Trauma is a powerful physical and or psychological reaction that is caused by exposure to extreme stress which may include a life threatening event or death. Traumatic events can be separated into two categories; type one trauma or type two trauma. Type one trauma is a single incident occurrence, such as an assault. Type two trauma, which may also be referred to as complex trauma, is usually prolonged, inter-personal and repetitive (e.g. domestic abuse). Exposure to either type one or type two trauma can lead to the development of Post-Traumatic Stress Disorder (PTSD).
Post-Traumatic Stress Disorder (PTSD)
PTSD involves being psychologically overwhelmed by persistent intrusive thoughts, memories or feelings associated with a past trauma. This can lead to avoidant behaviour, deterioration of mood and a reduction in quality of life.
Involuntary unprocessed memories and negative cognitions (i.e. thoughts) maintain PTSD through the perception that there is a current threat (e.g. hyperarousal). To avoid such reactions, maladaptive coping strategies, such as avoidance and thought suppression, are adopted by people experiencing the PTSD symptoms. However, these strategies increase negative thoughts, increase anxiety and reduce the potential for memories about the trauma to be processed and stored as past events.
The National Institute for Clinical Excellence (NICE) guidelines on the management of PTSD in adults and children (NICE, 2005) estimated that up to 30% of people develop PTSD after experiencing a traumatic event. Findings have identified that between 15 – 20% of children and young people develop PTSD following exposure to a traumatic incident. Females have been found to be more at risk than males of developing PTSD, potentially due to the type and severity of the trauma they are exposed to, whereas boys are more likely to experience physical assaults.
The severity and frequency of PTSD symptoms exist on a continuum dependent on the extent of the traumatic event. Symptoms include cognitive (e.g. negative beliefs about the world), emotional (e.g. fear, guilt) and behavioural (e.g. hypervigilance) symptoms which can lead to a detachment from relationships and a reduction in self-esteem. In children and young people, symptoms may also include the recreation of trauma through play.
The risk of developing PTSD is influenced by factors that occur before, during and after the traumatic event. The most influential risk factors tend to be those that occur after the event, such as social withdrawal and avoidance. However, these are closely followed by factors experienced during the traumatic event such as, perceived threat to life. The type of traumatic incident and its severity both directly relate to the risk of developing PTSD.
Peritraumatic dissociation, in which a person has an impaired awareness during their traumatic incident and disturbed and unclear memories afterwards, has also been identified as increasing the risk of developing PTSD. A further risk to the development of PTSD, and a potential contributing factor to the development of peritraumatic dissociation, is the occurrence of neurological damage, such as a mild traumatic brain injury (TBI) during a traumatic incident (e.g. head injury from a physical assault).
Treatment of trauma
Trauma Focussed Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) are the most effective treatments for reducing PTSD symptoms. During therapy it is also useful to consider systemic influences such as age, developmental stage, personal circumstances (e.g. family, friends, school, work and interests) and personal characteristics (e.g. gender).
For more information about attending therapy sessions for trauma and PTSD, please contact Belfast Psychology Services at firstname.lastname@example.org.