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The Canadian Association for Mental Health describes traumatic events as:

• a recent, single traumatic event (e.g., car crash, violent assault)
• a single traumatic event that occurred in the past (e.g., a sexual assault, the death of a spouse or child, an accident, living through a natural disaster or a war)
• a long-term, chronic pattern (e.g., ongoing childhood neglect, sexual or physical abuse).

During traumatic events, a person perceives that they or someone who they love will be seriously injured or will die as a result of the event. 

Trauma Responses

During a traumatic event the person will have one of four immediate trauma responses:

Fight, to become aggressive toward the perpetrator,

Flight, to try to run or escape from the perpetrator.

When experiencing fight or flight, a person may feel like they have had an explosion of awareness or sensation. They may have dilated pupils, pale or flushed skin, increased heart rate and trembling muscles.

Freeze, to become incapable of movement or conscious thought. When in the freeze state, a person may feel disoriented, and find it hard to perceive the world around them. They may feel numb, become tense and have irregular breathing, and be unable to speak.

Fawn, to try to change the actions of the perpetrator by trying to appease them. Fawn is most common to form as a response in children when the initial traumatic events are ongoing, and the abuser is a parent or authority figure. There is not a lot of research about the way it feels to have a fawn response.

After experiencing a trauma, the victim can experience a flashback of their original traumatic response, in response to a trigger. A trigger can be anything that reminds the victim of the trauma, that can be a taste, smell, sight, touch or sound. The flashback response affects the person’s system just as the original trauma did, and they may fight, flight, freeze or fawn. People may or may not know that they are experiencing a trigger, therefore they may or may not have the tools to manage them effectively. If a person is unaware, they may end up feeling ashamed or embarrassed by acting in a seemingly strange way, when there is no clear or perceivable danger present. A person experiencing a flashback may try to escape, become aggressive, freeze, or even have a panic attack.

In the past, surviving a traumatic event was often seen as the successful end of this experience. We are now beginning to understand that experiencing a traumatic event can result in long lasting changes.  

New research is showing that the trauma actually changes the brain. In the same way that a physical injury causes lasting changes to the body, trauma causes lasting changes to the brain.

When a person has been injured by trauma, they are likely to experience the following mental health consequences for many years afterwards and if left unsupported, indefinitely. They may experience an inability to:

• feel safe, even when there is no danger;
• see themselves, to see that they have value or individual worth;
• regulate emotions, so they may not have the ability to control how, when or where they express their feelings;
• to engage in healthy positive relationships.

The person can also be left constantly feeling:

• Ashamed or to blame for everything;
• Like they cannot control their lives;
• Like they cannot do things for themselves;
• Like they are always afraid.

Traumatic events and resulting short- and long-term trauma responses can occur at any point in a person’s life. Trauma that happens to children while their brain is developing, has a magnified and significant impact on adult mental and physical health and adult life outcomes. Trauma repeated over time also has a magnified effect on the brain and/or physical health outcomes – this is called complex trauma. There are no rules regarding how trauma will impact a person, it is very individual and dependent on many variables. 

Learn More

To learn more about defining trauma and the lasting effecs of trauma https://www.traumainformedcare.chcs.org/what-is-trauma/

• “ACEs” stands for Adverse Childhood Experiences.

A list of the prevalent types of adverse experiences that people experience as children was created by the Center for Disease Control and Prevention (CDC) in the United States and compiled into the ACEs questionnaire. The questionnaire is a tool to assess how many ACEs a person had and can be an excellent way to understand negative health, behavior and life outcomes in adulthood, for those who are struggling.  

• The ACEs work has proven that the more childhood ACEs a person has experienced, the more likely they are to have chronic health problems in adulthood. This risk of health problems strongly correlates with the number of ACEs increasing.
• Increased risk for mental health conditions such as substance abuse disorders, clinical depression and anxiety and physical health conditions such as diabetes, heart disease and obesity are all correlated with increased ACEs.

 (Click to see the ACEs Questionnaire which identifies the types of traumas)  

Over time this list has been expanded to look at experiences that can happen outside the home. This includes traumatic events that can happen in the community and in the environment such as racism or systemic racism. Expanding our understanding of traumatic events allows for acknowledging and witnessing the trauma that can occur at different levels, in communities, societies and in the environment.  

Why is ACE research important? “ACE research has uncovered a staggering connection between childhood trauma and chronic disease and the social/emotional struggles that people develop as adults. Trauma can have a resounding effect throughout a person’s life and is at the root of many adult health and wellness conditions.”  

https://www.cdc.gov/vitalsigns/aces/index.html

Learn More

• To find the ACEs questionnaire visit World Health Organization. Adverse Childhood Experiences International Questionnaire. In Adverse Childhood Experiences International Questionnaire (ACE-IQ). [website]: Geneva: WHO, 2018. https://www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_experiences/en/
• For the more about the origianl ACEs questionnaire and research https://acestoohigh.com/got-your-ace-score/ and https://www.cdc.gov/violenceprevention/aces/index.html

• The more ACEs people experienced as children, and the more repeatedly, the greater their risk of having significantly elevated levels of fear, anxiety or depression. Experiencing this can be so intense and strong that it feels unbearable. As an autonomic response, this causes them to search for anything to change the chemicals in their brain and make these feelings stop.
• Consuming food, alcohol, tobacco, methamphetamines and other substances is a common way for people to numb this type of pain.
• There is a strong correlation between higher number of traumas experienced and higher or more excessive the consumption of these substances.
• In the absence of these substances, the injuries to the brain that were caused by the trauma in childhood, left people in so much discomfort that they could not live peacefully or comfortably.
• Consumption acts as a double-edged sword: while consuming, the person can feel great relief from their intense negative emotion and pain, however, when they stop and the feelings of suffering return, they are even more intolerable and magnified, in contrast to the experience of the relief.

