Trauma and Abuse

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Trauma and Abuse 2017-05-25T15:27:08+00:00


Trauma and Abuse

Trauma Overview

Psychological trauma can be overwhelming in an emotional, cognitive, and physical sense. People who have been traumatized may alternate between feeling empty or “numb” to being flooded by intense feelings of fear, anger, shame, and other emotions.

Traumatic events often shatter the basic assumptions we hold about ourselves, others, and the world. After experiencing trauma, we may start to view ourselves as powerless and weak or bad, others as harmful or unhelpful and therefore not to be trusted or relied on for protection, and the world as unsafe, unpredictable, unjust or lacking in meaning. Physically, trauma can overwhelm our bodies, and the result can be chronic overstimulation of the nervous system with our bodies constantly on the alert for danger. This state of hyperarousal can result in chronic irritability and anger as well as physical problems such as headaches, hypertension, back pain, and gastrointestinal difficulties.

Trauma can result from single, unexpected, shocking events such as a sexual assault, being physically attacked, or a serious accident. However, more commonly, trauma results from exposure to repeated or prolonged stressors (e.g., childhood abuse or neglect, domestic violence, experiences during war) that occur within specific types of relationships (e.g., partner/spousal, parent-child) or other closed contexts (e.g., military unit, school).

Both sudden traumatic events and repeated or prolonged traumatic exposure may lead to the development of Posttraumatic Stress Disorder (PTSD). However, when the trauma is perpetrated by another human being, particularly if inflicted intentionally, there is a greater likelihood of developing PTSD. Additionally, cumulative interpersonal trauma, such as child abuse, can result in more severe and pervasive symptoms and problems. This type of trauma is often referred to as Complex Trauma.

Specific Types of Trauma

Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder refers to a cluster of symptoms that can develop following exposure to actual or threatened death, serious injury, or sexual violence. These events may be:

  1. experienced directly (e.g., being physically or sexually assaulted or abused, being mugged, suffering a serious car or workplace accident)
  2. witnessed (e.g., as a child seeing acts of violence/abuse toward a parent or sibling, witnessing atrocities in war)
  3. experienced indirectly (e.g., as a police officer or paramedic, dealing with repeated or extreme exposure to horrific details of traumatic events)

Posttraumatic stress reactions fall into four areas:

  1. Intrusions that cause you to relive the trauma. For example, you may:
    • experience repeated, involuntary memories or distressing dreams
    • feel or act as if the trauma is recurring
    • have intense emotional or physical reactions (e.g., panic symptoms) when something reminds you of the traumatic event(s)
  2. Avoidance of trauma-related memories, thoughts and feelings or other reminders such as people, places, or situations that could arouse these thoughts and feelings
    1. Negative changes in thinking. The way you think about yourself and others changes because of the trauma. You may notice that:
      • you forget about an important aspect of the trauma
      • you think in a much more negative way about yourself, others, and the world (e.g., “I am weak”, “No one can be trusted”, “The world is a completely dangerous place”)
      • blame yourself (or others) inappropriately for the cause or consequences of the trauma
    2. Negative changes in mood. In response to trauma, people often experience persistent negative emotions such as fear, horror, anger, guilt, shame, or sadness. Efforts to avoid or suppress specific feelings and memories of the trauma may also lead to general emotional numbing or “shutting down”. For example, you may notice that:
      • you lose interest or stop participating in important activities
      • you feel detached or cut off from others
      • you do not have positive or loving feelings
  3. Hyperarousal. You feel chronically agitated and on edge. This may cause different types of problems such as:
    • irritability and lashing out in anger, often with little provocation
    • being reckless or self-destructive (e.g., dangerous driving, excessive alcohol or drug use, self-injurious or suicidal behaviours)
    • always being on the alert and looking out for danger
    • being jumpy or overly startled by a loud noise or surprise
    • having difficulty sleeping
    • having trouble concentrating

The symptoms of PTSD are quite common immediately after traumatic events, but for most individuals, through natural recovery (and particularly in the context of good social support), the intensity and frequency of these symptoms decrease over time. However, for some, PTSD symptoms persist, become chronic, and interfere with daily functioning, such as work or school, social and intimate relationships, and physical health. At these times, professional help is usually required as chronic PTSD does not tend to resolve on its own with the passage of time.

There are several types of specialized cognitive behavioural treatment approaches for Posttraumatic Stress Disorder such as Prolonged Exposure and Cognitive Processing Therapy. Read more about treatment.

Complex Trauma/Childhood Abuse

Complex trauma refers to repeated interpersonal trauma, often occurring in childhood. This type of trauma includes sexual and physical abuse as well as emotional abuse and neglect. Emotional abuse can include verbal attacks, incidents of humiliating or threatening behaviour, and witnessing violence against loved ones; whereas, emotional neglect involves a failure to provide a child’s basic emotional needs, such as love, attention, understanding, affection, support, and protection.

Exposure to such experiences of abuse and neglect can be particularly damaging because they are usually chronic, occur during developmentally vulnerable periods of life (i.e., during critical periods of brain development and personality formation), and involve harm and/or betrayal within relationships that are supposed to be trustworthy, nurturing, and protective. As a result, these experiences compromise normal self-development and basic trust in primary relationships.

