Trauma

Understanding the Effects of Trauma

Psychological trauma is the lasting effect of an experience that felt harmful or life-threatening. It may follow one event, repeated events, or ongoing circumstances. It can change how you feel, behave, and function, even when other people cannot see what you are dealing with.^[1]

You might feel constantly on guard, pull away from people, or turn to something that briefly quiets your thoughts. Some responses ease with time. Others interfere with sleep, relationships, or daily responsibilities. Help can address those difficulties without requiring you to decide which diagnosis fits first.^[2][3]

Compulsive behavior means behavior you feel driven to repeat even when you want to stop. Trauma is one possible part of that pattern. It does not explain every harmful behavior or mean that addiction is inevitable.^[3]

If you are in immediate danger, call 911. For suicidal thoughts or an emotional crisis in the United States, call or text 988.^[2]

What Counts as Trauma?

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma through both the harmful experience and its lasting effects. Those effects can involve physical and mental health, relationships, emotions, and spiritual well-being. People can respond differently to similar experiences.^[1]

Events associated with PTSD include physical or sexual assault, abuse, serious accidents, disasters, and other dangerous experiences. A person may experience an event directly, witness it, or learn about trauma affecting someone close to them. A clinician considers the particular exposure and symptoms when assessing PTSD.^[2]

You do not need a PTSD diagnosis for your distress to deserve attention. Symptoms can interfere with daily life without meeting all the requirements for a disorder. An assessment can also consider depression, anxiety, substance use, and other possible explanations.^[3][2]

How Trauma Differs from PTSD

Post-traumatic stress disorder (PTSD) can involve unwanted memories or nightmares, avoidance of reminders, feeling persistently on guard, and changes in mood or beliefs. In adults, the required combination of symptoms lasts longer than one month, disrupts daily life, and is not better explained by medication, substances, or another illness.^[2]

That diagnostic time frame is not a reason to wait for help. If you feel unsafe or symptoms are severe, seek support now. Otherwise, a useful starting point is to describe what has changed, such as avoiding a once-familiar place, struggling to sleep, or using alcohol to get through the evening.^[2][4]

Childhood Trauma and Adverse Experiences

Adverse childhood experiences (ACEs) are potentially traumatic events occurring from birth through age 17. They include abuse, neglect, witnessing violence, and family circumstances that undermine safety or stability, such as a caregiver’s substance use problems or incarceration.^[5]

Those examples do not cover every harmful childhood experience. Food insecurity, homelessness, and unstable housing can also affect well-being. Repeated or prolonged stress can affect a child’s attention, learning, and developing stress response. Safe, stable relationships and supportive environments help protect children.^[5]

Research links childhood adversity with later health and substance use problems, but a history of adversity does not predict one person’s future. The circumstances surrounding an experience, available support, and other influences matter. An ACE score cannot explain every current symptom or replace an individual assessment.^[5][3]

A 2019 review illustrates both the connection and its limits. Researchers combined 19 reviews of childhood sexual abuse, covering 559 studies and more than four million participants before accounting for overlap between samples. Abuse was associated with 26 of 28 later health and social outcomes examined, including PTSD and substance misuse.^[6]

The quality of evidence varied. Many studies relied on people recalling past experiences, and other adversities could help explain the associations. These findings show why support matters. They do not establish that abuse alone caused every later problem or that a particular outcome is unavoidable.^[6]

What Complex PTSD Means

Complex PTSD includes PTSD symptoms plus persistent difficulties managing emotions, a deeply negative view of oneself, and difficulties with relationships. The World Health Organization’s diagnostic system, ICD-11, recognizes it separately. The DSM-5 framework commonly used in the United States does not list a separate complex PTSD diagnosis.^[7]

Complex PTSD is often discussed after repeated or prolonged trauma, but the ICD-11 diagnosis depends on symptoms rather than requiring one particular history. Labels also overlap across diagnostic systems. Tell a clinician about your experiences and difficulties rather than trying to settle the label by yourself.^[7]

In guidance for the VA’s National Center for PTSD, psychologist Sadie E. Larsen explains that existing PTSD treatments can help people with complex PTSD. That leaves room for individual needs, including work on managing emotions or relationships. A complex history does not mean that effective care is out of reach.^[8]

How Trauma Can Affect Daily Life

Trauma responses can affect thoughts, feelings, bodily sensations, and behavior. The patterns below help explain experiences people describe. They are not a diagnostic checklist, and several can happen together.^[3][2]

Feeling on Guard and Avoiding Reminders

Hyperarousal means feeling unusually alert and ready for danger. You might startle easily, struggle to concentrate, feel tense, or have trouble sleeping. A reminder can bring a racing heart or sweating even when the original danger has passed.^[2]

