TRAUMA, ABUSE & PTSD

“Traumatic events challenge an individual’s view of the world as a just, safe and predictable place. Traumas that are caused by human behavior … commonly have more psychological impact than those caused by nature.”  American Psychological Association

Traumatic experiences often involve a threat to life or safety, but any situation that leaves a person feeling afraid, overwhelmed, helpless, and alone can be traumatic, even if it does not involve direct physical injury. It is the person’s subjective emotional experience about the event that determines whether the person becomes traumatized. The more frightened and helpless a person feels, the more likely he/she will feel traumatized.

Abuse can take on various forms: sexual, emotional, physical, financial, medical, spiritual, and more. It can occur at any stage of life and can be extremely difficult to go through. Traumatic experiences often involve a threat to life or a threat to one’s safety, but any situation that leaves you feeling afraid, overwhelmed, helpless, uncertain, and alone can be traumatic. Your emotional experience of the events determines whether or not it is encoded as a trauma in your brain. Situations that become traumatic often vary – what traumatizes you might not traumatize someone else. The more frightened and helpless you feel, the more likely you are to feel traumatized.

Traumatic effects are not always apparent immediately following the incidents that caused them. Symptoms can remain dormant, accumulating over years or even decades. Then, during a stressful period or after another traumatic incident, symptoms can surface. A seemingly minor event can give rise to a sudden breakdown and inability to cope.

Less Obvious Causes of Trauma:

  • Minor automobile accidents, especially those that result in whiplash
  • Witnessing an accident or a death
  • Medical or Dental procedures
  • Falls and other minor injuries, including work-related injuries
  • Natural disasters
  • Illnesses, with or without fevers
  • Being left alone as a young child
  • Prolonged immobilization (such as a casting), particularly in children
  • Exposure to extreme temperatures
  • Sudden loud noises (this is particularly traumatizing for young children and babies)
  • Birth stress (the impact occurs for both the mother and the infant)

The DSM-V (the manual used for diagnosing psychological disorders) lists several types of Trauma and Stress-Related Disorders, including Post-Traumatic Stress Disorder, Acute Stress Disorder, Adjustment Disorders, and Reactive Attachment Disorder. In order to be diagnosed with any of these disorders, a doctor must determine that you meet certain criteria. Some of these include:

  • PTSD: Re-experiencing the event (intrusive memories, flashbacks, dreams), heightened arousal (difficult to concentrate, jumpiness, easily feels anger or irritability), avoidance/numbing (distraction, dissociation), and negative thoughts/moods/feelings.[1] PTSD symptoms may start within one month of a traumatic event; sometimes the symptoms may not appear until years after the traumatic event.
  • ASD: Intrusive symptoms (memories, dreams, flashbacks), negative mood, extreme anxiety, dissociative symptoms, avoidance symptoms, arousal symptoms. These symptoms occur within one month after exposure to an extreme traumatic stressor.[2]
  • AD: An overreaction to a situation, anxiety or depressed mood, an inability to cope with a specific stressor (such as moving to a new country, having a baby, retiring), and impairment in social, occupational/educational, and day to day functioning.[3] Adjustment Disorders are short lived, rarely lasting for longer than 6 months.
  • RAD: A condition in which a person has difficulty forming lasting relationships and has difficulty trusting others. Symptoms are caused by neglect during childhood and include patterns of withdrawal toward caregivers, inhibited social and emotional responses towards others, and periods of unexplained sadness/irritability/fearfulness.[4]

Types of Traumas

  • Sexual Abuse: This type of abuse involves someone forcing or manipulating another person into engaging in some type of sexual activity, without that person’s consent. Obstacles to consent include age, fear, disability, or the influence of alcohol/drugs.[5] Sexual abuse can happen at any age to both men and women.
  • Physical Abuse: Physical abuse is when someone uses intentional force or violence on someone else, resulting in pain or injury.[6] Physical abuse can be a way for one person to have control over another, within a relationship. Physical abuse can happen at any age to both men and women.
  • Emotional Abuse: Emotional abuse is a type of abuse that can damage your self-esteem and result in psychological issues such as depression.[7] Emotional abuse can occur when someone engages in name-calling, yelling, mocking, or swearing at another person. Emotional abuse can also occur in situations such as when others actively bully, reject, or threaten another person.[8]
  • Medical Abuse: This type of abuse usually occurs within the elderly population, and involves someone either withholding or forcing medications upon someone else. Medical abuse can happen in relationships as a form of control or to obtain something.
  • Neglect: Neglect is a form of passive abuse in which someone is not given the appropriate attention they need in order to meet their basic needs. There are different types of neglect, including emotional, financial, or physical neglect, or abandonment.

