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Do you know what the symptoms of trauma actually look like?

by Carmen Littlejohn

Being a psychotherapist that specializes in trauma, I have a unique opportunity to study the effects of trauma on the brain, on the body, and on the client’s subjective experience of the world. I think it is very important for the world of medicine and psychology to understand trauma in a deeper way, so that we can properly diagnose it and help our clients heal faster.

We tend to think of trauma as a war, car accident, or sexual abuse. This isn’t entirely true. Trauma is not the actual event that happens to the person. Trauma is the reaction of the brain being overwhelmed by the event. When fear or negative emotions overwhelm the brain, it needs to find a way to protect itself. This is the experience of trauma. The protection of the brain is automatic, not a conscious decision. To handle the experience, the brain will often split the experience up into many different parts and store them in the brain separately. “The traumatizing event results in memories that are stored in a dysfunctional way, that is, stored in isolation, unassimilated into the memory networks of the individual. The lack of adequate assimilation means that the client is still reacting emotionally and behaviorally in ways consistent with the moment of trauma” (Shapiro, 2001, p17).

Trauma, therefore, is a subjective experience. What overwhelms one person’s brain may not overwhelm another person’s brain. Also, what overwhelms a child will, very likely, not overwhelm an adult. A child is more susceptible to trauma because the child is not born with natural defenses to protect itself. As we get older and become adults, we become much more skilled in protecting ourselves, managing emotions, and setting boundaries. We are not as vulnerable to trauma. That is not to say that adults don’t experience trauma, just that adults are not as susceptible to trauma.

In the psychology world we have been talking about “big T” trauma and “little t” trauma for years. We know that having a “big T” trauma like war, car accident, or sexual abuse can create trauma in the brain. However, neuroscientific research has now shown that the “little t” traumas of childhood, often called attachment trauma, are just as harmful to the brain. For example, a child that constantly feels physically threatened, a child that finds themselves alone too much, or feeling like they don’t measure up in their parents eyes, we call this attachment trauma, as it relates to the attachment relationship of the primary caregivers and the feeling of safety and security of the child. The amazing thing about trauma is that the threat doesn’t have to be real to cause harm, just the perception of threat is enough to cause an overwhelming fear reaction in the brain.

Surprisingly in clinical work, “little t” or attachment trauma can be harder to resolve than “Big T” trauma; mostly because of the consistent nature of it. Research shows that this consistent type of trauma affects the brain even more because it is forming the child’s experience of life, safety and love. Some of the symptoms I often see in these patient’s lives are mental, physical, and relational.

Mentally, I see that the client may have abnormal amount of fears and phobias, chronic patterns of anxiety and hyper-vigilance, addiction issues, and a higher dependency on drugs. They suffer more from depression, personality disorders, and thoughts of suicide. Their symptoms may be misdiagnosed as ADD. Physically, I see all kinds of somatic symptoms: stomach issues, auto-immune diseases, poor posture, and chronic pain responses. Relationally, they are often in relationship dynamics that are unhealthy in some way. They may identify as a savior type or needing a savior to rescue them and keep them safe. They may have people-pleasing tendencies or rebel at authority. They may often feel overly helpless, get easily overwhelmed, feel like a victim, or always need to be in control.

We don’t tend to think of these symptoms as symptoms of trauma, but they are. Because trauma doesn’t reside in the thinking part of the brain, we can’t treat trauma by talking about it or taking medication to stop the symptoms. The trauma lives in the middle and lower centers of the brain, where the survival and reactionary parts of the brain are. When these parts of the brain get triggered our emotions get triggered and then our thoughts get triggered. To resolve this dilemma, we need to work from the lower brain up to the higher brain. This means getting to the unconscious and automatic responses that are outside of the individual’s cognitive awareness and working up towards their thoughts and cognitive schemas.

PTSD:

Under-diagnosed, under-treated, under-estimated

by Carmen Littlejohn

What is Post Traumatic Stress Disorder?

Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after experiencing or witnessing a traumatic event, or learning that a traumatic event has happened to a loved one. DSM5 defines a traumatic event as exposure to actual or threatened death, serious injury, or sexual violence.

