The field of mental health still has a long way to go in our general understanding of trauma. Trauma-based disorders are one of the few conditions that require a life-changing event for a diagnosis to be made. And unfortunately, many of our diagnostic understanding of trauma is looking at it after the fact. Mental health professionals typically explore the symptoms and functioning of people who have already endured a traumatic experience. But very little is said for the people who are still actively enduring traumatic situations, some even in their daily lives.
As with most things in healthcare, our current models of diagnosing and treating trauma are mostly during the post-traumatic phase.
Post-traumatic stress disorder has been the landmark understanding of trauma for decades. We know now these symptoms are only one possible presentation of trauma. Complex PTSD provides a deeper understanding of what it can look like for someone to endure chronic exposures to distress and overwhelm and helps paint a broader picture of symptoms that individuals may face
But there is an overwhelming need for us to examine what it looks like for people who are currently surviving adversity- understanding how symptoms present when exposed to active threats and how to better prioritize prevention. As with most things in healthcare, our current models of diagnosing and treating trauma are mostly during the post-traumatic phase. Protecting people from post-traumatic symptoms is an important part of this work, and we can best do that if we intervene as soon as possible- and we can only intervene if someone is capable of seeing that they are living through active distress.
What Happens When You Are in Active Distress?
Stress is psychological and physiological. It impacts you in your body and your brain- and the process by which this happens is a universal, neurobiological experience for everyone. In essence
- You are exposed to a demand or a threat that you perceive to be challenging or overwhelming
- This stressor is then processed by your body as a “bad thing” and a dangerous thing
- Your body communicates to your brain via the vagus nerve that you are now in the presence of danger and must shift into self-preservation mode
- This then puts you into fight or flight, and you shift out of your thinking brain
- Reflexively and automatically, you become more aware of how bad the stressor feels and you become fixated on how you can get relief from the stress
- Your body starts to feel uncomfortable because your heart is racing, your muscles are tense, your stomach hurts, and you have too much adrenaline and/or cortisol in your bloodstream
- It becomes harder to focus, to feel comfortable, to feel motivated and your behaviors shift into self-protective behaviors to get away from the stressor. You may:
- Fight: Become self-defensive or conflictual
- Flight: Try to avoid or escape the stressor
- Freeze: Become paralyzed or stuck
- Fawn: People-please or drop your boundaries
- Flop: Submit and give up
- Fright: Panic and explode
- You stay stuck in these behaviors until it feels like you have adequately dealt with the stressor
- Your body produces adrenaline and cortisol and then you crash into a low period so you can recuperate
This neurobiological process works great when presented with acute threats such as a bear in the woods. These processes do not work as great, however, when you are trying to function at work or in a relationship and you are stuck in a state of distress.
The longer you are in distress, the more damage your stress chemicals do to your brain and body. The more frequently you are exposed to distress, the more your ability to tolerate erodes away. The more intense or threatening the distress, the more you develop complicated or harmful coping strategies. When you are flooded with stress due to active crisis, your capacity to function becomes highly dysregulated. This regulation must be intervened before it becomes ingrained in us as a post-traumatic symptom of distress.
What Does Active Distress Mean?
While life almost always guarantees adversity, not everyone is exposed to the same intensity or frequency of adversity. And even fewer people are exposed to what would be considered true threats to their survival. When you have active threats of harm facing you, you move through the world differently than your peers. When exposed to intense, frequent, or harmful threats, you spend more resources in self-preservation and survival mode and therefore have fewer resources to expend on other parts of your life.
Systemic distress can look different to different individuals. For example:
- Financial insecurity is distressing because it poses a threat to housing or food.
- Housing insecurity is distressing because it poses a threat to safety and protection.
- Food insecurity is distressing because it poses a threat to survival and nourishment.
- Community violence is distressing because it poses a threat to safety and connections.
- Harsh political climates are distressing because they pose a threat to policy-driven needs and access to resources.
Some groups of people are more greatly impacted by these threats than others.
On a smaller scale, many people are exposed to threats of safety within their own homes. They may be exposed to
- An abusive partner, parent, sibling, or family member.
- High conflict or high control groups.
- Neglect or abandonment.
- Loss or grief.
- Substance use or harmful mental health challenges.
When exposed to intense, frequent, or harmful threats, you spend more resources in self-preservation and survival mode.
When Does Distress Become Trauma?
When someone is exposed to frequent, intense, and unsupported experiences of distress, it can become “toxic”. Your body is designed to only handle so much turmoil before it makes you sick. Trauma is psychological and physiological injury due to repeated or intense exposures to unregulated stress. Quite literally, trauma is when your stress exposure is so strong and so unmediated that it alters the way you feel and function.
