The Trauma Trap: How Your Brain Is Helping You Endure What You Shouldn’t Have To
Please be advised that this is not a lighthearted topic, and this episode includes examples, information, and statistics that may be upsetting. If you feel overwhelmed, have a hard time following along, or find you're responding in a more emotional rather than intellectual way, that's completely normal, but please remember to be nice to yourself, take breaks, and reach out to your support system, your psychotherapist or mental health provider, or a crisis line or crisis website, if you need to. [text/call 988 or visit 988Lifeline]
Hello, my friends. In the last episode, I went over several of the most common misdiagnoses assigned to neurodivergent adults, why that happens, and how to at least begin to explore any diagnoses you've been assigned that don't really explain your problems, and definitely aren't helping you solve them. Posttraumatic Stress Disorder is a diagnosis many neurodivergent people have, and likely many more qualify for, but haven't been assigned. Trauma responses, in general, have tremendous overlap with aspects of neurodivergence, which increases the likelihood of either one being diagnosed while the other is missed, but there's so much more information on this topic, it has to be its own episode. And even with it being today's topic, I'll only be able to scratch the surface, but people ask me about this very frequently, and it impacts nearly all of us in one way or another, so I'm going to take a run at it today. Part of the reason both neurodivergent and neurotypical people have so many questions about trauma is that the basic foundational concepts and definitions aren't well understood — or at least they're not spoken about, or depicted, accurately — in the general population. So I'm going to start with those concepts and definitions; then I'll speak more about the important ways neurodivergence and trauma intersect.
First, let's clarify what we mean by the word "trauma." Like the word "neurodivergence," trauma does not have a singular, uniformly accepted definition, so people can understand the concept, and use the word, in different ways without anyone being wrong. Even in the fields of psychology, psychiatry and mental health, professionals can use the word "trauma" in different ways, but it most often refers to: lasting, involuntary, negative impact on a person's functioning that results from an experience or experiences that were extremely frightening, upsetting, and/or disturbing, and usually were out of the person's control. That's the explanation I'm using today, so keep in mind that when I say "trauma," I'm not talking about an event, but what someone might experience after an event. In fact, no event is traumatic in and of itself, because trauma is in a person's individual experience. Some events are absolutely more likely to result in people experiencing trauma, and those are known as “potentially traumatic events.”
The experience of trauma, according to the definition we're using, has three components, all of which are necessary in order for an experience to be understood as trauma. #1 is an event or experience, which can be something that directly impacts you, or something you witness, and that you don't have the real or perceived ability to stop. #2 is the extremely distressing emotion or emotions the event or experience evokes, usually significant fear, distress, or a kind of emotional disruption that arises when what is understood to be right, acceptable, or possible is violated. And #3 is lasting impact on functioning that is involuntary and negative, or causes impairment.
Let's look at a few examples to explore what does and does not result in or constitute trauma based on that explanation. First, some examples of experiences: Being physically hurt can be traumatic, or result in a person having a trauma response, but generally only when it's outside of their control. So being injured in a car accident can be traumatic, whereas the pain caused by getting a tattoo, or even being hit while boxing, are not likely to result in psychological trauma. But witnessing someone being injured in a car accident can be traumatic to someone who only observed it.
Of course, experiences that don't evoke extremely distressing emotions are not traumatic, which is a good thing, since we all have hundreds, if not thousands, of experiences every day. The emotional response that makes an experience traumatic is generally fear-based, because the experience is physically painful, which implies damage to the body, and that implies risk of death. Whether you're experiencing the pain yourself, seeing it happen to another person in real time, or even watching or hearing or reading about it after the fact, the terror you feel is directly related to the risk of death, even if it isn't a life-threatening experience, per se. For example, some people experience trauma after reading about significant injuries sustained by victims who survived mass shootings, or watching footage of rushing flood water that does not include victims.
