​​​​Part I​

Psychological Trauma: An Introduction


The word ‘trauma’ is a subjective term and carries a range of meanings. In the context of psychology, Karen Saakvitne defines it this way: “Psychological trauma is the unique individual experience of an event or of enduring conditions in which the individual’s ability to integrate his or her emotional experience is overwhelmed (i.e., his or her ability to stay present, understand what is happening, integrate the feelings, and make sense of the experience), or the individual experiences (subjectively) a threat to life, bodily integrity, or sanity.” (Pearlman & Saakvitne, 1995, p. 60).


More simply put: psychological trauma is an inescapably stressful event or series of events that overwhelm a person’s ability to cope with and understand what has happened.


Bessel Van der Kolk, describes it this way: "Dissociation is ​the essence of trauma. The overwhelming experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations related to the trauma take on a life of their own. The sensory fragments of memory intrude into the present, where they are literally relived. As long as the trauma is not resolved, the stress hormones that the body secretes to protect itself keep circulating, and the defensive movements and emotional responses keep getting replayed." (2014, p. 66).

People react to threat or danger with a highly complex system of biological, cognitive, and behavioral responses. The biological responses involve many interdependent neurochemical changes in different parts of the brain and body. Normally, following the perception of threat or danger, the body’s neurochemistry eventually returns to normal. In post-traumatic stress disorder (PTSD), the neurochemical responses outlive the original threat and can inhibit the system’s ability to return to a baseline state. 


Further complicating the picture, the traumatic event may continue to be experienced as ‘in the present’ or ‘still happening’, because the brain is not able to integrate the whole experience and mark it with a kind of ‘context stamp’ that says, ‘this happened, and it is over’.

In these ways, a person who has experienced trauma can continue to feel as if the event is still occurring in the present, and as a result, they may move through their lives in an over-reactive, “hyper-vigilant” state, constantly on high alert for any potential danger. Often, to cope with this overwhelming sense of constant threat, many people learn to shut down or dampen the brain areas that send the physical sensations and emotions that accompany the feelings of threat and dread. Unfortunately, these are the same brain areas that are responsible for registering the full range of emotions and sensations that form the foundation of our self-awareness and sense of who we are (Van der Kolk, 2014). This lack of self-awareness can be extremely debilitating, and it is especially so in adults who have experienced chronic adversity and traumatization.


Part II: C-PTSD​

Complex - Post Traumatic Stress Disorder (C-PTSD)

The types of trauma that tend to have the greatest adverse psychological consequences are those related to repeated, interpersonal trauma - especially, childhood abuse and neglect.  

Research has clearly demonstrated that experiencing repeated traumatic stress in childhood can have a significant impact on the development of a child's brain and body. This type of repeated trauma that occurs early in human development has been termed complex trauma or complex PTSD (C-PTSD).

Trauma during childhood can result from experiencing a wide range of adversities. For example, being raised in situations where the parent’s needs – such as serious, untreated mental health issues, or drug and alcohol abuse, negatively impacts their ability to parent and to provide for their child’s needs. Complex trauma can result from adverse experiences that significantly disrupt a child’s sense of safety, some examples include:


  • Sexual, physical, emotional, verbal abuse
  • Neglect
  • Domestic violence 
  • Significant separation from a parent/caregiver
  • Physical or mental illness of parent/caregiver that substantially interferes with the caregiver's ability to provide for a child's needs
  • Intrusive medical procedures


There are several important factors that highlight the differences between PTSD and Complex PTSD.

    (1) Complex PTSD occurs over time and within the (attachment) parent/caregiver relationship.

    (2) Because young children are completely dependent on their caregivers, they are unable to escape

           from an abusive or damaging family dynamic.

    (3) Complex PTSD occurs before the child’s brain systems and cognitive abilities are fully formed.


Experiencing trauma as a young person affects the ways in which the brain and its communication systems develop, causing the individual to over-respond to perceived threat and danger, even when no danger exists. This can be a critical survival strategy in a threatening environment. The amygdala (a brain structure involved in "fight or flight" and memory) responds quickly to small signs of threat when the distress response system is activated frequently. The body then courses with adrenaline and cortisol to ensure the person can try to fight back or run away to safety. In complex trauma, neither of these options are available to a child. With a body full of stress chemicals on a regular basis, the child has few options left but to dissociate (freeze/shut down) to reduce such overwhelming internal stimuli. 


In children and adults who have experienced trauma, often, all available energy goes into self-protection, survival and coping. This leaves very little energy left over for learning, play and connection with others.

Living this way for a long time can have a significant impact on the body as well as the brain. The stress chemical overload can negatively impact immune and digestive system functioning. It also affects the body’s inflammatory environment and may contribute to a range of physical symptoms. Research strongly suggests that latent illnesses can be triggered into expression by this type of chronic stress. The often-unacknowledged sense that threat is ever-present (“hypervigilance”) can continue throughout adult life, even once a person is in an objectively safe environment.

​In addition to the physical symptoms, people who have experienced complex trauma may struggle with frustrating cognitive symptoms, including impaired memory, concentration, decision-making and judgement. 


The stress response that was helpful (adaptive) in an abusive or neglectful childhood environment can become “maladaptive” in a connected and fulfilling adult life. It is difficult to function in a job or relationship where the smallest emotional slight sends stress hormones soaring. Or where a colleague’s bullying behavior causes us to shut down, unable to interact with and respond to the immediate environment.


