As described in Chapter A4, trauma is a term that is widely used and may mean different things to different people. It can include a myriad of extremely threatening or horrific events, or a series of events, in which a person is exposed to, witnesses, or is confronted with a situation in which they perceive that their own, or someone else’s, life or safety is at risk [10, 11].
Most people will experience some emotional or behavioural reactions following exposure to a traumatic event such as anxiety or fear, aggression or anger, depressive or dissociative symptoms. These emotional and behavioural responses are to be expected and are a completely normal response to an adverse event. For the majority of people, these emotional and behavioural reactions will subside and/or reduce in intensity over time without the need for any intervention; for some people however, these reactions may be prolonged, leading to significant distress, as well as impairment in social, occupational and other areas of functioning [102, 156, 157]. Symptoms may be especially long-lasting or complex when the trauma is interpersonal and intentional (e.g., torture, sexual violence), and if the trauma occurred in childhood [157, 1285].
Approximately one in ten Australians who experience a traumatic event develop PTSD [157] (described in Chapter A4). Symptoms of PTSD include:
- Recurrent ‘re-experiencing’ of the traumatic event, through unwanted and intrusive memories, recurrent dreams or nightmares, or ‘flashbacks’.
- Persistent avoidance of memories, thoughts, feelings or external reminders of the event (such as people, places or activities).
- Persistent negative alterations in cognitions and mood, including guilt and hopelessness; feeling a distorted sense of blame of self or others; feeling detached from others; a persistent inability to experience positive emotions; and reduced interest in activities.
- Persistent symptoms of increased physiological arousal and reactivity, including hypervigilance towards distressing cues, sleep difficulties, exaggerated startle response, irritability, increased anger, and concentration difficulties.
Some people develop a more complicated form of PTSD referred to as complex PTSD, in which they also experience pervasive difficulties with emotional regulation, self-concept, and relationship difficulties across a variety of contexts (described in Chapter A4). Research among people with AOD use disorders indicates that 85% of those who meet criteria for PTSD experience it in this more complex form [1286]. Although complex PTSD may arise in relation to any trauma, it is typically associated with prolonged or repeated interpersonal traumas that occur during childhood [158].