Violence, injury, and suffering are inherently disturbing to most people, but other experiences can also be disturbing only because they are in substantial conflict with what we expect based on the norms of our culture and our personal history. For example, the common practices of cultures that keep mummified bodies of loved ones in the family home, or those that exhume family members' bodies for periodic celebratory reunions, are in stark contrast to U.S. customs around death and exposure to cadavers, so it can be disturbing to some people. As can the thought of eating certain types or parts of animals — but not others — so a person who regularly eats bacon, ham, steak, and burgers can be disturbed by the idea or imagery of people eating pig or cow brain, insects, or dogs. None of those examples involve harm to a living person or toward animals in ways that are more painful than occurs with the animals that are routinely consumed in the U.S., but they can evoke extremely disturbing emotions that are difficult to describe in the moment because they scramble our mental map with images or concepts that contradict what we understand about life.
That's why the third piece of the explanation of trauma we're using is important. One's initial, immediate, involuntary response to an experience can be extremely negative or impairing — whether it's emotional (like terror or rage), cognitive ( like confusion, dissociation, or word-finding problems), or physical (like paralysis, syncope or fainting, or even vomiting or involuntarily urinating). But those wouldn't fall into the category of trauma if they occurred only at the moment of the experience. When we talk about trauma in a serious way — separate from the casual, flippant use of the word — it involves involuntary changes in a person's functioning for a significant period of time after the experience itself has ended. Most of the time, the extent of those changes — both in terms of severity and duration — are directly related to the intensity of the emotions evoked by the experiences, which are in turn directly related to the degree to which the experience was physically painful, disturbing, or associated with real or perceived risk of death.
Keep in mind that human brain functioning is complicated to the point of being inconceivable to most of us. From birth, the human brain contains around 100 billion neurons that interact in hundreds of trillions of ways in adults. In toddlers, those 100 billion neurons are estimated to interact in around one quadrillion ways, so how one person's brain experiences something as painful, disturbing, or likely to result in death — and their physical, cognitive, and emotional responses to that experience — can't in actuality be generalized so that we can predict — or even describe with any kind of precision — what all people experience during or after any kind of event.
But our understanding is established enough that we do know that trauma, as I'm describing it now, is not a malfunction of the brain. Even when it's incredibly disruptive to a person's life, trauma is — at its core — a normal, healthy response to experiences that are not normal or healthy to have. Trauma is what the brain is supposed to do after experiencing something extremely frightening, upsetting, and/or disturbing that we could not, or did not think we could, control or stop. Trauma is a survival mechanism that involves brain structures that have been essentially unchanged over the course of human existence. That means they function basically the same as they did when human life was very, very different and people had experiences we now consider traumatic far fewer times over the course of their much shorter lives, and those experiences much more often resulted in their deaths, which would mean that, after those events, they didn't struggle with trauma — lasting, involuntary changes in functioning — for long or at all.
The complex systems that are responsible for trauma responses developed in the brains of early humans living in small groups of other people who benefited from everyone in the group being safe, unharmed, and well — and who couldn't be injured or die in a car accident, or a house fire caused by faulty wiring, or a gunshot — because there were no cars, guns, or houses with electricity. And if they were seriously injured in an earthquake or an animal attack, they almost certainly died as a result. That trauma response is life-altering by design, because if people survived an earthquake, animal attack, or violence from a member of their small group, their continued survival would very likely be contingent upon a change in their functioning that caused them to avoid that threat going forward. And again, the basic, inherent trauma response is largely unchanged — so in today's incredibly complex world, our brains produce the same life-altering trauma response if we're harmed by a random person we'll never encounter again, or we're seriously injured in a car accident, house fire, earthquake, animal attack, or by gunfire — all of which are statistically quite rare — or we see footage of that event, from multiple angles, on repeat, for days, months, or years after it happens, just by looking at the little device most of us keep on, or within a foot of, our bodies for the entirety of our lives.
The point I'm making is that trauma doesn't mean there's something wrong with the person who's experiencing it; it means there's something wrong with what they've been through. In other words, our brains were designed to do what they do in response to traumatic events because we weren't designed to experience traumatic events the way many of us do. That goes for all human beings living in the modern era, but on top of that, some people are more vulnerable to there being lasting, involuntary negative impacts on their functioning after extremely frightening, upsetting, and/or disturbing experiences. I can't possibly cover them all in a single episode, but it's important to understand that there are variables that increase the likelihood of an event being experienced as traumatic, and those variables can be present before, during, or after an event or experience.