To people trapped in the cycle of reliving trauma, very little feels within their control, especially the paralyzing fear, the reactivation of the body's alarm system, over and over, and the periods of shut down, when they become completely overwhelmed.


For many people coping with trauma, working with an experienced psychotherapist can be life-changing. Some central goals of treatment might look something like this:


  • Increase knowledge and awareness of the effects of trauma
  • Expand the capacity to manage emotions
  • Decrease reliance on strategies such as avoidance and numbing
  • Improve self-regulation 
  • Increase effective coping strategies
  • Re-establish a regulated stress-response
  • Process emotions and integrate traumatic memories
  • Strengthen sense of self and self-integration 
  • Improve and restore sense of safety ​​


​*This is in no way meant to be an exhaustive list; we are all individuals, this list is meant to be a sampling of goals that can be helpful in bringing about positive change in those affected by PTSD and C-PTSD.


Despite increased awareness and active research, complex trauma is not yet recognized as a separate diagnostic category in the revised Diagnostic and Statistical Manual of Mental Disorders - Fifth edition (2013), consequently, many survivors remain undiagnosed or are misdiagnosed.

Complex-PTSD vs. PTSD – What’s the Difference? 

While PTSD can develop in response to short-termexposure to a single traumatic event, C-PTSD only occurs when someone has experienced trauma within the caregiving relationship, over a period of time. C-PTSD is also sometimes referred to as “developmental trauma” as it is typically experienced in the context of childhood and therefore, occurs within the child-caregiver relationship.

Experiences Related to Complex-PTSD (many of which can be greatly improved through psychotherapy).

Flashbacks and Difficulty Controlling Emotion:

A person who has experienced trauma may have emotional flashbacks. Trauma survivors who have not integrated past feelings surrounding the trauma can become flooded and overwhelmed by them. When this happens, it can cause intense feelings that were originally felt during the trauma, such as fear, shame, or overwhelming sadness that can be triggered by relatively benign situations. A person who has experienced trauma may also have severe depression, anxiety, thoughts of suicide, self-harm, or have difficulty controlling anger or impulsivity.

Detachment (Dissociation):

Dissociation is the mind’s way of coping with an intensely traumatic experience. Those who experience dissociation may feel detached from their surroundings, their actions, and their body. They may experience gaps in their memory surrounding the original trauma or in an everyday task that reminds them of the trauma they experienced. 

Changes in Self-Perception

Complex PTSD can cause a person to view themselves in a very negative light. This negative self-image can include feeling as if they are intrinsically different from other people and can often include feelings of  worthlessness, guilt, or shame. Much can be done in the therapeutic relationship to repair and improve self-perception.

Difficulty with Interpersonal Relationships

Some with C-PTSD may develop difficulties within relationships because they find it very difficult to interact with and to trust others. Intense fear, anger and shame can be triggered in interpersonal relationships, and the present situation can be perceived and responded to in the same way as the old trauma.

Getting Support and Moving Forward

Many people believe that talking about traumatic events will make things worse. This belief can be part of the ‘avoidance’ of trauma that people unconsciously employ to deal with it. But talking about trauma can be helpful if it is done in an appropriate therapeutic environment and in a way which allows the thinking ‘front brain’ to stay online, this allows the brain to re-tag the memory as a part of the ‘past’. Of course, it is essential that talking about the trauma is not so dysregulating that it becomes retraumatizing. But if it is sensitively and skillfully handled, the trauma can eventually become an event that has happened, rather than continuing to be an event that feels as if it is still happening now.


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Things You Can Do For Yourself Now


Begin to learn to regulate your nervous system.
No matter how agitated, anxious, or out of control you feel, it’s important to know that you can change your arousal system and calm yourself when you need to. Not only will it help relieve the anxiety associated with trauma, but it will also help to create a greater sense of control. Here are a few simple things to try:

Mindful breathing. If you are feeling disoriented, confused, or upset, practicing mindful breathing is a quick way to calm your nervous system down. Sit comfortably and close your eyes if you wish, breathe in slowly through your nose while counting to 6, hold the breath for a count of 4 and then exhale slowly from your mouth (like you were softly blowing out a candle) to a count of 8, repeat this sequence for at least one full minute (4 full breath cycles) or longer. 

Sensory input. Does a specific sight, smell or taste quickly make you feel calm? Or maybe spending time with animals or listening to music works to quickly soothe you. Everyone responds to sensory input a little differently, so experiment with different quick stress-relief techniques to find what works best for you and use them liberally. Take a break for a walk outside, the act of walking can be very regulating for our nervous system, and of course, the fresh air is helpful, as well.

Staying grounded. To bring yourself back to the present and feel more grounded, try this simple exercise: Sit on a chair, feel your feet on the ground and your back against the chair. Look closely around you and name 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can imagine tasting, and 1 or more things that you feel grateful for. Notice how as you focus in on this exercise, your breathing gets deeper and calmer.


References
Pearlman, Laurie Anne, and Karen W. Saakvitne. Trauma and the Therapist. New York: Norton, 1995.

Porges, S. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication and Self-Regulation. New York: W.W. Norton & Company, Inc.

Schore, A. (2010). Relational trauma and the developing right brain: The neurobiology of broken attachment bonds. Chapter in T. Baradon (Ed.), Relational trauma in infancy (pp. 19-47). London: Routledge.

Van der Kolk, B. (2014). The body keeps the score: Brain, mind and body in the healing of trauma. New York: Penguin Books.

 

 

Amy Gray

Psychological Trauma: 

Post-Traumatic Stress Disorder (PTSD) and

 Complex-PTSD (C-PTSD)