Frances Kaplan Trauma Trauma and the physiological responses

Traumatology Trauma and the physiological responses Frances Kaplan

Index

Frances Kaplan Trauma Trauma and the physiological responses

1. Introduction 3 2. Examples of trauma 5 3. A short history 4. Common signs of a traumatic reaction 6 5. debate over early intervention for trauma victims 6 6. Treatment 7. Panic Disorder 8. Posttraumatic Stress Disorder 9. DSM IV criteria for PTSD 9 10. 11. 12. 13. Crimes In South Africa 11 Concerns of trauma therapists 12 Conclusion 12 References 13 7 7 8 5

Frances Kaplan Trauma Trauma and the physiological responses

Introduction Trauma can be defined as any shocking and unexpected experience that is characterized by extreme fear and horror. This type of experience has the ability to shake up most people even though even though individuals may react differently. It is not necessary to experience the traumatic event directly, as even being a witness to the event or being told about a traumatic event of a loved one, may be extremely traumatic. Hamber and Lewis (1997) define trauma as an event that overwhelms the individual's coping resources. Traumatic situations are those in which the person is rendered powerless and great danger is involved. Trauma generally includes events involving death and injury, or the possibility of death or injury. These experiences are unusual and out of the ordinary, and do not constitute part of the normal course of life. Examples of Trauma Some people may experience an even as traumatic where another person my not. SA Health Info describes typical examples of trauma as:

Frances Kaplan Trauma Trauma and the physiological responses

Human Violence for example: o Rape Rape in South Africa has reached epidemic proportions. It occurs

in all spheres of society and all women are potential victims. Women's fears of rape have begun to affect their basic day-to-day decisions and reduce their quality of life. Restrictions on movement, behaviour, and dress are imposed in order to elude the rapist. Precautions, however, are not always a reliable safeguard, for the woman's attacker is often the man she least suspects to be a rapist. Contrary to public opinion and to what many believe, the rapist is not the stranger who is psychotic, or a sex maniac who lurks in dark alleys waiting for his victim. He is in most cases a friend, an acquaintance, a date, a father, or a husband. The rapist is usually what society calls "the normal man". Unofficially, based on the premise put forward by the National Institute of Crime Prevention and the Rehabilitation of Offenders (NICRO) that only one in twenty rapes is reported, the figure is about 380 000 a year. This means that on average approximately 1000 women can expect to be raped a day in South Africa. o physical assault o domestic violence o kidnapping o gang violence o violence associated with military combat Natural Disasters o E.g. floods, earthquakes, tornadoes, or hurricanes Accidents involving injury or death

Frances Kaplan Trauma Trauma and the physiological responses

Sudden, unexpected death of a family member or friend Diagnosis of a life threatening disease

Following a trauma most people experience some unusually strong, even frightening, reactions, emotionally and physically. These reactions are the typical aftershock of a horrible event they are normal reactions to an abnormal experience. Most often these reactions appear shortly after the event, but there can sometimes be a delay. In fact, it may seem one is coping well, and then suddenly you are overwhelmed by intense emotional and physical reaction. A short history In the U.S. Civil War a syndrome named 'Irritable Heart' was diagnosed in soldiers depicting symptoms such as fatigue, shortness of breath, palpitations, headaches, excessive sweating, dizziness, disturbed sleep and fainting. During World War 1 the same symptoms was diagnosed as 'Effort Syndrome' and here the difficulty in concentrating was also noted. 'Combat Stress Reaction' was experienced by soldiers in World War 2. Survivors of Nazi concentration camps also complained of forgetfulness. The trauma related symptoms experienced by Vietnam War veterans finally brought about the concept of Posttraumatic Stress Disorder as we know it today and it was first introduced as a psychiatric diagnosis in late 1980. In all of the traumatic experiences, the severity of the symptoms experienced directly correlated to the severity of the stressor or event Sadock & Sadock (2007:612). Common Signs of A Traumatic Reaction

Frances Kaplan Trauma Trauma and the physiological responses

Victims Physical Reactions may include the following: Tremors, heart racing, dry mouth, sweating and indigestion. Change in sleep patterns, difficulty sleeping, bad dreams and nightmares Tiredness, lack of energy and drive Change or loss of appetite Hyperventilation and / or dizziness Headaches, muscle ache and chest pains

