In case you have not read my other posts on Post-Traumatic Stress (PTS), I’d like to begin by clarifying that just because somebody has gone through a trauma does not mean that they have a “disorder” (as in PTSd or Post-Traumatic Stress Disorder). A soldier returning from combat may or may not show symptoms of post-traumatic stress (PTS), but if they do it does not mean that they have PTS-d (that’s the disorder). PTS (no ‘d‘) is simply a set of symptoms describing a specific form of stress.
When a traumatic event strikes people often experience a variety of difficult symptoms ranging from irritability and insomnia to intense anxiety and flashbacks. But not everybody experiences the same PTS symptoms. And not everybody experiences them at the same degree of intensity. In this post, I will cover the differences between:
- Acute, chronic, immediate and delayed traumatic stress
- Single- and multiple-traumatic events
Acute traumatic stress
Sometimes called Acute Stress Disorder, acute traumatic stress symptoms usually last anywhere from a few days up to one to three months (to receive the diagnosis of Acute Stress Disorder, no more than one month).
Symptoms of acute traumatic stress
There are 5 basic categories of psychological acute traumatic stress symptoms:
- Intrusion – Often referred to as “Flashbacks” where intrusive memories of the traumatic event invade day to day consciousness and/or dreams
- Negative Mood – Irritability, depression, anxiety, and/or confusion
- Dissociation – Dissociation does not mean an alternate personality takes over. Instead, it refers to your experience of life feeling a bit detached, like time slowing down, walking around in a haze or fog, and even feeling like you are experiencing life from ‘outside of yourself’
- Avoidance – A pattern of avoiding thoughts, emotions, and people associated with the trauma. Drug and alcohol use may be one method of avoidance. Engaging in high-risk behaviors may be another avoidance behavior. Avoiding the location of the trauma is extremely common as well
- Arousal – Difficult sleeping, feeling ‘amped up,’ irritable, and having difficulty concentrating
Physical symptoms of acute traumatic stress
Physical symptoms are based on the activation of the sympathetic nervous system (the “fight-or-flight” response) and include surges of:
- Heart rate
- Breathing rate
- Blood pressure
- Muscle tension
These physical symptoms are the fight-or-flight survival mechanism, and all of the symptoms are designed to give your body the sudden boost of energy needed to either fight or flee. Immediately preceeding either fight or flight some people will experience the freeze reflex.
Psychological and physical symptoms begin and may get worse after a traumatic event like violence, natural disaster, or even witnessing a traumatic event. It is the perception of severity that causes the traumatic stress. Remember, these can be triggered even if the event is not actually life-threatening because your perception defines your reality.
Chronic traumatic stress
Chronic traumatic stress occurs when PTS symptoms last more than three months. Generally speaking, when people refer to “PTSD,” or Post-Traumatic Stress Disorder, they are referring to chronic traumatic stress symptoms.
Symptoms of chronic traumatic stress
These are the same symptoms as the acute symptoms above, but persist longer and may increase to include panic attacks, more vivid flashbacks, and more avoidant behaviors like total or partial isolation.
Delayed-onset traumatic stress
Why does delayed-onset PTSD happen?
When PTS symptoms manifest six months or more after a traumatic event. There are a variety of reasons for delayed-onset traumatic stress ranging from elaborate coping mechanisms of the unconscious mind, to the conscious repression of feelings and thoughts about the trauma itself, particularly when drugs and alcohol are involved in numbing the brain. Those that have experienced trauma before the most current event are sometimes sensitized to the effects of stress in general, and therefore may become re-triggered more than 6 months after the event because of the increased sensitivity to stress, including traumatic stress. Paradoxically, those that have experienced recurrent trauma may also become skilled at adapting to the initial symptoms of traumatic stress and thereby delay the full-impact that may arise later if re-triggered.
Delayed-onset traumatic stress occurs about 25% of the time when PTS symptoms are present AND have been experienced previously (this would suggest a re-triggering effect, often related to new stressors like job loss, relationship loss, etc.). This is a driving reason behind why getting debriefed within 48-72 hours of a trauma is important. Even though these symptoms may not reach clinical criteria for a diagnosis of PTSD until after 6 months, most often, symptoms like depression, anxiety, and invasive images are present in lower levels immediately after the traumatic event; this frequently is what drives avoidance and self-medicating that may cause the delayed full impact of PTSD (whereas dealing with the trauma sooner can actually prevent symptoms from becoming clinically diagnosable as a ‘disorder’).
Single-incident traumatic stress
Single incident traumatic stress involves a single traumatic event like a natural disaster, violent crime, etc. Single-incident traumatic stress can lead to acute, chronic or delayed post-traumatic stress. It is important to note that while the traumatic event may be the only activating event, the trauma can be re-experienced over and over through flashbacks, repeating the story of the event out loud to others, or self-narrating as ‘internal dialogue’ (the self-narration that most people notice when they are thinking consciously about something).
Multiple-incident traumatic stress
A multiple-incident trauma occurs when a person experiences a series of traumatic events. This can happen in rapid succession, or, for example, over the course of an abusive childhood that spans years but where the abuse is not necessarily daily (although many would correctly argue that the emotional trauma of living in fear would be daily).
Multiple-incident traumatic stress is often referred to as a “Black Cloud” trauma where the dark cloud of trauma seems to follow the person around.
Treatment of traumatic stress
Mindfulness-based Cognitive-Behavioral therapy (CBT or mCBT) methodologies have proven extremely effective for all forms of traumatic stress. Dialectical Behavior Therapy (DBT) is a very specific application of Cognitive Behavioral therapy, and it teaches 4 major areas of helpful strategies:
- Mindfulness Training
- Emotional Regulation
- Distress Tolerance
- Interpersonal Effectiveness
Trauma recovery groups based on DBT and/or CBT are very effective for many people. Critical Incident Stress Debriefing and Management are based on these concepts and is especially effective when initiated with 48-72 hours of the traumatic event; however, treatments are still effective after this timeframe, so do not avoid getting help.
Other highly effective modalities for treating traumatic stress include:
- EMDR – EMDR stands for Eye Movement Desensitisation and Reprocessing and involves syncing the 2 hemispheres of the brain to balance the processing of trauma
- Trauma-Focused Cognitive-Behavioral Therapy – A specific application of CBT that is based on specific needs of trauma survivors
Treatment of chronic traumatic stress (PTSD) and multiple-incident traumatic stress are similar to those for acute and individual-incident traumatic stress but may be longer in duration or more intensive depending on the person. Surviving intense child abuse, for example, will involve dynamics that may not be present with somebody that survived a flood. Moving from individual therapy to group therapy is a common way to step down from treatment for more chronic traumatic stress.
Learn more about Counseling for Trauma and PTSD in Austin.
Jonathan F. Anderson, LPC-s has worked in the helping profession since he started college in 1990. After completing his Bachelor’s degree at the University of Texas, Austin in 1994, he attended the highly-regarded University of Minnesota to earn his Master’s degree in 1997. He is a Licensed Professional Counselor and is recognized as a Board Approved Supervisor by the State of Texas Board of Examiners of Professional Counselors. Jonathan has completed Level-2 of the Gottman Method of Couples Counseling, and in 1998 received training by the International Critical Incident Stress Foundation in Advanced Critical Incident Stress Management & Debriefing. To learn more about Jonathan’s practice, click here: Jonathan F. Anderson, LPC-s.