O R I G I N A L P A P E R

Trauma Through the Life Cycle: A Review of Current Literature

Shulamith Lala Ashenberg Straussner •

Alexandrea Josephine Calnan

Published online: 31 May 2014

� Springer Science+Business Media New York 2014

Abstract This paper provides an overview of common

traumatic events and responses, with a specific focus on the

life cycle. It identifies selected ‘‘large T’’ and ‘‘micro’’

traumas encountered during childhood, adulthood and late

life, and the concept of resilience. It also identifies the

differences in traumatic events and reactions experienced

by men compared to women, those related to the experi-

ence of immigration, and cross generational transmission

of trauma. Descriptions of empirically-supported treatment

approaches of traumatized individuals at the different

stages of the life cycle are offered.

Keywords PTSD � Large-T and micro-traumas � Neurobiology � Gender differences � Immigrants � Treatment approaches

The past is never dead. It’s not even past.

William Faulkner

The conflict between the will to deny horrible events and the will to

proclaim them aloud is the central dialectic of psychological trauma.

Judith Lewis Herman

Introduction

As recognized by William Faulkner and Judith Herman, as

well as by many other writers and mental health profes-

sionals, trauma can take a tremendous psychological toll

that may not disappear even with the passage of time. The

term ‘‘trauma’’ comes from the Greek language meaning a

‘‘wound’’ or ‘‘hurt’’ (Oxford Dictionaries, 2013). Psycho-

logically, ‘‘trauma’’ refers to an experience that is emo-

tionally painful, distressful, or shocking, and one that often

has long-term negative mental and physical (including

neurological) consequence. An event is thought to produce

a traumatic response when the stress resulting from that

event overwhelms the individual’s psychological ability to

cope (McGinley and Varchevker 2013).

Although we often think of trauma as being synonymous

with the identified objective cause of the trauma, such as a

soldier losing his legs to a roadside bomb explosion, the

effect of the trauma is always subjective and refers to the

impact—the perceived ‘‘wound’’ or ‘‘hurt’’ as identified by

the early Greeks—that it has on the individual (Miller 2004).

Thus what might be a traumatizing, life-shattering event for

one individual might have minimal effects on another. Such

differential reaction is based on many factors, including the

individual’s age, gender identity, pre-morbid ego strength,

previous traumatic experiences, the chronicity of the trauma,

family history of trauma, current life stressors, social sup-

ports, and one’s cultural, religious or spiritual attitude

toward adversity (Amir and Lev-Wiesel, 2003; Brewin et al.

2000; Felitti et al. 1998; Foa et al. 2009; Stamm and

Friedman 2000; Straussner and Phillips 2004a).

Unfortunately, the experience of trauma is not uncommon.

Although there is a lack of recent national epidemiological

findings about trauma among adults [Centers for Disease

Control and Prevention (CDC) 2006], studies during the

S. L. A. Straussner (&) Silver School of Social Work, New York University,

1 Washington Sq. North, New York, NY 10003, USA

e-mail: sls1@nyu.edu

A. J. Calnan

Howard Center, 1 So. Prospect Street, Burlington,

VT 05401, USA

e-mail: ajcalnan@gmail.com

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Clin Soc Work J (2014) 42:323–335

DOI 10.1007/s10615-014-0496-z

 

 

1990s found that over 60 % of men and 51 % of women in the

United States report having experienced at least one traumatic

event during their lifetime (Giaconia et al. 1995; Kessler et al.

1995). Traumatic stress can cause disorganization of thinking,

awareness, impaired judgment, altered reaction time, hyper

vigilance, and unhelpful attempts at coping. While most

people will experience time limited reactions, such as acute

stress disorder, a smaller percentage may continue to manifest

more severe and often longer lasting trauma-related impacts.

These may include panic disorders, depression, sleep disor-

ders, substance use disorders, as well as post-traumatic stress

disorder (PTSD) (Kessler et al. 1995; Leskin and Sheikh

2002; Ringel and Brandell 2012).

While trauma can impact an individual at any time in the

life cycle, from pre-natal development through old age, the

impact and the treatment approaches vary depending on the

individual’s developmental needs and the psychosocial

environment. The purpose of this article is to provide an

overview of common traumatic events and responses with

a specific focus on the life cycle—identifying selected

traumas encountered during childhood and adolescences,

adulthood and late life. The differential impact of trauma

on men and women, on immigrants, transgenerational

transmission of trauma, the concept of resilience, and the

implications for the treatment of traumatized individuals at

the different stages of the life cycle are identified.

Nature of Trauma: ‘‘Large T’’ and ‘‘Micro-Traumas’’

There are many different kinds of traumas, ranging from

what Francine Shapiro, the originator of Eye Movement

Desensitization and Reprocessing (EMDR) treatment

approach (Shapiro 1995) has termed ‘‘large- T’’ traumas to

‘‘small- t’’ or, what Straussner (2012) refers to as ‘‘micro-

traumas.’’ Large-T traumas can impact individuals, fami-

lies, groups and communities and include natural disasters,

such as hurricanes, floods, wildfires, or nuclear disasters, as

well as human-caused disasters, such as deadly car acci-

dents, individual and mass violence, and other one-time

traumatic events. Large-T traumas can also include, what

Judith Herman (1997) termed as ‘‘complex traumas,’’ and

which others refer to as Complex Traumas and Disorders of

Extreme Stress (DESNOS- disorders of extreme stress not

otherwise specified)—traumas that involve events of pro-

longed duration or multiple traumatic events (van der Kolk,

Roth, Pelcovitz, Sunday and Spinazzola, 2005). Examples

of complex, large-T traumas [also referred to as Type II

trauma by Terr (1991)], include on-going interpersonal

violence, child physical or sexual abuse spanning several

years, never-ending wars, or constant acts of terrorism.

