Although both resilience and PTG often stem from an individual’s intrapersonal and community strengths, clinicians can help stimulate these processes through various interventions. Research suggests that interventions not specifically designed to target PTG can still facilitate growth (Roepke, 2015). One study showed that an emphasis on “value-directed living” was more closely associated with positive outcomes than directly targeting PTG (Baseotto et al., 2022). More research is needed Conclusion This chapter examined in greater depth the variety of responses to trauma, including the four responses that are biologically based: Hyperarousal, constriction, dissociation, and freezing. Reactions to traumatic stress were further differentiated by their temporal occurrence into three stages: Early, secondary, and later stage reactions. There is, however, considerable overlap within these three stages. This chapter looked at factors that contribute to the internalization of trauma responses into personality structure, as opposed to factors that enable a trauma response to be a temporary reaction. In particular, the difference between acute and chronic trauma was explored as one of the primary factors in determining the nature of the response. Chronic trauma is a major factor in the development of complex
to determine the precise factors that make interventions effective in PTG and resilience; however, trauma interventions such as exposure therapy, cognitive restructuring, stress management training, expressive writing/self-disclosure, and couples interventions have all demonstrated effects regardless of whether PTG was specifically addressed (Nijdam et al., 2018; Roepke, 2015). PTSD, affecting the individual’s perception of self and others, their worldview, spiritual meaning-making, and ability to regulate affect. This chapter also reviewed the current understanding and evolving definition of resilience. Although resilience literature is a burgeoning field, various factors that contribute to or hinder resilience were reviewed. The phenomenon of PTG was examined as a posttrauma healing construct that is distinct from resilience. The importance of understanding the differential stages in response to trauma as well as the contribution of chronic trauma to the development of complex PTSD is critical to the clinician’s ability to assess and appropriately treat clients with trauma histories.
TRAUMA AND CHILDREN
Trauma can occur across the life course; it is not bound to any one developmental stage. However, the impact of trauma can look quite different when considered within a developmental context. Children experience unique forms of trauma, they respond in developmentally significant ways, and their developmental trajectories can move off course with long-lasting effects. Children are especially vulnerable to exposure to interpersonal traumas. These traumas involve intentional acts by other humans that are a threat to the life or bodily integrity of children or their caregivers or primary support systems (Spinazzola et al., 2018). Some examples include physical/sexual/emotional abuse, parental neglect, and domestic or community violence where escape is impossible (Chen et al., 2018). Interpersonal traumas beget a unique response from children. Because children The Misdiagnosis of Trauma in Children According to Bessel van der Kolk (2017, p. 404), “When professionals are unaware of children’s need to adjust to traumatizing environments and expect that children should behave in accordance with adult standards . . . it can lead to labeling and stigmatizing children for behaviors that are meant to insure survival.” van der Kolk (2017) and other developmental trauma experts have advocated for professionals to refrain from categorizing childhood trauma sequelae into rigid diagnostic criteria. They argue that uninformed and limited conceptualizations of the ways in which trauma presents in children result in misdiagnoses and inaccurate treatment plans (van der Kolk, 2017). This situation is exemplified in research suggesting that children with trauma may end up receiving as many as five or six diagnoses unrelated to the traumatic roots of their problems (van der Kolk, 2017). Often, these children are mislabeled in daycare or school settings, where their trauma symptoms conflict with the structured social environments (van der Kolk, 2017). The following examples reveal the various ways in which trauma symptoms can masquerade as multiple, unconnected Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) disorders if practitioners simply consider symptoms in isolation (van der Kolk, 2014). ● A clinician who focuses on the vacillating mood swings may misdiagnose the child or adolescent as having bipolar disorder. ● Physiological distress from chronic child maltreatment may look like the symptoms of panic disorder.
are dependent on adults for survival, they naturally find ways to survive within traumatizing environments (van der Kolk et al., 2009). They will go to great lengths to remain in abusive contexts if it means continuing connection to their loved ones. They may remain silent; be compliant; or accommodate in any way, including the behavioral modifications they believe will help maintain their relationships (van der Kolk et al., 2009). This chapter addresses the complexities involved in recognizing and treating childhood trauma, considers early-life trauma within the context of the parent–child attachment relationship, presents severe attachment failures as forms of trauma, reviews common child trauma symptoms, discusses the intergenerational transmission of trauma, and presents existing and proposed diagnostic criteria designed to capture the distinct experience of trauma during childhood. ● If the child is restless or inattentive at school (possibly because of recurring trauma nightmares or hypervigilance), school officials may label the child with a learning disability or attention-deficit/hyperactivity disorder (ADHD). ● Frequent affective outbursts or temper tantrums may be classified as disruptive mood dysregulation disorder. ● If the clinician attends only to frequent, aggressive outbursts, they may believe the child has a conduct disorder. ● Children who are overly familiar with strangers because their sexual abuse histories have distorted their understanding of boundaries may be labeled with disinhibited social engagement disorder. ● Some children with physical abuse histories may be combative or argumentative with adults such as teachers and may then be labeled as having oppositional defiant disorder (ODD). ● If persistent negative affect and feelings of despair are presented, the clinician may believe the child is suffering from major depressive disorder (MDD). ● Unresolved trauma may contribute to explosive outbursts, which could result in an inaccurate diagnosis of intermittent explosive disorder (IED). ● If a clinician fails to make a connection between a child’s self-injurious behaviors and their trauma-fueled diminished self-worth, the clinician may focus on a classification of nonsuicidal self-injury. ● Dissociative symptoms, unstable relational patterns, and self- destructive behaviors may be categorized into a borderline personality disorder diagnosis, when all are actually symptoms of current, ongoing trauma.
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