Without elaborating, I want to give you some examples of what research shows increases vulnerability to trauma before a potentially traumatic event is experienced. They include: previous exposure to potentially traumatic events, especially in childhood; involuntary separation from family members; living with poverty or resource insecurity; exposure to racism or other forms of chronic discrimination; insufficient social support; certain cultural variables, including norms about individual experiences bringing shame to one's family; and certain genetic variables, including those that result in temperamental anxiousness, negative or depressive affect, and neurodivergence, especially ADHD, and autism, since those are the most studied.
Variables identified by research that are present during an event and increase a person's vulnerability to experiencing trauma include: experiencing dissociation; experiencing pain; experiencing serious injury or loss of physical functioning; experiencing or witnessing perceived threat to life; experiencing or witnessing sexual violence; experiencing violence, injury, or degradation at the hands of a loved or trusted person; witnessing a loved person experiencing violence, injury, or degradation; witnessing atrocities in the context of war, genocide, human captivity, torture, catastrophic natural disasters, and violent crime, especially as a first responder or investigator; and for law enforcement and military personnel, specifically being the perpetrator of violence, especially taking a life. And that's not to say that those who are not military or law enforcement aren't more vulnerable to trauma after taking a life, but there's more research about that as it happens in the line of duty.
Finally, the variables research has shown to increase a person's vulnerability to trauma after an event include: subsequent and repeated trauma, whether experienced or witnessed, such as by first responders, investigators, and children who are exposed to intimate partner violence against their parent or parents; continuous witnessing of trauma, such as in war, genocide, or situations involving human captivity for; refugees, acculturation stress; frequent, unavoidable reminders of the event, which can include a person or people; living with poverty or resource insecurity; exposure to racism or other forms of chronic discrimination; and when the event results in significant loss, including loss of a loved one of course, but also loss of pets, property, income, or ability — in the person or someone close to them.
There are two more that I want to mention together so that the distinction between them is clear: insufficient social support and trauma debriefing. Not surprisingly, multiple studies have demonstrated that, after a potentially traumatic event, people are more likely to experience trauma — and to experience trauma with greater severity and duration — if they feel they lack social support. And of course the inverse is true: trauma is less likely, less severe, and shorter, for people who have adequate social support. But what's even more interesting is that the likelihood of trauma is significantly decreased when, very soon after a person experiences a potentially traumatic event, someone who cares for them — but is not the perpetrator of the trauma — communicates to them that what happened was bad, it shouldn't have happened, it wasn't their fault, and what they're feeling makes sense. That might be more obvious if you think about something potentially traumatic happening to your small child, in which case you might instinctively offer that kind of validation, even if you weren't deliberately trying to hit those four points. But research shows that older children, adolescents, and adults benefit from that messaging, because most cultures operate with moral codes that imply or assert that good things happen to those who are good, and bad things happen to those who are bad. So even if no one says it directly, many people who experience potentially traumatic events have conscious or subconscious concerns that they somehow deserved it, which goes against our brain's automatic trauma response that is basically a full-body alarm alerting us to danger outside of ourselves. That tends to make the system go sort of haywire, which I'll explain next, but when our initial trauma response is validated in an authentic, caring way, we're generally able to regulate it, which is the metaphorical equivalent of telling it, "Thanks so much. That was awful, but I'm safe now, and I'll be okay. Thanks again for helping me protect myself."
However, trauma debriefing does not seem to function the same way. Trauma debriefing is a formal, group process facilitated by a trained professional immediately after potentially traumatic events. It's most often conducted with military service members in combat roles, police officers, firefighters, EMTs, and other first responders, but can also be offered in community settings after incidents with mass casualties, like disasters, shootings, and multi-vehicle accidents. In principle, trauma debriefing provides messaging that's very similar to the validation I just described as beneficial when it comes from someone close to you or who cares for you. And in fairness, there are certainly people who've received or participated in trauma debriefing who benefited from it. But a fair amount of research has been conducted around this in the past 20 years especially, and overall findings don't support it being helpful, and many studies have demonstrated that formal debriefing actually increases the likelihood that a person develops Posttraumatic Stress Disorder.
