Moment 174: Trauma Doctor Reveals Every Type Of Trauma & It’s Effects In 10 Minutes

In this moment, world-renowned trauma expert, Paul Conti discusses the different forms that trauma can take. Paul defines trauma as anything that overwhelms your coping mechanisms, which in turn changes the structure of your brain. Trauma can be broken down into 3 types: acute, chronic, or vicarious. Acute is a very evident type of trauma, and the one most people think of, this includes PTSD. Chronic trauma occurs over a longer period of time, and includes racism, bullying and neglect. Finally, vicarious trauma is the trauma people can get due to empathising with another person’s trauma and feeling their pain. Paul also outlines the hypothesis of ‘multiple hit’ trauma. This is the idea that after multiple traumas it can became too much for a person to cope with, and even a small trauma can then push a person over the edge. This hypothesis completely disproves the idea that what doesn’t kill us makes us stronger. Listen to the full episode here - Spotify- https://g2ul0.app.link/CtWAMbYKTLb Apple - https://g2ul0.app.link/TIVYc9ZjNu Watch the Episodes On Youtube - https://www.youtube.com/c/%20TheDiaryOfACEO/videos Paul: https://drpaulconti.com/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Steven Bartlett?

  What are the different types of trauma? Are there sort of different categorizations of trauma from like small to big?

• 0:09Speaker 01

  If we're using the definition that trauma is anything that overwhelms our coping mechanisms. So there are changes in the brain when our coping mechanisms are overwhelmed. And on the other side of that, our brains are different. So that's the biological definition. Then we would look at, well, how do we get there? Right? And it breaks down into three categories, then of acute, chronic, or vicarious. So the acute trauma is how we've traditionally seen trauma. So if you think about the idea that people were shell shocked after World War I, right? That was acute trauma, combat trauma. So our traditions of looking at trauma come from acute trauma. And it's just more evident, you know, after someone dies, or there's an injury,

• 0:52Speaker 01

  or there's a car accident, like, you know, we can see that, oh, okay, gosh, that could make some difference in the person. Like, we can kind of get that. And sometimes we can see the change in the person from before and after. So we have tended to equate trauma and post-trauma syndromes, like what happens to us after those changes in the brain are now with us to acute trauma. But again, it's not a soft definition. It's based on, do those changes in the brain happen in other ways? And the answer to that is yes. That if a person is seen as less than, for example, in a society, for whatever reason, across time, or even within a household, a person is being abused in a household, a child is being neglected,

• 1:36Speaker 01

  or a child is being emotionally or physically abused.

• 1:39Steven Bartlett?

  Bulleted at school?

• 1:40Speaker 01

  Sure, bullied at school, absolutely. Right? This over, so nothing happens all at once, right? But that brain changes just the same. So it's a scientific definition of traumatic change. And it is true in situations of chronic trauma, just as it is in acute trauma. Now, it doesn't mean all acute traumas or all chronic traumas make these changes in the brain. And then vicarious, so the third category, there would be vicarious trauma, which means like human Beings are empathic, right? I mean, thank, thank goodness, right? That's how all goodness comes in the world through our ability to have empathic connection. But that also means that our trauma can communicate from one to another. And again, it's not a soft concept.

• 2:23Speaker 01

  So people who are very much involved in other people's trauma, so in healthcare settings, sometimes in, in journalism settings, just in intimate home settings, in just spending a lot of time with the news, right, can become traumatized and have the changes in the brain that look the same as the person who lost two family members in the car accident. So it is true that vicarious trauma can change us in just the same way. The, the modern field acknowledges that if it's in the context of professional endeavors, which it really makes no sense, right? Like what we're talking about are brain changes, and brain changes can come through acute trauma, chronic trauma, or vicarious trauma because of our ability to have empathic connection

• 3:09Speaker 01

  and compassion with other humans.

• 3:11Steven Bartlett?

  I want to make sure that I've nailed this before we move on. So the acute trauma is, I get it, it's the, the big events. It's the going to war, it's the car accident, the big events that happen typically in an instant. Typically, chronic trauma, this is things like racism, sexism, bullying, that happen over a long period of time gradually, that make you often feel less than

• 3:31Speaker 01

  Right.

• 3:32Steven Bartlett?

  than other people. And the vicarious trauma is the trauma that, as you say, you get from empathy. So feeling someone else's pain, feeling someone else's trauma, and it becomes your own.

• 3:41Speaker 01

  Yes.

• 3:42Steven Bartlett?

  Okay.

