The Many Faces of Post-Traumatic Stress

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PTSD might bring to mind violent trauma like combat and natural disasters, but non-physical relationship trauma can also have subtle and lingering effects, including “flashbacks” of events, circumstances and behaviors connected to the trauma.

Many of us are familiar with the term Post-Traumatic Stress Disorder (PTSD), including what the disorder is and how it’s generally caused. But trauma in general can be experienced in many subtle ways in our lives, and the anxiety and other problems that can arise from trauma varies in both intensity and mode of expression. Let’s take a closer look at the nature of trauma and the psychological distress which some of the more subtle traumas we experience can engender.

The very nature of post-traumatic stress is a bit difficult to understand. At a fundamental level, trauma both shocks and scares us. Depending upon the suddenness, intensity, and unpredictability of the event that traumatizes us, the responses of our body and mind can vary considerably.

When something really unnerving happens, it’s natural to have certain reactions that upset our equilibrium. Usually, time is all it takes for that equilibrium to be restored, but sometimes the effects of trauma linger, “revisiting” us in unwanted and distressing ways.

The post-traumatic stress syndrome involves more than the symptoms of “re-experiencing” the traumatic event in some way. Our emotional functioning becomes unbalanced in a particular way, especially with respect to our systems of arousal and reaction. Our thinking is affected, too, as is the stability of our mood. And we tend to want to avoid situations we once felt comfortable with, especially if those situations remind us in any way of the trauma. When these aspects of our functioning are upset to the point where we cease being able to cope adaptively with our environment, the syndrome becomes a true “disorder.”

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Combat veterans who’ve witnessed death, destruction, and carnage; natural catastrophe survivors; and victims of physical or sexual assault can experience all the “classic” features of post-traumatic stress. When trauma is less intense or more subtle than these types of events, however, it’s harder to tell when someone is having a post-traumatic reaction.

Trauma often occurs in relationships. For example, there may be a trust betrayal in a marriage that had appeared stable and secure. When such an event happens, it can throw the person experiencing it into a mild state of shock. The person’s sense of reality can be shaken. They can initially feel numb. As the state of shock passes, a whole host of emotions can emerge, from sheer terror to anger, bitterness, and rage, to utter sadness and even despair. As is so often the case with PTSD, the person can also experience distressing “flashbacks” not only of the traumatic event itself but of all the events, circumstances, and behaviors connected to it. Those flashbacks can be pretty distressing in themselves; the person can also remain on edge, in anxious anticipation of the other proverbial shoe dropping.

A therapist acquaintance of mine once told me the story of a woman who’d come to her after she found out her husband of nearly 30 years had been carrying on a long distance relationship with another woman via social media messaging. Though they’d never even met in person or had a physical encounter, her husband and this woman had been carrying on for nearly a year, and she felt horribly betrayed. They’d been sharing intimacies she had long believed belonged exclusively to them. While it explained much of the emotional distance that had grown between them as a couple, it still came as quite a shock to learn of their relationship. Everything had seemed so normal until the day she found out. Then it seemed like her whole world got turned upside down. It became hard to tell what was real and what wasn’t. She couldn’t eat and she couldn’t sleep. She was beset by a wide range of emotions she felt helpless to control — one minute angry and full of rage and the next minute anxious and depressed, sobbing without warning and seemingly uncontrollably at times. Perhaps the worst things were the recurring intrusive thoughts and images: of the two of them sharing intimacies, of the day she found out, of the look on his face. These thoughts and images kept coming back and there seemed no way to stop them, no way of relieving the trauma.

In time, and with my friend’s help, this woman did heal, of course. But her story taught me much about trauma and the insidious ways the less dramatic forms of trauma we experience in our lives can leave their mark upon us. The probability that any of us will experience the dramatic kinds of trauma which disaster and combat survivors experience is relatively low. The potential for other kinds of trauma, however, especially within our relationships, is actually relatively high. That’s why it’s so important for therapists to be aware of the all too often missed signs of low-level post-traumatic stress. Missing the signs can lead to inadequate treatment, which has the potential to further traumatize the victim. It takes a great deal of time and compassionate care for a relationship trauma survivor to heal. But the process can barely even begin until both the person experiencing it and those who try to help them heal recognize and appreciate the full impact of trauma.

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by on and was last reviewed or updated by Dr Greg Mulhauser, Managing Editor on .

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