Psychological Trauma

Psychological trauma is referred to a mental injury to ones psychology or mind. The word trauma comes from the Greek and means injury / or damage without making a determination, as to what caused it.

In medicine, the term trauma refers to a wound that has been caused by an accident or an influence. This use has been documented since the 19th century. Analogous to this, psychology is characterized by a strong psychological shock, caused by a traumatizing experience, as a psychotrauma.

The term is not used uniformly and can refer to both the triggering event, but also the symptoms or the internal suffering caused. Psychological traumatization plays a central role in the development of mental disorders.

Terms of use

Traumatizing events can be, for example, natural catastrophes , wars, hostages , rape or accidents with imminent serious injuries. As well as, for example, war experiences, abductions, terror attacks, torture, stockpile, political imprisonment or violent attacks on one’s own person.

These events can cause extreme stress in a person and generate feelings of helplessness or horror. The anxiety and stress stress caused by this in human beings can fade away again in the majority of the affected persons, whereby the behavior also changes with these people.

However, in particular cases, if this increased stress stress persists for an extended period of time and there is no way to adequately process the experiences, it can lead to the development of partly intense psychological symptoms.

In about one-third of the affected persons, a mental illness is thus added to the painful memory which causes additional suffering. The most common of these diseases is the so-called posttraumatic stress disorder (PTSD).

In the everyday language there was an inflationary use of the term, and often the concept of trauma is used in connection with all particularly negative or painful experiences. However, in the field of medical or psychological literature, this term is much narrower and refers exclusively to events that could cause mental disorders.

Psychological traumata represent the scientific subject of psychotraumatology or conceptual methodologies that deal with the overcoming of trauma include resiliency, salutogenesis and hardiness.

Traumatizing Events

Events which often lead to retraumatization, or new ones as “potentially traumatic events” are, for example:

Natural disasters, war, fighting, torture, expulsion, terrorist attack, rape, accident with imminent serious injuries, traumas through medical interventions, sexual assault or sexualized violence, observation of the violent death of others, death of parents in childhood, loss of the loved one and Or their own children, life-threatening illnesses in childhood, severe emotional or physical neglect in childhood … (see also childhood trauma ).

But even less dramatic events can lead in the unfavorable case that a person gets into the state of intense helplessness and the own coping possibilities are thereby exceeded.

Examples which may be mentioned here are:

Severe personal attacks and abuse, long-term manipulation, bullying, emotional abuse, physical chastisement, divorce or separation, confrontation with dream episodes as helpers, traumatizing births etc …

Whether a situation becomes traumatic depends not only on the external circumstances, but also on the inner experience of this event. There are also events that almost always lead to a mental illness of some sort after the fact. After torture almost no one recovers by themselves, and after a rape only a quarter of the victims manage to recover by themselves.

Whether a person reacts to a psychiatric disorder due to a traumatic situation, and what is the most important cause of illness depends mostly on personal coping possibilities and many other factors.

Symptoms and behaviors

The main symptoms of traumatization include:

  • Intrusions with their extreme form, the flashbacks , which are triggered by certain key stimuli, recall the memory of the trauma.
  • Avoidance (avoidance of thoughts and feelings that could remind the trauma, avoiding the trauma or no longer leaving the house, avoiding painful memories by dissociation or by partial amnesia)
  • Hyperarousal (increased anger, difficulty concentrating, increased vigilance against dangers, easy frightening)
  • Even if traumatized patients are constantly restless and frightened, a very controlling behavior appears externally (since the trauma was experienced as an extreme loss of control)
  • Emotional numbness (ability to rejoice, love or grief is restricted)
  • Mental anticipation of the worst in order not to be surprised again, which is experienced by the environment as a nervous kind of lasting pessimism,
  • Disproportionately violent reactions to external or internal influences ( triggers triggered): for example , panic attacks , anxiety disorders , obsessive compulsive disorder , self-injury and dependency syndrome can be a feature of a psychological disorder caused by a trauma , as well as recurring nightmares and dissociative states.
  • Always recurring fears associated with the event experienced
  • Key stimuli such as similar odors, sounds, pictures, films but also anniversaries can trigger memories of the traumatic situation. [15] These key stimuli can persist into old age. The traumatized persons are mainly emotionally reminded of the trauma (usually in the form of fears). For example, the sound of a New Year’s bangers can be a panic of fear for a person who has witnessed a bomb attack as a child, even if the traumatic event is no longer deliberately remembered.

