Contemporary Views of Psychological Trauma
Written by listed counsellor/psychotherapist: Paul Renn
16th May, 20070 Comments
Psychological trauma is bio-chemically encoded in the brain and, if severe and prolonged, leads to the loss of regulation of the neurobiological processes dedicated to the appraisal of, and response to, threat and danger. Trauma results in subjective feelings of intense fear, helplessness, and threat of annihilation, states of mind that disorganise mental functioning and overwhelm the adaptations that ordinarily provide people with a sense of control, emotional connection and meaning. The explicit memory system may fail during conditions of high arousal because of unregulated increases in the levels of norepinephrine, dopamine, endogenous endorphins and cortisol, and a decrease in the level of serotonin, which mediates mood and emotion. These uncontrolled bio-chemical changes can have a profound effect on reality-testing and memory processing and are thought to be involved with dissociative reactions to trauma and the experience of depersonalization and derealization. The latter psychological processes reflect an altered state of consciousness which allows the victim either to avoid the reality of his or her situation or to watch it as an emotionally detached observer.
Dissociated traumatic memories are encoded and stored in the implicit memory system as sensory fragments with no linking narrative. The traumatized person is left in a state of “speechless terror” and thus is vulnerable to flashbacks of the traumatic event in the form of discrete sensory modalities. However, because dissociated memories still exist, albeit in an unintegrated form, they continue to influence emotion and behaviour without the person understanding quite how or why. Unprocessed traumatic affect is viewed as a significant factor motivating aggression and destructiveness. Dissociation in reaction to trauma represents an uncontrolled and negative expression of neural plasticity which is reflected in the disruption of learning, memory and neural network organization.
Post-traumatic stress disorder (PTSD) is the result of a loss of integration among neural networks that regulate affect, cognition, sensation and behaviour. Symptoms of PTSD centre on physiologic hyper-arousal and intrusion and avoidance of memories associated with the traumatic event. Research indicates that the dysregulation of fear states in early life results in a permanent sensitivity to stress in adulthood because the person cannot prevent an excessive reaction by terminating their stress response. Moreover, traumatic early life events appear to predispose certain individuals to later psychiatric disturbance when they re-experience an event matching the original stressor. In essence, cumulative trauma in infancy, consisting of oscillating states of hyper-arousal and dissociation, becomes the template for adult post-traumatic stress disorder. An impaired ability to maintain interpersonal relationships, cope with stress, and tolerate and regulate emotions is associated with anti-social, borderline and sociopathic personality disorders.
In summary, early trauma in the form of abuse, loss, neglect and severe misattunement compromises brain-mediated functions such as attachment, empathy and affect regulation. From an attachment theory perspective, patterns of attachment behaviour are encoded and stored as generalized relational patterns in the systems of implicit memory. These are conceptualized as cognitive-affective internal working models. These non-conscious, procedural models, within which early stress and trauma are retained, persevere into adulthood and serve to regulate, appraise and predict attachment-related thoughts, feelings and behaviour throughout the life cycle via the implicit memory system. Psychopathology is seen as deriving from an accumulation of maladaptive interactional patterns that result in character and personality types and disorders.
Disorganised, unresolved states of mind develop when there are additional or interactive factors aggravating the traumatic situation. Disorganised attachment may occur when the child’s parent is both the source of fear and the only protective figure to whom to turn to resolve stress and anxiety. In such instances, neither proximity seeking nor proximity avoiding is a solution to the activation of the child’s fear behavioural system. Disorganized attachment produces maladaptive internal working models and compromises reflective functioning, that is the capacity to reflect on and organize subjective experience. This leaves the individual vulnerable to affect dysregulation in interpersonal conflict situations that induce fear and shame. In such cases, alcohol and illicit drugs are often resorted to as a maladaptive means of suppressing dreaded psychobiological states and restoring a semblance of affective equilibrium.
Findings show that disorganised attachment developed in infancy shifts to controlling behaviour in the older child and adult, reflecting an internalized model of the self as unlovable, unworthy of care and support, and fearful of rejection and abandonment. Disorganised attachment is associated with a predisposition to relational violence, to dissociative states and conduct disorders in children and adolescents, and to personality disorders in adults. This state of mind constitutes a primary risk factor for the development of borderline and sociopathic personality disorders. The rate of such disorders in forensic settings is particularly high. Clinically, dissociated experience is unsymbolized by thought and language, being encapsulated within the personality as a separate, non-reflective reality which is cut off from authentic human relatedness. The information contained in implicit memory may be retrieved by state-dependent moods and situations. Archaic internal working models are then activated, influencing and distorting expectations of current events and relationships outside of conscious awareness, particularly in situation involving intense interpersonal stress.
In terms of therapeutic action, attachment research suggests that the mind can continue to develop throughout the lifespan via changes in internal working models. Such findings are supported by neuroscience which increasingly recognises that the brain retains plasticity throughout life, adapting to changes in environmental challenges and demands. One such challenge is provided by the process of therapy. The attachment relationship developed with the therapist establishes a secure-enough base from which the client can collaboratively explore and resolve early unresolved trauma, thereby attaining a state of “earned security”.
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