T.I.R.E.D.

Events and circumstances may include the actual or extreme threat of physical or psychological harm which may occur as a single occurrence or repeatedly over time. This element of SAMHSA's concept of trauma is represented in the Diagnostic and Statistical manual of Mental Disorders (DSM-5), which requires all conditions classified as "trauma and stressor related disorders" to include exposure to a traumatic or stressful event as a diagnostic criterion.  

The individual's experience of these events help to determine whether it is a traumatic event. How the individual labels, assigns meaning to, and is disrupted physically and psychologically by an event will contribute to whether or not it is experienced as traumatic. Feelings of humiliation, guilt, shame, betrayal, or silencing often shape the experience of the event. 

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How the event is experienced may be linked to a range of factors including the individual's cultural beliefs, availability of social supports, or to the developmental stage of the individual.

The long-lasting adverse effects of the event are a critical component of trauma. these Adverse effects may occur immediately or may have a delayed onset. The duration of the effects can be short or long term. in some situations, the individual may not recognize the connection between the traumatic events and the effects. 

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Advances in neuroscience and an increased understanding of the interaction between neurological factors and environmental factors have helped researchers and practitioners to better understand and respond to the effects of trauma. 

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Traumatic effects which may range from hypervigilance to a constant state of arousal, to numbing or avoidance, can eventually wear a person down, physically, mentally, and emotionally.