Psychological trauma

Psychological trauma is the emotional response to an extremely stressful event, typically involving death, threat of death, serious injury, or sexual violence. It may occur as a result of direct personal experience, witnessing the event as it happens to another person, or learning that a loved one has experienced it (secondary or vicarious trauma).

There are three types of trauma, depending on the triggering circumstances:

• Acute trauma: results from a single dangerous event, such as an accident, terrorist attack, rape, or natural disaster.
• Chronic trauma: occurs when a person is repeatedly and prolongedly exposed to a stressful situation. It is often the result of childhood abuse, bullying, combat exposure, or intimate partner violence.
• Complex trauma: arises from exposure to multiple traumatic events.

Psychological trauma does not develop in every individual who experiences an extreme event; it is estimated to affect between 15% and 30% of those exposed. Events involving human intentionality, such as rape or combat, are the most difficult to assimilate.

The prognosis of trauma is generally favorable when appropriate treatment is followed. Although recovery time varies significantly among individuals, most cases resolve in the medium term.

Symptoms

Trauma symptoms may manifest immediately after the event or may be delayed. The response to a traumatic situation may present in two forms:

• Emotional response: patients experience difficulty coping with their emotions and often withdraw from others. The post-traumatic reaction can be classified into four different groups:
  • Re-experiencing the event: the traumatic situation is relived in the form of:
    • Intrusive memories.
    • Flashbacks.
    • Nightmares.
• Avoidance: avoidance of places, situations, people, or conversations that recall the event. Denial commonly develops as a defense mechanism.
• Negative thoughts: persistent negative mood related to oneself or the world in general.
  • Sadness.
  • Demotivation.
  • Apathy.
  • Depression.
• Arousal: alteration of the body’s activation system:
  • Irritability.
  • Anger.
  • Aggressiveness.
  • Fear.
  • Hypervigilance.
  • Confusion.
  • Shame.
  • Insomnia.
  • Guilt.
  • Isolation.
  • Hopelessness.
  • Nervousness.
  • Concentration difficulties.
  • Self-destructive behaviors.
  • Derealization: perception that the world is not real.
  • Depersonalization: the patient feels like an external observer of themselves.
• Physical response: activation of the nervous system often results in physical manifestations, such as:
  • Headache.
  • Fatigue.
  • Gastrointestinal disturbances.
  • Tachycardia: accelerated heart rate.
  • Sweating.

Causes

Trauma results from events capable of producing excessive suffering, exceeding the natural coping mechanisms of human beings. These are extraordinary circumstances, including:

• Serious accidents.
• Robberies.
• Assaults.
• Rape.
• Kidnapping.
• Homicide.
• Terrorist attacks.
• Suicide of a close person.
• Death of a loved one.
• Bullying.
• Workplace harassment.
• Gender-based violence.
• Physical abuse.
• Sexual abuse.
• Psychological abuse.
• Child abuse.
• Natural disasters:
  • Fires.
  • Floods.
  • Hurricanes.
  • Earthquakes.

Risk factors

The risk of developing psychological trauma after a particularly stressful event is higher in the following cases:

• History of mental health disorders.
• Increased vulnerability.
• Low resilience.
• Lack of social support after the event.
• Age at onset: events experienced during childhood have a greater impact.

Complications

Trauma resulting from a highly stressful experience may lead to severe psychological disorders:

• Post-traumatic stress disorder (PTSD): trauma symptoms are persistent and do not diminish over time. It may last for years, although improvement may occur within several months with therapy.
• Acute stress disorder (ASD): intense reaction to trauma, with an estimated duration of one month.
• Adjustment disorder: general distress manifested as poor academic or occupational performance, changes in social relationships, relationship problems, or worsening of a pre-existing physical illness. Symptoms are similar to PTSD but milder.
• Reactive attachment disorder (RAD): diagnosed exclusively in children. It is characterized by:
  • Inability to establish social relationships.
  • Intense sadness.
  • Fear without apparent cause.
  • Irritability.
  • Limited positive affect.
• Disinhibited social engagement disorder (DSED): also characteristic of children. There is a lack of selectivity regarding attachment figures, resulting in excessive familiarity with strangers.

Prevention

Psychological trauma cannot be prevented. To avoid complications and the development of chronic symptoms, early intervention is essential to provide support to the patient as soon as possible.

Which physician treats psychological trauma?

Trauma is managed within the specialties of Clinical psychology and Psychiatry.