Small-t or micro-traumas are the more common traumas

encountered by many of us. While large-T traumas are

easily identified, many micro-traumas, such as being bul-

lied in school or in the workplace (Idsoe et al. 2012;

Mishna 2012), being stalked by someone (Purcell et al.

2005), living in severe poverty (Kiser 2007), childbirth

(Kendall-Tackett 2013), or being the recipient of on-going

individual discrimination because of one’s race, religion,

gender identity, or sexual orientation, often go unrecog-

nized and unacknowledged. Yet these micro-traumas may

still cause much psychic pain and life-long damage.

Exposure to and Impact of Trauma

In her classic book Shattered assumptions: Towards a new

psychology of trauma, Janof-Bulman (1992) reflects on the

psychological shattering of one’s worldview experienced

by traumatized individuals, especially if the trauma is

caused through deliberate human acts (Straussner and

Phillips 2004a). Whereas the world was previously viewed

as being trustworthy and benevolent, this belief may

become transformed into the sense that ‘‘people will hurt

me, and I can’t trust anyone.’’ Additionally, trauma sur-

vivors might find that the world they used to perceive as

being stable and predictable, now seems unpredictable and

out of their control. Consequently, their previous sense of

empowerment and of being in control of their environment

and their lives gives way to one in which they feel dis-

empowered, helpless, and unable to predict and plan for the

future. They may even have a sense of being psychologi-

cally damaged and defective (Janof-Bulman 1992).

The idea that trauma could result in specific clusters of

symptoms first became formalized by the inclusion of the

diagnosis of PTSD in the third edition of the Diagnostic and

Statistical Manual of Mental Disorders [DSM; American

Psychiatric Association (APA) 1980]. This new diagnostic

category was precipitated by awareness of the psychological

problems experienced by returning Vietnam War veterans in

the late 1970s and the growing literature by European

writers who survived their own traumatic experiences dur-

ing the Second World War—such as Gunter Grass, Primo

Levy, and Eli Wiesel among others—and who vividly

described the profound impact of mass violence on indi-

viduals, families and communities (Straussner and Phillips

2004a). Studies of survivors of the Nazi-caused Holocaust

(Krystal and Niederland 1968) and of the Hiroshima atomic

bombing by the United States (Lifton 1968), introduced the

concept of ‘‘survivors’ guilt’’ into our vocabulary.

The more recent recognition that traumatic reactions can

result from response to events other than war, such as

sexual assault, exposure to child abuse, domestic violence,

and accidents has made PTSD a widely recognized disor-

der throughout the world (Herman 1997; van der Kolk et al.

2005). The importance of PTSD as a diagnostic category is

324 Clin Soc Work J (2014) 42:323–335

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reflected in the newly revised DSM-5 (APA, 2013), where

PTSD and related conditions are no longer listed under

Anxiety Disorders or Adjustment Disorders as previously,

but are located in a separate chapter titled ‘‘Trauma- and

Stressors-Related Disorders.’’

While the experience of trauma is common, PTSD

diagnosis is relatively rare. The estimated lifetime preva-

lence rate of PTSD in the US is thought to range between 6

and 12 %, averaging around 9 % of the population (APA

2013; Breslau et al. 1991; Kessler et al. 1995; Resnick et al.

1993). However, the initial prevalence rates among active

duty military exposed to war conditions and among survi-

vors of mass trauma, such as the September 11, 2001 World

Trade Centers in New York, can range as high as 30 % and

more (Galea et al. 2005; Susser et al. 2002). According to the

latest edition of the DSM, the ‘‘[h]ighest rates (ranging from

one-third to more than one-half of those exposed) are found

among survivors of rape, military combat and captivity, and

ethnically or politically motivated internment and geno-

cide’’ (APA2013, p. 276). Recent United States- based

studies document higher rates of PTSD among African-

Americans, Latinos and American Indians than among white

or Asian populations (APA 2013). International annual

prevalence rates are believed to be somewhat lower than

those in the US (APA 2013; Landolt et al. 2013), although

studies in areas with on-going conflict, such as in Israel and

the Palestinian territories, point to rates that are similar to

those in the US among individuals who have been or are still

exposed to combat (Dimitry 2011; Gelkopf et al. 2008;

Solomon et al. 1996).

As pointed out earlier, trauma has a differential impact

depending on age, gender, and psychosocial factors, which

are discussed below.

Trauma and Children

As is recognized in the new Diagnostic and Statistical

Manual (DSM-5; APA 2013), while trauma has a profound

impact on all individuals, its impact on young children is

unique and particularly pernicious. Millions of children

throughout the world are currently growing up amidst

traumatic environments—they are being sexually and

physically abused at home, bullied at school, and trauma-

tized in their communities (Finkelhor et al. 2009). Many

lack adequate food and shelter, and some live in unsafe

communities and war zones witnessing violence occurring

to friends and family, including rape, torture and murder.

Numerous studies have shown evidence of long term

repercussions of exposure to violence at an early age (Anda

et al. 2006; Steele 2004). The implications of exposure to

trauma are now believed to have an effect on the infant

even before birth. A more detailed discussion of the impact

of trauma on children follows, starting with prenatal

impact.