It is unlikely (but not impossible) that you will have experienced all of the reactions discussed, so it might be helpful to pay particular attention to the ones that are the worst for you, and bother you the most frequently.

A. Re-Experiencing the Event (Intrusive Reactions)

Flashbacks

Flashbacks are intrusive memories that are experienced as if the event was happening all over again. They can occur during waking hours or be experienced as dreams or nightmares during sleep. Whether waking or sleeping, flashbacks can be extremely disturbing to the individual (and often to the family) because all the physical sensations that were present during the original trauma are usually experienced again. It is quite natural to feel that you are losing control or that your mind is being 'taken over' by past events. For seconds or minutes you may feel that you are again seeing, feeling, smelling, hearing, sensing and reacting to the event. The fear, the horror or the helplessness is also experienced again. One trauma researcher, Bessel van der Kolk (1994), has suggested that 'the body knows the score', in other words, the body retains memories that the mind is not yet ready or able to process. The traumatic images or pictures are presented again and again, as the mind struggles to make sense of what has happened.

Intrusive Recollections

While not every vivid memory is experienced as a flashback, most people will have trouble switching off their recollection of a traumatic event. Very simple things in daily life (even breathing heavily after hurrying or being pushed in a crowd) can become triggers that set off a whole chain of traumatic associations in an instant. This can often happen without you even being aware of the initial connection or trigger at the beginning of the chain. Be assured these are not signs that you are losing your mind! It shows that the mind is struggling to use its cognitive processes to make sense of what has happened to the world you knew before the trauma. Your sense of how the world should be has been violated. It feels as if the 'bubble of safety 'that surrounded you before the trauma, and made it possible for you to get through the day, has now burst. Therefore, the world no longer feels safe and secure.

B. Arousal Reactions

Sleep Disturbances

When you are highly agitated, unable to relax and constantly on the alert for danger, it is, of course, very difficult to enjoy restful sleep. In fact, disturbed sleep is the after-effect most commonly reported by people who have experienced traumas (Woodward, 1993) and this may manifest itself in several ways: finding it very difficult to settle to sleep, waking in the middle of the night, drenched in sweat, having nightmares or recurring dreams, restless sleep with limbs moving, crying out in sleep, waking in the early morning, e.g. 4 or 5 a.m., and finding it difficult to fall back to sleep again.

Bad Temper and Lack of Concentration

All the jumpiness and increased sensitivity is bound to have an impact on a person's mood, temper and ability to concentrate on everyday tasks. You might find yourself becoming very negative, argumentative or easily irritated, in ways that were very unlike you before the traumatic event. You could be angry with yourself for not being able to 'snap out of it'. Or you might find yourself shouting at co-workers or family members about trivial things or because they are pressing you to make simple decisions you don't feel ready or able to make. Such irritation could escalate if you feel that you have suffered because of government bureaucracy, the legal system or institutional mishandling. Often that deep-seated anger will show itself in biting sarcasm or in attempts to over-control every situation, because inside you are conscious of how difficult it is for you to concentrate and attend to details and you deeply fear making mistakes.

Hyper-Alertness and Exaggerated Concern for Safety

If the trauma you experienced was sudden and dramatic it is quite natural that your previous sense of safety and your ability to handle situations will have been utterly shaken. You may now be especially watchful of your environment. You may be checking things or places for safety and see potential danger in ordinary situations. This could include being especially careful about where you choose to sit when going out, for example, considering certain seats, such as the one with its back to the window, as unsafe domain. This concern might also extend to other people around you and to them you may come across as 'over-controlling' in your attempts to ensure their safety. This feeling of being on, red alert' - assessing potential danger all the time - can be extremely draining as your senses have to work overtime to achieve this high level of security.

Exaggerated Startle Response and Panic Attacks

Sudden noises and unexpected movements can startle you severely and the physical arousal reactions that go with this can stay with you for a long time, making you feel nervous and on edge. Nervous agitation might also be experienced as shakiness, light-headedness or even lead to a full-blown panic attack. Panic attacks can occur out of the blue, seemingly without warning, and are quite terrifying. They produce physical symptoms like sudden shortness of breath, severe chest pains or a feeling of dizziness or faintness. A panic attack is another way of showing, in an extreme fashion, the result of (traumatic) stress overload. Quite frequently, it is difficult to pinpoint a direct cause and some people suffer panic attacks after the trauma has passed. But the occurrence of such panic attacks may signal that there are still some deeper feelings to be dealt with. Understanding that they are a sign to 'pay more attention to yourself and your healing' and not the onset of a disabling disease, will make them less frightening. Use the strategies in the chapters on 'Managing Reactions' to help you to gain confidence and worry less about panic reactions.

C. Avoidance and Emotional Numbing Reactions

'Avoidance' reactions can manifest themselves in several ways:

Avoidance Behaviour

Avoidance behaviour means avoiding or literally keeping out of the way of any person, place or thing that might be a reminder (even very remotely) of the trauma. In particular, avoiding things that have already served as reminders or 'triggers' and caused great anxiety or other overwhelming feelings, such as rage, sadness, guilt or disabling grief, or that have set off a flashback. Thus your world gets narrower and narrower. Frequently, you don't want to 'lose face' by admitting that you are avoiding anything. so you make up excuses or make elaborate arrangements to avoid encountering the site of the trauma - the building, place, person or activity (such as driving after a road traffic accident).

