Trauma: A Misunderstood Phenomenon
August 27th, 2008 |By Patti Desert, LCSW-C, CEMDR, CP
Click here to contact Patti and/or see her GoodTherapy.org Profile
Post Traumatic Stress Disorder (PTSD) is conventionally diagnosed when a person has been in some way exposed to an event that involved actual or threatened death or serious injury to self or others. The person must also have experienced intense fear, helplessness, or horror and currently is re-experiencing these states in some form or other. In children these feelings may be expressed instead by disorganized or agitated behavior.
However, the experience of trauma does not always fit the clinical category of Post Traumatic Stress Disorder. A person can experience trauma in ways other than involvement with an actual injury or threat to self or others. It is inadequate understanding of this expanded awareness of trauma that stimulates further confusion, depression, anxiety, and stress in an already traumatized individual and has many therapists misidentifying the problem and thus effective treatment.
A diagnosis that more accurately describes trauma is Complex Post Traumatic Stress Disorder or Experiences of Extreme Stress. Included in these diagnoses is the understanding that trauma may not have involved actual or threatened death or serious injury to self or others. Instead it may involve a perception of threat in some way, a belief that one’s self is in jeopardy and that the threat bars any outlet to a feeling of safety. In this respect trauma compromises other than an individual’s physical well being. Rather it not only stimulates a pervasive feeling of anxiety and depression, but it chronically provokes an ongoing fear of the abuser in thought or in person, disrupts memory and consciousness, diminishes a positive perception of self and a felt sensation that all is right in the world, and destroys the ability to consistently manage distressful physical and emotional sensations.
From this perspective depression and anxiety and the symptoms of a host of other diagnoses can denote an underlying experience of trauma. By noting these areas of difficulty in individuals a therapist can determine whether or not the core problem is trauma. As importantly is the individual’s understanding how emotions relate to trauma and how they are the self’s wake up call that trauma has occurred.
The Affective System is key to determining this. The Affective System refers to a three-part system with which we are hard wired upon conception. It includes the drives, pain, and the emotions. Eating, drinking, and breathing are examples of three primary drives. Our emotions comprise the second part of our Affective System. Emotions regulate our drives so that we can experience a sense of healthy control. Pain is the third part of the Affective System. It is both a drive and an emotion and is the innate part of our affective system that signals danger.
It is the emotional part of our Affective System that uniformly debilitates trauma survivors. Our emotions are necessary to experience a felt sense of safety and fulfillment. They are triggered by thoughts, sensations, images, people, places, and things. And structures in our brain organize them to work properly.
Trauma disrupts this process of organization in the brains of trauma survivors and accounts for the chronic fear, depression, and/or anxiety survivors routinely report. Any effective treatment must adequately address this deregulation or clients will not heal.
This is not to discount cognitive-behavioral therapies. They are important and effective therapies at different stages of healing. However, for sustained change, ultimately treatment will need to provide survivors a broader spectrum for healing that helps effectively change negative beliefs and conjointly provides methods for managing painful emotions, for extinguishing painful reactions to debilitating memories, and for helping survivors make accurate meaning out of their experiences.
This holistic perspective recognizes that we are mind, body, spirit beings and offers methodologies that can gently, safely, and effectively support survivors to shift fearful thoughts, feelings of depression and anxiety, flawed sensing, and defensive behavior to a state of confidence and joy.
©Copyright 2008 by Patti Desert, LCSW-C, CEMDR, CP. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Patti and/or see her GoodTherapy.org Profile
August 28th, 2008 at 7:15 am
Dear Patti,
Your article makes some excellent points. The DSM-IV-TR category of PTSD often does not capture the full impact of chronic early maltreatment within a care-giving relationship; which is the basic definition of Complex Trauma or Developmental Trauma Disorder. This chronic early maltreatment within a caregiving relationship causes very pervasive damage across a broad range of domains…PTSD does not capture the full extent to the range of impairments in the domains of
1. Self-regulation
2. Interpersonal relating including the capacity to trust and secure comfort
3. Attachment
4. Biology, resulting in somatization
5. Affect regulation
6. Increased use of defensive mechanisms, such as dissociation
7. Behavioural control
8. Cognitive functions, including the regulation of attention, interests and other executive functions
9. Self-concept.
For a full description of this concept see:
Cook, A., Blaustein, M., Spinazolla, J. & van der Kolk, B. (2003) Complex Trauma in Children and Adolescents.White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force.National Center for ChildTraumatic Stress, Los Angeles, CA.
