What is Trauma?: Types, Psychological, physical effects of Trauma and Therapy
- Aaradhana Reddy
- 11 hours ago
- 11 min read
Trauma just like stress is a loosely used word today. But emotional/psychological trauma and the symptoms that occur and follow during and after traumatic events are complex, differing from person to person. In the following sections we will try to understand what exactly trauma entails, the types, symptoms and its impact both physically and mentally. It is estimated that 70% of the global population will experience at least one traumatic event in their lives (WHO, 2024). Hence, understanding and knowing how to deal with it becomes essential.
Contents
Understanding and Defining Trauma
Trauma can be understood as significant emotional distress which includes persistent fear, helplessness, dissociation, confusion and others which are a result of events that shatter the world views and sense of safety of the individual (American Psychological Association , 2026). The word ‘events’ here refer to traumatic events; which are events that cause psychological trauma during and after. The nature of resulting trauma, can depend of the event itself, its occurrence (single, repeated etc.), severity, first hand or vicarious, sudden/unexpected etc. Trauma can also be understood as emotional psychological distress to events that far exceed the individual’s ability to cope (Jae, 2024).
Examples of traumatic events can be divided into three types. Firstly, manmade events include war, mass shootings, abuse (physical, sexual, emotional), neglect etc. Secondly, environmental include natural disasters, pandemics etc. And thirdly, human experiences include accidents (road, air, water), death of loved ones (child, spouse, parents) and other painful experiences. Traumatic experiences usually change attitudes and behaviors of a person due to their effect on worldviews and sense of safety of an individual. A person’s sense of trust in people or the world, ability to meet, connect and engage with people, ability to find pleasure in hobbies and other activities etc., maybe affected.
As we mentioned earlier that a significant portion of the world population might experience at least one traumatic event in their lifetime; the resulting mental health conditions of trauma have become a major public mental health concern. Trauma and stress related disorders include Post-Traumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD), adjustment disorder etc. The lifetime prevalence of PTSD worldwide is 3.9% (WHO, 2024; Pan American Health Organization , 2026; Koenen, et al., 2017). Prevalence of PTSD in India is low, but this is most likely due to low treatment seeking behavior, limited access to mental health care and western centric diagnostic tools etc. (Chandna, et al., 2023).
Types of Trauma
There are four major types of Trauma. They are as follows:
Acute Trauma: Acute trauma is a result of single, one-time, short lived distressing/traumatic event. For example a car accident, medical emergency, death of a loved one, natural disaster, an attack etc. It leads to intense psychological distress during and after the event. Acute Stress Disorder (ASD) may follow immediately after the event and if left untreated it can lead to Post- Traumatic Stress Disorder (PTSD). ASD symptoms immediately after (3 days-1 month) may involve irritability, low moods, anger outbursts, dissociation*, avoidance of places/people/details of the traumatic event, flashbacks/nightmares etc. But with social support (familial, peers and community) and immediate help (therapy/counselling) psychological distress may subside, helping the individual make a full recovery (Jae, 2024).
Chronic Trauma: Chronic trauma occurs due to repeated and prolonged exposure to a traumatic event. Prolonged physical/psychological/verbal bullying, ongoing domestic violence (physical/psychological/sexual), childhood neglect/abuse, chronic medical conditions, living in a war zone/prolonged military deployment etc. Aspects of inescapability and the nature of chronic trauma, its effects can be intense, complex and lasting mental health concerns. Individuals may go on to develop anxiety, depression, suicidal tendencies, substance abuse, self- harm etc. (Jae, 2024).
Complex Trauma: While chronic trauma is repeated and prolonged exposure to single event (war, bullying, abuse etc.); complex trauma is prolonged, repeated exposure to multiple traumatic events. Complex trauma mostly occurs in formative years (infancy and childhood) within close relationships (caregivers). Childhood abuse and neglect with physical, psychological, sexual abuse, domestic violence with physical, controlling and psychological violence etc. are examples of complex trauma. Apart from exposure to multiple traumatic events, factors such as a shattered sense of trust, disrupted attachment styles/relationship with caregivers, betrayal etc. can lead to lasting psychological impact. Low self-esteem, difficulty forming and maintaining relationships, emotional dysregulation (feeling too much or too little (numb), chronic shame, isolation, dissociation etc. are all associated with complex trauma. PTSD and Complex PTSD (C-PTSD), anxiety, depression are associated as well (Jae, 2024).
