The Two Types of Trauma (and Why to Know the Difference)

I grew up thinking that trauma looked like Martin Sheen in the beginning of the movie Apocalypse Now. Sweating, shaking, eyes bulging with terror, shell-shocked and alone in a room. It stopped me from recognizing my own trauma from intimate partner abuse, because I didn't look like that.

Even through the worst of it, I was highly functional. I had my shit together. Trauma? I wasn't hunched up, crying in a corner. I didn't miss work. I figured I didn't have trauma. So I didn't notice the lack of sleep, the hypervigilance, the gradually intensifying isolation and crippling self-doubt — all so unlike me.

I didn't know how to see what was right in front of me, because I didn't know how to recognize the two types of trauma. All I knew about was the famous one — PTSD.

But there are actually two types of trauma. And once you know, they're simple to tell apart.

Why Everyone Keeps Talking about Trauma

Some of you have reached out to say, "Elie, why all this talk of trauma? I hear ‘trauma’ everywhere now!"

Trauma is entering into the public consciousness because in the last two decades, the evidence base and best practices for trauma recovery have undergone a seismic paradigm shift.

What we now know about trauma, the brain, and the body is currently revolutionizing medicine, psychology, therapy and psychedelic therapy, neurobiology, public health, and many other healing disciplines.

Learning about trauma is like learning about gravity. Some things are so simple that once you learn them, it's hard to remember how you saw the world before. For many of us, understanding trauma is like that. It suddenly makes a lot of things make sense.

Leaders and changemakers need to know about the two types of trauma so we can better support ourselves and each other.

A New Understanding of Trauma

"Trauma" is a “a deeply distressing or disturbing experience” or in medicine, a “physical injury.”

When a deeply distressing or disturbing experience happens, it affects all parts of us: our minds, our emotions, and our bodies.

Trauma can be observed as a brain injury and it presents as inactivity in the prefrontal cortex in studies of veterans with Post-Traumatic Stress Disorder, also known as PTSD.

Along with many trauma experts, I do not believe that our response to stress is a "disorder", but rather our bodies' mammalian and highly-intelligent way of responding to shock.

As trauma expert Peter Levine notes in his research, all mammals have an inbuilt mechanism that responds to stress and helps us reset afterwards (we literally shake it off).

Trauma happens when the body's system is overwhelmed and believes it is unable to handle whatever is happening.

As trauma expert Resmaa Menakem says, "Trauma is anything that happens too much, too soon, too fast, or for too long — and it's not enough of something reparative. We get stuck when there is no repair."

That is powerfully important.

Trauma is what happens when we don't get to reset and repair. When we don't get the connection and nourishment that we need in order to rest. When we force ourselves to push through something existentially overwhelming without time to repair.

1. PTSD

The first type of trauma is Post-Traumatic Stress Disorder (PTSD), which was identified in the West as a psychological disorder after decades of research on US Vietnam War veterans. "Shell shock" is another way to think about PTSD.

It took decades of work to create the paradigm shift that recognized PTSD. Before that, psychiatrists, psychologists, and physicians saw PTSD as a weakness in military men and not a natural consequence of war.

PTSD is about something really bad happening, a one-time incident that overwhelms the body and makes us feel like we are about to die. In the opening scene from Apocalypse Now, Charlie Sheen is experiencing a PTSD episode.

PTSD develops because in the aftermath, we are not able to complete the stress cycle. The body is so overwhelmed with terror that we don't move out of the stress and into the "rest and digest" part of the response. If we could, we would complete (and end) the stress cycle.

Each body has its own felt sense of overwhelm and terror. That’s why people can experience similar events and one person gets PTSD and the other doesn’t.

When the system is overwhelmed, a stressful event literally gets "stuck" in the body as sensations, emotions, and thought patterns. These patterns get activated by a traumatic “trigger” that initiates a flashback.

PTSD is characterized by a one-time event happening, like an accident, rape, or a violent assault. PTSD flashbacks are visual and feel like the body and brain are back at the actual event as if it is happening in real time all over again.

It is extremely intense and overpowering. A PTSD flashback is a visceral re-living of the traumatic event. It can be "triggered" by almost anything. A body with unresolved trauma is often hypervigilant, on the eternal lookout to prevent a repeat of what happened before.

2. Complex PTSD (CPTSD)

Complex PTSD is what happens when the traumatic event, rather than being a one-time thing, keeps happening. The trauma is ongoing and this has lasting negative impacts on mental, physical, and emotional health.

One of the characteristics of Complex PTSD is that the person could not or did not feel like they could get away. Being trapped is an essential part of it.

Complex PTSD flashbacks are often emotional or felt sensations, which can be confusing because we might not recognize where they come from or what they mean.

Complex PTSD also involves more deep-seated psychological and emotional wounding. For example, we might feel like failures, deeply ashamed of ourselves, and burdened with guilt without exactly knowing why. We might experience severely negative beliefs about ourselves, like I did when I was experiencing intimate partner abuse. For me, those thoughts were so unlike my usual nature that they raised alarms.

People with Complex PTSD are also easily emotionally dysregulated, meaning that it's harder for us to settle. Because Complex PTSD involves prolonged interpersonal trauma, it's also often difficult to trust other people or to feel safe being vulnerable.

Complex PTSD is often unrecognized and misunderstood, but it’s experienced by a significant number of people of all ages around the world.

Some people mistakenly think it’s a matter of willpower to “move on and get over it,” which just makes things worse. It’s not our fault that these events happened and our bodies responded in the natural way.

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I hope that learning about the two types of trauma will help you better understand yourself and others.

Most people don’t realize that trauma is a temporary state.

Whether it's from a one-time traumatic event or the ongoing trauma of childhood or intimate partner abuse, the body naturally wants to heal from what happened.

Remembering this always gives me tremendous hope, because it means that healing is always possible. No matter what.

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 Thank you for reading!

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