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UNDERSTANDING TRAUMAHannah HaskellOctober 4, 2009

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“Rehabilitation efforts will be for naught if the mental and psycho-social needs of the survivors are not met. We must take care of minds as well as bodies… If the victims are too distressed, they won’t eat, even if they have ample food. All the (rehabilitation) efforts become pointless.” Dr. Virgilio Ludovice

Regional Department of Health

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My own traumatic experiences

Summer 2002 - Gerona, Tarlac

October 14, 2007 - Taytay, Rizal

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What is a traumatic incident?It is a deeply distressing or disturbing experience

It is sudden and unexpectedIt takes one by surpriseThere was injury There was a threat to limb or life

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It is a catastrophe that results in death, destruction or loss of home and community

It is out of one’s controlIt renders one helplessIt is an exposure to violenceIt is witnessing grotesque death

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Traumatic incidents include(but not limited to)

kidnappingserious accidents natural disasters such as floods or earthquakes

violent attacks such as a mugging, rape, or torture

being held captivewitnessing grotesque death

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What happens during and after trauma?When you can’t escape or resist a

traumatic incident, your self-defense system (SDS) becomes overwhelmed and disorganized

Your SDS tends to persist in an aroused state long after the actual danger is over

Your SDS could also become disintegratedIntense fear but no memory of the eventDetailed memory but without emotionConstant state of vigilance and irritability without knowing why

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Time seems to freeze at the moment of trauma

The moment is encoded in an abnormal form of memory which breaks spontaneously into consciousness

The experience lacks words and context, it is encoded in vivid sensations and images

Traumatic memory remains a heightened reality

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Normal responses to traumatic eventTo resist or escape Automatic rush of adrenalin into a state of

alertConcentrate attention on the immediate

situation disregarding hunger, fatigue or painIntense feeling of fear and anger Intense bad memoriesEmotional numbingFeelings of unrealityBodily tensionHealthy adults who have been exposed to a single

discrete traumatic event usually recover within a few weeks

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When normal responses become acuteThey are characterized byPanic reactionsMental confusionDissociationSevere insomniaSuspiciousnessUnable to manage self-careImpaired functioning at school or

work

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From acute stress to Post-Traumatic Stress Disorder

Three main kinds of symptoms1. Re-experiencing symptoms2. Avoidant symptoms3. Symptoms of hyper

(increased) arousal

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1. Re-experiencing Symptoms• Intrusive memories of the traumatic event (flashbacks)• Recurrent, distressing dreams or nightmares about the traumatic event• Acting or feeling as if the traumatic event is reoccurring• Mental and physical discomfort when reminded of the traumatic event (e.g. on the anniversary of the traumatic event)• Recreating or reenacting the traumatic event (repetitive play in children)

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Traumatic memory is resolved when the survivor can integrate the experience into the pages of the story book of his/her life.

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Different theories why survivors relive or reenact traumatic experience

A fantasy of changing the outcome of the traumatic encounter

Attempt to integrate the traumatic event into one’s story

Attempt to master the overwhelming feelings of traumatic moment

Unsuccessful attempts at healing the memory

Traumatic experience is stored as “active memory” – the tendency is to repeat the contents

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2. Avoidant Symptoms

Paralysis of the mind (numbing effect) keeps painful memories split off from awareness

Avoiding thoughts or feelings, people or situations associated with the traumatic event

Not being able to recall an important aspect of the traumatic event

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Reduced interest or participation in significant activities

Feeling disconnected from others

Showing a limited range of emotion

Having a sense of shortened future

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Danger of numbing effect: Prevents integration necessary for healing

May use alcohol or narcotics to create the same numbing effect

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3. Symptoms of Increased ArousalSimilar to anxiety or panic attacksStartles easily (the body is always on

the alert for danger -hypervigilance)Reacts irritably or outbursts of

anger to small provocationsDifficulty concentratingDifficulty falling or staying asleep

(More sensitive to noise, awaken more frequently)

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Diagnostic-Statistical Manual-IV Criteria (309.81) for PTSD

Duration of the symptoms (re-experiencing, avoidant, hyper-arousal) is more than one month

There is significant impairment in social, occupational, and other areas of functioning

It is acute PTSD if duration of symptoms is less than 3 months

It is chronic if duration of symptoms is 3 months or more

Onset of symptoms could be 6 months delayed

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The Dialectic of TraumaHerman, J. L. (1997). Trauma & Recovery. NY: Basic Book

Intrusion Re-living &

Re-enactment

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Debriefing: Caring for Trauma Survivors

It helps survivor process the event and store it in long-term memory.

It helps decrease symptoms of avoidance, re-experiencing, and increased arousal.

Describing everything that happened allows the brain to make some sense of the events. The incident can be placed in the context of the rest of your life, instead of taking over your whole life.

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It enables the survivor to see the trauma as a time-limited event as opposed to a permanent negative effect of your future.

Debriefing provides survivor a sense of closure. The event is over, you are no longer under threat, you can start to move on.

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It does not take away the memory of the event, but it can stop the flashbacks. (Flashbacks could be more distressing than normal memories, because you don’t know what has triggered them).

Disclosing both the facts and feelings about a stressful event have more physical and psychological health benefits than disclosing just the facts or just the feelings.