What is Acute and Chronic Mental Health Trauma (Mental Trauma)?
The term “trauma” comes from Greek and means “wound” or “hurt”. In terms of mental health, trauma refers to an experience which someone perceives as painful or distressing, causing potential long-term mental and physical harm. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines a traumatic event as a potential threat of death, serious injury, or sexual violence. People can experience trauma in different ways – they may be directly involved in an event, witness it, or learn about it happening to someone else. Such events can leave a person feeling shocked, helpless, or out of control.
Trauma can take many forms, such as sudden personal loss, physical abuse, sexual predation, natural disasters, or exposure to war and violence. Since instances that cause trauma are widespread and affect almost everyone at some point, we can rightfully call it a nearly universal human experience. Studies indicate that trauma experienced during childhood tends to have more severe outcomes than trauma experienced later in life.
Trauma reactions can be acute (short-term) or chronic (ongoing). An acute response is typically a quick, intense reaction to a real or imagined threat, often triggering a “fight or flight” response. If this reaction persists, or if the threat is ongoing, it can evolve into a chronic trauma response, which can cause significant harm and complicate other health conditions.
Chronic stress reactions can happen after a singular traumatic event or multiple stress-causing incidents. People with chronic trauma may display several behaviors and physiological changes, such as extreme alertness (hyperarousal), avoiding reminders of the trauma, sudden flashbacks, or mood and thought changes. These symptoms are associated with Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD). The main difference between the two is the duration of symptoms after the traumatic event – ASD lasts less than a month, and PTSD more than a month.
Complex trauma refers to repeated exposure to serious trauma over a prolonged period, often due to the breakdown or loss of a significant relationship. It usually happens during childhood or adolescence, often perpetrated by those in a position of trust or authority, such as adult caregivers. This type of trauma makes the person feel trapped, leading to hypervigilance and ongoing negative moods. Complex PTSD includes PTSD symptoms combined with a negative self-image, emotional instability, and relationship problems.
What Causes Acute and Chronic Mental Health Trauma (Mental Trauma)?
Trauma can be caused by a wide range of events:
* Natural disasters like tornados, hurricanes, earthquakes, or fires
* Accidents such as car crashes or chemical spills
* Physical violence from being attacked or mugged
* Physical abuse, including severe physical discipline or domestic violence
* Sudden illnesses
* Sexual violence or assault
* Sexual abuse, such as inappropriate behavior towards minors, threats of sexual violence, stalking, or human trafficking
* Verbal and emotional abuse
* Sudden loss of loved ones
* Emotional or psychological abuse, like yelling, emotional manipulation, or controlling behaviors
* Homelessness or unstable living conditions
* Severe financial difficulties
Other major conflicts such as war, terrorism, or torture, as well as chronic illnesses or bullying can also cause trauma. It can happen due to real or perceived neglect or abandonment, and even from witnessing others experience these traumatic events.
Certain factors can also affect how trauma impacts a person’s well-being. These include:
* The person’s gender
* Age
* Their social and economic status
* Their race, ethnicity, and culture
* Their sexual orientation and gender identity
* The time they have to process the trauma
* Losses following the trauma, like a significant relationship, job, or stable housing
* Anticipating trauma
A person’s relationship to who or what caused the trauma, how they or their culture interpret the trauma, disruption of core beliefs, past traumas, resilience history, and history of mental illness can also affect their reaction to trauma.
Risk Factors and Frequency for Acute and Chronic Mental Health Trauma (Mental Trauma)
Studies from around the world reveal that about 70% of people experience traumatic events in their lives. This is according to a body of research, including recent data collected in 2022 from more than 50,000 individuals. On average, each person encounters around 3.2 traumatic experiences in their lifetime.
The types and frequency of trauma can vary greatly based on a person’s age and economic background. Younger people and those with lower socioeconomic status are more likely to experience violent trauma or accidents. Women often report intimate partner sexual violence, while men are typically more prone to physical violence and accidents.
People like police officers, first responders, and soldiers working in active combat zones often report fewer symptoms related to trauma. This might be because of selection bias or due to increased resilience in these populations. However, it’s not clear whether previous trauma actually helps improve resilience or instead makes these individuals more vulnerable to further trauma.
