Trauma and Mood Disorders

Childhood Trauma and Mood Disorders

There is a greater frequency of mood disorder diagnoses when children have had experiences of trauma. Adverse Childhood Experiences (ACEs) are experiences such as witnessing violence, neglect, or abuse in early life. ACEs can be a risk factor for mood disorder diagnosis. There is a strong correlation between ACEs and diagnoses of mental health conditions later in life. According to the CDC, preventing ACEs could reduce the number of adults with depression by as much as 44%. Studies have shown that ACEs increase the risk of developing bipolar disorder and might worsen treatment outcomes. More research needs to be done to better understand the relationship between ACEs and mood disorders.

Can trauma cause a mood disorder?

Trauma can change the way our brains work. It affects areas of the brain such as the hippocampus, responsible for emotion, memory, and the autonomic nervous system, and the amygdala, which helps us experience emotions. Alterations to these parts of the brain, especially if occurred during childhood, can change how these parts of the brain function. Our brains are adaptive so these changes can cause symptoms of a mood disorder to arise. It is understood that mood disorders can be heritable; when a traumatic event occurs, those with a predisposition may be more likely to experience symptoms of a mood disorder.

Trauma and Diagnosis

The Substance Abuse and Mental Health Administration (SAMHSA) defines trauma as an event or circumstance that results in physical, emotional, and/or life-threatening harm. Trauma broadly describes an experience that is traumatic in nature. Post-traumatic stress disorder (PTSD) is a specific diagnosis and a longer-term condition that is a reaction to the experience of a traumatic event or incident. Not everyone who experiences trauma develops PTSD, but some people do.

Post-Traumatic Stress Disorder

Symptoms of PTSD may vary based on the person. Some responses can be depression, anxiety, anger, or disassociation. Highly individualized responses to trauma also include coping mechanisms that individuals create in response to the experience. Coping can be internalized, such as rumination, feelings of depression, and anxiety. They can also be expressed as externalizing behaviors, in ways such as substance use, self-harm, or hypersexual behaviors. Because trauma responses can be highly individualized, more research to understand various types of traumas and how these traumas translate to symptoms is needed. Additionally, more research within certain groups such as in BIPOC (Black, Indigenous, and People of Color) communities and with children is needed and will add to our overall understanding of trauma.

A person might be diagnosed with post-traumatic stress disorder if they experience:

• Exposure to actual or threatened death, severe injury, or sexual violence in one (or more) of the following ways:

• Directly experiencing the traumatic event
• Witnessing, in person, the event as it occurred to others

• Learning that a traumatic event occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event must have been violent or accidental
• Experiencing repeated or extreme exposure to aversive details of the traumatic event (some examples are first responders collecting human remains; social workers repeatedly exposed to details of child abuse)

• The presence of one (or more) of the following intrusion symptoms associated with the traumatic event, beginning after the traumatic event occurred:

• Recurrent, involuntary, and intrusive distressing memories of the traumatic event
• Recurrent distressing dreams in which the content and/or effect of the dream are related to the traumatic event

• Dissociative reactions (such as flashbacks) in which the individual feels or acts as if the event were recurring
• Intense or prolonged psychological distress with exposure to cues that symbolize or represent an aspect of the traumatic event

• Persistent avoidance of stimuli associated with the traumatic event, e.g., avoiding memories and external factors that would stimulate distressing memories
• Negative changes in cognition and mood associated with traumatic events, such as:

• Change in memories (not remembering important details surrounding the event)

• Exaggerated negative beliefs about oneself
• Distorted thinking about the cause or consequences of the traumatic event
• Persistent negative emotional states (anxiety, fear, horror, guilt, shame, or anger)
• Diminished interest in participating in activities
• Feelings of detachment or estrangement, inability to experience positive emotions

• Changes in nervous system responses such as:

• Irritable behavior or angry outbursts
• Reckless or self-destructive behavior
• Hypervigilance or being in a state of constantly looking out for potential threats,
• Being easily startled
• Problems with concentration
• Sleep disturbances

Types of Trauma

Acute Trauma

Acute trauma is the immediate reaction after a one-time traumatic event. This type of trauma describes the intense emotional distress after such an event. Some examples of traumatic events that might cause acute trauma are sexual assault, the sudden death of a loved one, a car accident, or other accident that causes bodily or emotional harm.

