Trauma alters three primary parts of the brain: the prefrontal cortex (thinking center), the anterior cingulate cortex (emotional regulation), and the amygdala (fear center). The thinking center is located behind your forehead and is responsible for rational thought, problem solving, personality, planning, and empathy. The emotional regulation center is located next to the thinking center and is responsible for regulating emotion. When healthy, the emotional regulation center works closely with the thinking center. The fear center is located deep inside the brain and cannot be controlled by our conscious. The fear center is responsible for determining what is and is not a threat, and when it detects danger, it creates feelings of fear. When an individual has experienced trauma, their thinking and emotional regulation centers are underactive and the fear center is overactive.

Trauma survivors cannot simply leave their trauma in the past or choose to forget about it. To move forward, their brains need to be changed, which takes great effort, repetition, and time. Psychotherapy is the most beneficial way to bring about this result because it works with the body and the mind to help the traumatized person transition their brain back to a healthy state. Psychotherapy also helps the person integrate the trauma, which can help a survivor recover key traumatic memories that their brain blocked out due to the intensity of the event.

If you are a trauma survivor or have a loved one who is battling with trauma, learning about the symptoms of Post-Traumatic Stress Disorder (PTSD) and the phases of trauma will help you understand what happens as you walk through this process yourself or alongside another.


The American Psychiatric Association states that to have Post-Traumatic Stress Disorder (PTSD), “a person must have experienced or witnessed an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and which involved fear, helplessness, or horror.”

The four main symptoms of PTSD are re-experiencing, avoidance, hyperarousal, and negative thoughts and feelings.


Even when the traumatic event or events are no longer occurring in a survivor’s life, these events have a lingering affect which often leads survivors to feel that they are experiencing the trauma over and over again. Survivors of traumatic events re-experience their trauma in multiple ways:

  • Triggers. A trigger is a psychological stimulus that cause the survivor to recall his or her traumatic experiences. The stimulus itself does not need to be traumatic or even directly associated to the event.

  • Nightmares. For traumatized individuals, nightmares include the horrific elements that were occurred in the trauma, as well as associated elements.

  • Flashbacks. Flashbacks re-create the images, sensations, and emotions of the original event or events and cause survivors to experience similar levels of stress and hormones in the body that they had during the event.

  • Physical response. When reminded of the traumatic event, survivors can experience a surge in their heart rate or begin to sweat, often followed by a panic attack.

2. Avoidance

Survivors of trauma who struggle with PTSD subconsciously use avoidance techniques to steer clear of triggers or situations that might make them think about the trauma. Some of the most common characteristics of avoidance include:

  • Avoiding people, places, or situations that are reminders of the traumatic event.

  • Avoiding conversations or feelings that bring up the traumatic event.

  • Creating busyness in life to ensure that there is no time for the brain to be invaded by thoughts of the traumatic event.


Hyperarousal occurs when a survivor’s body jumps into high alert mode when triggered by their trauma. The trauma survivor does not have to be in imminent danger in order to feel as though they are. Trauma survivors in hyperarousal mode generally experience these symptoms:

  • Highly irritable, with outbursts of anger.

  • Struggle to concentrate or to remain focused for prolonged periods of time.

  • Jumpy, startled, and constantly on guard as though the danger is present.


After a traumatic event or series of events, survivors often feel confused, ashamed, fearful, and in shock. When the shock wears off, additional negative thoughts and belief creep in. Too often, others respond in ways that are not helpful to the survivor’s healing process, responses which also play into these common elements of the survivor’s negative thoughts and beliefs:

  • Dissociation, or a survivor’s feeling of being disconnected from themselves. With disassociation, a survivor can temporarily lose touch with what is happening, or in extreme cases, lose memories completely for prolonged periods of time.

  • Loss of interest in activities that were once important to the individual.

  • Difficulty experiencing feelings or creating associations that are positive and beneficial.

  • Feeling distant from loved ones and close friends.


Many people with PTSD experience a single traumatic event (perhaps a natural disaster or single violent assault). When the trauma is ongoing or occurs through a prolonged series of events, a Complex PTSD (C-PTSD) diagnosis bridges an important behavioral health gap. C-PTSD most frequently appears in those who’ve been abused by someone who was supposed to be their caregiver or protector.

Research on C-PTSD suggest that this type of trauma can have a lasting effect on the amygdala, hippocampus, and prefrontal cortex—areas which play a big role in memory function and how we respond to stressful situations.

Those with C-PTSD typically have the symptoms of PTSD along with additional symptoms, including:


Those with C-PTSD may have uncontrollable feelings, such as explosive anger or ongoing sadness.


This can include forgetting the traumatic event or feeling detached from one’s emotions or body, which is called dissociation.


C-PTSD can cause guilt or shame to the point where the person feels completely different from other people.


Someone with C-PTSD may avoid relationships out of mistrust or feeling that they don’t know how to interact with others. Others may seek out relationships with people who harm them because it feels familiar.


Some may become preoccupied with the relationship between themselves and the abuser. They may be preoccupied with wanting revenge or give the abuse complete power over their life.


Systems of meaning can refer to religion or beliefs about the world. For example, those with C-PTSD may lose faith in long-held beliefs they had or develop a strong sense of despair or hopelessness about the world.

It’s important to note that symptoms of PTSD and C-PTSD can vary widely among survivors and even within an individual. For example, a person might avoid social situations for a period of time, only to start seeking out potentially dangerous situations months or years later. If you’re close to someone with C-PTSD, it’s important to remember that their thoughts and beliefs may not always match up with their emotions.

Note: C-PTSD is a fairly new diagnosis, and a full diagnosis is not yet available in the Diagnostic an Statistical Manual (DSM) although C-PTSD is mentioned. The World Health Organization (WHO) has included C-PTSD in the final draft of the 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) published in June 2018. This means that while many countries recognize C-PTSD, the United States has yet to recognize the diagnosis.

Phases of Trauma


The survivor:

  • Is in shock, not in a safe place to begin processing the trauma.

  • Feeling unsafe in their bodies and with others.

  • Struggles to regulate and manage difficult and overwhelming emotions.

  • Avoids speaking about the trauma because it is emotionally overwhelming.

  • Needs to focus on calming the nervous system by determining which areas of life need to be stabilized and to accomplish that.


The survivor is:

  • Processing the trauma, beginning with putting words and emotions to the trauma.

  • Focusing on integrating the trauma through safety and stability rather than having fight, flight, freeze responses.

  • Needing space to explore grief and mourn the losses from the trauma.


The survivor is:

  • Creating a new sense of self and a new future. 

  • Redefining meaningful relationships.

  • Not defining life by the trauma; the trauma is integrated into their life story.

  • Recognizing their victimization while taking steps toward empowerment and resilience.

  • Possibly having thoughts or feelings associated with the trauma, but those thoughts or feelings no longer are in control.


Play Video

“Understanding Trauma: Scientific, Clinical, and Interpretive Perspectives on Sexual Violence.”
A conversation at the MSU Museum
Tuesday, Jan. 15, 2019
Moderated by:
Heather L. McCauley, 
MSU Human Development and Family Studies Department 

Rebecca Campbell, MSU Department of Psychology
Tana Fedewa, MSU Sexual Assault Program
Amy Bonomi, MSU Human Development and Family Studies Department
Nicole Buchanan, MSU Department of Psychology
Melissa Hudecz, The Army of Survivors
Apryl Pooley, Firecracker Foundation Board President