• 3:42Speaker 01

  Yes, and they can all lead us to the same brain changes. But people have different levels of susceptibility, right? So one person may have three big acute traumas, and that person's brain is still doing okay, right? It's not changed towards greater vigilance, right? It's not changed towards greater inflammation in their blood vessels. Then, you know, a, a, another person could have one incident that might seem more mild than the other three, the person, and that person can then have brain changes. So part of it is who are we genetically? How are we built? What kind of life experience have we had, especially early life? Experience, how susceptible are we to one thing versus another?

• 4:23Speaker 01

  And then this idea of the multiple hit hypothesis that I could have a number of traumas and then on a certain trauma that might be even mild compared to ones that came before it. Now it makes the changes.

• 4:34Steven Bartlett?

  What is that hypothesis?

• 4:36Speaker 01

  So that multiple hit, which, which, which says that this idea that what, what doesn't kill us makes us stronger is completely wrong. I mean, in absolutely every way, what, what doesn't kill us often makes us weaker. And that's why we have to be attentive to what hurts us, but doesn't kill us so that we don't get weaker. We get stronger. But what can happen is we can become more susceptible to the more likely that the next trauma, if we experience one, will then create the brain changes.

• 5:04Steven Bartlett?

  Cause I have often wondered, I'm the youngest of four kids. We all grew up in the same household. We experienced a variety of different traumas, in my opinion. Much of it was chronic, but again, being the only black family in a north white area, all these kinds of things. But I think I've always reflected on is for some reason, I think I experienced it much more, the trauma of that than my older siblings.

• 5:25Speaker 01

  Yes.

• 5:25Steven Bartlett?

  And I've pondered whether that's because of the timeline, being the youngest, it was worse in the later years. So I, I think my hypothesis has been that I experienced it more than my siblings. And I think I've embodied the shame a lot more than my siblings have, yet we both went through the same thing. So for whatever reason, I'm like really like, I'm a workaholic and I'm exceptionally driven. Not that my siblings are, but I'm obsessed in a way that's probably not completely healthy. And I look at my siblings and I go, they're not fucked up in the same way that I am. But we all went through the same thing.

• 5:54Speaker 01

  Part of what you're pointing out is that the variables of life matter, right? So circumstances are different, say for one child in formative years than for another. Those children could be affected differently, like economic circumstances. So some of it may be, and, and probably is impacted by the things that you're saying. But there probably are almost surely other factors to this kind of nature and nurture that people have what sometimes gets called different levels of attunement of, of the emotional compass. So, you know, some people are very sensitive and sensitized to things and very aware of what's going on around. And aware of their own feeling states and you know and other people can kind of go through life and you know emotionally buffeting things can happen but they kind of keep going you know

• 6:38Speaker 01

  and and look there are pros and cons to both of those ways of being but the person with the sort of more finely attuned emotional compass is the person who's likely to to register more things that are negative like things like subtle expressions of prejudice right that that someone with a less attuned compass may just you know kind of not see that or just it doesn't make it you know into their conscious awareness whereas someone else who'd be very attuned might see a lot of those things so it's this part like what is the nature like who is the person right and then what is the nurture meaning like what are the variables you know that that seed sort of falls into as we go through life.

• 7:18Steven Bartlett?

  You must have seen this a lot in your practice where an individual went through a really traumatic early event and you've got the person in your practice sat in front of you that is an alcoholic they are experiencing sort of suicidal thoughts but then when you look at the rest of the family the family are just doing fine to some whatever that means fine but.

• 7:38Speaker 01

  Right well one if to look at is the rest of the family doing fine because sometimes what it seems like on the outside is not true on the inside and then we do think about genetics especially around alcoholism there are we don't understand all of it of course but but there are genetic factors that can be very impactful then we'll look at personality structure you know is that person built to sort of internalize or externalize blame you know so why alcohol for this person and not for someone else how much is nature or nurture and how much may be formative it may be that for example that person was in social circumstances just real example that happens with some frequency is a mid to late teens where alcohol was accepted as a way of coping

• 8:20Speaker 01

  right and and maybe other people in the family weren't this circumstances were just different where they went to school was different and and they didn't have it modeled for them that this is how they cope so maybe their genetic factors that that push more towards alcoholism maybe there are social factors right that it was modeled for that person so you can put those things together and which is why we follow patterns and there's a science underlying all of this but we have to look at who is that person right you have to look at. You know, the family history, so the genetics that may have been passed on. And what does that seem like may be the case in the person? How can you be informed by that? And what were their formative life experiences? And you start, we start to build a picture of what's going on inside of us

• 9:04Speaker 01

  so that we can understand and change by looking at our history, which is why mental health doesn't often do this. You know, it takes an inventory of your symptoms now to reflexively prescribe a medicine, right? So we need to understand ourselves if we're going to understand whether trauma is afflicting us, how it's afflicting us, how we can prevent it, how we can treat it if it's there. And I think that means accepting that this is real and this is real science.