Midshipmen dealing with the impact of psychological trauma are encouraged to seek help at the MDC.
Psychological trauma is an umbrella term for a spectrum of reactions and responses to experiences that threaten our safety and overwhelm our typical coping skills and/or that disrupt or curtail our experience of the world. Such experiences may be rape/sexual assault; emotional, physical, and/or sexual abuse; neglect; harassment; stalking; exposure to war or combat; captivity/solitary confinement; the cumulative impact of racial, ethnic, and/or gender discrimination; genocide; human trafficking; the sudden loss of loved ones; natural disasters; car accidents; loss of home or livelihood; and/or some highly invasive medical treatments. While referred to as psychological (as opposed to a medical/physical trauma), this does not mean that it is “all in your head.” In fact, the trauma response and trauma symptoms engage and impact multiple physiological systems throughout the body, from the nervous system to the immune system.
How Does the Psychological Trauma Response Work?
The trauma response is activated when the brain’s limbic system registers an experience like those listed above as a threat to safety, or when we learn about or witness these events happening to others, particularly those to whom we are closely connected. This threat appraisal activates the fear response, also referred to as the sympathetic nervous system (SNS) or fight/flight/freeze. The fear response mobilizes our defenses to try to safely manage the threat, including releasing adrenaline into the body, raising the heart rate, and withdrawing energy from bodily processes that are not essential to survival in the moment (such as digestion). If the perceived threat turns out not be a danger, or if we can fight or flee from it and return to external safety, activation of the parasympathetic nervous system (PNS) helps us to eventually return to an internal place of calm. In these circumstances we may be able to “shake off” the frightening experiencing and make our way back to homeostasis.
When the circumstances are such that fight or flight is not a viable option or not enough to overcome the danger of the threat, or if we have entered a frozen/immobilized state (which usually happens without conscious awareness or intent), we are likely to remain in a prolonged state of SNS activation, affecting memory consolidation, emotional expression and regulation, thought processes, concentration, sleep, appetite, and blood pressure, among other reactions. At this point, the body has moved from the fear response to the trauma response. This does not necessarily mean that someone will enter a prolonged state of psychological trauma (or develop symptoms that eventually meet the diagnostic criteria for Posttraumatic Stress Disorder or other mental health disorders that can develop in response to trauma). It does, however, mean that it is harder to access the calming effects of the PNS. A midshipman whose SNS is in a prolonged state of activation may appear on edge, irritable, and easily startled, though they may also appear numb, lethargic, and zoned out. Often people experience changes in sleep and appetite patterns, difficulty concentrating, and racing thoughts.While distinct experiences that trigger the trauma response may lead to a prolonged state of psychological trauma, generally it is the before, during, and aftermath of the traumatic event that determines the impact and duration of a psychological trauma state and accompanying symptomatology. For example, high levels of social support before and after a trauma often mitigate symptoms and can increase speed of recovery. Low support or experiences of victim blaming after a trauma, such as when rape victims are asked what they were wearing or doing to incite the perpetrator, intensifies the severity of the traumatic impact and is often an impediment to recovery. Prior trauma exposure also matters; trauma is thought of as dose-specific, meaning that the greater the exposure to traumatic events, the greater the impact. Sometimes this can seem counterintuitive, as someone may have survived a trauma without presenting as symptomatic only to seemingly decompensate later on, often after an experience that does not appear to be as severe as what they have already lived through. This is not a sign of weakness, faking, or blowing things out of proportion. Trauma symptoms often have a delayed onset and might only present after some kind of triggering event. The symptoms and effects of trauma are discussed in the Trauma Symptoms and Effects tab.
