Updated: Feb 5, 2022
Often people ask what are the 3 types of trauma responses? If you are familiar with stress, you might have heard fight or flight. These are automatic reactions driven by our, appropriately named, autonomic nervous system.
Trauma researchers, treatment providers, and survivors are often also interested in a third trauma response; the immobilisation response. In the scope of trauma, this third trauma response occurs when fight or flight do not restore safety. But are there more than 3? Trauma specialists that have proposed at least 6.
Trauma responses are extremely disturbing, we're talking about automatic bodily reactions that serve to protect us from events that could kill us or shatter our sense of self or reality. The fact that our bodies even have these autopilot reactions is phenomenal. Personally, I like to think I'm fairly in control. But the fact remains that our bodies have an inherent intelligence and a hard-wired will to survive, and these processes take over when we need them the most.
For anyone that has suffered trauma, the experience of bearing witness to their being (i.e., their body and mind) going into autopilot beyond their mental and physical control can add another layer to the traumatic milieu. These processes can be beyond confusing and for some, met with shame.
I wanted to write this post for a couple of reasons. Firstly, I would like to offer those lucky enough to have not experienced trauma some insight into the overwhelming mental and physical experience trauma survivors have endured. Its a bit of a pet peeve of mine that that word trauma gets bandied about so easily these days. I'm not here to define trauma, that is a post for another day. But I am here to offer some insight into the depth of a trauma response.
Secondly, I wanted to write this for the trauma survivors. To offer some validation and to share with you a framework for understanding your experience.
Fight or Flight
I'll start with one of the best-known lines of defence- fight or flight. This is a body-based response controlled by our peripheral nervous system, which is situated outside of our brain and spinal cord.
The peripheral nervous system, or PNS, is subdivided into the somatic nervous system and the autonomic nervous system.
The Somatic Nervous System
This is the voluntary component of our PNS, which is responsible for our deliberate body movements and our senses such as taste and touch.
The Autonomic Nervous System
This system automatically regulates the function of body process outside of voluntary control and plays a key role in a trauma response.
The autonomic nervous system, or ANS, is further subdivided into three branches:
The sympathetic nervous system, which is activated in response to stress and trauma, controlling fight or flight.
The parasympathetic nervous system which is activated when we are calm. Often referred to as the rest and digest system because promotes growth and recovery.
The enteric nervous system, which controls the gastrointestinal system, sometimes called the second brain.
The sympathetic and parasympathetic nervous systems typically work in balance. When one is active the other is inhibited. Figure 1 shows a collection of some of the bodily functions under control of the autonomic nervous system.
Figure 1. Some of the bodily functions controlled by the parasympathetic and sympathetic divisions of the autonomic nervous system (ANS).
Stress Induced Fight or Flight
Stress can activate the sympathetic nervous system, resulting in bodily reactions such as dry mouth, increased breathing, increased heart rate, reduced gut motility, alterations in bladder activity, and changes in sexual reactivity. This system gives us the energy to fight or escape a situation. Once the stressor has been removed, or escaped, our body can find balance through activation of the parasympathetic nervous system. When this occurs, we enter a state of rest, recovery, and regeneration.
In healthy doses stress gives us the energy and focus to get things done, and rest gives us the space to recover. A day-to-day stressor may be a difficult project that we need to finish quickly. Generally, this is not life threatening but we feel there is a sense of urgency. We may focus and get the job done i.e., something akin to "fight", or perhaps we procrastinate i.e., something like "flight". Overall, we are in a state of balance when we are cycling between sympathetic and parasympathetic nervous system activation.
However, trauma is different from stress. There is a greater threat to life and sense of self, resulting in a feeling of fear. Our bodily and mental responses to trauma are different relative to stress. It has been suggested that we have a sequence of trauma responses that we move through as a threat escalates (Sachauer and Elbert, 2010). Our first line of defence is freezing. Specifically, if we encounter an event that risks our survival, we freeze so we can assess the situation. Similarly, but, as mentioned, to a lessor degree, the same could be said with stress- we pause to figure out how we are going to solve a situation. However, when we are experiencing fear our pupils dilate our sense of hearing and sight increases. We also signal our state of fear with eyes wide, eyebrows raised, and mouth open in a facial expression characteristic of fear (see Figure 2).
