The Traumatized Self:
Falling Apart on the Inside
When you’re born, a light is switched on, a light which shines up through your life. As you get older the light still reaches you, sparkling as it comes up through your memories. And if you’re lucky as you travel forward through time, you’ll bring the whole of yourself along with you, gathering your skirts and leaving nothing behind, nothing to obscure the light. But if a Bad Thing happens, part of you is seared into place and trapped forever at that time. The rest of you moves onward, dealing with all the todays and tomorrows, but something, some part of you, is left behind. That part blocks the light, colors the rest of your life, but worse than that, it’s alive. Trapped forever at that moment, and alone in the dark, that part of you is still alive.
—Michael Marshall Smith, Only Forward
Situations that explode our sense of what “normal” is can leave us feeling shaken and shattered. They can also leave us with a fragmented sense of our inner world. Significant traumatic moments may remain unprocessed within us due to the phenomenon of psychic numbing or the mind’s urge to throw frightening circumstances out of conscious awareness at the very same time that it is recording emotions and sense impressions that are part of that very experience.
A Mind/Body Picture of PTSD
It has long been recognized that the disturbing experience of war can produce reactions of shell shock or battle fatigue causing those who experience them to suffer both personally and in relationships long after they return home. Professionals in the mental health field began to recognize that children who grew up with adverse childhood experiences exhibited many of the same post-traumatic stress disorder (PTSD) symptoms that returning Vietnam war veterans exhibited (van der Kolk 1987). Following are some of the mind/body phenomena that underlie PTSD and cause it to have long-term impact.
Problems with Self-Regulation
The loss of neuromodulation (the ability to regulate moods) that is at the core of PTSD can lead to emotional dysregulation. Traumatized people tend to go immediately from stimulus to response without being able to first figure out what makes them so upset. They tend to experience intense fear, anxiety, anger, and panic in response to even minor stimuli. This can make them either overreact and intimidate others, or shut down and freeze (van der Kolk 1994).
Dysregulation involves both the mind and the body. We move from states of hyperarousal (that may include heart pounding, sweating, increased adrenaline, shortness of breath, dry throat, or shaking) to shutting down. Our emotions run strong when traumatic moments from our past are triggered in our present; we can have racing thoughts and disruptive imagery that dance along the surface of our mind. Because we experience these emotions and sensations in our bodies and because they are actually physical, we may want to swing into some form of action. Then, if action seems futile or impossible, we shut down; we go numb. This is the trauma dance: high intensity reactions followed by shutting down. Twelve-step programs have a colloquial expression for this cycling, referring to it as “black-and-white thinking.” We move from one extreme to the other and have trouble holding an intelligent center.
Hypervigilance/Anxiety
Hypervigilance is a symptom of PTSD and refers to the experience of being constantly tense and on guard. People experiencing this symptom of PTSD tend to scan their environment and relationships for signs of potential danger or repeated relationship insults and ruptures (van der Kolk 1987). At extreme levels, hypervigilance may appear similar to paranoia. The individual is constantly trying to read the faces of those in the environment in order to protect themselves against perceived pain or humiliation. Unfortunately, this hair-trigger reactivity can lead to perceptions of problems that do not exist, and, inadvertently, to their development, or to an exaggeration of problems that might have been easily managed.
Van der Kolk describes hypervigilance as an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats (van der Kolk 1987). Hypervigilance can also be accompanied by physical symptoms such as a state of increased anxiety, which can cause exhaustion, abnormally increased arousal, or a high responsiveness to stimuli. People experiencing hypervigilance may become preoccupied with studying their environment for possible threats, causing them to lose connections with their family and friends. They will overreact to loud and unexpected noises, become agitated in highly crowded or noisy environments, and may have a difficult time getting to sleep or staying asleep (van der Kolk 1987).
Numbing of Responsiveness/Emotional Constriction
Numbing is a natural part of the trauma response and may mean that those who have experienced trauma have a restricted range of feelings that they are comfortable experiencing and expressing.
