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1. Trauma
In this section, we define‘ trauma’ and describe psychological and physiological responses to extreme life-threatening events. People react in many ways to such experiences, but some patterns of behaviour are common. We describe below typical and frequently encountered immediate and long term reactions to threats, danger and humiliating forms of violence.
PART III: THEORY
Reactions to severe stress and life-threatening events
Human beings have always been exposed to traumatising events. Our physiological reactions have probably been remarkably persistent over time. It is difficult to predict which events cause traumatic reactions, because our perceptions of a threat greatly influence its psychological and physiological effect on us. Some people survive very dangerous experiences without developing symptoms, while others in the same situation will be markedly affected or become ill. Individuals employ a range of coping strategies and tolerate stress to different degrees, reflecting how they interpret their situation and how sensitive they are, as well as the response of the surrounding community.
The stressor
For a persistent reaction to occur, there must be a stressor. To become mentally traumatised in the course of surviving a traumatic event, individuals must experience something that is perceived to be catastrophic and that threatens their life and integrity( World Health Organisation definition). For some people, it can be enough to witness such an event. A stressor may be an earthquake, a tsunami, a war, a bank-robbery; it may also be a continuing experience of domestic violence or poverty.
Though people react differently to stress and threats, events such as rape, torture, and the violence associated with war are experienced as traumatising by nearly everyone, regardless of culture or other factors such as age or gender. It is therefore normal to have some or many symptoms of trauma after such experiences.
Reactions to trauma
Below, we list the most frequent forms of reaction after traumatic events. Our descriptions are based on those of the international diagnostic systems, primarily DSM-IV( American Psychiatric Association 1994) and the World Health organisation’ s International Classification of Diseases( ICD-10).
Acute stress reaction
This is defined by WHO as“ a transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and mental stress and that usually subsides within hours or days”( ICD-10).
People typically display erratic and changeable behaviour. Immediately after the event, they are often‘ dazed’ and find it difficult to concentrate or focus. They may feel that what happened is unreal, and behave normally as if nothing has occurred. If the stimuli are too powerful, they may become disoriented.
Subsequently, some people may withdraw, dissociate or become‘ stupefied’, while others respond by panicking and wanting to flee. They show signs of anxiety and fear, have a rapid heartbeat, sweat, experience nausea, vomiting, tremors, palpitations, breathing difficulties, or a range of