Figure 2. Examples of faces showing fear and anger (From Doty et. al. 2014)
During this freezing stage, we become hypervigilant: on guard, watchful, alert, hyper-focused, and ready to respond. We assess the situation and weigh our chance of survival if choosing fight or flight. For example, we might weigh up whether a perpetrator is bigger or stronger than us. Could we easily win a fight? If not, we might look around to find an escape route. If we find one, we might choose to take that option and escape. If not, we may need to form strategies to fight. Following this assessment, we might transition into a fight or flight. Or perhaps the we discover that object that had evoked a sense of fear, and demanded our attention, is actually of no concern... that's just a cord lying on the ground not a snake.
Trauma Induced Fight or Flight
A traumatic fight or flight response is more intense than that seen during stress, the bodily and mental reactions are greater and more prolonged. This is the peak of the trauma alarm response, which includes a pounding heart, increased breathing rate to oxygenate muscles, increased muscle tone sometimes resulting in shaking. We become adrenalized and ready physically to react. We fight or flight, but if this is unsuccessful, or unavailable, we start to experience increased feelings of fear, panic, and terror. These are extreme emotions that correspond with major shifts in the function of our nervous systems. Here the balance between sympathetic and parasympathetic activation is completely lost, instead both branches of the ANS become active, resulting in "dual autonomic activation".
Dual Autonomic Activation: Fright
Suddenly, the increased muscle tension that occurred during fight or flight to ready us for action becomes so strong that we become rigid "scared stiff "or "frozen with fear". We become paralysed, yet still very much aware; in a state of fright. This is the period before ‘‘shut-down’’. This trauma response is thought to have an evolutionary linage from times when we lived in greater risk of being attacked by wild animals. When physical still we are less likely to be attacked or eaten; we don't call attention to ourselves with movement. You might of noticed similar behaviour in small animals, e.g., rats and mice, when faced with a predator? As this stage progresses, we may experience dizziness, nausea, blurred vision, numbing, and an overall feeling that what is happening is not real. Here we are transitioning into a full shut-down immobilized trauma response.
Immobilization is the fifth trauma response. It often occurs in situations where the perpetrator is close or in contact, and during other life events dominated by helplessness. During an immobilization response our bodies initiate additional processes that protect us from further physical and mental harm. During this sate our parasympathetic nervous system dominates, instead of moving us towards rest and digest it goes further, and initiates physical shut-down and immobilization- sometimes called flag.
In this state there are changes in motor, sensory, and cognitive function. We become unable to move, and unlike the rigid freezing of muscles that were experienced earlier, our muscles become limp. In addition, our pain tolerance increases, physical numbness can occur, how we process information changes e.g., we lose sense of hearing and the ability to talk. There is a shift in our conscious experience e.g., we might feel that we are not a part of the event, or we might lose our sense of self and feel that it's not us that is having this experience. Memory consolidation becomes weak and later recall can be difficult. The result is a sense of depersonalisation from our body and thoughts. We enter a state of dissociation. All these reactions to trauma can be extremely confusing and alarming because they are outside of our realm of ordinary experiences.
Fainting: Loss of Consciousness
If the trauma event and defensive cascade continues, we might faint; losing consciousness altogether. It has been suggested that this is an evolutionary kindness, when faced with an event that threatens sense of life and self, loss of conscious awareness, in a way, removes us from the situation. The same could be said for dissociation. As the trauma event subsides, it can take a person minutes to hours to re-orientate back into realty from an unconscious and/or dissociated state.
Figure 3. Depiction of Dissociation from: https://www.rtor.org/surviving-trauma-dissociation-is-a-miracle
Persistent Defensive Trauma Reactions: Understanding PTSD
In all areas of life we make associations between objects, cues, and events and what they mean for us. We learn that a particular cue likely means that there will be a particular feeling or outcome. One of the strongest associations we can make is a fear memory. It makes adaptive sense to form fear memories quickly and strongly so that we have these memories to drive us away from similar life-threatening situations in the future.