In many people, these symptoms develop some time after the traumatizing event ( remission ), and the traumatic experience can be integrated into the CV. In some people, however, the mental health can not be restored by the self-healing forces even after a long time, and the formation of possibly very serious dream-related consequences occur. These can also be noticed only months or many years after the traumatizing event and may be associated with altered brain activities and neuroanatomic changes.

Primary mental disorders

The frequent psychological disturbances after traumatization includes:

Adjustment Fault

Mental stress responses triggered by events that do not correspond to the medical definition of the trauma are diagnosed as adaptation disorders. The events are more about the death of a relative or a distressing divorce. The adjustment disorder is in the borderline between a comprehensible disturbance due to a difficult life event and a patient’s inclination to depression and anxiety.

Acute stress reaction

In an acute stress reaction , the symptoms immediately follow the incriminating event.

Post-traumatic stress disorder

From a post-traumatic stress disorder is when to stop the symptoms observed over a longer period than four weeks and thus emerges a chronic course. If the symptoms continue for another eight months, the posttraumatic stress disorder can not be expected to return spontaneously.

Complex posttraumatic stress disorder

Since about 2000, the concept of complex posttraumatic stress disorder has increasingly become more and more common in the context of multiple traumatization and its comprehensive psychological and interpersonal consequences. Furthermore, these traumatization often require a different therapeutic approach. A similar phenomenon was described as a persistent change in personality according to extreme stress, which also manifests itself through multiple traumatization and possibly resulting permanent changes in individual and interpersonal behavioral patterns.

Secondary mental disorders

A traumatization increases the risk of developing almost all other mental illnesses. These include:

  • Dysthymia
  • Somatoform disorders
  • Agoraphobia
  • Generalized anxiety disorder
  • Drug and drug abuse
  • Nicotine abdus
  • Suicidal behavior

Specific phobias , obsessive-compulsive disorder and eating disorders are often not seen as a secondary mental disorder, but trauma is understood as an indirect risk factor for the development of one of these mental disorders. Even with the borderline personality disorder traumatic events are viewed as a major factor.

Other consequences of trauma

Sexualized violence can lead to various disorders of sexuality and lusciousness (both in the form of inhibition and exaggeration); Torture is often associated with idiopathic pain.

Psychotherapeutic treatment

Each major psychotherapeutic school has developed its own approach to the treatment of traumatic disorders, such as cognitive behavior therapy and behavioral therapy, and psychoanalytic procedures. Because of the hypothesis that traumatized people have different dynamics and physiology from different psychological disturbances, the methods developed by the neurophysiological findings have also developed methods that are specifically used for trauma treatment. The thesis that traumatized people show a dynamic and physiology clearly different from other psychological disturbances is, however, scientifically insufficient.

The aim of the psychotherapeutic procedures is to arrive at an orderly processing of the trauma or trauma and thus either to limit the traumatypical symptoms or to control or dissolve them. The different methods can be viewed as complementary multidimensional approaches for a multidimensional process. Help to integrate the different approaches promises the recently gained abundance of neurophysiological knowledge about traumatization.

Psychoanalytic procedures

In psychoanalysis , the unconscious effect of traumatization is examined and treated. Psychoanalysis understands under a transmission that the patient subconsciously transmits his own previous experiences with his reference persons to the analyst in the form of fixations and repetitions. The latter are updated in the therapeutic relationship as a “transmission neurosis” and can then be gradually broken down and treated by resistance analysis and interpretation. However, this transfer neurosis in a traumatherapy targeted promotion is contraindicated, Since a neutral attitude of the therapist unconsciously strengthens the self-accusation tendencies of the dream patient or the recovery of incriminating memories can be promoted to the action, which possibly has a retraumatising effect. Instead, there is a need for an “interactive understanding” of the therapeutic relationship. The relationship work requires the therapist to have flexible commuting between identification and detachment, the countertransference is viewed as interaction and understanding aid for the therapist. Also special “traps” are to be considered in the transmission of a dream therapy, such as the unconscious “relationship test of the patient for possible abuse by the therapist”, etc. A competent handling of transmission and countertransference is also necessary, Since dream therapists are at risk of being traumatized. This is caused by a direct overflow with trauma material in the case of too close proximity and by an indirect under-migration of the cognitive barrier in case of too much distance.

Imaginative procedure

Imaginative methods use deeper layers of the psyche through the use of inner images, dreamlike processing paths, and working with inner parts and aspects. In this way they come psychically to a deep level of processing. An example of an imaginary method is the psychodynamically imaginative dream therapy or the ego-state therapy .

