Baseer Maroof, LCSW · Raleigh, NC · Adults 21+
The trauma response
What your body did during the trauma wasn’t a decision. Here’s the wiring behind it, and why most people recover.
In short
- Your body’s threat responses run on their own: arousal, freeze, fight or flight, and, when there’s no way out, shutdown.
- None of these are choices. They’re built-in defences.
- In the first days and weeks, strong reactions are common and often fade on their own.
- PTSD is when the alarm keeps firing at reminders long after the danger has passed, and avoidance keeps it going.
The defence cascade
The defence cascade
Tap a step, or press Play. Switch to see what happens afterwards in PTSD.
Four paths
How symptoms change over time after a potentially traumatic event.
Four paths after trauma
Tap a path or a line.
The first month
Strong reactions early are common
Acute stress disorder describes heavy distress from 3 days to a month after a trauma. Across 70 studies, about 20% of people had it, more after interpersonal violence (36%) than after accidents (16%). It doesn’t reliably predict who will develop PTSD. (National Center for PTSD)
What helps in the first days
Under three days, the focus is general wellbeing: support from people you trust, physical activity, and dealing with practical stressors. Watchful waiting is reasonable. (National Center for PTSD)
If it doesn’t settle
For acute stress disorder, the VA/DoD suggests trauma-focused CBT to help prevent PTSD. After a month, if symptoms are still getting in the way, a PTSD assessment is the next step. (VA/DoD 2023)
Why the body overrides you
The defence responses run through old brain circuits (amygdala, hypothalamus and brainstem) rather than through deliberate choice. That’s why “why didn’t I just…” isn’t a fair question to ask yourself afterwards. (Kozlowska et al. 2015)
Sources
All sources, linked5 references⌄
- Kozlowska K, Walker P, McLean L, Carrive P (2015). Fear and the defense cascade: clinical implications and management. Harvard Review of Psychiatry, 23(4), 263–287. pmc.ncbi.nlm.nih.gov/articles/PMC4495877/
- Galatzer-Levy IR, Huang SH, Bonanno GA (2018). Trajectories of resilience and dysfunction following potential trauma: a review and statistical evaluation. Clinical Psychology Review, 63, 41–55. pubmed.ncbi.nlm.nih.gov/29902711/
- National Center for PTSD. Acute Stress Disorder. www.ptsd.va.gov/professional/treat/essentials/acute_stress_disorder.asp
- Schnurr PP et al. (2024). The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Annals of Internal Medicine (2024). doi:10.7326/M23-2757. www.healthquality.va.gov/guidelines/MH/ptsd/PTSD-in-Annals-2024.pdf
- National Center for PTSD. Prolonged Exposure for PTSD (for providers). www.ptsd.va.gov/professional/treat/txessentials/prolonged_exposure_pro.asp
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