To fully understand the impact of trauma and complex trauma, practitioners will need to familiarise themselves with the primary symptoms of trauma. While each survivor’s reactions to trauma are unique and will vary from person to person and depend on the type of trauma, age, the frequency and duration of the abuse, and the relationship to the abuser(s), there are a number of commonalities.
It is crucial that survivors are helped to recognise that the physical and psychological reactions to trauma are normal responses which serve to protect us, and are elicited outside of conscious awareness or control. These reactions are like an emotional immune system, which instead of fighting invading bacteria or viruses, fights to protect us from harm.
To help survivors understand their reactions to trauma, practitioners need to be able to convey the following information in a way that is easily understood by the client and that makes sense to them. This can be supported with directed reading or self-help books such as The Warrior Within (Sanderson, 2010c). Persistent re-experiencing of trauma can be triggered by both internal and external cues. This means that even if the survivor is currently not in actual external danger, inner feelings and sensations can trigger a range of PTSD reactions. Given that they may already be in an elevated state of anxiety, it is easy to set off an already highly sensitive alarm system on the basis of internal physiological arousal. This is potentially dangerous as it prevents the survivor from recognising actual external danger and makes it hard to assess objectively the degree of safety.
To help survivors understand the neurological and physiological responses to trauma it is helpful to explore their knowledge of how the body reacts to danger. When in the presence of danger primitive biological mechanisms such as the alarm system are activated to aid survival. As a result the brain releases a cascade of neuro-chemicals which start a complex chain of bodily reactions, all of which are designed to protect us from the harmful effects of trauma.
Although the alarm system does not stop the emotional pain, stress or trauma from happening, it does cushion the trauma and helps us to deal with it.
The alarm system acts as an emotional immune system, which like the physical immune system, is activated outside of conscious awareness and is therefore not under our control. It is vital that survivors understand that whatever their reactions during the trauma, these were outside of conscious control and therefore they are not to blame or at fault for how they responded. Recognising this can dramatically reduce any crippling feelings of shame, self-blame, or guilt.
When the body’s alarm system is tripped and goes on red alert it sends signals to the brain to prepare for fight, flight or freeze. This sets off two crucial biological defence systems: the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system mobilises high level energy necessary for fight or flight, while the parasympathetic nervous system slows down the heart and metabolic rate which results in the freeze response.
The two structures in the brain that regulate the alarm system are both located in the limbic system, the amygdala and the hippocampus. The role of the amygdala is to detect threatening information through external senses such as touch, taste, sound, smell or vision. The amygdala is responsible for determining whether incoming stimuli are desirable, benign or dangerous.
To maximise survival, this evaluation is instantaneous but crude and primitive in that it does not use deeper analysis, reason or common sense. This is why it is often referred to as the ‘fast and dirty route’. If the stimulus is life threatening, stress hormones such as adrenaline and cortisol are released, which send messages through the nervous system to the muscles and internal organs to either attack, run or play dead.
The amygdala is highly sensitive to any danger and is easily activated to increase readiness to attack or defend (fight), run (flight) or submit (freeze). In contrast to the ‘fast and dirty’ route of the amygdala, the hippocampus is a much slower route in that it evaluates the external threat through deeper analysis using conscious thought, memory, prior knowledge, reason and logic. The hippocampus is also critical in laying down new memories and experiences. If the danger is truly life threatening, the hippocampus will send messages to continue with appropriate responses. If however the deeper analysis concludes that the stimuli are not dangerous it will send messages to deactivate the responses.
In most cases of threat these two structures work in harmony to balance appropriate responses to the situation. When the trauma is prolonged and repeated such as in complex trauma, the feedback loop that controls these two systems malfunctions and floods the body with high levels of stress hormones.
While these stress hormones are critical for survival, they are highly toxic and only designed to circulate for short periods of time so that the individual can get to a place of safety or remain safe until the threat is over. In the case of certain traumas such as CPA or CSA where the child cannot fight or run to safety, the only option is to freeze. This means that the stress hormones cannot be discharged and remain in the system, which can have a number of negative consequences, not least forcing the alarm system to remain on red alert, or ‘online’(Sanderson, 2010c).
Evidence shows that high levels of cortisol that are not discharged can lead to the destruction of brain cells which can affect the function and size of the amygdala and hippocampus (Gerhardt, 2004; Teicher, 2000). Such malfunction leads to increased arousal, fear and anger responses, as well as memory impairments. When the brain and body are flooded with chronic levels of stress hormones the hippocampus goes ‘offline’and is unable to accurately evaluate the degree of threat or danger. It is also not able to assess whether the danger is internal or external, or whether the traumatic incident is over or on-going, and cannot send the appropriate messages to the amygdala to deactivate the alarm system. This leads to the alarm system remaining on constant red alert and the continued release of stress hormones.
As a consequence the body responds as though the trauma is on-going, even after the threat is over. Over time the alarm system is reset on a default setting of ‘on’, with survivors feeling as though they are being repeatedly traumatised. This leads to a heightened or continuous state of danger, known as hyper-arousal.
This hyper-arousal forces stress hormones to continue to flood the body and brain, and the tyranny of post-traumatic stress responses. Since the hippocampus is not able to regulate the alarm setting, or halt the release of chronic levels of stress hormones, its ability to store new memories is reduced. This means that the trauma is not stored within context or time, making it seem as though it is continuous and never ending.
This in turn prevents the processing of the trauma keeping it ‘online’ with the same vividness and intensity as when the actual assault happened. Not being able to process the traumatic experience makes it harder for survivors to store it in memory or to recall it leading to amnesia, or incomplete or fragmented memories. A crucial goal in recovering from complex trauma is to bring the hippocampus back ‘online’ so that its function can be restored to regulate the alarm system to evaluate danger, and differentiate between internal and external threat.
Prolonged release of high levels of stress hormones impacts on physical well-being leading to a range of physical problems such as hypertension, physical exhaustion, chronic fatigue syndrome (CFS), sleep impairment, and digestive, respiratory and endocrine problems. In addition, chronic fear reactions and high levels of adrenaline evoke waves of overwhelming anger which survivors cannot release for fear of consequences, thereby creating even further stress. Hyper-arousal also affects concentration and the ability to reflect on or process experiences, preventing survivors from making sense of their experiences.
While the alarm system can activate three alternative reactions – fight, flight or freeze – in most cases of complex trauma, especially when it occurs in childhood, there is only one option: to freeze. The freeze response is designed to conserve energy so that the individual can escape when the danger is over. Young children are not able to outrun or fight an adult effectively, and are thus left with no option but to freeze.
While the freeze response protects the individual from the greater threat of the consequences of fighting back or running away, it is often experienced as passive submission. This can make survivors feel as though they were weak in not fighting back or running away, which can lead to shame, self-blame and guilt. It is important to convey to survivors that realistically children are not able to escape, especially if the abuser is a significant figure in the child’s life such as a parent, relative or priest. In that moment they are both powerless and helpless.
However, the sense of submission can often haunt them and leave them feeling ashamed that they did not do more to prevent the abuse. This is also true for adults who are in thrall to an abuser who has power and authority over them. The freeze response also protects individuals from the full impact of the pain of the abuse.
As the parasympathetic nervous system kicks in, a sense of calmness descends on the brain, slowing everything down, and the body begins to feel numb in order to cushion the anticipated pain and the emotional terror of the trauma. Once the danger is over, these reactions fade and the stress hormones are discharged through movement.
Understanding the responses to trauma and conveying them to individuals suffering from them can help them recognise their own reactions and how to deal with them. This will empower them and give them the confidence to break free of the hold traumatic experiences have on them.