Category Archives: trauma

Trauma has many facets

Many descriptions of trauma include: Acute, Chronic, or Complex.

Acute trauma results from a single incident. Chronic trauma is repeated and prolonged, such as domestic violence, racial trauma, or sexual abuse. Complex trauma is exposure to varied and multiple traumatic events, often of an invasive, interpersonal nature. There is an increasing body of evidence that complex trauma may create layer upon layer of harm. Think of scar tissue that doesn’t heal.

The following are not specific diagnoses, but types of trauma that may bring someone to mental health treatment. Often, these are overlapping and cumulative.

*Financial trauma: food insecurity, becoming unhoused, eviction, juggling bills, bankruptcy, debt harassment, constant worry about finances, and social judgment regarding financial status

*Intimate partner violence: domestic abuse includes direct physical threats and aggression, sexual coercion, threats of perceived or actual violence to children or companion animals, throwing away someone’s personal possessions, frequent criticism and verbal abuse, and controlling or prohibiting friendships and social interactions of the partner.

More recently, this form of trauma can include the use of technology to control another person. For example, controlling the use of Wi-Fi, violating privacy by going through someone’s cell phone or laptop, using a smart phone to control the thermostat/lights/ movement detectors, and even changing passwords, codes, or locks; these are all forms of abuse.

*Religious trauma: descriptions of a person as a sinner; scenarios depicting a punitive afterlife or deity; cult-like indoctrination, use of religious practice to attempt to convert or change somebody’s personal being or beliefs,forced participation in organized religious activities; shunning or exclusion; or the opposite, minimizing or denying somebody’s religious or spiritual preferences.

*Relational trauma: ghosting, causing a rift or splits in a friend group, malicious gossip, threats of abandonment, rejection, gaslighting, and triangulation (aligning with another person or people to gang up).

*Bullying: Bullying is a deliberate and unsolicited action that occurs with the intent of inflicting social, emotional, physical, and/or psychological harm to someone who often is perceived as being less powerful. Being bullied is associated with symptoms of anxiety, depression, suicidal ideation, and school refusal.

*Vicarious trauma: trauma that generally results from work in fields such as medicine, mental health, hospice, first responder, and law where the person is exposed to frequent information regarding suffering or violence to others.

*Refugee trauma: displacement from a perceived home or community due to persecution, including political, war, religious, imprisonment, or out-group status (castes). This trauma can continue or be compounded in a new environment, where refugees may not be welcome or even criminalized.

*Natural disasters: exposure to hurricanes, earthquakes, tornadoes, wildfires, tsunamis, and floods, as well as extreme weather events such as blizzards, droughts, extreme heat, and wind storms. This type of trauma often overlaps with becoming unhoused, financially displaced, or physically injured.

*Medical trauma: life-threatening medical problems, chronic illness, chronic pain, multiple invasive surgeries, congenital conditions, or recurrent symptoms/relapses. A large body of research indicates that infants or children who are exposed to multiple medical procedures, chronic pain, or surgeries, may experience long-term or lifelong symptoms.

Also see Racial Trauma and Mental Health and Trauma is Not a Life Lesson.

Trauma is not a Life Lesson

Please stop describing trauma as a life lesson or badge of honor that people survived or it made them stronger.

-What doesn’t kill you can dysregulate your nervous system, That includes your mood, sleep, eating habits, and daily functioning.

-What you survived can impair your ability to have attachments or trust people. Your relationships.

-What you endured can make you sick. Trauma can contribute to chronic diseases such as type 2 diabetes, heart disease, and rheumatoid arthritis.

-What you “tough out” changes your brain. Trauma changes brain chemistry and structure from the hippocampus (which is your memory functioning), to your amygdala (your ability to manage stress and emotional responses) and your prefrontal cortex (problem-solving and reasoning).
Trauma sucks. Don’t glorify it.

