Understanding Trauma

Research shows that trauma – particularly adverse childhood events (trauma that occurs before ages 5 or 6) – is very predictive of developing all mental illnesses.

When we talk about someone’s risk for mental illness, we refer to the stress-diathesis model. We know that some people have a genetic predisposition, or diathesis, for bipolar disorder, depression, schizophrenia, PTSD, or other mental illnesses. Characteristics of their DNA put them at greater risk. But you can have a genetic diathesis for an illness and never develop symptoms. Research indicates that your experiences in your environment – stress, infections, toxins, etc. – influence the expression of those genes.

Adverse childhood events and other traumas, when added to a genetic diathesis, increase a person’s risk for developing mental illness dramatically. And a traumatic event in adulthood – for example an assault, car crash, or combat situation – can exacerbate mood and anxiety disorders or lead to the development of PTSD.

Trauma & PTSD

A common misconception is that everyone who experiences trauma develops PTSD. While trauma may impact someone’s life significantly, it does not always lead to the development of mental illness.

Trauma can influence or worsen all mental illnesses, not just PTSD. A survivor of trauma may be diagnosed with mood disorders like depression or bipolar illnessanxiety disorders, thought disorders like schizophrenia, personality disorders, and others.

PTSD is a specific diagnosis with distinct symptoms and diagnostic criteria. In the Diagnostic and Statistical Manual of Mental Disorders (DSM5), PTSD is included in a new category called Trauma- and Stressor-Related Disorders. A diagnosis of PTSD requires that a person meet all the following criteria:

  • has had exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence
  • persistently re-experiences the traumatic event through memories, nightmares, flashbacks, etc.
  • avoids similar situations or thoughts or feelings related to the trauma
  • has low mood and/or inability to recall key features of the trauma
  • has difficulty sleeping or concentrating, is hypervigilant, is irritable or aggressive, or engages in risky or destructive behaviors
  • has the symptoms described above for at least one month and the symptoms create distress or functional impairment

The DSM5 broadened the diagnostic criteria for trauma-related disorders to include not just people who directly experience violence or injury, but also people who witness traumatic events, people with a close relative or family member who experienced trauma, and people who are repeatedly exposed to the details of traumatic events.

What is effective treatment for trauma?

Determining the best psychiatric treatment options for someone who has experienced trauma can be challenging, even for mental health professionals.

A comprehensive diagnostic assessment can be very helpful. An assessment with a mental health professional can shed light on the larger constellation of symptoms and challenges a trauma survivor is experiencing, including mood, anxiety, substance use, or personality disorders. A thorough psychological assessment can also uncover opportunities to promote healing and recovery such as family therapy or strategies to improve sleep cycles or eating habits. A medical workup including labs may also be important to determine if there are biologic or physical reasons why someone might be having symptoms.

Research indicates that when trauma co-occurs with another mental illness, often the best course of treatment to is treat the trauma second, after first resolving the disability caused by the depression, anxiety or other illness with the goal of developing resiliency for the hard work of treating trauma.

How to support someone after trauma?

First and foremost, if someone you know experiences trauma, help them find professional mental health care as soon as possible. Connecting with psychiatric care promptly may prevent the development of chronic psychiatric issues, self harm or even suicide. Not all trauma survivors will require follow-up or on-going mental health care, but an initial evaluation is important.

While showing your support is critical, be careful not to ask your friend or loved one to recount or describe the event. Instead, try to focus on the here and now. What are your loved one’s plans to stay healthy? What support structures can we put in place now to help you with specific challenges?

If you feel that they may be at risk for additional harm or trauma, for example as part of an abusive relationship, try to protect your loved one from further harm. Seek help from appropriate professionals so that you do not put yourself in danger.

If your loved one tells you that they are having thoughts of suicide or that they want to die, take them seriously. Call a crisis hotline for immediate help and help your loved one connect with appropriate mental health services.

Supporting someone through a crisis can take a toll on friends and family as well. Pay attention to your own health and mental well-being and consider seeking professional counseling if you feel you need support. Couples counseling or family counseling may be beneficial to help you learn how to better communicate and support one another.

Recovery After Trauma

Each person’s experience with trauma is unique. The effects of trauma may be more far-reaching for some people than for others. For people diagnosed with PTSD or a trauma-related disorder, engaging in evidence-based mental health treatment, though incredibly challenging, can lead to a significant improvement in symptoms and a better quality of life. Trauma-informed care, through a residential mental health treatment program or day treatment program, may be the best next step for people with co-occurring diagnoses like major depression, anxiety disorders, schizophrenia, or borderline personality disorder.

Evidence-based psychiatric treatment for trauma and PTSD can help individuals fully engage in their communities and live full, meaningful lives.