Childhood Trauma: Illness, Death, Divorce & War (Children in Films Book 7)

Anxiety and fear in children

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ADAA does not provide psychiatric, psychological, or medical advice, diagnosis, or treatment. For the Public For Professionals. Conference Conference Why Attend? The disorder is characterized by three main types of symptoms: Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks, and nightmares.

Avoidance of places, people, and activities that are reminders of the trauma, and emotional numbness. Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered. By educating clients on the resilient qualities of dissociation while also emphasizing that it prevents them from addressing or validating the trauma, individuals can begin to understand the role of dissociation. All in all, it is important when working with trauma survivors that the intensity level is not so great that it triggers a dissociative reaction and prevents the person from engaging in the process.

Traumatic stress reactions vary widely; often, people engage in behaviors to manage the aftereffects, the intensity of emotions, or the distressing aspects of the traumatic experience. Some people reduce tension or stress through avoidant, self-medicating e.

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Others may try to gain control over their experiences by being aggressive or subconsciously reenacting aspects of the trauma. Behavioral reactions are also the consequences of, or learned from, traumatic experiences. Other associate elements of the trauma with current activities, such as by reacting to an intimate moment in a significant relationship as dangerous or unsafe years after a date rape. The following sections discuss behavioral consequences of trauma and traumatic stress reactions.

A hallmark symptom of trauma is reexperiencing the trauma in various ways. This is very apparent in children, who play by mimicking what occurred during the trauma, such as by pretending to crash a toy airplane into a toy building after seeing televised images of the terrorist attacks on the World Trade Center on September 11, Attempts to understand reenactments are very complicated, as reenactments occur for a variety of reasons. Sometimes, individuals reenact past traumas to master them. Examples of reenactments include a variety of behaviors: Self-harm is any type of intentionally self-inflicted harm, regardless of the severity of injury or whether suicide is intended.

Self-harm is associated with past childhood sexual abuse and other forms of trauma as well as substance abuse. More than likely, the client needs help recognizing and coping with emotional or physical distress in manageable amounts and ways. Many people find healthy ways to cope with, respond to, and heal from trauma. Often, people automatically reevaluate their values and redefine what is important after a trauma.

Such resilient responses include:. Marco, a year-old man, sought treatment at a local mental health center after a 2-year bout of anxiety symptoms. He was an active member of his church for 12 years, but although he sought help from his pastor about a year ago, he reports that he has had no contact with his pastor or his church since that time.

Approximately 3 years ago, his wife took her own life. He describes her as his soul-mate and has had a difficult time understanding her actions or how he could have prevented them. In the initial intake, he mentioned that he was the first person to find his wife after the suicide and reported feelings of betrayal, hurt, anger, and devastation since her death.

He claimed that everyone leaves him or dies. He also talked about his difficulty sleeping, having repetitive dreams of his wife, and avoiding relationships. In his first session with the counselor, he initially rejected the counselor before the counselor had an opportunity to begin reviewing and talking about the events and discomfort that led him to treatment.

In this scenario, Marco is likely reenacting his feelings of abandonment by attempting to reject others before he experiences another rejection or abandonment.

Professionals

Among the self-harm behaviors reported in the literature are cutting, burning skin by heat e. Cutting and burning are among the most common forms of self-harm. Self-mutilation is also associated with and part of the diagnostic criteria for a number of personality disorders, including borderline and histrionic, as well as DID, depression, and some forms of schizophrenia; these disorders can co-occur with traumatic stress reactions and disorders.

It is important to distinguish self-harm that is suicidal from self-harm that is not suicidal and to assess and manage both of these very serious dangers carefully. Self-harm can be a way of getting attention or manipulating others, but most often it is not. Self-destructive behaviors such as substance abuse, restrictive or binge eating, reckless automobile driving, or high-risk impulsive behavior are different from self-harming behaviors but are also seen in clients with a history of trauma. Self-destructive behaviors differ from self-harming behaviors in that there may be no immediate negative impact of the behavior on the individual; they differ from suicidal behavior in that there is no intent to cause death in the short term.