From a behavioral perspective: if you are exposed to so much stress that it is harming you, your behaviors are going to become hyper-fixated on getting relief from the distress. This might lead to the development of relief-seeking behaviors that often exist within self-harm: non-suicidal self-injury (NSSI), eating disorders, substance use, etc. People might also develop compulsive behaviors to get relief which can develop into obsessive-compulsive disorders. On a more surface level, someone may also spend so much time and energy on surviving (working too much, protecting themselves from harmful people, etc.) that they can’t do anything else.
From a neurobiological perspective: chronic and uninterrupted exposure to adrenaline and cortisol causes damage to your brain and body. Your amygdala grows, your hippocampus shrinks, and you have less activation in your PFC. This changes how you experience and process emotions, how you access memories, how you think, and how you make decisions. This changes your capacity to make good, healing choices.
When you are flooded with stress due to active crisis, your capacity to function becomes highly dysregulated. This regulation must be intervened before it becomes ingrained in us as a post-traumatic symptom of distress.
From a physiological perspective: adrenaline and cortisol are also degrading to your digestive systems, pulmonary systems, cardiac systems, and endocrinological systems. Stress chemicals degrade you from the inside out which is one explanation behind why trauma survivors have worse health outcomes. This changes how much you can rely on your body to move you through life.
From an evolutionary perspective: you are moldable so you can adapt to your environments. You adapt in spaces of hostility so you can ensure your survival, but those adaptations do not easily apply to worlds outside of your trauma. These changes can be hard to get away from, causing repeated patterns of pain even when trying to heal from past trauma.
In short- when distress is too much, too intense, or too frequent, you can develop symptoms of traumatic stress. And trauma is complicated because it compounds. When this compounding is complex and chronic, it can change the trajectory of development, play a hand in the worsening of mental health conditions, and change the way you perceive and interact with your world.
If you’re exposed to so much stress that it’s harming you, your behaviors may become hyper-fixated on getting relief from distress.
Does Everyone Realize They Are Developing Trauma?
When your world is so overwhelming and chaotic that the distress could be damaging, it also interrupts your ability to assess what’s going on. Your situation might be so familiar or so normal you don’t even know it could be harmful. It could be so overwhelming and consuming you don’t have the space to realize what’s happening. It can be so shameful or hard to look at that you ignore or deny it.
It is often difficult for people who are in active distress to act in ways that are healing enough to protect themselves from trauma. The way that we talk about trauma is so focused on how to identify it once you have survived. The gap in identifying how to know when you’re actively living it is so important for survivors to get help as soon as possible, to better prevent the establishment of long-term, chronic symptomatology. It also helps inform providers on how to best address symptoms of distress.
How to Tell if You Are Living in Active Distress
Typical adversity is acute, short-term, and usually recoverable with minimal effort. Everyone endures adversity, and as issues in our society get more complicated, the more intense the overall adversity impacts the members of that society. Right now, there is a lot of systemic pressure impacting people. You have collectively endured multiple political, social, financial, medical, and other crises that have changed the landscape in which you function. But this being normal and universal doesn’t make it any less traumatic on our body systems. Social normalization of distress does not lead to improved tolerance of distress. It just leads to a more distressed group of people.
On a personal level, you can assess for active distress by looking at 2 environments: internal and external.
- Internal environments are signs and symptoms coming from within the body. Your symptoms can be worsened by external triggers, but they can also be worsened by changes in health or illness. When faced with active distress, you can expect to experience big changes in the following:
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- Disruptions in sleep
- Disruptions in eating/drinking
- Changes in substance use
- Changes in self-destructive or harmful behaviors
- Disruptions in social behavior
- Changes in self-care or self-preservation
- Increases in discomfort, pain, or injury
- Increases in challenging emotions
- Increases in fear-based behaviors or responses
- Changes in thinking patterns
- Disruptions in hopefulness or helpfulness
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- External environments are triggers and influences coming from outside of yourself. These are stressors and sources of threat that may or may not be within your control. When faced with active distress, it is possible for your experiences to include:
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- Increases in conflict, chaos, or ruptures
- Increases in threats to safety or stability
- Exposure to frequent or intense adversity
- Disruptions in the community or connections
- Experience with harm, pain, or violence
- Losses, grievances, or abandonment
- Neglect or unmet needs
- Little or no supportive care or rehabilitation
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If you have unwavering symptoms, the development of worsening mental health, and a shift in how comfortable it feels to live in your body- that is a pretty good sign that you might be enduring active distress or crises. If these symptoms are being influenced by outside forces that cause harm or threaten your well-being, then you might be living through an active trauma event.
If you feel yourself slipping from reality, becoming unknown to yourself, and feeling shame or disgust in yourself, you are likely enduring active trauma.
