This conceptual framework for the effects of traumatic experiences addresses what makes an experience traumatic, what psychological responses are expected following such events, and why symptoms persist after the traumatic experience is over. Three elements are considered necessary for an event to be traumatizing: The event must be experienced as extremely negative, uncontrollable, and sudden. The initial core responses to trauma include reexperiencing and avoidance symptoms that occur across four modes of experience. Explanations of how each response is theoretically linked to traumatic events are offered to clarify how the responses reflect the natural human response to uncontrollable, negative, and sudden events. The framework delineates the behavioral learning and cognitive processes that elucidate the persistence of the initial response to trauma. Five factors are proposed that influence the response to trauma, including biological factors, developmental level at the time of trauma, severity of the stressor, social context, and prior and subsequent life events. Finally, secondary and associated responses to trauma are discussed that are common across many types of traumatic experience. These include depression, aggression, substance abuse, physical illnesses, low self-esteem, identity confusion, difficulties in interpersonal relationships, and guilt and shame.
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