Trauma and Behavioral Responses

Psychophysiological reactions to traumatic stress have been known to occur since ancient times. Traumatized people may 1) re-experience the event through obsessive recollections, flashbacks, or nightmares; 2) exhibit avoidant reactions; and/or 3) be easily hyper-aroused and vigilant.

Children whose families and homes do not provide consistent safety, comfort, and protection may develop ways of coping that allow them to survive and function day to day. For instance, they may be overly sensitive to the moods of others, always watching to figure out what the adults around them are feeling and how they will behave. They may withhold their own emotions from others, never letting them see when they are afraid, sad, or angry. These kinds of learned adaptations make sense when physical and/or emotional threats are ever-present. As a child grows up and encounters situations and relationships that are safe, these adaptations are no longer helpful, and may in fact be counterproductive and interfere with the capacity to live, love, and be loved.

The importance of a child’s close relationship with a caregiver cannot be overestimated. Through relationships with important attachment figures, children learn to trust others, regulate their emotions, and interact with the world; they develop a sense of the world as safe or unsafe, and come to understand their own value as individuals. When those relationships are unstable or unpredictable, children learn that they cannot rely on others to help them. Children who do not have healthy attachments may have trouble controlling and expressing emotions, and may react violently or inappropriately to situations.

Children who have experienced complex trauma often internalize and/or externalize stress reactions. Their emotional responses may be unpredictable or explosive and they may react to a reminder of a traumatic event with anger. This person may have difficulty calming down when upset. Since the traumas are often of an interpersonal nature, even mildly stressful interactions with others may serve as trauma reminders and trigger intense emotional reactions. Defensive postures are protective when an individual is under attack but become problematic in situations that do not warrant such intense reactions. Adaptive responses exhibited when faced with a perceived threat may be out of proportion compared to most people’s reaction to a normal stress. These reactions are often perceived by others as overreacting or as unresponsive or detached. Often both kinds of responses can be seen in an individual who has been traumatized as a child.

After becoming highly involved in adoption communities, I have learned a lot more about the effects of adoption trauma that both of my parents may have experienced. Trauma is a constant theme in adoption related communities. The first trauma is separation from the mother who’s womb the baby grew in. When an infant is still preverbal, the body remembers what the brain did not have language to interpret. For adoptees placed with abusive adoptive parents the trauma multiplies. This happens more often than most people might believe, due to the parents’ own unresolved feelings related to infertility and their knowledge that this child is not the one who would have been in their life with their own genetics – but for.

Within the community, it is frequently suggested how necessary it is to find a trauma-informed therapist because a therapist without this specialized perspective could do more harm than good.

Many people continue to reflect on the slap known around the world. Having an understanding of the behavioral effects of trauma, really put “the slap known around the world” event into perspective for me.

In his autobiographical book, “Will,” Smith recounts that as a child he witnessed domestic violence in his home. “When I was nine years old, I watched my father punch my mother in the side of the head so hard that she collapsed. I saw her spit blood. That moment in that bedroom, probably more than any other moment in my life, has defined who I am.”

“Within everything that I have done since then — the awards and accolades, the spotlights and attention, the characters and the laughs — there has been a subtle string of apologies to my mother for my inaction that day. For failing her in the moment. For failing to stand up to my father. For being a coward.”

Seeing the look on his wife Jada’s face, after she was targeted for having a shaved head due to suffering the disease of Alopecia by the comedian Chris Rock, it is quite likely Smith re-experienced that memory in the context of current events. In effect, however wrong, he could make up for his childhood inability to protect the woman he loved. His reaction that night had more to do with that 9 year old traumatized little boy, than the man he had become since then. That man unfortunately is now subject to public reinterpretation. I admit to being a fan of Will Smith movies in general and have loved his easy going personality in most of these.

All this to highlight the extreme importance of understanding the impact of an experienced trauma and the need to seek help in the form of trauma-informed therapy. Domestic violence is a devastating problem that affects individuals all over the world. I recently saw a video of Smith listening to his wife honestly describe her extra-marital affairs. His ability to listen and to take that knowledge in impassively, may have also been a trauma induced behavior from his childhood. The fear of losing the love of a manipulative person and at the same time needing the love of that person perhaps triggered the response the world witnessed.

Developmental Trauma Disorder In An Adoptee

“All diagnoses are wrong, but some are useful.” George Box

The kinds of complex issues that adoptees face can be difficult to treat. A 2013 study found that fewer than 25% of adoptive parents who sought mental health services felt that their mental health professional was adoption-competent. The symptoms and issues that adopted children experience are typically not taught in most graduate school mental health programs. Adding to the challenges faced by adoptive families, insurance companies will not cover what is really going on with these children and their families because it is not correctly conceptualized, coded, and diagnosed.