For those that have been diagnosed with PTSD these cues can become detached from the place and time of the danger, meaning that fear memories can be triggered with full ferocity in situations that are safe. Cues that could trigger a trauma response could be as simple as a sound, smell, or colour. Or inert physical sensations like the feeling of something touching our skin, a sense of increased heart rate, or breathing rate. It's worth pointing out that these cues can also trigger a trauma reaction when we are not consciously aware of them; there is a great deal of mental processing going on under the realm of our conscious awareness. Overall, these intrusive memories, which are often fragmented and repetitive, occur out of place and induce corresponding trauma reactions that seem disjointed. As a result, PTSD survivors can become ‘‘stuck’’ in their trauma.
Not everyone experiences the same PTSD symptoms. This is related to the types of trauma response they experienced during the trauma event or events. Specifically, not everyone will experience all 6 trauma responses described above. Individuals that went as far as sympathetic nervous system activation (i.e., fight or flight) will show similar responses when exposed to trauma cues. Those that experienced dissociative shut-down will also show a corresponding response when reminded of their trauma. Brain scans of individuals with fight or flight vs. dissociative symptoms show that different areas of the brain have been impacted by trauma. Specifically, areas such as the amygdala are involved in a fight or flight response, while higher order sensory cortices, which integrate sensory information, are involved in dissociative trauma responses.
PTSD Induced Changes in Trauma Responses
Individuals diagnosed with PTSD may not experience the first freezing hypervigilant orientating response. Instead, when experiencing a stressful or highly emotionally charged situation they immediately experience fight or flight. This is because many PTSD survivors are constantly in a hypervigilant state- they are stuck in the first phase of a trauma response. So, experiencing the next stage of the defensive cascade occurs quickly. However, with ongoing trauma this can also change.
When survivors of trauma speak about an event during exposure therapy or when triggered by a cue it can be obvious that their hearts are racing, their palms sweat, and their breathing becomes heavy. However, those that have experience multiple traumas soon stop having these body-based reactions, instead they report feeling numb and unreal. This almost seems like a protective mechanisms, because of repeated trauma we lose the ability to experience a physiological emotional reaction. But here, we develop some of the most profound body-based symptoms of trauma.
A trauma history can also change the way a person dissociates. Dissociative responses can be learnt. Initially it may take minutes to reach a dissociative state. For survivors of trauma the dissociative state offered a reprieve from the event, in a way it was rewarding. As a result, the process of dissociation can be reinforced. I have spoken to some of my clients about dissociation and some see it as a tool that they use as needed, they have control over their dissociative response and can choose whether they move into that sate. However, others unexpectedly dissociate. While yet others may experience a sense of control in some situations and loss of control in others.
Typically, when we think of trauma, it's not uncommon to think that there are 3 types of trauma response: Fight, Flight, and Freeze. (This is what I found when I did a quick google search). However, the work by Schauer and Elbert suggests that there are at least 6: Freeze, Fight, Flight, Fright, Flag (shutdown and dissociation), and Faint (loss of consciousness).
These are adaptive responses that serve to promote our survival. However, for those that develop PTSD these responses can become persistent and symptoms of their PTSD. Understanding how these symptoms came about can be beneficial for the healing process. In addition, knowing that these reactions are automatic can also be helpful for those that are dealing with confusion and shame associated with their reactions during and after the trauma event.
Here I've described a defensive cascade of trauma responses that occur during one or multiple trauma events. However, responses associated with more complex trauma or developmental trauma include some additional trauma response, which will be the topic of a future blog post.
I hope this information is helpful for trauma survivors and for those interested in finding out more about the profound depth of trauma responses.
About the author:
Kathie Overeem (PhD Psychology) has 9 years experience working in trauma. Her MSc and PhD focused on how we form and express fear memories, since 2018 she has worked therapeutically with survivors of trauma using trauma-sensitive yoga (i.e., TCTSY).
If you are interested in connecting or working with Kathie, please use the contact tab above.