Researchers looked at various Adverse Childhood Experiences (ACE’s include (a) psychological abuse, (b) physical abuse, (c) sexual abuse, (d) substance abuse by a household family member, (e) mental illness of a household family member, (f) spousal or partner violence, and (g) criminal behaviour resulting in the incarceration of a household member) and how they are related to adulthood health risk behaviours and disease outcome. They found that the more ACE’s that a person experienced, the greater the risk of developing negative health behaviours and various psychological and physical illness(es) in adulthood. In other words, negative life experiences do in fact accumulate over a lifetime and need to be addressed, since the cumulative effects of these experiences lead to overall negative health outcomes later on.[9]

Situations with High Risk of Traumatization:

  • Car Accidents
  • Work Injuries
  • Loss of Limb
  • Chronic Illness
  • Medical Procedures/Surgery
  • Dental Procedures
  • Home Invasion
  • Multiple betrayals from one or more partners
  • Working as a Police Officer, RCMP, or Emergency Worker
  • Physician working in specialities where patient death is likely to occur (Example: Physicians working in Emergency Rooms, Oncology, Cardiology, etc. Departments)
  • Witnessing death or suicide
  • Natural Disaster
  • Military Combat
  • Living with an abusive parent or partner
  • Carjacking
  • Gang violence
  • Near-death-experiences (drowning, heart attack, being trapped in a fire etc.)

Canadian Statistics

  • Sixty-seven percent of Canadians have known a woman who has been physically or sexually abused.[10]
  • Alberta has the highest reported incidence of sexual and physical abuse within Canada – at 74 percent.[11]
  • Cyber violence, which includes online threats, harassment, and stalking, has emerged as an extension of violence against women.1,2 Young women (aged 18-24) are most likely to experience online harassment in its most severe forms, including stalking, sexual harassment, and physical threats.[12]
  • Overall, men were responsible for 83% of police-reported violence committed against women. Most commonly, the accused was the woman’s intimate partner (includes both spousal and dating) (45%), followed by acquaintances or friends (27%), strangers (16%) and non-spousal family members (12%).
  • Violent crimes committed against men are mostly perpetrated by strangers or friends.[13]
  • Sexual Assault is the least likely violent crime to be reported to police, and the vast majority (90 percent) are never reported.[14]

Behaviours associated with Trauma & Abuse:

  • Having few friends because it is difficult to trust others
  • Startle response or having heart palpitations when someone touches you on the shoulder
  • Avoiding sleeping because you experience nightmares
  • Abusing drugs or alcohol as a way to numb out from traumatic memories or anxiety
  • Difficulty maintaining romantic relationships
  • Reacting strongly to loud noises
  • Withdrawing from others
  • Difficulty trusting others

Feelings associated with Trauma & Abuse:

  • Guilt/Shame
  • Anger/Irritability
  • Panic/Anxiety
  • Disbelief/Shock
  • Depression
  • Confusion
  • Self-blame
  • Sad, hopeless, or helpless

Thoughts associated with Trauma & Abuse:

  • “Even though I disagree with my co-worker, I’m going to keep my mouth shut so he doesn’t hurt me.”
  • “I can’t go hiking because I saw my sister fall from a cliff as a child. If I go hiking, there’s a good chance that will happen to me.”
  • “When my husband asks me to change a behavior, I think he’s telling me that I’m useless and a failure.”
  • “Even though she says she loves me, she’s only going to hurt me.”

