Eric Scalise, Ph.D.
This article was originally published in Christian Counseling Today, Volume 20-3
Trauma and its cognitive, neurobiological, emotional and relational consequences have been studied by researchers for decades. The type of trauma affects responses, although this can still vary from individual to individual. Basic trauma can result from natural disasters, accidents, and disease, to name a few. Complex trauma, on the other hand, generally refers to multiple traumatic stressors that involve direct harm and are interpersonal—premeditated, planned, and caused by other humans. A growing segment of scientific inquiry within this field includes the particular impact on brain functioning and relationships.
Judith Herman, professor of clinical psychiatry at Harvard Medical School, first described complex trauma in her 1997 book, Trauma and Recovery. Typically, these events, due to a deliberate versus accidental causation, cause more severe reactions in the victim than trauma that is impersonal and serve as precursors to the development of post-traumatic stress disorder (PTSD). They can be a single or isolated event (robbery, physical assault, rape) and perpetrated by a stranger or involve family members and other close relationships (clergy members, teachers, coaches, supervisors). In the latter case, the trauma and subsequent victimization may be repetitive and chronic (sexual/elder abuse, neglect, ritualistic abuse), where the effects are compounded, prolonged, and cumulative over time because perpetrators become increasingly emboldened and compulsive. Distorted trauma bonds may develop between perpetrators and victims leading to general debilitation, despondency, a state of adaption/accommodation as a means of survival, and dissociation. Relatively small events, repeated when an individual is young and most vulnerable, are potentially more toxic than events of greater intensity later in life.
Other diffused, but nevertheless adverse, environments can also represent forms of complex trauma. These include poverty and ongoing economic challenges combined with the lack of essential resources; excessive community violence and the inability to escape from it; homelessness; disenfranchised ethno-racial and religious status/repercussions; incarceration, residential placement and ongoing threat and assault; prostitution, sexual slavery, and sex trafficking; human rights violations, including political repression, genocide, ethnic cleansing, and torture; displacement, refugee status, and forced relocation; war and combat involvement; and exposure to death, dying, and the grotesque in emergency response work. The following observations are based on the work of psychologist and internationally-known trauma expert, Christine Courtois:1
- Alterations in the Regulation of Affective Impulses: difficulty with modulating anger and tendencies toward self-destructiveness, over-inhibition or excessive expression; pathological self-soothing behaviors and other methods of emotional regulation, even those that are paradoxical, such as addictions and self-harming behaviors; easily-aroused, high-intensity emotions; difficulty describing feelings and internal experiences; chronic and pervasive depressed mood, sense of emptiness or suicidal preoccupation; difficulty communicating wishes/desires; and impulsivity.
- Alterations in Attention and Consciousness: amnesias, dissociative episodes and depersonalization; problems with orientation in time and space; auditory/visual perceptual problems; impaired comprehension of complex visual-spatial patterns; impaired memory function; and the inability to recall or feel certain emotions, vacillating from numbness and detachment to hypersensitivity and flooding.
- Alterations in Self-perception: predominantly negative and low self-esteem involving a chronic sense of guilt; ongoing feelings of intense shame; a lack of a continuous and predictable sense of self; the belief that one has been permanently damaged by the trauma; a poor sense of separateness; and body image distortions.
- Alterations in Perception of the Perpetrator: incorporation of the perpetrator’s belief system; and complex relational attachment systems.
- Alterations in Relationships with Others: not able to trust the motives of others; reduced capacity for intimacy; problems with boundaries; distrust and suspiciousness leading to social isolation; unawareness that other people can be benign and caring; uncertainty about the reliability and predictability of the world; difficulty with perspective-taking; and difficulty enlisting other people as resources, advocates, or allies.
- Somatization and/or Medical Problems: concerns that involve all major body systems and include pain syndromes, medical illnesses and somatic conditions; sensorimotor developmental issues and problems with coordination/balance; and hypersensitivity to physical contact.
- Alterations in Systems of Meaning: feelings of hopelessness; despair regarding recovery from psychic anguish; difficulties in attention regulation and executive functioning; problems focusing on and completing tasks; difficulty planning and anticipating consequences; learning difficulties and problems with language development; and poor object constancy (the ability to see oneself as a separate and unique individual).