Counselors who are unqualified or uncomfortable working with clients who demonstrate self-harming, self-destructive, or suicidal or homicidal ideation, intent, or behavior should work with their agencies and supervisors to refer such clients to other counselors. They should consider seeking specialized supervision on how to manage such clients effectively and safely and how to manage their feelings about these issues. The following suggestions assume that the counselor has had sufficient training and experience to work with clients who are self-injurious.

Childhood Stress

To respond appropriately to a client who engages in self-harm, counselors should:. Counselors can also help the client prepare a safety card that the client can carry at all times. The counselor can discuss with the client the types of signs or crises that might warrant using the numbers on the card. Additionally, the counselor might check with the client from time to time to confirm that the information on the card is current.

There is no credible evidence that a safety agreement is effective in preventing a suicide attempt or death. Safety agreements for clients with suicidal thoughts and behaviors should only be used as an adjunct support accompanying professional screening, assessment, and treatment for people with suicidal thoughts and behaviors. Keep in mind that safety plans or agreements may be perceived by the trauma survivor as a means of controlling behavior, subsequently replicating or triggering previous traumatic experiences. All professionals—and in some States, anyone—could have ethical and legal responsibilities to those clients who pose an imminent danger to themselves or others.

Clinicians should be aware of the pertinent State laws where they practice and the relevant Federal and professional regulations. However, as with self-harming behavior, self-destructive behavior needs to be recognized and addressed and may persist—or worsen—without intervention. Substance use often is initiated or increased after trauma. Clients in early recovery— especially those who develop PTSD or have it reactivated—have a higher relapse risk if they experience a trauma.

In the first 2 months after September 11, , more than a quarter of New Yorker residents who smoked cigarettes, drank alcohol, or used marijuana about , people increased their consumption. Interviews with New York City residents who were current or former cocaine or heroin users indicated that many who had been clean for 6 months or less relapsed after September 11, Others, who lost their income and could no longer support their habit, enrolled in methadone programs Weiss et al. However, no definitive pattern has yet emerged of the use of particular substances in relation to PTSD or trauma symptoms.

Unresolved traumas sometimes lurk behind the emotions that clients cannot allow themselves to experience. Substance use and abuse in trauma survivors can be a way to self-medicate and thereby avoid or displace difficult emotions associated with traumatic experiences. When the substances are withdrawn, the survivor may use other behaviors to self-soothe, self-medicate, or avoid emotions. As likely, emotions can appear after abstinence in the form of anxiety and depression.

Avoidance often coincides with anxiety and the promotion of anxiety symptoms. Individuals begin to avoid people, places, or situations to alleviate unpleasant emotions, memories, or circumstances. Initially, the avoidance works, but over time, anxiety increases and the perception that the situation is unbearable or dangerous increases as well, leading to a greater need to avoid. Avoidance can be adaptive, but it is also a behavioral pattern that reinforces perceived danger without testing its validity, and it typically leads to greater problems across major life areas e.

For many individuals who have traumatic stress reactions, avoidance is commonplace. A person may drive 5 miles longer to avoid the road where he or she had an accident. Another individual may avoid crowded places in fear of an assault or to circumvent strong emotional memories about an earlier assault that took place in a crowded area.

Avoidance can come in many forms. A key ingredient in trauma recovery is learning to manage triggers, memories, and emotions without avoidance—in essence, becoming desensitized to traumatic memories and associated symptoms. A key ingredient in the early stage of TIC is to establish, confirm, or reestablish a support system, including culturally appropriate activities, as soon as possible. Social supports and relationships can be protective factors against traumatic stress. However, trauma typically affects relationships significantly, regardless of whether the trauma is interpersonal or is of some other type.

In natural disasters, social and community supports can be abruptly eroded and difficult to rebuild after the initial disaster relief efforts have waned. Survivors may readily rely on family members, friends, or other social supports—or they may avoid support, either because they believe that no one will be understanding or trustworthy or because they perceive their own needs as a burden to others.

Survivors who have strong emotional or physical reactions, including outbursts during nightmares, may pull away further in fear of being unable to predict their own reactions or to protect their own safety and that of others. Often, trauma survivors feel ashamed of their stress reactions, which further hampers their ability to use their support systems and resources adequately.

