The lay reader is tempted, using existing terminology, to equate all traumatic conditions with the diagnosis commonly known as "Post Traumatic Stress Disorder", otherwise referred to as PTSD. In fact, on reviewing the vast majority of victims surviving severe personal threat, only a minority develop the condition of PTSD.
Trauma varies in duration and intensity.
Survivors vary in age, temparement, and coping skills.
Trauma can be followed by rapid and robust rescue responses or apathy, indifference or even collusion by caretakers.
These are some of the determinants of the psychological outcome of trauma events.
The most benign trauma responses are referred to as "Trauma Related Symptoms".
In such cases, victims may experience worry, apprehension, and sleep disturbance. But when these victims receive or actively pursue rescue resources, even in the form of simple social bonding and "ventilation", these symptoms (despite appearing quite disruptive), tend to be benign and self-limiting.
When the trauma is of higher intensity and duration and rescue services fail, victims are much more likely to develop one of the more serious acute or chronic stress responses:
Acute Stress Disorder consists of a "dissociative" response in association with three other domains of symptoms:
1) Reliving the trauma as if it were continuing in the present, (such as experiencing "flashbacks").
2) Avoiding thoughts, feelings or situations that trigger scary images or thoughts related to the event, and
3) Over-arousal, where the individual is continuously scanning the environment to identify danger-signals.
"Dissociation" is a phenomenon whereby the victim`s defenses are so overwhelmed that the individual may temporarily lose his or her conscious grasp of the traumatic event, and may forget details of the traumatic event or even the entire event.
When the three above-mentioned domains of symptoms persist for a month or longer, the victim can be diagnosed as having PTSD.
Besides the psychological components of re-experiencing, and avoidance, the excessive arousal found in patients with PTSD can be measured by multiple biological changes in the limbic brain.These include elevations of CRF, and glutamate, the main stress-induced neurotransmitters produced by the Hippocampus.These toxic substances prevent the Hippocampus from processing and containing the trauma event in coherent memory. The downstream effects even appear to impact the body`s immune functions and increase the risk of cardiovascular disease.
Recently, attention has focused on an entity first described by Judith Herman as "Complex Trauma" a condition that occurs as a result of severe and persistent inter-personal trauma. This condition most commonly affects victims of child-abuse and political terror:
While healthy families and societies provide soothing and protective caretaking towards its most vulnerable members, the victim of caretaker abuse is threatened, demeaned,or even physically abused. The key factor in abuse is the state of helplesness imposed by the predator, who creates a constant terror paradigm. In such a dynamic, the victim`s boundaries are violated at the whim of the predator, without the security of external rescue responses.
It is believed that the long-term effects of this threat-dynamic impact on the individual`s sense of executive-functioning and ability to engage in future relationships lack a true sense of flexible power-sharing. Instead, the victim continues throughout his or her life, to re-live the role of being a victim. In the trauma literature, this is referred to as "trauma re-enactment".
Unfortunately, this condition, known as "Complex Trauma", frequently escapes diagnosis, but can nevertheless cripple the victim`s life-quality. Stripped and disempowered, the victim continues to play out his or her life on a stage bereft of joyful creativity, dominated by a world filled with dangerous and persecutory objects. Other symptoms include a failure of the victim to "self-soothe" or "affectively-regulate".When this is severe, and associated with disurbances in attention and self-boundary,a condition that merges with "Borderline Personality".
Some severely traumatized victims suffer from the above-mentioned deficits in healthy self-functions, (Complex Trauma), while other victims experience only the three domains of classic PTSD.
According to Julian Ford from the National Center for PTSD, traditional combat- trauma is the key risk factor for PTSD, while early childhood trauma and the witnessing of atrocities function as independent risk factors for the development of Complex Trauma.