Victim's feelings may include: Extreme vulnerability Panic when a memory of the event is triggered A need to talk about the event / a need to not talk about the event Insecure, frightened and suspicious Violated Exploited Helpless, powerless Out of control Self-doubt Anger

The victim's behaviour may include: Social withdrawal Tendency to avoid anything related to the event Restlessness, irritability Increase use of chemical substances Tearful

The victim's thoughts may include: Flashbacks

Frances Kaplan Trauma Trauma and the physiological responses

Preoccupation with recurring memories and thoughts about the event Poor problem solving Poor concentration and absentmindedness Debate Over Early Intervention for Trauma Victims

Most often police and therapists will recommend that victims of traumatic experiences receive immediate intervention, which is quite often referred to as psychological debriefing (PD). However, recent research is painting a different story and growing consensus is that PD does not necessarily prevent consequent psychopathology, in fact, it may intensify symptoms Litz (2002:112). Treatment Litz (2002:124) believes that Cognitive-Behavioral Therapy (CBT) has shown promising results in the prevention of chronic psychopathology after a traumatic event. The reason for this could be that CBT places great emphasis on repeated imaginal reliving of the traumatic event Litz (2002:126). In so doing the victim is able to desensitize the intense feelings of fear and hopelessness and relearn feelings of safety and calmness. Herman (1998:1) believes that the recovery process may be demonstrated in three stages: establishing safety, retelling of the story of the traumatic event, and reconnecting with others. She believes that trauma destroys the social systems of care, protection, and meaning that support human life. According to her, only through recreation of these systems can recovery take place (Herman 1998:1)

Frances Kaplan Trauma Trauma and the physiological responses

Panic Disorder After experiencing a traumatic event, one may suffer from panic disorder. It is an anxiety disorder and is characterised by unforeseen and recurring episodes of severe fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. Panic attacks can happen anytime, anywhere and without forewarning. You may live in trepidation of another attack and may evade places where you have had an attack. For some people, panic takes over their lives and they cannot leave their homes. People with panic disorder have feelings of dread that strike suddenly and frequently with no warning. During a panic attack, most likely your heart will pound and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have nausea, chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control (Anxiety & Trauma Clinic). According to the DSM-IV (The Diagnostic and Statistical Manual of Mental Disorders) criteria for a panic attack are: A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes: Palpitations, pounding heart, or accelerated heart rate Sweating Trembling or shaking Shortness of breath Feeling of choking Chest pain or discomfort

Frances Kaplan Trauma Trauma and the physiological responses

Nausea or abdominal distress Feeling dizzy, unsteady, lightheaded or faint Derealisation (feeling of unreality) or depersonalization (being detached from oneself) Fear of losing control or going crazy Fear of dying Paresthesias (numbing or tingling sensation) Chills or hot flushes Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a condition marked by the development of symptoms after exposure to traumatic life events. The person reacts to this experience with fear and helplessness, persistently relives the event, and tries to avoid being reminded of it To make a diagnosis, the symptoms must last for more than a month after the event and must significantly affect important areas of life such as family and work Sadock & Sadock (2007:612). The stressors causing PTSD is sufficiently overwhelming to affect almost anyone. Persons re-experience the traumatic event in their dreams and their daily thoughts; they are determined to evade anything that would bring the event to mind and they undergo a numbing of responsiveness along with a state of hyperarousal. Other symptoms are depression, anxiety, and cognitive difficulties, such a spoor concentration. DSM IV Criteria for Posttraumatic Stress Disorder

Frances Kaplan Trauma Trauma and the physiological responses

According to the DSM-IV (The Diagnostic and Statistical Manual of Mental Disorders) criteria for posttraumatic stress disorder are: A. The person has been exposed to a traumatic event in which both of the following were present: (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. (2) the person's response involved intense fear, helplessness or horror. Note: In children, this may be expressed instead by disorganised or agitated behaviour. B. The traumatic event is persistently reexperienced in one (or more) of the following ways: (1) recurrent and intrusive distressing recollections of the events, including images, thoughts or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed. (2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognisable content. (3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions,

