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Traumatic Life Experience Than by Any Congenital Impairment” -Tamsin Cottis

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Traumatic Life Experience Than by Any Congenital Impairment” -Tamsin Cottis 10/20/2013 "It is worth noting at this point that many patients referred...seem to have become disabled more by their traumatic life experience than by any congenital impairment” -Tamsin Cottis “In fact, the past is the past and the only thing that matters is what Lara Palay, LISW-S happens right now. And what is trauma is the residue that a past event leaves in your own sensory experiences in your body and it’s not that Senior Fellow event out there that becomes intolerable but the physical sensations with Mental and Emotional Health Program which you live that become intolerable and you will do anything to make them go away.” -Bessel Van der Kolk The Center for Systems Change “Trauma is a disease of not being able to be here.” -Pierre Janet Trauma A major trauma could be: Sexual Assault/Physical Assault Trauma is any experience or series of experiences that Natural or manmade disasters make the individual feel that he or she is in danger of dying, or of being emotionally “wiped out ”or Catastrophic illness annihilated. Loss of a loved one Humiliation Bullying Deprivation and powerlessness to act on one ’s own behalf Ford, Adler-Tapia, 2009 Not all trauma results in lasting problems. Individual factors also affect impact of trauma/stressor: Some contributing factors to traumatic stress: Previous history of traumas/stressors/abuse Duration History or family history of mental illnesses Intensity of stressor Inherent resilience/vulnerability Time of day Substance abuse Warning/ no warning Intentionality/preventability Difficult relationships/poor attachment to Scope/numbers affected others. This is especially true if the trauma Support system during and after traumatic event(s). has been caused by another person or people. 1 10/20/2013 Many people experience trauma. People with “Ordinary ” life event trauma could be: developmental disabilities are at greater risk for being victimized or abused (Sobsey, 1994). They “ ” Feeling different are also more likely to have everyday stresses or Not being accepted losses build up and become traumatic. Not being able to do what others do Moving to a new home or significant change at home Knowing that one has a disability and is “different ” than others Not being listened to Being misunderstood Failing at a task Getting confused and overwhelmed Ford, Adler-Tapia, 2009 Post-Traumatic Stress Disorder (PTSD) Trauma Symptoms People who have been through a traumatic experience may develop short-term symptoms Traumatic stress symptoms come in three clusters: (Acute Stress Disorder) or longer-term symptoms (Post Traumatic Stress Disorder, “PTSD ”). Not Hyper-vigilance (always on “red alert”) everyone who experiences trauma will develop a Constriction (avoiding things that can be triggering) Intrusion (having upsetting memories, thoughts stress disorder, but many people will experience and dreams) some symptoms, and some will experience almost all of them. Chronic trauma in childhood may not result in “classic” presentation of PTSD (Van der Kolk, 2005) Hyper-vigilance Constriction Avoids activities, places, people, things to keep Startling easily/frequently from being reminded/ ”triggered ” (avoidance can Irritability ripple out, become more and more removed from Difficulty concentrating obvious triggers of incident) Difficulty relaxing Can’t remember important parts of the trauma Difficulty falling or staying asleep Much less interest in significant activities Needing to be near or in sight of exits; agitation Feeling detached from others when blocked Narrow range of emotions, numbness Lack of a sense of future 2 10/20/2013 Intrusion Other ways symptoms might be observed… Flashbacks Nightmares Physical: Disturbing images/thoughts/fantasies Eating disturbances (more or less than usual) Physical response (sweating, shaking, freezing, Sleep disturbances (more or less than usual) lashing out) to internal or external triggers that Sexual dysfunction resemble the event (this is very common!) Low energy Chronic, unexplained pain Emotional: Cognitive: Depression, spontaneous crying, despair and hopelessness Anxiety Memory lapses, especially about the trauma Panic attacks Fearfulness Difficulty making decisions Compulsive and obsessive behaviors Decreased ability to concentrate Feeling out of control Irritability, anger and resentment Feeling distracted Emotional numbness ADHD symptoms (restless, agitated)-NOT Withdrawal from normal routine and relationships Shame and self-loathing the same as ADHD but may be misdiagnosed as such Remember! \ People with developmental disabilities may not be able to verbally express the things that are “People usually want to teach other