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Tuesday, March 17, 2015

Childhood Trauma: 8 Misconceptions about Traumatic Experience

From PsychCentral

By Támara Hill, M.S.
March 11, 2015

What is trauma? If I were to quiz you on trauma would you know how to define it? You might say something like, "trauma is a negative experience that you cannot forget or move past." I would give you an A+, but also challenge you to consider different situations in which trauma occurs and the impact on the victim.

For example, we all know that a child who has been abused and neglected or has seen something horrific would most likely be traumatized. But would you also consider a 3 month old baby who has been severely neglected to be traumatized? Why or why not? Would you consider an adult, who has a history of trauma, to still be suffering from the trauma? These questions will be answered in this article and I will provide an example case for your review.

As a therapist working with multiple families who have endured trauma, I have seen my fair share of traumatic experience and I’ve been challenged to treat kids who are unresponsive to or defensive in treatment. The problem is often that a child who has been traumatized is locked inside of themselves, fearful of coming out and being harmed again.We all know the feeling. Fear and anxiety can grip you and hold you captive.

Many traumatized children grow into fearful and anxious adults who are struggling with depression and uncertainty. Others simply become perfectionistic adults who cannot relax or enjoy life, everything must be perfect and mistakes are not allowed.

Trauma is a complex phenomenon that is intermixed with biology/genes, environmental influence and physiology. The chemicals in the brain and body work together during traumatizing circumstances to create real and lasting changes in the body. For example, humans have a stress hormone in the body known as cortisol and when cortisol gets out of control, the body becomes stressed and the brain responds in negative ways. The body sort of goes through “mini breakdowns” or “burn-outs.”

With all the physiological changes in addition to the individual’s subjective experience of the trauma, the person becomes more hypervigilant and, in some cases, struggles to trust others. A host of psychological and emotional changes occur and makes functioning in daily life very difficult and near impossible for many individuals.

It’s important to remember that trauma is not just an event that is easy for an individual to get over. Trauma has a psychological, emotional, and physiological effect on the body and brain development. The younger a child in a traumatizing situation, the worse the impact.

This is not to say that adults or older children cannot experience great distress in traumatic situations. But it is common knowledge that the younger the child, in some cases, the worse the impact of trauma. However, some studies show that younger children can be more resilient than others at bouncing back from trauma. It all depends on the child.

There are, of course, many factors that influence an individual’s resilience such as family support, environment, education, access to therapy, socio-economic status, etc.

For the purposes of this discussion, lets look at the factors that influence an individual experiencing (or having previously experienced) trauma:

Protective factors:
  • support system,
  • financial stability,
  • good emotional and psychological health,
  • positive coping skills,
  • connectedness with the community such as school, church, or youth/support groups,
  • social or familial connections,
  • education or academic achievement,
  • employment, and
  • problem-solving skills.
Risk factors:
  • low socioeconomic status, 
  • substance abuse, 
  • poor mental health or emotional reactivity, 
  • financial difficulties, 
  • poor coping style, 
  • others reaction to the trauma, 
  • no support system, 
  • lack of employment, 
  • being bullied or harassed, 
  • living in situations that increase one’s exposure to trauma, 
  • low self-esteem, 
  • lack of identity, 
  • domestic violence or abuse, and 
  • poor academic performance.
Both risk and protective factors have a lot to do with the impact that a traumatic experience will have on an individual. With a number of protective factors available, individuals are more likely to be resilient and bounce back.

Think of it this way: the more protective factors an individual has access to, the less the impact of trauma. This is why a child who has been severely abused and neglected by a parent can move in with a grandparent and do very well in the home, school, and community.

The protective factor is a support system which shows love and compassion and is dedicated to helping the child succeed. However, there are cases in which the traumatized individual has access to protective factors and still struggles with the consequences of that trauma. This would be considered complex trauma because the impact of that trauma, and on its treatment, is complex.

Many parents who see me for family therapy pose the following question: “why is this individual acting this way? I know he has experienced trauma, but we love him and give him everything. Why isn’t he getting better?”

Because trauma is so complex and at times really confusing, I often remind families of the influence of their own misconceptions of trauma. Most people forget that trauma is not just a bad experience that will eventually go away. It will always affect the individual in some way.

