Understanding Symptoms

Common Reactions to Trauma 

A traumatic experience produces emotional shock and may cause many emotional symptoms following the traumatic experience. This handout describes some of the common reactions people have after a trauma. Because everyone responds differently to traumatic events, you may have more of these symptoms than someone else, or less, or you may not have some of them at all. 

Remember, that experiencing emotional changes after a trauma is normal. In fact, most people who directly experience a major trauma have severe problems in the immediate aftermath. Many people then feel much better within three months after the event, but others recover more slowly, and some do not recover enough without help. Becoming more aware of the changes you've undergone since your trauma is the first step toward recovery. Some of the most common problems after a trauma are described below. 

Fear and anxiety. 

Anxiety is a common and natural response to a dangerous situation. For many it lasts long after the trauma ended. This happens when views of the world and a sense of safety have changed. You may become anxious when you remember the trauma. But sometimes anxiety may come from out of the blue. Triggers or cues that can cause anxiety may include places, times of day, certain smells or noises, or any situation that reminds you of the trauma. As you begin to pay more attention to the times you feel afraid, you can discover the triggers for your anxiety. In this way, you may learn that some of the out-of-the-blue anxiety is really triggered by things that remind you of your trauma. 

Re-experiencing trauma. 

People who have been traumatized often re-experience the traumatic event. For example, you may have unwanted thoughts of the trauma, and find yourself unable to get rid of them. Some people have flashbacks, or very vivid images, as if the trauma is occurring again. Nightmares are also common. These symptoms occur because a traumatic experience is so shocking and so different from everyday experiences that you can't fit it into what you know about the world. So in order to understand what happened, your mind keeps bringing the memory back, as if to better digest it and fit it in. 

Increased arousal 

Hyperarousal is also a common response to trauma. This includes feeling jumpy, jittery, shaky, being easily startled, and having trouble concentrating or sleeping. Continuous arousal can lead to impatience and irritability, especially if you're not getting enough sleep. Experiencing sleep problems (e.g., not able to fall asleep, waking often during sleep, waking early and not able to return to sleep) – a sign of hyperarousal or heightened anxiety—is incredibly common in PTSD. The arousal reactions are due to the fight or flight response in your body. The fight or flight response is the way we protect ourselves against danger, and it occurs also in animals. When we protect ourselves from danger by fighting or running away, we need a lot more energy than usual, so our bodies pump out extra adrenaline to help us get the extra energy we need to survive. 

People who have been traumatized often see the world as filled with danger, so their bodies are on constant alert, always ready to respond immediately to any attack. The problem is that increased arousal is useful in truly dangerous situations, such as if we find ourselves facing a 

tiger. But alertness becomes very uncomfortable when it continues for a long time even in safe situations. Another reaction to danger is to freeze, like the deer in the headlights, and this reaction can also occur during a trauma. 

Avoidance 

Avoidance is a common way of managing trauma-related pain. The most common type of avoiding is situational avoiding. This is when you avoid situations that remind you of the trauma, such as the place where it happened. Often situations that are less directly related to the trauma are also avoided, such as going out in the evening if the trauma occurred at nighttime. Another way to reduce discomfort is trying to push away painful thoughts and feelings. This can lead to feelings of numbness, where you find it difficult to have both fearful and pleasant or loving feelings. Sometimes the painful thoughts or feelings may be so intense that your mind just blocks them out altogether, and you may not remember parts of the trauma. 

Anger and Irritability

Many people who have been traumatized feel angry and irritable. If you are not used to feeling angry this may seem scary as well. It may be especially confusing to feel angry at those who are closest to you. Sometimes people feel angry because of feeling irritable so often. Anger can also arise from the feeling that the world is not fair. 

Guilt and Shame

Trauma often leads to feelings of guilt and shame. Many people blame themselves for things they did or didn't do to survive. For example, some assault survivors believe that they should have fought off an assailant and blame themselves for the attack. Others feel that if they had not fought back, they wouldn't have gotten hurt. You may feel ashamed because during the trauma you acted in ways that you would not otherwise have done. Sometimes, other people may blame you for the trauma. 

