Throughout evolution, humans have been exposed to a plethora of traumatic events, including violence, rape, incest, assault, natural disasters, wars, genocide, car accidents, and perpetual emotional abuse and neglect. Trauma can temporarily or permanently incapacitate an individual’s ability to cope with or pay attention to both new and familiar situations.
An Overview of Psychological Trauma
By Ray Doktor, Psy. D.
Throughout evolution, humans have been exposed to a plethora of traumatic events, including violence, rape, incest, assault, natural disasters, wars, genocide, car accidents, and perpetual emotional abuse and neglect. Trauma can temporarily or permanently incapacitate an individual’s ability to cope with or pay attention to both new and familiar situations. Most individuals who are exposed to disturbing events are able to adapt and continue with their normal daily functions without developing psychiatric disorders. However, for some individuals, traumatic experiences alter their psychological, biological, and social equilibrium to such a degree that their lives are disrupted and challenged. Post traumatic stress disorder (PTSD) has become a prevalent psychiatric diagnosis in hospitals for patients suffering with a mental disorder.
In the examination records of 384,000 Medicaid patients in Massachusetts between 1997 and 1998, PTSD together with depression was the most common psychiatric diagnosis. However, the patients suffering with PTSD spent ten times as much time in the hospital than the patients diagnosed with depression only. The majority of the patients with PTSD suffered from a complex constellation of symptoms. These patients seeking treatment for trauma-related problems had histories of multiple traumas.
During the past two decades, significant advances have been made in understanding the neurological underpinnings of PTSD. van der Kolk (1996) elucidated the degree to which malfunctions in brain processing contribute to the development of PTSD and biological emergency responses. The brain still performs functions in order for humans to survive much as it did for earlier primates and other creatures millions of years ago. The primal security system (the limbic system) worked in order for the human species to survive by giving appraisal to incoming stimuli or experiences as threatening or as non-threatening (Siegel, 1999). McLean (1980) described the brain as an analyzing device that detects, gives appraisal, and provides information for the human’s internal and external environment. These functions include: visceral regulation, temperature balance, and the ability to make decisions and function in social systems. When individuals are faced with life-threatening or traumatic situations, the primary function of the brain is for survival and self-protection.
Psychological trauma can involve a single event (e.g., combat, rape, or assault) or can be the result of exposure to perpetual and repetitive experiences such as domestic violence or incest. It is not the event alone that determines whether something is traumatic to an individual; but, rather, the individual's experience and beliefs about the event. The trauma can overwhelm the individual's ability to cope and integrate the emotions and experiences associated with the disturbing event. An individual might not recognize how traumatic the event was until symptomatology (e.g., dissociation, aggression) begins to surface in the reliving of intense emotions, visual memories, or flashbacks. An individual might not meet the full criteria of PTSD immediately after the horrific event. Memories and/or the reexperiencing of the past trauma can be delayed by weeks or even many years. Sometimes present experiences or stimuli (e.g., sounds, smells, seeing a similar situation on the news, driving by a car accident) can trigger old memories associated with the initial trauma. For example, a woman who survived a rape exhibited emotional trauma without meeting the criteria of PTSD. However, a month later, when her perpetrator was caught after murdering another victim; the shocking news about her perpetrator sexually assaulting and killing another victim propelled her into full-blown, diagnosable PTSD. In other words, her life-threatening experience might have not been actualized until another victim was found murdered.
In addition, psychological trauma may accompany physical trauma or exist independently of it. Common causes of psychological trauma are sexual or physical abuse and violence. For men, the most common causes of PTSD are combat, witnessing a death, or being severely injured. Sexual molestation and rape are the most common causes of PTSD in women. Catastrophic events such as earthquakes, volcanic eruptions, war or other mass violence can also cause psychological trauma. Long-term exposure to situations such as extreme poverty or other forms of abuse, such as verbal or emotional abuse, can potentially be as traumatic as a single, life-threatening event. The severity of symptoms associated with trauma depends on the individual; the age at which the trauma occurred; the type of trauma involved; and, the degree of emotional support that is received. Social factors play a major role in the shaping of the symptomatology.
Emotional and psychological trauma can become complex and confusing for an individual. For example, if the traumatic event is perpetrated by a family member whom the victim depends on for financial and other forms of security, the victim may be more inclined to respond to assault, including sexual abuse with increased dependence. The victim could experience paralysis in their decision-making processes because of their dependence on the perpetrator. A victim in situations of pedophilia, domestic violence, and/or neglect is often not identified and does not receive proper treatment for ongoing trauma. The longer the duration of the traumatic experience, the more prone the victim is to react with dissociation.
