Trauma and coping with trauma: Dealing with the consequences of violence


Trauma that was caused by sexualised violence is more than just a psychological or physical injury. In particular, the social consequences run deep, so counter-measures need to be taken at the level of society, by acknowledging the suffering of and demonstrating solidarity with survivors, and by prosecuting the perpetrators.

After traumatic experiences of violence, it is possible for individuals to regain stability, security and trust in relation to other people. The work of medica mondiale and local partner organisations has shown this. At the same time, medica mondiale is trying to prevent the pathologisation of affected people by drawing attention beyond these impacts to the experiences of violence that caused them. What is needed for this to succeed?

Trauma is an issue which is becoming the subject of widespread and diverse awareness in many fields, including international co-operation. Here we will take some of the key terms most relevant to project work on sexualised violence and trauma, explaining them from the perspective taken by medica mondiale.

The usual physiological stress reaction ebbs away after the stressor situation finishes, with the body returning to its usual state (homeostasis). However, if the stress reaction system is overwhelmed, our subjective experience is that we can no longer cope. It is this inability to deal with the experience which characterises the process of trauma, leading to the secondary reactions of traumatisation.

How is trauma triggered?

When a person lives through or witnesses an event that triggers an existential threat, and when there is no opportunity to fight, to flee or to seek assistance, then the body switches into ‘emergency mode’ in order to ensure that the person survives. The normal processes which would then take place to deal with a stressful experience and return to a normal state are no longer able to take place. In this way, a deep psychological wound can be inflicted. And the person might continue to experience a persistent, elevated sense of stress.

What factors reinforce a traumatisation?

There are numerous factors which can exacerbate the traumatisation, such as prior experiences of trauma or violence, pre-existing psychological conditions, or the extent of the violence suffered. The impacts of traumatic experiences can also be made worse due to factors such as living in ongoing situations of insecurity, new attacks happening, humiliation or feelings of guilt or shame. The social surroundings also play a major role: reactions can vary from compassionate through shaming to accusing.

What are the symptoms of trauma?

Trauma symptoms can be understood as the residues of the traumatic experience that have not been successfully processed. These force their way into our consciousness and trigger emotional memories or nightmares. We start to avoid or suppress any thoughts, activities, people or situations that remind us of the events. The consequences of this include symptoms such as jumpiness, anxiety, difficulties in regulating emotion, (social) withdrawal, pain, memory lapses, negative self-esteem or a negative outlook on life.

According to the current clinical definitions of the International Classification of Diseases published by the World Health Organisation (ICD-11 from 2019), PTSD is characterised by vivid intrusive images (re-experiencing the traumatic experience, triggered by a specific stimulus or nightmares), avoidance (of thoughts and memories, people, activities and situations) and hyper-arousal (heightened sense of threat).

The WHO classification ICD-11 introduced the diagnosis of Complex PTSD as the consequences of multiple or chronic interpersonal violence. This diagnosis comprises the above-mentioned symptoms of PTSD and additional symptoms related to disturbances in self-organisation: affect dysregulation, negative self-concept (deep-seated feelings of guilt, shame and failure), and relationship issues (difficulties in entering and maintaining intimate relationships).

Is trauma an illness?

A psychological trauma is actually a normal reaction to abnormal events that are full of violence and that threaten our survival. Examples include sexualised or racist violence that needs to be experienced, assessed and processed subjectively. However, these reactions can lead to an impairment in our quality of life if they persist for a long time. This is why trauma reactions are defined within a clinical diagnosis: it allows appropriate treatment to be claimed and performed.

In the field of psychology, resilience is the term used to describe our ability to cope with challenging circumstances such as emergency situations in an adaptive and integral way. The advantages of using this term lie in the emphasis of the capacities, resources and creativity we are endowed with as humans. The potential inherent in these resources does depend on the individual, and the experiences that person has lived through in their social surroundings and society as a whole.

What is retraumatisation?

Retraumatisation is the experience of another situation or event that the survivor associates with the original traumatic experience and therefore becomes traumatising. One example might be a gynaecological examination. This can lead to a significant deterioration in the survivor’s post-traumatic stress reactions.

How can retraumatisation be prevented?

By taking part in appropriate training, people helping survivors can gain an awareness of the trauma dynamics that can lead to retraumatisation, which in turn allows them to take pre-emptive measures. For example, during medical treatment it is important to remain in contact with the client and to be aware of possible symptoms of a retraumatisation such as quicker breathing or increased muscle tension. Then the helper can react accordingly.

Let us consider the example of counsellors: in the course of their work they listen empathically and compassionately to numerous descriptions of traumatic experiences, forming human connections to people who are suffering from the pain of trauma. This can all lead to them being affected in a similar way to people who experience violence directly and, for example, suffer similar symptoms such as nightmares or persistent heightened tension (hyper-arousal).

Sexualised violence is a particularly frequent cause of post-traumatic stress because it directly affects the most intimate self of a person. It is an invasive form of violence that violates the person’s integrity and is also subject of a taboo. Those affected are stigmatised and their suffering is not acknowledged. Sexualised violence is often an expression of emotional and economic power imbalances. This can also make it more difficult to process the violence.

What characterises sexualised wartime violence as a cause of trauma?

In sexualised wartime violence, the sexualised violence is used as a collective weapon of war in order to destroy families, communities and social cohesion. Studies have shown that the incidence of sexualised violence increases during phases of escalation in a conflict. As part of a military strategy, the aims are to humiliate and shame the enemy groups, to degrade people, and to force them to flee.

medica mondiale has a feminist and socio-political understanding of trauma. This is broader than merely looking at trauma as something suffered by the individual person: We always include violence as a cause of traumatisation, and we consider the social and societal conditions for coping with or processing trauma. We see post-traumatic stress reactions as strategies for survival and defence when faced with violence, threats and oppression.

For more than 25 years, medica mondiale has been assisting women and girls in and conflict areas who were affected by sexualised violence. One of our most important approaches to carrying out our work is to be active on both the individual and collective levels as we work to help people cope with the trauma caused by violence.

Our partner organisation Medica Afghanistan worked within communities until the Taliban came to power in 2021, offering psychosocial counselling groups where women were able to talk to each other and learned methods to decrease stress and tension and to cope with the consequences of trauma. This was complemented by offers of one-to-one counselling. Some of the participants then went on to lead ‘peer groups’ in other communities, where they were able to inform participants of the rights of women and helped to refer people to further offers of support.

Unfortunately, many conflict areas do not have the conditions that would be important for dealing with the consequences of violence and for eliminating its causes. So in order to help women affected by violence find sufficient support anyway, medica mondiale has worked together with its partner organisations to develop a multi-level model that brings together direct assistance in the form of counselling and support with measures to enact change at the social, political and social levels. This approach is designed to ensure long-term beneficial effects in the surroundings of those affected. The particular expertise of medica mondiale lies in the promotion and funding of a Stress- and Trauma-sensitive Approach and solidarity measures which ensure that all the stakeholders and organisations involved receive support and gain a sense of security.