Lets take a look at 8 common (mistaken) beliefs about trauma:
  • Trauma is short-term: The effects of a traumatic experience is lifelong. Even after years of repeated therapy, a traumatic experience will never disappear from the conscious level of the victim. I have heard many individuals who have been sexually abused say “the rape is over but the scar is there forever.” One very big misconception about trauma is that if the child is removed from the environment or the traumatic situation that the trauma is over. The reality is that the individual will need to be supported with treatment.
  • Traumatized kids don’t do “bad things”: Some kids who have had very traumatizing histories can develop into kids who exhibit extreme personality and behavioral problems. Sadly, some kids exhibit conduct problems in adolescence such as stealing, lying, cheating, manipulation, setting fires, animal cruelty, and property destruction that eventually aligns with symptoms characteristic of sociopathy. In other cases, some kids develop into adults who struggle with substance abuse, sex addiction, or oppositional behaviors. Repeated hospitalizations, incarcerations, risky behaviors, loss of employment, violent assault, or periods of intense depression is also common. It’s very common for people to think that children who have had traumatic histories might be a little depressed, anxious, or struggle with some academic problems. It’s also common to think that a child or teen will “grow out of” the negative behaviors. But the reality is that many kids face life-long challenges that can sometimes be crippling to them in their adult lives. This is certainly not an excuse for the above behaviors. But it is indeed reality for many people.
  • Trauma couldn’t possibly affect the brain and body long after the trauma: Some kids are very resilient during the first few years of life after a traumatic experience. Some kids develop without any problems, while other kids begin to struggle around ages 9-12. Many of my clients in this age range have experienced trauma and are now experiencing interpersonal, academic, and emotional challenges.. Their early childhood years were just fine and now that they are in school, being met with higher expectations, are asked to conform to societal standards, and must become more independent, they are struggling with the demands of daily life. For many parents and caretakers the behavioral and developmental problems that arise in late childhood are very confusing because according to the parents, behaviors come out of the blue.
  • Trauma can’t trigger life long behavior and mental health problems: Many kids who have experienced trauma are also struggling with some of the most common behavioral problems such as oppositional defiant disorder, conduct disorder, and ADHD. Attention problems, hyperactivity, and increased levels of anxiety are likely as well. Depression and phobias are also common. I’m sure you are well aware that most kids who are severely affected by trauma are diagnosed with post traumatic stress disorder.
  • Trauma can’t affect very young children: Trauma can have a sensory impact on children, according to the National Child Traumatic Stress Network. A child can hear, see, feel, or even smell things that can trigger fear, anxiety, and uncertainty. As a result, a trauma response can occur in children as young as 5 months. If the trauma is repeated and intense, the traumatic response can be much worse, interfering with proper cognitive, emotional, and physiological development. Head Start programs are very helpful in helping young children, age 0 to 5, cope with traumatizing early childhoods. The goal of these programs is to provide stability for households that are struggling and to help prevent further damage emotionally, psychologically, physiologically, and cognitively.
  • With help, anyone can get over their trauma: Trauma does not have to affect a person’s life forever if they receive the appropriate therapeutic services and have a good number of protective factors to support them. However, trauma can be so complex that a lifelong battle with flashbacks, addiction, fear, or anxiety and depression is not unheard of. Lifelong therapeutic treatment may also be required for some individuals who have experienced trauma. For many of us who have not experienced trauma, it’s difficult for us to understand just how emotionally and psychologically damaging trauma can be for many people. This doesn’t mean that a traumatized child cannot grow into a healthy adult. But it is important to understand that there will be moments of difficulty and that treatment will require patience and perseverance.
  • If you don’t see the trauma, it can’t affect you: Have you ever heard of the term vicarious (or secondary) trauma? This type of trauma affects an individual who has not personally experienced the trauma but has heard about it or experienced it second hand. Many first responders experience burn out and trauma after dealing with so many repeated cases of trauma. Natural disasters, murder scenes, child abuse and neglect, forensic work, mental health therapy, etc. can all affect first responders or even bystanders. A child who witnesses domestic violence, crime, or violent aggression can be traumatized. Believe it or not, a child who appears happy, laughs often, smiles, and enjoys typical childhood activities such as play, can also be traumatized. Children are quite resilient, but we cannot assume that because a child is being a child that they are not struggling with trauma. For many kids, their fears don’t show until bedtime or until faced with a trigger.
  • A substance-abusing parent cannot be traumatizing to a child: Believe it or not, any substance that affects a parents behavior in negative ways can be traumatizing to a child. An alcoholic parent, a heroin user, a chronic marijuana user, or a parent who abuses pills can behave in ways that negatively affects the child. An irritable, angry, abusive, and violent parent who drinks until drunk, can become even more abusive and irritable and say and do things that frightens the child. In many cases, a child of a substance abusing parent is often responsible for caring for siblings, cooking their own meals, and getting off to school. A child who sees their mother exchanging drugs on a street corner can also be traumatized by what he or she feels, sees, or hears. A drug bust or drug deal can also be traumatizing, depending on who is present or what actually happens. The simple fact that a child has to be responsible for themselves while their parent is high or drunk, can also be traumatizing. Many of my teen clients hold malice in their heart toward their substance abusing parent for these very reasons.
The most important thing to remember is that trauma affects each of us differently. The way person responds to trauma could be very different from how you or I would respond. We must also be mindful of the fact that exposure to trauma does not always mean a child will experience trauma-related symptoms or should see a trauma therapist.

In very rare cases, research has focused on children who are suggestable and have seen trauma therapists who begin to believe they were traumatized when in reality they were not. It’s a complex subject that requires further research.

In the meantime, it’s important that we all develop the appropriate knowledge about trauma and how it affects the victim. We cannot respond appropriately to the needs of a difficult child, teen, or adult until we open our minds to what could truly be affecting the individual.

About Tamara Hill

Támara Hill, M.S., NCC, LPC-BE, is a therapist working with children and adolescents suffering from behavioral and mood disorders. Although she has worked with trauma and autism spectrum disorders, she gleans most of her experience from working with parents, families, and caregivers within the mental health system as a consultant.

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