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Feb 08, 2013
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Transcript of "Trauma 101"
1. Trauma 101: Understanding the neurobiology of dysregulation. Presented by: Sophia Deborah Erez, MS, LPC, MFT Shared Hope International November 30, 2011Slide by Sophia Deborah Erez © 2008 520.302.5859
Our objectives:Slide by Sophia Deborah Erez © 2008 520.302.5859
What are your perceptions of trauma?Slide by Sophia Deborah Erez © 2008 520.302.5859
TraumaSusto Rape trauma syndromeAtaque de nervios Battered women’s syndromeRailway Spine Chronic interpersonal traumaSoldiers heart Chronic developmental traumaBattle fatigue Complex traumaWar combat syndrome Disorders of extreme stress notShell shock otherwise specified (DESNOS).War neuroses Coming soon DSM V . . .Posttraumatic stress disorder (PTSD)Complex PTSDSlide by Sophia Deborah Erez © 2008 520.302.5859
DESNOS “The DSM IV Field Trial supported the notion that trauma,particularly trauma that is prolonged, that first occurs at an early age andthat is of an interpersonal nature, can have significant effects onpsychological functioning above and beyond PTSD symptomatology.These effects include: problems with affect dysregulation aggression against self and others dissociative symptoms somatization character pathology These various symptoms tend to cluster into distinct patterns andto be highly interrelated” (van der Kolk, Roth, Pelcovitz, Sunday andSpinnazzola, 2005). Slide by Sophia Deborah Erez © 2008 520.302.5859
DESNOSEarly interpersonal traumatization gives rise to more complex posttraumatic psychopathology than later interpersonal victimization.These symptoms occur in addition to PTSD symptoms and do not necessarily constitute a separate cluster of symptoms.The younger the age of onset of the trauma, the more likely one is to suffer from the cluster of DESNOS symptoms, in addition to PTSD.The longer individuals were exposed to traumatic events, the more likely they were to develop both PTSD and DESNOS.DESNOS symptoms, rather than PTSD, may cause patients to seek treatment. (van der Kolk, Roth, Pelcovitz, Sunday and Spinnazzola, 2005). Slide by Sophia Deborah Erez © 2008 520.302.5859
Chronic Victimization• Alterations in emotional regulation. May include persistentsadness, suicidal thoughts, explosive anger, or inhibited anger.• Alterations in consciousness. Includes forgetting traumaticevents, reliving traumatic events, or having episodes in which onefeels detached from ones mental processes or body.• Changes in self-perception. May include helplessness, shame,guilt, stigma, and a sense of being completely different from otherhuman beings.Slide by Sophia Deborah Erez © 2008 520.302.5859
Chronic Victimization•Alterations in how the perpetrator is perceived. Examplesinclude attributing total power to the perpetrator, becomingpreoccupied with the relationship to the perpetrator, orpreoccupied with revenge.•Alterations in relations with others. Examples include isolation,distrust, or a repeated search for a rescuer.•Changes in ones system of meanings. May include a loss ofsustaining faith or a sense of hopelessness and despair.Slide by Sophia Deborah Erez © 2008 520.302.5859
Sophia’s definition:“A chronic dysregulation of the Nervous System resulting from the neurological, biological, psychological and social adaptations necessary for survivalwhen a human being is confronted with a perceived life threatening experience and/or a perceived absence of life promoting experiences.”Slide by Sophia Deborah Erez © 2008 520.302.5859
Trauma (dysregulation) is: •A normal reaction to an abnormal experience. •In the perception of the experience-not an event. •A biological response.Slide by Sophia Deborah Erez © 2008 520.302.5859
Trauma (dysregulation) is: •Necessary for survival. •Can be about what didn’t happen as much as about what did happen.Slide by Sophia Deborah Erez © 2008 520.302.5859
Key Points! • It is our “humanness” that makes us vulnerable • This biology is shared between across all cultures, languages, etc.Slide by Sophia Deborah Erez © 2008 520.302.5859
Common symptoms of dysregulation:•Self-destructive behavior •Psychomotor agitation•Flashbacks •Chronic pain•Startle hypervigilence •Numbing•Nightmares •Intrusive memories•Hyperarousal •Amnesia•Insomnia •Hypoarousal•Irritability •Decreased interest•Anxiety •Hopelessness•Panic attacks •DepressionSlide by Sophia Deborah Erez © 2008 520.302.5859
Dysregulation can occur in the absence of:•Control•Knowledge•Time•Support•Good enough parenting•General sense of safety in the world•Good enough affect regulation skills•Experience of repair in relationshipsSlide by Sophia Deborah Erez © 2008 520.302.5859
Dysregulation can occur in the presence of:•Fear•Horror•Belief that death is imminent•Shame – I am not worthy – I am not loveableSlide by Sophia Deborah Erez © 2008 520.302.5859
Trauma Terminology . . .•“Big T”•“little t”•Cumulative Trauma•Shock Trauma•Developmental Trauma•Complex Trauma•etc . . .Slide by Sophia Deborah Erez © 2008 520.302.5859
and the important difference. • Adult trauma changes the adult’s relationship with themselves and the world. • Developmental trauma changes the child’s character and personality.Slide by Sophia Deborah Erez © 2008 520.302.5859
How does trauma present? Note. From Complex trauma in children and adolescents (p. 32), by National Child Traumatic Stress Network, 2003. Retrieved April 9, 2006, from http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/ComplexTrauma_All.pdfSlide by Sophia Deborah Erez © 2008 520.302.5859
ren and adolescents (p. 32), by National Child Traumatic 9, 2006, from Slide by Sophia Deborah Erez © 2008 520.302.5859dfs/edu_materials/ComplexTrauma_All.pdf
Symptoms “valiant neurobiological attempts to cope with the trauma: self-injury and suicidality, risk-taking, re-enactmentbehavior, caretaking and self-sacrifice, re- victimization, and addictive behavior.” Janina Fisher Working with the Neurobiological Legacy of Early TraumaSlide by Sophia Deborah Erez © 2008 520.302.5859