Like the word "trauma," the term "PTSD" is used casually, humorously, and almost ironically — in that people often joke about developing PTSD from inconsequential events, like dropping their Starbucks or watching their team lose a playoff game. Of course, I understand that the general public uses clinical terms in nonclinical ways, and at the end of the day, I value the freedom that allows people to use language as they see fit. However, as a clinical psychologist, I don't love it, because Posttraumatic Stress Disorder isn't just a subjective state of being, like "hangry." It's a very serious diagnosis that can only be given to people who've experienced "exposure to actual or threatened death, serious injury, or sexual violence" (American Psychiatric Association, 2022), and that requires the presence of several changes in behavior, emotion, cognition, and perception that impair a person's functioning at least a month after the event, and sometimes for years after — even a lifetime. Actual PTSD is debilitating by definition, and it's fairly rare. Global estimates suggest that 70% of the world's population will experience a potentially traumatic event — and that number is substantially higher when we consider the potential for exposure on the internet — and yet only about 6% of the world's population will have PTSD in their lifetimes.
Like neurodivergence, PTSD is misunderstood, so many people who have PTSD are undiagnosed or don't have current, accurate information about how it actually impacts them. PTSD is not just what people see in movies and TV shows, which usually center around flashbacks. Flashbacks are a form of dissociation, which is "a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior” (APA, 2022). In the case of flashbacks, that disruption or discontinuity involves literally reliving the traumatic event in one's consciousness, so of course flashbacks are incredibly disruptive to real people's lives — and they make for very compelling scenes in movies and on TV — but not everyone with PTSD has flashbacks. In contrast, all people with PTSD experience negative changes in cognition, mood, and behavior that cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning” (APA, 2022), and those changes are present essentially all the time — not just when a traumatic memory is activated by a present experience.
Newer research is beginning to show that trauma can result not only in cognitive, emotional, and behavioral changes, but in physiological changes that result in chronic health problems, such as cardiovascular disease, gastrointestinal conditions, musculoskeletal problems, autoimmune issues, and low cortisol levels. That last one is especially fascinating because, as you may know, cortisol is the "stress hormone." It's said that chronic stress causes people's brains to be "bathed in cortisol," which is associated with many physical and mental health problems. But cortisol also has a regulatory effect on blood pressure, blood glucose level, and other aspects of stress responses. When cortisol goes up, other stress hormones — like adrenaline, which prepares our brains and bodies to fight or flee — goes down, and all of those things being in balance is part of good physical and mental health.
Research indicates that people who have experienced profound trauma have chronically low cortisol levels. This was discovered in studies of Holocaust survivors, combat veterans of the Vietnam War, and pregnant women whose partners were killed in the 9/11 terrorist attacks. But that's not all. Low cortisol levels were also found in the children of those Holocaust survivors, combat veterans of the Vietnam War, and pregnant women whose partners were killed in the 9/11 terrorist attacks, which proved that trauma impacts not only our individual minds and bodies, but our genetics, and therefore the genetics of our biological children. That's an example of epigenetics, which is impacted by many factors, but it's certainly worth noting that our biological parents' experiences of trauma impacted our physiological functioning through epigenetics, and if you have — or will have — biological children, they are — or will be — impacted by your epigenetics, too.
Now, let's double back to changes in cortisol levels, because this is one of the areas in which researchers are working hard to understand why neurodivergence is associated with increased biological risk of having a lasting trauma response after a potentially traumatic event. Studies are fairly limited, but from the research that's been done, it's estimated that people with ADHD are over 500% more likely to develop PTSD, while autistic people are over 600% more likely. Part of that astonishing increase in risk seems to be related to differences in the functioning of the stress response system in autistic people and people with ADHD. Though, like neurodivergence overall, it's complicated. Some neurodivergent people's stress response systems are overactive, producing more cortisol and other stress hormones than is typical, while other neurodivergent people's stress response systems are underactive, or result in less hormonal fluctuation in response to stress than is expected. Because trauma results in changes in stress response systems, the understanding is that the inherent differences in neurodivergent people's stress response systems play some role in predisposing us to experiencing trauma and developing PTSD after being exposed to potentially traumatic events.