In the United States, almost 90% of adults recall encountering at least one potentially traumatic event (PTE) in their lifetimes. Trauma can result in post-traumatic stress disorder (PTSD), which is one of the most common mental health conditions seen by clinicians. Roughly 5% to 6% of men and 10% to 12% of women experience PTSD, while about 8% of individuals exposed to trauma develop PTSD symptoms, with a majority recovering after their initial trauma experience.
It’s important to note that not everyone who experiences trauma develops PTSD or other disorders like depression, anxiety, or substance abuse. Rates of trauma exposure seem to be the same in urban and rural areas of the U.S, with more exposure to war-related trauma in rural areas and more substance abuse in urban environments.
- The most frequent traumatic event reported in a large 2016 study was the sudden and unexpected loss of a loved one.
- This event was experienced by about 31% of the respondents and made up one-sixth of all traumatic events.
- Witnessing death or serious bodily harm was the second most common traumatic event, reported by about 23% of people and also making up one-sixth of all traumatic events.
- The third and fourth most common traumas were muggings and severe motor vehicle collisions, reported by 14.5% and 14% of people respectively.
- The fifth most common trauma was a life-threatening injury or illness, which was reported by 11.8% of individuals.
All five types of traumatic events make up about half of all trauma experiences. Risk of PTSD development is most common during childhood, adolescence, and after age 65.
The type of trauma also has an impact on the likelihood of developing PTSD. Frequent physical violence, including combat, and sexual violence carry the highest risk. The unexpected death of a loved one or being directly exposed to death or serious injury also carry substantial risk. Despite these risks, these types of exposures are common in the general population.
Signs and Symptoms of Acute and Chronic Mental Health Trauma (Mental Trauma)
When a person has been exposed to trauma, they may experience an array of disturbances in their behaviour, feelings, and thinking processes. A doctor should collect a detailed summary of these experiences to understand the range of problems the patient is facing. Some symptoms that patients may report after a traumatic experience could include:
- Sleep problems
- Trouble focusing
- Changes in mood
- Increased impulsiveness
- Tendency to isolate themselves
- Constant movement or restlessness
- Self-harm
They might also describe emotional changes such as:
- Feeling down or depressed
- Feeling numb or disconnected from emotions
- Being easily irritated or angry
and cognitive issues like:
- Sustaining attention
- Feeling detached or spaced out (dissociation)
- Confused thinking
- Memory problems
Patients could also report symptoms of increased body awareness, including sensitivity to sound and touch, easily startled, anxiety, and fear. Recognizing these signals can help diagnose conditions like Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder (PTSD), which are identified based on how long the symptoms last after the traumatic event. Also, doctors should evaluate the risk of suicidal thoughts or attempts as they can be increased in patients exposed to trauma.
However, in a hospital environment, asking for a detailed account of traumatic experiences might not be appropriate or necessary because it can lead to traumatic responses and emotional unbalance. The exceptions to this are when reporting abuse in elders, children, and individuals with intellectual disabilities or when delivering trauma-specific treatment in consultation with the patient.
The doctor should carefully understand the reported symptoms and match the patient’s descriptions of their traumatic experience with medical terms to ensure accurate diagnosis. For example, if a patient describes feeling ‘paranoid,’ it could be identified as high alertness; or if they mention experiencing ‘amnesia,’ it might be a way to describe a dissociative episode.
Testing for Acute and Chronic Mental Health Trauma (Mental Trauma)
If a patient is receiving treatment, it’s important that doctors look for any physical problems that might interfere with the treatment. This includes liver diseases or other conditions that could impact how drugs are processed in the body or how drugs interact with each other. Currently, hormone tests like cortisol levels and dexamethasone suppression testing are not typically done. It’s also important to check for any substance use disorders, including alcohol and tobacco use, as these often occur along with trauma.
Even though there aren’t specific guidelines, it’s a good idea to consistently screen patients for a history of trauma. This is particularly important for patients who show signs of depression and anxiety or for those with a history that might have increased their risk of experiencing trauma, such as military service. Knowing how greatly a patient’s life is being affected can help identify if they have Acute Stress Disorder or Post Traumatic Stress Disorder.
