6 Things Unhealed Trauma Makes Us Do video
Following the line of McCann and Pearlman (1990), an event can be considered traumatic from a psychological point of view if it is a threat or attack that:
- It happens suddenly, unexpectedly, or outside the norm (this includes ongoing abuse).
- It exceeds the individual's perceived ability to handle the threat or attack.
- It disturbs the individual's frames of reference and other basic schemes that help him understand and deal with the world.
According to the WHO, in the ICD-10, trauma occurs when: The person has been exposed to a stressful event or situation (both brief and prolonged) of an exceptionally threatening or catastrophic nature, which could cause profound discomfort in almost everyone .
The Diagnostic and Statistical Manual of Mental Disorders, DSM-5 (APA, 2013), is more restrictive since it considers that for post-traumatic stress disorder to occur, there must be an event that implies (criterion A) exposure to death, serious injury or sexual violence, whether real or in the form of threat, own or someone close to you In considering this necessary for there to be post-traumatic stress disorder, this definition leaves out events that can be highly traumatic and have devastating effects; but that are not directly related to situations of physical violence or danger of death. For example, a partner's infidelity is experienced as a traumatic betrayal that has effects similar to post-traumatic stress disorder. However, the ICD-10 definition would consider the betrayal of the partner in infidelity as a traumatic event, which can trigger processes similar to those described in DSM 5 to define post-traumatic stress disorder.
The advantage of DSM 5 is that it has a more detailed list of the consequences of trauma when it becomes a psychological problem. Thus, they include (criterion B) that leaves sequels in the form of dreams, recurring memories or other ways of reliving what happened; (criterion G) that cause great discomfort that affects work or personal life. (Criterion C) when the person initiates an avoidance strategy against the sequelae trying to eliminate them, (criterion D) another series of emotional problems occur and (criterion E) there is also an alteration of alertness. (See in detail the criteria that the DSM-V considers by clicking here).
Traumas in childhood
In infancy, the child's survival depends on their caregivers. Any behavior of abuse or neglect can be experienced as a threat to your life and, therefore, affect you traumatically. Gilbert et al., (2009) have found that in developed countries a significant percentage of girls / boys are physically, sexually or psychologically abused by their caregivers. These authors reach the following conclusions:
- The abuse is often continuous and constitutes a chronic situation for children.
- Parental poverty, low educational attainment and mental illness are often associated with child abuse.
- Child abuse has long-lasting effects on girls' health, problems with drugs and alcohol, risky sexual behavior, obesity and criminal behavior, from infancy to adulthood.
- Neglect is at least as harmful as physical or sexual abuse.
The problem is that the behaviors that develop at these ages are automated and are repeated in adulthood. Thus, it has been seen that in all of us the attachment behaviors that develop in the relationship with caregivers are repeated in couple relationships.
The unfavorable effects of abuse and neglect on the emotional regulation of these children is also transferred to adulthood (Young and Widom, 2014).
It must be taken into account that one of the most frequent traumas appears as a consequence of gender violence: abuses and rapes, which also occur in girls / boys and in the family environment. Abuse often goes unnoticed by the adults around you and is difficult to detect even in the course of therapy.
There are indications that these traumas are more harmful than those that occur in contexts of physical violence without sexual abuse (Villavicencio and Montalvo, 2011). Perhaps it is because they affect adult attachment and bonding relationships.
Psychological processes that a traumatic event can trigger
Classifications of mental illness, such as DSM 5, are descriptions of behaviors that appear to be associated with disorders; but they do not give an explanation of the causes or the processes that underlie the appearance of these psychological problems. Post-traumatic stress disorder is an exception, as it is the only anxiety disorderin which a specific event or situation is recognized as causing it. The cause is the traumatic event and, when it leads to a psychological disorder, the consequences are the behaviors described in the diagnostic criteria. However, the processes that link cause and effect are not explained. In this section we are going to expose a series of processes that account for how trauma can produce post-traumatic stress disorder, which will allow us to shed light on how to treat it.
Each person subjected to a traumatic attack or threat reacts differently. Thus, 64% do not develop a psychological disorder considered as such (García-Vera and Sanz, 2016). So, what are the circumstances that must come together for a psychological disorder to appear? In children subjected to traumatic events, the characteristics that can predict who are more likely to develop post-traumatic stress disorder have been studied. Alisic, Jongmans, van Wesel, & Kleber, (2011) have found that the existence of problems present at the time of the event are the ones that best predict it. Among them are the previous existence of short-term post-traumatic stress, depression, anxiety, and that the parents have post-traumatic stress.
There are studies (Bardeen, Tull, Stevens, & Gratz, 2015; Orsillo & Batten, 2005) that affirm that one of the factors that has more weight in the development of post-traumatic stress disorder is experiential avoidance, which occurs when the The person tends to eliminate emotional suffering by all means, striving to avoid memories, feelings or thoughts related to the event and also any situation or element that may arouse them (criterion C of DSM 5). It is these avoidance behaviors that generate the main part of the suffering.
We know that memories of past events evoke emotional reactions very similar to those caused by the event itself (Purdon, 1999; Wegner, 1994; Hayes, Barnes-Holmes, & Roche, 2001). If these reactions are not avoided and normal life is carried on, their influence on the well-being of the person will eventually be minimized. However, when it comes to avoiding emotional suffering at all costs, you fight the thoughts, feelings, sensations, and emotions that remind you of the traumatic event. Then, the suffering is perpetuated and grows, because the more we want to throw a thought out of our head, the more present it is (Hayes, Sthrosal, Wilson, 1999). In this way, effects such as those described in criterion B of DSM 5 appear: recurring memories (flashbacks), nightmares that cause a great physiological activation, which does not improve with the passage of time.
The futility of the efforts made by the patient to control suffering causes feelings of depression and negative evaluations of himself, because he considers that something is not working in him because he cannot control the suffering. The fact that the traumatic event was unexpected and sudden leads him to fear that at any time and in any place it could happen again. This gives him a view of the world as a hostile enemy that can attack at any time (criterion D of DSM 5).
Wanting to prevent an unexpected event from appearing or repeating itself forces the person to get into a vigilant position, fully alert. It is an alert state in which the person is paying attention, not to what is happening around him, but to the possible presence of what he wants to prevent from happening. And this happens, whether it is objectively likely to happen or not. This alert state, the result of experiential avoidance, explains the characteristics included in criterion E of DSM 5: hypervigilance, startles, concentration problems, sleeping difficulties, reactions to others with irritable, reckless or self-destructive behavior, consequence of his state of permanent alertness.
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