Secondary and Vicarious Trauma: Secondary and vicarious trauma is a result of indirect exposure to traumatic events of others, of parents etc. This type is mostly found in caregiving professions of doctors, first responders and mental health professionals. These professionals may also experience compassion fatigue. Children and adolescents exposed to intimate partner violence at home (domestic violence between parents), attacks, witnessing crimes, gun violence etc. also experience vicarious trauma. They may exhibit the same effects of victims and if left untreated it may also lead to PTSD (Davis, et al., 2020).
Effects of Trauma
Effects of trauma are vast, complex and differ from person to person. Factors that determine the effects of trauma are as follows:
Type
occurrence (single or multiple)
time (short or prolonged)
Nature and number of losses caused by trauma
Time to process the traumatic experience: Was there enough time for the individual to process the traumatic experience? Especially in cases of complex and chronic trauma, the individual maybe exposed to multiple or single repeated traumatic event that might not give the individual time to process their experiences.
People responsible for trauma: impact maybe intense and long lasting when trauma is stemming from caregivers and known trusted people.
Sudden or expected
Direct or secondary/vicarious trauma
Aftermath of trauma: Sometimes especially in cases of accidents, death of a loved one, natural disasters aftermath maybe extremely disorienting. Loss of daily routines, normalcy, job, homes, financial strain, loneliness etc. may contribute or exacerbate the impact of trauma.
The nature of help available (social support systems and therapy) (Substance Abuse and Mental Health Services Administration., 2014).
Now that we understand the factors that contribute to the effect of trauma, lets look at the physical and psychological effects of trauma.
Physical impact of Trauma: There are myriads of changes that happen in our brain and body during and after a traumatic event. During trauma and intense stress our body’s alarm system Amygdala is activated which in turn triggers the HPA axis (hypothalamic-Pituitary-Adrenal axis) is triggered. HPA is a system that helps the body prepare for stress, flooding our system with cortisol; triggering the brain goes into fight, flight or freeze mode. Repeated and prolonged (chronic) activation of HPA axis may lead to HPA dysregulation. It is associated with mental health conditions like anxiety, depression, PTSD, persistent fatigue state, cortisol dysregulation, metabolic issues, cardiovascular conditions etc.
Trauma is also associated with limbic system dysfunction. Limbic system contains amygdala, hypothalamus, hippocampus etc., which are key parts of the brain for processing emotions and its regulation, forming memories etc. It can over activate the amygdala, leading to persistent fear state (hypervigilance- we are always alert and start to see everything as a danger). This leads to severe anxiety, flashbacks, exaggerated startle responses etc. Misalignment between pre-frontal cortex and amygdala, called the amygdala hijack where an overactivated amygdala dampens the function of prefrontal cortex, which is responsible for logic, reasoning, decision making and problem solving. Which is why during and after traumatic events people are unable to manage their emotions having anger outbursts, severe anxiety, persistent fear and low mood (hyper-arousal) or hypo-arousal which is characterized by numbness (numbing or flat lined emotions called blunted affect).
Apart from this trauma effects can also settle into the muscles. This can surface as pain, digestive issues, tightness in the chest etc.
Psychological Impact of Trauma: Psychological impact of trauma can emotional, cognitive (change in thoughts, attitudes, worldview, others and oneself) which in turn has effects on the behavior of the person as well. As we’ve seen earlier, trauma can lead to either too much of emotions (anger, sadness) or too little. People can have outbursts of anger, sadness, irritability or they can flat line their emotions and become numb to everything that happened and everything around them. Excessive guilt, overwhelm, feeling out of control, hopelessness and helplessness are some other emotional consequences to trauma.
Trauma can lead to a change in a person’s worldview, attitudes and how they look at life itself. We can understand cognitive changes by looking at three categories of thoughts which encompass our entire shift in perspective. First, it’s the thoughts about oneself. They reflect how the individual thinks about him/herself. “I am worthless/useless”, “I should have not done/reacted differently”, “I am damaged”, “If I never expect anything, nobody can hurt me” are some examples of how an individual’s narrative can look like during/after trauma.
