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Trauma / PTSD

 

 

The word trauma means injury or wound. When we talk about psychological trauma, we mean a type of event that can lead to psychological damage that afflicts the affected person in retrospect. 

Photo: by Marina Vitale on Unsplash


 

What is a traumatic event?

The Norwegian Psychological Association writes [Norwegian Psychological Association, 2021][1] :

The word trauma means injury or wound. When we talk about psychological trauma, we mean a type of event that can lead to psychological damage that afflicts the affected person in retrospect. There are many different definitions of traumatic events, but common to most is that trauma: 

 

  1. Comes suddenly, is uncontrolled and overwhelming,
  2. Usually arouses an extreme feeling of helplessness and fear
  3. Is often a threat to life and health
  4. May cause serious injury
  5. and / or strikes others so that you witness serious abuse or the suffering or death of others.

 

Reactions after trauma

The Norwegian Psychological Association writes further [Norwegian Psychological Association, 2021] :

Most people will have strong psychological reactions during a life-threatening event and in the immediate time thereafter. It is common for many to feel rushed and scared. They splash more easily, struggle to sleep and concentrate. It is also common to have intrusive images or sensory sensations associated with the trauma event, both during the day and in dreams. For some, these intrusive images can be so strong that it feels as if the traumatic event is happening again, so-called "flashbacks". Many people also have a feeling of confusion, they have memory problems, or they feel numb and distant. It is also common to feel ashamed or guilty of what one has experienced. 

After a single traumatic event, for most people these reactions will subside after some time. For some, however, the ailments will persist or return, which is diagnostically referred to as post-traumatic stress disorder (PTSD). 

 

Post-traumatic stress disorder (PTSD)

The ICD-10 Diagnostic Manual describes PTSD as follows [ICD-10][2] :

Occurs as a delayed or prolonged reaction to a stressful life event or situation (of short or long duration) of an unusually threatening or catastrophic nature, which would most likely cause severe discomfort to most people. Predisposing factors (eg compulsive or asthenic personality traits) or neurosis in the medical history may lower the threshold for the development of the syndrome or worsening of the course, but are neither necessary nor sufficient to explain the occurrence.

Typical traits include episodes where the trauma is re-experienced time and time again in intrusive memories ("flashbacks"), dreams or nightmares, with a persistent feeling of "numbness" and emotional flattening, distancing from other people, no response to the environment, anhedonia and avoidance of activities and situations reminiscent of the trauma.

There is usually a condition with increased autonomic alertness and alertness, increased splashing reaction and insomnia. Anxiety and depression are usually associated with the above symptoms and signs. Suicidal thoughts often occur. The debut comes after the trauma with a latency period of from a few weeks to months.

The course is fluctuating, but improvement can be expected in most cases. In a few patients, the condition can have a chronic course over many years, with a possible transition to a permanent personality change.

In the article from Norwegian Psychological Association it is further written about PTSD  [Norwegian Psychological Association, 2021]  that some people who are affected by traumatic events will experience that the immediate reactions persist for a longer period of time. This is referred to diagnostically as PTSD and is one of the most common psychological late injuries of traumatic events:

 

  1. You have been the victim of an incident that most people would perceive as serious and overwhelming.
  2. You experience constant intense memories or flashbacks from the event, possibly also as repeated nightmares at night.
  3. You avoid thinking about the incident as best you can. You avoid places, situations and people that may remind you of the event, isolate you socially and become emotionally flattened.
  4. You have an experience of being more squeamish, restless and tense, and you feel you have to be vigilant.

They add:

People with PTSD experience that they do not feel safe, even though they are objectively out of danger. They are bothered by intrusive images or dreams of traumatic events, which they are unable to stop. For many, this is experienced as if the traumatic event is happening again. This means that they try to avoid anything that may remind them of the traumas, while they are constantly on guard. 

 

Treatment of PTSD

Two forms of psychological treatment in particular are recommended: Eye Movement Desensitization and Reprocessing (EMDR) and Trauma-Focused Cognitive Behavior Therapy.

  • Source: [NKVTS, 2021][3]

 

Trauma and dissociation

An article on helpseeker.net says the following about trauma and dissociation:

Dissociation means splitting up. It acts as the brain's overprotection against experiences that are so strong that they explode our capacity to handle the event in a coherent way, and where the traumatic experiences are instead received in fragments or divided parts. Dissociation can play a role in various mental disorders, and in severe cases form the basis for a comprehensive fragmentation of the personality.

Examples of dissociation:

 

  1. The person "disappears completely" from the contact during a conversation
  2. Begins to speak in a childish voice despite the fact that he / she is an adult
  3. Gets strong physical re-experiences of something very traumatic
  4. Numbness areas in the skin that have no medical explanation
  5. Have unexplained paralysis or seizures that do not have a medical explanation
  6. Memory loss in relation to important events of recent date
  7. Dramatic mood swings
  8. Numbness and feeling of not being present; feeling of unreality
  9. Trans-like conditions with loss of normal consciousness; where this is not intentionally evoked, for example, in connection with religious rituals 
  10. Self-harm or suicidal behavior
  11. To feel that parts of the body do not belong to me
  12. To get a different type of handwriting than the one you usually have
  13. To get clear changes in one's personality that indicate that one is changing from one type to a completely different type
  14. Hearing voices in your head

The mentioned article on helpseeker.net also says:

If it is suspected that a person has a dissociative disorder, it is important to take a thorough psychiatric examination to clarify this question. Standardized mapping tools and structured or semi-structured interviews should be used to clarify a possible suspicion. In other words, it is important to obtain the extent to which the person has difficulties related to dissociation.