people from bothering them. Look for non-verbal signals of the top down, but the brain actually works from distress and anxiety, especially new or increased the bottom up” complaints. Non-verbal distress can be a sign of -Bruce Perry, M.D. many problems besides trauma, and a medical evaluation may be needed, but it’s a good indicator to pay close attention to find out more. 3 10/20/2013 Human Brain Development and Relationships: Brain Development and Neuroplasticity Repeated use of neural pathways makes them stronger and increases After the brain stem, the next part of the brain to develop in the fetus is their number. Pathways that are not used pruned, and wither away. the limbic system, where emotions, safety and memories are primarily This is the basis of neuroplasticity-the process by which the brain is processed. Eye contact, mirroring facial expression and responsiveness “plastic” or moldable, and changes its “maps” of neural connections from the parent stimulate these parts of the brain to continue based on use. “Use it or lose it” is actually how the brain works, to developing in infancy (Schore, 2003) . different degrees at different stages of life. Without this stimulation, the brain is impaired in developing. The individual may have extreme difficulty later in life attaching to others, The more complex the brain region, the more plastic it is. That is why reading facial expressions, self-regulating and having a continuous the cortex changes a lot as we learn, and the brainstem changes little sense of self. Early memories are encoded through the senses (this is why early memories often involve a strong sensation). These help to create the Let’s say it again… pattern against which other experiences will be evaluated. Thus, early Infancy, early childhood and young adulthood are periods of dramatic experiences may have more lasting impact than later ones (Perry, 2011). growth and pruning. During infancy, the limbic systems and cortexes develop directly in response to chemicals released through interaction with another human. (Schore, 2003) sensory The Brainstem Located at the very base of the brain, it looks like a stem (!) and bridges motor the bottom of the brain (diencephalon/cerebellum) and the spine. The is Hippocampus the part of the brain that generates reflexes. Amygdala Basic body functions (following the dictates of the hippocampus for Thalamus rhythm): mPFC Digestion Hypothalamus Body Temperature Breathing LC Startle responses NPG Pituitary PAG Adrenals cortisol Diencephalon/Cerebellum The Amygdalae Located under the hippocampus in the limbic system, on both Located in the lower, back part of the brain, above the brainstem. This is sides of the brain. This is often called the emotional center of the part of the brain that reacts to stimuli. the brain (as is the ‘limbic system” as a whole). Begins developing before birth. Contains in its core the Reticular System (RS) and controls “the four A’s” (Heller, 2002) : Involved with connection, trust and positive and negative o Awake associations (emotional or “implicit” memories), producing o Asleep emotional reactivity. o Arousal Evaluates incoming stimulus (from sensory thalamus) o Attention Asks question “am I safe?” Controls appetite and satiety Releases stress chemicals if not Involved in motor reactivity (Perry, 2011) 4 10/20/2013 The Hippocampus The Cortexes Located under the cortexes, part of the limbic system. This interacts Cover the top and front of the brain. Develop last, and control abstract with the subcortex and is involved with concrete operations and thought. Consciously decides to attend or ignore a stimulus. making sense (with the cortex) of sensations. Reasoning Involved with factual (or explicit) memories Abstract and symbolic thought Knits together (with the cortex) the incoming flow of sensations and Problem-solving experiences into a narrative. This is why non-stressful events can be Impulse control (anterior cingulate cortex) told like a story, but stressful events are like snapshots; the hippocampus is temporarily not communicating with the cortex). Delayed gratification Helps regulate bodily functions and rhythms (with the brain stem) Imagination Helps create a context for experiences, so that we can remind Planning ourselves what is happening to calm down, etc. Generalizing beyond personal experience Involved with affiliation, pleasure and reward (with the cortex) Cortex Development What happens to the cortexes during a traumatic event? The cortex is the last part of the brain to develop, and does not fully When the brain is flooded with stress chemicals, the left frontal cortex finish growing until around age 25 or so, which why adolescents and shuts down, including Broca’s area, which is largely involved with young adults have trouble with some of the most sophisticated kinds of speech. This means that
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