Trauma

Trauma – specifically emotional trauma - is any event that you were not equipped to handle at the time it happened. It can cover a broad array of events, including, but not limited to:

* common events like car accidents, assaults

* catastrophic events like earthquakes, floods  

* military or combat events  

* abuse or neglect – both physical and emotional

* medical traumas like being diagnosed with a life threatening illness or having a bad experience with a surgery or childbirth

* abandonment issues both from a parent actually physically leaving and also including mental illness or addictions in a parent or partner that makes then emotionally unavailable

* losses from death, divorce, and even anticipating future losses

* any life or death event where we think, even for a brief second, that we might die

Simply put, trauma is any event that is experienced with a surge of emotions, as this will cause the brain to store the memories differently.  

Can Childhood Neglect be Traumatic?

Childhood neglect is often overlooked, because it is not something we can see, but rather it is the absence of something. It is often difficult to recognize. Children have no way of knowing they are being deprived, as they assume what happens to them is what happens to everyone. But childhood neglect can cause problems like aggression, self-mutilation, attachment problems, hypersensitivity, and substance abuse issues.  

It has been shown that neglected infants adopted into a caring home by the age of four months old will typically be okay as adults. However, if the neglect continues after four months these infants have a high chance of suffering greatly in adulthood from disorders such as depression, substance abuse, personality disorders, PTSD, hyper-emotionality, irritability, and/or impulsivity.

What Happens in our Body as we Experience Trauma?  

In our brain is an almond-shaped organ called the Amygdala. It stores emotional memory and is the brain's fear center. (If you remove the amygdala of a rat it becomes entirely fearless, and, as you can imagine, typically lives a very short life.) The amygdala responds outside of conscious thought, meaning we cannot control it, and it responds to any threat in a fraction of the second it takes us to think about it how we want to react.

When the amygdala perceives a threat it causes many chemicals to be released in our bodies, which increase alertness, focus, and short term memory; cause pupil dilation which improves our eyesight; and increases our peripheral vision and muscle tone in our limbs. All of this is to enable us to fight, flight, or freeze/submit.  

After that, our hippocampus, another brain organ, will determine the severity of danger of the experience. It does this by comparing this new information with past associations, and uses the brain's problem-solving and planning areas. If danger is determined to be present, the hippocampus causes the hypothalamus to release more stress hormones to shut down what it considers for the time being to be superfluous body functions, such as digestion, immunity, hunger, sleepiness, sexual appetite, etc. Blood pressure and heart rate increase, blood flow to the stomach/digestive tract slows so more blood can be sent to the limbs, and also to the skin, so if injured we will bleed less; breathing quickens to give our bodies more oxygen; perspiration increases to cool down the now escalating body temperature; our liver increases the amount of glucose sent to our muscles for intense energy; and our pain threshold drastically increases. Our bodies are now ready to fight or flight.  

Incidentally, one of the stress hormones released by the hypothalamus in this scenario is CRF, which is the most potent brain chemical involved in producing anxiety and depression.

What Is the Freeze/Submit Response?  

When fight or flight doesn't seem to be helpful, our body will instead do a freeze/submit response. When this happens, more pain killing endorphins are released, our muscles are nearly paralyzed, our blood pressure steeply drops, and our heart beat dramatically slows down.

 
How Does the Brain Store Memories?

Recent research on REM sleep (the stage where your eyes move rapidly back and forth and when dreams occur) shows that the area of the brain that is responsible for learning is active during dreaming. Thus it is believed that during REM sleep the ordinary events of the day are reviewed in the brain and placed in a usable format in long term storage. Lack of REM sleep by study participants kept them from using skills acquired that day, where those participants who did get REM sleep could use those new skills. Thus it is believed the REM eye movements help the brain to process memories, so any knowledge gained from these events can be easily accessed. Infants dream much more than adults, and, likewise, they are learning at an incredible rate during that time.

Are Trauma Memories Stored Differently?

Research also shows that events that occur with strong emotion are not filed away in memory the same way that standard (non emotion-packed) memories are. The traumatic memories are kept as if frozen in time, without being processed and filed away. They are stored with the memory of what happened just prior to the trauma, and this preceding memory can become a trigger. Anytime another triggering event occurs, we can have the sensation of reliving the trauma. We call this a flashback. These can occur rarely, or over and over. When the flashback occurs, there is no sense of it having occurred in the past, but rather it seems to be occurring in the present. A current trigger can cause a traumatized person to behave as if they are reliving the trauma (e.g. the combat vet who hears a loud noise such as a car backfiring, gets triggered by the sound to relive being back at war, and runs for cover).

What Happens in the Body When the Trauma is Over?  

The hippocampus then calms our bodies by releasing chemicals which slow heart rate, lower blood pressure, put blood back to its normal balance, send the blood back to internal organs, and resume digestion and sexual interest. This system works well when we are exposed to few traumas, but if we continue to experience trauma after trauma, such as in war or childhood abuse, the hippocampus actually atrophies from the toxic levels of stress hormones in our system. This atrophying causes the hippocampus to lose its ability to shut down the trauma reaction. This causes us to stay in the fight, flight, or freeze/submit state and we then have great difficulty living life.

