Basically trauma covers a broad array of events, including, but not limited to, the following:

* common events, like car accidents, shootings, rapes

* catastrophic events, like earthquakes, floods

* military or combat events

* abuse or neglect

* medical traumas like being diagnosed with a life threatening illness

* abandonment issues, i.e., from mental illness or addictions in a parent or partner

* losses, including losses from death, divorce, and even anticipated losses

* any life or death event where we think, even for a brief second, that we might die

Simply put, trauma is any incident that we are not prepared to handle at the time of the occurrence. For our brain's purposes, trauma is any event that is experienced with a surge of emotions, as this will cause the brain to store the memories differently.

Childhood neglect is often overlooked. Because it is the absence of something, it is often difficult to recognize. Children have no way of knowing they are being deprived, as they assume what happens to them is what happens to everyone. But neglect can cause aggression, self-mutilation, attachment problems, hypersensitivity, and substance abuse issues. A neglect study was done with monkeys, who do not like alcohol and will typically avoid it. When monkeys are neglected, they will crave alcohol.

It has been shown that neglected infants adopted into a caring home by four months old will typically be okay as adults. After four months, if infants continue to be neglected, they have a high chance of suffering greatly in adulthood from depression, substance abuse, personality disorders, PTSD, hyper-emotionality, irritability, and/or impulsivity.

Recent research on REM sleep (the stage where your eyes move rapidly back and forth and when dreams occur) shows that the area of the brain that is responsible for learning is active during dreaming. Thus it is believed that during REM sleep the ordinary events of the day are reviewed in the brain and placed in a usable format in long term storage. Lack of REM sleep by study participants kept them from using skills acquired that day, where those participants who did get REM sleep could use those new skills. Thus it is believed the REM eye movements help the brain to process memories, so the knowledge gained from these events can be easily accessed. Infants dream much more than adults, and, likewise, they are learning at an incredible rate during that time.

Research also shows that events that occur with strong emotion are not filed away in memory the same way that standard (non emotion-packed) memories are. The traumatic memories are kept as if frozen in time, without being processed and filed away. They are stored with the memory of what happened just prior to the trauma, and this preceding memory can become a trigger. Anytime another triggering event occurs, we can have the sensation of reliving the trauma. We call this a flashback. These can occur over and over. When the flashback occurs, there is no sense of it having occurred in the past, but rather it seems to continue to occur in the present. A current trigger can cause a traumatized person to behave as if they are reliving the trauma (i.e., the combat vet who hears a helicopter, believes he is back in war, and runs for cover).

In our brain is an almond shaped organ called the Amygdala. It stores emotional memory and is the brain's fear center. (If you remove the amygdala of a rat it becomes entirely fearless, and, as you can imagine, typically lives a very short life.) The amygdala responds outside of conscious thought, and responds to any threat in a fraction of the time it takes us to think about it.

When the amygdala perceives a threat it causes many chemicals to be released in our bodies, which increase alertness, focus, and short term memory; cause pupil dilation which improves our eyesight; and increases our peripheral vision and muscle tone in our limbs. All of this is to enable us to fight, flight, or freeze/submit.

Next the hippocampus, another brain organ, determines the severity of danger of the experience. It does this by comparing this new information with past associations, and uses the brain's problem-solving and planning areas.  If danger is determined to be present, the hippocampus causes the hypothalamus to release more stress hormones to shut down what it considers for the time being to be superfluous body functions, such as digestion, immunity, hunger, sleepiness, sexual appetite, etc. Blood pressure rises, heart rate increases, blood flow to the stomach slows so more blood can be sent to the limbs, breathing quickens to give our bodies more oxygen, perspiration increases to cool down the now escalating body temperature, our liver increases the amount of glucose sent to our muscles for intense energy, and our pain threshold drastically increases. Our bodies are now ready to fight, flight or freeze/submit.

Incidentally, one of the stress hormones released by the hypothalamus in this scenario is CRF, which is the most potent brain chemical involved in producing anxiety and depression.

When fight or flight doesn't seem to be helpful, our body will instead go limp. When this happens, more pain killing endorphins are released, our muscles are nearly paralyzed, our blood pressure steeply drops, and our heart beat dramatically slows down.

