Louise Newman presentation

TRAUMA AND PERSONALLITY DEVELOPMENT
PROFESSOR LOUISE NEWMAN
MONASH UNIVERSITY

TRAUMA IN INFANCY & CHILDHOOD
Psychic trauma occurs when a sudden unexpected intense external experience overwhelms the individuals’ coping and defensive operations, creating the feeling of utter helplessness
Lenore Terr (1987)

TRAUMATISED AND TRAUMATISING PARENTS
Parents with unresolved traumatic attachment issues and histories of maltreatment/neglect
Range of issues and conflicts when they attempt to parent – from anxiety to avoidance to repetition
Opportunity for the prevention of disturbed parenting and abuse

CHRONIC TRAUMA AND DEVELOPMENT
Child adapts to enduring stress according to developmental stage and capacities
Chronic stress will effect all domains of development and neurobiological functioning
Vulnerability is greatest at stages of rapid neurobiological organisation

TASKS OF BIRTH
Adaptation to the particular infant
Coping with loss of fusion
Coping with fears of harming the infant
Tolerance of dependency
Tolerance of physicality

BABY AT BIRTH
Imaginary Baby
Relationship with developing fetus
Actual Infant

HIGH RISK PARENTING
Parenting relationships which impact adversely on child development and particularly on security of attachment
Spectrum of parenting behaviors, emotional responses, attitudes and conflicts (conscious and unconscious) which are traumatizing for the child and result in disorganization of attachment and impact on emotional and behavioral regulation
Influenced by parental attachment history, reflective capacity and mental state

TRANSGENERATIONAL TRAUMA
Patterns of traumatising parenting are often repetitions
Maltreatment, abuse and exposure to violence in infancy are risk factors for later abusive behaviour and revictimisation
Prevention of child maltreatment involves identification of high-risk parents and early intervention

THE LEGACY OF TRAUMA
Trauma is reenacted in the relationship with the infant
Unresolved parental attachment trauma is reflected in the handling and care of the infant
Trauma disrupts emotional interaction and regulation

TRAUMATISED PARENT
Unprocessed traumatic memories
Infant as a projective focus – misinterpretation
Infant experienced as anxiety provoking, persecutory, hostile

Patterns in high risk families
Distorted representation of the child
Parental preoccupation with past trauma
Parental anxiety
Parental deficit in interpretation of the infant emotional communication
Problems in interpersonal functioning
Limited reflective capacity

PARENTAL REFLECTIVE FUNCTIONING
Capacity to understand own and child's behaviour in terms of underlying mental states
Basis of parents ability to hold the infants affective experience in mind
Gives meaning to the child’s affective experience and re-presents it to the child in a regulated fashion

PARENTAL REFLECTIVE FUNCTIONING
RF is the basis of parental access to their own emotions and memories of their own early attachment experiences
Mediates the reworking of parents early relationships in the transition to parenthood and representation of the child
Impacts on interactive and parenting behaviours

THINKING ABOUT THE BABY
Crucial in establishment of attachment relationship and emotionally attuned early interaction
Gives infant experience of being validated and contained and is the beginning of self development

TRAUMA AND DEVELOPMENT
Effects of trauma during critical periods of development
Long-term implications of attachment disruption and maltreatment
New infant brain research and implications for decision-making, intervention and child protection

SPECTRUM OF TRAUMA
Single overwhelming events
Chronic enduring stressors
Indirect exposure
Transgenerational trauma

DEVELOPMENT IN INFANCY
Neuropsychological processes
Affect regulation
Representations of self, other
Attachment Style
Adaptation to Stress
Capacity for intimacy and empathy

INFANT CAPACITIES
Programmed for social interaction
Ability to communicate emotional experience
Move towards development and self-regulation

EARLY BRAIN DEVELOPMENT
Promoted by secure attachment
Sharing of positive affective states
Carer maintains optimal level of arousal
Mutually attuned synchronized interactions promote affective development