A word of caution before we move on, a lot of different situations in life can lead to such thoughts, these are not exclusive to trauma alone. Attaching labels to oneself without fully understanding, works something like an unnecessary sticker that doesn’t come off and impacts our worldview which can be detrimental. If you are reading and you feel like they are reflecting how you feel, please do reach out or take help before you label yourself. This is meant for information and not for diagnosis. Please consult a professional.
The next category is, thoughts about others and the world. Some examples might be “Others are not trustworthy”, “World is dangerous place”, “There is danger all around us”, “Anything can happen at any time”. If you have noticed some of these thoughts reflect the persistent fear state, hypervigilance, lack of a sense of safety and mistrust in the world and others we talked about earlier. The last one is, thoughts about future. For example: “There is no hope, nothing is going to change and there is nothing I can do about it” (reflecting hopelessness, helplessness), “There is no point in anything”, “I will always feel like this, I cannot get over it, it is impossible”. Consequences of such thoughts are the inability to form and maintain relationships (due to mistrust, low self-esteem, prior negative experiences with caregivers and others), foreshortened future, where an individual due to these thoughts about future may lead them to believe that there is no normalcy or normal life events that will happen after the traumatic event such as finding a job, relationship etc. Apart from this, individuals might also feel that others cannot understand their experiences hence they might not seek support. Difficulty concentrating, memory concerns etc. are some other cognitive effects of trauma. Cognitive patterns differ from person to person and a lot of factors before, during and after trauma can affect the individual’s cognitions.
Visual representation of cognitive triad in individuals experiencing trauma. Adapted from Becks cognitive theory.
Triggers are another common aspect found in trauma. Trigger (often sensory) is when a current similar or remotely similar experience activates the same psychological distress from previous trauma. For example: Let’s say Marco is on the way to work one day. He sees a minor accident on the way (trigger) and suddenly intense fear and panic flushes him because it reminds him of the road accident that he has been in. Hence, this trigger is a sensory reminder of his previous trauma. Triggers can range from straightforward to very subtle. Yearly anniversary of the death of a loved one, revisiting the same location of the trauma, being alone etc. are more straightforward. Sometimes trigger can be a smell, a dress, a color, some other visual reminder, a sound etc. It is important to be aware of our triggers and devise or know adaptive strategies to deal with them.
The last is behavioral effects of trauma. Behavior is often a consequence of our cognitions (thoughts that we discussed earlier). Mistrust in the world and others can lead to isolating oneself, fear of intimacy and vulnerability, inability to form and maintain relationships etc. A sense of danger and the world being an unsafe place, can lead to misjudging every other situation as dangerous, exaggerated startle responses, avoidance etc. Sometimes as way to cope and survive especially with children when their trauma is perpetrated by the caregivers, they may form trauma bonding with their perpetrators idealizing, rationalizing and justifying their behavior towards them (Substance Abuse and Mental Health Services Administration., 2014).
Some of the mechanisms like trauma bonding, fragmented memory of the event, hypervigilance are all coping/survival and defense mechanisms for the individual because their brain and body has been in survival mode for so long. Like it is always working on worst case scenarios, so that it can be ready when faced or completely avoid it altogether.
Childhood Trauma and Its Effects
Childhood trauma can be caused by neglect/abuse from their primary caregivers, attacks/assaults or other traumatic events they experienced in childhood. They are called Adverse Childhood Events/Experiences (ACEs). To know more you can visit our blog about child maltreatment. Childhood trauma has lasting effects psychologically. It is closely associated with mental health disorders like anxiety, depression, substance abuse, suicide etc. Complex trauma in childhood is widely associated with Dissociative Identity Disorder (DID) formerly known as multiple personality disorder. Apart from the psychological effects, childhood trauma can actually impact the physical structures in the brain. Studies have found volume or size changes in the core limbic emotion processing units amygdala, hippocampus and hypothalamus. Especially the volume changes in the hippocampal regions have been confirmed by various neuroimaging studies. Amygdala and hippocampal volume reductions have been notices especially in childhood physical and sexual abuse. Hippocampal atrophy (reduced hippocampus size) is consistently been associated with childhood trauma (Opel, et al., 2014; Lu, et al., 2024). Hippocampal atrophy is linked to mental health conditions like anxiety, depression, PTSD, emotional dysregulation etc. It is also linked to memory related deficits including fragmented memory of the event contributing to PTSD, associative learning etc. (Lambert & McLaughlin, 2019).
What Helps?
