What’s the Relationship Between Trauma and Anxiety?

When a mental health professional told me that my anxiety stems from trauma, I was surprised.  As such, I couldn't remember an isolated event that could explain the connection between trauma and anxiety.

Later, I learned trauma comes in all shapes and sizes; in my case, the emotional abuse I experienced since childhood on account of growing up with undiagnosed neurodivergence was traumatic for my body, and my anxiety was its manifestation.

Here’s what you need to know about the relationship between trauma and anxiety to manage your anxiety better.

Trauma has its roots in Greek and literally means ‘wound’. When used with respect to the human mind, trauma refers to the emotional response of an individual to a distressing event. However, trauma is highly subjective as the reaction to the same event differs for each individual. 

Broadly, trauma is classified as follows:

Acute trauma (AT) is how experts identify the emotional response to a single and brief traumatic event. Think of it as an alarm system that goes off when the body detects any real or perceived threat, triggering the ‘fight or flight’ response. AT may manifest as:

• Anxiety
• Agitation
• Depression
• Flashbacks
• Numbness
• Irritation or confusion
• Emotional dysregulation
• Avoidant behaviour
• Physical responses, such as aches and pains, nausea, sweating, erratic sleep, etc.

Such responses last for a short duration. Events that may trigger AT responses include accidents, terrorist attacks, natural disasters and physical or sexual assault. 

When your body experiences repeated or prolonged exposure to traumatic events over some time, such as ongoing abuse or domestic violence. The symptoms are the same as with AT but persist for a longer duration, impairing your ability to function.

Someone who experiences multiple traumatic events (such as sexual abuse, bullying, emotional or physical abuse, neglect, abandonment, etc.) involving interpersonal threats, especially during their childhood or adolescence, develops complex trauma.

Their nervous system always remains on ‘high alert’, as it perceives the body as being in a constant survival mode. Symptoms are similar to AT and CT, but they tend to be more intense and persist for longer.

Research shows that trauma can alter gene expressions, making it transmittable across generations. If your ancestors have survived events such as cultural genocide, war, racism or forced migration, you may experience trauma as a ripple effect even though you never directly lived through such events. In other words, you experience secondary trauma. 

The science behind trauma is complex.

The genesis of anxiety can be traced back to evolution — humans, too, are wired to recognise danger for survival. This is not only limited to dangers in the physical surroundings but also the cognitive environment.

According to psychiatrist Dr Milan Balkrishnan, “When a person experiences a traumatic event, their brain and body can enter a state of hyperarousal as a survival mechanism. This heightened state of alertness can persist long after the traumatic event has passed, leading to anxiety. The brain's amygdala — which processes fear — becomes overactive, while the prefrontal cortex (responsible for rational thought) may become less effective. This imbalance can cause persistent feelings of fear and anxiety, as the brain remains stuck in a 'fight or flight' mode, unable to fully process and move past the traumatic event.”

“Trauma-induced anxiety can manifest in a variety of ways, some of which may be unique compared to general anxiety. Symptoms can include intense flashbacks or nightmares related to the traumatic event, hypervigilance (being extremely alert and on edge), and avoidance of places or situations that remind the individual of the trauma,” notes Dr Balkrishnan.

“Physical symptoms like increased heart rate, sweating, and trouble sleeping are also common. Additionally, there may be emotional numbness, feelings of detachment from others, and a pervasive sense of doom or dread that sets trauma-induced anxiety apart from other forms.”

Therapy is the primary treatment for treating trauma-associated symptoms.

Research shows psychotherapeutic techniques such as cognitive-behavioural therapy (CBT) are effective in addressing trauma-induced anxiety. Cognitive processing therapy (CPT), a specialised form of CBT, is tailored for addressing long-term symptoms of trauma-induced anxiety.

Unlike CBT, which focuses on reframing overall negative thoughts and behaviour, CPT targets trauma-related ‘stuck points’.

Doctors may prescribe medications to address trauma-related mental health issues and recommend lifestyle changes such as increasing physical activity, maintaining a healthy diet, and getting enough sleep.

Given their nature, experiencing trauma and anxiety is not completely preventable. However, seeking guidance from a qualified mental health professional can help you cope better with the aftermath.

Anxiety is an individual stress response, making it difficult to predict a universal timeframe. “Symptoms of trauma or trauma-induced anxiety can show up several years after the traumatic event has taken place,” explains Aditi Thakur, Counseling Psychologist.

This is a coping strategy which involves identifying three objects, three sounds and moving three body parts. When you experience any trigger for anxiety, it can help you to calm down and anchor yourself.

Fear is an emotional response that signals the body about a potential danger or threat. It is also one of the potential responses to trauma as the nervous system signals the body to enter survival mode.

“Yes, it is possible to experience anxiety without trauma. Someone with trauma will likely experience anxiety in some form. However, it is not necessary that someone with anxiety has gone through a traumatic experience,” notes Aditi Thakur, Counseling Psychologist.

“Ongoing adverse experiences during childhood like sexual abuse, physical abuse, emotional neglect, bullying, domestic violence, war, etc., can result in anxiety. Single traumatic events like a natural disaster, accident, or loss of a loved one can also cause anxiety,” adds Aditi Thakur, Counseling Psychologist.