Many survivors of childhood abuse and interpersonal violence have experienced a significant sense of betrayal. They have often encountered trauma at the hands of trusted caregivers and family members or through significant relationships. This history of betrayal can disrupt forming or relying on supportive relationships in recovery, such as peer supports and counseling. Although this fear of trusting others is protective, it can lead to difficulty in connecting with others and greater vigilance in observing the behaviors of others, including behavioral health service providers.

It is exceptionally difficult to override the feeling that someone is going to hurt you, take advantage of you, or, minimally, disappoint you. Each age group is vulnerable in unique ways to the stresses of a disaster, with children and the elderly at greatest risk. Young children may display generalized fear, nightmares, heightened arousal and confusion, and physical symptoms, e. School-age children may exhibit symptoms such as aggressive behavior and anger, regression to behavior seen at younger ages, repetitious traumatic play, loss of ability to concentrate, and worse school performance.

Adolescents may display depression and social withdrawal, rebellion, increased risky activities such as sexual acting out, wish for revenge and action-oriented responses to trauma, and sleep and eating disturbances Hamblen, Adults may display sleep problems, increased agitation, hypervigilance, isolation or withdrawal, and increased use of alcohol or drugs. These chemical responses can then negatively affect critical neural growth during specific sensitive periods of childhood development and can even lead to cell death.

Heim, Mletzko et al. The researchers concluded that the association of study scores with these outcomes can serve as a theoretical parallel for the effects of cumulative exposure to stress on the developing brain and for the resulting impairment seen in multiple brain structures and functions.

Materials are available for counselors, educators, parents, and caregivers. Many trauma survivors experience symptoms that, although they do not meet the diagnostic criteria for ASD or PTSD, nonetheless limit their ability to function normally e. Like PTSD, the symptoms can be misdiagnosed as depression, anxiety, oran other mental illness. Likewise, clients who have experienced trauma may link some of their symptoms to their trauma and diagnose themselves as having PTSD, even though they do not meet all criteria for that disorder.

A phenomenon unique to war, and one that counselors need to understand well, is combat stress reaction CSR. CSR is an acute anxiety reaction occurring during or shortly after participating in military conflicts and wars as well as other operations within the war zone, known as the theater. It is similar to acute stress reaction, except that the precipitating event or events affect military personnel and civilians exposed to the events in an armed conflict situation.

Frank is a year-old man who was severely beaten in a fight outside a bar. He had multiple injuries, including broken bones, a concussion, and a stab wound in his lower abdomen. He was hospitalized for 3. For several years, when faced with situations in which he perceived himself as helpless and overwhelmed, Frank reacted with violent anger that, to others, appeared grossly out of proportion to the situation. He has not had a drink in almost 3 years, but the bouts of anger persist and occur three to five times a year.

Adverse childhood experiences and chronic illness.

They leave Frank feeling even more isolated from others and alienated from those who love him. He reports that he cannot watch certain television shows that depict violent anger; he has to stop watching when such scenes occur. He sometimes daydreams about getting revenge on the people who assaulted him. Other than these symptoms, Frank has progressed well in his abstinence from alcohol.

He attends a support group regularly, has acquired friends who are also abstinent, and has reconciled with his family of origin. In recounting the traumatic event in counseling, Frank acknowledges that he thought he was going to die as a result of the fight, especially when he realized he had been stabbed. As he described his experience, he began to become very anxious, and the counselor observed the rage beginning to appear.

After his initial evaluation, Frank was referred to an outpatient program that provided trauma-specific interventions to address his subthreshold trauma symptoms. With a combination of cognitive— behavioral counseling, EMDR, and anger management techniques, he saw a gradual decrease in symptoms when he recalled the assault. He started having more control of his anger when memories of the trauma emerged. Today, when feeling trapped, helpless, or overwhelmed, Frank has resources for coping and does not allow his anger to interfere with his marriage or other relationships.

CSR can vary from manageable and mild to debilitating and severe. Common, less severe symptoms of CSR include tension, hypervigilance, sleep problems, anger, and difficulty concentrating. Common causes of CSR are events such as a direct attack from insurgent small arms fire or a military convoy being hit by an improvised explosive device, but combat stressors encompass a diverse array of traumatizing events, such as seeing grave injuries, watching others die, and making on-the-spot decisions in ambiguous conditions e.

Such circumstances can lead to combat stress.

Trauma-Informed Care in Behavioral Health Services.

