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What Is Trauma?
Psychological trauma is the unique individual
experience of an event or enduring conditions in
which: The individuals ability to integrate
his/her emotional experience is overwhelmed
or the individual experiences (subjectively) a
threat to life, bodily integrity, or sanity.
(Pearlman & Saakvitne, 1995, p. 60)
Saakvitne, K. W. et al., Risking Connection: A Training
Curriculum for Working with Survivors of Childhood Abuse, to be
published by Sidran Press in January, 2000.
Little t traumas
Broken bones
Humiliation and ridicule
Empathic failures in infancy
Prolonged bullying
Feeling left out
Feeling not cared for
Symptoms as Adaptations
All trauma symptoms are adaptations to survive the
trauma
Traumatic events end, the person's reaction persists
The intrusion of the past into the present: re-experiencing
Intrusion may present as distressing intrusive memories, flashbacks,
nightmares, or overwhelming emotional states
Hypervigilance, dissociation, avoidance, and numbing are examples of
coping strategies that likely were effective when the trauma was
happening (or in the immediate aftermath) but now interfere with the
person's ability to live the life s/he wants.
Developmental Disruptions
Severe trauma can disrupt basic developmental
tasks
Developmental tasks underway when the
trauma happens can help determine what the
impact will be
Disruptions can include:
lack of self-soothing
the world is an unsafe place
hard to trusting others
poor executive function
more easily exploited
Developmental Disruptions
as Symptoms
Disruption of developmental tasks results in adaptive
behaviors (as we noted above)
The mental health system views these adaptations as
"symptoms," for example:
disrupted self-soothing is labeled as agitation
the disrupted ability to see the world as a safe place looks
like paranoia
distrust of others is interpreted as paranoia (even when valid)
disruptions in executive function for decision-making can look
like psychosis
avoiding/preempting exploitation is called self-sabotage
What Is PTSD?
PTSD is a type of anxiety disorder that occurs
post-trauma, or after being exposed to some
kind of traumatic event
Four clusters of symptoms make up a PTSD
diagnosis:
Re-experiencing
Avoidance (and Emotional Numbing)
Hyperarousal
Dissociation
Re-experiencing Symptoms
Frequent upsetting thoughts
or memories about a
traumatic event.
Recurrent nightmares.
Acting or feeling as though
the traumatic event were
happening again, a
"flashback."
Very strong feelings of
distress when reminded of
the traumatic event.
Strong physical responsive,
such as experiencing a surge
in your heart rate or
sweating, to reminders of the
traumatic event.
Avoidance Symptoms
Avoiding thoughts, feelings, or
conversations about the
trauma
Avoiding places or people that
remind you of the trauma
Difficulty remembering
important parts of the
traumatic event
Loss of interest in important
and once positive activities
Feeling distant from others
Difficulty with having positive
feelings, such as happiness or
love
Feeling as though your life may
be cut short
Hyperarousal Symptoms
Hyperarousal refers to
experiencing high
levels of anxiety:
Having a difficult time falling
or staying asleep.
Feeling more irritable or
having outbursts of anger.
Having difficulty
concentrating.
Feeling constantly "on guard"
or like danger is lurking
around every corner.
Being "jumpy" or easily
startled.
Dissociative Symptoms
The DSM-5 (Diagnostic and Statistic Manual of Mental
Disorders) has added a dissociative sub-type for PTSD
Dissociative symptoms were present in 14.4% of
subjects interviewed by WHO (2013)
Another study (2012) found 25% of their sample could
be characterized by high derealization and
depersonalization symptoms (types of dissociation)
Individuals who qualify for the dissociative subgroup
show more comorbid Axis I disorders and more
significant history of childhood abuse and neglect
Dissociation Defined
Dissociation as a process:
Overwhelming experience is split off and fragmented (the
thalamus is unable to process it)
Emotions, sounds, images, thoughts, and physical sensations
take on a life of their own
Dissociation as an experience:
Depersonalization: A subjective sense that one is changed,
has become vague, dreamlike, less real, or lacking in significance
feeling unreal as a person
Derealization: A subjective experience of unreality of the
outside world, what one sees lacks vividness or emotional
coloring, as seen through a fog, or a veil
Depersonalization and Derealization tend to co-occur
Dissociation
The more betrayal involved in the trauma, the
more psychogenic amnesia (inability to
remember the trauma) and dissociative
symptoms occur
Degrees of Dissociation
Day dreaming/
Highway
hypnosis
Dissociative
Identity
Disorder
combat (38.8%)
childhood neglect (23.9%)
childhood physical abuse (22.3%)
being sexually molested (12.2%)
Attachment Styles
Child and caregiver behavior patterns before the age of 18 months
Attachment
pattern
Child
Secure
About 2/3 of
adults
Avoidant
Little affective sharing in play. Little or no distress on Little or no response to distressed child.
departure, little or no visible response to return,
Discourages crying and encourages
ignoring or turning away with no effort to maintain
independence.
contact if picked up. Child feels that there is no
attachment; the child is "rebellious" and has a lower
self-image and self-esteem.
Ambivalent/
Resistant
Disorganized
Caregiver
Disorganized Attachment
Disorganized attachment: Activation of incompatible
approachavoidance systems, creating confusion
Caregiver is both a haven of safety and a source of
fear
(Main & Hesse, 1990)