Also see Racial Trauma and Mental Health

On Vicarious Trauma

What is Trauma?
Trauma is an experience where death, abuse, or serious injury is a very real threat. This can include your own direct experiences, witnessed events, or situations faced by someone you care about.

Vicarious Trauma
Vicarious trauma is a process of change over time that results from witnessing, identifying with, or hearing about other people’s suffering and loss. If you are regularly hearing about another person’s trauma, then you are at risk of developing vicarious trauma symptoms. When you identify with the pain of people who have endured terrible things, you bring their grief, fear, anger, and despair into your own awareness and experience. Your commitment, care, and sense of responsibility can contribute to feeling burdened, overwhelmed, depressed, anxious, and perhaps hopeless. Vicarious trauma, like experiencing trauma directly, can deeply impact the way you see the world and your deepest sense of meaning and hope.

Trauma in the Black Community
This familiar pain is a symptom of Black people’s shared post-traumatic stress disorder—a uniquely American epidemic, 400 years in the making. And as viral police killings, trials, and social media force Black Americans to repeatedly endure secondary trauma—or the emotional stress that results from witnessing the trauma of others—and also the hidden cost: the spread of a Black American stress disorder that is often undiagnosed, untreated, and, in the age of social media, ubiquitously spread. Listening to traumatic material can also trigger memories of personal previous traumas. Vicarious or secondary trauma is similar to direct trauma. It carries many of the same symptoms.

Common Reactions to Vicarious Trauma:

  • PHYSICAL: Feeling on edge, difficulty sleeping, feeling tired, getting sick
  • EMOTIONAL: Feeling sad or anxious, angry, irritable, lonely or unsupported, unsafe, hypervigilant
  • COGNITIVE: Difficulty concentrating or making decisions, repetitive thoughts, memory problems, disturbing imagery, nightmares, “zoning out”
  • BEHAVIORAL: Social withdrawal, substance abuse, changes in eating patterns, disturbed sleep, overprotectiveness, spending too much time scrolling through social media, canceling and avoiding activities
  • RELATIONAL: Expecting the worst of others, becoming judgmental, relationship problems, loss of friends, feelings of isolation
  • SPIRITUAL: Cynicism, discouragement, loss of faith, low motivation

How to Help Address Vicarious Trauma:

  • PHYSICAL & BEHAVIORAL: Exercise, sleep 8 hours, eat regular healthy snacks and meals, take necessary medications, limit alcohol, drugs, and smoking, drink water, get fresh air and spend time outdoors, shower to “wash the day away,” follow a routine, balance priorities
  • EMOTIONAL & RELATIONAL: Seek support, journal, paint, laugh, watch movies, avoid news/violent TV shows, read books, listen to music
  • COGNITIVE: Focus on positive experiences, affirm your strengths through self statements, do breathing and visualization exercises, remind yourself that this is temporary, stay in the present moment
  • SPIRITUAL: Participate in a community that you value, pray/meditate/do readings, connect to the outdoors, sing, listen to music, personal prayer

Adult Symptoms of Trauma – A Quiet Epidemic

The psychoanalyst Alice Miller wrote: “the true opposite of depression is neither gaiety nor absence of pain, but vitality—the freedom to experience spontaneous feelings. It is part of the kaleidoscope of life that these feelings are not only happy, beautiful, or good but can reflect the entire range of human experience, including envy, jealousy, rage, disgust, greed, despair, and grief. But this freedom cannot be achieved if its childhood roots are cut off.”

The SAMHSA’s National Child Traumatic Stress Initiative (NCSTI) reports that by the age of 16, two-thirds of children report experiencing at least one traumatic event. TWO THIRDS. The substance abuse and mental health services administration (SAMHSA) is the agency within the US department of health and human services that leads public health efforts to advance mental health in the country. 

According to the American Psychological Association (APA), a traumatic event is one that threatens injury, death, or the physical integrity of self or others and also causes feelings of horror, terror, or helplessness at the time it occurs. This can encompass many different situations and may even be different for each person who experiences a specific event.