 

Trauma and neglect

Relationship trauma is common in cases of neglect. As we write in another post on helpseeker.net: 

It turns out that neglect can dramatically lead to brain damage in children who are exposed to the neglected care.  

The brain is very complex and it is therefore difficult to give a complete description of how care or failing care affects the development of the brain. At the same time, it must be emphasized that it is in the interplay between heritage and the environment that the individual child develops with his or her strengths and limitations. It must therefore be warned against theories that simplify the view of why the individual child becomes exactly as he or she becomes.

However, some systems in the brain can be described here that have been shown to be highly relevant in relation to understanding children who have lived under severe inadequate care.

When the combat-flight system does not shut down after an "acute crisis", but continues to keep the person in high activity, we can call it being in a "constant state of alert." This means that the level of cortisol in the blood remains high, which has a negative effect on, among other things, the immune system, and which can also seem to have negative effects on brain development in young children.

When children have a constant alertness, this is a sign that the child is not feeling well. It is a common symptom in various forms of care failure situations.

 

find-help-mental-health-problems

What helps with trauma-related problems?

 

  1. Psychotherapy

     

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    Psychotherapy / treatment is a process characterized by a time-limited contact between a therapist and a patient / client, in which specific problems are thematized and worked with. Include different therapeutic traditions (for example cognitive behavioral therapy (CBT), psychodynamic therapy, family therapy, and more)

    A useful source that evaluate the effectiveness of specific therapies for different mental health problems is the website to the Cochrane Institute [Cochrane Institute][4] .

     

  2. Online therapy

     

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    Online therapy is similar to traditional therapy or treatment, but is provided by digital means (either phone, video conference, or similar). Digital interventions can include a broader range of options, such as therapist-guided self-help programs online.

    The current research literature provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity [Barak et al., 2008][5] .

     

  3. Support / self-help groups

     

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    Support / self-help groups can take a variety of forms, from providing a safe and supportive social environment; more or less structured group meetings; information and guidance relating to how to use available help services; and a lot more.

    While it is difficult to know the effectiveness of such services, due to very different compositions of support and self-help services, the research generally show the self-help groups may have important benefits for the participants [Kurouz et al., 2002][6] .

     

  4. Helplines and chats

     

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    Different helplines and chats exist. Some helplines are specialized in providing you with information and guidance, while others are more specialized in providing emotional support. Some helplines are highly professional, while others are more based on voluntary workers, that merely wish to be a caring listener.

    It is difficult to evalute how effective such services are, and it probably depends on many factors. For example, while the state of the science regarding the effectiveness of crisis response services remains limited, overall results provide support for such services [Hoffberg et al, 2020][7] .

     

  5. Online communities and forums

     

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    Online communities and forums are options to get in contact with other individuals that struggle with something similar to you or someone you know. Some communities are moderated by professional health workers, while most of them are not.

    Online communities is traditionally not understood as a support or health service, but rather a social area - that may have the potential of being supportive for the individual that uses it. Importantly, research has shown that "people with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours" [Naslund et al., 2016][8] .

    This seems to indicate that online communites should not be underevaluated as a potential resource to recovery, coping and enhanced quality of life for people affected by mental health problems.

     

 

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References & Footnotes
  1. Norwegian Psychological Association, 2021: Norwegian Psychological Association (2021). Hva er traumer og traumebehandling? [What is trauma and treatment for trauma?]. Retrieved 10th of February 2021 from: https://www.psykologforeningen.no/publikum/informasjonsvideoer/videoer-om-psykiske-lidelser/hva-er-traumer-og-traumebehandling
  2. ICD-10: World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research (Vol. 2). World Health Organization.
  3. NKVTS, 2021: NKVTS: Nasjonalt kunnskapssenter om vold og traumatisk stress [National competence centre on domestic violence and traumatic stress] (2021). Retrieved 10th of Februrary 2021 from: https://www.nkvts.no/kunnskapsbasert-traumebehandling/behandling-av-ptsd/
  4. Cochrane Institute: Cochrane Institute: "Trusted evidence. Informed decisions. Better health." Retrieved 9th of February 2020 from: https://www.cochrane.org/
  5. Barak et al., 2008: Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human services26(2-4), 109-160.
  6. Kurouz et al., 2002: Kyrouz, E. M., Humphreys, K., & Loomis, C. (2002). A review of research on the effectiveness of self-help mutual aid groups. British Journal of Clinical Psychology33, 198-200.
  7. Hoffberg et al, 2020: Hoffberg, A. S., Stearns-Yoder, K. A., & Brenner, L. A. (2020). The effectiveness of crisis line services: A systematic review. Frontiers in public health7, 399.
  8. Naslund et al., 2016: Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences25(2), 113-122.