Psychological Assessment of Trauma

A traumatic event is usually defined as an event that poses a serious threat to one’s life or psychological integrity. The person feels trapped in an inescapable, dangerous situation even if the traumatic threat is removed. The feelings of entrapment and helplessness are pervasive resulting in loss of control and personal agency.

The person may have suffered a traumatic accident, or has endured a traumatic loss or has been subjected to acts of physical, psychological or sexual violence. These are just some examples and they do not exhaust all the ways in which people may feel traumatically violated or ruptured.

The following are some signs of psychological trauma:

Emotional Disregulation: (disruption in emotional self regulation)

Under ordinary circumstances, most people are able to regulate their emotional experiences; that is they are able to self sooth and manage to remain calm in stressful situations. They can regulate feelings of anxiety, irritability, or sadness by adopting effective coping strategies. However, trauma can overwhelm an individual’s capacity to tolerate stress by disrupting the normal operation of the nervous system. A traumatized individual might experience dramatic mood fluctuations, oscillating between states of hyper and hypo-arousal. This means that the person alternates between states of depressive withdrawal, or anxious restlessness.

Symptoms of Traumatic Hyper-arousal:

• Fear, Insomnia, nightmares, restless agitation, extreme irritability, muscle tension

• Panic attacks (rapid breathing, heart palpitations, chest tightness, dizziness)

Symptoms of Hypo-arousal:

• Freezing response (numbness, paralysis), Stiff posture

• Depressive withdrawal from social contact

• Hyper-vigilance and sharpened focus in order to avert real or imagined threats

Intrusive Thoughts/Flashbacks

A traumatized individual might partially or fully re-experience elements of a traumatic experience. These traumatic flashbacks could be overwhelming and disruptive, since they feel real, vivid, and immediate (even though the threat is already removed).

These flashbacks can take on a visual, sensory and somatic form. For instance, if the person’s brain has stored only the visual fragments of the traumatic event, she is likely to experience and recall visual flashbacks. On other occasions, if the person has stored the physical, bodily sensations felt during trauma, (body posture, respiration, rapid heart rate, sexual arousal), she may experience somatic flashbacks. In this case, all or any bodily signals that are reminders of trauma are perceived as dangerous and psychologically threatening. This explains why the treatment of trauma is such a complex process. Any external or internal stimuli that are reminiscent of the incident are likely to activate a trauma response. Individuals who have suffered a traumatic event might avoid all life activities in order to stave off danger. Life becomes increasingly constricted, isolated, and lonely.

Dissociation

Dissociation is a natural mechanism of the mind that allows us to tune out excess noise and distractions in our daily life. Under normal circumstances, when we are calm and self composed, we can reasonably remember most aspects of our personal experiences; we may recall the bodily sensations, visual images or the emotional tone of an experience and we have a sense of what the experience meant. In Trauma, our awareness of that experience is fragmented. Elements of that experience are dissociated (kept separate) in our awareness.

Under extreme stress, the person is afraid of losing her life or falling apart psychologically. In such circumstance, the mind “shuts down” in order to cope with overwhelming stress. Traumatized individuals appear to be in a state of shock, physically paralyzed or emotionally disoriented. Dissociation is the psychic mechanism that allows the mind to shut down temporarily to manage psychic pain. During a dissociative episode, the full awareness of trauma is suspended. The person may be detached from her emotions, hence feeling flat and robotic; or she may feel physically numb and disconnected from her body.

In all these instances, the person is no longer capable of fully apprehending the reality of the traumatic event; the awareness is split, elements of experience (emotions, bodily sensations, images) are dissociated to keep the pain at bay. In other words, the mind has lost its capacity to fully integrate and process the experience. As such, unlike ordinary memories, traumatic memories are disjointed; they have no history, context or narrative. They are just fragments of experience floating in time and space.

Other signs of trauma include:

• Amnesia (spaciness, distortion of time/space)

• Reduced ability to deal with stress

• Helplessness, loss of personal agency, diminished capacity to make decisions

• Avoidance of daily activities, feeling unsafe in unknown places

• Fear of death & catastrophic events

• Diminished capacity to love, nurture, trust

• Acting Out: discharge of aggression, self mutilation, substance abuse

• Acting In: Somatic, physical symptoms (IBS, headaches, partial motoric paralysis)

It should be noted that experiencing some of these symptoms do not necessarily warrant the diagnosis of post traumatic Stress Disorder (PTSD). A full psychological assessment will explore these concerns in detail and it offers an in-depth understanding of the full extent and gravity of the traumatic experience.

Dr M. Gholamain, Ph.D. C. Psych

Psychologist