(p. 124) For Families and Loved Ones: Common Reactions to Trauma
Your loved one has arrived at our clinic after experiencing a traumatic event. A traumatic experience produces an emotional shock and may cause many emotional problems. Because everyone responds differently to trauma, your loved one may experience some of these reactions more than others. Some may not be experienced at all. It is helpful for significant others and their loved ones to remember that many of the changes experienced after a trauma are normal. In fact, most people who experience a major trauma have severe problems in the immediate aftermath. Some will feel much better within a few months after the event; others recover more slowly, and some do not recover well enough without help. Becoming more aware of the changes felt since the trauma is a first step toward recovery.
Fear and Anxiety
The most commonly experienced reaction to trauma is fear and anxiety. Fear and anxiety are natural and necessary responses to a dangerous situation. When a person is in a dangerous situation, an internal alarm system is triggered, warning the person and helping him to react in the best way. This “alarm system” triggers certain physical reactions (racing heartbeat, sweating, etc.) and helps the person to focus on the threat that he must defend himself against. During the traumatic event itself, these reactions are natural and necessary, but when these reactions last for many months or years after the traumatic experience has ended, they get in the way of life.
Your loved one’s view of the world may have changed from one of safety and predictability to one that is dangerous and unpredictable. Sometimes fear and anxiety can seem to come out of the blue, but often they are brought on by triggers or cues that remind the person of the trauma. Triggers may include places, time of day, certain smells or noises, certain people, or other situations.
Unwanted thoughts and feelings associated with the trauma are called re-experiencing symptoms. Many people report that the trauma is always on their minds. Cues or triggers associated with the traumatic event may cause strong emotions and/or physical reactions such as racing heart, sweating, or trembling. For example, a person who has experienced a car accident may become fearful (p. 125) or upset when driven past the scene where the accident happened. Some people may have nightmares or they may have night terrors (awaken in a state of upset or terror, but be unable to recall a dream or experience that provoked the feelings). Some people may experience flashbacks, which are very vivid images or extreme reactions in which the person feels as if the event is happening again. For example, a person who was traumatized in a shooting incident may jump to hide behind a barrier upon hearing a car backfire or a fireworks explosion. Re-experiencing symptoms occur because the traumatic experience is so shocking and different from the person’s everyday experiences that it doesn’t fit with what the person already knows and understands about the world. It is as if the mind of the person is trying to go over the event again and again to better digest and understand what happened.
Another common problem for people suffering from PTSD is avoidance. Avoidance reactions can be thought of as attempts to manage the emotional pain related to the trauma. Some people may try to push the thoughts away or distract themselves when thoughts or feelings associated with the trauma come into their minds. When reminded of the trauma, some people may change the topic or engage in distracting or disruptive activities to avoid thoughts or feelings. People with PTSD may also avoid situations, places, or activities that remind them of the trauma. For example, a woman who is brutally raped may avoid talking with men. A soldier who experienced an IED (improvised explosive devise) roadside explosion while driving may avoid driving or may feel extremely uncomfortable at stoplights or when caught in traffic.
Some people with PTSD may begin to use or increase their use of drugs or alcohol as a means of coping with the pain they are experiencing. Unfortunately, substance use can slow down recovery and cause problems of its own if unchecked.
Feeling on Edge
People who experience high levels of arousal feel jittery and on edge almost all the time. They feel that their bodies are hyper; for example, they have accelerated pulse and heartbeat or increased muscle tension. They are cautious and jumpy all the time, they are startled easily, and they react strongly to simple things. High arousal develops because the trauma overworked the body’s normal alarm system triggering a “fight, flight, or freeze” response. The “fight, flight, or freeze” response is how we gear up to protect ourselves when danger threatens us. Our bodies begin to pump out more adrenaline to give us energy to run away, to fight for survival, or to freeze as a way of hiding from danger. These responses are natural and helpful reactions in the face of danger. Unfortunately, the triggers and cues that remind people of a traumatic event (p. 126) can make it seem like danger signals are everywhere. This triggers the alarm system to give an alarm when there is no real threat. Because these triggers do not pose a real threat, this is actually a false alarm.
Since people with PTSD often see danger signals everywhere, they are in a constant state of anxiety and being “on guard.” Because of the heightened state of anxiety, some people often have difficulty falling or staying asleep. Concentration may also be difficult, and they can seem irritable and easily frustrated much of the time. Work may suffer. Relationships with peers and family members may become strained. Some people may seem sensitive and easily brought to tears. Others may seem jittery, jumpy, or unable to sit still. Loud noises or sudden movements can easily startle them, and they may become increasingly watchful and alert to their surroundings.
Grief and Depression
The trauma and the reactions that follow can so disrupt everyday life that the person feels tremendous grief and depression. This can include feeling sad, down, hopeless, or despairing. Some people will be able to say how they are feeling, while others will show how they are feeling by their behavior. A depressed person may appear more reserved, withdrawn, or detached from other people. Depressed people may also seem irritable, angry, or frustrated at times. This can be very confusing for the significant other who cares for the loved one; it is often those closest to the loved one who receive the brunt of the person’s anger and frustration. For people not used to feeling angry, these feelings can seem out of control and frightening.
