• Traumatic events are shocking and emotionally overwhelming situations that may involve actual or threatened death, serious injury, or threat to physical integrity.
• Reactions to traumatic events vary considerably, ranging from relatively mild creating minor disruptions in the person's life to severe and debilitating.
• Acute Stress Disorder And Post Traumatic Stress Disorder are mental health diagnoses associated with traumatic stress reactions.
• Other difficulties can co-occur with mental health symptoms, including physical health problems and changes in beliefs about safety.
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What can be helpful after trauma?

• Connecting to natural support systems (friends, family) and taking care of basic needs.

How to decide whether you need help

• For many people, natural coping allows the reactions to gradually diminish.
• When disturbing symptoms persist or worsen it may be useful to seek professional help.
• If attempts to cope lead to unhealthy or unhelpful outcomes (e.g. alcohol or drug use, withdrawing from friends and family), it may be useful to seek professional help.

Treatment options

• Integrative Trauma Focused therapy
• Trauma Focussed Cognitive Behaviour Therapy
• EMDR

During long-term traumas, the victim is generally held in a state of captivity, physically or emotionally, according to Dr. Herman (1). In these situations the victim is under the control of the perpetrator and unable to get away from the danger.

Examples of such traumatic situations include:

• Concentration camps
• Prisoner of War camps
• Prostitution brothels
• Long-term domestic violence
• Long-term child physical abuse
• Long-term child sexual abuse
• Organised child exploitation rings

An individual who experienced a prolonged period (months to years) of chronic victimisation and total control by another may also experience the following difficulties:

• Emotional Regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
• Consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes or body (dissociation).
• Self-Perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
• Distorted Perceptions of the Perpetrator. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
• Relations with Others. Examples include isolation, distrust, or a repeated search for a rescuer.
• One's System of Meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.

Because people who experience chronic trauma often have additional symptoms not included in the PTSD diagnosis, clinicians may misdiagnose PTSD or only diagnose a personality disorder consistent with some symptoms.

Care should be taken during assessment to understand whether symptoms are characteristic of PTSD or if the survivor has co-occurring PTSD and personality disorder. As Clinicians we need to assess for PTSD specifically, keeping in mind that chronic trauma survivors may experience any of the following difficulties:

• Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming.
• Survivors may use alcohol or other substances as a way to avoid and numb feelings and thoughts related to the trauma.
• Survivors may engage in self-mutilation and other forms of self-harm.
• Survivors who have been abused repeatedly are sometimes mistaken as having a "weak character" or are unjustly blamed for the symptoms they experience as a result of victimisation.

I offer a thorough Clinical Assessment and occasionally may recommend a Psychiatric Assessment if its appropriate for formal diagnosis and if required.