What Is Chronic Trauma? Symptoms, Examples, & Treatment

What Is Chronic Trauma?

Chronic trauma is one of the three main types of trauma commonly discussed and studied by professionals, along with acute trauma and complex trauma.¹ Chronic trauma occurs when you are repeatedly exposed to traumatic events over a period of time. Chronic trauma is cumulative in nature, meaning that the impact of chronic trauma grows with each instance of exposure, which in turn can increase the severity of symptoms and outcomes.

The compounded or cumulative effect of chronic trauma can cause a lot of distress and can result in the development of mental health conditions like post traumatic stress disorder (PTSD). It is important to get chronic trauma treated and work towards healing, because when chronic trauma remains as unresolved trauma, the resulting symptoms can cause significant and negative impacts in multiple areas of your life.²

Chronic Trauma Vs Complex Trauma

Chronic and complex trauma are sometimes used interchangeably and can look very similar; however, chronic and complex trauma do have some differences when it comes to their definitions^1,3 Chronic trauma refers to the experience of multiple traumatic events over a chronic duration of time. Complex trauma adds onto this concept of still being caused from multiple trauma events, but often also starts early in life and is perpetrated by a caregiver.

One of the reasons that these terms are often discussed together is because of the overlap between chronic and complex trauma symptoms. Chronic and complex trauma both can significantly affect those who experience trauma when it comes to overall development, relationships, school or work, suicidality or depression, physical health, and other life outcomes.^1,2

Acute Trauma Vs Chronic Trauma

Acute trauma differs from chronic trauma in that it refers to just one specific instance of a trauma event exposure, not multiple. Acute trauma exposures often trigger immediate and intense emotional responses, but these responses are more likely to resolve on their own than in the case of chronic trauma or complex trauma.^1,4,5 When acute trauma does not resolve on its own, the treatment is usually focused on the effects of the single event, allowing for a more targeted mental health treatment approach. In contrast, chronic trauma often requires a more comprehensive treatment approach.

Acute and chronic trauma differ quite a lot when it comes to the duration and number of exposures to trauma. However, when either type of trauma is unresolved, they have many similar psychological impacts and symptoms, including hyperarousal, avoidance behaviors, intrusive memories, mood and cognition changes, and other symptoms connected to your body’s natural threat and stress responses.⁴

Symptoms of Chronic Trauma

Chronic trauma often shows up through a complex set of symptoms relating to stress, anxiety, mood, functioning, and more.^1,6,7 Due to the cumulative nature of chronic trauma, these symptoms can evolve and stack up over time. As a result, you may experience some very intense and distressing symptoms due to your chronic trauma exposure that can be difficult to manage.

Common symptoms of chronic trauma include:

• Anxiety
• Depression
• Difficulty sleeping
• Dissociation
• Poor emotional regulation
• Poor boundaries
• Hyperarousal
• Anger or irritability
• Defensiveness
• Avoidance
• Suicidality and intrusive thoughts
• Negative self-thoughts
• Sexual concerns
• Tension reduction behaviors

Being exposed to traumatic events repeatedly or over a long duration of time can cause symptoms to be more persistent, more complex, and more integrated into your everyday life. If you have chronic trauma exposure, you may find yourself in a constant state of anxiety or hyperarousal, having difficulty sleeping, feeling more irritable, having more trouble with emotional regulation, and other things that make your everyday life harder than it has to be.

Chronic trauma exposure, especially trauma related to abuse or maltreatment,⁸ can also cause a lot of feelings of hopelessness, negative self-thoughts, more cynical life outlooks, and even severe depression or suicidal ideation. Additionally, behaviors you developed as coping mechanisms, like dissociation, avoidance, and tension reduction behaviors like substance use, can become maladaptive, leading to even more negative experiences in your relationships, at work or school, and in other areas of your life.

Examples of Situations Leading to Chronic Trauma

Chronic trauma occurs when you are repeatedly exposed to stressful and harmful situations that significantly impact your physical, mental, and emotional well-being over a longer period of time. These situations can include experiences such as abuse, war, crime, chronic illness, bullying, discrimination, natural or other disasters, poverty, violence, and more.⁴ In each case, your repeated exposure to stress, fear, instability, and uncertainty adds to the cumulative effects of chronic trauma.