Even though trauma and all the above information maybe overwhelming, there is help available. It is of utmost importance to seek help from a trauma informed mental health professional. Early intervention helps, leading to better recovery and prognosis rates. It is important that individual expresses their thoughts, emotions and behaviors to a professional. Cognitive Behavior Therapy (CBT) is widely used to deal with the thoughts and their consequent behavior and emotions. Disputation, cognitive restructuring, CBT worksheets, thought records, symptom maintenance cycles for client awareness are some techniques that are used. Behavioral techniques like biofeedback, grounding techniques, guided imagery, deep breathing etc. maybe used throughout the sessions in case of triggers, flashbacks causing panic, anxiety/distress.
Note: These techniques are mentioned for the awareness purposes. They must be done/used under the supervision of a trained mental health professional or in collaboration with one. Please refrain from using them without consulting a professional first or by oneself.
Additionally, environment of the individual also plays a major role in recovery. Adaptive social support systems can aid in recovery and even lead to post traumatic growth (PTG). Post traumatic growth is where an individual following a traumatic event and recovery experiences personal growth with shift in perspectives about life, new appreciation for life, spiritual enrichment, new meaning in life and its purpose and even psychological well-being. Social support can help individuals form new adaptive self-narratives, lead to self-discovery and actualization. This can result in eudaimonic and subjective well-being.
“…continued dialogue with relational partners over time could aid in the generation of new self-narratives and a redefined understanding of one’s character, meaning, and purpose (e.g., a newfound belief in one’s abilities after man aging reactions to traumatic event).” (Calhoun, et al., 2022, p. 957)
References
American Psychological Association . (2026). Trauma. Retrieved from American Psychological Association : https://www.apa.org/topics/trauma
Calhoun, C. D., Stone, K. J., Cobb, A. R., Patterson, M. W., Danielson, C. K., & Bendezú, J. J. (2022). The Role of Social Support in Coping with Psychological Trauma: An Integrated Biopsychosocial Model for Posttraumatic Stress Recovery. Psychiatric Quarterly, 949–970.
Chandna, A. S., Suhas, S., Patley, R., Dinakaran, D., Manjunatha, N., Rao, G. N., . . . Benegal, V. (2023). Exploring the enigma of low prevalence of post-traumatic stress disorder in India. Indian Journal of Psychiatry, 1254–1260.
Davis, H., Whitfield, A., Judge, S., Beverly, B., Minter, J., DeLaney, E., & Walker, C. (2020). Vicarious Trauma Exposure and Its Effects on Mental Health among Adolescents and Adults: A Narrative Research Review . Undergraduate Reserach Posters .
Jae, S. (2024). Analysing the Different Types of Trauma and their Impact . Neuropsychiatry (London), 1-2.
Koenen, K. C., Ratanatharathorn, A., Ng, L., McLaughlin, K. A., Bromet, E. J., Stein, D. J., . . . Haro, J. M. (2017). Posttraumatic stress disorder in the World Mental Health Surveys. Psychological Medicine , 2260–2274.
Lambert, H. K., & McLaughlin, K. A. (2019). Impaired hippocampus-dependent associative learning as a mechanism underlying PTSD: A meta-analysis. Neuroscience and BioBehavioral Reviews, 729–749.
Lu, S., Xu, Y., Cui, D., Hu, S., Huang, M., Li, L., & Zhang, L. (2024). Exploring the association between childhood trauma and limbic system subregion volumes in healthy individuals: a neuroimaging study. BMC Psychiatry, 1-12.
Opel, N., Redlich, R., Zwanzger, P., Grotegerd, D., Arolt, V., Heindel, W., . . . Dannlowski, U. (2014). Hippocampal Atrophy in Major Depression: a Function of Childhood Maltreatment Rather than Diagnosis? Neuropsychopharmacology , 2723–2731.
Pan American Health Organization . (2026). Post-traumatic stress disorder. Retrieved from Pan American Health Organization : https://www.paho.org/en/post-traumatic-stress-disorder#:~:text=Most%20people%20exposed%20to%20such,trained%20mental%20health%20care%20providers.
Substance Abuse and Mental Health Services Administration. (2014). Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. Rockville: HHS Publication.
WHO. (2024, May 27). Post-traumatic stress disorder. Retrieved from World Health Organization : https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder#:~:text=Around%2070%25%20of%20people%20globally,trained%20mental%20health%20care%20providers.
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