Aware of their difficulties in controlling their emotions, traumatized people seem to spend their energies on avoiding distressing internal sensations, instead of attending to the demands of the environment. In addition, they lose satisfaction in matters that previously gave them a sense of satisfaction and may feel “dead to the world.” This emotional numbing may be expressed as depression, as anhedonia and lack of motivation, as psychosomatic reactions, or as dissociative states. In contrast with the intrusive PTSD symptoms, which occur in response to outside stimuli, numbing is part of these patients’ baseline functioning. In children, numbing has been observed among elementary school children attacked by a sniper, among witnesses to parental assault or murder, and among victims of physical or sexual abuse. They become less involved in playful social interactions, and often are withdrawn and isolated. After being traumatized, many people stop feeling pleasure from exploration and involvement in activities and they feel that they just “go through the motions” of everyday living. Emotional numbness also gets in the way of resolving the trauma in psychotherapy: they give up on recovery and it keeps them from being able to imagine a future for themselves (van der Kolk 1994).
Somatic Disturbances: Body Aches and Pains
When a person is unable to experience or act on powerful emotions, those emotions may be experienced somatically as back pain, chronic headaches, muscle tightness or stiffness, stomach problems, heart pounding, or headaches. People traumatized as children may suffer from alexithymia—an inability to translate somatic sensations into feelings such as anger, happiness, or fear. This failure to translate somatic states into words and symbols causes them to experience emotions simply as physical problems (Saxe et al 1994).
Learning Difficulties
Physiological hyperarousal interferes with the capacity to concentrate, attend, and learn from experience. Aside from amnesias about aspects of the trauma, traumatized people often have trouble remembering ordinary events as well. Easily triggered into hyperarousal by trauma-related stimuli, along with a compromised ability to attend and pay attention, they may display symptoms of attention deficit/hyperactivity disorder.
Unresolved grief can also contribute to learning disabilities. In a study of bereaved adults with learning disabilities, only about half were known to have attended the funeral of their deceased parent (Hollins and Sinason 2000). As a group, these bereaved adults demonstrated more psychopathology and behavioral disturbances, including irritability, anxiety, adjustment difficulties, and depression than the controls. Nearly three-quarters of them were unaware of any connection between blocking their grief and their learning issues. A follow-up of this study group after five years pointed to the likelihood of delayed and/or prolonged grief in many people with learning disabilities, particularly those who had not had a bereavement-related intervention (Bonell-Pascual et al 1999), such as a funeral. This doesn’t mean that all losses require intervention, only that loss needs to be somehow felt and processed; funerals, friends, and family can be sufficient supports if not avoided. But family traumas, such as addiction, divorce, or dysfunction, often go unacknowledged and without bereavement.
Sleep Problems
Adults and children with hyperarousal and a loss of neuromodulation may experience sleep problems, both because they are unable to still themselves sufficiently to go to sleep and because they are fearful of having traumatic nightmares. Many traumatized people report dream-interruption insomnia: they wake themselves up as soon as they start having a dream for fear that the dream will turn into a trauma-related nightmare. They are also liable to exhibit hypervigilance, an exaggerated startle response, and restlessness.
Aggression, Anger, or Rage Against Self and Others
Issues with anger and aggression are part of the PTSD syndrome; ACoAs can carry resentments that morph into problems with anger management, rage issues, acting out behaviors, passive aggression, or self-medicating. They may not even know they are angry; that anger may be quite unconscious and unprocessed.
Another manifestation of unprocessed anger is depression. ACoAs may turn their anger against themselves and become listless, isolated, and sullen. Or they may act it out; they become the screw-up and blow up their own lives. They drink, drug, cut, or fall apart, engaging full-out in self-destructive behaviors that undermine their happiness and success. All of these are ways of not feeling the anger they carry.
Numerous studies have demonstrated that both adults and children who have been traumatized are likely to turn their aggression against others or themselves. Being abused as a child sharply increases the risk for later delinquency and violent criminal behavior. In one study of 87 psychiatric outpatients we found that self-mutilators invariably had severe childhood histories of abuse and/or neglect. There is good evidence that self-mutilative behavior is related to endogenous opioid changes in the CNS secondary to early traumatization. Problems with aggression against others have been particularly well documented in war veterans, traumatized children and in prisoners with histories of early trauma (van der Kolk et al 1991).
Learned Helplessness
When we feel that nothing we can do will affect or change the situation we’re in, we may develop learned helplessness. We may lose some of our ability to take actions to affect change (Peterson, Maier, and Seligman 1995). As a technical term in animal and human psychology, learned helplessness refers to a state of collapse in which one behaves helplessly, even when the opportunity is restored to help one’s self by avoiding a dangerous or harmful situation.
