This stigma had guided previous societal responses toward the victims of these traumas and such statements as “Just get over it” or “What’s wrong with you?” or “Get a handle on yourself, Symptom Clusters: Reactions to Trauma The diagnosis and observations of PTSD result in four main symptom clusters: Re-experiencing symptoms, avoidance symptoms, negative cognitions and mood symptoms, and arousal symptoms. Re-experiencing symptoms include spontaneous or intrusive memories and recurrent dreams or flashbacks; avoidance symptoms are efforts to avoid trauma- related stimuli (e.g., thoughts, feelings, or external reminders) after the trauma; negative cognitions and mood symptoms represent a plethora of thoughts and feelings ranging from self-blame to disinterest in activities, irritability, and a change in worldview; and arousal symptoms include hyperarousal, startle responses, hypervigilance, and sleep disturbances. Under stress and in the face of danger, the body tends to respond with a biological imperative: Flight, fight, or freeze. In the wild, the dance between predator and prey is a constant of life. When the hawk is stalking the rabbit, the rabbit has several choices available if it is to survive. It can attempt to outrun the hawk and reach the safety of the concealing brush (flight), it can turn and fight the hawk off (not a very good choice for a rabbit, but potentially a good choice for a wild boar being stalked by a lion), or it can freeze in its tracks. As put forth in the seminal work of Levine and Frederick (1997), because the hawk is tracking movement, a freeze strategy can sometimes be successful. Humans also tend to respond with one of these three strategies in the face of danger. If they are successful in their strategy and the anticipated attack does not occur or they manage to avoid it, they may have a posttraumatic response following the event (such as an adrenaline rush, shaking, or fear) but will probably not develop PTSD because they have experienced Conclusion This introductory chapter has served to orient the reader to the field of trauma study and its history. The differences between public and private traumatic events and the similarities and differences in response to them were examined. The concepts of learned helplessness and resilience were introduced. The history of the field of trauma studies was traced from its early roots in the work of Janet, Freud, and Breuer during the 1800s; through Kardiner’s World War I work; to the more modern conceptualizations of Herman, van der Kolk, and Levine and Frederick in the later twentieth and early twenty-first centuries.
already.” Today in many situations and institutions there is a more compassionate understanding.
empowerment and self-efficacy in thwarting danger. These body-based responses have important implications for treatment and will be discussed in more detail in later chapters. In recent years, researchers have begun to identify additional response strategies beyond fight–flight–freeze. Taylor and colleagues (2000) noted a propensity for females to respond to stress with a “tend or befriend” response focused on promoting safety and stress reduction for offspring as well as maintenance of social networks. Particularly when considering abuse that is ongoing and occurs early in life, it has been suggested that the fight– flight–freeze model may insufficiently capture the full array of responses that may occur to survive ongoing abuse (Katz et al., 2021). It is normal for individuals to respond to danger with feelings of distress. Acute symptoms may follow a traumatic event, and these symptoms may cause enough short-term impairment to be classified as acute stress disorder (APA, 2013) but not necessarily as long-term or chronic PTSD unless there are other mitigating factors. It is not the traumatic event that causes ongoing difficulties, but the individual’s response to the event. PTSD does not occur in the immediate aftermath of a traumatic event. It is important to understand that the development of PTSD is a process that is triggered by multiple factors, including the way in which the person responded during the event, the presence or absence of supports following the event, pre-existing traumas, other life events, family history, and personality style (Briere & Scott, 2014). These factors will be explored more fully in the next section on complex traumatic stress disorder (formerly known as complex PTSD) . This chapter discussed the development of the PTSD diagnosis, from the introduction of PTSD as a diagnostic category in DSM-III in 1980 to the 2013 categorization of PTSD in DSM-5. A brief description of Levine and Frederick’s seminal research on the psychophysiologic response to trauma, based on animal 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 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) from simple or acute 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 helplessness. Hyperarousal 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
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.
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 in their unconscious as happening in real time, always experiencing it as “now.”
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