VIOLENCE AND PTSD

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VIOLENCE AND PTSD

• Human Responses and Healing
• Brenda Wiewel, LCSW

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Your vision will become clear only when you can
look into your own heart. Who looks outside,
dreams. Who looks inside, awakes. Carl Jung
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SOURCES

• Dayton, Tian, PhD., 2000. Ending the Cycle of
  Trauma and Addiction Ending the Cycle of Pain
  Through Emotional Literacy, Deerfield Beach,
  Florida, Health Communications, Inc.

• Napier, Nancy J., 1994. Getting through the Day
  Strategies for Adults Hurt as Children, New York,
  New York, W.W. Norton and Company, Inc.

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DEFINITION OF POST TRAUMATIC STRESS DISORDER

• Persons are traumatized when they face
  uncontrollable life events and are helpless to
  affect the outcome of those events. (Lindemann,
  E., 1944)
• Events may include
• Possible death or injury
• Physical or sexual attack
• Childhood scenes of adult rage

• PTSD can result with exposure where
• one experiences, witnesses, or is confronted with
  events that involve actual/threatened death or
  serious injury or threat to physical integrity of
  self or others
• and reacts with intense fear, helplessness,
  and/or horror (DSM lV, 1994)

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Short Term PTSD Symptoms

• Recurrent/intrusive memories (images, thoughts,
  perceptions)
• Reliving parts of event through hallucinations or
  flashbacks
• Intense physiological arousal (rapid heartbeat,
  sweating, general anxiety, stomach queasiness,
  head pounding)
• Difficulty falling or staying asleep
• Difficulty concentrating
• Irritability or angry outbursts
• Hypervigilance
• Exaggerated startle response

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Long Term PTSD Symptoms

• Trouble with intimacy or commitment
• Unable to set or set overly rigid boundaries
• Inability to relax, have fun, be spontaneous
• Difficulty with trust
• Fixation on PTSD or Trauma (as if constantly
  reoccurring)
• Changes in personality
• Chronic depression with despair
• Psychosomatic symptoms
• Sensation seeking or numbing behavior (high risk
  acts or self-medicating)

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COMPLEX PTSD

• This occurs due to repeated early and later
  experiences of chronic and/or severe traumatic
  events and experiences
• Symptoms include
• Affect disregulation
• Destructive behavior toward self and others
• Dissociation (separating self into parts)
• Distortions in concept of self or others
• Inability to use emotions as signals so misread
  internal and external cues and significantly over
  or under react to present situations

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INTENSITY OF PTSD

• Severity and long term response based on
• Genetic predisposition
• Developmental phase (firm sense of identity and
  strong social support helps)
• Prior traumatization
• Preexisting personality (e.g. untreated phobias
  and maladaptations to previous life stressors
  more likely to result in psychiatric reactions)
• Nazi survivors 99 psychiatric disturbances, 87
  cognitive disturbances, 85 persistent
  nervousness and irritability, 60 sleep
  disturbances, 52 nightmares

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UNDERSTANDING THE BRAIN

• Fear, horror, and helplessness of traumatic event
  activates the amygdala (moderates hormones for
  flight, fight, or freeze) and basil forebrain
  (stimulates arousal and reward). This reaction
  evolved for human survival.
• Trauma aroused feeling states get frozen and
  stored as memories in the lower brain without any
  conscious thought processing. When these
  memories are triggered by external associations,
  the trauma is relived physiologically and
  hormonally leading to automatic reactions of
  fight, flight, or freeze (shutting down).
• There is no conscious knowledge or awareness of
  what is happening because the conscious part of
  the brain that ordinarily processes and provides
  meaning or context has not been activated.
• Feedback loop arousal triggered by environmental
  stimuli causes release of stress hormones which
  increase anxiety, which increases stress and a
  circular loop develops, often leading to acting
  out behaviors or emotional shutdown/numbness to
  manage the high levels of physiological
  flooding. This state interferes with ability to
  learn and improve coping.

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EMOTIONAL ILLITERACY

• Lack of conscious processing of reactions
• Feelings not processed experienced, labeled,
  or communicated.
• Interferes with development of healthy
  self-soothing and supportive relationships

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TRAUMA TREATMENT GOALS

• Ensure physical and emotional safety
• Create relationships where there is safety to
  share feelings and real support is consistently
  available
• Maintain sense of curiosity during exploration to
  find new parts of self with a story to tell and
  triggers with important bridges to unremembered
  experiences
• Monitor for self- frustration due to getting
  triggered and be gentle with self
• Work on how to listen to bodys distress and
  translate to feelings so symptoms have a voice
• Remember that the healthy adult self is a
  compassionate resource

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HOW TO PROMOTE HEALING

• See PTSD when it is in front of you
• Educate about how PTSD works
• Manage over or under reactive behaviors calmly
• Work toward emotional literacy by helping to
  convert sensed feelings into words to decode the
  inner world and create meaning within self
• Support communication of inner state to others
• Learn to recognize triggers, separate past from
  present, and create a new life narrative
• Help with grief work to prevent relapse
• Use letters, journaling, emdr, psychodrama

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BREATHING EXERCISE

• Sit quietly and settle into your chair.
• Feel your body as it touches the chair and your
  feet as they connect to the ground.
• Focus on your breathing.
• As you breathe in, say to yourself
• May I dwell in the heart of healing
• As you breathe out, say to yourself
• May I heal into my full self!