There are other differences in neurodivergent brain functioning that seem to be related to increased vulnerability to trauma — and all of them are both complicated and interrelated. I'll talk about them in simple terms and as distinct processes for ease of understanding and brevity, but do remember that adult brains are comprised of 100 billion neurons that interact in hundreds of trillions of ways, so nothing I've written about here so far, or will write about today, is as simple as I am trying to make it.
Okay, if you've read, watched, or listened to other episodes, you may recall some of what I presented about neurodivergent brain functioning in the context of monotropism, impulsivity, sensory processing, Rejection Sensitive Dysphoria, and the Pervasive Drive for Autonomy, also known as Pathological Demand Avoidance. In the most basic terms, those processes are related to differences in the ways the amygdala, prefrontal cortex, and reward system function in a neurodivergent person's brain. Neurodivergent people's brains tend to have overactive amygdalas, which means our amygdalas are often hyper-reactive to experiences that may be threatening based on memories that are often below our awareness, which results in emotional responses that are often disproportionate to whatever provoked them.
That, in and of itself, is adjacent to the processes of certain trauma responses, as are some of the differences in prefrontal cortex functioning. The prefrontal cortex is responsible for our highest level processing, including discriminating between relevant and irrelevant stimuli, and integrating multiple sources of information in order to prioritize, plan, make decisions, and coordinate our actions and responses.
In neurodivergent people's brains, those functions are impacted by differences in how much dopamine is present, as well as how dopamine, and other neurochemicals involved in rewarding certain experiences, are processed. As such, neurodivergent people often struggle to ignore certain stimuli information or processes to focus on others, and to stop or resist certain behaviors, even when doing so would be socially or personally beneficial.
Therefore, it's likely that the same processes that underlie, for example, a neurodivergent person's insistence on following a specific routine or method, hyperfocus on completing or repeating certain tasks, or inability to ignore a certain sound, contribute to posttraumatic hypervigilance about reminders of a traumatic experience. And recent research indicates that low dopamine functioning contributes to traumatic memory impairment in several ways. Differences in dopamine functioning are understood to play a role in the failure of some people's brains to encode the memory of traumatic events, in re-experiencing traumatic events in the form of flashbacks, dreams, and intrusive memories, and in deficits in normal fear extinction.
Fear extinction is a complex, subconscious process by which we and other animals stop being afraid of something we had reason to be afraid of before. Humans are born with reflexive startle responses to very loud noises and to sensing that they are physically unsupported — or falling — but all other fears are learned when a stimulus is associated with real or anticipated harm. So if a child is bit by a dog, they may learn to fear all dogs, but that fear can become extinct through exposure to dogs without being bitten, which involves creating new memories around dogs and recalling those memories — rather than the single, dated memory of being bitten — when encountering a dog in the present. Trauma disrupts this process, so trauma-related fears, which are learned from traumatic experiences, do not become extinct as expected. A person who was in a serious motor vehicle accident may have trauma responses in similar circumstances every time they drive a car for years, even though they should have hundreds of new memories of driving a car without being in a serious accident.
This is akin to neurodivergent people's propensity for rejection sensitivity, in which we tend to interpret other people's neutral behaviors as critical or rejecting, despite most of us having had far more neutral than harmful interactions with others. And studies are providing more and more evidence that the differences in brain chemistry and functioning that are seen in trauma are present in neurodivergent people prior to exposure to potentially traumatic events. Though traumatic experiences may exacerbate, intensify, and even alter those differences, they don't appear to cause them entirely, so the differences already present in the types of neurodivergence studied are likely to contribute to the differences experienced as trauma. But there's more. Neurodivergent people do seem to be inherently more vulnerable to experiencing lasting, involuntary negative impact on their functioning that results from a potentially traumatic event, but we're also considerably more likely to experience potentially traumatic events. Here's some upsetting data about that:
Neurodivergent children are three times more likely to be referred to Child Protective Services, and twice as likely to be placed in foster care, indicating far higher rates of abuse and neglect within their families.
Among peers, kids with ADHD are over 100% more likely to be victims of bullying, while kids with tic or communication disorders are around 200% more likely to be bullied. Autistic kids are over 200% more likely to be victimized by bullies, and children who have observable learning differences are almost 300% more likely to be bullied.
