The Difference Between Acute and Chronic Trauma

Trauma is defined as an emotional response to a terrible event. This emotional response may include denial, shock, anger, and fear.

Trauma can be acute or chronic, depending on the traumatic experience. A single, isolated event can lead to acute trauma, which may have both short-term and long-term consequences. Chronic trauma develops from repeated, prolonged traumatic events.

This article explores acute trauma and chronic trauma, including in children and teens. After discussing the symptoms of trauma, it outlines treatment options.

The Trauma Spectrum

People's response to trauma exists on a spectrum. Not everyone who experiences the same traumatic event will have the same response. Some people may go on to be diagnosed with post-traumatic stress disorder (PTSD), while others may be affected but for shorter periods or at a clinically undiagnosable level.

Acute and chronic trauma are categorized according to the type of event a person has experienced. For example, an isolated incident such as a car accident is considered acute trauma, but continuing events such as domestic abuse can be considered chronic trauma. Complex trauma is a combination of both acute and chronic trauma, often occurring in childhood, that disrupts many aspects of development and one's sense of self.

Trauma's effects on the brain are complex and not fully understood. However, it is known that various biological changes can occur after a traumatic event that affects the body's stress response and are associated with PTSD and other mental health conditions. Changes can be to limbic system functioning (behavioral and emotional responses), dysregulation of neurotransmitters that affect arousal (commonly known as the "fight-or-flight" response), and hypothalamic–pituitary–adrenal axis (HPA) changes impacting cortisol (a stress hormone).

Acute Trauma

Acute trauma refers to trauma brought on by a single, isolated event. Single-incident trauma can lead to significant, complex symptoms and even PTSD in some cases.

Studies on mass shootings, a type of acute trauma, have identified risk factors for adverse psychological effects. These risk factors include being female, being in close proximity to the event, experiencing greater psychological symptoms before the incident, and lacking psychological and social support resources.

Anywhere from 6%–33% of people who experienced trauma develop acute stress disorder (ASD) for the first month following the event. Most people with ASD go on to have PTSD in six months. ASD has the same symptoms as PTSD, but they get better within a month.

Causes

Examples of acute traumatic events include:

• Physical assault
• Sexual assault or rape
• Natural disasters (including hurricane, flood, wildfire, or earthquake)
• Mass shootings
• Terrorist attacks
• Car crashes
• Major injuries

Chronic Trauma

Chronic trauma refers to repeated, prolonged traumatic events. There is a large body of research on chronic trauma and its adverse health effects.

Studies show that children exposed to chronic trauma have a higher risk of mental health disorders, poor academic achievement, and becoming a juvenile offender. Mothers exposed to chronic war-related trauma have changes in their brain associated with showing empathy, possibly having implications for generational trauma.

Causes

Examples of chronically traumatic situations include:

• Domestic abuse
• Witnessing abuse of a parent or household member
• War or combat
• Community violence
• Chronic illness, including frequent invasive medical procedures
• Neglect, starvation, or deprivation
• Homelessness

Symptoms of Trauma

Response to trauma is extremely varied among individuals. Most people exposed to trauma, acute or chronic, do not go on to be diagnosed with a mental health condition like PTSD.

However, they may have an understandable emotional or physical response to the traumatic event(s), leading to a variety of symptoms. These symptoms may be experienced immediately after the traumatic event, or the response may be delayed by a period of weeks or months.

Emotional Symptoms

Emotional symptoms of acute or chronic trauma can include:

• Shock
• Denial
• Sadness
• Anxiety and fear
• Depression
• Anger
• Avoidance of emotions
• Agitation
• Numbness or dissociation
• Difficulty concentrating
• Intrusive memories or flashbacks
• Difficulty regulating emotions
• Loss of hope
• Feeling of foreshortened future

Physical Symptoms

Physical symptoms of acute and chronic trauma can include:

• Headaches
• Nausea
• Exhaustion
• Jumpiness or being easily startled
• Sweating
• Difficulty sleeping, including nightmares
• Frequent crying
• Gastrointestinal issues and stomach pain
• Shortness of breath
• Racing heart rate

Trauma Symptoms in Children and Teens

It's important to be aware that young people may respond differently to trauma than adults. Some symptoms of trauma in children and teens to be aware of include:

• Tantrums
• Clinging to parents and/or caregivers
• Acting out parts of the traumatic event during playtime
• Return to thumb-sucking or bed-wetting
• Nightmares and sleep issues
• Developing unusual fears
• Issues in school
• Losing interest in previously enjoyed activities
• Use of illicit drugs or alcohol

Treatment for Acute and Chronic Trauma

To respond to the initial response to trauma, try to find a safe environment where the person's essential physical and emotional needs can be met. This might include relocating to a domestic violence shelter, moving into subsidized housing, or obtaining a restraining order.

Once the person's basic needs are met and they are safe, they might benefit from treatment with a trained mental health professional who takes a trauma-informed approach.

Methods of therapy treatment include:

• Cognitive behavioral therapy (CBT): This type of talk therapy addresses harmful thinking and behavioral patterns by bringing awareness to and changing them.
• Cognitive processing therapy (CPT): CPT is similar to CBT, but is designed specifically for addressing distressing thoughts and beliefs related to trauma. The treatment typically consists of 12 sessions.
• Prolonged exposure: This talk therapy addresses avoidance symptoms of PTSD by gradually re-exposing people to trauma-related feelings, situations, and places. The experience can be uncomfortable but has also been shown to be effective.

Eye movement desensitization and reprocessing (EMDR), brief eclectic psychotherapy, and narrative therapy have less evidence to support them but are also used.

Medication may be prescribed on an individual basis, particularly if there are any co-occurring mental health conditions.

There are also some recommended lifestyle changes to help cope with trauma. Some methods to help cope in the aftermath of acute or chronic trauma include:

• Avoiding alcohol or substances
• Maintaining your regular routine as much as possible
• Keeping a normal bedtime and sleep routine
• Eating nutritious meals on a regular schedule
• Spending time with supportive loved ones
• Journaling or writing

When to Talk to a Therapist

If your symptoms are prolonged, interfering with your daily life, or if you are having difficulty moving on with your life, then it may be time to talk to a psychologist or mental health professional. They can help you process your trauma and learn new ways of coping and managing your emotions.

Summary

Trauma is an emotional response to a horrible event. It may lead to anger, denial, numbness, fear, and even physical symptoms. Acute trauma refers to trauma brought on by a single incident, whereas chronic trauma refers to trauma brought on by multiple or prolonged incidents. The response to these incidents is highly individual. Symptoms may occur immediately or after a delay, and treatment will differ based on a person's individual needs and response.