What is Psychological Trauma?
A person who experiences a traumatic incident directly, or witness it happening to someone near by, could develop Psychological Trauma. Some examples of traumatic events can be flood, earthquake, hurricane, accidents of all sorts that cause injury, long term illness, being bullied, assault, rape, torture, war, emotional, physical, sexual abuse, witnessing sudden death of someone very close, dealing with suicide of a family member or friend.
Psychological Trauma is a response to a life threatening event that shakes the physiology of the whole human body. When confronted with a traumatic event, the limbic system which is the survival centre of the brain, displays the instinctive reflexes of flight, fight and freeze.
Flight involves running away from the threat and it is usually the first line of defence, while fight is an attempt to resist the attacker.
The freeze response takes place when the flight and fight response are not available and it is usually experience in form of body numbness or paralysis.
The flight, fight and freeze response are very common in the wild when smaller mammals are attacked by bigger ones. In order to survive, prey animals freeze by playing dead.
What happens to the brain during Trauma?
In all mammalian brains the amygdala is responsible for assessing the states of both internal and external environment using sensory information. It is the amygdala that assigns an emotional interpretation to sensory information, instructing the body how to react and to transfer information to other brain structures. Following a traumatic event, the amygdala tends to be overload with sensory information, therefore perceives the world around as potentially dangerous.
The hippocampus is a particular structure of the brain that marks each event with a beginning, middle and end, informing the cortex about the time and context of an event. Following a traumatic accident the hippocampus becomes suppressed by the stress hormone (cortisol), therefore it is unable to mark the end of the trauma. Consequently the amygdala experiences the event as it is happening now, even if it something occurred long time ago.
In other words the amygdala tends to perceive the world in a state of constant alert, where the body becomes physiologically ready to flight, fight or freeze, because it has not received information from the hippocampus that the trauma is an experience that belongs in the past. Consequently the body is in a constant state of alert while the levels of cortisol increase. Too much level of cortisol experienced for prolonged period of time can decrease the overall health of the body and mind.
What is Dissociation?
Dissociation means being disconnected from the here and now. From time to time, everyone dissociates in forms of daydreaming, mind wandering or being on autopilot. Some research studies have demonstrated that everybody experience dissociation to a degree, ranging from mild to severe on a continuum. An example of mild dissociation occurs when there is narrowing of attention to focus only on what is essential, as the mind “dissociates” unimportant information, like when reading a book or driving a car in the highway. These responses take place when there is a sense of safety in the environment and are not responses to a threat.
Chronic and problematic dissociation develops when there is a repeat threat or trauma, especially when it starts at a young age, and when there is inadequate support or soothing from an attachment figure like a parent or a caregiver.
Dissociation is a coping response of memories, thoughts and feelings related to the traumatic event. During moments of dissociation people disconnect from their surroundings, which can stop the trauma memories, lower the fear, anxiety and shame.
Dissociation occurs when the brain stops to feel connected with the body. It is usually triggered when a person experience powerlessness in changing or stopping a traumatic event. In order to cope with feelings of helplessness a person in a state of dissociation detaches from the situation in order to go through the traumatic experience.
Dissociation can take place during a traumatic situation or later when thinking about it or being reminded about the trauma. Usually a person who is dissociating does not realise it is happening.
Some signs and symptoms of dissociation are spacing out, day dreaming, staring, glazed look, mind wandering, mind going blank, a sense of the world not being real, disconnection from surroundings, watching the self from the outside, detachment from self or identity, out of body experience. Dissociation is a normal response to overwhelming trauma.
Post Traumatic Stress Disorder (PTSD)
The intensity levels of dissociation occurred at the time of the trauma are responsible for causing complete amnesia or fragmented memories about the traumatic event. The mind and body of traumatised people have great difficulties in allocating events endured in the past.
In fact, Post-Traumatic Stress Disorder is a response to a trauma that has not been integrated as something that has already happened; consequently it creates a state of physiological alert triggering the fight, flight and freeze response to trauma along with flashbacks.
The person relieves the past trauma as if it is happening in the present moment and becomes overwhelmed during ordinary situations. In order to overcome this intense state of alert people tend to medicate themselves with alcohol, food or other substances. Recurrent nightmares, flashbacks, sleep disturbances, emotional numbness, inability to self –regulate and to distinguish between what is useful or dangerous, avoidance of places, people and activities that are a reminder of the trauma are also part of the unwanted symptoms of PTSD.
Dissociative Identity Disorder
Dissociative Identity Disorder (DID), used to be known as Multiple Personality Disorder, is the result of dissociation employed repeatedly as a survival strategy during childhood to something that otherwise be unbearably painful. While dissociating, the brain is unable to integrate the experience of sensations, perceptions, thoughts, memories, feelings.
Over time, the mind develops with a propensity for dissociation as a coping mechanism for all kinds of stress, not just traumatic stress.
Consequently people with DID experiences their personality being divided into “parts” that are disconnected and in conflict with one another. In other words they do not have a unitary sense of self; usually there can be parts who try very hard to get on with normal life with little or no memory or acceptance of the traumatic event, while other parts can be overly concerned about what happened and consume all their energy in trying to prevent the trauma from happening again.
Borderline Personality Disorder (BPD)
Experiences of early childhood trauma, abuse and neglect seem to be the principal causes for which BPD develops. Many people with a diagnosis of BPD suffer coexisting symptoms with PTSD, particularly flashbacks. BPD is also characterised by volatile emotions, severe mood swings, difficulties in forming and maintaining stable relationships.
It is common for people with BPD to rapidily shift their thoughts and feelings between “love “and “hate” towards another person, to report having a sense of “emptiness inside” or feeling like “not existing”. There is a tendency to display impulsivity of behaviour by engaging with self-harming and/or reckless behaviour.
Can I ever recover from Trauma, PTSD, DID and BPD?
Recovery from trauma is a unique and delicate journey for each individual. Understanding the physiology of Trauma, what happens within the body and mind during such an extreme event can be of help towards the development of self-awareness, self-acceptance and self-compassion, essential tools for reaching recovery.
The difficulty that is often faced during this process is the inability to have a narrative for the trauma experienced. Due to the fact that in the human brain the traumatic memories are stored separately from ordinary memories, there is no or little access to them and for some people attempting to access those memories in the first place can be too overwhelming.
It is for this reason that Trauma work needs to be paced, in order to gently encourage a person’s unique window of tolerance rather than putting pressure on the whole body system to recall traumatic memories that are unbearable.
My ethos of working with Trauma is to improve a person’s quality of life. Due to the volatile effect of trauma, I put emphasis on stabilisation, in supporting clients to re-acquire an internal sense of safety by getting in touch with what makes them resilients, because after all, you have survived!
Discovering what “grounding” means to each client along with the ability to “put on the brakes” when things become too overwhelming are essential pre-requisite for tackling trauma memories. It is extremely important that clients are empowered in choosing the way they want to recovery from Trauma, which may means that some client do not have any intentions to revisit the traumatic memories and this has to be respected.
However, the desire to revisit difficult memories has to be supported with the right knowledge and expertise in order to avoid re-traumatisation.