It’s 3 a.m. and Lyla is awake again. Her heart is racing, and her body is soaked in cold sweat. Was it the sound of a neighbor’s car pulling in that woke her this time? “Could have been anything, really,” she thinks to herself, feeling a sense of helplessness and defeat because she knows that hours are going to pass before she’s able to fall back asleep. When she finally succeeds, it’s only a few moments later that her alarm goes off—time to get up. She groggily slaps the “off” button, but it’s already done its job; she’s awake. A sharp shock of dread ripples through her mind as she remembers the previous day and simultaneously fears the day to come.
She can’t rid herself of the memory of her coworker’s face, and the sense it conveyed that she was somehow abnormal and strange. “Why did she have to have a panic attack when he took out a pocket knife to open a box of office supplies?” she bemoans silently. “Why did she have to run off frantically staggering toward the bathroom like some kind of drunken zombie?” She aches with shame as she recounts the event over and over again.
What Lyla isn’t aware of is the deep connection that lies nestled within the cordoned off regions of her unconscious, between cars pulling into the driveway late at night, cardboard boxes and pocketknives, and the physically abusive stepfather she no longer speaks to. These connections are too dangerous to make contact with her conscious mind, so she’s closed them off, placed them behind a firewall that’s far away from conscious awareness. Now their only expression is through insomnia and a panic that overwhelms her body while protecting her mind from the more frightening recollections they represent.
At first glance it may appear that Lyla is struggling with anxiety, and while she likely is what is more pressing is the presence of her trauma history. Lyla’s physical abuse is likely the root of her disturbances, which only manifest as insomnia and anxiety. Trauma has many faces and is often not what it seems. It’s easy for clinicians to be blinded by the surface expressions of trauma, because they present as almost every disorder that is listed in the DSM. Thus, it’s of the utmost importance that an initial screen for trauma is conducted when working with any client.
The example given with Lyla is just a brief snapshot of what a person experiencing PTSD may go through on a daily basis. The full-fledged disorder is multifaceted, consisting of eight criteria each with multiple expressions. (For more information on PTSD criteria and diagnosis you can look .)
Regardless of whether a person suffers PTSD, or a lesser form of trauma that does not meet diagnostic criteria, any trauma that leaves its negative stain upon a person has the ability to change one’s perception of reality. It can steal away a person’s ability to feel safe and trust others, which can manifest as being easily startled or feeling an intense free-floating anxiety both when alone and in the presence of others. On the other hand, it can leave a person feeling numb and disconnected from their surroundings with a lingering sense that something “just isn’t right”. Or it can manifest in an entirely different way, as these are just two examples of what ultimately is a very complex, isolating, and unique experience.
So what do you do if you suspect you are struggling with the after effects of traumatic experiences? In the next and final segment of this series I’m going to talk about a few trauma-focused treatment options that have the potential to greatly alleviate the negative after-effects of lingering trauma.
Elizabeth Carter, MS, NCC, LPCA
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.