Military personnel also serve in noncombat positions e. Several sources of information are available to help counselors deepen their understanding of combat stress and postdeployment adjustment. Friedman explains how a prolonged combat-ready stance, which is adaptive in a war zone, becomes hypervigilance and overprotectiveness at home.

This complicates the transition to civilian life. The following are just a few of the many resources and reports focused on combat-related psychological and stress issues:. Part of the definition of trauma is that the individual responds with intense fear, helplessness, or horror. Beyond that, in both the short term and the long term, trauma comprises a range of reactions from normal e.

ACEs Science 101

Most people who experience trauma have no long-lasting disabling effects; their coping skills and the support of those around them are sufficient to help them overcome their difficulties, and their ability to function on a daily basis over time is unimpaired. For others, though, the symptoms of trauma are more severe and last longer. The most common diagnoses associated with trauma are PTSD and ASD, but trauma is also associated with the onset of other mental disorders—particularly substance use disorders, mood disorders, various anxiety disorders, and personality disorders.

Trauma also typically exacerbates symptoms of preexisting disorders, and, for people who are predisposed to a mental disorder, trauma can precipitate its onset. Mental disorders can occur almost simultaneously with trauma exposure or manifest sometime thereafter. ASD represents a normal response to stress. Symptoms develop within 4 weeks of the trauma and can cause significant levels of distress.

Most individuals who have acute stress reactions never develop further impairment or PTSD. Acute stress disorder is highly associated with the experience of one specific trauma rather than the experience of long-term exposure to chronic traumatic stress. Diagnostic criteria are presented in Exhibit 1.

Exposure to actual or threatened death, serious injury, or sexual violation in one or more of the following ways: Directly experiencing the traumatic event s. The primary presentation of an individual with an acute stress reaction is often that of someone who appears overwhelmed by the traumatic experience.

The need to talk about the experience can lead the client to seem self-centered and unconcerned about the needs of others. He or she may need to describe, in repetitive detail, what happened, or may seem obsessed with trying to understand what happened in an effort to make sense of the experience. The client is often hypervigilant and avoids circumstances that are reminders of the trauma. For instance, someone who was in a serious car crash in heavy traffic can become anxious and avoid riding in a car or driving in traffic for a finite time afterward.

Partial amnesia for the trauma often accompanies ASD, and the individual may repetitively question others to fill in details. The next case illustration demonstrates the time-limited nature of ASD. The primary difference is the amount of time the symptoms have been present. The diagnosis of ASD can change to a diagnosis of PTSD if the condition is noted within the first 4 weeks after the event, but the symptoms persist past 4 weeks.

ASD also differs from PTSD in that the ASD diagnosis requires 9 out of 14 symptoms from five categories, including intrusion, negative mood, dissociation, avoidance, and arousal. These symptoms can occur at the time of the trauma or in the following month. However, many people with PTSD do not have a diagnosis or recall a history of acute stress symptoms before seeking treatment for or receiving a diagnosis of PTSD.

Two months ago, Sheila, a year-old married woman, experienced a tornado in her home town. In the previous year, she had addressed a long-time marijuana use problem with the help of a treatment program and had been abstinent for about 6 months. Sheila was proud of her abstinence; it was something she wanted to continue. She regarded it as a mark of personal maturity; it improved her relationship with her husband, and their business had flourished as a result of her abstinence.

During the tornado, an employee reported that Sheila had become very agitated and had grabbed her assistant to drag him under a large table for cover. Sheila repeatedly yelled to her assistant that they were going to die. Following the storm, Sheila could not remember certain details of her behavior during the event. Furthermore, Sheila said that after the storm, she felt numb, as if she was floating out of her body and could watch herself from the outside.

She stated that nothing felt real and it was all like a dream. Following the tornado, Sheila experienced emotional numbness and detachment, even from people close to her, for about 2 weeks. The symptoms slowly decreased in intensity but still disrupted her life. Sheila reported experiencing disjointed or unconnected images and dreams of the storm that made no real sense to her. She was unwilling to return to the building where she had been during the storm, despite having maintained a business at this location for 15 years.

