Table 1. Stages of Reaction to Trauma Early Symptoms
Second-Stage Reactions Emotional ● Panic attacks, anxiety, ● Inability to identify or describe emotions ● Abrupt mood swings (including aggressive ● Easily and frequently stressed ● Frequent crying Physical/Behavioral ● Exaggerated startle responses ● Attraction to dangerous development of phobias thoughts or actions against self or others)
Later Symptoms
Emotional ● Constriction of emotions ● Feelings of helplessness ● Abrupt mood swings (e.g., temper tantrums, sudden rages, or shame attacks) ● Inability to identify emotions or find words to describe them ● Low threshold for stress tolerance ● Inability to identify or describe emotions
Emotional ● Flat or dulled emotional responses ● Feelings of detachment or isolation ● Loss of interest in life ● Depression ● Abrupt mood swings ● Frequent crying ● Continued inability to deal with stress
Physical/Behavioral ● Hyperarousal ● Difficulty sleeping
Physical/Behavioral ● Chronic fatigue or very low energy ● Psychosomatic illness (very real physical symptoms for which no underlying organic cause is found), such as digestive problems, severe gynecological or menstrual symptoms, headaches or migraines, respiratory problems, back and neck problems, and skin disorders ● Immune system problems, or certain endocrine problems such as thyroid dysfunction ● Self-injurious behaviors (including substance use, self-harm, eating disorders, and suicidality) Cognitive ● Change in worldview ● Difficulties in ability to love, nurture, or connect with others ● Fear of dying, going crazy, or having a foreshortened life
● Inability to sit still or relax ● Hypervigilance (being on guard at all times) ● Startle responses ● Extreme sensitivity to sound and light
situations, impulsive and risk- taking behaviors
● Continued sensitivity to
environmental sensory input
● Hyperactivity
Cognitive ● Dissociation (including denial) ● Intrusive imagery or flashbacks ● Nightmares and night terrors ● Difficulty describing experiences
Cognitive ● Blankness or “spaciness” (early dissociative responses) ● Nightmares and night terrors ● Amnesia or forgetfulness ● Fear of dying, going crazy, or having a foreshortened life
It is important to note that some of the early symptoms can continue to occur in subsequent stages. No definitive timetable for varied responses exists; although listed linearly, they are individually variable. The symptoms listed are not all manifested by every person, and some symptoms may be manifestations of other physical or emotional Responses to Acute and Chronic Trauma The response to trauma varies, depending on whether the event is acute or chronic. When the traumatic event is an isolated or short-term occurrence (such as a natural disaster or car accident), rather than of an ongoing nature (such as childhood abuse), it is referred to as an acute traumatic event. Although the individual experiencing acute trauma is likely to develop many of the trauma-response symptoms listed in Table 1, the symptoms are generally short-lived and do not become embedded as an ongoing part of the individual’s overall response to life or become entrenched as part of their personality structure (Schore, 2019a). When life returns to the individual’s baseline normal, the symptoms that developed in response to the trauma tend to diminish and abate if that baseline is a relatively healthy and functional one. In this case, the person’s responses rarely progress beyond the early symptom stage; however, occasionally, some secondary responses may be seen if the individual experiences repeated stressors or insufficient treatment (Schore, 2019a). Additionally, the type of acute trauma experienced often contributes to the chronicity of symptoms, with interpersonal traumas (e.g., sexual assault) often leading to more prolonged reactions, as they may
illnesses. The final category lists symptoms that generally take longer to develop, often emerging when the traumatic events have been internalized into the system as a pattern that affects multiple aspects of a person’s biopsychosocial sphere.
disrupt one’s capacity for self-organization (Villalta et al., 2020). When the traumatic events are repetitive or long-term in nature, or when they occur within the context of a life that is already marginalized and stressful, a greater likelihood exists that the acute trauma response symptoms will become internalized and a fixed response to life events will develop after the original incidents are long past. In cases of chronic traumas—those involving repetitive events (e.g., growing up in a neglectful or abusive family)—the symptoms frequently develop into later-stage responses. It is important to note that intrusive re-experiencing and flashbacks are common features of both acute and chronic trauma. A flashback is an intrusive recollection of a traumatic event that occurs suddenly, without warning, and often in a neutral setting. It may also occur as a memory burst in an otherwise symbolic dream or as a nocturnal replay of a traumatic event during sleep. The recollection is usually startling and vivid and may contain images, sounds, smells, tastes, and sensations experienced during the original event. The survivor experiences the flashback as if the trauma is actually reoccurring at that moment.
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