The medical implications of COVID-19 are not debatable. Innocent people have lost their lives, families have been restricted from visiting their loved ones and the healthcare system has been impacted. The response from dedicated professionals that continue to brave the fight against this disease is nothing less than heroically admirable.

Amidst this medical challenge, there is a psychological one that we, as a society, can work together to overcome. As the coronavirus creates a medical ripple effect throughout Pennsylvania and the U.S., we cannot ignore the impact it has on individuals who have experienced trauma, specifically those that have experienced complex and attachment-based traumas.

A way to respond to the psychological trauma is to work collectively as a group in communities to support individuals with histories of past trauma. Just as there have been some claims in the media about not knowing who is a carrier of the coronavirus, we don’t always know who has survived trauma. Therefore, it is important that we be mindful of our actions, maintain a sense of awareness and respond with kindness and empathy.

When a trauma survivor is reminded of a past traumatic situation, an uneducated observer might think it is an overreaction. This is more accurately referred to as being“triggered”.  Smitha Bhandari, M.D., refers to triggers as “Sights, sounds, smells or thoughts that remind you of the traumatic event in some way.”

Someone that is reminded of past trauma may become emotionally overwhelmed, frightened or appear to display behaviors that are out of proportion for the given situation. What is important to understand is that the individual deserves to be treated with respect and dignity in these painful moments.

During a pandemic, it is even more important that we remember to be empathetic and compassionate because uncertainty and inconsistency contribute to a further sense of insecurity for individuals that have experienced trauma.

How to Offer Support

It is important to understand that we all find safety in our own ways. For individuals that experienced trauma at a particularly young age, safety was not something that was known to them; any perceived threat to safety can seem terrifying.

The “stay at home” orders that were implemented across the Commonwealth of Pennsylvania have been stated to serve a purpose of mitigating the spread of COVID-19. However, for those who have a history of attachment trauma, these orders can be catastrophic. Separation anxiety is not basic loneliness or sadness of not seeing someone. It is the severe, persistent sense of loss, and panic that a person will not see someone they care about again.

According to the Diagnostic Statistical Manual-V (DSM-V), there are several criteria which must be met to give a diagnosis of separation anxiety disorder. An individual must present with three out of eight specified symptoms for a given duration (different for children and adults), and meet other conditions, as assessed by a qualified professional.

Two possible criterion worth noting in this assessment include, “Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures,” and “Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters or death.”

If we examine the current climate with COVID-19, it makes sense why more individuals would be struggling with separation anxiety at this time. As a society, we need to ensure that we are being mindful of the many attachment traumas that are likely occurring as “stay at home” orders continue.

With attachment traumas, individuals have often experienced profound loss, or experienced abandonment, often from childhood abuse or neglect. To be restricted from access to safe supports in an individual’s life in the middle of a pandemic can and does cause significant harm to individuals. In society, we can help and offer kindness in return, by simple gestures such as offering connection-based conversation on line at the grocery store, offering a smile to someone walking on the sidewalk, doing a random act of kindness for someone and so many more individualized acts that involve social connection.

Complications of mental illness related to anxiety and depression as a secondary cause of traumatic stress-related disorders can and do lead to medical complications. Specifically, The Adverse Childhood Experiences (ACE) Study, completed at Kaiser Permanente, from 1995-1997, has shown data that has demonstrated a correlation of early experiences of trauma and adversity to various health problems later in life. The impact of trauma cannot be ignored.

Another situation to consider is the requirement for individuals to wear masks in the community. For many people, wearing masks are an inconvenience, or a slight irritation, with an understanding of their purpose. However, for others, wearing a mask can be a reminder of memories of past medical traumas, abuse and other significant traumas. By becoming aware of this, business owners and other customers can develop sensitive practices that enable them to still follow the requirements of enforcing mask wearing as required by the governor, while embracing a trauma-informed culture within their stores.

This could include trauma-informed shopping for one hour per week; individuals would know they would be among people who understood their concerns, and would share in the moments of solidarity offered, with supportive staff at registers and throughout the store to help those who are overwhelmed and struggling. While these accommodations might appear excessive to those who do not struggle with traumatic reminders, the difference it could make could forever change the culture in which we respond to trauma. We have an opportunity to make a difference.

As Aupperle, Melrose and others explain in their 2011 article Executive Function and PTSD: Disengaging from Trauma, when overwhelmed, executive brain functioning becomes impacted; it can be hard to remain present and focused, as this too, is an effect of trauma and its impact on the brain. By demonstrating tolerance and kindness, we can do more than we think to help others.

Most importantly, we need to remember that just as individuals did not choose to get infected with COVID-19, individuals did not choose to experience trauma. Their responses and behaviors, while sometimes extreme and disliked, are a survival response, no fault of their own. Remember to be a little extra-patient because everyone has a story. When we in society work together to create a safe atmosphere, we all thrive.

Sarah Falkson, MPA, MA, LBS, is a certified clinical trauma specialist and has worked in a variety of capacities in the mental health field for more than 15 years. She remains loyal to increasing empathetic ways in which society can respond to individuals who have experienced trauma and enhancing a culture of trauma informed care in the mental health field.