Trauma & Abuse and the Body:

Trauma & Abuse can have long-lasting effects on your body, even when the frightening situation is long in the past. Some of the physical symptoms include:

  • Racing heartbeat
  • Muscle tension
  • Aches and pains
  • Fatigue
  • Startled reflexes
  • Insomnia
  • Feeling numb
  • Nightmares
  • Strong startle reflex
  • Feeling disconnected from yourself
  • Fatigue and Restlessness

Trauma & Abuse and the Brain:

There are 3 areas of the brain which are involved and impacted by trauma and abuse. The first is the Amygdala, which is responsible for evaluating dangerous situations and generating fear. The second is the Medial Prefrontal Cortex (MPFC), which helps to reduce the fear response created by the Amygdala. Research has shown that people who have experienced trauma, such as army veterans, have less activity in the MPFC and increased activity in the Amygdala.[15] One other area of the brain that is impacted by trauma and abuse is the Hippocampus. This area is involved in the retrieval of memories and the prediction of future events.[16] Studies have shown that being exposed to trauma can reduce the volume of your Hippocampus, thus affecting the way you remember traumatic events. More specifically, people who have experienced traumatic events often have memory distortions when recalling instances of trauma.[17] Research has shown that the hippocampus not only affects how you recall the past but also how you predict the future.[18] Therefore, if you have distorted memories of the past, your future predictions are also likely to be distorted.

Does Psychology Work?

Sometimes, experiences of trauma and/or abuse can lead to a condition known as Post-Traumatic Stress Disorder (PTSD). PTSD occurs after the experience of a traumatic event and can begin at any time after the event. Symptoms of PTSD include reliving the event in your mind, avoiding situations that remind you of the event, increased negative beliefs, and hyper-arousal.[19] Much of the research on treating trauma has been focused on the treatment of PTSD. Effective treatments for PTSD include:

  • Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a type of therapy that aims to restructure your memories of traumatic events so that you can recover from them. EMDR has been scientifically proven to be an effective treatment for PTSD when compared to other effective treatments.[20] EMDR has been also proven to be an effective treatment for PTSD in rape victims; in one study, 75% of female rape victims no longer met the criteria for PTSD after EMDR treatment.[21]
  • Emotionally Focused Therapy (EFT): It can be difficult to maintain healthy interpersonal relationships if you are suffering from PTSD. One of the main issues experienced by people with PTSD is having extreme fear reactions even when no threat is present. These reactions can make it hard to maintain close relationships and can contribute to feelings of isolation and depression. Additionally, people who have been abused by another individual have difficulty trusting others and may have episodes of extreme anger. EFT focuses on strengthening attachment bonds and creating more trust, closeness, and comfort in relationships. Elements of this therapy include ending negative cycles and creating healthy patterns of communication. Research has shown that this type of therapy can significantly reduce symptoms of PTSD.[22]

Tips to Manage Trauma & Abuse!

  • Connect: Finding connections with loved ones is the antidote to trauma. Feeling alone can be one of the most painful parts of living through abuse and trauma, and often leads to more traumatization.[23] Although it might be difficult to share your experience with your loved ones, start with where you are at and share what feels most comfortable.
  • Grounding Technique: Find a comfortable place to sit and notice yourself being supported by the chair/couch while you look around the room to wherever your eyes want to go. Next, listen to your surroundings and then touch various objects in the room and notice what it feels like (notice the object’s temperature, texture, weight, smell, etc.). Being in the present moment allows you to feel a sense of safety, which over time helps decrease the symptoms of hypervigilance and anxiety.

People have different reactions to different life circumstances, and while some individuals develop trauma, others do not, even though they experienced the same situation. It is extremely important to get professional help as the symptoms of trauma often get worse due to self-isolation. Moreover, people continue to get re-traumatized when they re-experience nightmares and flashbacks. Trauma has an additive effect and oftentimes people oscillate between feeling highly anxious/panicked and feeling numb/dissociated. Finding a Psychologist who is a trauma expert is essential. It takes time to develop trust, so take your time and ask your therapist questions.

