Underlying Causes of Trauma
What happens in the brain – The limbic system is a set of brain structures located in the middle area of the brain. The limbic system is responsible for our survival instincts and reflexes. It manages body temperature, hydration, sexual arousal, the stress reaction, motivation, memory, emotional processes, and olfaction. Within the limbic system is the amygdala, a small almond shaped nucleus. The amygdala, in short, is the area of the brain that alerts us to danger and initiates autonomic responses to insure our safety. It is responsible for evaluating the emotional meaning of incoming sensory information to the brain. The amygdala is fully developed by the 8th month of gestation. The amygdala further apprises for danger and threat. The hippocampus is also a structure within the limbic system and processes data to make sense of an experience and places the information in a timeline. The hippocampus also interprets the safety of the environment. If not able to function properly, we may demonstrate impairment in discerning the signals in our environment. It also plays a role in consolidation of both short term and long term memory. When trauma occurs, the memory can be stored both in implicit memory (sub-conscious) and/or explicit memory (factual memory). Implicit memories may present as somatic symptoms in the body with no attached content for the individual.
When trauma occurs our natural biological processes are activated. Epinephrine is one neurotransmitter that is secreted during terror and acts to cement memory. Continued terror can result in too great a secretion of epinephrine, which can overwhelm the system and impair memory. Trauma memory is not linear. It becomes fragmented and disorganized. Trauma memory becomes stored in physical sensations, sounds, smells, images and other emotional and sensory traces. For this reason, anything can trigger a trauma memory. A trigger can be a scent, a location, a sound, a body position, a color, and more. Someone can be triggered into a trauma memory when a current internal state replicates an internal state from a previous event and time.
It is worth noting that the Olfactory Bulb (sense of smell) is within the limbic system and many childhood events are only remembered through our sense of smell. It is not surprising that many trauma memories may lack linear, visual detail but will be robust with the scents present at the time of the trauma. Scent memory is continuing to be tested but some recent research has demonstrated that not only does scent have effects on the body but that it does not require a great deal of odor to make this impact.
When under stress our bodies release a hormone called cortisol. Cortisol is critical for our survival in the short term as it fuels our body when the fight or flight response is needed. Too much cortisol however can essentially flood the hippocampus, and results in impairment of the hippocampus and consequently impaired memory and problems with new learning. The excessive release of cortisol can also impair the amygdala’s performance of regulating our emotions, specifically fear, in the case of trauma. The result is an impaired ability to exhibit the appropriate amount of fear in the context of what is happening around us.
Anyone consistently exposed to severe stress will become wired to operate from survival instincts of fight, flight and freeze, even when it is not necessary to do so.
Attachment Theory and Trauma
Trauma is often about unmet needs. All humans require a wiser and more advanced human to attach to in early life to ensure their survival. The one they attach to becomes their model from which they learn behaviors and how to interact with others to ensure they are fed, safe, nurtured and consistently cared for and provided for. If the attachment figure is inadequate, the system of healthy human connection is damaged. Infants react to a primary caregiver’s (usually Mother) emotional state. They personalize the mother’s emotional state. If, for any reason, the infant does not experience the mother as consistently safe and attentive or as frightening, neglectful or even rageful, the infant will not be able to connect to the mother in a way that supports optimal emotional, mental and behavioral health. We know that the first three years of human life is the period when the brain grows most rapidly. Attachment failure can occur during this time when the child is completely dependent on others for her survival. For the brain to wire and develop in the most optimum way for mental and emotional health, safety must be present in childhood. Disruption of the attachment system is trauma. The early life relationship dynamic we have with our caregiver is imprinted in the brain providing a template of how we engage in relationships in the future. Historically, children were able to have their needs met by attaching to a culture or a community. A village did raise a child and thus attachment failure was not as prolific. If attachment needs are not met; a child will find another way to connect. Examples today are through the Internet, Facebook, social media, texting etc. A great deal of critical learning involving self- soothing does not occur when there is not eye contact and physical touch from the primary caregiver in early life. Not everyone with symptoms from trauma has had attachment failure. Our culture places high expectations on us to manage ourselves in the face of disaster, to “get over it”, to move on etc. and these are unrealistic and harmful expectations. These messages can result in a need to medicate the emotional pain in some way.
The following sub-types of trauma are not found in the DSM. They are not coded diagnoses yet are very real and warrant the attention of any good clinician.
Complex Trauma or Developmental Trauma – Complex trauma results from exposure to repeated traumatic experiences over time. Developmental Trauma occurs when this repeated exposure specifically occurs across the developmental years. The impact on a developing child suffering repeated abuse, neglect, and more is profound and results in changes in the brain that affects the development of healthy neural pathway formation. Children who grow up in an environment of frequent terror, in which they need to stay vigilant for personal safety, can develop a brain state of chronic hyper-arousal. This state of hyper vigilance interferes with an individual’s ability to focus and retain information due to a need of maintaining high alert status for safety.
Over the years, I have worked with many patients admitting to treatment with diagnoses of ADD, Bi-Polar Disorder, Borderline Personality Disorder to name a few… that I have questioned as mis-diagnoses, as their behaviors seem more accurately to be the result of attempts to self-regulate after debilitating complex trauma.
Traumatic Shame – This can be considered another sub-type of Developmental Trauma. A child who is repeatedly subjectedto criticism, shaming, and devaluing comments over the developmental years will struggle with having healthy esteem, a sense of place in the world, and safety in the world. Children who are repeatedly shamed verbally, emotionally, physically and/or intellectually will develop traumatic shame. This shame can lead to behaviors, which have negative consequences such as addictions or other mental health conditions.