Trauma Symptoms and Effects
Psychological trauma is frequently explained as “a normal response to abnormal circumstances.” A better way to describe it might be as “a normal response to overwhelming circumstances that shock, flood, and confuse the brain and body,” as the causes and perpetuation of trauma occur too frequently for “abnormal” to seem like the correct descriptor. The important point is that the body’s way of responding to these circumstances is normal given the context from which they arouse. Trauma symptoms and effects are not “crazy;” they are either adaptations that assisted survival during the traumatic experience or direct effects of those adaptations. They become troubling as symptoms when the situation is such that they are no longer needed for survival or when they interfere with one’s ability to function or to find pleasure and peace in the present moment. For example, being hypervigilant (on high alert) is adaptive if you are in combat because the increased sensitivity to potential dangers may be what saves the lives of you and your platoon. It becomes a problem when it persists into civilian or non-deployed life and impedes your ability to rest or enjoy social gatherings. Difficulty remembering the exact details of a sexual assault is not evidence of someone lying but rather an effect of the hormonal surge of the HPA axis activation, which effectively floods the hippocampus, the area of the brain where new explicit memories are formed; like any other sensitive instrument, the hippocampus does not function as usual when flooded. With sleep and careful lines of inquiry, trauma victims can often remember more details over time. Reactivation of the HPA axis, however, can happen when someone is simply reminded of the trauma through any of the senses. A smell, a sight, a sound can all reactivate the HPA axis, and when this happens, the hippocampus is flooded repeatedly. This often results in general difficulty concentrating, memory problems, and usually a temporary decline in grades for students.
The following table from the National Institutes of Health’s National Library of Medicine provides a more inclusive, though not exhaustive, example of the wide-range of reactions that may be experienced in the aftermath of trauma.
Immediate Emotional Reactions Numbness and detachment Anxiety or severe fear Guilt (including survivor guilt) Exhilaration as a result of surviving Anger Sadness Helplessness Feeling unreal; depersonalization (e.g., feeling as if you are watching yourself) Disorientation Feeling out of control Denial Constriction of feelings Feeling overwhelmed Delayed Emotional Reactions Irritability and/or hostility Depression Mood swings, instability Anxiety (e.g., phobia, generalized anxiety) Fear of trauma recurrence Grief reactions Shame Feelings of fragility and/or vulnerability Emotional detachment from anything that requires emotional reactions (e.g., significant and/or family relationships, conversations about self, discussion of traumatic events or reactions to them) Immediate Physical Reactions Nausea and/or gastrointestinal distress Sweating or shivering Faintness Muscle tremors or uncontrollable shaking Elevated heartbeat, respiration, and blood pressure Extreme fatigue or exhaustion Greater startle responses Depersonalization Delayed Physical Reactions Sleep disturbances, nightmares Somatization (e.g., increased focus on and worry about body aches and pains) Appetite and digestive changes Lowered resistance to colds and infection Persistent fatigue Elevated cortisol levels Hyperarousal Long-term health effects including heart, liver, autoimmune, and chronic obstructive pulmonary disease Immediate Cognitive Reactions Difficulty concentrating Rumination or racing thoughts (e.g., replaying the traumatic event over and over again) Distortion of time and space (e.g., traumatic event may be perceived as if it was happening in slow motion, or a few seconds can be perceived as minutes) Memory problems (e.g., not being able to recall important aspects of the trauma) Strong identification with victims Delayed Cognitive Reactions Intrusive memories or flashbacks Reactivation of previous traumatic events Self-blame Preoccupation with event Difficulty making decisions Magical thinking: belief that certain behaviors, including avoidant behavior, will protect against future trauma Belief that feelings or memories are dangerous Generalization of triggers (e.g., a person who experiences a home invasion during the daytime may avoid being alone during the day) Suicidal thinking Immediate Behavioral Reactions Startled reaction Restlessness Sleep and appetite disturbances Difficulty expressing oneself Argumentative behavior Increased use of alcohol, drugs, and tobacco Withdrawal and apathy Avoidant behaviors Delayed Behavioral Reactions Avoidance of event reminders Social relationship disturbances Decreased activity level Engagement in high-risk behaviors Increased use of alcohol and drugs Withdrawal Immediate Existential Reactions Intense use of prayer Restoration of faith in the goodness of others (e.g., receiving help from others) Loss of self-efficacy Despair about humanity, particularly if the event was intentional Immediate disruption of life assumptions (e.g., fairness, safety, goodness, predictability of life) Delayed Existential Reactions Questioning (e.g., “Why me?”) Increased cynicism, disillusionment Increased self-confidence (e.g., “If I can survive this, I can survive anything”) Loss of purpose Renewed faith Hopelessness Reestablishing priorities Redefining meaning and importance of life Reworking life’s assumptions to accommodate the trauma (e.g., taking a self-defense class to reestablish a sense of safety)
Copyright: NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
If you are experiencing symptoms from the above list, please know that you are not alone, you are not losing your mind, and you are worthy of receiving help and feeling better. Information about healing after trauma is available in the Healing from Trauma tab.