A trigger is a reminder that brings up distress connected with an experience. It might be a sound, smell, place, conversation, or bodily feeling. For example, someone may avoid driving after a serious crash. Avoiding more and more safe situations can eventually make ordinary life harder.^[3][9]

There is an important difference between a safe reminder and an ongoing threat. Treatment should not ask you to remain in abuse or enter a dangerous situation. When danger continues, care needs to address the situation as well as symptoms.^[2][9]

Numbness, Low Mood, and Disconnection

You may feel cut off from people, lose interest in activities, or struggle to feel happiness. Guilt, shame, and self-blame can also occur. Because depression and PTSD can overlap, an assessment should consider the whole pattern rather than assuming all low mood comes from trauma.^[2]

Dissociation describes a sense of disconnection from yourself or what is happening. Some people feel as though they are watching an experience from outside their body. Others struggle to recall parts of an event. Describe these experiences to a clinician, including any substance use, so they can assess possible causes and safety concerns.^[3][2]

Dissociation is not required for complex PTSD, and not everyone who experiences trauma has it. Feeling numb also does not mean that the experience did not matter or that you are responding incorrectly.^[7][3]

Anger and Risky Behavior

Trauma-related distress can involve irritability, angry outbursts, impulsive decisions, or behavior that puts someone at risk. These reactions alone do not establish PTSD. They may need attention alongside sleep, mood, substance use, and relationship concerns.^[2][3]

Understanding a reaction does not excuse hurting another person. Anger management skills may be one part of a plan, while assessment addresses the broader problem. Safety and accountability still matter, including when the person causing harm has also experienced trauma.^[3]

When Coping with Trauma Starts Causing Harm

Some behaviors offer immediate relief from distress. A person might avoid reminders, overwork, eat compulsively, or use alcohol or drugs to feel less overwhelmed. SAMHSA describes these as possible ways of coping with traumatic stress, not proof that trauma caused every instance of the behavior.^[3]

Consider this illustrative pattern: after a frightening event, someone avoids a familiar social gathering because it brings up distress. Staying home feels easier that evening. If avoidance spreads to other safe activities, the person’s world becomes smaller. Therapy can help examine that pattern and plan manageable changes.^[3][9]

The same explanation should not be applied automatically to eating, spending, sexual behavior, gaming, or phone use. Similar-looking behavior can have different causes. A clinician needs to understand what happens, how often, what you feel driven to do, and what effect it has on your life.^[3]

For a first appointment, it may help to note:

• What happened just before the urge or behavior.
• What you felt in your body and what was going through your mind.
• What changed during the behavior, such as feeling distracted or less tense.
• What happened afterward, including costs, conflict, shame, or sleep problems.
• What you would like to be able to do differently.

These observations are a conversation aid, not a self-diagnosis. If eating is the main concern, an eating disorder assessment may be appropriate. If substances are involved, say so directly. Care can address both the distress and the behavior causing harm.^[3][4]

Trauma in Children and Teenagers

Children may show distress through behavior before they can explain it. Younger children may become clingy, have tantrums, struggle to sleep, or return to behaviors they had outgrown. Older children and teenagers may withdraw, become angry, struggle at school, or use substances.^[10]

These reactions do not automatically mean PTSD. Notice changes from the child’s usual behavior and how much they interfere with daily life. Seek help sooner for severe symptoms or safety concerns. NIMH advises contacting a provider when reactions persist, including new distressing symptoms continuing for more than a few weeks.^[10]

How Caregivers Can Help

Start with safety and basic needs. Keep familiar routines where possible, offer calm reassurance, and allow the child to talk, draw, write, or remain quiet. Avoid demanding a detailed account, telling them to be tough, or making promises you cannot guarantee.^[10]

Small choices, such as choosing clothes or a meal, can help a child feel some control. Strong feelings and acting out still need patient support. A pediatrician or clinician experienced in childhood trauma can help assess the response and recommend care. Caregivers may also need support for their own reactions.^[10]

If a Child Discloses Sexual Abuse

Stay as calm as you can. Tell the child you believe them, that the abuse was not their fault, and that telling you was the right thing to do. Take steps to protect them from the person who harmed them. Do not promise secrecy, because protecting the child may require involving other people.^[11]

A child may tell only part of the story or later take back what they said. The National Child Traumatic Stress Network explains that fear, pressure, or mixed feelings can affect disclosure. Taking back a disclosure should not automatically be treated as proof that the original account was false.^[11]

Arrange appropriate medical and mental health care and contact local authorities about suspected abuse. These principles also apply when suspected sexual abuse involved online contact. Call 911 for immediate danger.^[11]

For support and guidance on next steps, call Childhelp at 800-422-4453, or text “GO” to 800-422-4453. Message and data rates may apply. Childhelp provides support and referrals. It is not an emergency service or the line for making an official child abuse report.^[12][13]

Can Trauma and Addiction Be Treated Together?