Several tools can help doctors assess trauma-related disorders. Many of these tools are sound from a measurement point of view and can either be completed by the patient themselves or involve short structured interviews. Several of these tools are publicly available. They include:
- Screen for Posttraumatic Stress Symptoms (SPTSS)
- Clinician-administered PTSD Scale (CAPS-5)
- Impact of Event Scale – Revised (IES-R)
- PTSD Symptom Scale: Self-report Version (PSS-SR)
- Trauma History Questionnaire (THQ)
The SPTSS, IES-R, and PSS-SR are all self-report tests that patients can fill out quickly. The SPTSS is often used to identify whether patients meet the criteria for PTSD, whereas the IES-R is purely a screening tool. The PSS-SR screens for the level of dysfunction in key symptoms related to trauma. The THQ is designed specifically to help describe multiple traumatic events throughout a person’s life and help make sense of complex trauma histories. The CAPS-5 is a more structured interview and is considered the best way to diagnose PTSD due to its thorough examination of various aspects of trauma-related symptoms, including their duration, severity, and timing.
Research has found that these structured clinical interviews are more accurate in diagnosing trauma-related disorders, but they do require additional time and training to perform correctly. Although these screening and assessment tools can be helpful in identifying individuals at risk, they cannot replace a comprehensive medical and mental health evaluation.
Treatment Options for Acute and Chronic Mental Health Trauma (Mental Trauma)
Therapy is a primary treatment for trauma symptoms and disorders such as Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD). Many studies involving children, adolescents, and adults show that a variety of therapies are effective compared to no treatment. Currently, evidence points to Cognitive Behavioral Therapy (CBT) as being successful in reducing PTSD symptoms and associated anxiety and depression in young people, regardless of the type of trauma they’ve experienced.
Other treatments, like Cognitive Processing Therapy (CPT) and Exposure Therapy, are equally successful at treating PTSD, including when it’s specifically related to physical and sexual violence. Stress Inoculation Training is another helpful method that lessens the severity of PTSD symptoms and can maintain these effects for up to a year after stopping the treatment. Eye Movement Desensitization and Reprocessing (EMDR) is another commonly used treatment that addresses trauma and PTSD efficiently. Psychodynamic Psychotherapy also shows an effective treatment for PTSD.
The aim of therapy is to help patients identify and manage unhealthy thoughts, feelings, and behaviours. This helps reduce avoidance behaviours, lower intense psychological responses, and improve overall functionality. Different therapy techniques use various theoretical concepts to achieve this treatment goal.
Medication is another primary treatment for trauma-related conditions. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are the main types of drugs used. So far, Paroxetine and Sertraline are the only SSRIs approved by the FDA for treating PTSD. Despite lacking approval, Fluoxetine and Venlafaxine are still commonly prescribed and recommended by the Veteran Affairs/Department of Defense. Other non-SSRIs and antidepressants like Trazodone and Mirtazapine have also proven beneficial.
Animal studies have shown that these antidepressants can cause neurogenesis in the hippocampus, a process that is believed to be a mechanism of action in PTSD. Certain antipsychotics and mood-stabilizing agents have also shown clinical benefits. However, the side effects can limit how useful these medications are. Some research suggests that a combination of trauma-informed therapy and medication could have potentially beneficial combined results, but this requires further study.
Research is underway to identify treatments that can prevent the development of trauma-associated symptoms and diagnoses. A literature review by Qi et al suggests that short therapeutic interventions are likely unnecessary for most trauma survivors who already show symptoms. Hydrocortisone has shown some effectiveness as a preventive treatment, especially for those who haven’t used corticosteroids before. However, no effectiveness has been shown for Escitalopram, Gabapentin, Propranolol, or Temazepam. Some potentially promising new treatments involve hallucinogenic substances, but these will require further research to establish their safety and effectiveness in clinical practice.
What else can Acute and Chronic Mental Health Trauma (Mental Trauma) be?
