At some point in our lives, most of us will live through a terrifying event. It could be a car accident, a natural disaster, a medical emergency, a fire—or perhaps a trauma inflicted by another person in the form of assault, abuse, combat, or being robbed. Trauma can also come from seeing another person be seriously hurt or killed, or learning about something awful that happened to a person we love.
Whatever the source, trauma leaves its imprint on the brain. For example, research studies consistently show that post-traumatic stress disorder (PTSD) is linked to greater activity in brain areas that process fear and less activation in parts of the prefrontal cortex.
Two traumatic events from my own life stand out in this context. The first happened in the middle of my graduate education, the second after I had specialized in the study and treatment of post-traumatic stress disorder (PTSD). My experience after the second event was very different since I had learned a lot about what to expect after a trauma, even if a person doesn't go on to develop PTSD. While everyone's reaction to trauma is unique, there are common reactions, and knowing what they are can be helpful as we recover.
Part of what's helpful about knowing the common reactions is that after a trauma it can feel like we have 99 problems—I'm scared, I can't sleep, I'm on edge, I'm angry, etc.—and recognizing that all of these problems are tied to the trauma can make them feel more manageable: Maybe what I'm experiencing is one problem with many faces. It can also be useful to realize that as the recovery process unfolds, these experiences are likely to improve, which can instill hope.
In fact, a discussion of these reactions is part of Prolonged Exposure therapy, the best-tested treatment for PTSD. As therapists we point out during that discussion that these reactions are very common among trauma survivors, whether or not a person develops PTSD.
So what are some of the common reactions to a traumatic event?
1. Replaying the Memory. Many people find that the mind returns over and over to the upsetting memory, almost as if on a loop. It might feel like the brain is trying to make sense of the experience, or figure out if we should have responded differently. Whatever the cause, it can be extremely distressing to relive a nightmarish experience repeatedly, even as we try our best to get the memory out of our heads.
2. Nightmares. While the actual experience probably felt like a nightmare, it's common for real nightmares to haunt our dreams in the aftermath of a trauma. The nervous system has taken a major shock, and even in our sleeping hours the brain continues to process the event. Most of the time the nightmares aren't of the exact trauma experience, but have themes in common with it—for example, danger, dread, or being chased. Not surprisingly, these nightmares can contribute to the poor sleep that's common after a trauma.
3. Flashbacks. A flashback occurs when the trauma memory gets cued and makes it feel as if the trauma is happening all over again. I experienced a flashback months after my first trauma—a violent mugging—when a friend saw me walking down the street and changed direction to approach me. There was nothing threatening about my friend or his movement but it set off an alarm because my brain interpreted it as matching the movement of my assailant. Flashbacks are upsetting because they bring back a powerful flood of emotions and vivid memories of the trauma.
4. Fear and Anxiety. Perhaps the most common emotional reaction to a trauma is feeling fearful and anxious. It makes perfect sense that we would be afraid after something scary happened. In fact, like so many of these reactions, it's a sign that our nervous system is functioning as it should. Nevertheless, the fear following a trauma can be as bad or worse than the emotions we felt at the time of the trauma, and almost certainly lasts longer. You may feel like the fear is subsiding when something triggers a reminder of the trauma, and the intense fear returns. Thankfully like the rest of these reactions, most people find that they do decrease over time.
5. Anger. In addition to fear and anxiety, anger is a very common reaction to trauma. We might feel anger at the person or situation responsible for our trauma. We may be angry at ourselves if we blame ourselves for what happened. We might just be more irritable than usual, and have a hard time understanding why we're snapping at our partners or less patient with our kids. Like all of these reactions, it's perfectly normal to feel anger after a trauma.
6. Sadness. We often will feel sad and cry after a highly traumatic event. The crying can be a way for the nervous system to come down from the fight-or-flight response, since crying is associated with the parasympathetic nervous system which calms the mind and body. The sadness can also come from feeling overwhelmed by a world that feels terribly threatening. And of course sadness and grief are common when the trauma involved the loss of someone close to us. It's normal for these feelings of sadness to wax and wane.
7. Guilt. If the trauma involved someone close to us being injured or killed, we may blame ourselves and feel guilty that we didn't somehow prevent it. Combat veterans might feel guilty about actions they took in the course of their duties that resulted in the deaths of enemy combatants. Or we might feel responsible for being attacked or hurt, as though somehow we caused it.
8. Feeling Numb. Sometimes rather than feeling strong emotions, we feel shut down emotionally, as though we're made of wood. We might not have the positive emotions we know we "should" when good things happen in our lives. Part of the numbing response can come from the body and mind's self-protective efforts in the face of overwhelming emotions.
9. Trying Not to Think About the Event. By definition, a traumatic event is not a pleasant memory, so it makes sense that we would want to avoid thinking about it. As mentioned above, the mind tends to replay the traumatic memory, so it can be difficult to keep it out of our minds for long. With time most people find that it becomes less painful to remember the trauma.