Adverse Childhood Experiences (ACEs)

ACEs are traumatic experiences during childhood (from birth to 18 years old) which can have a lifelong effect on mental health. Examples of ACEs include experiencing or witnessing abuse, neglect, or violence in early life. When children experience these types of traumas in childhood, their development is affected. Children may develop maladaptive coping strategies to deal with such stressors. Emotional injury can last into adulthood. Learn More

Chronic Trauma

Chronic trauma describes a traumatic experience lasting for a long time. Persistent emotional or physical abuse can be categorized as chronic trauma. Examples include bullying, domestic violence, and long-term exposure to violence.

Complex Trauma

Complex trauma describes experiencing a traumatic event wherein the individual feels no ability to escape. This type of trauma undermines an individual’s sense of security, causing them to constantly watch their environment for potential threats. This type of hypervigilance and constant stress can erode one’s sense of self and safety.

Historical Trauma

Historical trauma is experienced over time and generations by individuals who share identities or common experiences. First named to describe the experience of Holocaust survivors, it is now understood to reflect the experiences of many diverse groups.

Historically marginalized communities have faced and continue to face trauma which continues to have generational impacts on quality of life. Identity and cultural background impact mental health because it shapes the way an individual experiences the world.

Read more here on the way identity and cultural background affect mental health.

Racial Trauma

Racial trauma or race-based traumatic stress (RBTS) derives from experiences of overt or covert racism. Discrimination based on race has a long and prevalent history in the United States and across the world. In the United States, this is especially true for individuals from the BIPOC (Black, Indigenous, and People of Color) community, for which white supremacy continues to be an ongoing trauma.

Racial trauma can occur from stressors that are specific to certain groups. This can be on the individual or societal level, such as experiencing continuous microaggressions. It also derives from the systemic level and is seen when social policies seek to subjugate and deter BIPOC communities from thriving.

Read more on the way identity and culture can impact mental health.

Secondary or Vicarious Trauma

Secondary or vicarious trauma refers to trauma that is exposed to another person’s trauma. This is especially prevalent for caregivers, first responders, and those who work with individuals that have experienced trauma. Especially for those who work in helping professions, exposure to secondary trauma regularly can lead to burnout or compassion fatigue. 

Effects of Trauma

Trauma activates the sympathetic nervous system, releasing adrenaline, noradrenaline, and stress hormones into the body. This activates the fight, flight, or freeze response in the human body. This stress activation in the body is a normal response to a traumatic event. These feelings can settle after a traumatic event; however, our bodies all store these feelings and memories in such a way that they may arise later. Stressful experiences or experiences that bring up memories of a traumatic event may also activate one’s nervous system in this way.

The long-term consequences of trauma are complex and affect everyone differently.

Some may experience:

• Disassociation,

• Extreme anxiety,
• Anger,
• Sadness, or
• Inability to feel pleasure.

A survivor of trauma may have a hyperactive nervous system. This is the body’s way of staying hypervigilant in the face of such experiences that activate the nervous system. When the body’s nervous system is chronically more activated this can lead to long-term problems associated with sleep, physical pain, social connection, and a diminished sense of self-worth.

Recovering from trauma is possible when a person is empowered with the right treatments and support to allow them to feel safe, secure, and empowered.

Treatment Options for Trauma

Whether you have a diagnosis of post-traumatic stress disorder (PTSD) or not, clinicians are interested in understanding if you have trauma in your background. Clinicians look to know this information because it can help inform what types of treatment may be most beneficial for you. You may be asked about these experiences as early as your first therapy session or work on talking slowly over time.

There are several different leading types of treatment for trauma which we’ll review in this section. Research has found that suppressing memories can potentially worsen symptoms of PTSD. A process of “reliving” the experience, with the support and encouragement of a therapist, may be the most effective treatment for trauma. That said, talking about trauma can potentially be a traumatizing experience.

What is trauma-informed care?

