Not All Trauma Is the Same

This post was co-written by Mellissa Withers and Kathryn Maloney.

January 11th is Human Trafficking Awareness Day, designed to raise awareness about the fact that human trafficking exists and affects people in the US and around the world.

Human trafficking survivors often have to deal with the aftermath of complex trauma for the rest of their lives. What exactly is trauma? The first thing that comes to mind might be an unusual event characterized by extreme violence or emotion, such as a terrorist attack, a natural disaster, or the unexpected death of a family member. However, trauma also applies to a much broader range of events that people can experience in their lifetimes.

Trauma manifests itself in many forms. Often, trauma is not limited to a single, acute event, but rather a culmination of factors and experiences. A trauma-informed approach is one that takes into consideration the range of reactions of people who have experienced child maltreatment and abuse, intimate partner violence, and even human trafficking.

Forms of trauma can include:

• Complex trauma versus single incidents: Complex trauma is usually prolonged trauma that occurs between people, often beginning in childhood or adolescence. Since the events often happen in secrecy, the victim may suffer in fear and silence. Single traumatic incidents usually have a clear beginning and end while complex trauma is ongoing or frequent, which does not allow time for the victim to recover. It often has more severe, persistent, and cumulative impacts, including negative coping mechanisms, such as addictions and self-harm, interpersonal relationship challenges, chronic feelings of hopelessness, and impaired daily functioning. It can also have a dramatic effect on physical and mental health and wellbeing over the lifespan.
• Direct versus Indirect: Trauma can be experienced firsthand or through vicarious exposure.
• Individual versus Mass: Individual traumas are events that happen to one person whereas community, group, or mass traumas affect a group of people, typically communities with a common identity and history.
• Naturally Caused: Naturally caused traumas are unavoidable incidents that some may view as “acts of God,” such as wildfires, hurricanes, epidemics, tornadoes, etc.
• Human-Caused Traumas: These can include accidental acts such as train derailment, accidental shootings, or airplane crashes. However, human-caused traumas can also be intentional acts or events, such as warfare, arson, torture, terrorism, and sexual assault. Because of the intentional nature, these traumas are often more difficult for survivors to process. They may struggle to understand the perpetrators’ motivations and the random or calculated nature of the act.
• Developmental Trauma: A trauma that occurs during a specific developmental stage in childhood that often will negatively impact the child over the life course. For example, adverse childhood experiences (ACEs), such as witnessing household violence or being a victim of abuse, increase the likelihood for repeated exposure to trauma later in life, including perpetrating violence.
• Historical Trauma: Originally used to describe the residual impact of the Holocaust on the children of survivors, this term is now used to examine the cumulative personal and societal impacts of trauma experienced by groups across generations. For example, exposure to long-term mass trauma through slavery, war, and colonialism can impact populations several generations after the original trauma has occurred.
• Retraumatization: This occurs when a victim experiences something that triggers a memory of the traumatic event or makes them feel as if they're experiencing a trauma again. It can often be a sensory reminder. For example, a physical exam by a healthcare provider may be a trigger for sex trafficking victims. Triggers can be identified but often come as a surprise.

Trauma is subjective. Different types of trauma can affect people differently and different people respond to the same event differently. An event that is traumatic for one person may not be for another. Numerous factors influence how trauma affects an individual; these include the nature of the event, amount and length of trauma exposure, life history, sociocultural factors, support network (i.e. family, friends, community), and access to treatment. In addition, survivors of trauma often do not recognize how it has impacted them. Some might have temporary reactions while others have more long-term responses. Generally, initial or short-term reactions are categorized by feelings of exhaustion, confusion, sadness, anxiety, agitation, numbness, dissociation, confusion, physical arousal, and/or blunted affect.

Long-term responses vary in nature, and may be:

• Emotional: This type of response varies but is typically characterized by feelings of anger, fear, sadness, and shame. They may also react by shutting down and their behavior may be viewed by others as numb or withdrawn.
• Physical: This type of response is associated with somatic complaints (symptoms without a medical explanation, such as headaches or gastrointestinal distress), as well as sleep disturbance, cardiovascular, neurological, musculoskeletal, respiratory, and dermatological disorders, urological problems, and substance use disorders.
• Cognitive: Trauma can alter a survivor’s perception of the world, leading them to believe they are endangered or vulnerable in some spaces (e.g., outside of their home). This is particularly common in survivors who feel shameful about their traumatic experiences, as is often the case after sexual assault. They may see themselves as “incompetent or damaged," distrust others, and feel the world is “unsafe and unpredictable.” Due to prolonged stress reactions, they may live in a constant state of hypervigilance, or high alert. Living in this “survival mode” can result in short-sighted decision-making that sacrifices long-term goals in order to survive today.
• Behavioral: This type of response includes negative coping mechanisms and destructive behaviors such as alcohol use, overeating, high-risk behaviors, or self-injury. This may also include a subconscious reenactment of the trauma as well; survivors may consistently relive or even recreate the trauma. One explanation for this is that it is related to the desire to master or overcome the trauma and/or reclaim their own control and agency.
• Interpersonal: Survivors need to reintegrate themselves in their social relationships and build a support network. At the same time, this can be difficult because their ability to trust others and their interpersonal relationship skills may have been impacted by trauma. They may also fear not being understood, have feelings of betrayal, or feel that they are burdening someone with their troubles. They may even want to protect others from their unpredictable reactions to unfamiliar situations. In other cases, trauma bonding may cause victims to express loyalty to their abusers and may not be willing to leave them or to report them to the police.

In addition, trauma survivors may experience:

• Memory disruption: Survivors often have difficulty remembering details or timelines accurately. They may have disjointed memory where they cannot recall key details of the event. Sometimes survivors even doubt their own reality and/or fear that others won’t believe them. This doesn’t mean that they are lying but instead is a result of the disruption of processes in the brain.
• Memory distortion: In some cases, those with the condition of traumatic memory distortion will remember experiencing more severe trauma than they actually did. These memories and their associated fear can help condition someone to avoid future danger. Over time, this may even grow and impact their mental health negatively.
• Triggers and flashbacks: A flashback is typically caused by a trigger and causes the victim to re-experience their trauma as if it were actually happening.
• Dissociation, depersonalization, and derealization: People who have experienced long-term trauma and could not escape physically develop mental strategies to escape. These defense mechanisms result in a person having a distorted sense of time, space, or identity. They may be seen by others as “zoned out.” Survivors can have difficulty being present or connecting to emotional or physical feelings. They sometimes have what is described as an out-of-body experience during the traumatic event where they feel that what is taking place is unfamiliar or not real.

The duration of trauma, the losses caused by the trauma, whether the trauma was expected or unexpected, whether the trauma has isolated or pervasive effects, whether the trauma was experienced directly or indirectly, and what has happened in the survivor’s life since the trauma can all affect how survivors’ respond to traumatic events.

There is no one appropriate response; experience of trauma is subjective. Appreciating the diversity in possible survivor responses will help to reduce victim-blaming. It can provide important insight into the reasons for maladaptation and negative coping skills. Taking the time to understand the lived experiences of survivors of trauma can also help us to learn how to enhance resilience and to better support survivors on the road to recovery.

Mellissa Withers is an associate professor of global health at the University of Southern California's Online Master of Public Health program.

Kathryn Maloney is a USC student majoring in global health.