Why Trauma Survivors Develop Depression?

The year 2020 alone has seen many devastating, traumatic events along with the global pandemic and the numerous lives lost. The various events around the world have been emotionally and physically traumatic for individuals around the world. With such changes and experiences, there has also been an increased awareness about the importance of mental health. In this article, we briefly understand what trauma is, the most common symptoms and type of depression that can result from such traumas and lastly, how to emerge from traumas.

What is Trauma?

The word trauma is commonly associated with experiencing a violent and devastating event consisting of physical injury, warfare, sexual assault, or natural disasters. While these events indeed cause trauma in individuals, trauma can also result in response to unpleasant psychological and emotional experiences. It can stem at any age and can be either prolonged or relatively short, but can be equally stressful, negative, and distressing.

Traumatic experiences play a critical role in the formation of beliefs about self and the environment. Often people who survive trauma blame themselves or feel responsible for the traumatic event when, in reality, they could have done very little or nothing at all to control the situation. Sometimes people are not even aware they have suffered a traumatic event as in many cases trauma symptoms do not appear for days, weeks, months, or even years after the event.

What happens when you experience a traumatic event?

Everyone reacts and responds in a different way to a traumatic experience. These reactions can be a biological reaction, i.e. physiological responses and emotional or psychological reactions. Physiological responses are your body’s response ad a defence to the situation; generally, it is called the fight and flight response. This involves high blood pressure, pounding heart and excessive sweating etc. On the other hand, emotional responses involve, feelings of guilt and shame, denial, shock, crying excessively, withdrawn behaviour and mood swings etc. There is no right or wrong way to react, think and feel in such events.

Biological/physiological responses
Emotional responses
Easily startled, difficulty in concentrating.
Shock, disbelief, denial
Insomnia, nightmares
Confusion, disorientation
Increased heart rate and sweating
Anger, mood swings, sadness
Loss of appetite
Anxiety and fear
Tensed muscle, body aches and pain
Guilt, blaming self, shame associated with the event
Numbness
Withdrawn nature
Nausea, fatigue, or loss of energy
Feeling of hopelessness

Note: The symptoms mentioned in the above table are not diagnostic criteria or classic symptoms for people who experience trauma.

Depression and Post-Traumatic Stress Disorder (PTSD)

Depression (major depressive disorder-MDD) is a common but a severe mental illness which negatively affects life. The diagnosis of major depressive disorder entails a distinct change in mood, characterized by sadness or irritability and supplemented by psychophysiological changes, such as disturbances in sleep, appetite, loss of energy, fatigue, suicidal thoughts, difficulty concentrating and making decisions and loss of interest in activities which were once pleasurable. These changes must last at least two weeks and interfere with normal functioning (Belmaker & Agam, 2008).

Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder, often referred to as ‘shell shocked’, involves experiencing an event involving exposure to injury, violence, danger, or death. Its symptoms can vary widely between individuals. The symptoms for diagnostic criteria involve four main categories (Edition,2013):

1. Reliving the trauma through memories and thoughts of the event; this includes flashbacks, hallucinations, and nightmares.
2. Avoiding people, places, thoughts, and situations related to the trauma, causing isolation and detachment from family and friends.
3. Increased arousal includes extreme emotions; difficulty sleeping, irritability, anger outbursts, a problem in displaying and feeling affection; difficulty concentrating, being easily startled. It may also include physiological reactions to cues relating to the traumatic event.
4. Negative cognitions and mood are the thought and feelings of shame, guilt, self-blaming estrangement, inability to remember the events of the traumatic event, negative beliefs about self and persistent negative emotions.

How can trauma turn into depression?

Often when left untreated, trauma can persist for a long time causing psychological, physical, social, and personal life to deteriorate; this may eventually lead to depression. Depending on the various factors, different types of depression can occur from untreated trauma. Multiple studies suggest evidence relating low cortisol levels experienced immediately after trauma may lead to a higher risk of developing PTSD (Ehring, Ehlers, Cleare, & Glucksman, 2008). Some studies have also shown cognitive and emotional responses to trauma may predict PTSD, although exact biological risk factors are unknown (Ehring et al., 2008).

A recent study by Blakey, Jennifer, and colleagues (2019) examined the behavioural model of depression, which theorizes that depressed mood results from inadequate positive reinforcement and social skills. Consider this example; A man experiences his brother getting hit by a speeding car while returning from their favourite restaurant. Witnessing such a traumatic event where someone lost their loved one can be heavily traumatizing. He may become emotionally withdrawn after the event; he would try to repress all the memories of the event and previous visits to the restaurant. He would not only do this but also avoid taking the route where the event happened; he may become emotionally susceptible in specific conversations which may cause him to react with anger outbursts or result in an emotional explosion. This can cause him and others to be distant, and they end up spending more time alone. He may also resort to consumption of alcohol and drugs, leading to further deterioration of his mental and physical health. Eventually, not enough rewarding experiences and social support may cause him to fall in the pit of depression.

Healing from trauma

The aftermath of experiencing trauma is a critical period to maintain well-being. It is difficult to process and control emotions, but it is not impossible to heal and ascend from it. Some ways to ensure healing from trauma are:

•  Learn how to regulate emotions and practice stress-reduction techniques.
• Take time off from work and other responsibilities if necessary, to prioritize mental well-being post-trauma
• Meditate and exercise regularly to maintain mental and physical well-being.
• Do not isolate yourself, seek support from others and do not hesitate to outpour your emotions and feelings
• Find a trauma specialist or therapist to seek professional help when necessary.

Conclusion 

Trauma is a challenging experience as it involves significant distress relating to severe, violent, emotional, or physical damage. Trauma, when left untreated, can often lead to depressive mood and behaviour commonly; Depression (MDD) and PTSD. It is essential to regulate post-trauma emotions and feelings properly to avoid trauma leading to depression.

There are various ways to heal from trauma like meditation, seeking support from therapists, exercising and other psychological interventions that can facilitate the healing processes. It is important to remember that you are not alone, and it is alright to seek external help to maintain well-being.

References

1. Belmaker, R. H., & Agam, G. (2008). Major depressive disorder. New England Journal of Medicine, 358(1), 55-68.
2. Blakey, S. M., Jennifer, Y. Y., Calhoun, P. S., Beckham, J. C., & Elbogen, E. B. (2019). Why do trauma survivors become depressed? Testing the behavioral model of depression in a nationally representative sample. Psychiatry Research, 272, 587-594.
3. Edition, F. (2013). Diagnostic and statistical manual of mental disorders. Am Psychiatric Assoc.
4. Ehring, T., Ehlers, A., Cleare, A. J., & Glucksman, E. (2008). Do acute psychological and psychobiological responses to trauma predict subsequent symptom severities of PTSD and depression? Psychiatry Research, 161(1), 67-75.

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