Some examples of situations that could result in chronic trauma include:

• Long-term abuse: long-term abuse is when you experience emotional, physical, or sexual harm repeatedly over an extended period of time. Long-term abuse often occurs in environments or situations where you should feel safe, like at home or with your partner.^9,10
• Exposure to war or conflict: Being exposed to war or conflict means that you are living and seeing armed violence and experiencing the constant threat of harm. This is a constant or chronic exposure to life-threatening situations and witnessing violence is traumatic.¹¹
• Living in a high-crime area: If you live in a place where a lot of crime occurs, then you are likely consistently either exposed to violence or live with the constant threat of violence. Both this chronic state of alertness to potential danger and the experience of traumatic events themselves are harmful and traumatic.^10,11
• Enduring chronic illness: Living with a chronic illness involves more than just physical symptoms. You have to constantly manage your condition and cope with the impact of your condition on your daily life. This ongoing stress, along with any acute experiences related to your chronic illness can be traumatic.¹²
• Enduring bullying: It can be traumatic if you have or are dealing with bullying, especially over a long period of time.¹³ Bullying can involve being repeatedly harassed, intimidated, or harmed. Bullying can be a type of chronic trauma regardless of if it is physical, verbal, or takes place online.
• Experiencing discrimination: Repeated encounters with racial, ethnic, sexuality, and/or gender-based discrimination, whether direct experiences or witnessing such acts, can lead to chronic trauma. This ongoing exposure to prejudice and injustice in daily life, workplaces, political systems, and public spaces can contribute to a sustained traumatic impact.¹⁰
• Experiencing natural disasters: If you live in an area with ongoing consequences of a natural disaster, you’re constantly facing the possibility of sudden, catastrophic events. It’s this recurring exposure to potential devastation that can lead to chronic trauma.¹⁴
• Living in poverty or with economic instability: Continuously struggling with poverty and financial insecurity involves dealing with stressors like inadequate access to basic needs, housing insecurity, and the stigma associated with poverty. This persistent state of uncertainty and hardship can be a source of chronic trauma.^13,14

How Chronic Trauma Impacts Daily Life

Having unresolved chronic trauma can feel like you are carrying the weight of your traumatic experiences and the resulting symptoms around with you every day. Chronic trauma can have serious impacts on your daily lived experiences and on your ability to function.² This includes your relationships and social interactions, work or school performances, and your overall mental and physical health.

Chronic trauma can make it more difficult to form and maintain relationships due to trust issues and emotional dysregulation, can impact school by affecting concentration due to hyperarousal, can reduce productivity and job performance, and has been linked to multiple mental and physical health outcomes.² These impacts are why it is important to seek therapeutic intervention to help manage, process, and resolve chronic trauma.

Treatment for Chronic Trauma

Therapy for trauma can help to provide a safe environment for you to develop strategies for coping with, processing, and healing from traumatic experiences. Many therapeutic models have been found to be effective in working with the complex nature of trauma by alleviating trauma symptoms, improving mental health, and improving the overall quality of life of those who have experienced trauma.¹⁵

Common therapies used to treat chronic trauma include:

• Trauma-informed therapy: Trauma-informed therapy models actively integrate knowledge about trauma into all aspects of your therapeutic treatment. This can help to make sure that therapy is a safe, supportive environment where you can heal from your trauma.
• Trauma-focused cognitive-behavioral therapy (TF-CBT): Trauma-focused CBT is a treatment model that works with children and adolescents through the three phases of stabilization, trauma narration and processing, and integration and consolidation to treat and resolve trauma.
• Eye movement desensitization and reprocessing (EMDR): EMDR therapy for trauma uses an eight-phase model that was developed around the use of bilateral stimulation to help process and resolve traumatic memories in a safe and controlled environment.
• Trauma-focused group therapy: Trauma-focused group therapy involves participating in a group setting with others who have experienced similar traumas as you have. The group environment brings a type of community processing, validation, and support to the treatment for chronic trauma.¹⁵
• Narrative therapy: Narrative therapy focuses on separating the person from the problem through a process known as re-storying. Skills training in affective and interpersonal regulation (STAIR) narrative therapy, narrative exposure therapy, and restorying trauma with narrative therapy are all narrative therapy based approaches used for treating trauma.^17,18,19
• Attachment-based therapy: Attachment therapy can be especially helpful if your chronic trauma occurred in childhood. Attachment therapy focuses on creating a sense of security in relationships and healing negative attachment patterns so that you can work toward developing healthier, more secure relationships.²⁰
• Internal family systems (IFS) therapy: IFS therapy recognizes and brings the different aspects of your personality into the therapy room. IFS can help you better identify and understand your traits and what is needed for you to heal from your chronic trauma.²¹
• Somatic experiencing: Somatic-based therapy models are body-focused and can help you resolve the physical tension and bodily symptoms associated with trauma.²² By focusing on bodily sensations rather than solely on thoughts and memories, you can better release and resolve trauma that is stored in your body.
• Trauma-related exposure therapy: Trauma-related exposure therapy gradually and systematically exposes you to the thoughts, feelings, and situations related to your trauma in a controlled, therapeutic setting. Virtual reality has been used in implementing this therapy.²³
• Trauma-informed expressive arts therapy: Trauma-informed expressive arts therapy uses trauma-informed principles and creative practices like art, music, and dance in the therapy process. This allows for a non-verbal way to confront and process your chronic trauma. This therapy may be a good choice if it is difficult for you to talk about your trauma.²⁴

