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How Trauma Affects Your Brain

How Trauma Affects Your Brain

When a person experiences a trauma, the brain reacts in several different ways which can affect the life of that person moving forward.  Just as a physical injury from a traumatic accident can affect your body at the site of the injury for years to come, your mind can be also be impacted for years after a traumatic incident, whether due to a physical or psychological trauma.

Trauma causes an overwhelming feeling of helplessness and fear of potential death, serious injury, serious loss (death of someone else), pain, or entrapment. These overwhelming feelings and fear cause the brain to react in ways to try and protect itself.  Traumatic experiences can overwhelm the brain’s ability to cope using normal methods of stress relief, and thus alternative coping methods have to be developed, which can cause disruption in the lives of people trying to recover from trauma.

In order to understand why people may have certain reactions to traumatic events, it is important to understand what trauma really is and the range of ways that the brain reacts to the trauma.

Defining Traumatic Experiences

Trauma can occur in response to major onetime events such as natural disasters, a car accident, witnessing or being a victim of violence or a crime such as sexual or physical assault. It may also occur in response to chronic or repetitive experiences such as child abuse or neglect, military combat, neighborhood violence and crime, wartime atrocities, physically or emotionally abusive relationships, and long-term deprivation.

The most important thing to understand about trauma is that it is based on a person’s subjective experience. Two people could experience a similar  incident but react in very different ways.  The objective facts of the experience do not always cause the same reaction in everybody, so it’s important to understand that it is the individual that defines whether the experience was traumatic or not.

Whether a person perceives an incident as being traumatic or not often has to do with how much danger they were in during the event, whether loss of life occurred or could have occurred, whether it was a one-time incident or an ongoing experience, whether they have access to reasonable safety measures, how much support they have from friends and family, and whether they are validated or shamed for their experiences.

What are the Symptoms of Trauma

When a person has experienced a trauma, such as a sexual assault, a home invasion, or a significant loss, they may experience a wide range of symptoms in reaction to the trauma.  Remember that these are NORMAL reactions to ABNORMAL situations. These symptoms may include:

  • Emotional distress
  • Distressful and intrusive memories
  • Constant feeling of being in danger
  • Sleep disturbances
  • Fatigue
  • Emotional numbing or disconnection from others
  • Inability to trust others
  • Anger
  • Hyper-arousal (constant worry or checking behaviors)
  • Physical reactions (headaches, muscle aches)
  • Anxiety
  • Uncontrollable fear
  • Confusion about timing or order of events
  • Feelings of guilt, shame, or self-blame
  • Difficulty concentrating

These are all indications that the brain is attempting to either prevent further trauma from happening again by keeping you in a constant state or arousal or protecting you from potential emotional distress by suppressing upsetting or painful emotions. It is also normal to experience an increase in these symptoms in reaction to another stressors that arises or surrounding a stressful time such as an anniversary or other significant date related to the trauma.

The Effects of Trauma on the Brain

When you have experienced trauma, your brain goes into a state of hyper-arousal, basically because your fight or flight response has been triggered and your brain reacts by trying to prepare you for potential danger.  That potential for danger reverberates through your entire body, including your limbic system and your autonomic nervous system.

Your limbic system includes the hypothalamus, the hippocampus, and the amygdala, as well as other areas of the brain, and has to do with processing emotions and forming memories. The hypothalamus is responsible for regulating many bodily functions, including your arousal to emotional circumstances and the functioning of your autonomic nervous system (blood pressure, breathing rate, sweating, heart-rate). The hippocampus helps you convert what is happening in the present moment into long-term memories. The amygdala helps to control reactions to stimuli, such as aggression and fear.

When trauma triggers a stress reaction in your limbic system, it can feel overwhelming because your brain is not used to dealing with such a high level of stress, and so its functions can be negatively affected.  This reaction in the brain accounts for why some trauma survivors have difficulty recalling the correct order of timing or certain details of the event.

It’s not because they are lying or exaggerating, which some trauma survivors are accused of when their memory is impaired due to a trauma. It is because the part of their limbic system responsible for creating and storing memories was flooded by stress and the entire system was reacting in ways to focus solely on surviving the traumatic situation. Unfortunately, this memory impairment in reaction to trauma is often used against survivors to try and minimize what happened to them or cause doubt in their account of the events.

The truth is that when traumatic events happen, your memory can get mixed up and certain events may not be organized correctly in your brain’s memory filing system, so to speak. This doesn’t mean that a survivor’s perception of events is invalid, it just means that their memory may have been damaged during the traumatic event, which can cause further confusion, shame, or embarrassment about the traumatic event.

