Exhibit 1.3-1Immediate and Delayed Reactions to Trauma

Immediate Emotional Reactions
Numbness and detachment
Anxiety or severe fear
Guilt (including survivor guilt)
Exhilaration as a result of surviving
Feeling unreal; depersonalization (e.g., feeling as if you are watching yourself)
Feeling out of control
Constriction of feelings
Feeling overwhelmed
Delayed Emotional Reactions
Irritability and/or hostility
Mood swings, instability
Anxiety (e.g., phobia, generalized anxiety)
Fear of trauma recurrence
Grief reactions
Feelings of fragility and/or vulnerability
Emotional detachment from anything that requires emotional reactions (e.g., significant and/or family relationships, conversations about self, discussion of traumatic events or reactions to them)
Immediate Physical Reactions
Nausea and/or gastrointestinal distress
Sweating or shivering
Muscle tremors or uncontrollable shaking
Elevated heartbeat, respiration, and blood pressure
Extreme fatigue or exhaustion
Greater startle responses
Delayed Physical Reactions
Sleep disturbances, nightmares
Somatization (e.g., increased focus on and worry about body aches and pains)
Appetite and digestive changes
Lowered resistance to colds and infection
Persistent fatigue
Elevated cortisol levels
Long-term health effects including heart, liver, autoimmune, and chronic obstructive pulmonary disease
Immediate Cognitive Reactions
Difficulty concentrating
Rumination or racing thoughts (e.g., replaying the traumatic event over and over again)
Distortion of time and space (e.g., traumatic event may be perceived as if it was happening in slow motion, or a few seconds can be perceived as minutes)
Memory problems (e.g., not being able to recall important aspects of the trauma)
Strong identification with victims
Delayed Cognitive Reactions
Intrusive memories or flashbacks
Reactivation of previous traumatic events
Preoccupation with event
Difficulty making decisions
Magical thinking: belief that certain behaviors, including avoidant behavior, will protect against future trauma
Belief that feelings or memories are dangerous
Generalization of triggers (e.g., a person who experiences a home invasion during the daytime may avoid being alone during the day)
Suicidal thinking
Immediate Behavioral Reactions
Startled reaction
Sleep and appetite disturbances
Difficulty expressing oneself
Argumentative behavior
Increased use of alcohol, drugs, and tobacco
Withdrawal and apathy
Avoidant behaviors
Delayed Behavioral Reactions
Avoidance of event reminders
Social relationship disturbances
Decreased activity level
Engagement in high-risk behaviors
Increased use of alcohol and drugs
Immediate Existential Reactions
Intense use of prayer
Restoration of faith in the goodness of others (e.g., receiving help from others)
Loss of self-efficacy
Despair about humanity, particularly if the event was intentional
Immediate disruption of life assumptions (e.g., fairness, safety, goodness, predictability of life)
Delayed Existential Reactions
Questioning (e.g., “Why me?”)
Increased cynicism, disillusionment
Increased self-confidence (e.g., “If I can survive this, I can survive anything”)
Loss of purpose
Renewed faith
Reestablishing priorities
Redefining meaning and importance of life
Reworking life’s assumptions to accommodate the trauma (e.g., taking a self-defense class to reestablish a sense of safety)

From: Chapter 3, Understanding the Impact of Trauma

Cover of Trauma-Informed Care in Behavioral Health Services
Trauma-Informed Care in Behavioral Health Services.
Treatment Improvement Protocol (TIP) Series, No. 57.
Center for Substance Abuse Treatment (US).

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