Behavioral therapy: exposure and cognitive restructuring

A dream-focused behavioral therapy is also used to mitigate the stressful memories. It is also used to circumvent and dissipate trained protective mechanisms that burden everyday life. Essential elements, especially the so-called triggers , which create the external or internal triggers for the trauma, concatenate a stimulus with an undesirable reaction. Behavioral therapy attempts to identify the individual elements that cause a traumatic reaction and to decouple the reaction from the stimulus, thus achieving the triggering of the trauma symptoms. Together with the EMDR, dream-focused behavioral therapy can demonstrate the highest degree of treatment success in evidence-based medicine . Narrative exposure is a newly developed special form of behavioral therapy.

Narrative procedures

In traumatized people there is usually an inner urge to combine the lost or isolated elements of the trauma into a story, to connect them with meaning or meaning and to integrate them into the personal life story (see Narrative Exposure Therapy ). Storytelling procedures have the goal to come to this related story, in which it is possible to include all the trauma elements so that strong emotions or physical responses are finally lost. Meanwhile, there is good empirical evidence for the efficacy of narrative exposure therapy in simple and multiple trauma. This therapy method is also recommended internationally (see ‘NICE Guidelines’).

EMDR Eye Movement Desensitization and Reprocessing

A central element of this therapy is the so-called ” bilateral stimulation”. This means an intensive stimulation of both hemispheres through eye movements, sounds or short touches. In this way, blocked or incompletely integrated memories are to be loosened and fed to a processing process. This method was developed by Francine Shapiro , who accidentally observed during a walk that an angulation was carried out by rapid eye movements and their traumatic memories of a previously diagnosed cancer disease changed. She developed a method for the purpose of conveying traumatic memories with the aid of bilateral stimuli.

Gestalt therapy

The Gestalt therapy avoids an isolated approach of body, mind and soul. All three levels influence each other in a reciprocal process and must be considered in therapy. Furthermore, man must be viewed within his social environment. The contact boundary between the individual and the environment is of particular importance since contact disturbances to themselves or to the outside world can lead to the suppression or denial of natural needs, which can lead to problematic modes of behavior and experience.

In the case of a trauma such as a sexual attack, it is possible that this contact limit is no longer felt after the attack by the person concerned and the classical methods of Gestalt therapy fail, Since the self-regulatory powers of the person concerned can no longer be activated.

The Gestalt therapy must then be modified in such a way that the person concerned has to be actively imparted an idea of ​​the fact that there is something like boundaries and needs at all. Special care-therapeutic techniques are also to be used with caution, which reinforces the expression of feelings such as anger, hatred and aggression, so that those affected can control them at any time and do not have to fear being overwhelmed by these feelings.

Likewise, difficulties in promoting body perception may arise when questions are intended to draw attention to body signals associated with a traumatic event, and this event has been experienced as a disgrace.

Debriefing

Debriefing is a controversial method used in mass events. The story is repeated in the circle of those concerned, until the excitement in the narrative flattens and a certain integration takes place. It is more an emergency aid than a therapy. For people who do not have a traumatic information processing disorder, but only a high stress burden, talking about traumatization can be helpful and lead to relief; In others the processing can even be made more difficult and the trauma can be deepened by activating additional trauma networks.

Physiotherapeutic procedures

Examples are TRE -exercises (a particular evaluiertes in disaster areas intrinsically induced tremors ) or Somatic Experiencing (a trauma and body-oriented treatment model).

Creative Therapy

For example, art therapy

Other procedures

For example, multi-generational psychotraumatology

Drug treatment

For certain disorders or from a certain degree of severity of the symptoms, a drug therapy of traumatolysis disorders is indicated. In this case, psychopharmaceuticals are used alongside psychotherapy. Psychopharmaceuticals influence the balance of neurotransmitters in the brain and thereby interfere with the brain functions of the patient. Clinical studies have been able to analyze which neurotransmitter systems have to be used to reduce the dream-related symptoms or to regulate stress physiology. However, since none of these drugs are causative, they can not replace a dream therapy, but in some cases they can prepare or accompany it. The selection of the respective medication depends on the main complaints. A comparable success of psychopharmacotherapy , as in the treatment of schizophrenia , has not yet been achieved.

Critics say about the fact that the drug is often a helpless response to crises in the case of dream apologists, and a subsequent withdrawal of the drugs is usually no longer risked after a crisis has passed. ( Ulrich Sachsse , Traumazentrierte Psychotherapie).

