Trauma and

Post Traumatic Stress

Janet Louise Parker,

B.S., M.S., D.V.M.

“People are like stained glass windows. They sparkle and shine when the sun is out; but when the darkness sets in, their true beauty is revealed only if there is a light within.” Elizabeth Kübler-Ross

Positive Stress (or eustress)

• Competent management

• Mature leadership

• Everyone is valued and supported.

enhances well-being

• Enhances performance and fuel

achievement.

Negative Stress (or distress)

• Threat

• Coercion

• Fear

• Dysfunctional and inefficient

management

• Diminishes quality of life

• Injury to health

Post Traumatic Stress

Post Traumatic Stress Disorder

(PTSD) is a natural emotional

reaction to a deeply shocking

and disturbing experience. It is a

normal reaction to an abnormal

situation.

Who Gets PTSD

• Crime Victims

• Persons experiencing death of family

member, friend, co-worker

• Returning Veterans

• Cancer Survivors & their family

• Domestic Violence Victims

• Sexual Assault Victims

• Targets of Workplace Bullying

Origin is External not Internal

• Any human being has the potential to

develop PTSD

• Cause external – Psychiatric Injury

not Mental Illness

• Not resulting from the individual’s

personality – Victim is not inherently

weak or inferior

DSM-IV-TR (APA, 2000)

Impact of Trauma

• Difficulty trusting others and forming close

relationships (may appear withdrawn,

uncooperative, defensive or aggressive).

• Fear or concern about safety.

• Difficulty managing and expressing feelings.

• Lack of belief in self-worth and capabilities.

Hyper-arousal

• Hypervigilance

• Irritability

• Depression

• Proneness

to anger

• Exaggerated startle

response

• Sleep disturbance

• Dissociation

• Problems of

concentration

• Vulnerability to

medical illness

Traumatic Memory

• Intrusive

recollections

• Nightmares

• Emotional

(somatic)

memories,

actingout/

reliving trauma.

• Reenactment

play

• Perceptual

illusions

• Dissociation,

memory retrieval

Denial

• Avoidance

• Emotional

numbing,

• Amnesia,

• Loss of active

social

interpersonal

engagement,

• Substance abuse,

• Social/geographical

isolation

• Desexualization,

estrangement and

detachment

• Obsessive-

compulsive

• Attention diversion

as defense

Self-concept, Ego states

• Demoralization,

ego fragmentation

• Identity diffusion

• Vulnerability

• Loss of spirit and

vitality, dysphoria,

• Prone to

dissociation,

hopelessness and

helplessness

• Shame, guilt

• Misanthropic

beliefs

• Faulty cognitions

Interpersonal relations:

• Alienation

• Mistrust

• Detachment

• “Boundary”

problems with

others

• Issues of loss,

abandonment

• Impulsiveness

• Self-destructive

relationships

Patterns of anticipation

• Individuals suffering from PTSD live

daily life as if the traumatic

experience is recent, even though it

may have happened years earlier.

• Triggers will cause the event to be

re-experienced.

• “Isolation and paralysis of the

mind”(Holter, 2005, abstract).

NCPTSD, July 4, 2007

• 32 % War experiences

• 48 % Abuse (spousal, childhood,

sexual, bullying)

• 19 % Crime

• 18 % Accidents

• 8 % Acts of terrorism

• 5 % Natural disasters

Response to Chronic Stress

• Breakdown of immune

system

• Increased heart rate and

blood pressure

• Increased cortisol level

• Shrinking of the hippocampus

(affecting learning and memory)

• Enlargement of the amygdala

(affecting emotional behaviors)

Dissociation

• PTSD is “soul murder”

• Disconnection between the traumatic

events and the meaning associated

with those events

• Interferes with ability to verbalize the

events and their meaning

3 Levels of Victimization

1. Loss of feelings of safety, loss of

perception of an orderly world, and

loss of a positive sense of self.

2. People do not believe, and deny the

severity of the trauma thus blaming

and stigmatizing the victim. (Ridicule

and Punishment)

3. Perceiving oneself as a victim with

no personal power

Daubert Standard

• Standard for admitting expert

testimony

• Scientific basis for professional

opinions

Federal Rule of Evidence 702 when evaluating claims of

psychological injuries as authorized by the Civil Rights Act

of 1991

Trauma-Informed Services

Trauma-informed

• Problems/Symptoms are

inter-related responses to

or coping mechanisms to

deal with trauma.

• Providing choice,

autonomy and control is

central to healing.

• Primary goals are defined

by trauma survivors and

focus on recovery, self-

efficacy, and healing.

