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 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 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
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). 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.
Table 1. Stages of Reaction to Trauma Early Symptoms Emotional ● Constriction of emotions ● Feelings of helplessness ● Abrupt mood swings (e.g., temper tantrums, sudden rages, or shame attacks) ● Inability to identify emotions or find words to describe them ● Low threshold for stress tolerance ● Inability to identify or describe emotions Physical/Behavioral ● Hyperarousal ● Difficulty sleeping ● Inability to sit still or relax ● Hypervigilance (being on guard at all times) ● Startle responses ● Extreme sensitivity to sound and light
Second-Stage Reactions
Later Symptoms
Emotional ● Panic attacks, anxiety, development of phobias ● Inability to identify or describe emotions ● Abrupt mood swings (including aggressive thoughts or actions against self or others) ● Easily and frequently stressed ● Frequent crying Physical/Behavioral ● Exaggerated startle responses ● Attraction to dangerous situations, impulsive and risk-taking behaviors ● Continued sensitivity to environmental sensory input ● Hyperactivity
Emotional ● Flat or dulled emotional responses ● Feelings of detachment or isolation ● Loss of interest in life ● Depression ● Abrupt mood swings ● Frequent crying ● Continued inability to deal with stress Physical/Behavioral ● Chronic fatigue or very low energy ● Psychosomatic illness (very real physical symptoms for which no underlying organic cause is found), such as digestive problems, severe gynecological or menstrual symptoms, headaches or migraines, respiratory problems, back and neck problems, and skin disorders ● Immune system problems, or certain endocrine problems such as thyroid dysfunction ● Self-injurious behaviors (including substance use, self-harm, eating disorders, and suicidality) Cognitive ● Change in worldview ● Difficulties in ability to love, nurture, or connect with others ● Fear of dying, going crazy, or having a foreshortened life
Cognitive ● Dissociation (including denial) ● Intrusive imagery or flashbacks ● Nightmares and night terrors ● Difficulty describing experiences
Cognitive ● Blankness or “spaciness” (early dissociative responses) ● Nightmares and night terrors ● Amnesia or forgetfulness ● Fear of dying, going crazy, or having a foreshortened life
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Book Code: PYFL4024
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