6. Trauma and Personality Flashcards
What is trauma
a wound of the mind - an event leaving some lasting negative impacts on the mind
What are the types of trauma?
Complex
Betrayal: when people you should be able to trust, betray you
Developmental: sometimes called complex or attachment
Massive: one big event
Cumulative: over time, little bits of trauma which accumulate
Intergenerational trauma: trauma from one generation that’s passed down
Moral trauma: when you have a moral dilemma that fundamentally shakes your values
Very difficult to predict who will get traumatised
Outline the history of trauma: Pierre Janet
Theory: diathesis stress (certain people were predisposed to having an illness, but the environment needed to trigger it)
- they didn’t have enough mental energy to integrate their brain
- if conscientiousness occurred, there would be a split in their consciousness
- created the idea of ‘subconscious’
At this time: asylums were like prisons
History of trauma: Breuer and Freud
They were mentored by Janet and had 2 theories about how traumatisation could impact the mind
- if you were in a hypnotic state and the traumatising event occurs, this would lead to the memory of the event being split off
- traumatic event occurs, the memories of that event get cut off by pushing them away (repression)
Freud developed 2 models of traumatisation
- Unbearable situation model: the event is so unbearable you cannot deal with it
- Conflict model: you might have a desire to do something, but there’s so much stress about acting upon the desire that you cut off the desire
History of trauma and personality: WWI
Psychic, nervous, mental shock –> shell shock
Diverse range of symptoms: amnesia, confusional states, somatoform symptoms, exhaustion
Idea: if you have bombs exploding around you, they were making minute imperceptible damages to the brain (not true)
Newer idea: traumatic neurosis (psychological disorder related to traumatisation)
Outline DSM 3 and PTSD
PTSD was conceptualised as an anxiety disorder (with social phobia and OCD)
Criterion A: traumatic stressor - distressing event outside normal range of experience that evoked fear, terror, helplessness
Symptoms:
- reexperiencing traumatic events
- nightmares
- avoidance
- hyperarousal
Duration > 1 month
Expansion of DSM3 PTSD diagnosis to DSMIV
DSM-III: threat to life / physical integrity
DSM-IV: expanded to include developmentally inappropriate experiences without violence of injury
DSM 5 model of PTSD
No longer an anxiety disorder
Removes reference to subjective response (terror does not necessarily have to be experienced - some people disassociate)
Adds to symptoms: persistent alteration of mood and cognition
Criterion A expansion: First hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related)
Outline PTSD onset
Can occur at any age after the first year of life
Usually within the first 3 months after trauma
Can have delayed onset trauma: after many months or years
Or delayed expression (delay in meeting full criteria)
What are some criticisms of trauma research?
- initially only included life threatening events but criterion has expanded and may diminish this (i.e. concept creep: will we pathologize normal stress responses?)
What are some difficulties associated with trauma research?
- Correlation and demonstrating causation
- Retrospective studies (malleability of memories)
- Very difficult to predict specific outcomes
what is a relational view of traumatisation
- events are not traumatic in themselves, rather, they may be so in their effects on a given individual
Involves:
- the objective aspects of the events
- an individual and their reactions
- the acute and chronic effects
What are important risk factors for developing PTSD
Most important variable = severity of trauma
Social support
General life stress
Ecology of trauma model
The science of interrelationship of organisms and their environments - understanding trauma with respect to the person, the event and broader environment:
Person x event x environment
These interact with eachother to shape traumatisation
What are the environmental variables in Harvey’s Ecology of Trauma Model?
Environmental variables: important role in community and culture
- role of community
- social, cultural and political factors
- cultural concepts of distress
Cultural beliefs help determine both trauma vulnerability and resilience.
Cultures can be protective
- e.g. Aboriginal kinship relations
Statistics on traumatisation childhood:
Worldwide;
1/3 of children suffer physical abuse
1/4 of girls and 1/5 of boys suffer sexual victimization
Trauma and attachment theory - Bowlby
Theory: all humans have a fundamental psychological need to develop an attachment to a caregiver.
Object relations theory of psychoanalysis - how relationship during development effect how we related to the world and how we relate to ourselves.
If children didn’t have supportive caregivers that could physically and psychologically nurture them, this leads to problems.
Outline an ethological approach to attachment theory
Scientific and objective study of animal behaviour in natural conditions - looking at how attachment occurs in an evolutionary context to survive.
Child develops emotional relationships with caregivers as a protective framework:
- Universality: when given an opportunity, all infants will become attached to a caregiver
- Normative: majority are securely attached in contexts not inherently threatening to survival
- Sensitivity: attachment security dependent on child-rearing antecedents
- competence: secure attachment leads to positive child outcomes in a variety of developmental domains
Is attachment universal?
Allo-parenting: “cross cultural evidence indicates that in most societies, non-parental caretaking is the norm or common”
i.e. in congo, infants have average 14 caregivers in first 18 weeks of life
How can attachment theory be a basis for risk and protective factors in traumatisation?
If you have caregivers that help you feel you are a valuable person, and they are trustworthy - you might have positive views of yourself and positive views of others.
i.e. influence the internal working model (belief systems) of self and of others
What is mentalization?
The capacity to understand ourselves and others in terms of mental states (similar to TOM)
- relationships are essential for learning about our own and other’s minds
What is mirroring? (and marked mirroring)
Caregiver or someone acts as a mirror to the child to help them understand:
- own experience of yourself and world
- your emotions and help you regulate them
- to see yourself as different from others
Marked mirroring: that’s your experience, not mine
What is containment?
Involves the presence of another being who not only reflects the infant’s internal state, but re-presents it as a manageable image, as something that is bearable and can be understood
Reacting to a temper tantrum: “i see you’re upset, but you’ll be okay in 5 minutes”
Complex trauma is
trauma that occurs across a period of time in a developmentally sensitive period involving victimization
aka attachment trauma, type 2 trauma, early relational trauma, developmental trauma
Complex trauma is associated with
violence in relatoinal contexts where safety and protection should be provided
child maltreatment
betrayal of trust by caregivers / authority
intentional violation of bodily boundaries
Intentoinal acts by other human beings (interpersonal) that are inescapable and create insecurity
What is the proposed Complex PTSD
Core features;
affect dysregulation, identity alterations and relational impairment (AIR)
Refers to the chronic exposure to interpersonal stressors (compared to acute exposure to impersonal / interpersonal traumatic stressors)
dissociation
disconnect between bodily states and the psychological emotional experience
there are high levels of dissociation associated with BPD and PTSD
- is BPD less of a personality disorder and more a trauma related disorder
Is BPD a trauma related disorder?
High levels of dissociation found in both BPD and PTSD
BPD = 13.9x more likely to report childhood adversity than onn-clinical controls (emotional abuse and neglect are the largest)
BPD 3.15x more likely to report childhood adversity than other psychiatric groups
BPD and PTSD share common neuropathological pathways
Most robust risk factors for bpd:
- Social: low SES, stressful life events, family adversity
- maternal psychopathology
- family: affective parenting (low warmth, hostility, harsh punishment)
- maltreatment
- individual differences: low iq, high levels of negative affectivity and impulsivity, internalizing and externalizing psychopathology