In addition to being at higher risk for developing PTSD, individuals who have suffered complex trauma are also at higher risk for other anxiety disorders, depression, low self-esteem, substance use problems, and impulsive and self-destructive behaviours. Complex trauma can profoundly affect fundamental aspects of oneself and one’s ability to relate to others, resulting in problems in the areas of:

  1. Emotion
    • Emotion regulation difficulties such as too much or too little emotion, limited awareness of feelings, difficulty with self-soothing
    • Chronic feelings of fear, anger, shame, sadness, helplessness, hopelessness
    • Impulsive or self-destructive behaviours related to difficulties managing emotions (addictions, self-harm, disordered eating)
  2. Mind/Self-Concept
    • Sense of self as bad, inadequate, weak, powerless, worthless, undeserving
    • Self-critical and self-blaming; hypersensitivity to criticism & rejection
    • Identity problems (e.g., not feeling whole, lacking a clear, stable sense of self, inner sense of confusion, frequent changes in career, life goals, etc.)
    • Alterations in attention and memory (e.g., dissociation, difficulty focusing)
  3. Relationships
    • Problems with trust and intimacy in relationships (e.g., jealousy, difficulties committing to relationships, difficulty being vulnerable)
    • Difficulties with self-assertion and setting limits in relationships
    • Sense of isolation and alienation (e.g., difficulties connecting to others)
  4. Body
    • Frequent physical health problems (e.g., chronic pain, irritable bowel syndrome, headaches, hypertension, sexual pain and dysfunction)
    • Hypersensitivity to physical contact, sounds, and other stimuli
    • Sleep problems

Emotion Focused Therapy for Trauma (EFTT) is an effective treatment for complex trauma related to childhood abuse or neglect. Read more about treatment.

Treatments for PTSD and Complex Trauma

Avoidance of trauma-related memories, feelings, thoughts, and situations is a natural response to painful experiences. However, avoidance can prevent processing and integration of the trauma and ultimately perpetuates symptoms and interferes with natural recovery. Chronic avoidance also leaves people stuck in the feelings and perceptions formed at the time of the trauma.

In order to heal from trauma, people need to remember, to tell the story over again in a safe and validating environment in order to work it through and begin the healing process. Talking through the trauma helps individuals get ‘unstuck’, gain more control of their thoughts and feelings about the trauma, make sense of it, and integrate it into their experience so that it does not continue to haunt them. This process of integration allows the trauma to become a part of normal memory rather than something to be perpetually feared and avoided, interfering with normal life. Revisiting the traumatic event(s) is hard at first, but many feel better over time and notice reduced symptoms as well as feeling more empowered, more connected to themselves and others, and regaining a sense of meaning in life.

There are several effective treatments for PTSD and complex trauma. These therapies all teach skills to manage anxiety and other intense emotions. They also involve working directly with trauma memories and feelings to process them, and helping individuals make sense of the trauma. However, therapy for complex trauma is typically longer and the therapeutic relationship plays a more central and direct role in the treatment. Additionally, more time is spent addressing emotion regulation (e.g., awareness, tolerance, managing intensity of emotions, coping), relational problems (e.g., learning how to effectively communicate feelings and needs, setting healthy limits) and self-related problems (e.g., self-criticism, self-blame).

Prolonged Exposure

Prolonged Exposure is a type of cognitive behaviour therapy for PTSD that helps people approach trauma-related thoughts, feelings, and situations that they have been avoiding due to fear. Repeated retelling and visualizing of the traumatic event (called imaginal exposure) helps to process the trauma leading to reduced posttraumatic symptoms as well as reduced fear of trauma-related memories and emotions. Individuals are also helped to confront safe but avoided situations in the real world. Repeated exposure to these thoughts, feelings, and situations helps reduce the power they have to cause distress.

Cognitive Processing Therapy

Cognitive Processing Therapy focuses on the meaning given to the traumatic event(s) and problematic beliefs about the trauma that interfere with recovery, called “stuck points”. In revisiting the trauma memory, individuals are helped to understand how their interpretations of the event contribute to persisting negative emotions such as fear, guilt, shame, and anger; skills are taught to challenge and change problematic beliefs. In particular, therapy attends to areas of safety, trust, power, control, esteem, and intimacy which may have been disrupted by the trauma. Cognitive Processing Therapy has shown effectiveness for PTSD and complex trauma.

Emotion Focused Therapy for Trauma

Emotion Focused Therapy for Trauma (EFTT) is an effective treatment for complex trauma that was specifically developed for individuals who have experienced different types of childhood abuse (emotional, physical, sexual abuse, emotional neglect). In addition to addressing symptoms of distress and problems in functioning associated with this type of complex trauma, this approach focuses on resolving issues with past perpetrators of abuse and neglect, usually attachment figures (e.g., parent) and healing these specific emotional injuries. There is also a focus on modifying maladaptive trauma-related emotions such as fear and shame and an emphasis on helping individuals draw on inner strengths and access adaptive emotions as healthy resources.

Please contact us to find out more about treatments for trauma and abuse.

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