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In addition, she began smoking marijuana again because it helped her sleep. She had been very irritable and had uncharacteristic angry outbursts toward her husband, children, and other family members. As a result of her earlier contact with a treatment program, Sheila returned to that program and engaged in psychoeducational, supportive counseling focused on her acute stress reaction.

She regained abstinence from marijuana and returned shortly to a normal level of functioning. Her symptoms slowly diminished over a period of 3 weeks. With the help of her counselor, she came to understand the link between the trauma and her relapse, regained support from her spouse, and again felt in control of her life. Intervention for ASD also helps the individual develop coping skills that can effectively prevent the recurrence of ASD after later traumas. Although predictive science for ASD and PTSD will continue to evolve, both disorders are associated with increased substance use and mental disorders and increased risk of relapse; therefore, effective screening for ASD and PTSD is important for all clients with these disorders.

Individuals in early recovery—lacking well-practiced coping skills, lacking environmental supports, and already operating at high levels of anxiety—are particularly susceptible to ASD. Events that would not normally be disabling can produce symptoms of intense helplessness and fear, numbing and depersonalization, disabling anxiety, and an inability to handle normal life events.

The trauma-related disorder that receives the greatest attention is PTSD; it is the most commonly diagnosed trauma-related disorder, and its symptoms can be quite debilitating over time. Nonetheless, it is important to remember that PTSD symptoms are represented in a number of other mental illnesses, including major depressive disorder MDD , anxiety disorders, and psychotic disorders Foa et al.

She trains as a psychologist and makes a career for herself. He maintains a relationship with his kids and eventually remarries, although he feels constrained in life. In the end, Mason heads to college and Olivia is left with a feeling of terrible empty meaninglessness in her life.

It also gives his children an ACE score of 1 since he is divorced as well , tells Charlie Rose in an interview that he related to the way this movie normalizes the fact that we all have secrets. Instead, he finds that it helps you see how no one really has a normal family. The ACE studies show us that Mason is actually at high risk of having many difficulties in his adult life, including being at increased risk of developing a chronic illness, dying at a much younger age than his peers who have lower scores, being hospitalized for an autoimmune disease, being depressed, and having difficulties of his own with alcohol or other addictions, among other effects.

Such approaches also contribute to reducing risk for the effects that often show up much later, including chronic illness in adulthood. As we get better at recognizing trauma in all the different ways it can show up, we can begin to better work with it, including as a way to improve health and symptoms in those of us living with chronic illness. Shots , 18 Starecheski, L. Shots , 19 Starecheski, L. Links between adverse childhood experiences and chronic illness are what I mainly focus on in this blog and post since links between trauma or adversity and chronic illness is the main focus of my blog.

Nearly 1 child in 10 is limited by a chronic disease National Health Council. Chronic diseases, like childhood trauma, are difficult to see by looking at a person. Acknowledging the difficult events that have happened in our lives, and finding ways to work with them, is how we can become more whole, and begin to come back into the world. Risk for chronic illness is especially high when a person has experienced 4 or more ACEs. With a score of 4 or more, risk for diabetes goes up 1. But even an ACE score of 2 is significant.

Psychosom Med, , 71 2 p. Dube and Felitti et al found that:. Psychol Med, , 44 9: In these conditions, lowered cortisol is not due to any adrenal or pituitary insufficiency. These changes reflect a plausible early-life adaptation to increase the persistence of active cortisol in liver to maximize fuel output and kidney to increase salt retention without elevation of circulating levels, thus avoiding their deleterious effects on brain and muscle.

Stress-related psychiatric disorders with low cortisol levels: You can give these to your doctor, teacher, lawyer, friends and family and others or just use it for yourself to know what ACEs mean. Like family physician Gabor Mate and author Johann Hari , Felitti discovered from his patients that behaviors such as addictions to drugs, food, and alcohol among others are ways of coping with overwhelming feelings from unresolved trauma rather than an addiction to a chemical substance 24 Felitti, V.

Old traumatic events tend to be unrecognized and dismissed by our culture. And they remain grossly underestimated in our medical health care system. The ACE studies give us the information we need to begin to take it seriously for ourselves and for our children. The findings in the ACE studies reflect patterns commonly seen in trauma of all kinds. These effects are not limited to PTSD but also include the very real physiological, biochemical and nervous system patterns that underlie chronic illnesses of all kinds.