Following the event, people with PTSD report intrusive symptoms such as repetitive and upsetting memories that can present verbally, “I can’t stop hearing that crunch noise when the car hit the tree,” or acted out in play such as a child repeatedly hitting a toy car against the wall. Other intrusive symptoms include distressing and vivid night and day dreams or flashbacks, and becoming highly distressed when exposed to reminders of the event. They can also avoid or try to stay away from any reminders of the event, report inability to recall significant details of the event, experience a range of negative emotions such as sadness, guilt, shame, and confusion, and lack interest or desire to participate in important activities. They may also experience irritability, being jumpy or on edge, trouble concentrating, and sleep difficulties. Some people may experience a delayed reaction to the trauma so that clear signs are not noticeable until months or even years after the event.

1. Recurring thoughts, ‘flashbacks’ or nightmares about the event (Each person’s experience with flashbacks is unique. Some people have “complete” flashbacks, while others may re-experience a feeling, smell, sight or sound from the event without losing touch with the present. You may not even know you’re having a flashback.)

2. Changes in sleep patterns or appetite

3. Anxiety and fear, especially when confronted with events or situations that remind you of the trauma

4. Feeling “on edge,” being easily startled or becoming overly alert

5. Crying for no reason, feeling despair and hopelessness or other symptoms of depression

6. Memory problems including finding it difficult to remember parts of the trauma

7. Feeling scattered and unable to focus on work or daily activities

8. Difficulty making decisions

9. Irritability or agitation

10. Anger or resentment

11. Guilt

12. Emotional numbness or withdrawal

13. Sudden over-protectiveness and fear for the safety of loved ones

14. Avoidance of activities, places or even people that remind you of the event

15. Physical health problems like dizziness, stomach upset or decreased immune system

Thoughts (Note young children they may be unable to identify specific fear thoughts):

It’s my fault it happened

All men are dangerous

I need to stay alert at all times to protect myself

I deserved it, I’m a bad kid

Physical sensations:

Stomachache, headache, muscle tension, irritability, feeling amped up, feeling detached from one’s body

Emotions:

Sadness, anger, shame, guilt, anxiety, fear, panic, confusion

Behaviors:

Avoiding participating in new activities or going places
Refusal to sleep alone or trouble falling/staying asleep
Asking a parent to be present or available
Recreating the traumatic event through play
Crying or tantrumming
Restricted play
Trouble concentrating
Aggression and hostility

Common Situations or Affected Areas

Avoiding contact with, or reminders of, the traumatic event
Declining grades or academic failure
Engaging in high risk or dangerous behaviours
Trouble making friends, dating, and development of meaningful relationships
Restricting life plans or reduced ambition
Social withdrawal

How PTSD impacts the child at different ages

Children may show their symptoms of PTSD in different ways:

1. Fear of strangers.

2. Fear of family members.

3. General avoidance of situations that are not related to the trauma (for example, avoiding going to school, going out in public).

4. Traumatic play; re-enacting parts of the trauma in their play (drawings, acting out).

5. Regressive behavior (thumb sucking, bed-wetting).

6. Omen formation: This is the belief that there were "warning signs" before the trauma occurred. Children with this belief are always on the alert for signs or warnings of "future danger". For example, if it was raining on the day of a car accident, your child might believe that the rain was a "warning" of something bad happening, and refuse to leave the house when it rains.

7. Traumatic play: Similar to very young children, elementary school children may compulsively repeat the trauma in their play. For example, a child who was traumatized by a car accident may then play with toy cars, and have them crash in to each other.

8. Parents may notice dramatic changes in their teen, such as a teen who was once a straight “A” student is suddenly failing, or a teen who never used drugs and respected her curfew, is now dressing inappropriately, smoking, and staying out late.

9. Teens with PTSD often show increased aggressive and impulsive behaviours, and are at greater risk of engaging in high risk or reckless behaviors such as drug and alcohol use, speeding, unprotected sex, etc.

PTSD Checklist

INSTRUCTIONS: Below is a list of problems and complaints that people sometimes have in response to stressful experiences. Circle the response that indicates how much you have been bothered by that problem in the past month. Then add up the numbers. If you scored 44 or higher it is possible that you may have PTSD. We strongly recommend that you discuss the issue of PTSD with your therapist or doctor.

Repeated, disturbing memories, thoughts, or images of a stressful experience?