Can you experience a traumatic event and not be traumatized?

For many people, symptoms occur late, when the brain is no longer so worried or the person has the opportunity to assimilate what has happened. There is no definitive answer to why some people who experience trauma develop PTSD and others don't. Experts don't know why some people experience post-traumatic stress disorder after a traumatic event, while others don't. A history of trauma, along with other physical, genetic, psychological, and social factors, may play a role in the development of PTSD.

The following sections focus on some common reactions across the board (emotional, physical, cognitive, behavioral, social and developmental) associated with unique, multiple, and long-lasting traumatic events. These reactions are usually normal responses to trauma, but they can still be nerve-wracking to experience. These responses are not signs of mental illness or indicate a mental disorder. Traumatic stress-related disorders comprise a specific constellation of symptoms and criteria.

Trauma-based care (TIC) involves a broad understanding of reactions to traumatic stress and common responses to trauma. Provide information about the experience of triggers and flashbacks, and then normalize these events as common traumatic stress reactions. Somatic symptoms are more likely to occur in people who have traumatic stress reactions, including PTSD. The diagnostic criteria for PTSD place considerable emphasis on psychological symptoms, but some people who have experienced traumatic stress may initially have physical symptoms.

Alcohol and drug use may be, for some, an effort to manage traumatic stress and specific symptoms of PTSD. Sleep disorders are more persistent among people who suffer from trauma-related stress; the disorders sometimes remain resistant to intervention long after other symptoms of traumatic stress have been successfully treated. The main presentation of a person with an acute stress reaction is usually that of someone who seems overwhelmed by the traumatic experience. Early betrayal can affect the ability to develop attachments, but forming supportive relationships is an important antidote in recovering from traumatic stress.

Research has shown that traumatic experiences are associated with both behavioral health and chronic physical health conditions, especially traumatic events that occur during childhood. Self-harm is also associated with (and is part of the diagnostic criteria) several personality disorders, including borderline and histrionic disorders, as well as DID, depression and some forms of schizophrenia; these disorders can coexist with traumatic stress reactions and disorders. Certain characteristics make people more susceptible to PTSD, such as each person's unique personal vulnerabilities at the time of traumatic exposure, the support (or lack of support) they receive from other people at the time of trauma and at the onset of trauma-related symptoms, and the way in which other people in the person's environment assess the nature of the traumatic event (Brewin, Andrews, & Valentine, 2000). Because numbing symptoms emotionally hide what's happening inside from an emotional point of view, family members, counselors, and other behavioral health personnel may evaluate traumatic stress levels, symptoms, and the impact of trauma as less severe than they really are.

A prospective longitudinal study (Malta, Levitt, Martin, Davis, & Cloitre, 200) that followed the development of PTSD in disaster workers highlighted the importance of understanding and appreciating numbness as a traumatic stress reaction. The following examples reflect some of the types of cognitive or thought process changes that can occur in response to traumatic stress. In fact, a past mistake in the psychology of traumatic stress, particularly with regard to group or mass trauma, was the assumption that all survivors need to express the emotions associated with trauma and talk about the trauma; more recent research indicates that survivors who choose not to process their trauma are as psychologically healthy as those who do. The following sections provide a brief overview of some mental disorders that may result from (or be worsened by) traumatic stress.