Trauma

First published in the Spring 2001 NETWORKS, the quarterly magazine of the National Center for Victims of Crime, 2111 Wilson Blvd., Suite, 300, Arlington, VA, 22201; phone: (703) 276-2880; website: www.ncvc.org. Reprinted with permission from the National Center.

Understanding Victim Behavior: The Psychobiology of Trauma
By Teresa Descilo

Have you ever watched someone go downhill mentally or physically long after the danger or injury had passed? Have you ever wondered why a domestic violence victim would return to her or his abuser? Have you ever experienced memory lapses after a very stressful time?

The answers to these questions can be found in our bodies' responses to traumatic events. New studies on what happens when we have been traumatized offer important information for all those who work with victims of crime. The findings are also important on a personal level because almost no one on planet earth goes through life without experiencing trauma. While the data presented here on the psychobiology of trauma are simplified and inconclusive, they help to explain what we see and experience on a daily basis.

What is "Trauma?"
In defining trauma in children, Beverly James provides a definition that I think applies to all of us. "Trauma occurs when an actual or perceived threat of danger [or loss] overwhelms a person’s usual coping ability." I added "or loss" because hearing that a loved one has been murdered or that you have a fatal disease qualifies as a traumatizing event. Note in this definition that trauma is a perception: what is traumatic for one person won't necessarily traumatize another. Further note this difference usually has to do with what sort of coping abilities one has developed.

Posttraumatic Stress Disorder (PTSD) sets in when responses to a traumatic event-re-experiencing the event through nightmares, flashbacks, avoiding reminders of the event or strong emotions, feeling hyper-vigilant and/or easily startled-result in diminished functioning in some area of life and last more than a month. Anyone who works with crime victims should become fully familiar with PTSD as it is critical for victims to receive help, hopefully, before these extreme symptoms present.

Chemical Reactions
A real or perceived danger or reminder of a past traumatic event sets off a series of bodily chemical reactions that have been described as "fight or flight." "Freeze" needs to be added to this description since that is a common reaction of many people faced with danger. The system in our body responsible for this reaction is called the sympathetic nervous system and it is part of the hypothalamus-pituitary-adrenal axis (HPA), the system responsible for bringing the body back into balance in any circumstance. Knowing the pituitary regulates the thyroid, this last piece of data about the HPA axis was of particular interest to me when I developed a thyroid condition after a very stressful period in my own life.

When the sympathetic nervous system generates the trauma response, major chemicals are activated in our system:

  • 1. Catecholamines (epinephrine and norepinephrine) responsible for the fight or flight response;
  • 2. Corticosteriods (glucocorticoids and cortisol) regulating the catecholamines that increase energy and the body's immune functioning;
  • 3. Opiods that help in preventing us from experiencing the pain and inhibit memory consolidation;
  • 4. Oxytocin, a hormone inhibiting memory consolidation. (The best example I can give of chemicals that "inhibit memory consolidation" comes from my own experience. After surgery I was given percoset, a narcotic for pain. Although the pain was still present, it felt "over there," everything was "cool," and I just mentally floated along.) Oxytocin is known as the bonding hormone since it is the hormone that sets off labor and is responsible for bonding mother and child. It may be the reason anyone would have a second child because if we were to experience the pain of childbirth fully, it probably wouldn’t happen a second time.

 

These chemicals are supposed to help us function better during trauma. But if the trauma is too severe, goes on too long, or is triggered too often, they begin to have a very negative impact on our bodies, behaviors, and very important to note, our memories. Here is the downside:

  • 1. The catecholamine levels become chronically increased, resulting in damage to passages in the brain responsible for memory and rational thought and creating a constant feeling of hyper stress and inability to distinguish danger signals;
  • 2. The corticosteriods become chronically low, resulting in reduced immune functioning and lack of regulation of the catecholamines;
  • 3. The opiod levels increase to the point that an equivalent of eight milligrams of morphine is entering our system. (Have you ever seen someone who has a flat affect or looks "out of it" after a trauma?)
  • 4. Oxytocin contributes to a victim's bonding with a perpetrator and causes damage to memory. While oxytocin is a factor for both women and men during trauma and triggering events, recent research strongly indicates that estrogen amplifies and androgens diminish the effects of oxytocin. Because of the chemicals' interplay, a trauma victim is unable to remember the facts of the incident consciously since the conscious part of the brain is shut down fully or in part, and the emotional and painful parts of the incident continue to play in the present as though they were still happening. Thus the brain, which functions in a use-dependent manner-how you use it is what you get-becomes programmed to stay in a mode of feeling perpetually traumatized.

 

Implications of Trauma
In a number of studies on Vietnam veterans and sexual assault victims, brain scans showed they had five to eighteen percent less brain mass than normal in that part of the brain responsible for conscious memory. Many similar studies of children confirm that the continual presence of trauma chemistry on a developing brain actually causes the brain to be malformed. In many cases this means that traumatized children grow up more prone to becoming victims, criminals, or more prone to learning, relationship, and health impairments. We have only begun to understand the profound implications of early childhood trauma on our society.

Law enforcement officials and prosecutors need to understand that a person's memory directly after the traumatic incident may not be completely accurate. Time, clinical treatment, and retelling the story will bring up new details and, in some cases, a somewhat different story than what was originally reported may emerge.

What We Can Do
While this information is distressing, it isn't all bleak. Some actions can provide immediate relief and effective treatments now exist to integrate traumatic memory. Recommended first aid for trauma includes sweating out the stress chemistry through exercise and drinking lots of water. Keeping a journal has proven effective in helping relieve the impact of the incident as well as integrating the memory of it. At our Victim Services Center, we primarily use a person-centered exposure treatment called Traumatic Incident Reduction that has been very successful in relieving the impact of trauma. We also use Eye Movement Desensitization and Reprocessing (EMDR) with excellent results.

It is important for all those who assist victims to take care of themselves as well. While it is critical for victims to talk about their experiences in a safe setting, those who hear the horror stories must have time and space to talk about and process what they hear as well. We have always known this is not easy work. Science is beginning to document what a toll it takes-primarily on victims but secondarily on us.

Teresa Descilo, MSW, CTS, is the director of Victim Services Center, PO Box 570068, Miami, FL 33257. Her email address is: dakini11@bellsouth.net.

Endnotes
Bremner JD. 1999 Biol Psychiatry Does stress damage the brain? Apr 1; 45(7):797-805

Bremner JD, Randall P, Vermetten E, Staib L, Bronen RA, Mazure C, Capelli S, McCarthy G, Innis RB, Charney DS. (1997) Magnetic resonance imaging-based measurement of hippocampal volume in posttraumatic stress disorder related to childhood physical and sexual abuse--a preliminary report. Biol Psychiatry Jan 1;41(1):23-32.

James, B. (1994) Handbook for treatment of attachment-trauma problems in children. New York: Lexington Books.

Perry, BD Incubated in Terror: Neurodevelopmental Factors in the 'Cycle of Violence' In: Children, Youth and Violence: The Search for Solutions (J Osofsky, Ed.). Guilford Press, New York, pp 124-148, 1997

Shelley E. Taylor, Laura Cousino Klein, Brian P. Lewis, Tara L. Gruenewald, Regan A. R. Gurung, and John A. Updegraff University of California, Los Angeles (2000). Biobehavioral Responses to Stress in Females:

Tend-and-Befriend, Not Fight-or-Flight. Psychological Review, in press van der Kolk BA (1994) The body keeps the score: memory and the evolving psychobiology of posttraumatic stress. Harv Rev Psychiatry, Jan-Feb; 1 (5):253-65

In publication in the National Center for Crime Victims newsletter.

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