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M. et al. (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.
The pervasiveness of these impairments requires a treatment that addresses these areas. Dyadic Developmental Psychotherapy is an empirically supported evidence-based treatment for children with trauma and attachment disorders. See, for example:
Becker-Weidman, A., & Hughes, D., (2008) Dyadic Developmental Psychotherapy: an evidence-based treatment for children with complex trauma and disorders of attachment. Child and Family Social Work, 13, pp. 329-337.
For a sort of treatment manual about Dyadic Developmental Psychotherapy see:
Hughes, D., (2007) Attachment Focused Family Therapy, Norton, NY
Becker-Weidman, A., & Shell, D., Creating Capacity for Attachment, Wood N Barnes, Oklahoma City, OK.
Thanks for a very good article that describes a complicated set issues quite clearly.
Art
August 28th, 2008 at 9:44 am
All of this is very fascinating. It is amazing how many things are so interrelated that may have never made sense before but now do all of a sudden. Thanks for the great insight.
August 29th, 2008 at 3:07 am
Does anyone know the numbers about what percentage of people who go through a depressive episode it boils down to being a result of some trauma they have experienced in their lifetime? This would be interesting data to track.
August 29th, 2008 at 6:18 am
Many individuals who experience Complex Trauma, which is a clinical formulation and not a DSM-IV diagnosis, or PTSD, which is a psychiatric diagnosis, have depressive symptoms. A significant majority, in fact. However, regarding how many people who meet the DSM criteria for any of the depression diagnosis have Complex Trauma or PTSD, that is a good question and I just don’t know the answer to that.
regards
Art
August 30th, 2008 at 2:59 am
I have a friend whose father, a war veteran, has had his entire life crippled from the effects of PTSD as has the entire family as a result. I am glad to see that there is progress being made in the research behind this mental illness, but there is still a lot of work to be done to ensure that veterans and really anyone who suffers with this is able to get the treatment and recovery resources that they need as well as deserve. This is something that I have watched firsthand devastate the lives of so many and I am hopeful that this new research will put it back in the forefront so that those with PTSD have to suffer no longer.
August 31st, 2008 at 8:48 am
Dear Michael,
I’d hope your friend’s father is receiving treatment as there is good and effective treatment for PTSD, especially when combat related. While the VA may have a very long waiting list for services, if they have private insurance, they may be able to find good treatment quickly. One approach that is quite useful in such instances as you describe is EMDR.
regards,
Art
August 31st, 2008 at 12:50 pm
Well you stated the big problem. No private health insurance and the VA center in our area is very tough to get in for appointments unless it is deemed a “physical” problem. Seems there is no recognition of mental issues there. Any other suggestions?
August 31st, 2008 at 1:56 pm
Dear Michael,
I am so sorry about your plight. No insurance leaves few options. However, sometimes the local Community Mental Health Clinics may be a resource. In NY many of the mental health clinics have specific PTSD treatment programs and they accept health insurance, Medicaid and Medicare, and have reasonable sliding scales. So, I’d suggest contacting the local CMHC to see what they have to offer. In addition, you may qualify for Family Health Plus or another governmental health plan.
I hope this is helpful…let me know.
regards
Art
September 4th, 2008 at 2:56 am
What a shame that lack of health insurance keeps someone in need from getting the medical treatment that he needs.
September 4th, 2008 at 1:32 pm
Johnson,
Yes, it is awful. I would hope that they might qualify for some government insurance such as Child Health Plus or Family Health Plus (New York State programs) or Medicaide or Medicare…
Art
September 14th, 2008 at 11:17 pm
In a number of road accidents, I believe people causing them are as traumatised as the victims involved in it. Especially where the victim has died. The cumulative stress in today’s life makes a person constantly tired. The physical and mental exhaustion of the day’s events causes road rage and careless driving.
September 15th, 2008 at 11:20 am
Ben,
I believe you are right. I’ve worked with a number of persons convicted of DWI and vehicular homicide, and they, too, often are traumatized by what they have done.
Thanks for the comment.