According to the National Institutes of Health, approximately 25% of all children in the United States will experience at least one significant traumatic event before the age of 16, with 15% of girls and 6% of boys developing symptoms of post-traumatic stress disorder. The recently released DSM-5 now includes a category for minors under the age of six. Based on the theory of Developmental Trauma Disorder (DTD), this addition to the diagnostic classification system was endorsed because the previous descriptors for PTSD were inadequate in addressing childhood traumatization. Children and adolescents who have experienced sequential (repetitive) trauma suffer greater emotional and physiological dysregulation because there is a chronic activation of certain neurobiological systems that produce stronger and more immediate reactions to emotional stimuli, with the effects often lingering into adulthood.2 The dysregulation can lead to functional impairment (within familial, educational, and social environments), legal and health related problems, and neurological impairment.3 It should be noted some researchers have voiced concern that the focus for PTSD primarily emphasizes a psychosocial etiology and does not give enough attention to the biological/genetic factors that may come into play.
What the research has revealed, however, is that the brain is not rigid as once believed, but pliable (defined as plasticity) and can change its structure and function in response to lived experiences. When someone is repeatedly exposed to traumatic stress, disruptions occur in brain functions and structures, endocrinological and immunological function, and central and autonomic nervous system arousal. The hypothalamic-pituitary-adrenal triad—HPA Axis—is responsible for bringing the body back into balance in the face of traumatic events. If the trauma is severe or recurrent, certain chemical responses ensue. For example, catecholamines such as adrenaline and dopamine are chronically increased, which damage memory function and rational thinking, lead to hypervigilence, and compromise the ability to accurately perceive danger. Opioid levels also increase, creating a flat affect; while corticosteroids, in contrast, are chronically lowered and reduce immune system capacity.
Complex trauma results in a lingering over-activation (sensitized neural responses) of an individual’s autonomic nervous system, resulting in fight-flight-freeze responses to seemingly random and unrelated cues long after exposure to traumatic experiences have ended.4 Recent research suggests that for younger children, neuro-psychological development is actually altered, which, in turn, can shift learning patterns, behavior, belief systems, cognition, self-identity, and social skills. The amygdala and the hippocampus, both part of the limbic system and highly sensitive to stress hormones, actually change after exposure to a traumatic event. These changes result in a restricted flow of information from the limbic system and higher cortical levels associated with consciousness and executive function. A person’s ability to plan and think objectively is dramatically distorted and the essence of objective thinking and judgment is significantly impaired when a triggering episode occurs.
Intervention and crisis response considerations need to be targeted, such as immediate and/or direct medical attention for self-injury, suicidal ideation/gestures and assaultiveness; contacting emergency 911 and mental health services as warranted; possible hospitalization for reasons of safety and further evaluation; assistance in establishing self-control, emotional self-regulation and self-processing; relational engagement; medication evaluation and proper pharmacological supervision; and an appropriate course of psychotherapy.
In closing, the words of the prophet Isaiah are comforting for all who suffer from trauma, “… Do not fear, for I have redeemed you; I have called you by name; you are Mine! When you pass through the waters, I will be with you; And through the rivers, they will not overflow you. When you walk through the fire, you will not be scorched, Nor will the flame burn you. For I am the Lord your God, the Holy One of Israel, your Savior…” (43:1-3).
1 Courtois, C.A. & Ford, J.D. (2009). Treating Complex Traumatic Stress Disorders: An Evidence-based Guide. New York, NY: The Guilford Press.
2 Schmid, M., Peterman, F. & Fegert, J. (2013). Developmental Trauma Disorder: Pros and Cons of Including Formal Criteria in the Psychiatric Diagnostic Systems. BMC Psychiatry, 13(3), retrieved from: ncbi.nlm.nih.gov/pmc/articles/PMC3541245/.
4 Sherin, J.E. (2011). Post-traumatic Stress Disorder: The Neurobiological Impact of Psychological Trauma. Dialogues in Clinical Neuroscience, 13(3), 263-278.
Eric Scalise, Ph.D., is the Vice President for Professional Development with the American Association of Christian Counselors. He is a Licensed Professional Counselor, a Licensed Marriage & Family Therapist, the former Department Chair for Counseling Programs at Regent University in Virginia Beach, Virginia, and has more than 32 years of clinical and professional experience in the mental health field. Eric is an author, a national and international conference speaker, and frequently consults with organizations, clinicians, ministry leaders, and churches on a variety of issues.