Effects of prolonged trauma on Self-Functions

May 16th, 2013

February 15, 2012

The core elements of the PTSD construct  consist primarily of  the three  “symptom-domains”,  of  “Intrusive Symptoms” (such as flashbacks), “Over-Arousal” (such as heightened vigilance and exaggerated startle-response), and ‘Avoidance”.

This is the most common outcome to a single, life-threatening event  (or Type-I Trauma).

In contrast, individuals subjected to repeated physical  or emotional “abuse”, are more likely to show deficiencies in completely different domains that involve the functioning of “the self”.

Poor early- attachment relationships, deficient emotional nurturance, boundary violations and the lack of a safe “holding-environment” tends to affect the victim of  such chronic trauma in ways ranging from how they think  to how they emotionally regulate.

Many victims of chronic abuse fail to recall their abuse, but present with a characteristic  array of  disturbances ranging from self-perception, and subservience in relationships, to  physical symptoms entirely disconnected  from their traumatic origins.

Issues with Power Failure or Submission

Predatory behavior can be observed  both in the interpersonal and global arenas.

The victim is often unaware of a personal trauma history as these painful events are “repressed”.

Throughout life, most un-recovered victims organize subsequent relationships around the original abuse-dynamic.

All new relationships may follow a limited template focused on personal safety dominated by appeasement and obedience.

Victims may feel unwittingly trapped within in relationships since they have a narrow range of expected outcomes.

Since victims of early-interpersonal trauma suffer a loss of personal autonomy they may relinquish their personal rights and dignity in order to remain attached.

Abuse-generated expectations and survival tactics may carry-over into the larger world.

Trauma-victims may not feel entitled to self-regard, respect, or affection. They may allow continued abuse by all authority figures, and lack the skills to identify or free themselves from these negative entrapments.

Women may find themselves repeatedly lured by men who are sexually exploitative or degrading, yet cannot be assertive or disrupt their participation in such relationships.

The notion of escape overwhelms them with fear.

Chronic trauma-victims cannot perceive an alternative way to move beyond this narrow script.

In general, such relationships lack spontaneity and fluidity. Victims cannot articulate their goals or make life choices until they have transcended their trauma narrative.

Gaining “ownership” of the “trauma narrative” provides victims the opportunity to enjoy the full landscape of social freedom.

Confronting these maladaptive self-schemas and reclaiming self-agency is a vital component in the recovery from Complex Trauma.


Negative Interpersonal Schemas

As we grow up from infancy, each of us forms mental pictures, “templates,” or “models” of relationships with others, which I refer to as an “interpersonal schemas.”

They are built primarily by our early relationships with parents or other caretakers, and these interpersonal memory templates will influence the dynamics of our future relationships with others.

Victims of interpersonal abuse usually have negative interpersonal schemas that they carry over into their lives as they grow older, and tend to reenact.

Eventually those individuals, abused during childhood, tend to relive the traumatic events in their adult lives.

According to the school of “Cognitive Therapy,” abuse schemas subsequently sabotage all interpersonal relationships.

The victim’s schemas will later translate into miserable or dysfunctional relationships, and such individuals live in a world where to be “attached” means to be “abused.”

The basic elements of the abuse-generated schema are the following:

  • Children have a normal instinct to seek attachment and comfort, even from bad caregivers.
  • Models learned within the context of traumatic relationships become programmed into the brain and are called “interpersonal schemas.”
  • These schemas guide subsequent expectations and behaviors in future interpersonal situations.
  • Childhood abuse distorts and disrupts the formation of healthy schemas.
  • Abused or neglected children carry these distorted schemas into adulthood.
  • These schemas might continue to influence your experiences and feelings about relationships and events throughout your life.
  • They can inadvertently result in patterns of repeated negative relationships.
  • You may be easily exploited or feel helpless to stand up against predators.
  • Such schemas have to be re-shaped in recovery.

Identifying and changing unhealthy relationship patterns are central to the reversal and disruption of these abusive patterns.

Such patterns have to be replaced by the victim’s capacity to feel safe, confident, and empowered in all relationships.