And of course, those numbers include only reported cases, both in the first statistics about abuse and neglect in the home, and with regard to bullying by peers.
Due to widespread under-reporting, there's no clear data about adult victims of bullying, but neurodivergent adults often describe workplace bullying, including being mocked, excluded, and even taunted by coworkers, which are less commonly discussed as problems by neurotypical adults.
Rates of incarceration are estimated to be 2 to 3 times greater for neurodivergent adults overall, and up to 10 times greater for adults with ADHD, relative to the general population.
Among neurodivergent people as a whole, 90% experience sexual abuse or assault at some point during their lives, and 50% experience 10 or more incidents of sexual abuse or assault.
In adulthood, biological females who are neurodivergent are 970% more likely to be sexually assaulted than those who are neurotypical.
And when victimization is assessed broadly to encompass physical and sexual abuse, physical and sexual assault, and maltreatment, including verbal abuse and cruelty, unfairness, exclusion, and exploitation, over 80% of neurodivergent adults report polyvictimization — or being victimized in multiple ways — in the last year.
And lastly, finally, neurodivergent adults as a whole are more likely to be involved in serious accidents, to be involved in accidents involving substance misuse, and to consider, attempt, and die by suicide — and all of those risks escalate when there are multiple risk factors, like poverty, resource insecurity, inadequate social support, limited access to healthcare and social services, prior exposure to trauma, chronic stress, and marginalization due to sexual orientation, gender identity or expression, race, or ethnicity.
I don't know what to tell you, because it's not fair. At least the biological predispositions are the flip sides of some of the greatest things about us — even though they increase some risk of harm that involve our own choices. But the victimization rates from childhood through adulthood are the result of complex, long-established, interconnected cultural institutions that are profoundly flawed and currently failing not just neurodivergent people, but nearly all Americans in one way or another, and far too many people everywhere.
Humanity advanced so much faster than our brains could evolve, and we benefit from a lot of that, but we suffer more, too. People are impacted in lasting ways by experiences our brains aren't designed to have, and statistically speaking, that's even more true for neurodivergent people. You've probably heard me say that life feels harder for neurodivergent people because it is, and this is part of it, but that doesn't mean we're doomed. Being doomed is ultimately a feeling, a perspective, related to surrendering to a possible negative outcome. Because most of us live in cultures that reward conformity and compliance, punish individuality and disobedience, and imply or assert that good things happen to good people and bad things happen to people who deserve it, as neurodivergent people, most of us spend our lives trying to fix what we think is "wrong" with us, which we think is our fault in the first place, and that's also true of trauma.
But now you know more about the ancient brain processes that cause trauma and the variables that make many people — including us — more vulnerable to experiencing trauma, which means that you can stop blaming yourself for being traumatized, and that will help other people stop blaming themselves — by your example, and maybe if you have it in you to start telling people what trauma is, and while you're at it, what neurodivergence is. But no pressure there. It can be a hell of a fight, believe me, so take it on if you want to and can — but if and when you don't or can't, know that you are changing this fucked up mess just by being nice to yourself, by understanding and having compassion for yourself, and by acknowledging that some trauma is much harder for anyone to unlearn, and some brains learn and unlearn things differently. In both cases, the solution is not for the traumatized person to try harder, do more, do better, or be better. The solution is in creating a world where every human brain — in all of our ancient similarities and neurodiverse variations — are safe far more than they're not — and every human body, too. That would be a hell of an improvement, and I wish we were already there, or closer, and that the few people who have the power to change more things — faster and for more people — would do that, but it's looking like we'll have to do it ourselves, so it's a good thing there's so many of us, and we're so amazing.
This was a heavy episode, so if you've made it all the way through and you're feeling overwhelmed or emotional, please take extra good care of yourself, and reach out to your support system, your psychotherapist or mental health provider, or a crisis line or crisis website if you need to. [text/call 988 or visit 988Lifeline]
Until next time, remember: You don't have to change yourself to deserve happiness or success. Being who you are isn't the problem; it's the solution. I'm rooting for you — exactly as you are. I'll see you next week.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