Summary of the Science. Some symptoms may be seen immediately or very soon after traumatic events occur, such as in children who experience nightmares, have difficulty concentrating in school or who act out. Chronic physical illness, however, may not manifest for decades.

This delay, often referred to as a latency period in the literature, is a large part of why identifying links between trauma and chronic illness have been so under-recognized and so difficult to identify. The relationship between childhood experiences and adult health status is likely to be overlooked in medical practice because the time delay between exposure during childhood and recognition of health problems in adult medical practice is lengthy 26 Felitti, , p.

The ACE studies underscore the concept that long stretches of time can occur between a traumatic event and the onset of psychological, behavioral or physical symptoms. The average age of study participants was 57 years old 27 Felitti, and the traumas they divulged on their surveys occurred decades before the onset of their chronic diseases.

They had been kept secret out of shame, social taboos and time. A person with a score of 4, for example is 12 times more likely to attempt suicide than a person with a score of 0 28 Felitti, This is an example of how trauma is additive in powerful and unexpected ways. As we see in Boyhood, Mason was not only a witness to domestic violence, he was also exposed to psychological abuse, substance abuse, and divorce. This is not uncommon. In contrast to what we might tend to think, Mason has not emerged from his childhood unscathed. The ACE studies indirectly highlight the fact that parents who are abusive or neglectful, who are substance abusers or have mental illness or are incarcerated etc, are very likely trauma survivors themselves.

Such behaviors and symptoms also often serve as coping mechanisms in the face of life events that were too overwhelming to deal with in other ways 31 Felitti, V. Problem, Solution, or Both? The Permanente Journal, Through detailed calculations, the ACE studies have demonstrated that events that create ACEs in children are the same types of events experienced by their parents in their own childhoods. The behavioral, psychological and physical health problems of parents directly affect the health of their children.

As mentioned above, adults who experienced ACEs in childhood have frequently grown up with parents who were traumatized. This is one way in which trauma can perpetuate its effects over generations. She has found that children of Holocaust survivors are more vulnerable to posttraumatic stress disorder PTSD than kids who grow up with non traumatized parents. This is true even though both groups of children were exposed to similar numbers and intensity of life events 33 Yehuda, R.

Am J Psychiatry, Research is ongoing to better understand the role of nervous system changes, immune system responses and other long-term physiological consequences of trauma, looking for the freeze response is another way to understand potential mechanisms. In one scene in Boyhood, the freeze response is readily visible. Alcoholic step-dad 1 creeps into a rage-filled drinking splurge at dinner time one day. He is itching for a fight. We watch him challenge the kids and Olivia with questions as they try to eat their meals at the dinner table.

No one makes eye contact or says a word unless spoken to because any wrong move could escalate his behavior and place someone at risk of physical harm. This scene shows us what a freeze response looks like and how it can affect everyone in the family system.

The freeze response is the default mechanism of survival when no other option exists. It is a hallmark of trauma. No one is physically strong enough to fight this big, angry man. No one is going to be able to run or get away or make it out the front door. The freeze response is one of the ways that our nervous systems take on new patterns of functioning.

Adverse childhood experiences alter how genes behave through epigenetics 35 Romens, S. This is a process by which small chemicals attach to the surface of genes to influence how they express themselves. The chemicals attach and detach based on environmental factors such as stress and diet, exercise and trauma. While epigenetic changes can last a decade or a lifetime, the beauty is that they are sometimes often?

The CDR is regulated by the nervous system, happens at the cellular level of defense, is affected by epigenetics, and has been proposed to underlie over different diseases 38 Naviaux, R. These 10 tools offer additional ways that are sufficient for some to improve from or heal chronic disease. In the video above, Dr. Some communities, organizations and states are beginning to implement evaluation, prevention and treatment strategies for ACEs 39 see this 1.

Robert Anda ,et al. What do Future Leaders need to Know? Felitti emphasizes that it is challenging: A serious question is what primary prevention would look like. One suspects that improving parenting skills across the nation might be the crucial issue here.

The number of adults is myriad —including physicians—who have had no firsthand experience of supportive parenting. How might we address that serious lack on a population basis? The impact of a successful approach here might be as great as that of a major vaccine. Resistance to obtaining and acting on this information from childhood is to be expected.

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