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Frances Kaplan Trauma Trauma and the physiological responses

hallucinations, and dissociative flashback episodes, including those that occur on awakening, or when intoxicated). Note: In young children, trauma-specific re-enactment may occur. (4) intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event. (5) physiological reactivity on exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event. C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: (1) efforts to avoid thoughts, feelings, or conversions associated with the trauma (2) efforts to avoid activities, places, or people that arouse recollections of the trauma (3) inability to recall an important aspect of the trauma (4) markedly diminished interest or participation in significant activities (5) feeling of detachment or estrangement from others (6) restricted range of affect (e.g. unable to having loving feelings) (7) sense of foreshortened future (e.g. does not expect to have a career, marriage, children or a normal life span) D. Persistent symptoms of increased arousal (not present before the 11

Frances Kaplan Trauma Trauma and the physiological responses

trauma), as indicated by two (or more) of the following: (1) difficulty falling or staying asleep (2) irritability or outbursts of anger (3) difficulty concentrating (4) hypervigilance (5) exaggerated startle responses E. Duration of the disturbance (symptoms in criteria B, C. & D) is more than 1 month. F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important functioning. Specify if: acute: if duration of symptoms is less than 3 months chronic: if duration of symptoms is 3 months or more Specify if: with delayed onset: onset of symptoms is at least 6 months after the stressor Crimes In South Africa South Africa is renowned for being the most violent nation in the world. As a result, most South Africans have tales of trauma and victimization. According to Isserow (2001:2), the following are the capitals experiencing the most crime: 1 in 75 people in Tswhane and 1 in 92 people in Cape Town fell victim to house burglaries in 2001, these 2 areas have the highest burglary rates in South Africa 12

Frances Kaplan Trauma Trauma and the physiological responses

Per capita, Johannesburg ranks highest in terms of aggregated robberies involving a firearm. I in every 110 people living in Johannesburg has fallen victim to a aggravated robbery.

1 in 65 people was a victim of theft from a motor vehicle in Cape Town. Johannesburg has one of the highest rates in car-jackings with an occurrence rate of 1 in every 605 persons. Per capita, attempted murder is greatest in Cape Town (1 in 879 people), and Johannesburg (1 in 954 people) Rape per capita, occurs at the highest rate in Nelson Mandela (1 in 559) and Johannesburg (1 in 607)

From these statistics it is clear to see that crime is a serious and threatening problem throughout South Africa, with Johannesburg falling victim to most of the highest rates of crime. Statistics seem to support the view that South Africa is an exceptionally violent country. Hamber & Lewis (1997) state that a 1996 study indicated that over a period of five years, about 70 percent of the urban population in South Africa were victimised at least once (van Dijk, 1996). The experience of being violently victimised in South Africa has become a statistically normal feature of everyday life in the urban and rural setting. South African Police Service (SAPS) figures indicate that in 1996 there were a total of 25 782 reported murders, 28 516 attempted murders and 12 860 car hijackings. Concerns for Trauma Therapists Herman (1998:2) believes that trauma is contagious. In the role of therapist we play witness to the horrific ordeals that our clients have been victim to. This may stimulate intense feelings of fear,

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Frances Kaplan Trauma Trauma and the physiological responses

horror, sorrow etc. within ourselves, and perhaps dig up old and buried feelings from our past experiences. In such situations the therapist may feel the need to disregard boundaries, defend the client or even feel the need to withdraw. It is therefore vital that trauma therapists have an ongoing support system. Herman (1998:2) states that Just as no survivor can recover alone, no therapist can work with trauma alone. Conclusion As therapists in South Africa, trauma therapy will become a usual part of the daily routine. Traumatic syndromes are intricate disorders requiring intricate therapy. Trauma affects the victims entire being and it is important that the entire being be treated, including the family and friends of the victim Herman (1998:3).

References Buell, S., Lo, B., Ruston, D.C., Swenson, S.L., White, M., Zetler, P. 2004. Patient-centred communication Do patients really prefer it? J Gen intern Med, 19: 1069 1079 Corey, G. 2005 7th Edition. Theory and practice of counseling & psychotherapy. United States of America: Thomson books/Cole

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