Living with trauma

Trauma is understood as the psychological response to traumatic events. These responses are categorized in different ways, one of which is post-traumatic stress disorder (PTSD).

PTSD is just one of the possible responses to trauma. Equally important are anxiety, depression and unresolved grief, somatic symptoms, interpersonal relationship problems and their feedback loop of symptoms, excessive use of medical services, and so on. PTSD is an interesting concept that offers significant advances in many areas, although in this sense, it is conceptually limiting. PTSD is not an illness, but a normal response to a situation/event that is abnormal for human beings: the traumatic experience.

It is the wound left behind after experiencing a situation that completely overwhelms our coping abilities. Our brain, our nervous system, and our entire body react and activate coping strategies to deal with the threatening, dangerous, or harmful situation. If these strategies are not switched off once the threat has passed, they become dysfunctional and develop into the symptoms of post-traumatic stress disorder.

Some people have more risk factors for developing trauma. Some examples of risk factors that increase the likelihood of a poor prognosis are:

• Having suffered other potentially traumatic events.
• Not having a good support network, or having a negligent or harmful one.
• Having a rather avoidant coping style.
• Having coping strategies based on dissociation.

If it is not identified, properly diagnosed, and treated appropriately, the discomfort may accompany us throughout our lives.

The truth will come when you visit a mental health professional who can give you a proper evaluation and diagnosis. Generally, what you'll notice is that you have a persistent feeling of unease . The longer the event, the more varied the symptoms will be, because co-occurring conditions often appear.

Some signs that indicate we may not have fully integrated a situation are:

• Reacting to certain situations in an excessive way without really knowing why.
• Problems with concentration or attention.
• Irritability, which may be more localized in response to gestures or behaviors of others without apparent reason).
• Avoiding things we used to do.
• Changing habits to avoid doing things that, from a certain point on, generate a rejection of doing them.
• Sleep problems (insomnia, night awakenings, etc.).
• Mood disorders.
• Dissociations.
• Be constantly alert.

Intestinal problems or frequent infectious diseases can also occur due to a poorly functioning immune system. In this case, it's because of the modifications our body undergoes to enter "survival mode," which over time generate dysfunctions at different levels.

It can be understood as a double-edged sword. Experiencing a potentially traumatic situation will, among other things, activate our resilience. If we ultimately don't develop post-traumatic stress disorder, our resilience will have been strengthened, and we'll be better prepared to face any situation next time. If, on the other hand, due to various factors, we do end up developing trauma, we may be more vulnerable to developing other types of comorbid pathologies . It's also true that, in that case, if we receive appropriate treatment and are able to integrate what happened, recalibrate our nervous system, and return our brain networks to a state of safety, that susceptibility disappears.

The intergenerational transmission of trauma refers to a process by which the traumatic experiences of parents are currently negatively affecting their children by interfering with their socio-emotional development. These offspring may exhibit psychological sequelae. This transmission could explain the persistence of these sequelae and the negative mental health outcomes in vulnerable communities, even decades after the violence has ceased.

When a traumatic event occurs, such as abuse, relational patterns are profoundly affected . This can lead, for example, to families where parents have suffered abuse exhibiting more hostile parenting styles, fear of normal child behavior, explosive anger, and harsh parenting. However, this is not always the case, as studies also show that these parents can compensate and even become more effective figures in their relationships.

This topic has been widely discussed, and not always from a scientifically grounded perspective. Current studies indicate that what we inherit are the epigenetic changes caused by trauma in our ancestors, up to three generations back. This means that we don't inherit the trauma itself, but rather the vulnerability or susceptibility it generated in our ancestors. The latest studies focus on determining which structures or mechanisms might be affected, such as inheriting a larger amygdala. This alteration could make us more susceptible to having, in general, more intense alert reactions and, therefore, a greater likelihood of developing trauma in even less stressful situations, which we would perceive as more threatening.

Aside from this explanation based on genetics and biology, there is another consideration based on behavioral studies. Traumatic response patterns can be inherited through vicarious learning . In this sense, it wouldn't be inheriting the trauma itself. During childhood, if our primary caregivers suffer from post-traumatic stress disorder, we may end up internalizing ways of functioning or responding to certain situations that are, in reality, unconscious traumatic reactions from our caregiver.

