Traumatic events can have a profound effect on those who experience them. The powerful feelings of fear and lack of control that it may be triggered can in turn cause feelings of anxiety that, if left unchecked, can become entrenched and pathological. Trauma and anxiety disorders are often associated, as feelings of fear and worry associated with the event can be overwhelming; and when these cognitive aspects are coupled with the autonomic arousal in anxiety (such as sweating, a racing heart, tense muscles, etc.) and resultant (avoidant) behavioral changes (also known as avoidance behavior), a pattern of behavior develops that has a significant impact on a person’s life.
Not everyone who has experienced a traumatic event goes on to develop an anxiety disorder. That is where individual difference comes in – genetics, brain chemistry, personality types all have a part to play. One theory, for example, is that some are genetically or biologically more predisposed to anxiety, but that it is the traumatic life event that serves as the catalyst.
Trauma is defined as the emotional reaction someone has to an extremely negative “out of the ordinary” event. Whilst the reaction might be completely explicable, on occasion, its effects can be so severe that the ability to live a normal life can be severely compromised.
What causes trauma?
Trauma can be caused by an overwhelmingly negative event that causes a lasting impact on the victim’s mental and emotional stability; generally-speaking it is essentially the experience of witnessing or experiencing a harmful or life-threatening event. While many sources of trauma are physically violent in nature, others are psychological/emotional in origin.
Some common sources of trauma include:
Childhood sexual or physical abuse
Physical assault or violent threats of harm
Road traffic accidents
Medical events (including death and childbirth) or medical diagnoses
"Acts of terror" such as terrorist attacks.
Trauma is typically associated with being present and witnessing a horrific event, although people can also experience vicarious trauma which refers to indirect exposure to traumatic events.
Whether or not trauma is a dominant feature in adult life, anxiety can persist in the long-term for individuals with a traumatic life history as the trauma causes the development of certain coping styles such as learned helplessness that they carry into stressful situations, or even into their everyday lives. It is often a projection of actual helplessness that they have suffered, often during childhood.
A significant proportion of trauma experienced arises as a result of abuse, neglect, and/or abandonment in early life; these early experiences have a significant impact upon an individual's neurological, cognitive, and psychological development. In children, traumatic experiences necessitate the development of coping responses, which given the child's developmental stage may be necessarily dysfunctional. Often children will detach themselves from a painful experience or they may even suppress the distress and “somatize” - that is, experience the psychological pain through illness and disease symptoms. Where children repeatedly experience trauma, they often begin to become hypervigilant to future trauma and attempt to anticipate coping with resultant distress. This is where they may develop an anxiety disorder.
How does trauma lead to anxiety?
Previous studies have found that physical, emotional and sexual abuse alongside other childhood adverse experiences are strongly associated with the development of both post-traumatic stress disorder and social anxiety disorder. Another large-scale meta-analysis found that early emotional trauma is a risk factor for panic, generalized anxiety, and social anxiety disorders in later life. Children who experience trauma are more likely to have high levels of trait anxiety (the tendency to experience, focus upon, and report negative emotions such as fears, worries, and anxiety across many situations, especially those in which most people do not experience such responses) and anxiety sensitivity (fears of anxiety-related symptoms). Interestingly, studies have also found that girls score higher on anxiety sensitivity than boys, despite having similar rates of trauma.
Trauma also has an impact upon the neural pathways associated with fear which creates a framework conductive to anxiety in later life. Neural imaging has shown differences in various parts of the brain when exposed to trauma: such as lasting changes in the volume of certain areas as well as increased and/or decreased functions in others. Studies show altered circuitry in many areas, but the amygdala, hippocampus, and prefrontal cortex seem to be particularly involved in the stress response; as do neuro-chemicals such as cortisol and norepinephrine. It is unclear as yet if this observable biological difference is as a result of the trauma or whether it is part of the specific manifestation of post-traumatic stress disorder itself.
How do we know someone has suffered from trauma?
While the causes and symptoms of trauma are varied, there are some basic symptoms that are commonly associated. People who have experienced a traumatic event may appear shaken and disoriented and often appear withdrawn or detached in interpersonal interactions. Typically, shock and denial are usual reactions to a traumatic event. Over time, all of these emotional responses may diminish, but long-term reactions may persist, such as:
Anger and irritability and general emotional lability
Ongoing feelings of despair and sadness, isolation and hopelessness
“Flashbacks” or reliving of the event
Physical symptoms, such as nausea and headaches
Strong feelings of guilt
The key symptoms of PTSD fall into the following three categories:
Re-experiencing the event by continual intrusive recollections, "flashbacks", and also nightmares.
Emotional numbness and avoidance of reminders of the trauma. This could be people, places, activities, for example.
Increased arousal such as insomnia, difficulty concentrating, exaggerated startle response (feeling at unease or very "jumpy"), and emotional lability such as being irritable or quick to anger.
Increased arousal in the form of anxiety is a common sign of a traumatic stress response. Anxiety as a result of trauma can be manifested in the form of night terrors, edginess, irritability, poor concentration and mood swings. However, sometimes traumatic responses can be hidden, even from close family so it is not always obvious.
Trauma often manifests physically as well as emotionally. Some common physical signs of trauma include many of the symptoms we would associate with anxiety, such as sweating or a racing heartbeat. So whilst trauma can lead to anxiety disorders in themselves, traumatic stress disorder can also share many symptoms which can lead to misdiagnoses and inappropriate treatment. When anxiety results from, say, complex trauma, the anxiety felt is an automatic physiological response to a real-life event that has been experienced. Those living with generalized anxiety often fear the future; whereas those with complex trauma fear the future because of past experiences. It is not to say that a life event hasn't been a trigger for an anxiety disorder or that those who have experienced trauma cannot experience anxiety but the root cause differs and so strategies for treatment need to differ. Whilst clinicians may still tackle the presenting symptom (anxiety) in the first instance, they may need to dig a bit deeper to be clear on its etiology and tailor treatment accordingly.