Mental Health

A mental trauma means a severe mental injury. It can be the result of an exceptionally stressful personal experience. Such an experience can have a traumatising effect if one’s own possibilities for coping with the situation are not sufficient, and those affected are consequently massively overtaxed. This creates an extremely high emotional strain (stress). In such situations people often feel completely helpless, experience great fear or are horrified.

Possible traumatizing events are situations of extraordinary threat or catastrophic proportions that would cause deep despair in almost everyone. Examples include natural disasters, serious accidents, wars, deaths of close relatives, life-threatening diseases, and physical or sexual violence.

People can be affected by extremely stressful events in various ways. They can be affected themselves, have observed this (e.g. as helpers) or be affected by the news of the actual or imminent death of loved ones.

Many immediate psychological reactions to very stressful experiences are normal and not an expression of mental illness. Whether an event has a traumatizing effect also depends on the circumstances and the individual people with their personal experiences. For example, the sight of a severely injured person can have a traumatic effect on a passer-by, while for rescue services it is usually routine and not traumatic. The social support experienced by those affected after very stressful events also has a great influence on whether a psychological problem (so-called trauma disorder) arises.

Which situations can have a traumatising effect?

There are various extremely stressful events that can be distinguished.

There are situations caused by chance (e.g. accidents, natural disasters) and by people that can have a traumatising effect. The latter are characterised by the fact that people have inflicted the extremely stressful event on other people (e.g. physical or sexual violence). Severe illnesses, medical interventions and experiences of loss can also be experienced traumatically.

A distinction is also made between how long the stress lasts and how frequent it is. An assault usually lasts for a short time and is unique, while physical violence in a partnership can last a long time and can occur again and again over many years.

Already in childhood and adolescence many people experience traumatic situations. In active forms, people actively inflict violence on children and adolescents. This is the case, for example, with physical violence (e.g. beating, slapping), sexual violence or emotional violence. Sexual violence refers to all sexual acts carried out against the will of the victim using violence, threatening with present danger to life or limb or exploiting an unprotected situation.

Emotional violence, for example, means conveying to a child that he or she is worthless, unloved, in danger, or exists only to meet the needs of others. Neglect belongs to the passive forms, because children get too little of something. Children who are physically neglected, for example, are not protected enough or have too little food. Children who are emotionally neglected receive less closeness and security than they actually need.

How common are extraordinarily stressful events?

In Germany, about 24 out of 100 people experience at least one traumatic event in the course of their lives. There are differences between women and men with regard to the type of traumatic experience. More women experience sexual violence, while more men experience accidents, assaults and imprisonment in war. Older people have experienced traumatic events in war more often than younger people. According to estimates, 1 to 13 out of 100 people in Germany have already been victims of sexual violence in childhood.

Acute stress reaction

As a direct consequence of a traumatic experience, an acute stress reaction can occur, which usually passes after a few hours or days.

Various symptoms can occur. For example, some people no longer feel any feelings, feel indifferent, confused and withdraw. Some still feel very threatened and physically very restless. Some people can no longer remember the event or have the feeling that their own person, other people (depersonalisation) or the environment (derealisation) has changed, looks strange or unreal.

These complaints can be accompanied by anxiety, depressive moods, physical complaints and the use of substances such as alcohol or medication.

Post-traumatic stress disorder

If these mental complaints last longer than 4 weeks in a very stressful form, a post-traumatic stress disorder may be present. The discomfort can also be delayed, i.e. it can occur for the first time some time after the traumatic event.

What can those affected do to cope well with stressful experiences?

After one or more exceptionally stressful events, the threat should be ended and the greatest possible security restored. In the event of accidents and major emergencies, the police, fire brigade and rescue services can help. For psychological support during or shortly after such events, psychosocial emergency services are available in many places (e.g. emergency pastoral care or crisis intervention teams). In case of violence by strangers or within relationships or families, the police and other contact points (e.g. confidential telephone counselling, victim counselling centres, women’s shelters or youth welfare offices) can help.

The loss of security and control experienced during and after critical situations is often particularly stressful. It is therefore very important for those affected by such experiences to regain as much control as possible over their own lives as well as their safety. So it can be helpful to determine as much as possible yourself (e.g. whom I would like to have with me now, where I would like to be now, etc.).

The possible psychological consequences of the experiences cost a lot of strength, which is why the resilience of those affected usually decreases at first. Then it is good to provide some relief and to seek out pleasant and restful situations. Moderate physical activity can help with high levels of tension, and the exercise of familiar activities is often helpful with stress caused by memories that come to mind.

Familiar persons or trained personnel can help to deal with the extreme situation they have experienced. Talking to these trustworthy people about what they have experienced in a way that is relieved but not overburdened can help them cope.

Anyone who continues to suffer severely from the consequences during the first days and weeks after the stressful event or who experiences difficulties in everyday life (e.g. feeling overburdened) should seek medical or psychotherapeutic help.

Even if strong fears, physical tension, the feeling of being numb, re-experiencing the traumatic situation, avoiding the memory of the traumatic situation, risk behaviour (e.g. increased alcohol or drug consumption) or similar complaints persist after the situation, it is advisable to seek medical or psychotherapeutic help.

How can others help?

Direct support during the potentially traumatic situation.

As described, potentially traumatic events are often accompanied by strong feelings of helplessness and loss of control. Therefore, any support should help those affected to recognise and use their own coping skills (increasing “self-efficacy experience”).

One possibility for this is to let the affected person determine what would be helpful for them now. In order to convey security and offer additional orientation, it can be helpful to speak with the affected person as calmly, clearly and unambiguously as possible. Helpers should only touch affected persons with their express consent. Sometimes a friendly touch is experienced as threatening due to negative previous experiences as well as great fear and tension.

Support by close persons after the potentially traumatizing situation.

It is important for those affected that close people recognise their reaction as a normal response to an abnormal event and are there for them. If the person wants to talk to their loved ones about what they have experienced, this can also be very helpful.

Here it is particularly advisable to be there, to listen and not to judge the narrative, as the person in question sometimes blames himself or herself. However, everyone should also pay attention to their own stress limits and, if necessary, suggest involving professional help.

Especially when close people have experienced the situation themselves and are therefore affected themselves, it can be helpful to talk to other people who are not affected in order not to burden each other too much.