Feeling guilty about the trauma means that you are taking responsibility for what occurred. While this may make you feel somewhat more in control, it can also lead to feelings of helplessness and depression. 

Grief and depression 

Grief and depression are also common reactions to trauma. This can include feeling down, sad, hopeless, or despairing. You may cry more often. You may lose interest in people and activities you used to enjoy. You may also feel that plans you had for the future don't seem to matter anymore, or that life isn't worth living. These feelings can lead to thoughts of wishing you were dead or doing something to hurt or kill yourself. Because the trauma has changed so much of how you see the world and yourself, it makes sense to feel sad and to grieve for what you lost because of the trauma. 

Changes to Self-image 

Self-Image and our views about the world often become more negative after a trauma. You may tell yourself, "If I hadn't been so weak or stupid this wouldn't have happened to me" or The world is horrible and that is why this happened.” Many people see themselves as more negative overall after the trauma ("I am a bad person or I’m weak.” ). 

It is also very common to see others more negatively, and to feel that you can't trust anyone. If you used to think about the world as a safe place, the trauma may suddenly make you think that the world is very dangerous. If you had previous bad experiences, the trauma convinces you that the world is dangerous and others aren't to be trusted. These negative thoughts often make people feel they have been changed completely by the trauma. Relationships with others can become tense and it is difficult to become intimate with people as your trust decreases. 

Sexual relationships 

Sexual relationships may also suffer after a traumatic experience. Many people find it difficult to feel sexual or have sexual relationships. This is especially true for those who have been sexually assaulted, since in addition to the lack of trust, sex itself is a reminder of the assault. 

Substance Abuse

Some people increase their use of alcohol or other substances after a trauma. There is nothing wrong with responsible drinking, but if your use of alcohol or drugs changed as a result of your traumatic experience, it can slow down your recovery and cause problems of its own. 

Symptoms Can Be Connected

Many of the reactions to trauma are connected to one another. For example, a flashback may make you feel out of control and will therefore produce fear and arousal. Many people think that their common reactions to the trauma mean that they are "going crazy" or "losing it." These thoughts can make them even more fearful. Again, as you become aware of the changes you have gone through since the trauma, and as you process these experiences during treatment, the symptoms should become less distressing. 

An Acute Stress Reaction is a surge in difficult, often overwhelming, feelings following  a painful, frightening or traumatic event. 

Acute stress symptoms can last for days or weeks and is a normal reaction to extremely stressful or traumatic circumstances.

When a person is given the support and assistance they need, acute stress reactions decrease over time and resolve. 

However, if a person does not receive the support they need, these symptoms can become chronic and develop into Post Traumatic Stress Disorder (PTSD).

Common Symptoms of Acute Stress and Trauma

Physical Symptoms:

Muscle Tension, headaches, stomach aches, fatigue, racing heart, problems sleeping, loss of appetite, increase in blood pressure, dizziness.

Emotional Symptoms 

Shock, numb, overwhelmed, depressed mood, high levels of anxiety or chronic anxiety, anger, irritability, helplessness, hopeless.

Mental Symptoms

Poor Concentration/ can’t think, rash decisions, confusion, dissociation, shut down. 

Spiritual Symptoms 

Loss of faith, heart feeling shut down, difficulty feeling connected to others or to the deepest part of your own essence. 

These symptoms are similar for children, teens and adults.

Feelings of Grief and Loss are likely to follow a a trauma.  

This is especially true when we have suffered personal loss 

or we know someone who has. 

Symptoms of Grief & Loss overlap with symptoms 

for acute stress, anxiety and depression and include:

• Disbelief, shock, & feeling numb
• Sadness/ Depressed Feelings
• Anger and Irritability
• Confusion / Feeling that nothing makes sense
• Overwhelm
• Hopelessness/ Helplessness
• Guilt 
• 
  

Healing from grief and loss can be hard, but it also leads to a

 deepening of love and to new growth

Symptoms of Grief and Loss in children and teens are similar

to those in adults and are following trauma and loss.

