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  • Trauma and Its Aftermath
    Part II: The Trauma Response: Fleeting or Enduring?

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    Liz,* age 25, came to therapy for help with work stress triggered by her unreasonable boss. In the course of taking her history, I learned she had been sexually abused by her third-grade teacher on about 10 different occasions. He threatened to hurt her little brother if she told. While she described the abuse as traumatizing at the time, further questioning indicated she had no lasting trauma symptoms—no nightmares or flashbacks, no disconnection from her emotions, no random anger, no sexual difficulties with her long-term boyfriend.Rachel, 28, had a similar abuse history: when she was 6, her 14-year-old brother fondled her over a period of six months. But for her, the trauma was still very much present. She entered therapy struggling with depression, shame and periodic nightmares. She found herself shutting down during sex with her husband. Her symptoms met the criteria for post traumatic stress disorder (PTSD).

    According to the U.S Dept. of Veterans Affairs, 50-60 percent of us will experience some trauma in our lives, but only 4-10 percent of the overall population develops PTSD. Why does one person’s trauma resolve quickly, while another’s suffering endures for years? The answers lies in a complex interaction of personal variables (age, gender, psychological stability) and external factors (the type and duration of the trauma, the response of loved ones).

    Let’s start with the nature of the traumatizing experience. Those who are in closer proximity to a natural or man-made disaster—be it hurricane, flood or the combat—will develop PTSD at higher rates than those who are further away. Those exposed to traumatic events of longer duration—growing up in a war zone, or being imprisoned and tortured for months, or enduring physical or sexual abuse throughout one’s childhood—are much more likely to develop PTSD than victims of a single event, such as a car accident or a tornado.

    Another factor that increases the likelihood of PTSD is the degree of brutality involved. As trauma expert Belleruth Naparstek points out, “Atrocities and interpersonal violence have a more devastating effect on the human spirit” than accidents or natural disasters; “When people are subject to malevolence and brutality at the hands of fellow human beings, the ravaging symptoms of PTSD go wider and deeper” (Invisible Heroes, Ch 4).

    Naparstek notes betrayal is also a strong predictor of PTSD: “Sexual abuse by a trusted family member, friend or community authority yields the astronomical rate of 87 percent PTSD in its victims.”

    Other variables that increase the risk of PTSD: If a person believes s/he is going to die (independent of the actual threat of death), unpredictability, if there is an element of physical entrapment, or if the victim suffers injury or loss, especially the loss of a loved one.

    Personal traits of victims can also determine the severity of their trauma response. As you might expect, children exposed to trauma are more vulnerable to PTSD than adults. Cross-cultural studies show that women are twice as likely as men to develop PTSD, even when exposed to the same traumatic event. Those who are more educated, have more social supports and a more stable psychological history are more likely to escape PTSD. A prior history of trauma heightens the risk that a new trauma will lead to PTSD.

    Even when cases are demographically similar, as with Liz and Rachel, what happens after the victim tells of the abuse can profoundly impact how the trauma plays out. When Rachel told her mother that her brother was abusing her, her harried single mother questioned the brother, and believed his denials. She depended on her son to babysit Rachel while she was working her swing shift at a local casino. Perhaps if she had been less overwhelmed herself, Rachel’s mother would have found the energy and insight to stop the abuse and get help for both her children. As it was, Rachel was not only not believed, but again placed in her brother’s “care.” The abuse continued, and Rachel was on her way to a decades long struggle with anxiety, shame, mistrust and hopelessness.

    Liz’s post-abuse story is quite different. When she finally overcame her fear of her teacher’s threats and told her mother he was “touching” her, Liz’s mother took her word for it. She comforted her daughter in the moment, then called the police to report the perpetrator. She took Liz to a child psychotherapist for treatment. Liz was believed and protected, her emotional wounds taken seriously and treated. Moreover, she got justice: the teacher was arrested, convicted and imprisoned for his crimes. With the help of a wise parent and supportive psychotherapist, she was able to integrate this terrible experience in the most adaptive way possible, seeing herself as a courageous survivor who was worth protecting, and the the world as place where speaking up for yourself pays off.

    This sense of efficacy—of having a degree control over one’s fate—is a key factor in how trauma plays out, both in the moment and over time. More on that next time.

    * Names and clinical details have been altered for client privacy

    To learn more:

    US Department of Veterans Affairs

    National Institutes of Mental Health

    Mayo Clinic


    The Body Remembers by Babette Rothschild

    Invisible Heroes: Survivors of Trauma and How They Heal by Belleruth Naparstek

    Getting Past Your Past by Francine Shapiro, PhD