Childhood Trauma Presentation

AN INTRODUCTION TO CHILDHOOD TRAUMA

A lecture by:Dr. Loghman ZaiimMedical Director,

North Carolina MENTOR

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Childhood Trauma/LZaiim MD

Childhood Trauma 1 - Introduction

2 Childhood Trauma/LZaiim MD

Trauma Overview-1

• Trauma=Wound in Greek• Trauma: If an individual’s perception of an event(s) is processed as threatening coupled with helplessness

• Acute VS. Chronic Trauma

• “T” Trauma= ‘Too Much’ at once +/- for too long (child abuse; disasters; violence; major loss; physical trauma…)

• “t” Trauma= ‘too little’ traumas for too long (medical/dental procedures; minor car accidents; dog bites …)

• “H” Trauma= “Hidden” traumas for too long (poverty, racism, homophobia, witnessing violence…)


Trauma Overview-2

• Shock Trauma VS Developmental Trauma (many have experienced both)

• Shock Trauma has a sudden, massive impact on the individual requiring more reflexive autonomic NS including extreme survival mechanisms

• Developmental trauma is harmful/age inappropriate demands made on children leading to development of character defenses which may be functional initially but are dysfunctional in long term

• Has an impact on behaviors and relationships as adults


The Triune Brain

• Neo-Cortex : Thinking Integrates input from all 3 parts: Cognition, beliefs, language, speech, thought

• Limbic Area: Emotions Assess risk…negative focus Expression and mediation of emotions and feelings

• Primitive Brain: Survival Fight, Flight, Freeze Breathing, circulation, digestion reproduction


Neo-Cortex

• Conscious thought and choice-making

• Self-awareness

• Integration of thinking, feeling and sensing

• Seat of executive functioning such as working, problem solving, verbal reasoning, planning, organizing, inhibition, attention…

• Last to develop

• Most easily disturbed


The Limbic Area

• Amygdala- Determines emotional significance of sensory input- Organizes our attachment experience- Creates ‘fear’ templates - Must be inhibited to promote social engagement- Amygdala’s response may not make sense to the Neo-Cortex

• Hippocampus-Organizes explicit memory-Stores initial fear memory


Survival Brain

• Plays a major role in trauma and survival

• Formed earliest

• Responds to sensations and body memory…

• Does NOT respond to language and conscious thought


The Startle Circuit

• Amygdala has a dual sensory input system running from our sense organs to thalamus. From the thalamus these two inputs diverge. One pathway leads directly to the amygdala and the other to the cortex.

• Pathway connections between the cortex and the amygdala are less well developed than are connections from amygdala to the cortex. This means that the amygdala exerts a greater influence on the cortex than vice versa and once the amygdala is turned on, it is difficult for the cortex to turn it off.

• As the "emotional brain" responds to threats, it easily overrides and bypasses the conscious mind at times of stress.


Fight and Flight Response-1

• Information from senses, internal and external, received by thalamus. If based on our past conditioning, memories and our temperament the stimuli is recognized as significant and dangerous; the thalamus directs it to the amygdala, which initiates the body's fight-flight response.

• An activated amygdale does not wait around for instructions from the logical mind and triggers a body wide emergency response with in milliseconds.

• Impulses from the amygdala are sent to the hypothalamus. Once the hypothalamus is aware of the potential danger it activates two different pathways simultaneously. It activates the sympathetic nervous system (SNS) in the spinal cord which affects heart rate, respiration, vasoconstriction, sweating, etc. Hypothalamus also sends signals to the pituitary gland. Pituitary gland in turn secretes hormones which signal other glands in the body such as the adrenal gland to flood the bloodstream with stress hormones like epinephrine, nor epinephrine and cortisol affecting blood pressure, body temperature, metabolism etc.


Fight and Flight Response-2

• The net effect of this fear reaction on our mind-body system is multiple. Within our mind, the activation of this fear response, based on our past conditioning, memory and our genetic make up leads to a series of fearful thoughts. These thoughts lead to feelings of anxiety, caution, anger, worry, panic, etc. Our body shuts down the non- emergency functions such as digestion in favor of directing the body's resources to increasing our heart rate, respiration, muscle strength, etc. All of this allows our body to move quickly for attack or escape.

