The Trouble with Trauma

The trouble with trauma, besides its obvious discomfort, is that many people equate trauma and its symptoms with full-blown Post-traumatic Stress Disorder (PTSD). If you’ve been traumatized, then you must have PTSD. The real story is actually quite different. Trauma manifests in many different ways, at many different levels—and each manifestation can be inhibitive.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), clinically valid PTSD must cover 6 categories of diagnostic criteria, 4 of which contain several different symptoms. In fact, out of 21 total possible symptoms, a minimum of 10 symptoms must be present in order to be diagnosed with PTSD. If a patient exhibits 7or 8 symptoms, then technically the patient does not qualify for PTSD, but rather, has what is known as, sub-syndromal PTSD. For example, consider the following symptom (taken from the DSM-IV, category C of diagnostic criteria for PTSD): Efforts to avoid activities, places, or people that arouse recollections of the trauma. This symptom can lead to withdrawal and isolation. People don’t want to leave their house. They miss work and/or other activities of importance. They become homebound.

Another diagnosis, Simple Phobia, easily accounts for half of the MVA patients that I treat. People are too afraid to drive or be driven. Imagine being too afraid to drive—how utterly debilitating! Again, this does not qualify as full-blown PTSD but you can see how imposing it becomes in one’s life. Sometimes it can be severe, like the case of one woman who literally would not get into any moving vehicle. She finally had to drug herself up because she had to get to the next state in order to help her ill mother.

Panic attacks are another example of a symptom that can profoundly disrupt one’s life. A patient had come to me, a young man in his twenties, who was experiencing panic attacks after being in a motor vehicle accident. Clearly, panic attacks are a powerful, visible symptom of trauma and should not be taken lightly. He described attacks that would erupt seemingly out of nowhere, not connected to being in a car or any other obvious stress trigger. The attacks would abruptly stop him from whatever he was doing, leaving him extremely short of breath, very anxious, cold, sweaty palms, and unable to function. He literally would have to sit down and ride it out, hoping not to pass out. He never knew when they would hit. And they were hitting him almost daily. That aspect alone scared him enough to go to therapy.

Often panic attacks occur when one encounters a trigger, a reminder of a traumatic event. Ironically though, this patient presented with a mystery. His latest attack occurred when he was alone at Mt. Tabor, walking around calmly taking photographs. There was no one around, no sudden, loud noises, nothing unusual. He was not thinking about accidents or automobiles. He was feeling happy and peaceful. Suddenly he was stricken with an attack and had to sit down or he would have fainted.

The intake session, and several subsequent sessions revealed that he had been watching in his rear-view mirror while the car behind him rammed into him. During this brief time, the patient, unawares, had been holding his breath. This pose or stance is what got “frozen” or “stuck” in him, physically and emotionally. He simply was not breathing. Not breathing creates loss of oxygen, which then creates panic. He didn’t need to get triggered by an outside stimulus—he simply had unconsciously adopted this pose and then suffered panic attacks at any given time.

The therapy then consisted of him voicing/articulating the sequence of the accident. When he stopped breathing, as he had done during the real accident, I loudly told him, “Breathe” as he told about the actual impact. The deep breath finally freed him from his locked up pose.

The following week he reported vastly fewer attacks. He was reminded to keep checking himself to make sure that he was breathing fully. The next week he was done to no panic attacks.

Trauma hits in different ways and in different intensities. Most manifestations can be ripe for therapeutic treatment.

Beverly Schwartz, LCSW
Spring 2010
SOMA Trauma Therapy, LLC


Contact and Scheduling