Donders Wonders

Pencil illustration attempting to visualize PTSD. Those that suffer from this disorder are constantly trying to regain some sense of the normalcy they had before events that caused pieces of themselves to go missing.

When Trauma Affects Decision Making

This post is also available in Dutch.

Trauma-related associations prompt people with post-traumatic stress disorder (PTSD) to make decisions differently than adults without PTSD.

Survivors of war, those who’ve experienced near death experiences, or victims of sexual assault have one thing in common: post-traumatic stress disorder (PTSD). U.S. Air Force illustration by Master Sgt. William VanceCreative Commons Zero (CC0) license.

Traumatic events are difficult to heal and can leave scars for life. People with PTSD are afraid to form new relationships, and find it difficult to express their needs or their creative potential. They have vivid flashbacks of traumatic events, and will therefore try to avoid any cues that relate back to the trauma.

Research has shown that people with PTSD differ in the function and structure of the amygdala, hippocampus and ventromedial prefrontal cortex – regions that regulate and influence our response to stress. Therefore, people with PTSD perceive stress differently than people without. Researchers have also proposed that trauma may even change the way a person makes decisions.

The associations we live (and act) by

Our actions have consequences, some are positive and some negative. Consequently, we associate our actions with their outcomes, and quickly learn to seek reward and to avoid punishment.

By default, the things that give us more “wins“ are associated with taking action (e.g., cooking, exercising, meeting new people, etc.), while the things that bring us “losses” are associated with taking no action (e.g., not falling off a cliff, not eating something poisonous, etc.). These “default” options are called Pavlovian biases: they stem from us wanting to take action in order to gain a ‘win’, or wanting to not take action to avoid a ‘loss’. This bias therefore triggers ‘confusion’ when the following two scenarios occur: 1) when we want to take action because we associate that action with winning, but it results in a loss; and 2) when we do not want to take action because we associate that action with loosing, but it results in a win.

We face these conflicting situations daily, and to solve them, additional effort is needed, or cognitive control. Food, for example, is a source of pleasure for most humans (here’s the “win” we’ve just mentioned), however it takes some effort to stop eating late, when dieting. On the other hand, studying hard for an exam is associated with hard work (“loss” in a way), and it takes additional cognitive control to study hard, because in the long term it brings a “win’’.

What goes wrong
In the experiment carried out by Ousdal and colleagues, survivors of the 2011 Norwegian terror attack were asked to perform a task along with non-traumatized participants. All participants had to learn rules while playing a game, where the purpose was to win as much money as possible. Trauma survivors performed much worse than non-traumatized participants when a ‘response’ was needed in order to not lose money, and a ‘no-response’ was needed in order to win money.

These findings show how trauma survivors seem to have stronger associations between taking actions to gain “wins” and not taking actions to avoid “losses”, in other words a greater Pavlovian bias. Ultimately, this bias makes decision making less adaptable for people with traumatic experiences.

Trauma affects many aspects of our cognition, and decision making is one key aspect that becomes affected. Understanding the effects of trauma on other aspects such as working memory, planning and attention may help researchers better describe the complexity of PTSD, and ultimately find a better treatment for survivors of trauma.

Written by Lara, edited by Marpessa.

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5 thoughts on “When Trauma Affects Decision Making

  1. I have suffered a remarkable traumatic events which I feel have predisposed me to manage my life to poor effect.

    Feeling like a misfit growing up, married at age 20, living in a foreign country, working 3 jobs to pay for my studies; divorced by 22.

    Have someone threaten to shoot me at 23, driver of a 4×4 that rolled 3 times in Africa; off work with injuries for 4 months. Married again at 25; stoppped at red traffic light when hit by a 20 tonne truck; first daughter born at 27.

    Divorced again at 33, pregnant with 2nd child at 35, married. Partner became viciously abusive and stopped working so I had to support the family.

    Wanted to leave when my baby was 6 months. Raped by my husband, pregnant again when baby was 5 months old. Went for abortion counselling, but could not proceed.

    Stayed in abusive relationship until my previous husband abducted my oldest daughter. This gave me the courage that I needed to kick out my abusive husband and institute divorce proceedings.

    He refused to pay maintenance and insisted on regular contact with the children who were unbelievably distressed whenever they saw him.

    My Mom was diagnosed with lung cancer in Feb 201 and in May 2010 the children told me how their father was sexually abusing them. They were very small so were examined under general anaesthesia by a panel of 3 Gynaes who concurred that the abuse was longstanding.

    The children were questioned by The Teddy Bear Clinic who produced a flimsy report that referred to the divorce as a possible reason for th children to be “coached” – have you EVER met 2 under 5 year olds who BOTH tell the SAME stories with the identical details?

    State case returned the conclusion that the children were too young to testify and so they would have supervised access for 6 months and then he would have FREE access to them!!! I launched a High Court case to remove his rights and responsibilities which cost everything that I had, but kept my children safe.

    My Mom passed away shortly after we had to relocate and change identities to protect them as state witnesses. My Dad was dating within 3 months and married a year later.

    I chose to get involved with someone completely irresponsible who ended up alienating me from my father who decided it was best for my children to go to hostel as I could not pay their school fees.

    I am broken and sad and so often feel like giving up. I feel that nobody is on my side, or ever will be and I am tired of fighting for a tiny patch in the sun.

    I am only now beginning to understand how the trauma that I experienced affected my ability to make good quality decisions for myself and my family.

    It has taken years to overcome all the negative loop feedback that goes on in my head, telling me that I deserve all this pain and suffering. To allow myself to believe that i DESERVE that spot in the sun and if I show myself for who I truly am, others will support my efforts rather than undermine them,

    1. Hello Rose, Your resistance story is impressive. My life story allows me to understand you a little and you deserve all the good things that life has to offer. Rose, Honey, you have a right to be happy, respected, loved. There is no reason for this not to happen. I hope you are well and that life has given you some rest. I continue on my way and leave a suggestion: visit

      Keep fighting for yourself and the ones you love.

      Courage and don’t forget you are important! You are loved exactly as you are.

    2. Bro girl I totally get you so many losses all at once and life stress on top of it how are we supposed to move forward when we don’t even know what we have inside anymore?

  2. Wow your story is pretty much exactly the same as mine!!! Why is life so hard for us and not for others? Will I ever feel sane agen all the trauma has made me feel totally broken and unable to make any decisions because i don’t trust myself to make the right ones because terrible stuff keeps happening to me did you find any copeing methods I don’t even know what makes me feel good anymore

  3. Hi.
    What do you think of this behavior?
    A friend aged 89 had expressed his wish not to be resuscitated in case of an accident because he did not want to risk being infirm.
    His trusted paid aid deliberately went against his wish.
    Luckily he survived intact.
    However, our friend developed a passion for the guy, disinherited his nephews, and gave everything to the guy.
    The guy’s wife said that our friend had completely changed and after the event, her husband the aid could do no wrong!
    The decision was taken 2 weeks after the event DESPITE our friend being so adamant for years that he preferred to die than the risk of being dependant.

    After the event, he basically completely forgot the guy had put him at risk.

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