EXPERIENCE & DEVELOPMENT
Experience activates specific neuronal connections
Sharing positive emotional states with a caretaker promotes brain growth and the development of regulatory capacities
Secure attachment promotes neuobiological functioning, emotional regulation and adaptation to stress

NEUROBIOLOGY OF ATTACHMENT
Secure attachment promotes brain growth
Attachment relationship regulates emotional experience and level of arousal
Attachment figure acts as an external neurobiological regulator

NEUROBIOLOGY OF ATTACHMENT
SECURE ATTACHMENT – optimal level of arousal
AVOIDANT ATTACHMENT – downplaying of emotional display
AMBIVALENT ATTACHMENT – heightened emotional display
DISORGANISED ATTACHMENT – high arousal and stress

ATTACHMENT DISORGANISATION
Associated with trauma and abuse
Lack of effective strategy for dealing with caretaker
High levels of stress and related hormones
Defensive exclusion of understanding of caretaker
Excessive use of dissociation and opioid related states

ATTACHMENT DISORGANISATION
Poor development of internal state language
Poor reflective function
Deficits in empathy
Contradictory representations of self and other
Dysregulation of behaviour, affect and impulses

MODERATE STRESSORS
Emotionally unavailable carer - depression,anxiety, bereavment
Parental hostility and anger
Family conflict and domestic violence
Unpredictability and inconsistency
Neglect and stimulus deprivation

EXTEME & CATASTROPHIC STRESSORS –NCCIP Classification
Loss of attachment figure
Continued physical/sexual abuse
Family overwhelmed- war, displacement, terror
Abandonment and gross neglect

TRANSGENERATIONAL TRAUMA
Repetition of disturbed interactions and patterns of relationships
Repetition of abuse and maltreatment
Issues for abused parents - anxiety, compensation and reparation, envy
Re-enactment of unresolved attachment trauma

NEURODEVELOPMENT & TRAUMA
Dysregulation of HPA axis functioning - stress system
Altered cortisol pattern- stress hormone
Reduced volume of hippocampus- memory
Reduced volume of corpus callosum- information processing
Potential effects on mood and impulse control, emotional regulation

BRAIN FUNCTION & EXPERIENCE
STRESS – hyperactive stress response
CHAOS – poor sensory integration, attentional and processing problems
NEGLECT – poor emotional regulation, deficits in processing of socioemotional information and attachment
ABUSE – poor regulation of anger, aggression, impulses, anxiety; deficits in emotional understanding,

IMPACT OF TRAUMA
Severity of the stressor
Developmental level of the child
Availability and capacity of adult support

CHILDRENS’ RESPONSES TO TRAUMA
Children process and recall acute traumatic events
Persistent high arousal and anxiety
Immediate reactions include regression,clinging, muteness
Traumatic re-enactment in play and behaviour

RESPONSES TO THREAT
HYPERAROUSAL – fight or flight response; adrenaline/noradrenaline; sympathetic
DISSOCIATIVE – freeze or play dead response; opiods and dopamine; parasympathetic

TRAUMA SPECIFIC DIAGNOSES
Acute stress responses in infants - dissociation
Post-traumatic stress disorder - traumatic play, fears
Disruptive Behaviour Disorders
Attachment Disorders

TRAUMA AND THE BRAIN
Stress hormones and cortisol are neurotoxic
Sensitised pathways develop in R orbito-frontal brain regions - PTSD
Long lasting impairment in brain regions involved in regulation of the intensity of feelings
Persistent dissociation

CHRONIC TRAUMA
Persistent orientation to threat and activation of stress response
Altered opioid, dopaminergic and serotinergic systems
Hyperarousal and overactivity
Affective dysregulation and impulsivity

TYPE 2 TRAUMA - TERR
Adaptation - avoidance, repression, dissociation
Repetition – re-enactment, play, identification
Anxiety - arousal, aggression, self-harm
Self-Concept - depression, guilt, shame