What Other Factors play into the Impact of Trauma?

In no specific order, important factors to consider are:

Age: The younger we are, the more we are impacted by the trauma. This is because traumatic events early in life have more impact on the most basic structures of the still developing brain, and this will impact our ability to respond to stress later in life.

Causation/Betrayal: Symptoms can be more severe or longer lasting if it is another human being who caused the trauma, and even more so if it involved an act of betrayal by a trusted person.

Coping Skills/Support System: The better our overall coping skills and support system, the better we can cope with trauma.

Survivors: If we see ourselves as survivors of a trauma, rather than a victim, we will fare better following a trauma.

Disassociation/Amnesia/Panic: If during the event we disassociate (when it feels surreal, or we have a sense of leaving our body), or if we cannot remember parts of the event, or we have a panic attack within 24 hours of the event, we have a much higher chance of suffering from PTSD.

Recent Interpersonal Loss: If we have suffered an interpersonal loss within 1 year prior to the trauma, we have a much higher chance of suffering from PTSD from the event.

Past History of Trauma: With each traumatic event we suffer, our chances of developing PTSD from the event increase.

Values: If during the trauma we violate our own personal values, or if we are shamed by someone following our trauma, we can experience worse symptoms.

 
What is Post Traumatic Stress Disorder (PTSD)?

The simplest definition of Post Traumatic Stress Disorder, or PTSD, is a normal response to an abnormal event. The DSM-V, the counselor's current diagnostic manual, states that to have PTSD one must have:

A.  Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

1.  Directly experiencing the traumatic event(s).

2.  Witnessing, in person, the event(s) as it occurred to others.

3.  Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.

4.  Experiencing repeated or extreme exposure to adverse details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

Note:Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

1.  Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.

2.  Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.

3.  Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note:In children, trauma-specific reenactment may occur in play.

4.  Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

5.  Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

C.  Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

1.  Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

2.  Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

D.  Negative alterations in cognition and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

1.  Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).

2.  Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).

3.  Persistent, distorted cognition about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.

4.  Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

5.  Markedly diminished interest or participation in significant activities.

6.  Feelings of detachment or estrangement from others.

7.  Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

E.  Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

1.   Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.

2.  Reckless or self-destructive behavior.

3.  Hypervigilance.

4.  Exaggerated startle response.

5.  Problems with concentration.

6.  Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

F.  Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.

G.  The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H.  The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

PTSD can also include dissociative symptoms, depersonalization, derealization, and delayed expression.  

 
What About Depression?

Many people survive traumas without any ill effect. Of those who are impacted by trauma, the most common disorder these people will suffer from is not PTSD, but rather depression. Anxiety and substance abuse are next most common, and the prevalence of PTSD is fourth most common following a trauma. Also the severity of the trauma does not equate with the severity of the disorder(s) that may follow.  

How Do We Heal from Trauma?

Counseling provides a safe place where you can heal from your trauma. Some people will have a strong urge to talk about it, some may not want to even think about it. Some people find talking about the event helps, others choose not to do so. Most people find help in being able to express their anger, rage, fear, shame, confusion and/or pain in a safe place with someone who can provide the nurturing and guidance necessary to facilitate healing. Counseling provides a safe place for all of these events to occur, when and if you need them.

In Patricia Tighem's book, The Bear's Embrace: a Story of Survival, Patricia tells the very moving story of how she was attacked and mauled by a bear in the 1980's. In the book she tells her story of the incident and the emotional trauma of the repeated surgeries to her face. But for her the worse part of this intense event is the emotional pain around her unmet need to talk about her trauma. Over many years, she is medicated and diagnosed with many different disorders, but she suffers years of emotional pain before she is finally recognized as having PTSD, and people finally listen to her talk about her intense and painful ordeal.

There are many other things to do to help recover from trauma. Some people find relief in meditation and/or yoga. Many find a spiritual direction to focus on as a result of their trauma. Some people will use their survival to help others in their own path of healing.  

Regular exercise has many benefits for physical health. It also is very helpful in recovering from trauma. Among many other things, exercise will increase BDNF, a protein made in our brains that protects the hippocampus from the toxic effects of excess stress hormones. BDNF also helps the regrowth of nerve cells in the hippocampus. When we are depressed, our bodies do not produce BDNF. Antidepressants and exercise stimulate BDNF production.

There are many outlets for healing. If you are unable to find a direction after trauma, counseling can also help you to discover a new path for your life.

References

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, APA, Arlington VA, 2013

Naparstek, Belleruth, Invisible Heroes: Survivors of Trauma and How They Heal, Bantam Books, NY, 2004  

National Institute of Neurological Disorders and Stroke, Brain Basics: Understanding Sleep, NIH Publication No.06-3440-c, Last updated May 21, 2007, a copy can be found at: http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm#dreaming. 

Preston, John, MD, Introduction to PTSD for Clinicians, Alliant University online course. See http://uofthenet.com, 2009

Siegel, Daniel J., MD, The Developing Mind:  How Relationships and the Brain Interact to Shape Who we Are, The Guilford Press, NY, 1999

VanTighem, Patricia, The Bear's Embrace: a Story of Survival, Pantheon Books, NY 2001