Monday, February 24, 2014

Trauma's Long Term Effects

Tiffany was adopted at the age of four after being removed from a mother with schizophrenia and a father with substance abuse.  She had been exposed to emotional abuse and neglect.  She lived in several foster homes including two failed adoptive placements.  At the age of nine, Tiffany was still suffering stress that had developed into Chrone’s Disease, a condition in which stress begins to attack the organs and appears as gastrointestinal pain.  As in adults, stress in children often appears as somatic symptoms like headaches and stomach aches.  Tiffany was working with a therapist to use biofeedback techniques to reduce her pain. Sensors and a monitor help patients become aware of their respiration, pulse rate, and skin temperature, and to practice relaxation techniques to reduce them.    Hooked up to this equipment for the first time, watching her favorite cartoons on a normal day in the home in which she has had great success, five years after her adoption finalized, the equipment showed Tiffany’s stress level alarmingly high.  A combination of therapy, relaxation, exercise, diet, and medication would get it under control. 
     This is an example of the life-long impact of trauma.  Traumatic events have physiological effects on the brain and body.  In the face of a stressful event, the body releases the  hormones cortisol and adrenaline.  They are very helpful in preparing the body for performance in exciting experiences or defending against threat.  However, repeated exposure to trauma causes the body to release these hormones even when they are not needed, and these chemicals stay in the brain, bloodstream, and body causing long term damage.  Survivors of trauma may then attempt to cope with this stress in ways that cause additional damage.

    Trauma is an event or set of circumstances that overwhelms an individual's ability to cope.  It can include abuse, neglect, abandonment, death, divorce, separation, violence, war, natural disaster, crime, mental illness, substance abuse, incarceration, and serious medical illness or procedures.  Research shows 61% of men and 51% of women report experiencing trauma, a majority more than one event as a child or adult.  Those reporting trauma include; 90% of mental health clients, 97% of homeless women, 66% of substance abuse clients, and 77% of male veterans.  In addition to mental illness and substance abuse, trauma can lead to eating disorders, smoking, self harm, sexual promiscuity, heart disease, liver disease, cancer, and early death.

   My experience working with children who have been abused and neglected is that this high level of stress is just under the surface and drives many of the maladaptive behaviors that interfere with family life.  Almost everything from food hoarding and stealing to aggression and poor self care can be traced back to early experiences of trauma.  And because the earliest trauma happens in the context of what is supposed to be a nurturing relationship with a primary caregiver, the resulting stress affects relationships with parents, siblings, caregivers, teachers, and other adults.  To trust an adult, to be close, to receive nurturing care is highly stressful for these children, youth, and adults.  Their coping, then, is driven by the stress including efforts to avoid intimacy.

   Trauma-informed care and parenting then requires an acceptance and appreciation of this trauma including the person's efforts to avoid more pain and suffering and to manage stress that never leaves.  The goal of the parent, caregiver, or professional is to provide a safe environment in which the survivor of trauma can process what has happened to them, develop safe and healthy coping skills, and reconnect in relationships.  Since trauma is so prevalent and universal, it is important for helpers to address our own trauma histories,  to prepare to be triggered, and to practice self care.