A child subjected to emotional shaming will develop negative self-cognitions such as “I am unworthy”, “I am unlovable,” “I am a mistake,” etc. Examples of the emotional shaming messages that as they accumulate become traumatic are comments such as “You are stupid, who asked for your opinion? “I wish you were never born, you don’t have anything smart to say, you are a disappointment, what is wrong with you, what makes you think you know anything?” As a child becomes increasingly distressed finding no comfort or emotional safety from those responsible, a cascade of brain changes occur that end up compromising the function of the amygdala, over sensitizing it, and also impairing the hippocampus. When these two areas of the brain are sabotaged, the result can be memory distortion, and skewed intense emotional responses to seemingly minor stimuli.
When an infant or child pre-language age is exposed to repeated negative experiences, the emotions and experiences are stored in implicit memory and body memory as the child had no capability for language at the time of the traumatic occurrences.
Implicit Memory – Implicit memory is critical to better understand-ing the impact of trauma. Implicit memory is subconscious and is stored in the brain’s frontal lobes. It is responsible for storing proce-dural information relevant to learning tasks, skill performance and emotional associations. An example of implicit memory is learning to ride a bicycle. Perhaps I don’t ride a bike for many years, but my procedural memory allows me to get back on the bike and ride effortlessly years later. Implicit memory in general is memory that I don’t have grasp of but it has associations paired with a specific event. In terms of emotional associations, imagine a toddler is learning to walk and as her parents sit facing her with looks of joy and pride, she begins her first steps towards them. In an instant, the family dog jumps up and knocks the toddler over. Just as the parents see the dog moving towards the toddler their faces change to looks of fear and anger. The toddler takes in a snap shot of their faces just as she falls. She begins to cry. Perhaps the child begins to associate achievement with pain. She does not remember the incident but the event could be important in understanding a pattern she develops of self-sabotage over time, fearing success and not knowing why. This is how implicit memory can play a critical role in shaping patterns of behavior.
In 2008, I attended a conference in Phoenix on Trauma and Bereaved Parents. Dr. Robert Scaer was the Keynote Speaker and stated “PTSD is a complication of memory.” He further described how individuals with PTSD might have images, behavioral impulses, and body sensations but no understanding of why and may lack any context to connect these two.
Traumatic Grief – Despite a strong movement by psychiatry,
this disorder did not make it into the DSM V. The diagnosis is characterized by a sudden, unexpected, and perhaps untimely death that includes both violent death and non-violent death that result in traumatic separation. An adult form of separation anxiety that is severe is at the root of traumatic grief and is connected to attachment theory. Traumatic grief is misunderstood in our culture and many myths exist as to how symptoms should progress and just disappear over time. This does not happen. Individuals may develop shame over long-term grief over a loss. Traumatic grief and the long-term symptoms are normal reactions to horrific loss and in some instances extreme separation anxiety.
The continued need to be in close proximity to the deceased lends to the separation being traumatic. Some symptoms include a preoccupation with the deceased that results in longing and searching, an example being scanning the environment for cues of the loved one. In addition, shock, disbelief, purposelessness, difficulty imagining a fulfilling life without the loved one, numbness, detachment, distortions of time and memory and more. As a bereaved parent, I relate at a deep personal level to this diagnosis.
Betrayal Trauma – This diagnosis is frequently used to describe the resulting symptoms of a spouse or significant other after discovering their partner has engaged in secretive, sexual behaviors and/or gone outside of the relationship emotionally as well. If repetitive deception occurs, the resulting emotional and psychological pain for the partner can be staggering, as the neurochemicals in the brain are released preparing the betrayed for the next possible unseen threat or danger. Emotional trauma can result in the brain staying in a state of high alert with resulting hyper vigilant behaviors to protect the self. These behaviors can be seen in the betrayed partner’s seeking safety by spying, snooping, and seeking more evidence of improprieties as the need to know becomes obsessive and all consuming.
Betrayal and resulting trauma can occur in a variety of contexts besides an intimate partnership. Work environments in which employees are in constant competition for maintaining a position, promotion, or the good graces of their supervisor are rich with betrayal. Fear based organizations may have shareholders and board members whose employees perceive as strangers and disconnected from the day to day operations of a facility. We all have an innate need to be recognized. If one believes their employer sees them solely as a dollar number, not an individual, the fear spreads and creates an environment ripe for betrayal. Nepotism continues to be rampant across the business world and trust in leadership can be nil if employees view a leader as unskilled and in the position solely due to familial relationship. Sudden job termination with no explanation after long-term commitment, high performance, and loyalty to a company can be devastating and experienced as a trauma.
Betrayal comes in many forms as seen in cases involving incest, religious abuse, terrorizing to control, seduction, and abuse of power.
Multi-generational trauma – Much has been written about the unspeakable long lasting day after day horror experienced by victims of the Holocaust. Research has revealed that the emotional and psychological scars suffered by the victims are still reflected in the behaviors of descendants. Physical adaptations such as changes in the body to better tolerate starvation are found in later generations of Holocaust survivors, despite not needing that adaptation in their current environment.
In Part 3, we will discuss the Treatment for Trauma.
Nancy Jarrell O’Donnell specializes in addiction and trauma treatment. She has spent most of her 25-year career working in residential and in-patient facilities. Her experience ranges
from Psychotherapist to Clinical Director to President of Clinical Services/Operations. She is a licensed therapist in Arizona currently in private practice. She developed The Sabino Model: Neuroscience Based Addiction and Trauma Treatment™