The achievement of this goal frees the individual from the compulsion to “act out” past traumas in the present.


Prolonged trauma and cognition

During the Cold War, individuals living under Soviet rule would have to be on constant guard against “thought police.”

Children were indoctrinated in school to inform authorities if their parents spoke critically or questioningly against “the State,” even within the privacy of their home.

In political tyranny, rulers routinely use propaganda and intimidation to “dumb down” the masses. In order to keep group members obedient, political tyrants and cult leaders  project their image  as being larger-than-life  or  transcendent in quality and worthy of  the blind faith of their followers.

A common methodology of creating a culture of obedience and capitulation is via the fabrication of simplistic ideologies.

This form of interpersonal abuse would fall under the title of “political terrorism.” It is more likely to thrive under conditions of fear, deprivation. Young adults with undeveloped sense of personal identity are most vulnerable.

The scourge of modern terrorism is built on a paradigm of creating fear and confusion while offering ideological remedies.

The Stockholm syndrome

The concept of the “Stockholm syndrome” began on August 23, 1973, when Jan Olsson began a bank robbery that would forever transform the spectrum of how the world would view the outcome of hostage situations.

It started with the storming of a local Kredit Bank in downtown Stockholm, Sweden, and the shooting of the police officers who had gone in after Olsson.

With this action, a six-day ordeal and hostage situation known as the Norrmalmstorg Robbery began.

Three women and one man were confined to a small room, fighting to survive.

The four hostages were taken into the bank’s vault. Dynamite was strapped to them, and they were rigged to traps that would kill the hostages regardless of any rescue attempts.

Yet when these captives were released, they had more sympathy for their captors than the police who had rescued them – and went so far as to publicly decry their own rescue.

Two of the hostages became friends with the captors, establishing a fund to help pay for their defense fees accrued through the trial. They continue to support their captors against the police even today.

The psychologist Nils Bejerot named the captives’ attachment towards their abusers the “Stockholm Syndrome.”

While the phenomenon of “emotional bonding” between hostages and their captors had been familiar in psychological circles, the use of the term “Stockholm syndrome” became popularized following the publicity of two more high profile hostage cases: Patricia Hearst and Elizabeth Smart. Both cases involve the kidnapping of a woman to pursue the ideals of their captors.

The Stockholm syndrome refers to the unique bond of loyalty established between a hostage and his or her captor occurring within the dynamic of the victim’s absolute dependence upon the predator.

This unique attachment established between the victim and captor evolves from the exclusive dependence by the former on the latter.

In exchange for the restricted life granted by the captor, these victims are willing to adopt a false reality in which no harm can come to them.

In the case of Elizabeth Smart, instincts of survival and protection produced the development of a strong bond between herself and Brian Mitchell, characteristic of a Stockholm syndrome.

During her captivity, an attachment developed towards her captor to the point where she even adopted, as her own, the propaganda presented to her.

This paradoxical sense of loyalty was exemplified by her behavior in the willful obstruction of rescue attempts by family and law enforcement.

Smart had heard her uncle searching and calling for her, not far from her hidden location, but did not call out or attempt to draw attention to herself.

The pervasive resistance to be rescued dominated the entire nine months during which she was kept hostage.

It took several years after returning to regular life before Smart was able to testify against her captor.

This reality-distortion of idealizing cult-leaders can also be witnessed in modern history with public idealization of leaders such as Kim-Jong – II,  a merciless tyrant who constellated public support, even adoration, while bankrupting his country and allowing two million citizens to die of starvation.

In an apparent act of self-deception, victims of Stockholm syndrome believe that their irrational empathy for their captors and their ideologies will protect them.

The psychological dynamics of dominance that determine subservient bonding patterns have been observed amongst abused children, cult members, mistreated prisoners of war, and criminal hostage situations.

However, on a more global scale these same predatorial dynamics still occur under Socialist dictatorships such as the Soviet Union, China and North Korea.

In this fashion (through a combination of threat, isolation, and propaganda), political tyranny continues to assert itself over the collective consciousness of large populations inducted into the mythical ideologies of their rulers.