Once we develop post-traumatic stress disorder, we will always need the intervention of a specialized mental health professional. Support from those around us is fundamental to recovery; however, it alone will not allow us to fully integrate what happened.

Trauma treatment is a long, phased process . Before beginning to address the trauma itself, people need to recover sufficient resources and even positive experiences from their lives that help them find stability. Gaining the reassurance that trauma doesn't define one's life is crucial, and therefore, first and foremost, it's necessary to revisit other experiences that have made you feel proud or genuine interpersonal experiences of love that we all have. I always say that it's the people themselves who open the door and let you know when they're ready.

Specialized trauma-focused therapies are designed to avoid retraumatizing the individual. A qualified mental health professional will know how to address the symptoms appropriately and within the necessary timeframe to prevent adding to the person's suffering. Retraumatization is more likely if the problem is not addressed specifically or if non-specialized approaches are attempted.

Currently, there are many therapies that address PTSD. The American Psychological Association recommends four in particular, which are variations of cognitive behavioral therapy (CBT) :

• Cognitive-behavioral therapy itself.
• Cognitive processing therapy.
• Cognitive therapy.
• Prolonged exposure therapy.

This organization makes this recommendation based on available scientific studies that support the effectiveness of these therapies. In addition to those already mentioned, it includes another group of therapies and medications that are recommended conditionally. Among these, we find, for example , eye movement desensitization and reprocessing (EMDR) therapy , which has generated considerable interest in recent years. This means that, despite studies demonstrating its effectiveness, there is less conclusive evidence than for the other therapies.

Internal family systems therapy is one of many therapies that attempts to reconcile the profound disintegration left by severe traumatic experiences. It involves treatments for severe traumas that produce dissociation , which is like a part of ourselves becoming disconnected from the rest.

Human beings have a natural tendency to integrate their life experiences into a complete narrative, which helps shape their sense of self—the concept of who they are as individuals. This integration cannot occur properly if a person grows up in an environment that does not provide the necessary physical and emotional safety and security.

In simplified terms, dissociation can be described as a lack of integration between different aspects of the personality . This disconnection can occur in various ways and to varying degrees, as the level of consciousness can differ considerably.

All these therapies help to integrate these dissociated parts; they are therapies that are not usually used as much in the child and adolescent field, since the personality is still developing.

No, the therapeutic approach will generally be different. In fact, one of the reference diagnostic manuals (ICD-11) currently distinguishes between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) . PTSD is usually the result of a single traumatic incident, whereas CPTSD typically develops after experiencing continuous, repeated, or multiple traumatic events. It is even noted that CPTSD is more common in people who have experienced these events during an early stage of their development. For these reasons, and others related to the differences in symptoms, the approach will, in principle, be different .

First and foremost, it's crucial to find a good mental health professional specializing in trauma treatment with whom you feel comfortable. From there, they will guide the intervention, focusing primarily on helping you regain a sense of safety and control. They will work to help your brain, nervous system, and entire body gradually recover a sense of security, moving away from survival mode. There are many ways to process a past event, and not all of them involve confronting or repeatedly exposing yourself to what happened.

It depends. There are trauma-focused group therapies, but they have a very specific approach that doesn't always involve sharing what happened. I say it depends because, depending on the group and how the sessions unfold , we can, on the one hand, be retraumatized, and on the other hand, we can develop secondary traumatization—the kind we suffer from being exposed to traumatic experiences in others (as can happen to internet moderators or war correspondents, for example). So, I lack the information to fully answer the question.

There are specific considerations that are not currently included in diagnostic manuals. The symptoms are the same, but they are often easily masked by other symptoms or characteristics. There is a wonderful book by Isabel Paula called *Complex Trauma in Autism: The Urgency of Sensitive Intervention* (Alianza Publishers), which I highly recommend.

Undoubtedly, childhood traumas can be more serious , given that they occur in a developing brain and can have a greater impact. The brain develops sequentially and very rapidly in the first years of life.