Yes. PTSD and substance use problems can be treated at the same time. In published commentary from the VA’s National Center for PTSD, clinical psychologist Ron Acierno explains that both can receive concurrent treatment. That means you do not automatically have to finish one course of care before addressing the other.^[4]

Concurrent care can involve two coordinated therapies with different clinicians. Integrated treatment addresses both problems within one treatment approach. Ask a provider which they offer and how the clinicians will communicate. Our dual diagnosis guide explains care for mental health and substance use conditions together.^[4]

Alcohol or drugs may initially seem to help with sleep, social discomfort, or unwanted thoughts. They can also worsen sleep, irritability, judgment, and daily functioning. A substance use disorder is the clinical term for addiction involving alcohol or drugs. Both concerns deserve assessment when they occur together.^[4]

What a Combined Care Plan Can Include

A plan may address immediate safety, withdrawal risk, sleep, cravings, traumatic memories, and avoided activities. If abuse or danger continues, help with that situation belongs alongside symptom treatment. Care should reflect your circumstances rather than a fixed sequence imposed on everyone.^[2][4][14]

Substance use care may include several approaches:

• Motivational enhancement helps you explore your reasons for change and readiness for treatment.
• Cognitive behavioral therapy helps you recognize situations linked to substance use and practice different responses.
• Contingency management uses structured rewards for agreed treatment goals, such as attending sessions.
• Relapse prevention helps you prepare for situations that could lead to renewed use.
• Medication may help with particular substance use disorders, cravings, or withdrawal. The choice depends on the substance and your health needs.^[4]

One integrated approach is COPE, which combines prolonged exposure therapy for PTSD with substance use treatment. Studies in veterans and civilians have found improvement in PTSD symptoms. Mutual-support groups can also be helpful, but they do not replace treatment specifically addressing PTSD.^[4]

Do not abruptly stop regular heavy drinking without medical guidance. Alcohol withdrawal can become life-threatening. Benzodiazepines, including medicines such as alprazolam, also require a clinician-guided plan when reducing or stopping ongoing use. Treating trauma and substance use together does not mean ignoring medical withdrawal care.^[14][15]

Trauma-Informed Care and Trauma Treatment

Trauma-informed care describes how services are provided. It emphasizes safety, trust, choice, collaboration, and awareness of trauma’s effects. A program might explain a procedure before it happens, ask permission, and work with you to reduce avoidable distress.^[16]

Trauma-focused treatment addresses the experience and its effects directly. For PTSD, specific therapies have research support. A service describing itself as trauma-informed does not by itself tell you which treatment it provides or what training its clinicians have.^[17][18]

Understanding the Kind of Help Being Offered

Type of help	What it does	A question to ask
Trauma-informed care	Organizes services around safety, trust, and participation. It can apply across settings.[16]	“How will you explain choices and respond if something feels overwhelming?”
Trauma-focused therapy	Uses a specific treatment to work on traumatic memories, meanings, or avoidance.[17]	“Which therapy do you offer, and what training do you have in it?”
Concurrent or integrated care	Addresses PTSD and substance use problems during the same period.[4]	“Who will treat each concern, and how will the plan fit together?”
Peer or mutual support	Offers connection and support from others. It does not replace PTSD treatment.[4]	“How could this support fit alongside professional care?”

What Trauma Therapy Can Involve

Care begins with understanding your symptoms, goals, and circumstances. For PTSD, the VA identifies trauma-focused psychotherapy as the most effective type of treatment. Cognitive processing therapy, prolonged exposure, and EMDR are leading options. Having experienced trauma does not mean that every person needs the same treatment.^[17][2]

You and the provider can discuss what you would do in sessions, practice between appointments, possible discomfort, and alternatives. These differences help you choose an approach you are willing and able to try. Our PTSD guide explains treatment choices in more detail.^[19]

Cognitive Processing Therapy

Cognitive processing therapy (CPT) helps you examine beliefs that developed around trauma, such as blaming yourself or believing no one can be trusted. You learn to consider the evidence and develop a more balanced understanding of what happened and what it means now.^[20]

Sessions may address safety, trust, control, self-esteem, and relationships. Worksheets and practice between sessions are common. A detailed written account of the event is optional rather than required in every case. VA describes a usual course of 12 weekly sessions, with individual or group formats.^[20]

