by Tom Cloyd (reviewed 2019.08.24:2001)
Is trauma an event? An event which provokes a particular reaction? Or an emotional response of a certain kind, without regard for what provokes it? Clinical psychology and psychiatry have yet to reach any clear consensus on this crucial question.
1. “For each of us there is a point at which anxiety and fear cross the line into trauma. Trauma can cause severe disturbances in the integration of cognitive and emotional processing. The neurobiological reactions to these experiences appear to lie on a continuum of intensity. The earlier, more severe, and more prolonged the trauma, the more negative and far reaching the effects.”1 “Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.”2
2. A “traumatic stressor” is “…any event or events) that may cause or threaten death, serious injury, or sexual violence to an individual, a close family member, or a close friend.”3
3. “What is traumatic for one person may not be traumatic for another.”4
4. “…Trauma is the impact on the organism of a traumatic event. …The DSM-IV-TR criteria for posttraumatic stress disorder…[requires] the presence of a traumatic event… DSM-IV-TR recognizes that, for the definition of trauma, events cannot be disentangled from the response to those events; …there is no pure ‘traumatic event’ in nature, independent of the trauma response of the individual. This makes sense and doesn’t make sense.”
“The conventional definition of trauma is incomplete because it focuses too much on traumatic events, on bad things that should not have happened. For complex, highly comorbid patients, the bad things that happened in childhood are probably less important, less damaging, and less traumatic than the events which did not happen. It is the errors of omission by the parents, not the errors of commission, which are the fundamental problem. The deeper trauma is the absence of normal love, affection, attention, care, and protection. The trauma is not being special to mom and dad. But this deeper trauma does not meet criterion A for PTSD [in the DSM-IV-TR, or in the DSM-5].”
“From the perspective of trauma therapy, it is trauma to the person’s attachment systems during childhood which really counts. The betrayal of trust is often more hurtful than the abusive event itself. …Childhood incest and emotional neglect, for instance, are surely traumatic, but do they really meet criterion A for PTSD if they are not accompanied by threats or violence, or if there is no threat of malnourishment? In the end, no summary definition of trauma has much utility. Trauma is a complex interaction of external events and the organism’s response to them.”5
5. “…Many trauma experts prefer to define as traumatic that which is overwhelming to the individual or to the individual’s defenses rather than what may be viewed as an objective trauma. Others dispute this approach, noting that without an objective measure of trauma, anything that is merely upsetting might be described as traumatic. One result of this dilemma is that the current connotations of the word include both these meanings: Trauma may refer both to an objectively catastrophic event and to something that feels subjectively upsetting. This dual meaning creates confusion. …How, then, do we resolve these confusions and contradictions in definition? One useful approach lies in a description of the specific effects of the traumatizing event on the person.”
“…The most fundamental effect of trauma is dissociation. Accordingly, we might best define trauma as ‘the events) that cause dissociation.’ …People vary so much in their resilience to so-called objectively traumatizing events that it does not make sense to speak of trauma as defined by objective trauma. …We cannot quantify trauma, but we can define it conceptually in terms of its effects on individuals.”6 “Dissociation is the essence of trauma.”7
6. “Psychological distress following exposure to a traumatic or stressful event is quite variable. In some cases, symptoms can be well understood with an anxiety or fear-based context. It is clear, however, that many individuals who have been exposed to a traumatic or stressful event exhibit a phenotype in which, rather than anxiety- or fear-based symptoms, the most prominent clinical characteristics are anhedonic or dysphoric symptoms, externalizing angry and aggressive symptoms, or dissociative symptoms. …It is not uncommon for the clinical picture to include some combination with or without anxiety- or fear-based symptoms).”8
7. “Most people think of trauma as a ‘mental’ problem, even as a ‘brain disorder’. However, trauma is something that also happens in the body. We become scared stiff or, alternately, we collapse, overwhelmed and defeated with helpless dread. Either way, trauma defeats life.9
8.”Trauma is not limited to life-threatening experiences… For a young child, trauma may be experienced in the form of separation from parents, looking into the eyes of a depressed mother, or being in a household with a high level of marital tension. For an adolescent, chronic stress and trauma may come from the incessant teasing of peers or taking care of the needs of an alcoholic parent. For an adult, chronic loneliness, the loss of a pet, or a constant sense of shame or failure may have the same impact.”
“…There is a distinct possibility that stress is possible even before birth; an unborn child may become stressed as a result of the shared biological environment with its mother. Studies suggest that maternal stress is associated with their children’s lower birthweight, irritability, hyperactivity, and learning disabilities. …Prenatal stress may also result in permanent alterations in dopamine activity and cerebral lateralization, making offspring more susceptible to both anxiety and limiting their functioning into adulthood.”
“…Maternal depression may actually serve as a highly stressful or traumatic experience for infants and children.” Studies have show that “…infants whose mothers were depressed during the infant’s first year of life demonstrate biochemical, physiological, and behavioral dysregulation. …Just like their depressed mothers, such infants engage less in interactive behaviors e.g., orienting toward and gazing at others) that are so vitally important for healthy development. Infants of depressed mothers behave this way even with other adults, making it more difficult for them to successfully interact with nondepressed others.”10
9. “Trauma…refers to exposure to events that represent a real or perceived threat to safety and/or existence and thus elicit subcortical mammalian, or animal, defenses that are not mediated by the cortex; in fact, they actually disable cortical activity when engaged. The defenses can be loosely categorized into three general subsystems, all of which arose as ways of preserving survival: 1) relation-seeking actions, 2) mobilizing defenses, that organize overt action, and 3) immobilizing defenses that engender a lack of physical action.”11
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (fifth edition). Washington, D.C: American Psychiatric Association.
Cozolino, L. J. (2002). The neuroscience of psychotherapy: building and rebuilding the human brain. New York: Norton.
Howell, E. F. (2011). Understanding and treating dissociative identity disorder: a relational approach. New York: Routledge.
Levine, P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. Berkeley: North Atlantic Books.
Ogden, P. (2009). Emotion, mindfulness, and movement: Expanding the regulatory boundaries of the window of affect tolerance. In D. Fosha, D. J. Siegel, & M. F. Solomon Eds.), The healing power of emotion: affective neuroscience, development, and clinical practice (pp. 204–231). New York: W.W. Norton & Co.
Ross, C. A. (2000). The trauma model: A solution to the problem of comorbidity in psychiatry. Richardson, TX: Manitou Communications.
Van der Kolk, B. A. (2014). The body keeps the score: brain, mind, and body in the healing of trauma. New York: Viking.
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