When an individual is traumatized, especially when perpetrated by a family member, negative beliefs about oneself and/or ones environment can develop. Shapiro (2001) noted that trauma survivors develop negative cognitions regarding the traumatic event and regarding themselves. She further posited that emotional and psychological trauma can be precipitated by an array of feelings and experiences such as the threat to one's life or loved ones; perpetual humiliation and bodily harm; the violation of the individual's familiar ideas about the world and human rights; the state of extreme confusion and loss of security; and, betrayal to the individual in some unforeseen way. The victim may feel that both his external and internal world have been violated. His sense of self and how this "self" functions in relation to the world may be shattered in response to psychological trauma.
After a traumatic event, an individual may also reexperience the trauma mentally and physically. Symptoms may include: avoidance, detachment, dissociation, depression, anxiety, numbing, shortness of breath, and palpitations. In addition, trauma survivors often experience patterns of increased arousal, hypervigilance, and avoidant behavior. Hyperarousal can cause a traumatized individual to become easily distressed or irritated by unexpected stimuli that may be associated with the past traumatic experience. The quality of life could start to diminish for traumatized victims because of their inability to experience joy and pleasure. Victims might start avoiding situations that serve as reminders of the trauma and withdraw from engagement with others. Emotional triggers and cues can act as reminders of the trauma, and can cause anxiety and other associated emotional distress. Often, these victims are completely unaware of what these triggers are. In many cases, this lack of understanding causes an individual suffering from traumatic disorders to engage in disruptive and/or self-destructive coping mechanisms; often without being fully aware of the nature or causes of their own actions. Traumatized individuals may turn to alcohol and/or drugs to try to escape or to numb the overwhelming feelings that arise. Panic attacks are an example of a psychosomatic response to such disturbing emotional triggers. Intense feelings of anger may surface in very inappropriate or unexpected situations. The fear of danger (e.g., assault, abandonment, feeling trapped) may always seem to be present to trauma survivors. Upsetting memories such as images, thoughts, or flashbacks may haunt the individual. A victim might frequently experience nightmares. Insomnia may also occur as lurking fears and insecurity keep the traumatized individual hypervigilant and on the lookout for danger, both day and night.
Some traumatized individuals may feel permanently damaged when trauma symptoms are not ameliorated and their quality of life does not improve. This can precipitate feelings of despair, helplessness, and depression. In time, the development of affect dysregulation, amnesia, somatization, distrust, shame, insomnia, and self-hatred can be exhibited in the moods and behaviors of trauma victims. The PTSD diagnosis captures the most common effects of traumatization. However, depersonalization, compulsive behavioral repetition of traumatic scenarios, dissociation, depression, increased aggression; as well as a disruption or decline of family and occupational functioning have been exhibited by traumatized individuals without their meeting the full-blown criteria for PTSD.
Traumatized individuals who suffer with PTSD often organize their lives around the past trauma. This compulsive behavior is one component that distinguishes individuals with PTSD from those who are transiently stressed. There are other major elements that can be characterized in the diagnosis PTSD, such as: the constant repetition of reliving memories of the traumatic event; the avoidance of reminders or triggers of the trauma; and, the increased arousal, expressed by hypervigilance, irritability, memory loss, sleep disturbances, decreased concentration, and an exaggerated startle response. Individuals suffering with PTSD might respond to the reliving of memories by numbing or detaching themselves due to the extreme physiological and psychological distress. Anniversaries of the event can be very difficult. Disturbing memories may occur spontaneously, or can be evoked by threatening, symbolic stimuli. Victims have a tendency to become excessively focused on similarities between the present and their traumatic past. Consequently, these distorted cognitions may reinterpret neutral experiences as being associated with the past trauma.
Individuals with PTSD also have a tendency to quickly shift from stimulus to reaction without understanding what provoked them. Innocuous sounds and trivial cues can provoke a heightened startle response. Ordinarily, autonomic functions that alert an individual to interpret the world, especially those of potential threat in nature, begin to cease as guides for action. The bombardment of persistent neuronal activation causes the central nervous system to misinterpret incoming stimuli to overaroused emotional states. As a result, trauma victims respond with “fight or flight” reactions. Because many individual suffering with PTSD are not able to use their emotions to help reach adaptive solutions, reminders of the trauma along with their inability to affect the outcome can cause extreme feelings of anger and helplessness. A traumatized individual’s own physiology can become an origin of fear through overidentifying with the trauma and symptomatology.
In summary, individuals are traumatized by an array of experiences such as domestic violence, sexual abuse, perpetual emotional abuse, assault, and natural disasters. When an individual is traumatized, the disturbing experience can disrupt the victim’s emotional and psychological equilibrium. Individuals who have the inability to process a traumatic experience can develop PTSD. Individuals suffering with PTSD often relive the disturbing past through visual memories, intense emotions, or flashbacks. Many individuals with PTSD experience debilitating symptoms and behaviors, including depression, increased agitation, numbing, dissociation, anxiety, palpitations, and increased blood pressure.
About Ray Doktor, Psy. D.
Ray Doktor, Psy. D. is a clinical hypnotherapist, past-life therapist, spiritual counselor, and life coach based in Los Angeles and Santa Monica. He can be contacted at his website http://www.wholeminds.com