Prolonged Exposure

Prolonged exposure (PE) helps you gradually approach memories, emotions, and safe situations you have been avoiding. You and the therapist make a plan. For example, practice might involve returning in manageable steps to a safe place associated with a frightening experience.^[9]

PE also involves talking about the trauma in detail and practice between sessions, which may include listening to a session recording. VA describes 8 to 15 weekly sessions lasting 60 to 90 minutes. Temporary discomfort can occur. Tell the therapist if it feels unmanageable so you can discuss the plan.^[9]

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) involves bringing a traumatic memory to mind while attending to alternating movements or sounds. Treatment includes preparation and coping skills before that work. You usually do not have to describe every detail aloud.^[21]

EMDR is generally individual therapy without routine homework. VA describes a typical course of about three months of weekly, 50-to-90-minute sessions. These are usual formats, not a deadline for recovery or a guarantee about how much care you will need.^[21]

A 2017 review of eight randomized trials, with 295 participants, found promising results for post-traumatic and anxiety symptoms.^[22] Although framed around children and adolescents, it included one young-adult sample. Comparisons involved different control conditions, including delayed treatment and other therapies.^[22]

The small studies and inconsistent results limit firm conclusions. Some findings lost statistical significance when individual studies were removed, and the review did not establish that EMDR was superior or equivalent to CBT for young people. Ask a child’s clinician about age-appropriate options and the evidence for their needs.^[22]

Medication

Medication can be an option for PTSD, including when someone prefers it or trauma-focused therapy is not available or feasible. Sertraline and paroxetine are FDA-approved for PTSD. Venlafaxine also has guideline support but is used off-label, meaning it does not have that specific FDA approval.^[23]

A prescriber should discuss expected benefits, side effects, other health conditions, and how progress will be monitored. Medication and psychotherapy may both be part of someone’s care, but combining them is not automatically proven better for PTSD. Do not change or stop prescribed medication without discussing a plan.^[23][2]

Finding a Trauma Therapist Near You or Online

Look beyond the phrase “trauma specialist.” Ask which treatments the clinician provides, what training they have, and whether they work with your age group and particular concerns. If substances or another harmful behavior are involved, ask how those concerns will be assessed and treated too.^[18][4]

Your primary care provider can be a starting point for referrals. You can also contact mental health clinics, your insurer’s provider directory, or local professional organizations. Ask about cost, insurance participation, reduced-fee options, and waiting times before assuming a listed provider is available or affordable.^[18]

For online therapy, check that the clinician can treat you in the state where you will be during sessions. Discuss privacy at home, a reliable connection, how materials are shared, and what happens if the connection fails or you need urgent help.^[24]

Research supports delivery of some PTSD treatments, including CPT and PE, by video. Much of that evidence comes from studies with veterans. It does not establish that every app, text-based service, or online platform provides equivalent trauma treatment.^[24]

You can also ask how much detail is needed at the first appointment and how the provider will help you make treatment decisions. A clear explanation of the process can help you decide whether the service fits your needs.^[19][16]

Recovery and Support from Loved Ones

Recovery is not measured by whether you never think about the experience again. Work with your clinician on changes that matter in daily life, such as sleeping more consistently, returning to safe activities, feeling less self-blame, or responding differently to reminders.^[2][20][9]

Symptoms often improve gradually. Some people recover within months, while others need longer or a different treatment plan. A therapy’s usual session count is not a recovery deadline. Ongoing danger, other health conditions, and practical barriers can affect what support you need.^[2][17]

If progress is limited or treatment feels unmanageable, tell the provider. Discuss what has changed, what has not, and whether the approach still fits. NIMH recommends discussing symptoms that are not improving after six to eight weeks. Seek help sooner for worsening symptoms or urgent safety concerns.^[2]

Loved ones can listen, offer practical help, and avoid pressing for every detail. You might offer to help find a clinician or accompany the person to an appointment. Let them have a say in the support they receive, and avoid promising a particular outcome.^[2][16]

Taking the Next Step

If trauma-related distress is affecting your life, an appointment can start with what is difficult now. You can describe sleep problems, avoidance, relationship changes, or a behavior that feels hard to control. You do not have to arrive with a diagnosis or a complete account of the experience.^[2][19]

Our mental health guide can help you explore related concerns. If alcohol or drugs are part of the picture, seek care that addresses both concerns. Effective PTSD and substance use treatments can be delivered during the same period.^[4]

If you are struggling with suicidal thoughts or an emotional crisis in the United States, call or text 988. If there is immediate danger or a life-threatening emergency, call 911.^[2]

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