Tranquilizer

The most commonly prescribed tranquilizers are the substance class of benzodiazepines . Known trade names include tranxilium, alzepram. Benzodiazepines reliably reduce anxiety and can create a pleasant feeling of calmness and serenity. In particular, they also act against traumatic over-excitement symptoms, such as increased irritability, sleep disorders and flightiness. They act almost immediately and have hardly any side effects. However, a positive success beyond the time of the drug could not be demonstrated and is considered unlikely. Benzodiazepines have a high risk of addiction. Already with a lasting intake of over six weeks is to be feared in addition to the physical dependence of a physical. The fact that many doctors still prescribe benzodiazepines is probably due to the fact that many doctors are not adequately informed about the possibilities of modern antidepressants.

Antidepressants

As antidepressants drugs are called, are used to treat depression are used. Most antidepressants are involved in the cycle of neurotransmitters noradrenaline and serotonin . Results from basic research suggest that many dream-related symptoms are due to a serotonin disorder and antidepressants can compensate for this imbalance. Antidepressants have a lightening effect and reduce anxiety. Some are antioxidant, other antidepressants are drive neutral or drive-reducing. The latter are mainly used when those affected are very nervous. Depending on the content of the product, many preparations take effect after a period of one to six weeks.

Tricyclic antidepressants

In the early days of psychopharmacological research on the effects of traumatic disturbances, war veterans were treated with different medicines from the substance group of the tricyclic antidepressants. Among others, amitriptyline and imipramine have been used. Both of them attack serotonin and lead to a demonstrable improvement in all symptomatic parameters. Desipramine, which is rather noradrenergic, could not convince.

SSRI (selective serotonin reuptake inhibitor)

SSRIs block the resorption of serotonin in the nerve cells and ensure that a serotonin deficiency is compensated. They are the first choice for both acute and long-term treatment with PTBS. In contrast to tricyclic antidepressants, they are generally more tolerable and in particular have no anticolinergic side effects. Concerning the effectiveness of traumatic disorders, convincing results from studies with large groups of treatment are available. SSRIs were able to reduce aggravating memories (flashbacks) as well as the avoidance behavior, but also the overactivation. In this way, a processing process in a psychotherapy could be supported or made possible. Effectiveness tests were performed for fluoxetine (20-80 mg), Paroxetine (20-50 mg) and sertraline (50-200 mg, mean doses between 100-150 mg). Symptom reduction usually occurred after two to four weeks. In Germany, only the active substance paroxetine is authorized for the treatment of PTBS patients.

Other antidepressants

For mirtazapine , bupropion and trazodone smaller studies exist. An effect similar to that of sertraline could be demonstrated.

Neuroleptics

Neuroleptics interfere with the synaptic transmission of the brain by inhibiting the transmission of the neurotransmitter dopamine so that it can no longer activate the postsynaptic receptors. In this way, they are partially soothing and are suitable for the breakdown of all psychotic conditions. Neuroleptics can with receptors for serotonin, acetylcholine , histamine interact and norepinephrine. Neuroleptics, which act on the so-called positive symptoms of schizophrenia (for example, hallucinations, delusions), are known as conventional (typical) neuroleptics. Newer (atypical) neuroleptics also partly reduce the so-called negative symptoms of schizophrenia (including drive impairment and concentration problems). Atypical neuroleptics, such as, for example, olanzapine , quetiapine and risperidone, have been used in traumatic patients with psychotic symptoms (eg, delicate disorders) or in insufficient SSRI efficacy. Successes have been achieved, however, randomized and controlled studies are still missing. Delicate disturbances) or if the SSRI is not sufficiently effective. Successes have been achieved, however, randomized and controlled studies are still missing. Delicate disturbances) or if the SSRI is not sufficiently effective. Successes have been achieved, however, randomized and controlled studies are still missing.

Effects on Life

The effects of trauma often influence the lives of those affected. Traumatized people often alternate between avoiding memories of the mental injury and its consequences (to trance-like states or dissociations ) on the one hand and the sudden “attack” by memories (so-called flashbacks ) on the other. These often occur in the form of individual images, feelings, odors in the consciousness, or certain triggering factors ( key stimuli = trigger ) which trigger the trauma, often triggering emotions and anguish, often without the person concerned being attributed to the trauma.

This can even lead to other people as medically necessary assistance is denied because the trauma sufferers perceive this as a fault in its regulated process and ignore the situation simply using it as non-existent look (= deny ) to suggest to normality. This behavior controls the unconscious and is a protective reaction, some of which is automatically trained over years, in order to avoid re-traumatization. Another problem for the ill people is the feeling of being imprisoned in their role , which is equally underpinned in the social environment.

Although the traumatizing experience must have been of a certain strength and left a lasting, lasting impression on the person concerned, the person can not be aware of this at the time of the experience or later. Furthermore, the experience can be completely forgotten or suppressed over a long period of time , without experiencing one ‘s own serious injury or mental injury.