Research studies found that the strongest predictor of a depressive response to a situation is a perceived lack of control over a circumstance. Illustrating this point are experiments done with people performing mental tasks while there is distracting noise. Those who had access to and could use a switch to turn off the noise had improved performance, even though they rarely bothered to do so. Simply knowing this option was available was enough to substantially counteract its distracting effect (Blumenthal et al 1999).
Making positive choices builds resilience and makes it less likely that those affected by adverse circumstances will develop PTSD. Even participating in cleanup efforts of one’s environment after a disaster builds resilience. Children who are trapped in dysfunctional homes benefit by making choices to better their lives in small ways; babysitting to get out of the house and earn some money and having extracurricular activities, friends, or programs to attend where they can feel safe, can all reduce the feeling of being trapped and helpless. Recovery for ACoAs is also a way of beginning a choice-making process that will counter the effects of learned helplessness.
Intrusive Reexperiencing
Traumatized people may experience past trauma intruding into their “normal” consciousness in a variety of ways—through memories, dreams, distress responses, or flashbacks. They may have flashes of traumatic imagery, overpowering emotions, or feel defined by what happened to them and fearful of a repetition of anything like it occurring again. Remembrance and intrusion of the trauma is expressed on many different levels, ranging from flashbacks; mood swings; somatic sensations, or body aches; nightmares; interpersonal reenactments, including transference repetitions; personality characteristics; and pervasive themes that play out in one’s life.
Dissociation/Memory Disturbances
Extreme fear such as that experienced by CoAs can cause them to “leave their bodies,” to feel they do not “live in their own skin,” so to speak. There may be an experience of “derealization”—or feeling as if they or the world is not “real”—and “depersonalization”—feeling as if they are losing their identity or adopting a new identity. Dissociation can involve a feeling of disconnection from the body or surroundings, either momentary or lasting ones. Dissociation may also involve “losing time” or experiencing amnesia regarding entire traumatic events or significant periods of them.
The person who dissociates has “difficulty tolerating and regulating intense emotional experiences. This problem results in part from having had little opportunity to learn to soothe oneself or modulate feelings, due to growing up in an abusive or neglectful family, where parents did not teach these skills” (Rauch, Metcalfe, and Jacobs 1996; van der Kolk and Fisler 1996). When we feel overwhelmed with intense emotion that we cannot regulate, we psychically and emotionally disconnect from the situation that is overwhelming us while still staying physically in it. We zone out, and “depersonalization, derealization, amnesia and identity confusion can all be thought of as efforts at self-regulation when affect regulation fails. Each psychological adaptation changes the ability of the person to tolerate a particular emotion, such as feeling threatened” (ibid).
During the stage of life that children naturally try on different identities in their daily play activities, children who are exposed to prolonged and severe trauma may even be capable of organizing whole different personality fragments in order to cope with traumatic experiences. Over a long period of time, and in cases where there is severe trauma, this may give rise to the syndrome of dissociative identity disorder (DID), which may occur in about 4 percent of psychiatric inpatients in the United States (Saxe et al 1993).
Desire to Self-Medicate
Someone who is coping with the sorts of symptoms here described may become engaged in a compulsive relationship with alcohol, drugs, food, sex, work, or money as a way of quieting the disturbing mental, physiological, and emotional disequilibration that the symptoms engender. Self-medicating can seem to be a solution, a way to calm an inner storm and restore “balance,” as it really does make pain, anxiety, and body symptoms temporarily abate. But in the long run, it creates many more problems than it solves.
Hyperreactivity
Living with relationship trauma can oversensitize us to stress, causing us to overrespond to stressful situations and blowing out of proportion conflicts that could be managed calmly; we overreact. This hyperreactivity can emerge whether we are in a slow grocery line, in traffic, at work, or in relationships. Triggers can be stimuli reminiscent of relationship trauma. Feeling helpless, rejected, abandoned, or humiliated can trigger old vulnerability. Being around yelling or criticism, or even observing certain facial expressions on others, may trigger a stronger reaction than is appropriate to the situation. So can being in closed-in places that make one feel trapped. Because traumatized people often have a loss of neuromodulation and self-regulation, they may not be able to “right size” their emotions once they have been triggered. They may explode and get aggressive or implode and withdraw. Working with these triggers and working through the unconscious feelings from the past that drive them is central to the treatment of the ACoA trauma syndrome.