Symptoms associated with trauma appear across various types of disorders and require careful consideration, as they can significantly affect the chosen method of treatment. For instance, signs such as consistent low mood, withdrawal from social interactions, and disrupted sleep patterns are common in those suffering from both PTSD and depressive disorders. Symptoms normally associated with ADHD, like increased physical activity, lack of attention and impulsivity, can be seen in trauma-related conditions. Similarly, people with anxiety disorders may also exhibit signs related to trauma, such as persistent restlessness or avoidance behaviours. Even certain symptoms usually linked to psychosis, like hearing or seeing things that aren’t there, are often experienced by individuals who have a history of trauma. People might also struggle to describe feelings of paranoid thoughts or being constantly on high alert. Symptoms that seem similar to self-isolation and mistrust, usually found in PTSD, could also be hints of negative psychotic symptoms.
There’s a recently identified mental health disorder called Complex Post Traumatic Stress Disorder (CPTSD) which is similar to PTSD, but it includes feelings of emotional numbness, a distorted sense of self, persistent feelings of worthlessness, and issues regulating emotions and maintaining relationships. These symptoms can be seen in Borderline Personality Disorder (BPD), which has led to debates on whether CPTSD and BPD refer to the same condition. Current research, however, suggests that these two are distinct disorders.
Researchers are proposing a new diagnostic category called Developmental Trauma Disorder (DTD) to better represent the recurring symptoms and distinct patterns that tend to emerge from long-term or serious exposure to trauma during childhood. This disorder involves a series of disruptions in regular cognitive, emotional and behavioural functioning and can become apparent in various ways. Some individuals may repetitively harm themselves, exhibit suicidal tendencies, demonstrate antisocial behaviors, or struggle with facing reality. The significance of this broad diagnostic category is to avoid mistakenly labeling individuals with excessive disorders and to encourage a comprehensive, team-based approach to treating those who have experienced severe and repeated traumas during their childhood.
What to expect with Acute and Chronic Mental Health Trauma (Mental Trauma)
Research on trauma-related symptoms finds that about half of the people suffering from Post-Traumatic Stress Disorder (PTSD) start to feel better within the first six months after the traumatic event. This pattern seems to be consistent across different types of traumatic experiences. However, it’s not clear why some people recover quickly, while others don’t.
For the other half of PTSD sufferers, the duration of symptoms can vary significantly. For instance, people usually experience symptoms for about a year after natural disasters, while the effects of combat experiences can last an average of 13 years. It’s important to be aware that repeated exposures to physical or sexual violence greatly increase the risk of developing mental health problems.
A study of patients who underwent treatment for physical injuries found that those who only experienced mild symptoms soon after their trauma were less likely to suffer from Acute Stress Disorder (ASD) or PTSD. On the other hand, those who had severe symptoms immediately after the traumatic event faced a higher risk of mental illness, which often does not improve on its own. Also, patients with moderate symptoms showed varied rates of symptom progression during recovery.
People often think of ASD as a stepping stone to PTSD, implying that ASD usually turns into PTSD. However, this isn’t always the case. A recent analysis found that about half of PTSD patients did not meet the criteria for ASD in the first 30 days following their trauma. Among the remaining half, immediate symptom development did not consistently anticipate the onset of PTSD.
Possible Complications When Diagnosed with Acute and Chronic Mental Health Trauma (Mental Trauma)
Recent studies have indicated that individuals who’ve been through acute or chronic trauma could have negative impacts on their health. Acute stress responses have been connected with higher risk of sickness and death, increased usage of healthcare services, pain, and poor overall health. Other risks include increased injury rates, potential heart disease through secondary risk factors, and increased usage of medical and mental health services.
People diagnosed with Post Traumatic Stress Disorder (PTSD) are also more likely to have poor overall health, several medical diagnoses, and functional issues that could even appear years after the initial trauma, especially if the trauma responses were prolonged. Victimization traumas could affect one’s sense of well-being and satisfaction with life, and this gets worst as the severity of the trauma grows. This connection was proven in a study that found a positive correlation between the amount of traumatic events someone experiences in their entire life and the likelihood of them having adverse health outcomes.
