The Basics:
Here you’ll find the ‘basics’ – the baseline knowledge needed for an overview of what trauma is, how it comes about and some of the impacts this can have.
This page will be regularly updated and maintained.
What is trauma?
The word trauma, as related to psychological trauma, is defined as “severe and lasting emotional shock and pain caused by an extremely upsetting experience” (Cambridge Dictionary, 2019). The UK Trauma Council (2023) defines trauma as “…the way that some distressing events are so extreme or intense that they overwhelm a person’s ability to cope, resulting in lasting negative impact”.
In short, trauma is the reaction to a negative and upsetting experience, which may persist even after the experience has ended. This can be summed up nicely as ‘trauma is not what happens to you, it is what happens in you as a result of what happens to you’ (Maté, 2022*), as trauma is inherently linked with a person’s ability to cope with a situation.
What causes trauma?
There are many experiences which can lead to trauma – too many to list in their entirety. Common causes of trauma include, but are not limited to: childhood abuse, domestic violence, natural disasters, terrorist attacks, death of a loved one (particularly if unexpected), painful medical procedures and many more. Any experience which is so distressing it shuts off the body, mind and brain’s ability to cope can lead to trauma.
Impacts of Trauma – Mental Health
Trauma exposure can result in a variety of mental health difficulties including, but not limited to: depression; anxiety; substance misuse disorders; post traumatic stress disorder (PTSD); complex post traumatic stress disorder (CPTSD); dissociative disorders; personality disorders e.g., borderline personality disorder (BPD) (Substance Abuse and Mental Health Services Administration, 2014; Kleber, 2019; Koirala et al., 2020). Risk of mental illness is heightened if the trauma is experienced during childhood or adolescence (McKay et al., 2021) and many conditions are comorbid – meaning they occur at the same time – particularly PTSD and anxiety disorders (Brady et al., 2000). This is not an exhaustive list and, of course, doesn’t include every possible symptom of trauma e.g., difficulties regulating emotions or interpersonal difficulties, which may result from trauma but don’t necessarily qualify as their own condition.
What are Adverse Childhood Experiences (ACEs)?
The original adverse childhood experience (ACE) Study (Felitti et al., 1998) was the first large scale research into the link between ACEs and overall health throughout life. This was a ground breaking study which continues to shape the face of research today. In the original study, researchers used 10 questions which looked, broadly, at three areas: abuse; neglect; household dysfunction. For each question a person answers ‘yes’ to, they add one point to their score. The minimum score is zero and the maximum score is 10. These questions can be found below, in the appendix.
What the ACE Study Showed:
Although we often think of trauma to be a rare experience, Felitti et al. (1998) found over half of the participants had experienced at least one ACE. The ACE study has been replicated many times (Zarse et al., 2019) and similar is found across a range of groups, regardless of socioeconomic status, ethnicity, sexuality or similar. In short, trauma is not as rare as we like to think.
Felitti et al. (1998) found a ‘graded relationship’ between the number of ACEs an individual had experienced and their overall health outcomes. That is to say, the more ACEs a person experiences, the greater their risk of developing certain condition such as heart disease, substance misuse disorders ad depression. There will be an upcoming post going into more depth on the ACE study and research which has followed, including the expanded ACE questionnaire.
Recommended Read: The book ‘Toxic Childhood Stress: The Legacy of Early Trauma and How to Heal’ by Dr Nadine Burke Harris is laymen-friendly and goes into great depth on ACEs, what they mean and how we can arm ourselves with knowledge to take control of our own outcomes.
Limitations of the ACE Study
Whilst the ACE study was certainly ground breaking, like anything, it is not without it’s limitations. There are two very important things to remember: (1) having an ACE score of 1 or more does not mean that any of the negative outcomes are a certainty; (2) having an ACE score of 0 does not mean there is no possibility of negative outcomes. Rather, the the presence or absence of ACEs simply indicates a risk factor for certain conditions and health profiles.
Other limitations of the ACE study include bias. For example, one question featured in the ACE questionnaire is:
‘Was your mother (or stepmother):
Sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her?
Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard?
Ever repeatedly hit over at least a few minutes?
Ever threatened with, or hurt by, a knife or gun?’
Although it is true that domestic violence is most commonly perpetrated by men against women, this is not the only way domestic violence occurs. Women also have the capacity to perpetrate domestic violence against men, though this is understudied and often unrecognised. As such, an individual could answer ‘no’ to this question, but still have an ACE related to parental domestic violence, simply due to the question being unnecessarily gendered. Additionally, the heteronormative phrasing of the question fails to account for same-sex, particularly gay, couples.
