Chronic Trauma

‘Trauma’ is a broad term, but generally falls under the following three categories:

Acute (or ‘simple’ trauma)
Chronic trauma
Complex trauma

This blog will examine the second category – chronic trauma. It will explore what happens to the body on a physical level when chronic trauma occurs, and some of its most common causes and symptoms.

The term ‘chronic trauma’ is sometimes interchanged with ‘complex trauma’. Both conditions share similarities. Both are types of post-traumatic stress disorder (PTSD) and require professional treatment for a person to heal. Chronic trauma refers to Post-traumatic Stress Disorder, while complex trauma refers to a more severe form of PTSD, known as Complex PTSD, or C-PTSD.

Trauma and the Nervous System

When we experience a threatening event (i.e. something that puts our life in danger, either real or perceived), our nervous system reacts by entering survival mode.^[1] Signals originating in the amygdala, a small structure in the brain, tell our muscles to get ready for mobilisation (fight or flight). If the threat cannot be fought or ran from, as is the case for a child experiencing abuse in the home, the nervous system utilises its third threat response – freeze.^[2] This involves an emotional and psychological shut down to prevent the psyche from becoming too overwhelmed. Though freeze has a survival function, it is maladaptive when it persists. For survivors of chronic trauma, the nervous system remains frozen in its threat response, making even safe environments and people seem threatening.

Causes of Chronic Trauma

Chronic trauma refers to trauma that has occurred following a series of events (unlike acute trauma, which refers to trauma following a single event). These events have happened multiple times, and include experiences such as^[3]:

Prolonged child abuse
Prolonged exposure to war and combat
Repeated sexual abuse
Direct experience of or exposure to ongoing domestic violence
Exposure to repeated natural disasters

Survivors of chronic trauma usually require extended treatment, as the pain and symptoms that result can be severe and protracted.

Symptoms of Chronic Trauma

The symptoms of PTSD can sometimes take years to come to the surface, unlike acute trauma, symptoms of which show up in a matter of weeks.

Chronic trauma often causes those experiencing it to engage in maladaptive coping behaviours. The symptoms themselves can be a significant source of distress and can be so overwhelming that the person feels compelled to take some kind action against them. Common actions observed in chronic trauma survivors include:

Denial
Avoidant behaviours, such as social withdrawal or substance abuse
Rationalisation

The symptoms of chronic trauma are intense and disruptive to normal daily functioning. In combination with maladaptive behaviours, survivors are likely to experience^[4]:

Anxiety
Depression
Sadness
Confusion
Anger, rage, violent outbursts
Over-reactions to normal events
Impaired or distorted memories
Low self-worth
Fatigue
Sleep problems
Distorted perception of one’s environment (believing one is under threat when they are safe, misreading of others’ facial expressions)
Nightmares, flashbacks

The above symptoms can be self-perpetuating, meaning that when a person experiences them, the very experience causes the symptoms to intensify. To cope and restore some sense of normality without professional treatment, survivors of chronic trauma are likely to engage in unhealthy and destructive behaviours, such as^[5]:

High-risk behaviour (unprotected sex with multiple partners, reckless driving)
Sexual avoidance
Violence
Unhealthy relationships
Substance abuse

Treatment for Chronic Trauma

Chronic trauma significantly impacts a person’s quality of life, affecting everything from work and school performance, to interpersonal relationships, to general motivation, and interest in life. Not only does it wear away at a person’s physical and psychological well-being, it also increases the risk of further physical and psychological damage as a result of destructive coping behaviours. Substance abuse is common among chronic trauma survivors and can lead to serious financial and legal issues, strained relationships, and even death.

To overcome chronic trauma, professional treatment is required. The good news is that treatment is available, and can help clients restore their lives back to health and normality.

Typical treatment options for chronic trauma include^[6]:

EMDR (Eye Movement Desensitisation and Reprocessing)
Somatic Experiencing
Trauma-Focused Cognitive Behavioural Therapy (TFCBT)
Medication

As mentioned earlier, trauma impacts the nervous system’s ability to regulate itself, which makes exploration of the trauma narrative and the ability to tolerate the associated distress difficult. EMDR and Somatic Experiencing help clients by improving regulation of the nervous system and better preparing clients to explore their trauma narrative.

Cognitive Behavioural Therapy and medication help clients recover from chronic trauma by reducing trauma symptoms and strengthening the client’s ability to tolerate distress.

The Importance of Support Networks in Recovery from Trauma

An important aspect of recovery from chronic trauma is the availability and accessibility of a strong support network. Trauma can make a person extremely isolated, where it seems that nobody quite understands the difficulties and challenges associated with the condition. To reduce this sense of loneliness and prevent unhealthy isolation, survivors of chronic trauma are often encouraged to engage in social support groups with others who have been through similar experiences. Support networks offer clients a chance to feel heard, validated, and deeply understood. This sense of acceptance and connection can make a huge difference to therapeutic outcomes, and reduce the risk that a person will engage in maladaptive behaviours such as substance abuse.

Get in touch

If you have a client, or know of someone who is struggling to heal from psychological trauma, including Chronic Trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours)

Sources

^[1] Harvard Health. 2011. Understanding The Stress Response – Harvard Health. [online] Available at: <https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response> [Accessed 23 October 2020].

^[2] Schmidt, N., Richey, J., Zvolensky, M. and Maner, J., 2008. Exploring human freeze responses to a threat stressor. Journal of Behavior Therapy and Experimental Psychiatry, 39(3), pp.292-304.

^[3] nhs.uk. 2018. Post-Traumatic Stress Disorder (PTSD) – Complex PTSD. [online] Available at: <https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/complex/> [Accessed 23 October 2020].

^[4] Adaa.org. 2020. Symptoms Of PTSD | Anxiety And Depression Association Of America, ADAA. [online] Available at: <https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/symptoms> [Accessed 23 October 2020].

^[5] Adaa.org. 2020. Symptoms Of PTSD | Anxiety And Depression Association Of America, ADAA. [online] Available at: <https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/symptoms> [Accessed 23 October 2020].

^[6] Gielkens, E., Sobczak, S., Rossi, G., Rosowsky, E. and van Alphen, S., 2018. EMDR as a Treatment Approach of PTSD Complicated by Comorbid Psychiatric, Somatic, and Cognitive Disorders: A Case Report of an Older Woman With a Borderline and Avoidant Personality Disorder. Clinical Case Studies, 17(5), pp.328-347.