Your autonomic nervous system includes the sympathetic and parasympathetic nervous system, and it is responsible for alternately preparing you to handle a dangerous situation, and then calming you back down when the danger is over.

During a stressful event, the nervous system releases the stress hormone cortisol to give you a boost of energy to react to the dangerous situation. Normally, when a stressful even passes, the nervous system will then regulate your hormonal output and bring your back to your normal homeostasis.  However, when a major trauma overwhelms your system in reaction to the perceived danger you are in that flood of stress hormones might remained heightened, leaving you feeling stuck in a constant state of hyper-arousal.

This state of hyper-arousal gets exacerbated when you are being constantly flooded with stressors, such as being stuck in an abusive relationship (where you feel you’re always walking on eggshells), or if you experience multiple triggers back to back (such as losing several loved ones in a short period of time).  This relentless stress to your system causes your brain to react in a way that can feel like you are constantly on the look-out for the next potential danger or loss, and can make it hard to get back to a period of relative emotional stability.

When to Seek Treatment for Trauma

Trauma recovery can take time, and there is no hard and fast time-line for how long it takes for each individual. However, if you have been experiencing the symptoms described above for more than 3 months after the initial trauma, you may need to seek out professional help. Remember that it is normal to have these emotional reactions to trauma, but talking with someone in a safe environment can help you to process your fears and the emotional damage that you have endured.

If you have people who you know are supportive and understanding, it can be helpful to talk to those who care about you and explain what you are going through. It can be hard to reach out for help, but it is so helpful when you feel supported by those who truly care about you. Talking about trauma can be hard, so turning to a professional therapist or a support group for people who have been through similar traumas can be incredibly healing and help you get to the next level in your recovery.

If you are experiencing any of the following after a trauma, please consider seeking out a professional with experience in trauma recovery:

  • Severe fear, anxiety, or depression
  • Trouble with functioning at home or work
  • Disturbing nightmares or flashbacks
  • Avoiding more and more things to prevent distress
  • Unable to talk about the trauma with caring friends or family
  • Feeling overwhelmed or frozen in life and unable to move forward
  • Abusing substances to feel relief from emotional distress

Trauma recovery involves processing memories related to the trauma and the feelings that were triggered during and after the event.  An informed trauma therapist can help you to face feelings and memories that have caused you distress and discharge some of the emotional energy or anger you may feel related to the traumatic event.  You may also learn new ways to cope with overwhelming feelings and learn how to re-build your ability to assess safety and build trusting relationships.

Trauma disrupts your body and your brain’s ability to feel safe and at ease. Your nervous system may feel like it is stuck in overdrive and you can’t calm down or feel balanced. In order to dispel that excess energy and feel safe again, you may have to go through some uncomfortable things, like talking about painful memories. Don’t push yourself to do things you’re not ready for, but recognize that healing takes time and you don’t have to go through it alone.

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For more on trauma recovery, see this post on 5 Things Needed for Trauma Recovery.

When is the Right Time for Hospice Care?

When is the Right Time for Hospice Care?

I spent 4 years working as a hospice social worker, which was an invaluable experience for me.  I spent most of my time with hospice care in long-term care facilities.  Hospice patients can receive care in any setting that they reside in.  Many hospice patients receive hospice services in their homes, others at in-patient hospice facilities, and still others in assisted living or nursing care facilities.  I was fortunate enough to work with a wonderful network of facilities that by and large took very good care of their patients.  This is unfortunately not always the case, and because the goal of hospice care is to ensure the comfort of the patient, hospice services can be a wonderful addition to the care of the patient, but hospice care is not for everyone.  There are some important considerations to think about if you have a family member or loved one that may benefit from hospice services.  Overall you want to make sure that you know what hospice care is all about, who qualifies for hospice services, and when the right time is to ask about hospice services.

What Is Hospice For?

First and foremost, hospice care is about ensuring the comfort of a patient who has a terminally ill condition.  Hospice is not intended to provide aggressive treatment, and thus if someone has a medical condition that they are pursuing treatment for, such as chemotherapy or other cancer treatments, they wouldn’t be appropriate for hospice services while they are in treatment.  Hospice comes in to help ensure that patients who are approaching death but who are no longer pursuing treatments for their conditions are comfortable and are able to pass away peacefully under the conditions that are closest to the wishes of the patient and family.  A nurse will regularly evaluate the patient’s needs and condition, a doctor will oversee the care of the patient, and the hospice care organization will provide most of the patient’s care and supplies needed.  This means that a hospice care team will typically provide any pain medications needed to keep the patient comfortable, medical equipment like hospital beds, and hygiene care supplies like shower seats or incontinence supplies.  They can also provide hygiene related care, such as CNA assistance with bathing and changing clothing.  A hospice team will also usually include a social worker to support the patient and family emotionally and help advocate for the patient’s needs, and a chaplain to provide spiritual support to the family if desired.  These services are provided in addition to care that the patient may already be receiving from family members or the staff in an inpatient or nursing care facility.  There is a wide range of options for care, based on how much support a patient has and what their own capabilities are as they begin to decline.