Some common diagnoses used with adopted children include Pervasive Developmental Disorders, Oppositional Defiant Disorder, Conduct Disorder, Reactive Attachment Disorder, Affective Disorders, Anxiety Disorders, Attention-Deficit Hyperactivity Disorder, Post-Traumatic Stress Disorder, and Borderline Personality Disorder. Each of these may characterize certain symptoms that these children demonstrate, but none of them systemically addresses the developmental aspect of trauma that most (if not all) adopted children experience. None take into account the sad possibility of being traumatized by birth or foster-parents. “There is no diagnosis for children that more than partially addresses the symptoms associated with these impairments in self-regulation” according to Julian Ford, PhD, who is a psychologist with the University of Connecticut.

“Developmental Trauma Disorder” or DTD includes symptoms that differentiate it from Post-Traumatic Stress Disorder PTSD more commonly associated with the “Battle-Fatigue” symptoms of WWI. Children are often traumatized in the context of relationships. Because children’s brains are still developing, this trauma has a much more pervasive and long-range influence on their self-concept, on their sense of the world, and on their ability to regulate themselves.

There are four diagnostic areas involved in DTD – [1] Exposure [2] Triggered pattern of repeated dysregulation in response to trauma cues [3] Persistently Altered Attributions and Expectancies and [4] Functional Impairment. Those who’s work has been focused on adopted children who have suffered various forms of Complex Trauma will recognize the manifestation of these. The American Psychiatric Association failed to include this in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (also known as the DSM-V).

The problem with this oversight is that after experiencing chronic trauma, the current standard of clinical practice often reveals no diagnosis, inaccurate diagnosis or inadequate diagnosis…all of which leads to misguided or complete lack of treatment plans. Further, because there is almost always considerable dysregulation of body (sensory and motor), affect (explosive/irritable or frozen/restricted), cognition (altered perceptions of beliefs, auditory and sensory-perceptual flashbacks and dissociation) and behavior (multiple forms of regression), the diagnoses of bipolar, oppositional defiant disorder/conduct disorder, attention deficit hyperactivity disorder (ADHD) or other anxiety disorders are made. Many of these disorders are co-morbid with developmental trauma disorder, as they tend to cluster in these complex families. But the importance is that the developmental trauma disorder would be primary and thus guide the treatment plan…and further, refine the inclusion (or not) of other co-morbid disorders.

Today’s blog was informed by an article Could My Adopted Teen Have Developmental Trauma Disorder? by Dr Norm Thibault, LMFT

Healing Trauma

I’ve only just learned about this book and have not read it but didn’t want to wait for whenever, if ever, that might happen to pass it on to readers here.

Many adoptees and foster children have some degree of trauma. It is said that this is one of the best-known books about trauma, and in particular early life trauma (which especially applies to the topics I cover in this blog).

It is not light weight reading, has almost 500 pages that includes a significant reference section. Someone who did read this (link at bottom of this essay) says – “It’s very in-depth, giving plenty of detail, but it’s not unnecessarily complicated. There’s some technical terminology used, particularly with respect to the functioning of the brain, but I thought this was explained well.”

Van der Kolk is a psychiatrist who initially began working with trauma while treating war veterans. There was a lot that wasn’t known about trauma then. He’s been an active researcher throughout his career and often considered at the forefront of new trauma-related knowledge.

In this book, he repeatedly stresses the importance of recognizing the changes that occur in the brains and nervous systems of people who’ve been through trauma, and targeting treatment accordingly with the goal of getting back the functioning they have lost. He is quoted as saying, “Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.”

Imaging studies have produced some new understandings about flashbacks. There’s activation of the right brain along with a drop in activity in the brain structure called the thalamus, which prevents the events from being remembered as a coherent narrative, as would be the case with other kinds of memories.

Brain scans have also shown an impaired self-awareness. Van der Kolk explains that this is why it’s important to work on breathing, mindfulness, and recognizing the link between physical sensations and emotions. He writes further: “The body keeps the score: If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic assumptions.”

The book pays a lot of attention to early life trauma, including issues like attachment and attunement. The author explains that trauma increases the need for attachment, even when the only attachment figure available to the child is the abuser.

Van der Kolk championed adding complex PTSD as a separate diagnosis from PTSD. He was part of the working group that proposed C-PTSD for inclusion in the DSM-IV, and the group that proposed developmental trauma disorder for inclusion in the DSM-5. American Psychiatric Association did not approve any of these suggestions as new diagnoses.

I am indebted to Ashley of The Mental Health @ Home blog for her review which is the basis of my own blog today. You can read more about this book in her article.

What is C-PTSD ?

Most of us have heard of PTSD but until this morning, I didn’t know there was a more severe version called Complex-PTSD.

Most people who have looked at adoption very closely already know that trauma is an aspect of having been surrendered to adoption for most adoptees. I’ve become so steeped in it that I can recognize effects now in statements made by an adoptee that to them a vague issues they still don’t know the source of. This lack of awareness occurs most often in teenagers and young adults. Most mature adoptees have worked through many of these and may have had some counseling or therapy to help them uncover the underlying emotions and possible sources of these.

Complex PTSD, however, is specific to severe, repetitive trauma that typically happens in childhood – most often abuse. On the surface, both PTSD and C-PTSD both come as the result of something deeply traumatic, they cause flashbacks, nightmares and insomnia, and they can make people live in fear even when they are safe.