When adversity is so impactful it changes us, that is trauma. If you feel yourself slipping from reality, becoming unknown to yourself, and feeling shame or disgust in yourself, you are likely enduring active trauma. Getting help as soon as possible is the best way to avoid continued dysfunction and to get yourself back to stable functioning.
Why is it Hard to Get Help When I am Living in Active Trauma?
Seeking out therapy when in active trauma can be both complicated and burdensome. Some reasons why therapy in crisis can be hard:
- You have limited time, resources, or energy given how consuming your active distress is, leaving little left to seek out or engage in therapy. Even if you do engage in therapy, you might not have the bandwidth to participate in deep healing or challenging interventions.
- You may not even be aware of what is going on. You might be socialized to ignore your distress or power through it on your own. You may not know that you can get help when you are in crisis, or you may fear that you won’t be taken seriously.
- You cannot change your circumstances, so it feels like you need whatever coping mechanisms you have developed. The idea of losing these mechanisms, no matter how harmful they are, can feel very scary.
- Your symptoms are being misinterpreted as something else. If you struggle to talk about what is happening, your treatment provider may misunderstand your symptoms, and this might lead to misdiagnosis and therefore the treatment is less effective. This can result in an attempt to treat the symptoms without any change to the underlying distress that is bringing the symptoms forward.
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Oftentimes, this can look like “treatment resistance”, when in reality, you are just generating symptoms at the same rate as you are enduring distress
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This can be a Band-Aid effect that doesn’t offer real relief or change, causing frustration or a lack of trust in treatment
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There might be an overemphasis on over-pathologizing a normal reaction to an abnormal situation
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- You don’t have to wait until you are post-trauma to get treatment. Receiving appropriate, trauma-informed care can help you navigate your active crises while mitigating the long-term impact they have on you.
If you feel yourself slipping from reality, becoming unknown to yourself, and feeling shame or disgust in yourself, you are likely enduring active trauma.
What Does Therapy for Active Trauma Look Like?
As a trauma therapist, it is most important to establish trust with clients- especially those in active crisis. One part of that is helping you to build awareness and acknowledge the harmful nature of your current circumstances:
– Naming your distress as traumatic helps communicate that it must be changed, survived, or escaped. It paints a clearer picture of your reality and provides the opportunity to make healthier decisions
Establishing safety is the most important step when working through active trauma. In our work, this means helping move you away from the threat in as reasonable and timely manner as possible.
– If you are living in an environment that is hostile or abusive, the first step is working with a provider on how to get safe. What safety looks like for you depends on your specific areas of distress. Communicating to a provider about what needs are unmet is the best way to get connected to the appropriate resources.
– You might need help finding housing support, financial or food support, case management, changes in health insurance, domestic violence support, substance use support, etc.
Understanding your symptoms through compassionate education can relieve a lot of shame. Providing normalization of trauma while validating the experience is vital in the healing process.
– When you have the words to explain what you are going through, you feel less alone. When you can understand there is some normalcy in developing challenging symptoms when faced with challenging circumstances, you feel less ashamed about your behaviors and difficulties
– When you can name what’s wrong, you can better and more appropriately apply intervention
Learning how to tolerate distress for the unavoidable will help mitigate long-term symptoms. By teaching clients how to better manage their symptoms, they’re able to regain a sense of comfort and control within their own bodies.
– When in active trauma, you may not be able to get away from the source of your threats. The only thing you can do then, is manage the impact this threat has on your systems. Learning to apply distress tolerance skills may not solve the problem- but it will certainly reduce how much the problem hurts.
– Building healthier coping skills will prevent harmful behaviors from becoming habits- meaning they will stick around even once the threat is gone. If the world is hurting you, the least you can do is not inflict further pain or unnecessary suffering.
Connecting with support and community can help cushion the impact of trauma. This connection starts in the therapy space but then spreads out into your life.
– Isolation is one of the most damaging facets in developing post-traumatic stress symptoms. When you are enduring overwhelm that can’t be escaped, finding connection among trusted people and learning to safely attach can prevent a lot of long-term symptoms.
If you have signs or symptoms that you may be enduring active trauma, it is an act of love and survival to reach out for support. While it may be uncomfortable, communicating to your therapist where your sources of threat are coming from is a very important way for you to be connected to the appropriate safety resources. As a trauma therapist, I am trained to look at areas of vulnerability and to build a safe relationship for you to explore your distress.
Just as hostility and chaos change your brain- so does healing and connection. Trauma therapy has been shown to reverse trauma-induced changes in the brain and has evidential support for building resilience and post-traumatic growth following adversity. Your challenges don’t have to damage you- with help, you can endure the inescapable and still find a life worth living on the other side.
