Defining Trauma

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Defining Trauma

October 12, 2018
child with trauma
By: Sara Gill, PhD

Defining trauma has been a challenge across many fields over the past few decades.  This is in part because it must go beyond identifying specific events or types of events, and instead must focus on the experience and perceptions that create the trauma.         

According to leading researchers (Cohen et al., 2006), the best definitions of trauma incorporate the following features when distinguishing traumatic events:

  1. Sudden or unexpected events
  2. The shocking nature of such events
  3. Death or the threat to life or bodily integrity
  4. The subjective feeling of intense terror, horror, or helplessness

Common examples of such events can include witnessing or being a victim of domestic violence, a car collision, an environmental disaster, a physical illness that is potentially life threatening, the death of a loved one, and exposure to high stress living conditions.

However, traumatic events are not always easily identified or defined. Those who are affected, are impacted in different ways. While the examples listed above may seem fairly self-evident, there are any number of events that can be experienced as traumatic by the individual going through them. These events may be one time events, such as an accident, or they may be long-term or chronic events that, due to the buildup of stress over time, become traumatic.

Individuals or families may often experience a combination of these types of experiences. For example, a specific event may occur, such as an unexpected death, that leads to chronic stresses in the environment, such as the loss of income.  In this situation both the initial death and the ongoing fears and stresses related to the loss of income, such as insecure housing, are experienced as trauma.  The National Stress Network lists the following 14 categories of trauma:

  1. Sexual Abuse or Sexual Assault: This includes but is not limited to physical contact. It can also involve exposure to inappropriate sexual material or environments.
  2. Physical Abuse or Assault: This includes both actual or attempted infliction of pain.
  3. Emotional Abuse/Psychological Maltreatment: This includes verbal abuse, emotional abuse, excessive demands on a child’s performance, emotional neglect, or intentional social deprivation.
  4. Neglect
  5. Serious Accident or Illness/Medical Procedure
  6. Witness to Domestic Violence
  7. Victim/Witness to Community Violence
  8. School Violence
  9. Natural or Man-made Disaster
  10. Forced Displacement
  11. War/Terrorism/Political Violence
  12. Victim/Witness to Extreme Personal/Interpersonal Violence
  13. Traumatic Grief/Separation
  14. System-Induced Trauma: This can include removal from home, placement in a foster home, sibling separation, or multiple placements in a short amount of time.

Others have grouped the causes of physical and mental trauma into broader categories.  One such system includes the following:

  1. One-time events: This includes accidents and injuries. Events in this category seem to be particularly impactful if they occur in childhood.
  2. Ongoing relentless stress: This includes neglect, bullying, living with a chronic illness, or living in chronic poverty.
  3. Commonly overlooked causes: This includes surgeries (specifically in for children 3 years old and younger), a break up, a humiliating or cruel experience.

As noted above, there can be significant differences in how individuals experience an event, which directly impacts whether it is considered to be a trauma. This is often due to the fourth factor listed above, namely the feelings of intense terror, horror, or helplessness.

How an individual experiences an event and how they are then able to process it or make meaning of it helps to determine whether that event is experienced as traumatic. Said another way, two individuals may experience the exact same situation, but have markedly different experiences and outcomes. One person may have resources and supports, as well as other coping skills that prevent them from being overwhelmed by negative emotions and may help to prevent them from feeling truly helpless and terrified.  Conversely, the other person may have his or her coping skills completely overwhelmed by such feelings. In this case, it would be much more likely that the second person would exhibit symptoms related to trauma.

As you might imagine, this picture becomes even more complicated when talking about children and families. A child’s age, developmental stage, individual attributes, and more all impact whether or not they experience an event as traumatic. The Early Trauma Treatment Network defines trauma for children under the age of six years old as, “An exceptional experience in which powerful and dangerous stimuli overwhelm the child’s capacity to regulate emotions.”  They also note that for children under the age of four years old, seeing an adult caregiver physically threatened can be a particularly powerful or potent form of trauma.

Taken together, this means that children and adolescents are particularly vulnerable to experiencing trauma depending on the resources that are available to them. And research has shown that childhood trauma can continue to impact an individual throughout his or her lifetime and leave them at increased risk of experiencing additional traumatic events in the future.

The emotions and behaviors exhibited by individuals who have experienced trauma can vary greatly.  In children it can become even more varied as their reactions may change over time as their understanding of different events matures. Symptoms of trauma can include, but are not limited to, the following:

Emotional and psychological symptoms:

  1. Shock, denial, or disbelief
  2. Confusion, difficulty concentrating
  3. Anger, irritability, mood swings
  4. Anxiety and fear
  5. Guilt, shame, self-blame
  6. Withdrawing from others
  7. Feeling sad or hopeless
  8. Feeling disconnected or numb

Physical symptoms:

  1. Insomnia or nightmares
  2. Fatigue
  3. Being startled easily
  4. Difficulty concentrating
  5. Racing heartbeat
  6. Edginess and agitation
  7. Aches and pains
    • In children this may also take the form of stomachaches and/or headaches.
  8. Muscle tension

Not all individuals, whether adults or children, who experience a traumatic event need treatment. However, it is incredibly important to seek help when symptoms being to impact the individual’s ability to engage in daily activities.  Providing a child or adolescent with additional support can be an important step in helping them gain the resources they need to process the range of feelings they are likely experiencing related to their trauma. Individual, family, and group therapy can all be important resources as your child works to process his or her trauma.  It is important to speak with a qualified provider to determine the best course of treatment for you and your family.

 

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