• The stress hormones also act on the brain to form a memory of the stressful event. Amygdala tells the brain to make a strong memory of the perceived threat. The more significant the event the stronger the memory of it.


Fight

• Examples of Fight Response seen in Clinical Practice


Flight

• Examples of Flight Response seen in Clinical Practice


The Freeze Response

• Unable to fight or flee, the person/animal freezes

• As a result of perceived inescapable attack

• The biological response of the ANS

• The SNS and PNS are activated and overwhelmed

• The freeze response may increase or decrease the chance of survival


Freeze

• An altered state of reality• Time slows down• Pain/fear awareness is diminished• May appear calm outside, but not inside• The body or parts of it feel frozen and numb• Vacant eyes

• Inescapable fear can overwhelm biological and psychological coping mechanisms

• May be part of dissociative Disorders

• Examples of Freeze Response Seen in Clinical Practice ?


Short Term Effects of Fight/Flight

• The stress response was designed to work in short infrequent bursts

• Harmful effects of fight-flight response are minimal, as long as this response is short in duration and infrequent.

• Increased: heart rate, respiratory rate, blood pressure, blood sugar, strength, alertness, learning, memory vasoconstriction.

• Decreased: Digestive and reproductive functions.

• Too Much/Too Long = trauma


Right vs. Left Brain

• The infant's early developing right hemisphere affects limbic and ANS development, influencing stress response

• Hyperactive right hemisphere= selective "processing negative emotions, pessimistic thoughts and unconstructive thinking styles", vigilance, arousal and self-reflection

• Hypoactive left hemisphere= decrease in processing “pleasurable experiences” and “decision-making processes".

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The Limbic System

• Hippocampus= consolidation of information from short-term memory to long term memory and spatial navigation

• People with PTSD cannot integrate the memories of the trauma properly

• Amygdala= processing and memory of emotional reactions

• Corpus Callosum= connects the left and right cerebral hemispheres

and facilitates their communication


Brain Changes Due to Trauma-1

• Early abuse alters brain development, particularly the limbic system maturation

• The patients with BPD had smaller volumes of the hippocampus and the amygdala

• Hippocampal and amygdala volume was also found to be smaller in the patients with dissociative identity disorder

• The hippocampus = learning and mediates storage and categorization of memory

• Hippocampus/Amygdala important in processing of reward, punishment and uncertainty

• The corpus callosum, were smaller in abused subjects• Intracranial volume robustly correlated positively with age of onset

of PTSD trauma (i.e., smaller brains were associated with earlier onset of trauma) and negatively with duration of abuse.


Brain Changes Due to Trauma-2

• Children psychologically abused or neglected were found to have abnormalities in the left side of the temporal region

• It is postulated that left hemisphere dysfunction in children may result in greater use or dependence on the right hemisphere. Increased dependence on the right frontal lobes may, in turn, lead to increased perception and expression of negative emotion and may facilitate unconscious storage of painful childhood memories

• The brainstem was found to be 'dysregulated' in traumatized patients which in turn results in a host of signs and symptoms related to abnormal brainstem functioning, including: altered cardiovascular regulation, affective ability, behavioral impulsivity, increased anxiety, increased startle response and sleep abnormalities.


Hormonal Changes Due to Trauma• Alterations in the noradrenergic and dopaminergic neurotransmitter systems and the stress

response of the hypothalamic-pituitary-adrenal axis are well documented in PTSD - adrenergic dyregulation, enhanced thyroid function, and altered HPA activity

• Also affects the immune system• Subjects with PTSD excreted significantly greater amounts of urinary free cortisol and catecholamines. These biological stress measures correlated positively with duration of the PTSD trauma and symptoms of intrusive thoughts, avoidance, and hyper-arousal• May lead to permanent changes in the NS• Amnesia seen in PTSD is likely to be caused by excessive norepinephrine (NE) release at the time of the trauma• Secretion of endogenous opioids may account for emotional responses being blunted during the traumatic stimulus


Trauma and Somatosensory Memories“Some mental representation of the experience is probably laid down by means of a system that records affective experience but has no capacity for symbolic processing or placement in space or time. It is theorized that the failure of semantic memory leads to the organization of memory on a somatosensory level--such as somatic sensations, behavioral enactments, nightmares, and flashbacks.”

