What Is Trauma? Understanding PTSD, Complex PTSD, and the Long-Term Effects of Trauma

Trauma is a highly complex subject, both for patients and clinicians. While people often associate trauma with catastrophic events, trauma may also emerge from repeated experiences that may not even seem traumatic to many people.

The way trauma presents can vary considerably. For some individuals, trauma presents through obvious symptoms such as flashbacks, nightmares, or hypervigilance. For others, the effects are far more subtle, appearing through chronic anxiety, numbness, shame, difficulties in relationships, or persistent patterns that are not always immediately recognized as trauma.

Treatment can also take very different forms. For some individuals, treatment primarily involves reducing intrusive symptoms and suffering. For others, processing trauma becomes a way of understanding themselves — understanding how certain ways of feeling, reacting, relating to others, and experiencing the world may have been shaped by earlier experiences.

What Is Trauma?

There is not a single universal definition of trauma, but most people would agree that experiences such as natural disasters, sexual assault, severe accidents, physical violence, sudden loss, war, or combat exposure can be traumatic.

However, other forms of trauma may be more easily overlooked. Experiences such as neglect, chronic criticism or humiliation, interpersonal abuse, unstable or unsafe environments, and attachment disruptions can all be deeply traumatic for many individuals, even if others may not immediately recognize them as such.

The subjective nature of trauma is therefore very important. The psychological impact of the experience — including how the individual processes it — is often what defines trauma. Some people appear more resilient than others even when their experiences were similar.

Equally important is recognizing that direct exposure is not always necessary for trauma to occur. Indirect experiences, such as witnessing another person’s trauma or suffering, can themselves become traumatic.

What Is the Difference Between PTSD and Complex PTSD?

As a psychiatrist who works extensively with trauma, I can say without hesitation that trauma may present in extraordinarily complex ways.

In some individuals, particularly those exposed to repeated trauma over long periods of time, trauma affects far more than isolated intrusive symptoms such as flashbacks, nightmares, or intrusive memories. It can appear as though the entirety of the person’s inner world has been shaped by traumatic experiences.

Clinicians and researchers have long attempted to capture this broader and more pervasive reality through the concept of complex PTSD (C-PTSD).

Why Is Trauma Often Missed in Mental Health Treatment?

Trauma is frequently overlooked in psychiatric and psychological settings. There are several reasons for this.

In many cases, trauma may remain unspoken during appointments because of hesitations coming from both clinicians and patients.

Some clinicians may hesitate to explore trauma because they fear overwhelming reactions that cannot easily be managed within limited appointments. Others may feel uncertain about how to approach trauma safely or effectively.

Patients themselves may also hesitate to discuss trauma because of shame, fear, difficulty trusting others, or lack of awareness regarding the relevance of certain experiences.

In other cases, trauma may be acknowledged but not adequately connected to the origins of one’s symptoms. For example, symptoms may instead be attributed primarily to other conditions such as ADHD, depression, bipolar disorder, anxiety, obsessive-compulsive disorder, or psychosis.

Why Is It Important to Explore Trauma in Psychiatry or Psychotherapy?

For many individuals, this is not really a question. Trauma is so present at the forefront of their minds that it becomes difficult to ignore, and the reason they seek psychiatric treatment is specifically to address it.

Others may seek treatment for reasons that they do not initially recognize as related to trauma, such as depression, anxiety, irritability, substance use, or relationship and work instability. For these individuals, recognizing that some experiences in their life were traumatic can be the beginning of a deeper understanding of themselves.

Even individuals seeking treatment for a particular trauma may sometimes overlook earlier experiences that are also worth exploring.

How Is Trauma Properly Assessed in Psychiatry and Psychotherapy?

Effective trauma treatment begins with careful and comprehensive assessment.

Assessing trauma requires understanding the experiences that were perceived as traumatic with openness, curiosity, and an effort to understand how the individual experienced those events from their own internal reality rather than through our own expectations.

This requires being capable of holding the complexity of one’s internal reality and being willing to work through feelings and thoughts that may be complicated and at times conflicting.

The assessment also requires understanding how those experiences affected the individual psychologically, relationally, and biologically over time.

It is important that we look not only into the past, but also into the present — into the dynamics that emerge during our days, our relationships, our reactions, and even during our nights when we fall asleep.

The assessment often involves understanding different parts of ourselves and different “selves” existing in different states of mind. At times, the adult part of ourselves may consciously long to “let go” of the trauma, while our inner child may continue holding on to it.

What Are the Goals of Trauma Treatment?

Treatment of PTSD and other forms of trauma may take various forms, ranging from different forms of therapy to medication management.

The goals of treatment are individualized and dynamic. Oftentimes, it is important to establish which symptoms are most debilitating and provide some degree of relief, whether that pertains to intrusive symptoms, mood, anxiety, irritability, or even psychosis in broader trauma presentations.

With time, other goals may emerge. Oftentimes, the goals go beyond symptom reduction and extend toward understanding oneself and finding new ways of relating to oneself and the world around us.

Why Are Antidepressants, Mood Stabilizers, and Antipsychotics Used for PTSD or Complex PTSD?

Patients are sometimes confused when medications such as antidepressants, mood stabilizers, or antipsychotics are prescribed for PTSD or complex PTSD.

However, psychiatric medications are generally selected based on the symptoms and neurobiological systems involved — not simply based on the traditional name of the medication category.

In many cases, medications are selected because trauma may affect mood, sleep, anxiety, perception, and the way individuals respond to stress in highly complex ways.

Medication treatment is therefore often approached through a broader and more individualized understanding of psychological functioning, neurobiology, and symptom patterns.

Trauma Requires Patience, Safety, and Compassion

Working through trauma can be deeply demanding. Even subtle exploration of trauma may trigger feelings of vulnerability, helplessness, fear, grief, shame, overwhelm, or numbness, and may even temporarily increase intrusive symptoms. The process is not linear, and at times it may feel as though things are getting worse when they should be getting better.

Because of this, trauma work often requires patience, consistency, safety, and compassion — both from clinicians and from patients themselves.

In Summary

None of us is entirely immune to traumatic experiences. At the same time, trauma affects different individuals in profoundly different ways.

Providers should not place themselves as evaluators of whether someone’s experiences were “bad enough” or whether someone should simply “let go” of their trauma.

Instead, providers are asked to approach trauma with careful assessment — past and present — from the perspective of the patient’s inner reality.

Once trauma is adequately understood, meaningful treatment can occur, and patients may gradually move toward lives that are less organized around trauma.

- Helder Araujo MD PhD