There are also many other events which can be see as adverse childhood experiences which aren’t included on the ACE questionnaire. These include, but are not limited to, racism; homophobia; ableism; homelessness and insecure housing; experience of the foster care system. So, whilst the ACE study and knowledge of ACEs is incredibly valuable, it is by no means a complete picture.
Where to go from here?
Now you know what trauma is, some examples of what may lead to trauma and some of the impacts this may have for an individual. This is just a very short overview, but should allow you to find your landmarks and begin your journey into finding the knowledge to set you free.
References:
Brady, K.T., Killeen, T.K., Brewerton, T. and Lucerini, S. (2000). Comorbidity of Psychiatric Disorders and Posttraumatic Stress Disorder. The Journal of Clinical Psychiatry, [online] 61(7), pp.22–32. Available at: https://pubmed.ncbi.nlm.nih.gov/10795606/ [Accessed 9 Sep. 2023].
Cambridge Dictionary (2019). TRAUMA | meaning in the Cambridge English Dictionary. [online] Cambridge.org. Available at: https://dictionary.cambridge.org/dictionary/english/trauma.
Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P. and Marks, J.S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), pp.245–258. doi:https://doi.org/10.1016/s0749-3797(98)00017-8.
Goodman, A. (2022). ‘The Myth of Normal’: Dr. Gabor Maté on Trauma, Illness and Healing in a Toxic Culture. [online] Democracy Now! Available at: https://www.democracynow.org/2022/9/16/myth_normal_gabor_mate_trauma_mental [Accessed 10 Sep. 2023].
Kleber, R.J. (2019). Trauma and Public Mental Health: A Focused Review. Frontiers in Psychiatry, [online] 10(451). doi:https://doi.org/10.3389/fpsyt.2019.00451.
Koirala, R., Søegaard, E.G.I., Ojha, S.P., Hauff, E. and Thapa, S.B. (2020). Trauma Related Psychiatric Disorders and Their Correlates in a Clinical Sample: A Cross-sectional Study in Trauma Affected Patients Visiting a Psychiatric Clinic in Nepal. PLOS ONE, 15(6), p.e0234203. doi:https://doi.org/10.1371/journal.pone.0234203.
McKay, M.T., Cannon, M., Chambers, D., Conroy, R.M., Coughlan, H., Dodd, P., Healy, C., O’Donnell, L. and Clarke, M.C. (2021). Childhood Trauma and Adult Mental disorder: A Systematic Review and Meta‐analysis of Longitudinal Cohort Studies. Acta Psychiatrica Scandinavica, 143(3), pp.189–205. doi:https://doi.org/10.1111/acps.13268.
Substance Abuse and Mental Health Services Administration (2014). Understanding the Impact of Trauma. [online] National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/books/NBK207191/ [Accessed 9 Sep. 2023].
UK Trauma Council (n.d.). Trauma. [online] UK Trauma Council . Available at: https://uktraumacouncil.org/trauma/trauma?cn-reloaded=1.
Zarse, E.M., Neff, M.R., Yoder, R., Hulvershorn, L., Chambers, J.E. and Chambers, R.A. (2019). The Adverse Childhood Experiences questionnaire: Two Decades of Research on Childhood Trauma as a Primary Cause of Adult Mental illness, addiction, and Medical Diseases. Cogent Medicine, [online] 6(1). doi:https://doi.org/10.1080/2331205x.2019.1581447.
* Gabor Maté has said this frequently, over many years, so tracing the exact orgin of this quote proved difficult. Referenced, is when he said this in a video interview in 2022 whilst discussing his book The Myth of Normal.
Appendix
- Did a parent or other adult in the household often or very often…
Swear at you, insult you, put you down, or humiliate you?
or
Act in a way that made you afraid that you might be physically hurt?
- Did a parent or other adult in the household often or very often…
Push, grab, slap, or throw something at you?
or
Ever hit you so hard that you had marks or were injured?
- Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way?
or
Attempt or actually have oral, anal, or vaginal intercourse with you?
- Did you often or very often feel that …
No one in your family loved you or thought you were important or special?
or
Your family didn’t look out for each other, feel close to each other, or support each other?
- Did you often or very often feel that …
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?
or
Your parents were too drunk or high to take care of you or take you to the doctor if you needed it? - Were your parents ever separated or divorced?
- Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her?
or
Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard?
or
Ever repeatedly hit at least a few minutes or threatened with a gun or knife? - Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
- Was a household member depressed or mentally ill, or did a household member attempt suicide?
- Did a household member go to prison?
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