Potentially traumatic events can include:

  • Physical, emotional, and sexual abuse
  • Neglect
  • Community or school violence
  • Racism and microaggressions
  • Sexual exploitation
  • Sudden or violent death of a loved one
  • Witnessing or experiencing domestic violence
  • Natural disasters or terrorism
  • Refugees or war experiences
  • Assault
  • Serious accidents
  • Life-threatening illness; Chronic illness or multiple surgeries

If untreated, childhood trauma can have long-lasting effects. Trauma can affect children’s mood, development, and their ability to regulate their emotions at the neural level. Consequently, as an adult, they are two times times more likely to develop major depression and three times more likely to develop clinical anxiety.

Symptoms of Trauma in Adults

There are a number of different ways in which symptoms can manifest for adults living with childhood trauma. Unfortunately, there is no clear-cut recipe to follow when diagnosing an adult with lingering signs of trauma, however, there may be some common physical, emotional, and behavioral symptoms. Listed below are just a few symptoms of someone living with trauma. It’s important to know that these are not static, nor linear.

  • Anger
  • Hypervigilance
  • Unresponsiveness
  • Anxiety
  • Emotional outbursts
  • Depression
  • Panic Attacks
  • Physical Pain
  • Poor Concentration
  • Shakiness
  • Night Terrors
  • Lack of Energy
  • Physical Illness
  • Sleep Disturbances
  • Intrusive Thoughts
  • Compulsive behaviors
  • Eating Disorders
  • Impulsiveness
  • Isolation
  • Numbness or Seeming Callousness
  • General disorientation/Confusion

Based on my clinical work, these are just a few of the LESSER known experiences of adult trauma survivors:

-You feel no one understands you, and perhaps no one will. Adult trauma survivors sometimes say, “I don’t fit or belong anywhere or with anyone”.

-You may minimize. Adult survivors say to me, after describing extremely painful experiences, “but, doesn’t everybody go through that? “
One meme that was shared with me by an adult survivor said:
Get up. No one‘s coming to help you. This is a trauma response

-You overperform. Meanwhile, you’re silently dreading the mountain of tasks you’ve signed up for — a list that only seems to get longer as the week wears on.

-You’ve got a love/hate relationship with work or being helpful, and no matter how many times you try to break up with the word “yes,” saying “no” just doesn’t come naturally to you. Extra hours to work on the weekend? You’re the first one in line.

-You may spew emotions seemingly out of nowhere. To others, who are not part of your trauma history, it might seem random or unfair. I have found that people described as “drama queens “ often have unspoken histories that are very painful.

-You might be unloading feelings onto distant strangers. For example, you might be able to talk to your deepest feelings to a server, bartender, or someone you just met at a party, but not to friends or family who have known you for a while. This might seem paradoxical, but it’s not. You do not want to be seen as a burden to those closest to you, which means you’re reluctant to open up when you’re struggling, so you only do so when you’re on the brink of totally breaking down, because you’ve held it all in for far too long.

Similarly, social distance may make it easier to express feelings.
Hello, Social Media: Sure, I’ll tell you all about my trauma. That way, if someone bails on us for being messy or “too much,” it stings less, and the stakes don’t feel as high.

-You feel guilty when you’re angry at other people. You might get angry, only to feel like a terrible person for having feelings at all five minutes later. You might even feel like you’re not “allowed” to be upset with other people. One adult symptom of this is constantly apologizing. In my experience, adult survivors of trauma are apologizing for their very existence. So even minor infractions may send them into a flurry of apologizing. 

-You feel responsible for other people’s reactions. Whenever you recommend a restaurant, a movie, or a book to someone, there’s a moment or two of intense panic. “What if they hate it?” Sometimes you just let other people make decisions on where we go and what to do, because if something goes awry, it won’t be because they failed” to make a good choice.

