Trauma

Introducing and Defining Trauma

This section looks in more depth at trauma by introducing and defining trauma, reviewing the psychology theory underpinning trauma, and describing the signs and symptoms of trauma and PTSD, including information on how children react to trauma.

Trauma refers to the response to a highly stressful event. It refers to extreme stress that overwhelms a person’s ability to cope, where the person’s sense of safety and security is undermined.

Regardless of its source, trauma contains three common elements:

1. It was unexpected

1. The person was unprepared

3. There was nothing the person could do to stop it from happening

A traumatic event, like a critical incident, can involve a single experience, or enduring repeated or multiple experiences, that completely overwhelms the individual’s ability to cope or integrate the ideas and emotions involved in that experience.

Trauma is determined by how the person experiences and makes sense of the situation rather than the situation itself. Thus, what is traumatic to one person may not be (as) traumatic to another.

There are several types of trauma - Simple, complex and development:

Simple trauma is a single event that lasts a short time and involves a one off crisis.
Complex trauma describes both children’s exposure to multiple traumatic events and the wide ranging long term impact of this exposure. Complex trauma involves threats and violence between people.
Developmental trauma is when children are exposed to long standing or repeated traumatic events. This could include incidents when the children are neglected, abused or experience ongoing conflict.

Introducing and Defining Trauma

Psychological Theory - Adaptive Information Processing

Psychological Theory

The information processing system processes our experiences and stores memories in an accessible and useful form. Memories are linked in networks that contain related thoughts, images, emotions, and sensations. Learning occurs when new association are forged with material already stored in memory.

When a traumatic or very negative event occurs, information processing may be incomplete, perhaps because strong negative feelings or dissociation interfere with information processing. The Adaptive Information Processing model suggests that trauma is the result of unprocessed experiences.

Recovery follows the integration of traumatic experiences into existing memory networks – forming new association and connections that enable learning to take place with the memory stored in new adaptive forms. As a consequence, when the individual thinks about the trauma, or when the memory is triggered by similar situations, the person may feel like they are reliving it or experiencing strong emotions or physical sensations.

This video demonstrates this concept in more detail using the analogy of a chest of drawers.

With thanks to Dr Deborah Flitcroft (Specialist Educational Psychologist - Trauma).

Signs of Trauma

Traumatic events can have an effect on thinking, feeling, behaviour and physical symptoms.

Examples of possible feelings are:

Shock
Sorrow
Grief
Sadness
Fear
Anxiety
Distress
Anger
Numbness

Examples of physical effects could include:

Tiredness/fatigue
Headaches
Muscle tension
Jumpiness
Stomach aches
Sleep difficulties
Loss of appetite

Cognitive effects could include:

Confusion
Disorientation
Difficulties with concentration
Worrying thoughts
Intrusive thoughts and images
Self-blame
Survivor guilt
Nightmares

A person’s thoughts may be affected in addition to their ability to process information.

Possible behaviours could include:

Withdrawal
Avoidance of situations
Aggression and conflict
Self-harm
Risky behaviour

Responses to Trauma

It can be useful to think of all trauma ‘symptoms’ as adaptations or survival responses, which represent a person’s attempt to cope in the best way that they can with overwhelming feelings.

The fight, flight and freeze responses are used to shield and defend a person as much as possible from harm. These adaptive responses are normal following a traumatic event although they can become less successful and problematic over time.

There are a range of factors which will impact upon children’s reactions following a traumatic event. Please refer back to the bereavement and loss section in order to find out more about the developmental understanding of grief.

Pre-existing difficulties could affect a response to trauma and could include any special educational need or disability e.g. autism, learning difficulties.

The level of exposure relates to the person’s physical closeness to the event or whether they suffered injury or bereavement. Children may be more at risk if their parents or family members were involved in the traumatic event or struggled to provide support following the event.

Although Post Traumatic Stress Disorder (PTSD) won’t always develop as a result of an acute trauma reaction, it is important to be aware of some of the symptoms. If you're concerned about a child or young person, it might be useful to share signs/symptoms with The Child and Adolescent Mental Health Services (CAMHS) in your area.

Not everyone who experiences trauma will develop PTSD and strong feelings of anxiety, stress and sadness would be considered a normal response.

Some common symptoms of PTSD also include:

Nightmares
Memories about the event
Trouble sleeping at night

It is also important to remember that some of these symptoms can still exist even when a person does not have PTSD, and could just be a side effect of the stress e.g. problems with sleeping at night.

For a diagnosis of PTSD to me made, a certain set of criteria must be evident. This includes:

Criteria A – A stressor
Criteria B – Intrusive symptoms
Criteria C – Avoidance
Criteria D – Negative alteration in mood
Criteria E – alterations in arousal and reactivity
Criteria F – Duration: The symptoms in A, B, C, D and E must persist for more than one month
Criteria G – Functional significance: Impairment of different areas of life e.g. social
Criteria H – Exclusion: The above can’t be related to medication, substance use or another illness.

Further information around this can be found in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

It is important to note and share with staff that ‘Survivor Guilt’ can be a normal reaction to a traumatic event. However, if the guilt persisted and began to disrupt a child or young person’s life, therapeutic assistance should be sought.