Some people can develop a preoccupation with death or have difficulty imagining themselves in the future. It can sometimes seem that the trauma has ruined all their future plans and hopes. If depression is severe, the person may even feel that life isn’t worth living anymore and may express thoughts or wishes to be dead. While this reaction to trauma is not uncommon, it is certainly one of the more frightening reactions for significant others and one that can best be managed in coordination with a mental health professional.
Guilt and Shame
Many people feel tremendous guilt and shame about the trauma. A person who witnesses domestic violence between his parents may believe that his parents fought each other because of him. People often feel responsible for much of what happens in their lives, good or bad, but this may be especially true if peers have blamed them or lead them to believe that they deserved what happened to them. For example, a child who has been abused by an adult caretaker may have been (p. 127) told that he deserved the abuse because he was a “bad child.” Adults may also be confused in this way if they trusted or admired the person who hurt them, or if they enjoyed some parts of the relationship with the person who hurt them. Feeling guilty or responsible for a trauma may also make the person feel as if he has more control over the event, or that he can avoid the event in the future. However, self-blame can intensify feelings of shame and depression.
Self-image may suffer greatly after a trauma. Self-blame and guilt may lead to feelings of worthlessness and a belief that the loved one deserves to be punished. “Survivor guilt” may also be present if the person survived a traumatic event (e.g., a serious accident, bombing, or attack) while his or her comrades lost their lives. Many people will tell themselves that they are weak or stupid for not being able to control or stop the traumatic event. They will second-guess their reactions and responses during the trauma and say to themselves that they “should have” done this or that and it would have prevented the incident from occurring. The person’s image of the world often suffers as well. It is very common to feel that others can’t be trusted, and to expect that other people are dangerous. This can make it difficult for the person to make friends or trust people.
Effects on Sexual Intimacy
Some sexually abused people may develop distorted beliefs about sexuality and sexual behavior. For some people, this can lead to fear and avoidance of normal, developmentally appropriate behaviors. For example, normal interest in dating can be disrupted or delayed. Maladaptive beliefs can lead to sexual acting out such as inappropriate touching and showing, sexual language or gestures, and preoccupation with sexual themes. Others may engage in sexual relationships before they are emotionally or intellectually ready. These behaviors can compound the trauma and lead to further experiences of shame and exploitation.
Connection Between Reactions
Many of these reactions are connected to one another. For example, a person who experiences an unwanted reminder of the traumatic event may become fearful and anxious. The person may then blame himself for not being able to cope with his anxiety. He may tell himself that he is stupid or crazy because he cannot control his emotions. This can lead to further emotional upset and feelings of being out of control. This increases fear and anxiety. As the person begins to process the trauma and his reactions to it, his understanding will increase and so will his feelings of competence and control.
(p. 128) Common Reactions of Significant Others
As a significant other, you may be experiencing your own reaction to the trauma. Sometimes this occurs because the whole family experienced the trauma (e.g., a house fire). When this happens, significant others may be dealing with their own reactions, in addition to those of their loved one. Other times, even if the trauma was experienced by the loved one alone, significant others’ connection and attachment to their loved one can lead them to feel as if they experienced a trauma as well. Sometimes significant others experience intrusive thoughts, react to reminders of the trauma, and have feelings of guilt and blame because they feel that they were unable to protect their loved one from harm. Like the person affected by PTSD, a significant other may avoid situations and places that trigger memories surrounding the trauma. Because remembering the trauma is so painful, a significant other may avoid thinking about it and may encourage his or her loved one to stop thinking and talking about it. Statements like, “Put it behind you,” “Just move on,” “Get over it,” “Think about happy thoughts,” and “Forget it ever happened,” can be well-meaning, but can get in the way of both the significant other’s and the loved one’s processing of the event. Clearly, if the loved one could “just move on,” he or she would have done so by now. Be patient with your loved one and yourself. Healing is often slow, but it can happen with time and patience and loving support.
Significant others may also develop extreme fear and anxiety about their loved one’s safety and well-being. Significant others can react to these feelings of trauma by overprotecting their loved one. The significant other’s actions may communicate fears to the loved one and can add to the person’s anxiety and upset. Sleep and concentration problems are also common among significant others of the persons who have experienced trauma. The same “fight, flight, or freeze” response is at work in the significant others’ lives as they deal with the urge to protect their loved one from further harm. Significant others may find themselves scanning the environment for danger as they become increasingly mistrustful of other people who have access to their loved one. The constant heightened arousal can lead to irritability and poor concentration and feelings of incompetence and lack of control.
Just as the loved one needs to become aware of the changes that have taken place as a result of trauma, significant others must become aware of their own reactions to the trauma as a first step toward processing and understanding the trauma itself. If a significant other’s reactions are difficult to manage, or if reactions interfere with the significant other’s ability to help the loved one recover, it is important for the significant other to get assistance so that both she and the loved one can move past the trauma.