Trauma

What happens when terrible things happen to us?

We frequently help people with post-traumatic stress disorder (PTSD), so let’s review some of those experiences and what we’ve learned.

During a traumatic event, a person may feel powerless and in mortal danger. The body floods the brain with stress hormones such as cortisol and adrenaline. These chemical surges are adaptive in the short term but can become toxic when sustained. Prolonged exposure to these elevated stress chemicals can impair memory processing and emotional regulation in brain regions like the hippocampus and amygdala (van der Kolk, 2014).

Not everyone who experiences trauma develops PTSD. Trauma is part of the story, but it is not the whole story. Consider soldiers: a group may endure the same firefight, yet only some develop PTSD. This difference points to resilience—a blend of biological and psychological factors that helps certain individuals recover more effectively. However, even resilient individuals can develop symptoms after repeated exposure. Soldiers who complete multiple tours of duty sometimes develop PTSD after years of cumulative stress, showing how repeated activation of the fight-or-flight response can wear down the brain’s capacity for regulation.

Recently, another term has gained attention: complex PTSD (C-PTSD). While not a formal DSM-5 diagnosis, it emerged to describe the effects of chronic or repeated trauma—such as prolonged combat, childhood abuse, or captivity. Whereas traditional PTSD is often tied to a single incident, complex PTSD reflects long-term exposure that alters personality, trust, and worldview. It can appear in both soldiers and civilians, though the term is sometimes applied too broadly. Distinguishing between trauma severity and chronicity is essential to accurate diagnosis and treatment (American Psychiatric Association, 2022).

When assessing trauma, we always begin with a simple question: How is this trauma affecting you now? PTSD is not a life sentence—it’s a disorder of adaptation. It involves re-experiencing, avoidance, negative changes in mood and cognition, and hyper-arousal. For some people, these symptoms emerge immediately after the event; for others, they surface months or years later.

A typical case might look like this: a person experiences a single traumatic event and later develops PTSD. Memories and emotions intertwine, and seemingly unrelated cues—sounds, smells, or environments—can trigger flashbacks or panic. One of the most common coping mechanisms is avoidance, which can evolve into what I call the shrinking world phenomenon.

At first, the person avoids one place or situation associated with trauma. Gradually, avoidance expands. They avoid the nearby roads, then the entire neighborhood, then travel altogether. In severe cases, people isolate at home with locked doors, closed curtains, and a weapon within reach. The “shrinking world” is both a metaphor and a reality: safety becomes confinement.

Another common symptom is hyper-vigilance—the need to monitor surroundings constantly. People may choose seats that face the door, avoid crowds, or react strongly to unexpected noises. Nightmares and flashbacks often reinforce this state of alertness, keeping the nervous system locked in survival mode.

There’s also an uncomfortable reality within the system that treats PTSD. Because the diagnosis carries validation and, in some cases, financial compensation through veterans’ benefits, it can become politically charged. Some individuals may be incentivized—consciously or not—to remain “sick.” Yet, for most people, the label is not about money but meaning. It gives language to invisible pain and helps others empathize with what they’ve endured.

Ultimately, PTSD is both biological and existential. It reshapes how people view the world and themselves, but recovery is possible. Healing begins when survivors learn that the trauma is over, that safety is possible again, and that the brain can be retrained to rest. Treatment—whether through therapy, medication, EMDR, or social connection—helps the body and mind complete the response that trauma once froze in place.

Trauma changes us, but awareness changes trauma. The same brain that learned to survive can learn to heal.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Author.

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.