6. Trauma and Personality

Question 1

What is trauma

Answer 1

a wound of the mind - an event leaving some lasting negative impacts on the mind

Question 2

What are the types of trauma?

Answer 2

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

Question 3

Outline the history of trauma: Pierre Janet

Answer 3

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

Question 4

History of trauma: Breuer and Freud

Answer 4

They were mentored by Janet and had 2 theories about how traumatisation could impact the mind

1. if you were in a hypnotic state and the traumatising event occurs, this would lead to the memory of the event being split off
2. 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

Question 5

History of trauma and personality: WWI

Answer 5

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)

Question 6

Outline DSM 3 and PTSD

Answer 6

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

Question 7

Expansion of DSM3 PTSD diagnosis to DSMIV

Answer 7

DSM-III: threat to life / physical integrity

DSM-IV: expanded to include developmentally inappropriate experiences without violence of injury

Question 8

DSM 5 model of PTSD

Answer 8

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)

Question 9

Outline PTSD onset

Answer 9

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)

Question 10

What are some criticisms of trauma research?

Answer 10

• initially only included life threatening events but criterion has expanded and may diminish this (i.e. concept creep: will we pathologize normal stress responses?)

Question 11

What are some difficulties associated with trauma research?

Answer 11

1. Correlation and demonstrating causation
2. Retrospective studies (malleability of memories)
3. Very difficult to predict specific outcomes

Question 12

what is a relational view of traumatisation

Answer 12

• 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

Question 13

What are important risk factors for developing PTSD

Answer 13

Most important variable = severity of trauma
Social support
General life stress

Question 14

Ecology of trauma model

Answer 14

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

Question 15

What are the environmental variables in Harvey’s Ecology of Trauma Model?

Answer 15

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

Question 16

Statistics on traumatisation childhood:

Answer 16

Worldwide;
1/3 of children suffer physical abuse

1/4 of girls and 1/5 of boys suffer sexual victimization

Question 17

Trauma and attachment theory - Bowlby

Answer 17

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.

Question 18

Outline an ethological approach to attachment theory

Answer 18

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

Question 19

Is attachment universal?

Answer 19

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

Question 20

How can attachment theory be a basis for risk and protective factors in traumatisation?

Answer 20

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

Question 21

What is mentalization?

Answer 21

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

Question 22

What is mirroring? (and marked mirroring)

Answer 22

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

Question 23

What is containment?

Answer 23

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”

Question 24

Complex trauma is

Answer 24

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

Question 25

Complex trauma is associated with

Answer 25

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

Question 26

What is the proposed Complex PTSD

Answer 26

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)

Question 27

dissociation

Answer 27

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

Question 28

Is BPD a trauma related disorder?

Answer 28

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