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Special Feature Series: Trauma Informed Care, Part 3 – Manifestations of Trauma

Experiencing trauma is an essential part of being human” (van der Kolk and McFarlane 1996)

Traumatic events affect people very differently.

Elizabeth Vermilyea points out that one of the best documented research findings in the field of trauma is the dose-response relationship. The more trauma a person experiences, the more potentially damaging the effects are. The effects are more severe if the trauma is repeated, experienced in childhood, caused by another human being, inflicted with deliberate intent, unpredictable or perpetrated by a caregiver.(1) “Children need strong, healthy bonding to caregivers in order to grow, flourish and mature.”(2)

Memory and trauma

We have two distinct kinds of memory. One is the declarative or explicit memory, which is our logical, conscious memory . This is recalling your shopping list when you are in the grocery store. The other is called the implicit memory. This is a kind of unconscious, procedural memory which doesn’t involve the hippocampus. This is the imprinted memory involved in tying your shoe or riding a bicycle.(3)

Some people survive traumatic events and seem completely unaffected. It is common with early developmental trauma (childhood neglect and abuse) that the traumatic events are completely erased from conscious memory. Research shows these memories are stored in the implicit memory.(4)

How trauma manifests

The implicit memory can surface in later life as nonsensical fragments, or may manifest in overpowering flashbacks of an event. Nightmares may result in a lack of sleep. People may be anxious, depressed, irritable and hypervigilent. Physical symptoms such as headaches, heart dysrhythmias, GI problems, gynecological issues, asthma and chronic pain can be the result of chronically high stress hormone levels.

Trauma survivors may engage in self-soothing behaviours such as prescription or non-prescription drugs or alcohol, altered eating patterns, increased or decreased sexual activity and self harming behaviors.

In her self-help toolkit for managing traumatic stress, E. Vermilyea provides a useful list of traumatic stress responses people commonly experience after trauma.(5) You can download this list (Traumatic Stress Responses) under Additional Resources at the end of this post.

Clinical implications

As health care providers, we can see how these manifestations of trauma can interfere with a person’s sense of safety, self and self-efficacy, as well as their ability to regulate emotions and navigate relationships.(6)

Elizabeth Vermilyea explains the relevance of understanding trauma for health providers. “Most of our client populations have been exposed to trauma at some points in their lives. Trauma Informed Care is a way of integrating an awareness of the impact of trauma with existing practice. It is a framework that can be applied to every interaction and intervention with those seeking care. It is not about doing extra work. It is about applying a trauma lens to view the things you already know and adding that perspective to your job.”(7)


  1. Allen, J. 1999. Coping with Trauma. American Psychiatric Press, Lutherville, Maryland.
  2. E. Vermilyea. 2000. Growing Beyond Survival. The Sidran Press. Intro., pxiii
  3. http://www.human-memory.net/types_declarative.html
  4. Nadel, L. and Jacobs, W.J. 1996. The role of the hippocampus in PTSD, panic and phobia. In N Kato (Ed.), Hippocampus: Functions and clinical relevance (pp.455-463). Elsevier, Amsterdam.
  5. E. Vermilyea. 2000. Growing Beyond Survival. The Sidran Press. p. 8-9.
  6. Trauma Informed Practice Guide, Draft 5. 2012. Vancouver, British Columbia.
  7. Elizabeth Vermilyea. Trauma Informed Care: Trauma and its relationship to Addiction, HIV and STIs. Lecture at BC Centre for Disease Control, 24 November 2012, Vancouver, BC.

Next installment

Prevalence of Trauma (August 2013)