“Research suggests the emotional memory may be indelible but is held in check by cortical and hippocampal inhibitory control. Decreased inhibitory control may occur under a variety of circumstances such as under the influence of drugs and alcohol, during sleep, with aging, and after exposure to strong reminders of the traumatic event. Traumatic memories could then emerge as affect states, somatic sensations, or flashbacks. Such somatosensory memories are timeless and unmodified by further experience”


The Physiological Response to Trauma

• Rapid heartbeat • Elevated blood pressure • Difficulty breathing & hyperventilation • Palpitations, irregular heartbeats • Muscle tension • Fatigue or overly sleepy • Pain including headaches • Fainting • Flushed face or pale appearance • Chills and cold clammy skin • Increased sweating • Dizziness, vertigo • Twitches • Stomach upset or feeling tight • Difficulty sleeping • Exaggerated sensitivity to light and sound, and/or quick movements


The Emotional Response to Trauma

• High states of anxiety, irritability panic, horror, terror and fear

• Hyper-arousal and overgeneralization= react in an extreme fashion to events that resemble the original trauma

• Shock reactions, including feeling numb and feelings of being in a fog

• Feelings of being paralyzed, immobile, frozen • Dissociation which may manifest in the person appearing

dazed, apathetic and vacant "as if he is not there" • Feelings of isolation, hopelessness and helplessness• Depression and feelings of guilt• Abrupt mood swings • Grief


The Cognitive Response to Trauma

• Inability to concentrate/racing thoughts • Disorientation and confusion • Difficulty making decisions • Vulnerability and suggestibility • Forgetfulness • Self-blame and projection of blame on others • Hyper vigilance, feeling 'on guard' at all times • Preservative thoughts of the traumatic incident


The Spiritual Response to Trauma

• Anger directed toward God • Disbelief that God has not protected

him/family, community • Withdrawal from religious services • In the converse, some immediately turn toward

God and begin attending services for the first time

• May project anger toward clergy and faith community

• Some may recite prayers, hymns and arrange special services to help with ¬anguish resulting from trauma


The Behavioral Response to Trauma

• Withdrawal • Immobility • Disconnection - "spacing-out" • Changes in speech patterns • Regressive behaviors • Impulsivity which may include erratic movements • Physical movements including pacing and

inability to sit • Exaggerated startle response • Antisocial behaviors


Effects of Long-Term Trauma on Health

• High blood pressure which can lead to stroke, enlarged heart and kidney disease.

• Coronary artery disease.• Increased risk of drug use and addictions• General anxiety and depression.• Sleep interruption and insomnia. • Chronic fatigue.• Impaired memory.• Heart burn, ulcers and irritable bowel.• Increased risk of infections and cancer.• Obesity and increased risk of diabetes.• Worsening of all forms of pain.• Worsening of PMS and infertility.• Worsening of certain skin diseases.• Sexual dysfunction.• Premature aging.• Worsening of certain auto immune disorders such as arthritis.


Long-Term Health Effects of Childhood Trauma

Adverse Childhood Experience (ACE) study American Journal of Preventive

Medicine 11/09

•Of 17,337 adults members of Kaiser, – %64 had one or more of adverse

childhood experiences (ACE) such as abuse, neglect, major family dysfunction

•Strong link found between ACE and adult onset of chronic illnesses such as CVD, DM, Hepatitis, Chronic Lung Diseases, Depression, Suicide•Those with 6 or more ACEs died nearly 20 years earlier on average, 60.6 years VS 79.1 years•A public health issue


The Resilient Zone


Trauma Zone(s)


Childhood Trauma Presentation

Health & Medicine

Transcript of Childhood Trauma Presentation