About Trauma

Our nervous system and so our bodies may be in a state of balance and thriving or in a state of stress or distress. Our environmental experiences whether positive or negative will influence our nervous system’s response moment to moment. Our thoughts and beliefs about ourselves can also trigger either positive or negative feelings and reactions or responses. 

The brain is divided into three main areas, the lower primitive brain, the limbic brain and the higher pre-frontal cortex. The limbic brain houses a structure called the amygdala which appraises information coming through our senses. The amygdala which communicates closely with the primitive brain, is like our house alarm, which goes off if someone is trying to break in, i.e. someone is a threat. Therefore, the amygdala and primitive brain alert us when we  feel threatened or may be at risk from harm. Our nervous system has a number of possible modes of reaction depending on the source and appraisal of any stimulation.We may react with:

1. When the stimulation does not feel threatening and particularly if it is positive- the ventral branch of vagus nerve ( the safe, calm/relaxed zone) – involving the social engagement system- activation of this enables us to feel relaxed, emotionally open and non-defensive in our responses in relationship with other people.
2. When we perceive threat- the sympathetic system responsible for fight or flight- we feel defensive with a need to fight or run away from anything we think is a threat
3. When we perceive threat- the parasympathetic system involving the dorsal branch of the vagus nerve, triggers immobilisation, shutdown,  defensive- withdrawal/avoidance/emotional numbing.(There is an exception to this whereby the dorsal vagus can enable us to get into a highly relaxed state when we feel safe).

By way of surviving childhood trauma our nervous systems and body will have adapted to the challenging experiences we are exposed to and thereafter if trauma is not resolved our nervous system may be hijacked into automated ways of responding and we may get stuck in fear expectation and prediction, in that our nervous system can believe the bad thing is going to happen again and that we need to do something to protect ourselves in order to survive. Then when we have any experience that is reminiscent of the original trauma for example it may be triggered by a smell, sound, image, texture even movement, we can be catapulted into a self-protective response. When this re-experiencing remains unresolved we can get trapped in habitual reactivity and despite wanting to and trying to change we may feel unable to; we are caught in a vicious cycle.

Portia Nelson’s poem “Autobiography in Five Short Chapters” captures beautifully how these habitual responses can lead us back to the same mistakes or unhelpful choices, as well as how through learning to recognise of our patterns we can begin to spot the triggers and chose to respond differently.

Chapter 1

I walk down the street.

There is a deep hole in the sidewalk.

I fall in.

I am lost…..I am hopeless.

It isn’t my fault.

It takes forever to find a way out.

Chapter 11

I walk down the same street.

There is a deep hole in the sidewalk.

I pretend I don’t see it.

I fall in again.

I can’t believe I am in this same place.

But it isn’t my fault.

It still takes a long time to get out.

Chapter 111

I walk down the same street.

There is a deep hole in the sidewalk.

I see it there.

I still fall in….it’s a habit….but my eyes are open.

I know where I am.

It is my fault.

I get out immediately.

Chapter V

I walk down another street.

Below is a graphic that demonstrates the numerous creative ways our nervous system responds to try and protect us. When we understand the mechanisms of the impact of trauma on our brains and nervous systems we are able to look at our thoughts, feelings and behaviours more objectively and with greater levels of understanding and self-compassion. We may believe that we are trapped, powerless  and helpless, however this is a common manifestation of trauma which relates to the feelings and bodily experiences we would have had when the trauma happened. Overcoming trauma gives us back our sense of empowerment and agency as well as enabling us to become more reflective about our thoughts, feelings and behaviours in order to change them.

Experiences of previous trauma means that we all have unique triggers which can potentially push us outside our window of tolerance and may affect us so that we get stuck in the fight/flight mode or the shutdown/dissociated mode.

When we are pulled out of the safe or ventral vagus state- we lose properties of safety, curiosity, openness to connection with and compassionate towards others, as well as options for constructive problem solving. Moving into unsafe move from a triggering of the dorsal branch can also send us into apathy, depression, despair, helplessness and hopelessness.

Psychological trauma is an emotional response to a deeply distressing and disturbing experience which overwhelms a person’s ability to cope. Although there are situations and experiences which will be traumatic for most people, people will differ in their perception and individual responses. Therefore it may be our subjective experience that determines whether it is traumatic and just how traumatic an experience actually is. Other factors such as the level of security of attachment relationships we experience in childhood will have a strong influence.Experiences from childhood where we may not have felt seen, accepted for ourselves or our behaviour, or where we didn’t receive love and validation can in themselves be traumatic. Also not being afforded adequate and healthy levels of personal power can leave a child feeling disempowered and unaware of their resources and personal agency. Therefore, if a person experiences something as traumatic then it is so for them.