CORE DEFICITS
Problems with interpersonal relationships
Problems with affect regulation
Ongoing vulnerability to stress
Self and other representations- negative self-concept, mistrust of others
Deficits in reflective function and empathy

HEALTH SERVICE APPROACHES
Screening by health care professionals and training for health professionals
Therapeutic approaches and services for children
Services for children who witness violence
Services for adults abused as children

TRAUMA & PERSONALITY DEVELOPMENT
Dysregulation of affect and impulses
Disorganised attachment
Multiple models of self and others
Poor reflective function
Negative self-introject

SEVERE PERSONALITY DISORDER
Syndrome of neurophysiological and psychosocial dysregulation
Symptoms as attempts to reestablish homeostasis
Basis in traumatic early attachment experiences and neurodevelopmental effects of trauma

PERSONALITY DISORDER
Dysregulation of affect and intolerance of anxiety
Limited internal state language
Contradictory representations of self and other
Limited reflective capacity
Unintegrated traumatic memories

NEURODEVELOPMENT IN PD
Limbic irritability
Reduced size of hippocampus
Reduced left temporal lobe development
Reduced left-right integration
Reduced volume of corpus callosum
Decreased blood flow to cerebellar vermis

FEATURES OF BPD
Self-destructive behaviour
Dissociation
Psychotic-like symptoms
Relationship disturbances
Affective disturbances
Identity disturbances

Borderline Disorder
Current Issues
Diagnosis and classification
Relationship to early trauma
Early intervention and prevention
Effective intervention

Borderline Disorder
Failure of caretaking environment
Maltreatment and abuse
Trauma in infancy and brain development
Inadequate social support and structure

Borderline Disorder - Biopsychosocial Model
Genetics
Neurodevelopmental
Self disorder
Social fragmentation

CONTEMPORARY MODELS OF BPD: FONAGY AND TARGET
BPD as deficit state
Defensive exclusion of reflective capacity - mentalization
Role of child maltreatment and trauma
Implications of disorganization of attachment

Borderline Personality Disorder - Psychological
Unresolved trauma and loss
Poor reflective self function
Disturbed self-experience
Disorganized attachment
Maladaptive defense style

CHRONIC TRAUMA
Persistent orientation to threat and activation of stress response
Altered opioid, dopaminergic and serotinergic systems
Hyperarousal and overactivity
Affective dysregulation and impulsivity

Genetics
Environment
Disorganised attachment system
Temperament Traits
Maltreatment Chronic Stress
Integrative processing problem Dissociation
Emotional dysregulation
Behavioural dysregulation
Cognitive dysfunction
Intense Unstable relationships
Identity diffusion
Integrated model of borderline personality disorder

INTERVENTION APPROACHES
Cognitive behavioral and psychoeducational
Attachment based – importance of parental capacity to perceive and sensitively respond to child's emotional needs
Without emotional attunement parenting programs may improve management but not the emotional aspects of the parent-child relationship

EMOTIONAL REGULATION
Parent has difficulty in recognizing infant affect and may misinterpret signs of distress. This reflects their own distorted or denied affect related to early experiences
Limited reflective function related to maladaptive parenting such as withdrawal, hostility and intrusiveness

ATTACHMENT BASED INTERVENTION
Early intervention – antenatal, infant and toddler
Program incorporating focus on emotional development and child’s needs for attachment
Focus on improving maternal emotional availability and reflective capacity
Evidence for medium term programs

SERVICE ISSUES
Need for integrated child protection mental health early intervention approaches – risk assessment, parenting capacity and identification of infant trauma. This has training, workforce and redesign implications
Role and place of infant mental health programs – across maternal health, paediatrics, CAMHS, child protection

RESEARCH ISSUES
Neurobiology of aberrant parenting- fMRI
Targeted interventions for parents with histories of abuse and neglect
Antenatal Interventions for women affected by substance abuse
Child abuse prevention – improving parental reflective capacity with attachment and trauma focused approaches

Louise Newman presentation

by mhcc on Jul 27, 2011

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Louise Newman presentation — Presentation Transcript