Who Pays for Hospice?

Hospice services are primarily funded by Medicare, which means that most patients who need hospice care qualify under Medicare’s definitions.  Many community-based hospices have other donors and funders who help to fill in the gaps for funding needs.  In order to qualify for hospice services, a doctor needs to certify that the patient’s prognosis for a terminal condition is 6 months or less.  Typically, this will be done by the doctor at the hospice organization based on their evaluation of the patient’s condition and prognosis.  Hospice services can generally step in and provide support to the patient and family once the patient and family have decided to stop aggressive treatment of their terminal condition and focus on comfort care.

It is important to note that Medicare and Medicaid are different and pay for different things when it comes to end of life care.  Medicare is not the funder when it comes to nursing home care.  For example, if a person is no longer able to be cared for in their own home, and they need to go into a nursing care facility due to their level of care needs, Medicare does NOT pay for this.  Each patient is responsible for paying their own room and board expenses in a nursing care facility.  This is why there is a HUGE disparity in the type of accommodations people receive in nursing care or assisted living facilities.  Just like with private housing, you will be able to get into a much nicer facility if you have the money to pay for it, and nursing home care can cost upwards of $10,000 a month or more.  However, Medicaid DOES pay for nursing home services, but you must qualify for Medicaid in order to receive that benefit.  This means that you will either be indigent, or you will have already spent all or most of your money on your own care before Medicaid will kick in and start paying for nursing home care.  Again though, just because Medicaid is paying for the nursing home care, doesn’t mean that you can go to any nursing care facility you want.  Most of those really nice facilities that cost $10,000 + a month are going to be private facilities that do not accept Medicaid.  Therefore, if Medicaid is the only option to pay for care, the patient will only be able to get into a facility that accepts Medicaid for payment.  This is not to say that facilities who accept Medicaid give poor care.  There is just going to be some variations in the quality of care you receive no matter who is paying for the care.  I have been to facilities who reserved some beds for Medicaid patients and the rest were for private pay, but it just depends on the facility.

When is it Time for Hospice Care?

There are many reasons why a patient and family may choose to stop treatment, and every circumstance is unique.  In my particular experience, I worked with a lot of patients who were elderly and had been in nursing care for quite a while, and their health was more rapidly declining.  Some of my patients had been living with dementia, ALS, heart disease, or COPD for years, and they and their families were tired of taking medication and going to therapies and struggling to complete everyday tasks.  Many of them were ready to die, and just wanted to be comfortable and spend time with their families before they passed away.  Often it was harder on the families who were losing a loved one and experiencing grief than it was for the patients themselves.  Many were just tired.  Tired of fighting, tired of struggling.

This was not always the case.  When someone is dying of cancer in their 40’s, it’s not the same as someone who is dying of heart disease in their 90’s.  Every patient’s circumstances are unique and thus so is their outlook.  As human beings we tend to have an easier time accepting that a very elderly person who has been suffering for years with their decline is ready to come to the end of their life than it is to accept that a person in the middle of their life who still has young children at home will not recover from their illness.  This of course, also will be much different for a family who is facing the impending death of their own child due to a terminal condition.  Even the parents of terminally ill children sometimes have to make the decision that ongoing treatment may cause more harm than good in the quality of the remaining life of their child.  No one can decide for a patient and their family when the right time to stop treatment and move into hospice care is.  That decision needs to be made by the patient, to the extent that are able to communicate their wishes, or by their health care surrogate, who should be given all the information and options available in order to make an informed decision about the best care for the patient moving forward.

Hospice care workers are a special class of caregivers.  I was endlessly impressed with the compassion and fortitude of the nurses, doctors, social workers, chaplains, and CNAs that I worked with during my employment in hospice care.  When the time is right, and the patient and family have decided that comfort care is the top priority, hospice can be an amazing asset.  If your family is considering hospice care for a loved one with a terminally ill condition, think about what your goals are at this time in their care plan, and reach out to the hospice providers in your area to learn more about their particular services and your options for care.