When providers identify as trauma-informed, they approach their work from a perspective that acknowledges the prevalence and pervasiveness of trauma in our society. A trauma-informed provider is competent in understanding trauma and knowledgeable about types of treatments that may help a trauma survivor. It is important to have a trauma-informed provider because this limits the possibility of re-traumatization. Re-traumatization occurs when individuals process their trauma experience in a way that causes further harm.

Working with Your Provider

Finding the right provider can be challenging, but it is important to find one who will meet your needs. Processing trauma can potentially be retraumatizing if not done in a safe space with a trusted provider, which is why finding a provider that meets your needs is so important. Further, not all providers are trained in trauma care and thus may not be comfortable treating trauma.

Feeling safe in treatment is of utmost importance. Here are important notes on finding a provider who can help treat trauma:

• Trauma-focused treatment should only be done with the guidance of a provider trained to do so and who can create a safe and supportive environment
• It’s important that the individual be ready for trauma-focused treatment
• Everyone experiences trauma differently, so the way providers go about treatment for trauma should be sensitive to each experience
• Cultural and identity factor into how an individual experiences and processes trauma

Read more on how to find the right therapist for you.

What are the types of treatment for trauma?

Now that we’ve covered the importance of finding a provider right for you, here are some of the leading treatment options for trauma. 

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) focuses on having the individual examine their thoughts and feelings as they relate to their behaviors, especially those “uncovered” during the reliving process. By examining thoughts and feelings in this way, individuals become more aware of how certain thoughts and feelings influence their behavior. CBT helps the individual understand how their current thoughts and feelings may be shaped by their trauma background. CBT therapy can be done in as little as twelve sessions but is typically done somewhere between 12-16 sessions.

Cognitive Processing Therapy

Cognitive Processing Therapy (CPT) is a type of cognitive behavioral therapy that helps clients to challenge unhelpful beliefs about their trauma. This type of treatment is usually done in 12 sessions. Through this process, the individual challenges “automatic” and upsetting thoughts that are prolonging symptoms. The individual will also write out their trauma history (one approach to reliving), to which the therapist will use Socratic questioning and other techniques to help dislodge unhelpful thinking.

Prolonged Exposure Therapy

Prolonged Exposure (PE) is a specific type of cognitive behavioral therapy that helps individuals to gradually approach trauma-related memories, feelings, and situations. Individuals work with their therapist in a safe, graduated fashion to face stimuli and situations that evoke fear and remind them of the trauma to increase their comfort and reduce their fear. PE is typically done over several months with weekly sessions for 12-15 sessions. Some therapists may decide to conduct a longer session beyond the typical 50-minute and may recommend 90-minute or even 120-minute sessions.  

Eye Movement Desensitization and Reprocessing Therapy

Eye Movement Desensitization and Reprocessing Therapy (EMDR) is a specialized form of treatment that works by having an individual relive the trauma experience while a provider simultaneously simulates rapid eye movement. Brain studies showed that the rapid movement of the eyes during this experience helped reduce the memory’s anguish and vividness. This special therapy must be done by trained providers and is typically done 1-2 times a week over 6-12 sessions. Whether it Is the eye movements themselves or simply occupying attention while one relives the traumatic event that is therapeutic is still unclear, but anything that commands slots in memory while reliving and reconsolidating the traumatic memory appears to be helpful.

Narrative Exposure Therapy

Narrative Exposure Therapy (NET) helps an individual tell their trauma story. This structured therapy allows an individual to create a reliable narrative they can lean on to process their experiences. This type of therapy can be done in small groups as well as individually. It is typically done anywhere between 4 and 10 sessions. This form of therapy can be studied with individuals who have been a refugee and has been seen as useful.

Medication

Some providers may recommend medication for the treatment of trauma. There are four medications that have a conditional recommended use for the treatment of trauma—sertraline, paroxetine, fluoxetine, and venlafaxine. Never start, stop, or change your course of treatment without talking to the doctor who prescribed you the medication.

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References:

https://www.sciencedirect.com/science/article/abs/pii/S173411401830197X

https://www.apa.org/ptsd-guideline/treatments