-You find yourself compromising your personal choices. This can be difficult to notice at first. You might think of yourself as being chill, good at compromise, easy to get along with. But if you pay attention to the conversations you’re having, you might notice you’re a little too agreeable. Sometimes it’s seemingly benign things, like saying you don’t have a preference for what you want to eat for dinner when you actually do. Other times, it may include validating a perspective or behavior that you don’t agree with. It’s not speaking up when you have an opinion, or something is upsetting.

-You sometimes dissociate in social situations. This is where you disconnect emotionally. This can show up as daydreaming, spacing out, withdrawing, or even “going blank”. I’ve heard many adult survivors say that they have been accused by partners, colleagues, and family members of not paying attention or not caring.

-You may feel numb, even cauterized. During the pandemic, I have heard numerous trauma survivors say that they do not feel any significant fear or concern. They may actually function more calmly than others who have not experienced a history of trauma.

Overall, this limited list of behaviors I have observed over the years in clinical work has one thing in common: an inability to fully experience the range of feelings that make us human. Restricted experiences have consequences for our interpersonal relationships, choices, lifestyles, and longterm mental health.

Restorative writing and mental health

As a psychologist and writer, I believe writing aids us in understanding life’s challenges, and that through practice, we become better writers. When we translate painful or confusing events from the unspoken into written language, we alter our perceptions and fundamentally make the experience graspable. You can heal the body by connecting to the mind using writing as a restorative tool.

Natalie Goldberg, author and writing guru wrote, in her books about writing:
“Write about what disturbs you, what you fear, what you have not been willing to speak about. Be willing to be split open.”

It took several losses for me to finally “split open” and comprehend what life, at least my life, was about.  Writing was a pathway, and part of my clinical strategy in my work as a mental health professional, that I call stones across the river. The river being the rapids of life. Many of my patients have experienced relief from writing their experiences in a journal or computer, between our sessions.

Writing Shines a Light Into the Abyss
The subconscious mind can be a dark source of paralyzing nightmares, intrusive thoughts, worries, and unhealed trauma. This stockpiled stress allows illness to infiltrate cells and psyche, through the release of stress hormones such as cortisol, and unhealthy habits such as self-medicating, insomnia, and poor nutrition. 

Think of writing your truth, whether it be grief, loss, fear, illness, or heartbreak, as though you are shining a light into abyss. Once this light is shone, the dark places tend to wither, and sooner or later their influence over you starts to wane.

Through Writing, I Created My Own Shaman
Many people who write create characters or experiences from deep in the subconscious mind psychologically. Writing accesses a place that you may not be able to speak about as easily.

Writing as a Mindfulness Technique
Cambridge University, Department of Psychology recently posted interesting research about individuals who were asked to engage in expressive writing for 15-minutes a day, without downplaying their emotions. The research found that people who weren’t shy about expressing the difficult emotions they experienced in their writing had better physical and mental health than those who wrote on neutral topics. One benefit of writing is that it helps you concentrate on one thing and free your mind from other stuff that bothers you and can overcrowd your brain. Practicing writing every day will help you understand your actions and behaviors better, but will also help relieve anxiety.

Clearing Space in Your Head
Sometimes thoughts, feelings, and emotions overfill our minds, creating traffic jams and bringing anxiety. What your mind needs at this point is a tool, like a traffic light, to bring some consistency and structure to your thoughts and emotions. Writing can serve that function.

Veterans Day

You may know already that I worked for the Washington DC VA hospital as a neuropsychologist consultant. Veterans Day is an opportunity to honor those individuals who have served to protect our country. Psychologists work throughout the year to acknowledge that spirit, supporting military personnel and veterans, their families and their communities.

The American Psychological Association strongly advocates for funding and support for veterans’ health research and clinical services, including therapies to address post-traumatic stress disorder, traumatic brain injury, also known as TBI, anxiety, and depression and more effective suicide prevention efforts in military and veteran populations. The suicide rate for veterans is disproportionately higher than the rest of the country.