• Proactive – preventing

further crisis & avoiding

retraumatization.

Traditional Approaches

• Problems/Symptoms are

discrete and separate.

• People providing services

are the experts. Trauma

Survivors broken, &

vulnerable.

• Primary goals are defined

by service providers and

focus on symptom

reduction.

• Reactive – services and

symptoms are crisis driven

and focused on minimizing

liability.

Understanding Trauma

• Anxiety causes traumatized individuals to have

difficulty in processing information.

• Understanding trauma response and its triggers.

• Recognizing behaviors as adaptations.

• Identifying and reducing triggers to avoid re-

traumatization.

Poor Support – Intensifies

Damage

When an individual

suffering from

PTSD is unable to

resolve issues

related to the

trauma he/she is

unable to establish

a new baseline of

biopsychosocial

functioning.

Secondary Re-Traumatization

• The loss of human potential is

incalculable.

• Society has a tendency to blame the victim

for not being able to simply “get over it”

and this cultural lack of support can be

classified as secondary wounding and

promotes a victim mentality, thus keeping

the problem going.

“Human beings, like plants grow in the soil of acceptance, not in the atmosphere of rejection.” John Powell, S.J.

Re-Experiencing Trauma

• Re-experiencing original trauma (symbolically or actually).

• Trauma Survivor responds as if there is danger even if it is not actual danger.

• Triggers may be subtle and difficult to identify.

“One of the most courageous things you can do is identify yourself, know who you are, what you believe in, and where you want to go.”

Sheila Murray Bethel

Trauma Victims Disposable?

• Our society views many objects as

disposable and when an object is

tarnished or dented the tendency is

to deem its value gone, throw it away,

and rush to the stores to replace it.

• Humans are not objects, and the

growth potential available though the

healing process is infinite.

From Vulnerability to Strength

Celebration – Self Actualization

Overcoming Vulnerability – Recognition

Compensation – Self Esteem Needs

Sharing with Others (Sense of

Belonging)

Exploring Protection Needs

Identifying Safety Needs

Denial of Vulnerability

Elimination of Danger

Vulnerable

Promoting Safety

• Because PTSD is “soul murder” and splinters the sense of self, and creates acute mistrust in the individual’s environment .

• Provide a safe physical environment.

• Provide emotional safety: tolerance for wide range of emotions.

• A Sense of Safety is Critical to relationship building.

Build Trust – Long Term

Process

• PTSD changes the diagnosed

individual’s life and greatly impacts

the lives of those with whom they are

close and regularly interact.

• Trusting relationships are

essential to combat the

dehumanizing effect of trauma.

Supporting Control,

Choice & Autonomy

• Trauma survivors feel powerless.

• Equalize power imbalances.

• Recovery requires a sense of power and control.

• Relationships should be respectful and support

mastery.

• Trauma Survivors should be encouraged to make

choices.

Communicating Openly

“If I can listen to what he tells me, if I can understand how it seems

to him, if I can sense the emotional flavor which it has for him, then

I will be releasing potent forces of change within him.”

Carl Rogers

• Respect Trauma Survivor’s right to open

expression.

• Discourage withholding information or keeping

secrets.

Integrating Care

• Because of the dehumanizing nature of trauma it

is important that care approaches deal with the

client holistically as opposed to treatments

designed solely to reduce symptoms.

• Trauma Survivor’s symptoms and behaviors are

adaptations to trauma.

• Services should address all of the survivor’s

needs rather than just symptoms.

Fostering Healing

• Humans are not objects, and the growth

potential available though the healing

process is infinite.

• Instilling hope.

• Strengths-based approach.

• Future orientation.

• Cultural Competence

Inward Reflection

• Trauma causes individuals

to look spiritually inward.

• The “healed self that was once

traumatized can project itself into the

future with joy, serenity, and a

measure of wisdom.” Walsh (1985)

According to Wilson et al., 2001

Individuals, once healed, are

“potential guides, healers, teachers,

and may be subjects of scientific

inquiry concerning resiliency,

salutogenesis, and self-efficacy”

UPSIDE to Trauma?

Inspirations

“Great minds have purposes, others have wishes. Little minds are

tamed and subdued by misfortune, but great minds rise above them.”

Washington Irving

“Sometimes I think that the main obstacle to empathy is our persistent belief that everybody is exactly like us.” John Powell, S.J.

“The deepest craving of human nature is the need to feel appreciated.” William James

“Great Things are not done on impulse but by a series of small things brought together.” Vincent van Gogh