10. Avoiding Things Related to the Event. Sometimes we avoid people, places, or things related to our trauma because they trigger the painful memory. For example, we might avoid TV shows that remind us of the event. Other times we might avoid things because they feel dangerous, like a section of the city where we were assaulted. It's common to want to avoid being in crowds after a trauma, even if the traumatic event wasn't caused directly by another person (such as an earthquake).
11. Difficulty Trusting People. When we've been attacked by another person, it can be hard to know whom we can trust—especially if we were caught off guard. We might start to suspect everyone, feeling like "if that person could hurt me, why not this person?" Not uncommonly we may wall ourselves off from others to protect ourselves.
12. Believing the World Is Extremely Dangerous. Immediately after a trauma, the mind is likely to see the world as very dangerous. Whereas we might have underestimated the danger in the world before the trauma, we might overestimate danger in the aftermath of a trauma. After all, our most recent experience of the world is as a very threatening place. Over time our beliefs tend to shift toward the middle, recognizing that the world can be quite dangerous at times, and that at other times it's relatively safe.
13. Blaming Yourself for the Trauma. As mentioned above, it's common to feel guilty after something terrible happens to you, as though you're to blame that it happened. The mind may cast about for ways that you could have avoided the trauma:
It's easy to use the advantage of hindsight to see the "mistakes" we made. In reality we almost certainly overstate our own responsibility for the traumatic event, and as a result feel unnecessary guilt. All the same, it's a common response after a trauma.
14. Thinking You Should Have Handled the Trauma Differently. So many trauma survivors I've treated have talked about how they "should have" had a different response to the trauma, which was something I thought as well for both of my incidents. It's another example of "Monday morning quarterbacking"—second guessing split-second decisions made under a high degree of stress. Perhaps we can think of a better reaction when we have hours or days to mull it over, but life is lived in real time.
15. Seeing Yourself as Weak or Inadequate. It's not uncommon after a trauma to start to see ourselves as being "less than" in some way. Maybe we tell ourselves we're weak for "letting it happen." I remember thinking after getting mugged that if I'd been a more intimidating presence that my wife and I wouldn't have been targeted—which ignored, of course, the fact that he had a gun. As with many trauma-related beliefs, we often are more critical of ourselves than we need to be.
16. Criticizing Yourself for Reactions to the Trauma. In addition to beating ourselves up for having experienced the trauma, we might also be upset with ourselves for being upset. As one person said to me, "How come everyone else has gotten over it and I can't?" There's an irony in how common it is to believe after a trauma that "nobody else would have the same kinds of struggles I'm having," given how many people feel this way.
17. Feeling Constantly On Guard. When the nervous system has had a terrifying shock, it doesn't immediately settle down. It's going to be turned up for a while, alert for the possibility of further danger. You might keep looking over your shoulder, or be constantly scanning your surroundings for threats. You've been hurt before, and you don't want to be caught off guard. It really means your brain is doing its job to protect you, although this knowledge doesn't make it any more comfortable to feel on edge all the time.
18. Seeing Danger Everywhere. When your nervous system is highly attuned for danger, it's going to be set to detect any possible threat, which probably means you'll have a lot of false alarms. You might see your assailant walking toward you, and realize as your heart pounds out of your chest that it's really just your friendly neighbor. You might be startled by a movement out of the corner of your eye, and then realize it's your own reflection. I remember literally jumping at the movement of my own shadow in the streetlights one night, thinking it was someone walking up behind me.
19. Being Easily Startled. A nervous system temporarily stuck in the "high" setting is going to be easily startled by things like a slamming door. You may find yourself jumpier than usual, or taking longer to come back to your baseline. It's common to feel anger at the cause of the startle.
20. Difficulty Sleeping. Sleep is a vulnerable state, and when the brain and body are revved up, we're likely to have a hard time sleeping. It's as though the mind is saying, "Danger! This is no time for sleeping!" The nightmares that are common can also interfere with sleep, and can make us reluctant to go to bed.
21. Loss of Interest in Sex. As with sleep, the brain may be inclined to avoid sexual activity following a trauma. It's easy to understand if the trauma was a sexual assault, when sexual activity may trigger painful memories of the attack. Even if the trauma was not of a sexual nature, we may be less interested in sex as we recover from a recent trauma.
If you've been through a trauma you may have had many or few of these experiences, or you may have had ones that aren't listed here. It's important to keep in mind that everyone's reaction is different, and to allow room for your own reaction to be exactly what it is.
While these reactions are common, most people will find that they gradually subside over a period of days to months. If you find that you're struggling to recover from your trauma, don't hesitate to seek professional help. There are highly effective treatments for post-traumatic struggles, including PTSD and depression, that greatly help the majority of people who receive them.
I also want to note that not all post-traumatic reactions are bad. In fact, one of the common reactions at some point following a trauma is post-traumatic growth—a topic I'll pick up in a later post.