Typically, people who have experienced abuse/trauma tend to avoid things/people that remind them of the abuse/trauma, in order to cope. Some ways of coping include working, eating, exercising, sleeping, watching TV, or playing computer games, to name a few. Additionally, people may turn to problematic behaviour, such as drinking alcohol or using drugs, as a way to cope because it can numb out some of the troublesome symptoms that they may be experiencing. Additionally, it is common for people who have experienced abuse and/or trauma to disconnect from others and to have difficulty trusting others. It can feel very isolating and alone.

At Hopewell Psychological, we provide expert trauma counselling and are open, transparent, and collaborative in our work. We know that trust takes time and we want to ensure that you are supported and resourced before we begin working on trauma. We also provide other evidence-based treatment such as Emotionally Focused Couples and Family Therapy, to help you improve your most important relationships. It is possible to resolve your trauma symptoms can resolve in therapy. You can develop a sense of safety and control of your life and you can improve your relationships. The past does not need to impact your present or future.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] Posttraumatic Stress Disorder (PTSD) DSM-5 309.81 (F43.10).” Theravive. 2017. Web. Apr. 2017.

[2] “Acute Stress Disorder.” TraumaDissociation.com. Web. Apr. 2017.

[3] Bressert, Steve. “Adjustment Disorder Symptoms.” PsychCentreal. 2016. Web. Apr. 2017.

[4] “Reactive Attachment Disorder.” TraumaDissociation.com. Web. Apr. 2017.

[5] “What is Sexual Violence?” National Sexual Violence Resource Center. 2010. Web. Apr. 2017.

[6] “Physical Abuse.” National Committee for the Prevention of Elder Abuse. 2008. Web. Apr. 2017.

[7] Gibb, Brandon E., and John RZ Abela. “Emotional abuse, verbal victimization, and the development of children’s negative inferential styles and depressive symptoms.” Cognitive Therapy and Research 32.2 (2008): 161-176.

[8] “VCH ReAct: Adult Abuse and Neglect.” Vancouver Coastal Health. 2002-2017. Web. Apr. 2017.

[9] Felitti V. J., et al. “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences Study.” Journal of Preventative Medicine 14.4 (1998): 245-258.

[10] “Sixty-Seven Percent of Canadians have known a woman who has experienced physical or sexual abuse.” Canadian Women’s Foundation. 2012. Web. Apr. 2017.

[11]  Duggan, Maeve. “Online Harassment.” Pew Research Center. 2014. Web. Apr. 2017.

[12] See 11.

[13] “Gender Differences in Police-Reported Violent Crime in Canada.” Statistics Canada. 2008. Web. Apr. 2017.

[14] “Trends in Sexual Offenses.” Statistics Canada. 2013. Web. Apr. 2017.

[15] Williams, Leanne M., et al. “Trauma modulates amygdala and medial prefrontal responses to consciously attended fear.” Neuroimage 29.2 (2006): 347-357.

[16] Buckner, Randy L. “The role of the hippocampus in prediction and imagination.” Annual review of psychology 61 (2010): 27-48.

[17] Hayes, J. P., et al. “Reduced Hippocampal and amygdala activity predicts memory distortions for trauma reminders in combat-related PTSD.” Journal of Psychiatric Research 45.5 (2012): 660-669.

[18] Eichenbaum, H., & Fortin, N.J. “The neurobiology of memory based predictions.” Philosophical Transactions of the Royal Society B: Biological Sciences 364.1521 (2009): 1183-1191.

[19] “PTSD: National Center for PTSD.” U.S. Department of Veteran Affairs. 1 Jan. 2007. Apr. 2017.

[20] Benish, Steven G., et al. “The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: A meta-analysis of direct comparisons.” Clinical Psychology Review 28.5 (2008): 746-758.

[21] Rothbaum, Barbara O., et al. “Prolonged Exposure versus Eye Movement Desensitization and Reprocessing (EMDR) for PTSD Rape Victims.” Journal of Traumatic Stress 18.6 (2005): 607-616.

[22] Greenman, Paul S., Johnson, Susan M. “United we Stand: Emotionally Focused therapy for couples in the treatment of posttraumatic stress disorder.” Journal of Clinical Psychology: In Session 68.5 (2012): 561-569.

[23]  “How to Manage Trauma.” National Council for Community Behavioral Healthcare. 2012. Web. Apr. 2017.

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