I encourage people to honor military personnel, men, women, families, and service dogs (mainly Labrador retrievers, German Shepherds, and Dobermans), today in whatever way they can.

Brain trauma and psychological functioning

One of my amazing mentors was Dr. James Lewis, clinical psychologist and neuropsychologist, whom I met when I was studying for my doctorate at Catholic University, in Washington DC.

While completing my neuropsychology training, I worked with Dr. Lewis, who often represented many patients in court, innocent victims in cases of lead poisoning, shaken baby syndrome, and traumatic brain injuries.

When there is a direct blow to the head, shaking of the child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in motor vehicle accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countrecoup. A bruise directly related to trauma, at the site of impact, is called a coup (pronounced COO) lesion. As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a countrecoup lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain. In simple terms, your brain/us around inside your skull, which is very hard, and creates damage.

General symptoms of a head injury:
A person may have varying degrees of symptoms associated with the severity of the head injury. The following are the most common symptoms of a head trauma.
Symptoms may include:
Raised, swollen area from a bump or a bruise
Small, superficial (shallow) cut in the scalp
Sensitivity to noise and light
Lightheadedness and/or dizziness
Problems with balance
Problems with memory and/or concentration
Change in sleep patterns
Blurred vision
“Tired” eyes
Ringing in the ears (tinnitus)
Alteration in taste
Fatigue or lethargy
Moderate to severe head injury (this requires immediate medical attention).
Loss of consciousness
Severe headache that does not go away
Repeated nausea and vomiting
Loss of short-term memory, such as difficulty remembering the events that led right up to and through the traumatic event
Slurred speech
Difficulty with walking
Weakness in one side or area of the body
Pale skin color
Seizures or convulsions
Behavior changes including irritability
Blood or clear fluid draining from the ears or nose
One pupil (dark area in the center of the eye) is dilated, or looks larger, than the other eye and doesn’t constrict, or get smaller, when exposed to light
Deep cut or laceration in the scalp
Open wound in the head
Foreign object penetrating the head
Coma (a state of unconsciousness from which a person cannot be awakened; responds only minimally, if at all, to stimuli; and exhibits no voluntary activities)
Vegetative state (a condition of brain damage in which a person has lost his thinking abilities and awareness of his surroundings, but retains some basic functions such as breathing and blood circulation)
Locked-in syndrome (a neurological condition in which a person is conscious and can think and reason, but cannot speak or move)
The symptoms of a head injury may resemble other problems or medical conditions. Always consult your doctor for a diagnosis.

The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the doctor obtains a complete medical history of the patient and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.
Diagnostic tests may include:
Blood tests
X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Electroencephalogram (EEG). A procedure that records the brain’s continuous, electrical activity by means of electrodes attached to the scalp.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. You may have to drink a fluid that helps with imaging, called with contrast.

Treatment is individualized, depending on the extent of the condition and the presence of other injuries. If the patient has a severe head injury, he or she may require monitoring for increased intracranial pressure (pressure inside the skull). Head injury may cause the brain to swell. Since the brain is covered by the skull, there is only a small amount of room for it to swell. This causes pressure inside the skull to increase, which can lead to permanent brain damage.

Lifetime care:
The key is to promote a safe environment for children and adults and to prevent head injuries from occurring in the first place. The use of seat belts when riding in the car and helmets (when worn properly) for activities, such as bicycle riding, in-line skating, and skateboarding may protect the head from sustaining severe injuries.

I very firmly tell my patients that they cannot afford to fall down or take a tumble. Please use canes, walkers, or whatever is required to prevent injury in the future, please. 

Persons who suffer a severe brain injury may lose muscle strength, fine motor skills, speech, vision, hearing, or taste function, depending on the brain region involved and the severity of brain damage. Long- or short-term changes in personality or behavior may also occur. These persons require long-term medical and rehabilitative (physical, occupational, or speech therapy) management.