Childhood trauma

The term childhood trauma ( including childhood stress factors , early childhood stress experiences , Adverse Childhood Experiences brief: ACE ) is summarized: child abuse , sexual abuse of children, serious neglect, war experiences (see also war crimes ), separation / divorce of parents and other family / Social stress factors. A trauma is a serious mental injury.

In South Africa, the frequency of severe trauma events is between 1 and 11% of the population.

Childhood traumas can have dramatic and long-term consequences for the health of those affected, especially if a corresponding vulnerability (vulnerability, diathesis ) is present.

There is a dose-response relationship: the more severe and prolonged the trauma events are, the earlier they occur and the more events and burdens overall, the higher the probability of physical and / or psychological illnesses both in childhood and in childhood In the adult age. On the other hand, the vast majority of affected persons do not develop any disease in the long term, if there is no vulnerability,

The development of childhood to adulthood disorders occurs mainly in two ways:

On the one hand, the vulnerability increases with those affected by future stress events, and on the other hand, affected persons show increased health risk behavior, for example smoking or alcohol abuse.

The results are on the frequency of large studies epidemiologically hedged. They suggest measures of prevention in early childhood , for example through the use of family midwives .

Childhood Impact Category Prevalence%
Emotional abuse 10.6
Physical abuse 28.3
Sexual abuse (physical contact) 20.7
Emotional neglect 14.8
Physical neglect 9.9
Violence against mother 12.7
Substance abuse by household member 26.9
Psych. Disease from household member 19.4
Separation / divorce of the parents 23.3
Imprisonment of a household member 4,7

Mental illness

Psychological disorders also occur more frequently, depending on the extent of the childhood stress factors, namely depressive and anxiety disorders , suicidal behavior , somatoform disorders , eating disorders , seeker disease , personality disorders and posttraumatic stress disorder. It is also assumed here that the risk behaviors are involved in the development of the disease.

Patients with borderline personality disorder have suffered a large number of traumas in their lives: sexual assertions of about 65%, physical exertions of about 60%, neglect of about 40%. From a psychotherapeutic perspective, sexual traumatisation in childhood is the most important cause of borderline personality disorder. According to “years of clinical experience, violent sexual penetration of the body’s limbs is the most psychologically damaging to a child.” Some of the borderline patients have grown up without severe trauma events, but in a “negligible, rigidly normative or invaliding educational environment” Which can be an emotional neglect or an emotional abuse.

The most important cause of dissocial behavior and the development of dissocial personality disorder is “frequent, repeated, prolonged, humiliating physical abuse”. Individuals with a dissocial personality disorder have “in some cases suffered the most severe loss and lack of experience [in the sense of abuse, abuse and neglect] in early childhood as well as in the further course of their lives.”

“In summary, the results of dream research suggest a significant influence of trauma [in childhood] on the development of later personality disorders  traumas are, however, not necessary or even sufficient conditions for the development of personality disorders. “According to trauma experience, primarily narcissistic, borderline and dissocial personality disorders develop (so-called cluster B personality disorders).

According to the psychoanalytic view, early childhood experiences, as well as traumatic and stressful events during childhood, decisively influence the development of personality and lead to the development of mental illnesses. The above-mentioned risk behaviors can be understood as mechanisms for the defense of unconscious inner conflicts as well as the restoration of traumatic parent-child constellations ( repetition constraint ). The results of the ACE study are evaluated as an epidemiological confirmation (validation) of the corresponding psychoanalytic concepts.

Life disadvantages

Separation and divorce of the parents as well as the death of a parent are in any case incriminating and drastic events for the children concerned. For themselves, however, they have “no relevance for the later psychological vulnerability.

In combination with the experience of a child, however, the divorce of the parents increases the risk “for later mental illness considerably.

Even if persons who are affected by childhood trauma do not manifest, they can subsequently be severely disadvantaged in their social adaptation.

Persons who had been abused or neglected as children up to the age of 11 (according to law enforcement acts) show about 20 years later a case against a case control group a generally unfavorable life course:

Among other things, their measured intelligence is lower; They tend to end the school; Their professional level is lower; Unemployment is higher; The partnership situation is unfavorable (rare stable marriages, more often than divorce).

For women who were chastised or physically abused in childhood and / or sexually abused by physical contact, there is a significantly higher risk of physical or sexual violence in their partnership.

Parents who have been chastised or physically abused in childhood, and / or who experience violence in partnership, have a higher risk of chastising or abusing their children. The childhood tragedies lead to a revision of the victim’s rights or a transfer to the next generation.