PYB321- Intro to Psychology of Trauma

What does troma mean?

Origin of the word ‘trauma’. Means breach of barrier, or to pierce or wound.

Early trauma definitions…. (with examples of names)

Attempt to acknowledge embodied impacts of trauma.
Soldier’s heart, irritable heart, shell shock, soul pain, sleep paralysis.

Janet (1909) theory:

Terrifying experience → overwhelming emotions → mind cannot process → fragmentation → intrusion & dissociation.

Processing lens definition:

Whereby trauma = any experience in a persons life that overwhelms their processing capacity which affects their physiology resulting in an inability to understand and make meaning.

When was trauma first introduced to the DSM?

DSM-III (1980, due to Vietnam veterans).

How was trauma initially viewed in the DSM?

Believed to be uncommon. Noted traumatic events as ‘outside the range of usual human experience’.

DSM-5-TR definition:

Exposure to actual or threatened death, serious injury, or sexual violence. (In one or more of 4 exposure types).

What are the 4 exposure types in the DSM-5-TR?

1. Direct experience.

2. Witnessing events happen to others.

3. Learning a family member or close friend experienced it.

4. Experience extreme and/or repeated exposure to traumatic details (e.g. first responders).

What is the core feature of trauma?

Trauma overwhelms a person’s capacity to cope and alters their physiology.

What three types of traumatic experiences exist? (give examples for each)

Single-event (natural disasters, accidents, terrorism, one-off physical or sexual assault, medical trauma, traumatic grief).
Series of events (multiple traumatic events overtime, e.g. 2 separate occasions of SA, combat trauma).

Chronic conditions (domestic violence, childhood neglect).

Definition of single-event trauma:

A one-off event limited to a single point in time.

How do people typically recover from single-event trauma?

Most can recover without intervention, for others it may cause mental health problems including depression, anxiety and PTSD.

9/11 study:

Many residents experienced sleep disturbances and intrusive nightmares even if they only viewed it on TV.

What other names can complex trauma be referred to?

Relational or developmental.

What causes complex trauma?

Repeated or sustained traumatic events/ relationships that are interpersonal and invasive.

Where does complex trauma often occur?

In ongoing relationships that must be managed and endured (e.g child neglect/abuse and DFV).

What does complex trauma describe?

Both expose to multiple traumatic events and the long-term, wide-ranging effects of this exposure.

When does complex trauma typically begin?

Early in life, especially with repeated trauma in childhood (neglect/abuse).

How can it occur for adults (who didn’t experience it as a child)?

DFV, refugee/asylum, trafficking, sexual exploitation, genocide.

Is complex trauma common?

Yes, it is more common than single-event trauma.

What are the impacts?

More complex, especially when beginning in childhood.

What issues appear with diagnosis?

Polydiagnosis (multiple at once) and misdiagnosis.

What kind of treatment does it often need?

Long-term and systematic interventions.

Which ancient cultures recorded PTSD like symptoms?

Mesopotamian - 3000+ years ago, nightmares, flashbacks, depression, higher vigilance.

Roman and Greek as well describe post conflict symptoms.

What is railway spine (Erichsens’s disease)?

Passengers of railway accidents experiencing exhaustion, trembling, and chronic pain after rail accidents even without physical injury.

What are the 3 waves of modern trauma awareness?

1. Hysteria (late 19th century).

Shell shock/ combat neurosis (WWI → Vietnam war).

Sexual and domestic violence (1970’s feminist movement).

Who were the key researchers on Hysteria?

Charcot, Janet, Freud & Breuer.

What did Charcot focus on with Hysteria?

“Great Neurosis”. Neurological damage symptoms (amnesia, convulsions, paralysis (motor), sensory loss). 1880 → demonstration symptoms were psychological, induced/relieved by hypnosis.

How did Janet and Freud/Breuer explain Hysteria?

Linked it to psychological trauma; trauma → unbearable emotions → altered state of consciousness.

Janet: dissociation/somatic symptoms.

Freud/Breuer: double consciousness.

Who did Janet vs Freud/Breuer believe was at risk of trauma?

Janet: only weak people.

Freud/Breuer: anyone could be traumatised.

What did these theorists believe Hysteria symptoms represented?