Post-traumatic Stress Disorder (PTSD)

People may experience single traumatic events or repeated ongoing stressful or traumatic events. Single event trauma is related to what is commonly known as Post-traumatic Stress Disorder.

Events that can cause PTSD are:

• serious road traffic accidents
• violent assault
• sexual violence
• witnessing a distressing event such as a violent death
• involvement in military combat 
• terrorist attacks
• natural disasters such as earthquakes, tsunamis
• a complicated bereavement

These single event traumas can have a significant impact on the quality of life and functioning of many people. However, it is treatable with trauma focused interventions which address the source of the trauma and resulting symptoms directly.

Developmental or complex trauma are terms which are often used interchangeably which refer to trauma that happens during the course of a child’s development, which may begin pre-birth, can occur during birth and up to the age of five years of age.

Early childhood is a time when many key developmental tasks are navigated, such as the development of basic trust and security, the beginning of a capacity for self- reflection, the foundations of physiological and emotional self-regulation, as well as identity and sense of self.

Attachment problems or relational trauma results when the connection in relationship between a parent and baby/child is disrupted for whatever reason. In the face of a relational disconnection or poor connection, children will have no option but to find the most effective means of surviving in order to go on living and so will develop strategies to cope. A child’s ability to process information and make sense of what happens to them will be  impacted and their nervous system, emotional and psychological development will organise around the stress as they develop attachment behaviours that enable them to carry on. The child may present as  covering up their emotions as if they are okay, or with serious behaviour problems and expression of anger and even rage. Recurring, ongoing trauma in early childhood has been shown in neuroscience studies to alter a child’s biological, psychological and social balance to such an extent that it impacts on numerous areas of functioning and behaviour through childhood, and if unresolved it may be carried into adolescence and adulthood.

It is also important to add that some children may present with difficulties that can occur as a result of their temperamental sensitivity or an underlying neurodevelopmental problem which can manifest through problem behaviour and so requires professional assessment.

Experiences that are Traumatic for Children

• Ongoing moderate to extreme maternal stress during pregnancy and post birth
• The birth experience from medical intervention
• Medical interventions during infancy and childhood
• Accidents
• Parental unavailability through substance misuse (drugs, alcohol), trauma, depression or general overwhelm
• Parental rejection
• Divorce or parental separation/loss if accompanied by excessive disruption/ lack of predictability or unrelenting parental conflict
• Exposure to domestic abuse
• Physical/emotional abuse
• Exposure to sexual abuse of any nature

Possible Symptoms of Complex oR developmental Trauma in Toddlers, Children and Adolescents

• Activity levels- hyperactive/hypoactive
• Problems with focus and attention affecting functioning and progress in learning
• Problems regulating body and emotional arousal
• Feeding/eating problems- problems with digestion- overeating or restricted eating or elimination- wetting/soiling
• Low levels of responding or lack of responding, low interest in interacting with adults
• Zoning out, rapid shifts in mood, awareness, presentation and behaviour (need to exclude medically explained seizures).
• Fear of abandonment/unable to separate from parent/carer at age expected stage
• The child may not seek comfort from an appropriate adult when hurt or care or help when in need
• High levels of emotional responsiveness- constant crying, fussing, tantrums, aggression, not following parental instruction or guidance, trying to assert control
• A child may be over-compliant and be unhealthily eager to please
• Unable to play or difficulties with exploration through play
• Withdrawing from social contact, wanting to play alone/ difficulties with peer relationships
• Unable to feel and/or express their feelings (age expected stage)
• Unrelenting sadness, depression
• Self-harming behaviour for example picking skin, pulling hair, cutting self
• Hypervigilant- constantly monitoring the environment and people
• Sleep problems/nightmares
• Cognitively, socially and emotionally underdeveloped in that the child’s chronological or actual age is out of step with their presenting stage of development. 
• Children may be delayed in their development or regress to earlier developmental stages in the face of trauma
• Repeated and unrelenting somatic complaints with no apparent medical cause- such as headaches and stomach aches
• Reaction to triggers/reminders- with distress, avoidance- for example a boy who experienced medical trauma became highly distressed when medical programmes came on the TV.
• Preoccupation with and engagement with related themes such as traumatic play repeatedly acting out violent, emotionally distressing themes or stories.
• Age-inappropriate sexualized behaviour
• Generalization of traumatic experience to areas in current life – for example a child may experience a near choking experience with food and then refuse to eat solid or textured food.

