19 July 2023

Cumulative trauma

This article is part 3 of a series on trauma written by the Fortem clinical team. To read part 2, click here.

The majority of folks in the general public will experience 1 to 3 traumatic events in their lifetime. In contrast, first responders are often exposed to repeated and prolonged trauma due to the nature of their work.  

What is cumulative trauma? 

Cumulative trauma refers to the gradual and progressive impact of repeated or prolonged exposure to trauma. First responders often talk about this like a backpack they carry throughout their careers. This backpack gets filled with experiences, some of which are heavier than others. Over time, the load can get increasingly heavy and start to weigh you down or begin to overflow so that what was once manageable starts to feel overwhelming. 

The cumulative effect of repeatedly encountering traumatic situations can contribute to the development of exhaustion, compassion fatigue, depression, PTSD and other mental health challenges. 

What contributes to cumulative trauma? 

Just like some physical injuries can be the result of repetitive strain, traumatic stress injuries don’t always occur immediately after a particularly overwhelming event. Sometimes they build up over time and you become affected by the sum total of traumatic experiences. 

Sometimes there are particular themes in traumatic events that seem to re-occur. Themes of senseless loss, danger, human cruelty, or injustice can become harder to process when they happen in quick succession or mount up over time. 

A key element of cumulative traumatic stress is not being able to process the impact of traumatic events. First responders have a remarkable capacity for resilience. However, there are factors that can interrupt the natural process of recovery. These include: 

  • Operational tempos that don’t allow time to process events when going from one job to the next 
  • Organisational and cultural factors that don’t allow space for acknowledgment of the impact of certain events 
  • Lack of psychological tools or resources to help process the emotional toll of traumatic events 
  • Poor work-life balance creating limited time to “reset” and mitigate the build-up of stress in the body 

What does cumulative trauma feel like? 

As trauma accumulates, first responders can start to feel changed by what they have experienced. It can feel like you’re being systematically worn down as a person, like your sense of self and capacity for joy and connection to others is being stripped away. You may feel emotionally raw or completely numb. You can start to dislike the person you are and feel less lovable or useful to others. You may notice yourself feeling more sensitive to difficult jobs, feeling less resilient and more vulnerable

What to look out for 

The effects of cumulative trauma can be so slow and subtle that they don’t immediately show up on your radar. While family members of first responders are often the ‘canaries in the coal mine’ when it comes to catching the signs of traumatic stress, the first signs you notice might show up in your body, with things like increasing sleep difficulties, reduced immunity, or developing recurrent digestive complaints. 

Other things to look out for include: 

  • Starting to be more focused on safety, threat, and danger than things like relationships and enjoyable activities 
  • Feeling flat and unable to enjoy things as much as usual 
  • Loss of passion for the work and reduced care for others or yourself 
  • Shifting to a darker worldview and becoming more irritable, angry, or cynical 
  • Dwelling on traumatic events and finding it hard to switch off 
  • Heightened feelings of responsibility for the community 
  • Starting to feel like you are not yourself and don’t have as much to offer the world 

How to mitigate the risks of cumulative trauma 

Protect your work-life balance: Try to make sure you have enough downtime to reset your body from the stress of work. You need a good dose of light to counterbalance the dark. Try to have a routine that helps you to actively switch off from work and switch over to home life.  

Prioritise social connections: Focusing on fun activities and quality time with family and friends is one of the best ways to burn off stress and build a strong “wellbeing muscle” that has been shown to protect first responders against the effects of trauma exposure. 

Make processing the emotional impact of trauma part of your routine: Make use of available supports to acknowledge challenging events. This can include mates, family, PSOs, chaplains, your wellbeing team or EAP providers. You don’t have to share graphic details; sometimes it’s helpful just to be able to say “today was a hard day” or “that job today has left me feeling really sad.” 

You can take this one step further and proactively engage with a psychologist to work on developing your skills in identifying and responding to the emotions that can come up in traumatic events. 

What’s next?

Next week we will be exploring the topic of moral injury. 

Article written by Dominic Hilbrink, Senior Clinician at Fortem Australia.