Disguised representations of traumatic events pushed from unconscious memory.

What is the “talking cure”?

1890’s- symptoms reduced/disappeared when traumatic memories were recovered and verbalised.

What symptoms did WWI soldiers show?

Freezing, uncontrollable crying/screaming, mute, numb, memory loss.

Why was it called shell shock?

Thought to be concussions from exploding shells. Also seen in soldiers without physical injuries.

What was the early stigma of trauma in soldiers?

Seen as weak, cowardly and malingering.

What did W.H.R Rivers emphasise in treatment?

Respect, and dignity. Encouraged soldiers to talk and write freely about their traumas.

What were Rivers 2 key principles?

1. Even brave soldiers can be overwhelmed.

2. Love and loyalty to fellow soldiers is a strong motivator.

What happened post WWI?

Trauma studies started to fade as society wanted to forget. Work from Kardiner (“traumatic neuroses”) in 1917 not published until 1941.

what did Appel & Bebe discover in WWII?

Any soldier could be impacted. 200-240 days of combat exposure likely leads to breakdown. Risk rises with intensity.

What did Kardiner and Spiegel argue?

They argued that the strongest protective factor was the relationships between soldiers and their superiors. Relationships & support.

What did medical staff focus on after WWII?

Identifying protective factors and ways to promote faster recovery. Treatment focused on memories and associative emotions being integrated into consciousness, not just relived.

How did Vietnam veterans influence PTSD research?

Shared experiences through VVAW sessions → led to treatment programs and research linking combat exposure to PTSD.

What did the 1970s women’s movement reveal about trauma?

Violence against women was widespread and far more common than war trauma.

What was consciousness raising in this context?

When women would meet in groups to share their experiences of domestic evidence or rape.

What are the 1970s events that pushed this further?

First public discussion 1971 (women openly discussed rape).

Mid 1970s - rape reform legislation drafted by national organisation for women (U.S.).

Mid 1970s - pressure from feminist groups → centre for rape researcher (NIMH). Findings aligned it’s Freud’s early work. Violence against women and children endemic.

1971 - first rape crisis centre in the U.S.

What did Burgess & Holstrom (1972) study find?

Identified “rape trauma syndrome”.

Symptoms included life-threatening perception, fear of death/mutilation, insomnia, nightmares, startled response, anxiety, numbing. Similar to combat trauma.

92 women and 37 children interviewed in hospitals after going in for treatment about rape).

What did Russell’s (1980s) epidemiological study find?

1 in 4 women raped, 1 in 3 sexually abused as children. (900 participants).

How did the definition of trauma change?

No longer a “military disorder” → affects broader population.

What were some later advancements in trauma research?

1980s - recognition of torture effect and refugee needs.

1990s - recognition of male sexual assault.

1990s - false memories debate.

1996 - van der kolk: attention to physiology of trauma (first identified by Kardiner 1940s).

Awareness of ritual abuse (churches, professionals, institutions).

PTG - post traumatic growth.

Didn’t ion between complex and single event trauma (debate over DSM-5).

What is the role of the prefrontal cortex?

Reflective brain.

Planning, analysis, critical thinking, sense of time/context, inhibits actions.

Develops last (late 20s). Can go “offline” when under threat.

What does the limbic brain do?

Emotional learning brain.

Emotions, memory, relationships, danger monitoring.

Develops mostly in first 6 years.

What does the brainstem and midbrain do?

Survival brain

Maintains basic functions - breathing, arousal, hunger, sleep/wake, chemical balance.

Develops in the womb. Highly responsive to threat.

What is the function of the survival brain?

Focuses on immediate safety. Relays sensory information to upper brain. Reacts instinctively. Raw emotions. Connects via spinal cord.

What is the function of the emotional learning brain?

Limbic system: thalamus, hypothalamus, amygdala, hippocampus.

Stores memories and controls hormones. Translates sensory information coming from survival brain to shape emotion processing and perspective for reflective brain.

What is the function of the reflective brain?

Cortical brain (including the prefrontal cortex, insula, anterior/mid/posterior cingulate.

Reflection, critical thinking, planning, emotional control, and meaning making.

What is the function of the ANS and the two branches and their roles?