The very heart of C-PTSD – what causes it, how it manifests internally, the lifelong effects (including medically), and its ability to reshape a person’s entire outlook on life – is what makes it considerably different.

PTSD typically results from “short-lived trauma”, or traumas of time-limited duration. Complex PTSD stems from chronic, long-term exposure to trauma in which a victim has limited belief it will ever end or cannot foresee a time that it might. This can include: child abuse, long-term domestic violence, being held in captivity, living in crisis conditions/a war zone, child exploitation, human trafficking, and more.

The causal factors are not all that separates PTSD from C-PTSD. How their symptoms manifest can tell you even more. PTSD is weighted heaviest in the post-traumatic symptoms: nightmares, flashbacks, hyperarousal/startle response, paranoia, bursts of emotion, etc.

C-PTSD includes all the symptoms of PTSD as well as a change in self-concept. How one sees themselves, their perpetrator, their morals and values, their faith in others or a god. This can overhaul a survivor’s entire world view as they try to make sense of their trauma and still maintain a belief that they, and the world around them, could still be good or safe.

When an adult experiences a traumatic event, they have more tools to understand what is happening to them, their place as a victim of that trauma, and know they should seek support even if they don’t want to. Children don’t possess most of these skills, or even the ability to separate themselves from another’s unconscionable actions. The psychological and developmental implications of that become complexly woven and spun into who that child believes themselves to be — creating a messy web of core beliefs much harder to untangle than the flashbacks, nightmares and other post-traumatic symptoms that come later.

The effects are usually deeply interpersonal within that child’s caregiving system. Separate from both the traumatic events and the perpetrator, there is often an added component of neglect, hot-and-cold affections from a primary caregiver, or outright invalidation of the trauma, if a child does try to speak up. These disorganized attachments and mixed messages from those who are supposed to provide love, comfort and safety – all in the periphery of extreme trauma – can create unique struggles.

Credit for this blog and for the beginning of my education in this new concept goes to Beauty After Bruises.

Anne with an E

I’m only vaguely familiar with Anne of Green Gables. Anne has been a bona fide cultural icon for over a century, ever since Canadian author L M Montgomery first debuted her in 1908. Anne was orphaned as a baby and in care until age 12 when she is adopted. She experienced a lot of abuse during her time in care.

We don’t have commercial TV or streaming in our home – while we do have internet the limited allowance and expense when adding onto that prohibit our streaming anything beyond a few youtubes and that costs us a lot as it is.

However, I was reading about this version in the all things adoption group I belong to and I became intrigued. The woman who brought this to my attention describes it as – “a very dark portrayal, with depiction of trauma, flashbacks, so many feelings of abandonment, as well as the difficulties her adoptive parents have in relating to her.” That was enough to get me looking into it.

Another woman said – “The first season is the darkest with the flashbacks. As it goes on, it’s not as dark but continues to deal with a lot of other feelings that people not raised by biological family go through. I honestly loved this series. I felt it was a more honest portrayal of children who were in foster care and adopted than I have seen in a long time. This show helped my children discuss the hardships that adopted people or abused/traumatized people deal with.”

Another woman said – “The other depictions we saw didn’t seem to focus so much on the trauma. We listened to the book as we drove up to Prince Edward Island and there’s definite evidence of her struggles in there, but this series took it to another level and made it real and made the connections very visible of past trauma, fear of abandonment, and the inner world she creates to get away from it all.”

Vanity Fair had a review of this series. They note that in the first episode Anne with an E graphically depicts, via chilly flashbacks, the years of abuse Anne sustained before she came to live with the Cuthberts. While Anne likely did suffer some torment during her tenure with the Hammond family, Anne with an E ramps up the trauma by having Mr Hammond die of a heart attack brought about by beating the tar out of poor Anne.

This version retains some of Anne’s eccentricities—a fierce imagination and intricate fantasy life, as well as a fondness for high-flown language. This is an Anne with PTSD. Anne of Green Gables endures as a cozy story that reveals the resiliency of the human spirit through small-scale, domestic victories and setbacks, as well as the mundane, everyday tragedies of human life.

In episode 4, the town’s minister takes misogyny to its historic depiction because Anne doesn’t want to go back to the school where she has continued to suffer abuse. He tells her adoptive mother – “This problem is easily solved. If the girl doesn’t want to go to school, she shouldn’t go. She should stay home and learn proper housekeeping until she marries. And then the Lord God said, ‘It is not good for man to be alone I shall make a helper for him.’ There’s no need for her to bother with an education. Every young woman should learn how to be a good wife.”

The Vanity Fair review complains that “Anne with an E seems to think Anne’s triumphs are only noteworthy if she’s continually told she can’t succeed, when in fact her unfettered brilliance needs no such clumsy opposition.” Judge for yourself. Don’t know if I’ll ever watch this but maybe if it comes out on dvd. Clearly, it spoke to the wounded hearts of the people in the adoption group I belong to.