is very worried about safety, it can make everyone else feel unsafe too. However, something that helps one person feel safe, like a loaded weapon under the bed, may make another person feel unsafe.

Family members can also experience fear when the trauma survivor is angry or aggressive. As described above, trauma survivors can become angry & aggressive automatically if they feel they're in danger.

Trauma survivors may also become angry & aggressive because they're frustrated that they have trauma symptoms, or because they learned to be aggressive as a way to protect themselves in the trauma situation.

No matter what the reason for the anger & aggression, it naturally makes family members fearful.

Many trauma symptoms can cause family members to worry. A wife might worry that her traumatized husband who becomes angry & violent at the least provocation will be injured in a fight or get in trouble with the police.

A daughter may worry that her mother will make herself ill by drinking heavily as a result of a traumatic event.

A man's inability to keep a job because of trauma-related problems may cause his family to worry constantly about money & the future.

Avoidance

Just as trauma survivors are often afraid to address what happened to them, family members are frequently fearful of examining the traumatic event as well. Family members may want to avoid talking about the trauma or trauma-related problems, even with friends.

People who have experienced trauma hope that if they don't talk about the problem, it'll go away. People also don't wish to talk about the trauma with others because they're afraid that others won't understand or will judge them.

Sometimes, if the traumatic event is one associated w/shame, such as rape, family members may avoid talking about the event & its effects because of social "rules" that tell us it is inappropriate to talk about such things.

Family members may also not discuss the trauma with others because they fear it'll bring their loved one more shame.

Family members may avoid the things that the trauma survivor avoids because they want to spare the survivor further pain, or because they're afraid of his or her reaction.

For example, the wife of a combat veteran who's anxious about going out in public may not make plans for family outings or vacations because she's afraid to upset her husband. Though she doesn't know what she can do to "fix" the problem, she does know that if the family goes to a public event, the husband will be anxious & irritable the whole time.

Guilt & Shame

Family members can feel guilt or shame after a traumatic event for a number of reasons. A family member may experience these feelings if he or she feels responsible for the trauma.

For instance, a husband whose wife is assaulted may feel guilt or shame because he was unable to protect her from the attack. A wife may feel responsible for her husband's car accident if she thinks she could've prevented it if she'd gotten the car's brakes fixed.

A family member may feel guilt & shame if he or she feels responsible for the trauma survivor's happiness or general well-being, but sees no improvement no matter how hard he or she tries to help.

Sometimes, after years of trauma-related problems in a family, a family member may learn about posttraumatic stress disorder & realize that this is the source of their family problems. The family member may then feel guilty that he or she was unsupportive during the years.

Anger

Anger is a very common problem in families that have survived a trauma. Family members may feel angry about the trauma & its effect on their lives. They may be angry at whomever they believe is responsible for the traumatic event (this includes being angry at God). They can also feel anger toward the trauma survivor. Family members may feel that the survivor should just "forget about it" & get on with life.

They may be angry when their loved one continues to "dwell" on the trauma. A wife may be mad because her husband can't keep a job or because he drinks too much or won't go w/her to social events or avoids being intimate w/her or doesn't take care of the kids.

Family members may also feel angry & irritable in response to the anger & irritability the trauma survivor directs at them.

Negative Feelings

Sometimes family members have surprisingly negative feelings about the traumatized family member. They may believe the trauma survivor no longer exhibits the qualities that they loved & admired. A person who was outgoing before a trauma may become withdrawn. A person who was fun loving & easy-going before a trauma may become ill tempered.

It may be hard to feel good toward a person who seems to have changed in many ways. Family members may also respond negatively to behaviors that develop following a trauma.

For instance, family members may be disgusted by a woman's over-drinking in response to a trauma.

Family members may also have negative feelings about the survivor that are directly related to the traumatic event. For example, a wife may no longer respect her husband if she feels he didn't behave bravely during a traumatic event.

A husband whose wife was raped may feel disgusted about what happened & wonder if she could've done something to prevent the assault. A son may feel ashamed that his father didn't fight back when he was beaten during a robbery.

Sometimes people have these negative feelings even when they know that their assessment of the situation is unfair.

Drug & Alcohol Abuse

Drug & alcohol abuse can become a problem for the families of trauma survivors. Family members may try to escape from bad feelings by using drugs or drinking. A child or spouse may spend time drinking with friends to avoid having to go home & face an angry parent or spouse.

On the other hand, spouses sometimes abuse drugs or alcohol to keep their loved ones "company" when they're drinking or using drugs to avoid trauma-related feelings.

Sleep Problems

Sleep can become a problem for family members, especially when it's a problem for the trauma survivor. When the trauma survivor stays up late to avoid going to sleep, can't get to sleep, tosses & turns in his or her sleep, or has nightmares, it's difficult for family members to sleep well.

Often family members are also unable to sleep well because they are depressed &/or they're worried about the survivor.

Health Problems

Family members of trauma survivors can develop health problems for a number of reasons. Bad habits, such as drinking, smoking & not exercising may worsen as a result of coping with a loved one's trauma responses.

In addition, many illnesses can be caused by trauma-related stress if it goes on for an extended period of time. When family members constantly feel anxious, worried, angry, or depressed, they're more likely to develop stomach problems, bowel problems, headaches, muscle pain & other health problems.

What can families do to care for themselves & the survivor?

Trauma survivors & their families often don't know what to do to care for themselves. First, it's important to continue to learn more about trauma & its effects.

Some books are listed below that may be helpful. For veterans, educational classes may be available thru a local VA Medical Center or VA Readjustment Counseling Service Vet Center (see below).

Treatment for PTSD is available in most communities thru psychologists & social workers in private practice. Insurance may help pay for this treatment. Community mental-health centers & private mental-health clinics