When entire communities lose their power of critical thinking, who is there to protect them from the exploitation of their leaders?

Trauma and Emotional Dysregulation

Emotional regulation refers to our capacity to tolerate all kinds of emotional states while feeling comfortable in one’s own skin and positively engaged in life.

This requires the capacity to soothe oneself, while staying connected with one’s environment.

Victims of severe or prolonged psychological trauma, however, are more likely to feel they are living in a world dominated by internal emotional turbulence or dysregulation.

Abused children are more likely to feel constantly negative, and are more easily upset by seemingly trivial triggers.

Since abuse victims lack the capacity to neutralize unpleasant feelings or “self-soothe,” they are prone to erupt in the form of angry outbursts.

When triggered, this can lead to self-directed rage, or this can be displaced towards others who serve as triggers to a chain-reaction of unexplained emotional and impulsive behavior.

Alternatively, victims may escape overwhelming distress by numbing themselves with alcohol or illicit drugs, or engaging in other self-injurious behaviors such as binging or self-mutilating.

Effective emotional regulation contributes to more fulfilling relationships, work-effectiveness, and parenting.

Strategies for regulating emotions are learned throughout development, but are primarily embedded in early development by our parents or other caretakers.

Abused children often report parents being unable to respond effectively to their needs, as well as being unable to regulate their own emotions.

Good parenting involves a parent correctly identifying and validating a child’s experience. This is sometimes referred to as a “mirroring response.” When children feel protected, they are more successfully able to learn effective coping strategies, both cognitively (“everything will be all right”) and behaviorally (such as eliciting social support).

Healthy maturation allows one to face negative emotions in relationships by holding onto good internalized objects (such as parents) which have a soothing and containing effect.

When this capacity is lacking because of early neglect or abuse, victims are more likely to continuously re-experience and reenact their early abuses without any emotional safety buffers.

The Neurobiological underpinning of mood dysregulation appears to be driven by the loss of Hippocampal volume, particularly in the left-brain, during prolonged trauma. This results in the accumulation of cytotoxic levels of glucocorticoids and glutamate.

The Hippocampus and amygdala are structures in the limbic brain that are respectively responsible for the restraint or activation of the Hypothalamic-Pituitary-Adrenal Axis.

Magnetic Resonance Spectroscopy and other functional imaging techniques have recently demonstrated that the right Hippocampus mediates unpleasant moods and subjective experiences, which include feeling endangered and becoming hyper-vigilant.

The left Hippocampus, in contrast, mediates a sense of comfort and well-being.

The fact that trauma appears to cause more shrinkage on the left has a compounding result of more unpleasant feelings, as well as excessive emotional arousal.


Somatic Symptoms of Trauma

Rothschild describes how the body remembers psychological trauma.

She explains that while trauma is experienced emotionally, it is interpreted cognitively;and expressed physically (The Body Remembers: The Psychophysiology of Trauma. W.W. Norton, 2000).

The central nervous system stores trauma memories somatically.

In other words, the emotions connected to a trauma may be carried in somatic memory storage. Therefore, the body can remember a trauma that the conscious mind does not.

It is interesting to note the early association between trauma and physical ailments by Freud and Janet.

The early psychoanalysts often identified victims of childhood abuse (sexual molestation in particular) as presenting frequently with symptoms of chronic pain, digestive symptoms, and sexual symptoms.

Other common symptoms associated with an overestimated autonomic nervous system include insomnia, fatigue, fibromyalgia, headaches, and irritable bowel syndrome.

Sometimes psychogenic-induced symptoms are referred to as “conversion symptoms.” The theory behind this phenomenon is dissociation, whereby unbearable psychological pain is “split off” from consciousness and “parks itself” in the victim’s body organs.

Trauma recollections can then function as triggers to elicit pain, allergic hives, or menstrual pain or irregularities, depending on the nature of the trauma and corresponding trigger.

In addition, since PTSD causes prolonged activation of stress systems, PTSD patients may be at risk for cardiovascular disease resulting from increased platelet stickiness and hypercoagulability.

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