By Susanne M. Dillmann, Psy.D.

Click here to contact Susanne and/or see her GoodTherapy.org Profile

Most people find their reactions to traumatic experiences to be confusing; they often feel that they are no longer themselves, but rather a bizarre and ‘crazy’ person . When you know what the common reactions to trauma are, you will be able to identify which of your behaviors are linked to your traumatic experience(s). This identification will allow the feelings of ‘craziness’, isolation and overwhelm to dissipate. In addition, you will gain some control over the behavior, which ultimately will allow you to change the behavior. How to go about changing these common trauma reactions is not the focus of this article. I encourage you to work on these issues with your individual therapist.

There are four common categories of trauma reactions: intrusive and arousal reactions as well as avoidance and the catch-all “other” category. This article will look at the first two of these categories. Intrusive and arousal reactions are both examples of your body getting stuck on ‘red-alert’. The body’s emergency response system does not turn off and, “The smallest reminder of something remotely associated with the [traumatic] event can set off a dramatic response” (Herbert & Wetmore, p. 18).

Arousal reactions are often the first to appear after a traumatic event. This is mainly due to the body still being in a state of heightened physiological arousal. The end result of this is that the individual often responds to new experiences as though they are dangerous. This manner of over-responding impacts a person’s ability to sleep as well as concentrate and leads to a state of hyperalertness – also called hypervigilance. Arousal reactions also lead to an exaggerated startle response, increased irritability and excessive anger outbursts.

Difficulties with sleep, such as: troubles falling asleep, waking up often & not being able to fall asleep again and waking up drenched in sweat are some of the most common post-trauma arousal reactions. Due to sleep being a reduced level of consciousness one is more vulnerable when asleep. During sleep one cannot protect oneself as readily, meaning that solid sleep requires a certain sense of safety. Following a trauma this pre-requisite sense of safety is shattered and one’s body is more alert for danger, thus wrecking havoc with sleep.

Just like sound sleep, concentration requires one to ignore information about what else is occurring in one’s environment. One must focus primarily on the task at hand and therefore reduce awareness to other sources of information. When one’s body and mind are expecting another disaster, one will not screen out extra information from the environment. Rather one stays alert to all information so to catch any sign of danger, even if the extra information one is taking in competes with the task at hand. The real world implication is that it is nearly impossible to concentrate – or concentrate at one’s peak ability – when one does not feel safe.

The next arousal reaction to be discussed is that of hyperalertness. Hyperalertness arises from the attempt to stave off danger coupled with an exaggerated sense of potential danger. At a sensory level this is manifested as utilizing all of one’s senses to perpetually scan the environment for possible danger. Using ones senses in this non-stop manner is both exhausting and strenuous while also doing little to actually protect one. This lack of genuine protection is due to the fact that if one perceives most signals as signs of danger one may actually miss the bonafide danger signs.

Hyperalertness leads to an exaggerated startle response. Due to one’s body being in constant alert mode unexpected noises or movements startle one and cause one to respond in a physical manner (exaggerated startle response). The physical manner of responding can be freezing, fleeing or getting ready to fight – it should be mentioned that most people freeze and that one’s style of response has nothing to do with moral character. Some people act on this urge for action while others seek to block the action. The acting out or blocking of one’s particular action urge can lead to a lingering sense of edginess or nervousness. The physical toll of being perpetually prepared to respond and perennial anticipation of danger can also lead to light headedness, shakiness, or even a panic.

For some people these physical manifestations of the exaggerated startle response and heightened sense of danger can in turn increase irritability and anger outbursts. Even if outbursts do not occur, many people – following a trauma – often find themselves with a short fuse, becoming easily irritated, argumentative, angry and negative. Part of this is due to the stress and strain that the other arousal reactions place the individual under and part of this is due to the emotional pain and anger at having been victimized.

Arousal reactions, which are often the first responses after a traumatic event, are linked to the person’s relationship with the external world. These reactions arise as the person navigates the environment and assess sensory (and other) information from the external world. Unlike these reactions, intrusive reactions center more on the individual and her or his internal world. Intrusive reactions are moments of re-experiencing the trauma after it has ended. Re-experiencing can occur in a variety of ways, some of the most common are: flashbacks, dreams & nightmares, rumination and intense & seemingly unprovoked emotions.

Flashbacks (though often associated with combat, flashbacks are not unique to combat veterans) are memories of the event but unlike other memories, there is no sense that the event is in the past. During a flashback memory it is as if the event were happening all over again in the here and now. The emotions, fear, helplessness, smells and sights – the physical sensations and sensory experiences of the event – are vividly present. People do not black-out or lose consciousness during a flashback. Flashbacks occur while one is awake and can last for seconds or minutes. Some people may even move in and out of a flashback memory. Flashbacks occur because something in the environment triggered that trauma memory. Triggers are often sensory experiences – such as a smell – and may only have a vague connection to the original trauma. Flashbacks often lead people to think that they are losing their mind. The truth is that you are not going ‘crazy’ or becoming psychotic, rather a memory of the trauma is coming into your awareness.

Traumatic dreams are essentially flashbacks while one is asleep. It is possible to dream about the trauma exactly the way it happened. Dreams having to do with situations similar to the trauma, dreams about themes linked to the event and dreams in which one experiences the emotions felt during the trauma are also common. People do not always remember the dream when they wake, but the terror and fear experienced during the dream tends to remain with the person for several hours or days. During the dream people may yell, shake or thrash about. These intrusive dreams can disrupt sleep and lead to people fearing sleep.

Unlike dreams, rumination occurs during the waking hours. The intrusive symptom of rumination is when one thinks about aspects of the trauma over and over again, seemingly unable to stop. Things in one’s everyday life can trigger this excessive thinking and like all triggers, it may not be obvious what is leading to this manifestation of the trauma. The difference between a flashback and rumination is that rumination is thinking about the traumatic event while a flashback is reliving the event.

The final type of intrusive experience is intense and seemingly unprovoked emotions. Following a traumatic event people sometimes have sudden, unexpected and powerful emotions of anger, rage or pain. People are often aware that these emotions are tied to the trauma but do not know why the emotion is coming up at that point in time. While these intense emotions seem to materialize out of thin air, they are reactions to reminders of the traumatic event.

As is evident by this discussion of arousal and intrusive reactions, the natural responses to a traumatic event can have a wide reaching and negatively impacting influence. Therefore it is vital to increase our collective knowledge of psychological trauma so that at a minimum we can have understanding for our fellow citizens who are grappling with the manifestations of a traumatic event.

©Copyright 2009 by Susanne M. Dillmann, Psy.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Susanne and/or see her GoodTherapy.org Profile