Information about trauma and its consequences plays an important role in recovery. Survivors and their family members who understand trauma are better able to predict when symptoms will occur and learn new, more effective coping skills.

The links below are designed to provide some of the information that can be critical in recovery:

1. Psychological Symptoms After Trauma
2. Acute Stress Disorder
3. Post-Traumatic Stress Disorder
4. What to Expect
5. Managing Sleep Problems After Trauma
6. Managing Flashback

Most of those who are exposed to a potentially traumatic event do not develop significant psychological symptoms and will recover with little difficulty.

Below is a list of possible trauma-related symptoms:

Initial Crisis Reaction
"Fight or flight," physical shock, disorientation, numbness, enhanced psychological/physical abilities, fatigue

Short Term Response
Fear/terror, anger, guilt/questions about response, thinking about and/or reexperiencing the event, withdrawal and isolation, sensitivity to triggers, avoidance of reminders, problem concentrating

Long Term Response
Work problems, development of psychological problems, i.e. anxiety, depressive disorders, conflict, physical problems

The Diagnostic and Statistical Manual (DSM-IV), published by the American Psychiatric Association, describes psychological disorders. They are used by mental health professionals and others to make diagnostic decisions.

A. The person has been exposed to a traumatic event in which both of the following were present:

1. the person experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
2. the person's response involved intense fear, helplessness or horror

B. Either while experiencing or after the experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:

1. a subjective sense of numbing, detachment, or absence of emotional responsiveness) a reduction in awareness of his or her surroundings (e.g., "being in a daze")
2. (3) derealization
3. 4) depersonalization
4. 5) dissociative amnesia (i.e. inability to recall an important aspect of the trauma)

C. The traumatic event is persistently reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the event.

D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g. thoughts, feelings, conversations, activities, places, people).

E. Marked symptoms of anxiety or increased arousal (e.g. difficulty sleeping, irritability, poor concentration, hypervigilence, exaggerated startle response, motor restlessness).

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.

G. The disturbance lasts for a minimum of two days and a maximum of four weeks and occurs within four weeks of the traumatic event.

H. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, an is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

— DSM IV, American Psychiatric Association

The Diagnostic and Statistical Manual (DSM-IV), published by the American Psychiatric Association, describes psychological disorders. They are used by mental health professionals and others to make diagnostic decisions.

A. The person has been exposed to a traumatic event in which both of the following were present:

1. the person experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
2. the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed by disorganized or agitated behavior

B. The distressing event is persistently re-experienced in at least one of the following ways:

1. recurrent and intrusive distressing recollections of the event including images, thoughts or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed
2. recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
3. acting or feeling as if the event were recurring (includes a sense of reliving the experience, illusions, hallucinations, or dissociative flashback episodes, including those that occur on awakening or when intoxicated. Note: In young children, trauma specific reenactment may occur.
4. intense psychological distress at exposure to internal or external cues that symbolize or resemble as aspect of the event.
5. physiological reactivity on exposure to internal or external cues that symbolize or resemble as aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness is (not present before the event), as indicated by three (or more) of the following:

1. efforts to avoid thoughts or feelings or conversations associated with the trauma
2. efforts to avoid activities, places or people that arouse recollections of the trauma
3. inability to recall an important aspect of the trauma
4. markedly diminished interest or participation in significant activities
5. restricted range of affect, e.g., unable to have loving feelings
6. sense of a foreshortened future, e.g., child does not expect to have a career, marriage, or children, or a long life

D. Persistent symptoms of increased arousal (not present before the event) as indicated by two (or more) of the following:

1. difficulty falling or staying asleep
2. irritability or outbursts of anger
3. difficulty concentrating
4. hypervigilance
5. exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

— DSM IV, American Psychiatric Association

Immediate emotional changes are normal. For most people, they will fade with time. About 25% of those exposed to trauma will experience longer term problems.

Survivors who have experienced other traumatic events may be more or less likely to have further difficulties.

Survivors with difficulties may alternate between periods when they are anxious and re-experience the incident and times when they are depressed and withdraw from family, friends and activities. These changes are to be expected.

Situations which include strong reminders of the traumatic incident may make post trauma consequences worse.

Anniversaries of the event may cause memories and worsen post trauma consequences.

Families and friends become co-survivors and often experience post trauma consequences of their own.

Survivors who recover most effectively are those who take specific actions to manage their consequences.

There is no substitute for sleep. Sleep provides important physical and psychological benefits and provides the opportunity to replenish important brain chemicals. People need a wide variation of sleep, anywhere from one to ten hours a day. The important thing is that you receive enough sleep to feel relaxed and alert.

Sleep problems are common among people exposed to traumatic events. You may find that your usual methods of falling asleep no long work or that you wake up during the evening or early in the morning. Nightmares and terrors may also occur.

Practicing good sleep hygiene may be of some assistance. Consider some of the following tips adapted from an article by Connie Saindon, a psychotherapist in California.

1. No reading or watching TV in bed. These are wake activities. Your bed should be used for sleep activities.
2. Go to bed when you're sleep-tired, not when it is time to go to bed by habit,
3. Wind down during the second half of the evening before bedtime. 90 minutes before bed, don't get involved in any kind of anxiety provoking thoughts or activities.
4. Do some breathing exercises or try to relax major muscles groups starting with the toes and ending with your forehead.
5. If you don't fall asleep in 15 to 20 minutes, get up and do something relaxing.
6. Have your room cool rather than warm.
7. Don't count sheep, counting is stimulating.
8. Exercise in the afternoon or early evening, but no later than 3 hours before bedtime.
9. Don't overeat and eat 2-3 hours before bedtime.
10. Don't nap during the day.
11. If you awake during the middle of the night and can't get to sleep within 30 minutes, get up and do something else.
12. Have no coffee, alcohol or cigarettes two to three hours before bedtime.
13. Schedule 30 minutes of writing about your concerns and hopes each day to reduce anxiety.
14. Listen to calm music or a self-hypnosis tape for sleep

Only a few people experience flashbacks after exposure to a traumatic event. The more vivid the sights, sounds and smells of the incident, the more likely you will be to develop them.

Here are some suggestions that you may find helpful in managing flashbacks.

You are likely to experience more flashbacks if you believe that you are "going crazy" or "losing it". Flashbacks will likely fade as you remind yourself that they are okay.

Flashbacks may follow a "trigger". A trigger is an event or thought which reminds you of the traumatic incident. It is also possible that there will be no trigger. These flashbacks seem more scary because they are less easily explained.

Learn how to talk to yourself. When you have a flashback, remind yourself of the facts. Talk to yourself by saying something like:

I’m okay. I just had a really scary flashback," or "Flashbacks are normal after what I lived through."

Learn how to talk to others. Tell them in detail about what you have experienced. Ask them if you can talk to them again when you have other post trauma consequences.

If flashbacks interfere with your work or at home, consider seeking post-trauma counseling.