The extent of the person’s recovery depends on the type of brain injury and other medical and psychiatric problems that may be present. It is important to focus on maximizing the person’s capabilities at home and in the community. Positive reinforcement will encourage the patient to strengthen their self-esteem and promote independence, which is the overall goal. 

Indigenous Americans, youth, and mental health.

Indigenous/tribal communities face significant behavioral health challenges and disparities. For Indigenous Americans, multiple factors influence health outcomes, including historical trauma and a range of social, policy, and economic conditions such as poverty, under-employment, lack of access to health care, lower educational attainment, housing problems, and violence.

These disparities have important consequences. Suicide is the second leading cause of death among Native American youth ages 8 to 24. Also, while there is general awareness that Native Americans experience higher rates of alcohol and substance use, the scope of these behavioral health problems is not fully understood.

With 564 federally recognized American Indian and Alaska Native (AI/AN, is the designation currently used by the Census Bureau) tribes, 100 state recognized tribes, and over 200 languages, there is a great need for the development of mental health programs aimed at AI/ANs that center culture as a dominant aspect of treatment. The deficit in culturally relevant treatment programs aimed at Indigenous Americans people living with mental illness is glaring. These communities cope with intergenerational trauma which has a historical context, occurring when exposure to trauma takes place in an earlier generation and continues to affect subsequent generations. The stress of intergenerational trauma contributes to the erosion of family structure, tribal structure and even spiritual ties. It can affect one’s identity, relationship skills, personal behavior, transmission of traditions and values, and attitudes and beliefs about the future. The stress of these traumas combined with the complex and ongoing mistreatment of AI/AN citizens contributes to the rates of mental illness in AI/AN communities and can manifest in a high rate of substance abuse disorder, PTSD, anxiety and depression.

Additional stressors such as a lack of access to health insurance, pervasive poverty and unemployment, and higher suicide rates exacerbate these issues.

I have compiled this list of resources for indigenous clients. Please note that the hours of availability may have changed, but they are all in service at the present time.

Mental Health Resources For Native And Indigenous Communities:
–  Indigenous Story Studio creates illustrations, posters, videos, and comic books on health and social issues for youth.

–  Suicide prevention.
–  National Alliance on Mental Illness.
–  One Sky Center: The American Indian/Alaska Native National Resource Center for Health, Education, and Research; mission is to improve prevention and treatment of mental health and substance use problems and services among Native people.
–  WeRNative: a comprehensive health resource for Native youth by Native youth, promoting holistic health and positive growth in local communities.
–  Ask Auntie: similar to an advice column – type in your question and it will pull up similar ones; if none answer what you’re asking, Auntie Amanda will write up an answer and notify you when it is posted.
–  StrongHearts Native Helpline: The StrongHearts Native Helpline (1-844-762-8483) is a confidential and anonymous culturally-appropriate domestic violence and dating violence helpline for Native Americans, available every day from 7 a.m. to 10 p.m. CT.

Minority Mental Health: Everyday Traumas and Microaggressions

Just a few words about the presentation that I’ll be giving to the Association of Practicing Psychologists (, Montgomery & Prince George’s Counties on November 17th.  The topic is Minority Mental Health: Everyday Traumas and Microaggressions and its being offered as part of their Continuing Education series.

APP is a professional organization for practicing psychiatrists, and as such they are approved by the American Psychological Association to sponsor continuing education for psychologists. This workshop is for licensed psychologists who want to better describe, discuss and assess the psychological stressors that clients may struggle with in the context of everyday micro-aggressions or racism.

I’ve been told by the organizers that my workshop is almost sold out already. I’m gratified to know that so many of my colleagues are committed to cultural diversity and minority mental health. And I look forward to giving similar workshops, with/for APP and other organizations in the future.



Embolden Psychology

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.