Adverse childhood experiences include traumatic events that occured when the child is in developmental stages, such as childhood and adolescence. This includes abuse, neglect, and loss of a caregiver. Research has shown that exposure to such trauma repeatedly can have significant impacts on the development of coping skills, personality, and attachment style. It also raises the risk of further trauma and development of mental health issues. Severe emotional reactions or stress after exposure to trauma, accompanied by significant automatic activation, appears to predict the development of PTSD.
The initial response to trauma and the following avoidant behavior are connected with increased symptoms of PTSD. This was the base for the establishment of protocols for acute desensitization that eventually weren’t found to provide any substantial benefit. In some cases, they have even worsened symptoms. Current research strongly suggests that chronic stress in childhood is connected with disrupted attachments early in life, poor development of coping skills, heightened stress responses, and a hugely increased risk of developing mental health issues in adulthood. Chronic trauma during childhood also seems to be connected with poorer academic performance that is made worse by mental illness. This is becoming a barrier to access to mental health care and is associated with increased risk of reduced employment and educational opportunities.
Studies have extensively described the connection between sexual and physical violence and poor health outcomes. In general, sexual trauma and nonsexual physical violence are connected with more symptomatic presentation of PTSD and lifetime trauma types compared to other traumas. Nonsexual physical violence is connected with substance use disorder in about 25-45% of PTSD cases. The unexpected death of a loved one was associated with comorbid depression. In all cases, developing depressive symptoms in both people with and without PTSD is common, especially after periods of high acute stress responses.
Exposure to trauma has shown a strong connection to suicidal thoughts and attempts in a person’s entire life span. This holds true even for childhood trauma exposure, increasing the risk of developing suicidal thoughts in children and adults, especially in cases of sexual trauma. Men in the military who have experienced childhood trauma, especially sexual abuse, have an increased likelihood of attempting suicide and getting hospitalized, when compared to simple suicidal thoughts. Women, on the other hand, are more likely to commit suicide if they have experienced childhood neglect, particularly emotional neglect.
Current research has found a strong connection between exposure to trauma and the risk of developing symptoms of psychosis in the future, like chronic auditory and visual hallucinations. One study found that the types of hallucinations experienced by a patient was directly connected to exposure to childhood trauma after controlling for suicidal thoughts and other potential diagnoses. Exposure to at least one traumatic event led to 2.5 times increased risk of developing thoughts of paranoia and almost five times increase in risk of developing verbal hallucinations.
These risks are associated heavily with severe childhood sexual abuse and non-victimization or witnessed events; the only exception was adult physical attacks which were not associated with an increased risk of developing such symptoms. A recent study of hallucinations and delusions connected to trauma also found that the severity of hallucinations is connected to specific types of trauma, which included childhood sexual abuse and neglect. The severity of delusions is associated with childhood sexual abuse and overall trauma sustained. Symptoms of psychosis that were negative, like limited social interactions and flatter affect, were found to be associated with childhood neglect.
Preventing Acute and Chronic Mental Health Trauma (Mental Trauma)
Preventing exposure to traumatic events is crucial but challenging due to their widespread occurrence. Professionals often work to prevent further damage after an individual has been exposed to a traumatic event. It’s important to focus on safety when helping people deal with trauma and its associated symptoms. Several methods have been identified to help people manage trauma and its effects:
Establish a safe physical and emotional environment whenever possible, avoid causing additional trauma, and provide knowledge about trauma. This education can help patients understand their symptoms and reassure them that these reactions are normal. It also offers hope for recovery by outlining the potential for successful treatment. Encouraging patients to learn about trauma, addressing sleep disruptions, and acknowledging any losses or grief experienced because of the trauma are also important.
A newer concept in trauma research is resilience, or the ability to adapt to drastic changes or stressors that can be overwhelming or life-threatening. While often seen as a characteristic that a person either has or doesn’t have, resilience might be more accurately seen as a process. It involves developing and using adaptable thoughts and behaviors to deal with or recover from a psychological injury. Strategies for enhancing resilience include strengthening positive relationships, managing emotions, and identifying and building on personal strengths. Numerous programs, both in schools and communities, have been created to improve resilience in children and adults, showing positive outcomes.
