The Impact of Trauma

Chapter 4
The Impact of Trauma


Gwen Adshead


Forensic Psychiatry, Southern Health Foundation Trust, UK






OVERVIEW



  • 60–70% of people will suffer a psychologically traumatic event in their lifetime
  • The two most common traumas are traumatic bereavement followed by criminal victimisation
  • Most people will experience psychological distress in the first 6–12 months, but only a third will experience chronic distress beyond this
  • Psychological trauma reactions include post-traumatic stress disorder (PTSD) but also depression, anxiety states and substance misuse
  • There are good-quality evidence-based psychological therapies that really help, and people should be referred quickly to trained therapists
  • There is no good-quality evidence that telling people to forget about a trauma helps them recover or that PTSD is linked to compensation claims




What is a traumatic event?


There is nothing abnormal about feeling bad when bad things happen to you. But, as with fractured limbs, the fact that pain, distress and dysfunction are ‘normal’ does not mean that we do not intervene! Furthermore, over the last 30 years it has been recognised that traumatic events can lead to pathological stress reactions that, without treatment, cause severe distress and disability.


A ‘trauma’ or traumatic event is an experience that causes intense fear and helplessness in humans. Such events are usually (although not always) associated with imminent threat to life and serious injury. It has been known for centuries that people can still be affected for some time after they occur. Since the 1970s, post-traumatic psychological phenomena have been recognised as specific disorders that cause distress and dysfunction.


The commonest types of trauma are listed in Box 4.1. Doctors should be aware that medical interventions may also be experienced as traumatic and have been known to cause PTSD.






Box 4.1 Commonest types of trauma experienced


Commonest adult traumatic events



  • Traumatic bereavement.
  • Witnessing someone being badly injured or killed.
  • Being involved in a fire, flood or natural disaster.
  • Being involved in a life-threatening accident.
  • Combat exposure.
  • Physical assaults (men and women).
  • Sexual assaults (women).

Commonest childhood traumatic events



  • Sudden loss of a parent.
  • Physical abuse (boys).
  • Sexual abuse (boys and girls).




Does everyone who experiences trauma get PTSD?


Most people suffer a period of acute stress responses, which can last up to a year (Table 4.1). About 30% of people will develop longer-term post-traumatic conditions (PTSD, depression and anxiety states). It is important to try and prevent PTSD and other chronic conditions, because they are harder to treat once established.


Table 4.1 Normal stress reactions after trauma.





















Time period Effects
Anticipation phase (often not present) Anticipatory anxiety/fear, denial
Immediate Shock, numbness, disbelief
Acute distress
Dissociation and denial
Short-term
(1–6 weeks)		 High levels of arousal
Intrusive phenomena of trauma: thoughts, flashbacks, nightmares
Poor concentration
Disturbed sleep, appetite, libido
Irritability
Persistent fear and anxiety, especially when reminded of trauma: leads to avoidance behaviour
Long-term
(6 weeks to 6 months)		 Features described above persist, but should decrease in intensity and frequency
Increased avoidance behaviour
Irritability often most persistent
Substance misuse (including alcohol) common as a way of managing arousal
12 months post-trauma Possible anniversary reactions
Persistent intrusive phenomena may indicate PTSD

Some people are particularly resilient (see Chapter 8) and seem to experience very little distress after trauma (possibly through genetic variation and other factors shown in Box 4.2). Other people are more at risk – usually those who have experienced childhood trauma or previous traumatic events. Some types of event cause more PTSD than others, such as events involving mass casualties and exposure to traumatic images, sounds and smells. Sexual assaults and violent crime cause more PTSD than noncriminal traumatic events (see Chapters 6, 18 and 19). Even a trauma of short duration may give rise to serious effects, although in general the more extended the trauma, the worse the effects.


What about the impact of childhood trauma?


Children who are exposed to frightening events may develop PTSD in the same way as adults. This is important to consider in children of refugees or migrants to the UK fleeing conflict and after events that affect whole families, such as road traffic accidents.






Box 4.2 Associations with development and maintenance of PTSD


Risk factors for developing PTSD



  • Magnitude and degree of exposure to the stressor.
  • Gender (women have twice the rates of men, despite lower reported exposure).
  • Previous personality traits, coping styles, experiences (a repressive coping style is protective: low anxiety and high defensiveness).
  • Previous traumatisation.
  • Peritraumatic dissociative experiences.
  • Early sensitisation of the hypothalamic–pituitary axis.

Risk factors for maintenance of chronic PTSD



  • Poor social support and organisational environment.
  • Being divorced or widowed.
  • Lower education and income.
  • Concurrent family stressors.
  • Low level of psychosocial functioning.



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Dec 9, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on The Impact of Trauma

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