The Autonomic Nervous System unconsciously regulates heart rate, breathing and digestion.

Sympathetic → mobilises for action (increased heart rate, increased blood flow to muscles and lungs, increased vision and increased adrenaline).

Parasympathetic → calms and restores normal function (decreased heart rate and decreased breathing).

How does the body respond to threat?

Changes arousal, perception, emotion and attention. Increased adrenaline, attention narrows, may ignore hunger/pain/fatigue, intense fear/anger possible.

Nervous system prioritised survival, body is mobilised via sympathetic ANS.

What is the core idea of the polyvagal theory?

Humans are wired to connect. Interactions regulate the ANS. Nervous system mediates responses to environment.

What is neuroception (“gut feeling”)?

The nervous systems unconscious ability to detect safety, danger or life threat.

Signals from inside, outside and between people.

What does the vagus nerve do?

Connects brainstem to gut. Links face and organs. Part of PNS - key for autonomic regulation and social engagement. 2 branch’s (ventral and dorsal).

How does trauma affect the nervous system?

Lowers reactivity threshold → misreading internal, external and relational cues, hyper or hypo reactivity, dissociation, shutdown.

What are cues of safety?

Top 1/3 of face (eyes), voice prosody, head movement, proximity, gesture.

Are threat responses pathological?

No. They are adaptive survival responses.

What is the initial response to danger?

“Orienting freeze” scanning for cues, heart rate decreases.

What are the three stages of the defence cascade?

Flight, fight, freeze.

What is tonic immobility?

Some people may experience this. When the body cannot move despite high arousal. Parasympathetic and sympathetic active simultaneously.

What is the shutdown/collapse response?

Extreme hypoarousal, numbness, low muscle tone, reduced breathing, parasympathetic dominance.

What is Walkers 4th F?

Fawn. No empirical evidence for physiological effects. People pleasing, compromising, loss of self.

What are the 2 adaptive relational stances in inescapable trauma?

Submission - “going along” to reduce risk of greater harm.

Identification - “Stockholm syndrome” aligning with perpetrator perspective.

Both adaptive, both can occur with dissociation.

How does trauma affect the body and sense?

Significantly impacts bodies ability to auto regulate. Produces altered and long lasting changes in emotion, perception, arousal and attention.

Nervous system can disconnect from present and remain “stuck” in trauma time.

How does trauma affect touch?

Touch may feel threatening and can alter responses to contact. Barrier between self and environment.

What changes occur in vision after trauma?

Hyper vigilance to cues of threat, or hypo vigilant (leading to detachment (e.g. unable to remember PuV face, memories are in black and white).

How is hearing affected by trauma?

Hypersensitivity to sounds, increased startle response, concentration and emotional regulation may be impacted.

What is the effect on proprioception?

Awareness of body in space. Trauma can alter muscle tone and body maps.

How does trauma impact the vestibular system?

Mostly unconscious. Trauma disrupts balance, grounding and emotional stability.

How can olfaction trigger trauma responses?

Certain smells can evoke strong trauma memories. Processed in memory centres to provide contextual reminders.

What happens to interoception after trauma?

Internal body cues (e.g. heartbreak, stomach sensations) can become numb, avoided or mistrusted.

What is Deb Dana’s patterns of trauma?

“Trauma replaces patterns of connection with patterns of protection”

What is FND?

Functional Neurological Disorder. Caused by disrupted brain-body signalling, producing involuntary functional symptoms (hardware vs software example).

What are some common symptoms of FND?

Dissociative episodes (can be seizure-like), tremors/tics, movement/walking difficulties, sensory changes, weakness/paralysis, cognitive difficulties (memory), speech challenges.

Can trauma cause FND?

Trauma can predispose or precipitate FND, particularly dissociative symptoms, but can also occur without trauma.

Trauma is strongest association for dissociative FND symptoms.

What is the predictive processing explanation for FND?

After trauma, the brain may over-prioritise threat information and under-prioritise sensory feedback, shifting from conscious to automatic control of movement/sension.

How has FND been historically conceptualised?

Previously called conversion disorder. Freud linked it to repressed trauma. DSM-5 updated to FND in 2013, with psychological factor no longer required.

