Since announcing Trauma Services as a specialty at Mind Therapy Clinic, we’ve been receiving a lot of questions about therapy as it relates to trauma. Most commonly people want to know what is PTSD, and who gets it and why? With so many traumatic experiences in today’s news – from police shootings, racial tensions, car crashes, pedestrian and bicycle accidents, physical and sexual assaults, gun violence, natural disasters, , etc. – it makes sense that there is a heightened awareness and interest in the need to fully understand the impact of these events and treatments for those who are affected. Media often presents PTSD with a military focus, but recent research has revealed that civilian PTSD is 13 times more common. In fact, an estimated one out of every nine women develops PTSD (more than twice as likely as men). [1]
THE TRAUMA RESPONSE
Trauma can be defined simply as any threatening event that overwhelms a person’s ability to stay present, understand what is happening and make sense of the experience. The moment of perceived threat triggers an immediate sequence of brain and body reactions that prepare you to protect yourself. These responses begin faster than you could recognize consciously.
This survival response shows up as an immediate impulse to fight, flee or freeze to avoid the danger. However, when it is not possible to resist or escape from the danger – for example, due to things happening too fast as in a car accident, or due to the magnitude of the event such as a natural disaster, or the fight/flight response was attempted but unsuccessful – then, the autonomic system of self-defense becomes overwhelmed and disorganized. This can be followed by a period of days to weeks where the body and mind try to settle and integrate what has happened.
During this adjustment period, referred to as an Acute Stress Reaction, it is normal to have upsetting memories, feel on edge or have trouble sleeping afterwards. It may be difficult to concentrate or carry out your usual daily activities. Most people feel better within a few weeks; however, those continuing to suffer longer than a month after the event may have developed acute PTSD. [2]
CATEGORIES OF TRAUMATIC EXPERIENCE
The examples above refer to single incidents of trauma exposure. But, as we know other kinds of traumas can be repeated and enduring such as domestic violence, military combat, or living in a war zone. These can have an even more pervasive effect than a single incident trauma since the mind/body may not have time to settle before the next threat occurs.
An even more insidious form of trauma is that which occurs during the critical developmental years of a child, thought to be 0-6 yrs of age [3]. When an event in childhood is overwhelming it elicits the same survival circuit as in adults. But for a child, an experience of overwhelm does not require the same magnitude of threat that it would take for an adult to feel overwhelmed, due to their vulnerability and lack of survival resources.
Exposure to situations such as being raised by a frightening caregiver, (e.g., threatening words or behaviors); neglect, separation, abandonment, or death of a parent; exposure to domestic violence or parental fighting; secondary effects of PTSD or other mental illness in a parent; accidents, surgery, and medical procedures are all sufficient to elicit the trauma response in a child. [4] Obviously, severe neglect and physical/sexual abuse are extreme examples of what will overwhelm any child.
Trauma occurring during childhood has been referred to as “complex trauma” and may lead to “complex PTSD” which shows up in specific ways in childhood and later in life. This is different from PTSD that follows a single adult trauma. Growing up with constant fear creates lasting physiological changes in the brain and body that impact every area of life including later social, emotional and cognitive functioning. , The expression of these changes may show up as difficulty with the child’s ability to control their own feelings, thoughts, beliefs, an impaired sense of self, and a loss of trust in relationship as a source of support and safety. [5, 6, 7]
Complex trauma has been found to greatly increase the risk of a psychiatric disorder by adulthood – not only complex PTSD, but also depression and anxiety and symptoms that might be attributed to a personality disorder such as dissociation, cognitive distortions, impaired affect regulation, interpersonal problems, low self-esteem, self-harming behaviors, compulsions, addictions and suicide attempts. [7, 8, 9] Furthermore, a history of complex trauma greatly increases the risk of PTSD symptoms appearing or worsening after an adult traumatic experience.
Fortunately, not all children exposed to complex trauma will experience complex PTSD. The outcome is affected by many variables including the age at which it occurs, the type, frequency, duration and severity of the trauma, the relationship between the child and the abuser, [10] and the availability of at least one safe attachment figure.
INCIDENCE OF PTSD
About half the adult population will experience a traumatic event at some point during their lifetime, and of those people, 8% of men and 20% of women will go on to develop PTSD. In cases of sexual assault or combat trauma, the incidence is even be higher. [11]
However, symptoms of PTSD can subside over time in many persons and probably reflects a process of assimilation and integration. In one study, 94% ofrape victims reported symptoms of PTSD within one week of the event. By 9 months 47% continued to report such symptoms. [12]
Who gets PTSD and who doesn’t?
Research has shown that one of the largest factors in determining whether an individual develops PTSD is their “stress resilience” – that is, the ability to “bounce back” after an upsetting event.
What makes some people resilient and others vulnerable? [11]
The variables include:
- Childhood environment
- Adult trauma
- Social isolation
- Access to treatment after the event
Childhood Trauma. If a person was raised in a nurturing environment with love and acceptance from parents/caregivers and developed a healthy sense of self that person will be much more resilient and better able to heal from a traumatic event. Someone exposed to repeated trauma during their childhood will be much less resilient and at higher risk for development of PTSD or worsening of existing PTSD symptoms following a new traumatic event. [13]
Prior Adult Trauma. Unlike those diseases that cause your body to build immunity after recovery, prior exposure to a trauma, especially if the effects have not been fully resolved, increases the risk that a new trauma later in life will trigger the symptoms of PTSD to appear or worsen.
Social isolation. After a trauma, some people tend to isolate themselves from family and friends, feeling like they need to deal with the after effects on their own. This isolation can make PTSD more likely to occur, while social support has the opposite effect and therefore the incidence of PTSD is reduced.
Access to treatment. Once symptoms of PTSD appear, getting help early makes it easier to treat than when symptoms have gone untreated for many years. But, for those that have delayed getting treatment, don’t despair because chronic PTSD lasting many years can also be treated.
If you have questions about trauma and PTSD, feel free to send me a note at drcampell@mindtherapyclinic.com.
REFERENCES
1] Statistics from National Institutes of Health, Department of Veteran Affairs, and Sidran Institute.
2] Ogden, P. (2012) Trauma Training Syllabus, SensoriMotor Psychotherapy Institute.
3] Cutler, A. (2014) Sensorimotor Psychotherapy Developmental Training, Berkeley CA.
4] Fisher, J. (2012) Working with the neurobiological legacy of early trauma. Trauma series Webinar.
5] Herman, J. (1992) Trauma and Recovery. Basic Books.
6] Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In Schetky& Benedek (Eds.), Textbook of child and adolescent forensic psychiatry (pp. 221-238). Washington, D.C.: American Psychiatric Press, Inc.
7] Terr, L. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry(148), 10-20.
8] U.S. Department of Health and Human Services, 2012.
9] Duarte G. et al. (2007). A Multi-modal treatment program for childhood trauma recovery: Women recovering from Abuse Program (WRAP). Journal of Trauma and Dissociation, 8(4), 7- 24. doi:10.1300/J229v08n04_02.
10] National Child Abuse Statistics, 2012.
11] Understanding PTSD brochure. ptsd.va.gov.
12] Foa E., Rothbaum B. (1989) Behvaioral psychotherapy for post-traumatic stress disorder. International Review of Psychiatry, 1, 219-226.
13] Elaine, M. (2013).”Analysis of the Real World Application of Sensorimotor Psychotherapy for the Treatment of Complex Trauma” . Master of Social Work Clinical Research Papers. Paper 172. (h8p://sophia.stkate.edu/msw_papers/172).