Symptoms of Grief & Loss overlap with some of those 

for acute stress, anxiety and depression and include:

• Disbelief, shock, & feeling numb
• Sadness/ Depressed Feelings
• Anger and Irritability
• Confusion / Feeling that nothing makes sense
• Overwhelm
• Hopelessness/ Helplessness
• Guilt 

While there are outliers, kids and teens don't know how to identifying or express their feelings as well as adults simply because they have less experience doing so.  

This means kids and teens can have a harder time letting us know 

what they are going through, even if they want to share. 

Answers like, "I'm good," or I'm fine," "I don't know," or answering "Nothing" when asked "What's wrong?" happen even when something is upsetting them. 

It doesn't necessarily mean they're trying to withhold from us. It can simply mean they haven't fully digested what they've experienced and don't know how to translate it to us.

Depression in children and teenagers may not look like sadness and crying although it can. Often it manifests as an increase in acting out behaviors, irritability and angry outbursts.

Social withdrawal is another way depression can show up in kids and teens, along with low energy and not wanting to participate in activities they normal would have.

Poor concentration, especially in school is very common. 

Somatic Symptoms

(Headaches, stomach aches, muscle aches, and other physical symptoms are common)     

Negative self-talk, a drop in self-esteem, and feelings of worthlessness are an indicator of depression. However, these can be especially hard to notice since they are happening internally. Follow up if you hear your child say something harsh or negative about themselves. Don't just let it go. 

Checking in with children and teens when there are hard events going on and asking specifically if they are feeling angry, sad, or scared inside can be helpful as long as you don't over do it. Make sure you pay closer attention to their mood, behaviors and affect following trauma. 

Changes in eating: They may start eating much less or a lot more.

Changes in sleep: They may appear or say they are more tired or you may notice sharp increases in sleep. The opposite can also occur and they may having trouble falling or staying asleep. 

All of these symptoms can be normal following events that are acutely stressful or traumatic. However, if you find these symptoms are getting worse or are not getting steadily better, it is important to get professional help. 

Anxiety in children and teens can manifest as  an increase in acting out behaviors, more irritability, angry outbursts and significant difficulties concentrating.

Worrying more and thinking negative thoughts about themselves, others and life in general can happen. 

Children and teens can also become more fidgety and restlessness when they are anxious and may need to go to the bathroom more often.

It is common for children and teens to socially isolate and withdrawn when they are experiencing anxiety. They may want to stay close to home and not go out with friends. They may also seclude themselves in their rooms.  Going out into the world can feel intimidating after traumas such as accidents, disasters, and bullying, and they may push back against activities and errands that they would have participated in before.

Somatic symptoms such as headaches, stomach aches, muscle aches, and other physical symptoms are common in children with anxiety, especially since they have a harder time expressing feelings and asking directly for help. 

Appetite and sleep changes are also common.

 If They’re ok, let them be ok

Kids are really resilient and naturally present in their lives. They are also (hopefully) dealing with less exposure to the trauma such as having to be responsible for everything that needs to be handled in the aftermath. So if you're lucky and your kid is doing ok, don't push them to be hyper aware of everything going on and to process feelings that you think they are feeling; They may just be ok. Let them focus on friends, play and enjoy life as much as possible.

Stick to routines like eating meals together and playing games together.

The sooner you can get their lives to feel somewhat normal following a trauma, the sooner they will regulate and feel better.

Limit their exposure to repetitive news reports

Let them sleep in your room or with a light on if they’re having trouble sleeping

Loosening rules in the direction of comforting them and providing opportunities for extra moments of connection to you is always recommended following trauma. 

Educate them about all the good being done. 

Being able to picture what’s going on helps give kids a renewed sense of safety. It helps them focus on the positive amidst all the hard things going on.  

In the case of the Los Angeles Fires, for example, telling kids about the role of firefighters, police officers, paramedics, medical personnel, shelters, educators, churches, The Red Cross, FEMA and the thousands of other professionals and volunteers who are working together to help those who are in need can help them focus on the positive and help them understand good is happening around them.