Emotional Numbness

A form of avoidance behaviour that is much less easy to identify and understand is emotional numbness - a feeling of hollowness or of being in a void. The traumatized person may feel as though a part of them (the feeling part) has been removed or has died and they experience a sense of being shut down, without the capacity to connect to the world through feelings. This can affect your capacity to laugh, to feel happy or even your ability to cry although you may still feel very sad. Sometimes you might feel that even your capacity to love has been affected, and this can be very frightening, especially if, as a parent, you feel that your capacity to love and feel for your children has dried up.

Alienation, Disconnection and Difficulty with Intimacy

A third form of avoidance is the difficulty in getting close to and communicating with other people. Often people experiencing this feel that they have lost the capacity to connect to the world and their loved ones. They feel a pressure from friends and loved ones to become the person they were before the trauma, but this may not be possible. The response to the pressure to be 'normal' may be to withdraw from company and say very little and there might even be resentment toward people who expect you to 'get over it'. Another common experience is to feel disengaged from other people in your surroundings, as if you are watching things from behind a glass window. You might even feel, for short periods of time, as though you are observing yourself from outside your body.

Your sense of touch and ability to cope with intimacy and physical contact may be affected, too. If you jump when others touch you unexpectedly and shy away from hugging or displays of affection, this is probably because you are so caught up in trying to keep yourself together and contain your feelings that you can't respond to unexpected demands. If, at times, your guard is lowered (for example, during sex or when falling asleep) this may provoke feelings of sudden panic. The reason for this is that reverting to your former ways of feeling will also 'get you closer' to the traumatic experience and the possibility of having to go through it all again.

Alcohol, Drugs and Comfort Eating

People will often use alcohol or drugs to escape or block out the painful reactions connected to their trauma and obtain a temporary respite. You might dread falling asleep, because of disturbing or repetitive dreams or fear 'losing control' by letting down your guard and becoming too relaxed. When one's sleep is disturbed over a long period, there is a strong temptation to take a pill to enhance sleep.

Some people also use food and comfort eating as a way of blocking out painful feelings temporarily. For some, just the action of filling themselves with food can alleviate feelings of inner emptiness and unconnected ness.

Although such behaviour can temporarily improve things, the improvement is artificial and can have a rebound effect. Overuse of alcohol, drugs, comfort eating or any other artificially induced 'numbing' agent can actually inhibit restful sleep and simply compound the problem.

Avoidance behaviour or emotional numbing reactions are often motivated by the desire to prevent further pain and to protect the wounded self through a very narrow interpretation of what is 'safe'. A number of factors such as guilt or self-blame or a particularly horrible detail which you are keeping secret may increase the pressure to preserve that 'numbness' as it seems safer. Again, the end result can be counter-productive and you may end up isolated and prevented from moving on with your life and your healing.

D. Other Reactions Following Trauma

Depression and Traumatic Grief

In the early stages, following a traumatic incident, some people want to sleep all the time. This is a common immediate reaction, but if it continues for months it may signal the presence of 1 depression.

Depression literally means 'pressed down'. It is very common for those who are grieving to go through a stage of depression. The burden of overwhelming sadness that accompanies a severe loss can be too much for some survivors to bear. They find it almost impossible to imagine life carrying on without the loved one they have lost and feel lost and helpless themselves

Loss of a limb or limbs, or the loss of former looks through physical disfigurement, can be just as painful as losing another person through death. It can feel as if a part of yourself has died. And often, less obvious losses, such as being made redundant, losing friends and associates, a miscarriage (or therapeutic abortion), loss of physical strength or ability - or loss of faith in yourself - can be the trigger for depressed feelings. You might begin to think 'I'll never get beyond this' or 'I'll always feel this way' and you might minimize any efforts you have made on your own behalf. As you sink further into depression, your thinking becomes more negative and may focus on feelings of worthlessness. Self-defeating thoughts, such as: 'I've never been any good', 'I always screw things up', may become familiar patterns in your thinking. There may even be a slightly superstitious tendency in your thinking: 'Bad things happen to anyone who's around me', 'I should have expected something like this. Things were going just too well for me.'

Depressed thinking is so caught up in negative patterns that it becomes difficult to concentrate on other things. Your mind may feel as if it is racing and at the same time you experience people feel little motivation to eat, this can lead to significant weight loss, even heath problems. Alternatively, others might use comfort eating to block out their distress. Memory for everyday details, appointments and even ordinary, routine activities is likely to be unreliable. The term 'burnout' is often used to describe the experience of those who have been doing too much for too long. Trying to cope with impossible demands and finally sink into a state of exhaustion. Burn-out can also be applied to people who have been trying very hard to cope after trauma, doing all the right things and yet still find themselves sinking more and more into a depression.

Guilt and self-blame

It is very common for people to blame themselves for all or parts of the traumatic incident. They might think that if only they had done things differently on the day of the trauma, it might never have happened. Often they take personal responsibility for the terrible outcomes, thinking that they ‘should have known' and thus could have made their decisions differently before or during the trauma. They might also feel guilt for having survived when others didn't. A belief that 'It should have been me who died. Her life was worth so much more than mine', is typical of survivor guilt.

Decreased self-esteem and loss of confidence

As we have seen, one feature of self-blame is a very negative pattern of thinking, where you constantly put yourself down and take no credit for those things that you have achieved. Gradually, your confidence is eroded, leading to feelings of worthlessness and very low self-esteem, which may be further confirmed by the disabling effects of other reactions to the trauma. For example, you may not understand your reactions to the trauma and may belittle yourself for withdrawing from people or avoiding activities that previously you would have really liked to do. Negative thoughts lead to a sense that you are losing control, and even losing your mind: you are caught in the downward spiral of low self-esteem.

(C.Herbert & A.Wetmore "Overcoming Traumatic Stress")

(Faure - "Pavane")