Trauma Guide

Trauma can mean two things: a shocking, frightening or dangerous event, and the lasting effects such an event can have on a person. Clinicians use a narrower definition of the event when they diagnose PTSD. The VA's National Center for PTSD says most people who go through a traumatic event will not develop PTSD.

In the first days and weeks after a traumatic event, reactions such as upsetting memories, jumpiness, poor sleep and numbness are common. The VA's National Center for PTSD calls them normal and not weakness. For most people they gradually ease. Official sources advise seeing a professional if they last longer than a month, are very upsetting or disrupt daily life.

Clinicians look for four groups of PTSD symptoms: reliving the event, avoiding reminders, more negative thoughts and feelings, and feeling on edge. For a diagnosis, symptoms must last longer than a month and interfere with daily life. About 6 in 100 people in the U.S. have PTSD at some point. Only a mental health provider can diagnose it.

Complex PTSD is a diagnosis in ICD-11, the World Health Organization's international classification. It requires all the features of PTSD plus lasting problems with managing emotions, a negative view of oneself and difficulty in relationships. The American manual, DSM-5-TR, has no separate complex PTSD diagnosis. Research on how best to treat it is still limited.

Research on adverse childhood experiences (ACEs) links hard early experiences with higher rates of health and mental health problems in adulthood across large groups. It shows association, not cause, and a 2021 study found that ACE scores predict poorly for any one person. "Developmental trauma" is a descriptive term, not a formal diagnosis. A score is not a destiny.

Trauma can affect the body as well as the mind. Official sources list a pounding heart, feeling jumpy, trouble sleeping and stomach upset as common stress reactions, and research links PTSD with chronic pain, heart disease and diabetes. Those links are associations, not proof of cause. New physical symptoms belong with a doctor.

A flashback is feeling as if a traumatic event is happening again. A trigger is something you see, hear or smell that brings it back. The VA's National Center for PTSD gives simple steps for the moment, such as looking around and noticing where you are. For nightmares, expert bodies disagree about which treatment to recommend.

Dissociation is a disconnection between a person's thoughts, memories, feelings, actions or sense of self. Mild forms such as daydreaming are ordinary, and feeling detached or numb is a common reaction after trauma. If it lasts longer than a month, is very upsetting or disrupts daily life, a mental health professional can assess what is going on.

Listen more than you advise, offer practical help, and encourage professional care if symptoms last. The VA's National Center for PTSD suggests telling the person you want to listen and that you understand if it is not the right time to talk. Research associates social support with lower risk of PTSD. Look after yourself too.

When a death is sudden or violent, grief and trauma symptoms can arrive together. What that looks like, how treatment is paced, and where to find support.

Not necessarily. The VA's National Center for PTSD says most people recover from trauma naturally. It advises talking to a doctor or mental health provider if symptoms last longer than a month, are very upsetting or disrupt daily life. A screening questionnaire cannot settle the question. Only a clinician can assess it.

For PTSD, U.S. guidelines most strongly recommend specific trauma-focused psychotherapies: cognitive processing therapy and prolonged exposure in both major guidelines, and EMDR strongly in one. Psychodynamic therapy has been studied much less, and both guidelines find insufficient evidence to recommend for or against it. Body-based approaches have little research so far.

Not always, and not in detail in every treatment. Prolonged exposure involves talking through the trauma in detail. Cognitive processing therapy makes a written account optional, EMDR asks you to think about the memory, and present-centered therapy does not focus on the event. Dr. Rabin's trauma page says you always control what is discussed.

The 2023 VA/DoD guideline recommends three trauma-focused psychotherapies over medication when both are available. It also recommends three antidepressants, two of them FDA-approved for PTSD, and recommends against benzodiazepines and cannabis. It finds insufficient evidence for or against combining therapy and medication. Medication decisions belong with a prescriber.

PTSD and problems with alcohol or drugs often occur together. The VA says over 4 in 10 U.S. adults with PTSD also have problems with drug or alcohol use. Guidelines say substance use should not rule out PTSD treatment, and the two can be treated at the same time. Help lines that answer around the clock are listed below.

The PTSD treatments that guidelines recommend most strongly are short by design: about 12 weekly sessions, or roughly three months, in official descriptions. Some people need more, and guidance allows more time for complex presentations without saying how much. No source gives a typical length for open-ended therapy. With Dr. Rabin, length is something to discuss with her.

How PTSD differs from an anxiety disorder, how often the two occur together, and why a person's history matters when choosing a treatment.

Trauma-informed describes how a clinician or service works with people: with attention to safety, choice and collaboration, whatever the therapy. Trauma-focused names therapies that work directly on the trauma memory or its meaning. U.S. guidelines most strongly recommend trauma-focused therapies for PTSD. Neither label is a license, so ask what a therapist actually does.

Look for a licensed clinician who has experience with people who have been through trauma, who can say plainly which treatments they offer, and with whom you could be honest. Guidelines most strongly recommend specific trauma-focused therapies for PTSD, so ask any therapist whether they offer the one you want. Licenses and training claims can be checked.

Trauma therapy with Dr. Rabin starts with a free consultation of about 15 minutes. Sessions are usually weekly and last 45 to 50 minutes, in person in Brookline or by secure telehealth in Massachusetts. The work is guided by safety, pacing and the relationship, and you decide what is discussed and when. No therapist can promise a result.