The hippocampus then calms our bodies by releasing chemicals which slow heart rate, lower blood pressure, put blood back to its normal balance, send the blood back to internal organs, and resume digestion and sexual interest. This system works well for a few traumas, but if we continue to experience trauma after trauma, the hippocampus actually atrophies from the toxic levels of stress hormones in our system. This atrophying causes the hippocampus to lose its ability to shut down the trauma reaction. This causes us to stay in the fight, flight, freeze/submit state and have great difficulty relaxing.

In no specific order, important factors to consider are: 

Age:  The younger we are, the more impactful the trauma. This is because traumatic events early in life have more impact on the most basic structures of the still developing brain, and impact our ability to respond to stress later in life.

Causation/Betrayal:  Symptoms can be more severe or longer lasting if it is another human being who caused the trauma, and even more so if it involved an act of betrayal by a trusted person.

Coping Skills/Support System:  The better our overall coping skills and support system,  the better we can cope with trauma.

Survivors:  If we see outselves as survivors of a trauma, rather than a victim, we will fare better following a trauma.

Dissassociation/Amnesia/Panic: If we suffer a dissassociative/amnesic epidose during the event, or a panic attack within 24 hours of the event, we have a much higher chance of suffering from PTSD. 

Interpersonal Loss: If we have suffered an interpersonal loss within 1 year prior to the trauma, we have a much higher chance of suffering from PTSD from the event.

Past History of Trauma: With each traumatic event we suffer, our chances of developing PTSD from the event increase.

Values:  If during the trauma we violate our own personal values, or if we are shamed by the public following our trauma, (more commonly found in war veterans), we can experience worse symptoms.

The simplest definition of Post Traumatic Stress Disorder, or PTSD is a normal response to an abnormal event. The DSM-IV, the counselor's diagnostic manual, states that to have PTSD one must have experienced an event in which "both of the following were present: (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others  AND (2) the person's response involved intense fear, helplessness, or horror." The DSM-IV categorizes three different types of symptoms:

1) Re-experiencing the traumatic event through:

* distressing dreams and/or nightmares

* the repeated sensation of the event reoccurring (flashbacks)

* intense distress at reminders of the event

* recurrent intrusive memories of the event

* an emotional reaction to reminders of the event

2) Avoidance symptoms which include:

* avoiding people, places, or things which remind you of the event

* avoiding thinking about and/or letting yourself feel feelings about the event

* lacking memory of parts of the event

* marked loss of interest in previously enjoyable activities

* feeling detached or estranged from others

* restricted feelings

* having a sense of a shortened future

3) Arousal symptoms which include:

* being easily startled

* hypervigilance

* sleep disturbances

* irritability

* difficulty concentrating

* anger outbursts

No. Many people survive traumas without any ill effect. Of those who are impacted by trauma, the most common disorder these people will suffer from is depression. Anxiety and substance use and abuse are next  most common, and the prevalence of PTSD is fourth most common following a trauma. Also the severity of the trauma does not equal the severity of the disorders that may follow.

Counseling provides a safe place where you can tell your story if you need to, or not. Many people will have a strong urge to talk about it, but at the same time not want to think about it. They will sometimes deny, sometimes admit it happened, and sometimes flip back and forth between these. Some people find talking about the event helps, others choose not to do so. Most people find help in being able to express their anger, rage, fear, shame, and/or pain in a safe place with someone who can provide the nurturing and guidance necessary to facilitate healing. Counseling provides a safe place for all of these events to occur, when and if you need them.

In Patricia Tighem's book, The Bear's Embrace: a Story of Survival, Patricia tells the very moving story of how she was attacked and mauled by a bear in the 1980's. In the book she tells her story of the incident and the emotional trauma of the repeated surgeries to her face. But for her the worse part of this intense event is the emotional pain around her unmet need to her talk about her trauma. Over many years, she is medicated and diagnosed with many different disorders, but she suffers years of emotional pain before she is finally recognized as having PTSD, and people finally listen to her talk about her pain.

There are many other things to do to help recover from trauma. Some people find relief in meditation and/or yoga. Many find a spiritual direction to focus on as a result of their trauma. Some people will use their survival to help others in their own path of healing.

Regular exercise has many benefits for physical health. It also is very helpful in recovering from trauma. Among many other things, exercise will increase BDNF, a protein made in our brains that protects the hippocampus from the toxic effects of excess stress hormones, as well as helps the regrowth of nerve cells in the hippocampus. When we are depressed, our bodies to not produce BDNF. Antidepressants and exercise stimulate BDNF production.

There are many outlets for healing. If you are unable to find a direction after trauma, counseling can also help you to discover a new path for your life.