How to Manage the Long-term Effects of Chronic Trauma

Ongoing therapy is an important option for managing the long-term effects of chronic trauma and typically includes attending a therapy session for one hour a week. That leaves 167 other hours each week that you must manage the effects of trauma outside of the therapy room. There are some effective strategies you can use to help cope and help release trauma from the body, including self-care practices, journaling, having a strong support system, spending time with pets, and more.

Some ways to help manage the long-term effects of chronic trauma include:

• Self-care practices: Self-care involves activities that promote physical, emotional, and mental well-being for those with chronic trauma, such as daily pampering, relaxation techniques, and hobbies. These practices help reduce stress and give you a better sense of control while you are processing traumatic experiences.
• Building resilience: Building resilience is about improving your ability to adapt to and recover from adversity or stressful experiences. If you have chronic trauma, resiliency may include improving emotional regulation, changing perspectives, and for finding supports to help you while you manage and recover from trauma.
• Journaling: Journaling about trauma provides a private space to write down and discuss your experiences and feelings. It can help you to organize your thoughts and function therapeutically during your healing process from trauma.
• Regular exercise and healthy eating: Physical activity can alleviate symptoms of anxiety and depression while boosting endorphins, and improving mood and overall physical health.²⁵ Similarly, a balanced diet can support your physical health while you are managing trauma. 
• Taking time to rest: When recovering from trauma it can be important to explicitly allow yourself regular breaks, ensure adequate sleep, and engage in relaxing activities. Rest helps to reduce stress and getting enough rest can make it easier for you to cope with the effects of trauma.
• Engaging in restorative hobbies: Incorporating hobbies that rejuvenate and bring you joy can be helpful while managing chronic trauma. Engaging in hobbies can help you to take a break or momentarily step away from everyday stressors.
• Establish a routine: Creating a consistent daily routine can provide structure and a sense of normalcy, which is often disrupted by chronic trauma. Having a predictable routine can help reduce anxiety, improve focus, and provide a sense of control in your daily life while managing trauma-related symptoms.
• Connecting with others: Spending time with friends, family, or others who understand and support can help with emotional regulation, reduce feelings of isolation, and provide a sense of belonging.²⁶ Engaging in social activities can also bring joy and a different perspective while you process your chronic trauma.
• Connecting to nature: Time in nature, like walking in a park or gardening, can help with stress relief and help you feel connected to the natural world. This feeling of belonging can help ground you during your healing process.²⁷
• Engaging in mindfulness: Daily mindfulness exercises, including mindful breathing and meditation can help you to focus on the present moment, helping you better manage emotions and stress. Be aware that while mindfulness can help with trauma it may worsen trauma symptoms in some scenarios. Please work with your mental health provider while exploring mindfulness if you have unresolved trauma.²⁸
• Spending time with pets: Pets can provide comfort and companionship while reducing anxiety and improving your mood. Caring for a pet and the emotional reciprocity from animals can be helpful while you are coping with trauma.²⁹

Where to Find Professional Help for Chronic Trauma

Finding the right therapist to help you with chronic trauma is important. An online therapist directory can be a good starting place where you can access the profiles of many different mental health care providers near you. When looking for a therapist, you can use filters like location, specialty, and if they accept your insurance to narrow down your results.

It is important to know that even if you are planning to attend therapy virtually, the therapist you see must be licensed in your state. To find a therapist who is educated and trained in working with chronic trauma, you can filter by a trauma specialty. You can continue to use filters to narrow down your search until you find a therapist you want to reach out to.