Counseling resources at USNA include MDC, Behavioral Health Clinic at NHCA, and Fleet and Family Services.
- Midshipmen Development Center (see How Do I Schedule an Appointment at MDC below)
- Naval Health Clinic Annapolis Behavioral Health Clinic
- Fleet and Family Services
If you have experienced sexual violence (rape, assault, unwanted touching, sexual exploitation, etc.) SAPR Victim Advocates can provide non-counseling support, resources, transportation to medical care, and information about reporting options:
Healing from Trauma
Though psychological trauma can have wide ranging effects and impact multiple domains of a person’s life, healing and recovery are indeed possible. Some people even experience “post-traumatic growth”--the realization of strength and resilience within oneself that one had not previously recognized. However, there is no shortcut to those experiences of growth and the road to healing is not experienced as a smooth, linear path. Trauma symptoms generally occur in a cyclical manner, with triggers like anniversaries or analogous situations reigniting symptoms or mood states that may have receded or been easily managed for a time. Often times thoughts or behaviors that were believed to have been “gotten over” come back, and generally there are frequent ups and downs in mood. This is the expected course of recovery and is not a failure or evidence of “moving backwards.” Because this is so difficult, however, people often wish they could completely forget about or “just move on” from what happened. This is completely understandable but not effective for healing, and, in fact, being told to “just move on” creates a greater impediment.
While nothing short of a time machine (*not currently available at MDC*) can undo what has happened in the past, one of the ways therapy works is by helping to integrate traumatic experiences into the overall narrative of a person’s history so they do not have as much power to intrude into or dominate the present and expectations of the future. This can be approached and achieved from multiple modalities, including:
- Mindfulness and trauma-focused cognitive behavioral techniques to manage symptoms and increase emotional regulation.
- Development of the therapeutic dyad (in other words, your relationship with your counselor) to build and explore trust, boundaries, self-worth, and healthy relationships.
- Abreaction/processing of traumatic memories
- Eye movement desensitization and reprocessing (EMDR)
- Creative expression
- Support groups
Along with some form psychotherapy, therapeutic body work (such as acupuncture or massage) and yoga or other forms of physical activity can be integral parts of the healing process. Depending on symptom severity and type, some people may benefit most from combining psychotherapy with a psychiatric medication.
Many fear that counseling or therapy for psychological trauma requires endlessly focusing on the traumatic experience and recounting it repeatedly in excruciating detail. This would actually be harmful and counterproductive to the healing process, as it is more likely to result in retraumatization rather than to support integration, particularly if one’s symptoms are overwhelming. The first phase of trauma therapy is centered around establishing safety--both physical and emotional--and generally focuses on symptom management techniques, psychoeducation about the impact of trauma, and establishing self-care. Some people may choose to end or suspend treatment if their symptoms have decreased without ever going deep into past trauma experiences and that is absolutely okay. At the MDC, you and your therapist would work together to establish the course and goals of treatment that will be most helpful to you, knowing that every individual brings a unique set of needs, strengths, and experiences. If you are not sure about whether this is a good time for you to engage in therapy, you are welcome to meet with a counselor to discuss your questions.
How do I schedule an appointment at MDC?
There are several ways to make an appointment at the MDC: submit an intake online, by telephone, or in person.
- Online: The easiest way to make an appointment with a dietitian or psychologist is to visit the MDC website. On the MDC homepage, click on "Request an Appointment" or contact the center form in the menu on the left. Follow the instructions, then fill out and submit the "Appointment Request." Once you submit, the MDC Office Manager will contact you to schedule an appointment.
- Telephone: You may contact the MDC at 410-293-4897 to schedule an appointment.
- In person: You may visit the MDC in person to ask any questions you may have prior to filling out the Intake Form.