What are the evidence-based treatments for FND?

CBT (cognitive behavioural therapy), ACT (acceptance and commitment therapy), emerging evidence for psychodynamic treatment.

Treatment often in 3 phases. 1) symptom management. 2) safety and stabilisation. 3) trauma processing.

What are the 5 main symptom responses to trauma?

Hyper arousal, intrusion, dissociation, avoidance, emotional dysregulation.

What is hyperarousal?

Nervous system stays on alert including during sleep. Can cause sleep problems, irritability, anxiety, aggression, poor concentration, startle response. Chronic bodily discomfort, can lead to somatic problems (heart rate and blood pressure).

What is intrusion?

Re-experiencing trauma via flashbacks, nightmares, re-enactments or fragmented memories. Triggered my cues (because stored in implicit memory).

How do traumatic memories differ from normal memories?

Often fragmented, non-linear, stored in implicit memories. Central details only partially encoded, focus on peripheral details as a way to cope.

How does dissociation protect someone?

Shuts down awareness, emotion, memory and bodily perception when escape isn’t possible. Adaptive neurobiological response. Continuum from mild (daydreaming) to extreme (DID).

What are the 5 key ways people can be impacted by dissociation?

Depersonalisation - detached from one’s body/out of body experience.

Derealisation - feeling like world isn’t real, watching it detached from the world.

Dissociative amnesia - inability to recall information. Often experience micro-amnesias where parts of conversations aren’t remembered. Often forgetting periods of time in life, experiences of abuse.

Identity confusion - feeling confused around who one is. E.g. feeling overjoyed by activity that would normally illicit a negative response.

Identity alteration - sense of being significantly different to other parts of oneself. Subtle (different facial expressions, language, tone of voice) or can shift into alternate personality.

What can increase risk of dissociation?

Severity of trauma, repeated/chronic trauma, disorganised attachment, invalidation or denial of trauma by others.

What are the 5 defining features both both acute stress and PTSD in the DSM-5?

1) intrusive re-experiencing

2) avoidance of reminders

3) increased arousal or reactivity

4) negative mood or thoughts

5) Dissociative symptoms

What is the difference in diagnosis for acute stress and PTSD in the DSM-5?

duration of acute stress disorder lasts 3 days - 1 month.

PTSD is more than 1 month.

PTSD diagnosis in the DSM-5 (A-H)?

A. Exposure to trauma (actually/threatened death, serious injury, sexual, violence).

B. Intrusion symptoms beginning after event (1+ out of 5).

C. Persistent avoidance of stimuli associated with traumatic event (1 or both).

D. Negative alterations in cognitions and mood (2+ out of 7).

E. Marked alterations in arousal and reactivity (2+ out of 6).

F. Duration of disturbances is longer than 1 month (criteria B, C, D, E).

G. Disturbance causes clinically significant distress or impairment.

H. Disturbance not attributable to the physiological effects of a substance or another medical condition.

What is the specificity with dissociative symptoms and PTSD in the DSM-5?

That dissociative symptoms are persistent and recurrent in relation to 1) depersonalisation 2) derealisation.

What is the ICD 11 (International Classification of Diseases) PTSD diagnostic definition?

Exposure to event or situation of extremely threatening or horrific nature such as natural or hand-made disasters, combat, serious accidents, torture, sexual violence, terrorise, assault or acute life threatening illness; witnessing the threatened or actual injury or death of others in a sudden, unexpected, or violent manner; learning about the sudden, unexpected or violent death of a loved one.

What is the ICD11 diagnostic criteria?

Development of characteristic syndrome lasting for at least several weeks, consisting of all 3 core elements:

1) re-experiencing

2) deliberate avoidance

3) hyper vigilance

What are the issues with trauma diagnosis?

Tend to get multiple diagnoses, typically inaccurately identifying core of the issues (trauma). Misdiagnoses ignore role of trauma and typically place inherent blame on person.

How many diagnoses do people who have experienced complex trauma typically have?

4-6

What is the definition of Complex PTSD in the ICD-11?

Disorder that may develop following exposure to an event or series of events extremely threatening or horrific nature (most commonly prolonged or repetitive, where escape is difficult of impossible.