Signs and symptoms of Complex or Developmental trauma in Adulthood

• Constantly feeling highly aroused (in fight or flight) and finding it difficult to relax or in a state of freeze- feeling numb/deadened, depressed, disconnected and lacking in direction and motivation
• Some people may oscillate between being in a heightened state and shut down as the nervous system rather than the two systems working in a complimentary way, they are working against each other
• Rumination and preoccupation- struggling to stop thinking about incidents or events from childhood or everyday experiences that are upsetting.
• Difficulties in trusting other people- generally seeing relationships as unsafe, people as untrustworthy, with expectations that the person will be let down.
• Difficulties forming healthy relationships- can feel disempowered and lack assertiveness or feel safer through when in control
• Unable to ask or receive help/isolating self from other people
• Trusting too readily without having a healthy circumspection about other people’s authentic motives, availability and  reliability.
• Problems with a solid sense of self and identity- may carry negative and inaccurate beliefs about the self
• Self-harming behaviours
• Parents who themselves have experienced childhood trauma may find it difficult to meet their child’s needs because they may feel so overwhelmed and consumed with their own unmet needs
• Experiencing phobias and exaggerated reactions wanting to avoid to what seem like benign experiences
• Addictions to for example, food, alcohol, drugs, gambling, exercise, work

How Trauma Affects People

Trauma affects people in a number of ways, physically in how their brain and bodies respond to certain cues from the environment, how people view themselves and the world, as well as how they feel emotionally. Trauma changes us forever, it can shatter our trust in the world and in other people. It organises and reorganises aspects of our personality, our identity and social relating. Trauma can have a profound effect on psychological wellbeing and a person’s ability to function on a daily basis. In addition to psychological effects, stress as a result of trauma has also been found to have a significant effect on a person’s body, creating a greater vulnerability to physical illness.

One  of the world’s leading trauma experts- Peter Levine says that

“trauma shocks the brain, stuns the mind and freezes the body”. It is critical to appreciate how trauma becomes riveted in the body’s instinctive reactions to perceive threat, how it becomes fixated in certain emotions, particularly those of fear, terror and rage, as well as habitual effective mood states such as depression, bipolarity, loss  of vital energy and how it plays out in various self-destructive and repetitive behaviours”                (Levine, 2015).

One of the major challenges of trauma that happens in the first 2 yrs or so, is that it is not consciously remembered. Rather it is subconscious, and the memories are implicit in that they are stored in our minds and bodies but not consciously remembered. These memories are referred to as pre-verbal memories and as they are not supported by  language or a narrative, they are inaccessible through talking therapy.

Traumatic memories are different from other types of memory and can create great confusion when re-triggered even decades after the trauma happened. Locked into nervous system, mind and body, no matter how much we try to change our thoughts and behaviours we may be triggered into the replaying of these memories through our relationships and behaviour. Preverbal memories can impact on us when we are both awake and when asleep-invading our dreams seeking resolution. Contrary to popular folklore it is not best to let sleeping dogs lie. When we make peace with our trauma we can liberate ourselves from the detrimental hold it may have on us.

In trauma Psychotherapy clients can come to uncover and understand how the trauma that they have experienced has resulted in the development of self-protective or survival strategies as well as how it has shaped their beliefs and thoughts about themselves and other people. The function of trauma reactivity is to mind us from the fallout of the trauma we have experienced. Although these strategies may have served us well when we were dependent as children, they are what continue to wrong step us in our lives through symptoms, emotional distress and perhaps a lack of a sense of pleasure and fulfilment in life.

The most important relationship is the one that we have with ourselves for it is from this all other relationships are experienced. In the quest to heal from childhood trauma, the relationship that a person builds with their therapist holds great significance as in order for us to feel able to face our worst fears we need to feel safe enough to bring all parts of ourselves, including the parts we may be criticising or rejecting.

Seeking helps can feel daunting and scary. The Psychotherapist’s role is to create a sense of trust and safety for the person to be able to explore their experience and to make sense of the psychological and emotional conflict, confusion and distress they are carrying. When seeking a therapist to help yourself or your child through recovery, it is important to find practitioners who are appropriately trained and experienced in working with trauma and who will support you to find acceptance, kindness, compassion and love for yourself. If this is a journey we are able to begin as traumatised people, the gains are significant- greater self-knowledge and understanding, self-acceptance, authenticity, more inner peace, as well as greater spontaneity and joy through a stronger connection to self and others.

Complex Trauma and Unexplained Medical Symptoms

People who have experienced complex trauma can present with a host of emotional, mental health and physical health problems. They often visit a range of practitioners struggling to find answers and in the process are given a range of diagnoses and prescription medication or are told that there is no diagnosis or answers for their condition.  This  is not to question the valuable contribution of conventional medicine, however with Complex Trauma is it a common experience that a person experiences bodily expression of a dysregulated nervous system through physical symptoms and so may feel something is medically  wrong. They may struggle to find satisfactory answers and treatments. If the underlying cause is trauma through the impact of toxic stress on the nervous system, this will need to be addressed through safe processing involving body and mind and therefore resolution of the trauma through Trauma Psychotherapy.