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Trauma: What's Normal?

There has been a lot of trauma reported in the news recently, including an incident in Bondi that was highly traumatic for many people.

There were of course people who were direct witnesses to the event who will be feeling the effects of trauma.

Family members who feared for their loved ones.

Emergency service personnel who responded & saw the direct aftermath.

Plus the many Australians who felt fear as they identified with the victims who were just going about an every-day activity of shopping when they were attacked.

A traumatic event like this has a ripple-effect throughout families & communities & the affects of this can be long-lasting.

So let's talk trauma. What's 'normal'; what's not & when to worry.

A traumatic event is defined in the Diagnostic & Statistical Manual of Mental Health Disorders, 5th Edition (DSM-5) as;

... direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganised or agitated behaviour) (Criterion A2) (p. 463).

By this definition, we can see that emergency service & healthcare workers experience can trauma daily. Which is why the mental health of our emergency workers needs ongoing care & attention. The human brain is affected by trauma, regardless of how much training we may have had.

What is a 'Normal' Trauma Reaction?

We know from research in the area of trauma that the first 30-days following a traumatic event will involves a range of experiences for most people. These may include:

  • Nightmares

  • Intrusive thoughts & memories

  • Disorganised thoughts

  • Difficulties concentration

  • Difficulties with memories

  • Sleep disturbance

  • Appetite disturbance

  • Preoccupation with the traumatic event

  • Urges to avoid memories of the traumatic event

Expect to feel entirely crazy & out-of-sorts for at least a month after a traumatic event.

This is what a healthy brain does in response to trauma in the short-term, & it's important we don't pathologize these normal reponses.

What's the Best Support Directly Following a Traumatic Event?

Individual responses to trauma are highly varied, so the kind of support people may need is highly varied too. Common forms of immediate support (within the first month) following trauma are:

  • Debriefing: Critical incident debriefing has historically been used for frontline workers following traumatic events. The evidence on formal debriefing is varied. Some people may find it helpful, but others may actually find it more traumatising. Critical incident debriefing should never be forced & should always be facilitated by those with specialist training in this area. Informal, ad-hoc debriefing amongst colleagues or survivors of an incident does appear to be helpful in most contexts, as it is initiated & controlled by individuals. Being able to discuss the incident openly with others in an informal way does seem to be helpful for most.

  • Immediate/ Crisis Counselling: Research into the effects of immediate 'crisis' counselling following a traumatic event shows there is no real benefit to immediate counselling (& in some cases it can make people feel worse). In this context, counselling means in-depth exploration of the emotions & reactions following a traumatic event, in a formal setting by a professional trained in counselling skills. The reason immediate counselling may not be helpful is that part of a normal trauma reaction is often shock & disbelief. This can a a protective mechanism where the brain is not overwhelming the person all at once with the reality of the trauma, but cleverly titrating exposure to make it more manageable. Pushing heavy exploration of feelings & memories at this time may disrupt this helpful process, thereby inadvertently making people feel more overwhelmed.

  • Immediate/ Crisis Support: Differing from counselling, crisis support refers to practical support in the immediate hours, days, weeks & months following a traumatic event. This may include financial support; housing (in the case of natural disasters for example); food, practical resources & assistance etc. Research shows this type of support is very helpful following a traumatic event. So if you know someone who has been through a traumatic event or loss, dropping over that pre-cooked meal may be the best thing you can do (but just drop it on the doorstep- don't insist on a conversation!)

What About Support Later?

So we know most people will feel entirely out-of-sorts for a month following a traumatic event. This is a normal response.

But what about after that initial month? What is 'normal' & when should you get help? Again, this is a difficult question to answer, as people are so varied. However, for a person to be diagnosed with post-traumatic stress disorder) PTSD, symptoms must last for more than a month and must cause significant distress or problems in the individual's daily functioning.

There are some key elements of PTSD which may warrant seeking assessment & treatment, in particular:

  • Intrusive thoughts &/or memories of the traumatic event that interfere with daily functioning

  • Persistent negative/ low mood

  • Dissociative symptoms that are causing distress (eg. feeling disconnected from reality; altered sense of reality).

  • Problematic avoidance behaviours, eg. heavy drug & alcohol use; isolation that's interfering with daily functioning

  • Persistent nervous-system arousal that interferes with functioning, eg. persistent sleep disturbance; hyper-vigilance to threats; inability to concentrate; memory problems; irritability &/or angry outbursts.

It is important to know that for significantly traumatic events, these symptoms will likely be present for some months for most people. However what's important to understand is HOW the symptoms are affecting the person. Help should be sought if these symptoms are interfering with the person being able to function in their job, study or relationships.

Where To Seek Help:

The best place to start if you're worried about your mental health is your GP. They can then refer you to specialised support if needed.

Other support organisations include:

  • Lifeline 13 11 44

  • THISWAYUP – Experts at St Vincent’s Hospital Sydney developed the THISWAYUP e-mental health programs. They include an online PTSD treatment course for people who’ve been feeling symptoms for more than 4 weeks after a traumatic event.

  • Mindful Recovery Services is a private practice in Erina, NSW with expertise in treating trauma & other mental health concerns- (02) 4660 0100;

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