“When toxic stress response occurs continually, or is triggered by multiple sources, it can have a cumulative toll on an individual’s physical and mental health—for a lifetime.”

Toxic Stress

 When traumatic events are ongoing, this is known as toxic stress and causes a toxic stress response.  So, from the ACEs research, we know that traumatic life events, especially experienced during childhood, correlate to many types of negative adult outcomes, there is new research that explains the various ways that long term exposure to these traumas wear and tear on the body and mind.

Toxic stress research examines the physiological roots and causes for the negative outcomes found in ACEs research.

Toxic stress is the repeated experience of a stressor, it is not always a traumatic event. Instead, it could be the experience of repeated stress resulting from for example, poverty, which can cause prolonged insecurity of food, water, housing or income.

Toxic stress response, is an excessive or prolonged activation of the stress response systems in the body and brain.  Because the stress system is activated for such a prolonged time (because of the prolonged exposure to significant stress) toxic stress response has a damaging effect on learning, behaviour, and physical health across the lifespan.

For example, when a person experiences perceived threat, the body increases heart rate increases blood pressure and produces stress hormones- such as cortisol.  These reactions can even trigger the “Fight, Flight, Freeze or Fawn”(see definition above) response in the person.  Toxic Stress Response happens when there are repeated or prolonged exposures to threatening experiences.

Learn More

• To learn more about Toxic Stress vist the website of Harvard’s Center on the Developing Child. This guide to toxic stress defines it, explains the causes as well as strategies for preventing and addressing it. https://developingchild.harvard.edu/guide/a-guide-to-toxic-stress/

The frequent and prolonged nature of toxic stress cause wear and tear on the body — just as it would damage a car if the engine was constantly revving, even when parked in the driveway.

Toxic stress responses cause the body to release stronger and more frequent surges of adrenaline.  Toxic stress or complex trauma can increase inflammation in the body and early exposure to trauma disrupts the development of the entire inflammatory system.  Inflammation is the body’s natural response to threat or possible disease. When the body is experiencing the physical response to toxic stress or trauma, the body may produce inflammation as an attempt to protect itself. If this happens repeatedly, constant inflammation has been associated with a broad range of illnesses, including many long-term chronic health problems. (put a link to inflammatory diseases)

Intense physical reactions to toxic stress also physically wear and tear on the organs in the body and make people more prone to a number of different health conditions, including heart attack, stroke, obesity, diabetes, autoimmune diseases, and cancer.

Toxic stress immediately interrupts all of the necessary processes of the brain required for learning. This is true at any age. However, when it happens to children, they miss the opportunity to build positive healthy learning strategies and the implication of this follows them into adolescence and then adulthood. Being able to take in new information and process it, as well as remembering facts and pulling them from memory banks when needed, becomes challenging or even impossible depending on the level of toxic stress response the individual is experiencing. This negative effect on thinking and learning is compounded by impulsive behaviour and the inability to peacefully sit still and focus. During toxic stress response, the mind is consumed with reacting to the toxic stress and, survival may depend on that. So other functions of the brain are shut down to give the mind the required energy and resources to deal with the threat.

Learn More

• To learn more about Toxic Stress vist the website of Harvard’s Center on the Developing Child. This guide to toxic stress defines it, explains the causes as well as strategies for preventing and addressing it. https://developingchild.harvard.edu/guide/a-guide-to-toxic-stress/

Research also indicates that supportive, responsive relationships with caring adults as early in life as possible can prevent or reverse the damaging effects of toxic stress response.

Survivors of trauma or ACEs often benefit greatly from treatment approaches that are “trauma-informed.”

 Trauma-informed care refers to therapeutic approaches that validate and are tailored to the unique experience of a person coping with the lasting effects of toxic stress responses and trauma.

Those working under a trauma-informed approach understand the symptoms of trauma to be coping strategies that have developed in reaction to a traumatic experience.

They try to non-judgmentally, recognize that a person may have behavioural, emotional or physical adaptations that have developed in specific response to overwhelming stressors.

As support professionals, the goal is to soften the approach we take with people. It is important to keep in mind that people who have grown up with toxic stress or trauma can sometimes be difficult to deal with, they can be volatile or withdrawn. They can appear to behave irresponsibly or struggle with addiction. But if we consider the root of these issues, it becomes clear that whatever can be done to offer structure, ideas to help in planning and to reduce stress, as well as to increase access to positive experiences, will begin a healing process, even if only in a small way. 

Changing Approaches

Instead of saying: “What’s wrong with you?” say, “What happened to you?”

Validate the experience and tailor the approach, so that it is unique to the experience of each person.

Understand the symptoms of trauma to be coping strategies that have developed in reaction to a traumatic experience.

Non-judgmentally recognize that a person may have developed behavioural, emotional or physical adaptations in specific response to overwhelming stressors. Moving away from these, if they are damaging, would require replacing them with another protective mechanism, strategy, or support.

Learn More

To learn more about taking a Trauma informed appraoch visit the Trauma-Informed care implementation resource center to find out what Trauma-Informed care is and how to implement it https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/