responses to attacks in the wild, was provided with its implications for treatment, which underscore the importance of attending to the whole individual, including the body– mind system. Finally, an initial look at symptom clusters was provided. THE CORE ELEMENTS OF TRAUMA REACTION AND LONG-TERM EFFECTS This chapter will provide a greater exploration and
from simple or acute reactions will be discussed, along with the developmental disorganization that is seen in chronic and long-term responses. Finally, the chapter will examine the mitigating factors that determine how and why different individuals may respond differently to similar traumatic stimuli. to take defensive action. Perception of the environment also constricts so that full attention is directed toward the threat in a type of narrowed focus or tunnel vision. A form of hypervigilance, or being on guard at all times, also results from constriction. Such reactions are useful in the face of real and present danger; however, they become outlived and problematic if they are not discharged when the actual danger has passed. Dissociation Dissociation is a breakdown in the continuity of a person’s sense of time and space and includes distortions in perception. It is a temporary disconnection from the temporal reality of the moment, as if the body is present but the mind has gone somewhere else. In other words, a person may feel out of their body. Dissociation can look like and be experienced as spaciness. However, disassociation is actually an association to something other than current shared reality. Abused children are frequently able to make themselves “disappear” from what is going on. They experience the abuse as if it is happening to someone else, or they remove themselves mentally to a different, safer place (van der Kolk, 2014). Dissociation can be fleeting or long lasting and can occur along a continuum from mild to severe. The extreme end of the dissociative continuum is dissociative identity disorder, previously known as multiple personality disorder, which is discussed in Chapter 5. Freezing The freeze response is a primitive biological response to overwhelming danger or threat and is associated with a concomitant feeling of helplessness. Compared to the “active” response of hyperarousal, immobility responses are viewed as defensive reflexes in response to overwhelming, unavoidable threat (Lloyd et al., 2019). This extreme form of stopping or applying the brakes involves more than simply being stopped momentarily in one’s tracks; rather, it is a sense of being completely immobilized so that the body cannot move. This sense of paralysis explains the phrase “speechless terror.” Following the traumatic event, a version of frozen immobility can remain in the system. Long-term, this can disconnect individuals from their current experience and lead to interpersonal avoidance (Lloyd et al., 2019).
understanding of reactions to traumatic events, including the biological basis for these reactions and the four core elements of a trauma response. The development of complex traumatic stress disorder will be examined. The factors that differentiate posttraumatic stress disorder (PTSD) Traumatic Reactions An individual may experience four primary components to a reaction during a traumatic event (Levine, 2015; van der Kolk, 2006, 2014); however, the duration and severity of the responses will be mitigated by other factors. The four biologically mediated core elements of traumatic reactions that can occur while the traumatic event is taking place are hyperarousal; constriction; dissociation; and freezing (immobility), which is associated with a feeling of Hyperarousal is experienced by most people in the form of somatic symptoms, which may include increased heartbeat and rapid breathing, racing thoughts, tension, agitation, muscle tightness, difficulty sleeping, and anxiety or panic attacks. It is important to remember that trauma symptoms begin to develop as short-term protective solutions and provide the arousal and heightened energy needed for protection and self-defense during the traumatic event. These often-distressing symptoms must first be recognized for the necessary role they play in assisting the victim in the face of danger. All of the symptoms, especially the hyperarousal cluster, initially serve an important function: To alert and prepare the victim to defend against real or perceived danger. These reactions result in accumulated energy within the individual. When this accumulated energy is not fully discharged during a successful action that allows the individual to defend against the danger or to flee, the effect on the system is to conclude that it is still in danger. This misperception continues to restimulate the nervous system in order to maintain the arousal and preparedness needed to face the danger. The person does not realize that the event is actually over, and instead stores the event helplessness. Hyperarousal in their unconscious as happening in real time, always experiencing it as “now.” For this reason, many clients have the very real sense that the traumatic event is still endangering them. Constriction Constriction alters physiology, shortens breathing, tightens muscle tone, and affects posture by drawing everything in to protect the core. Blood vessels constrict, preparing the system to send blood and energy to the muscles needed Stages of Reaction to Trauma Table 1 describes the symptoms and stages of trauma reactions. These symptoms can appear as the system compensates for the unreleased and unresolved energy created in reaction to the traumatic event (Levine, 2015). Some of the symptoms presented in the table are
Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) diagnostic criteria for PTSD, whereas others occur frequently but are not included in the DSM-5 criteria.
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