The same miraculous plasticity that allows young brains to quickly learn about love or language, unfortunately, also makes them highly susceptible to negative experiences. Just as fetuses are especially vulnerable to specific toxins depending on the trimester of pregnancy in which they are exposed, children are more or less vulnerable to the lasting effects of trauma depending on when it occurs. Consequently, the same trauma experienced at different times could result in different symptoms .

For example, a one- or two-year-old who doesn't yet have the language to describe the repeated and painful sexual abuse they have suffered may develop a complete aversion to being touched, serious problems with intimacy and relationships, and generalized anxiety. However, a ten-year-old boy who has been subjected to virtually identical abuse is more likely to develop more specific fears related to the abuse itself and to deliberately work to avoid particular cues linked to the place, person, and manner of the abuse. Their anxiety will come and go depending on their exposure to memories of the sexual abuse.

The way the environment interprets events is very important; in other words, the narrative surrounding them. Discussing complex situations is a broad topic, but undoubtedly the most important thing is always not to minimize the problems children share , and to convey that feeling bad is normal.

Perhaps I would also add the importance of not rushing things so that children "feel good." Often, we adults are more anxious about the children's suffering than the children themselves, and they pick up on this.

Why is it so important to validate our children's emotions?

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Neither one nor the other. These are two possible communication patterns following trauma: either intensive, unfiltered communication about the traumatic experiences, or a conspiracy of silence, where communication about what happened is inhibited. Both communication styles negatively impact children's mental health.

Rather, we speak of moderate disclosure , which consists of adapting the communication we choose to share to the child's development and needs (not our own). This must always be for the benefit of the children and not to make them complicit or demand that they understand us.

Of course. Prolonged and repeated traumatic experiences lead to complex post-traumatic stress disorder (CTSD), which is characterized by the accumulation of adverse experiences over time, often of an interpersonal nature. CTSD is characterized by a symptomatic triad that includes:

• Alterations in affective regulation: manifested by difficulties in modulating intense emotions, episodes of dissociation, and disproportionate anger responses. (Van der Kolk, 2014).
• Distortions in self-image: feelings of shame, guilt, and a negative perception of oneself, which can lead to a fragmented or diffuse identity. (Courtois & Ford, 2009).
• Difficulties in interpersonal relationships: tendency towards social isolation, distrust of others and dysfunctional relational patterns that perpetuate cycles of victimization or dependence. (Cloitre et al., 2018).

These clinical manifestations reflect the deep and lasting impact of chronic traumatic situations, such as physical, emotional or sexual abuse during childhood, exposure to domestic violence or severe parental neglect.

A great deal, especially when it occurs in the first three years of life , which is when the bond is forming. When the trauma is interpersonal during the first years of life and perpetrated by the parents, it profoundly alters the attachment system.

Interpersonal trauma can occur due to:

• Direct effect: the caregiver is the source of direct violence .
• Lack of availability of a responsive attachment figure to comfort and regulate the stress of fear-evoking events, which are a daily part of the child's experience (Schuder and Lyons-Ruth, 2004).

The caregiver serves as a regulator of the internal homeostasis (the body's ability to maintain a constant internal balance despite changes in the external environment) of the developing child.

The regulatory function of the child-caregiver interaction is an essential promoter to ensure the normal development and maintenance of synaptic connections during the establishment of functional brain circuits (Ziabreva et al, 2003); in other words, human connections enable brain connections .

Complex PTSD and disorganized attachment are two distinct ways of conceptualizing the development of a person severely disrupted by the impact of risky parental behaviors, whether due to direct trauma or neglect. In both cases, the caregiver, who is abusive or unable to meet the infant's basic needs, prevents the establishment of a secure attachment, which is the foundation of basic trust and emotional and interpersonal stability.

Bullying is defined as repeated aggressive behavior in which an individual or group intentionally harasses another person with the aim of harming or belittling them. It is essential to recognize that bullying can manifest in various ways, the most common being physical, verbal, relational, and cyberbullying. Physical bullying involves the use of force and can include hitting, pushing, or any other form of physical aggression. Verbal bullying, on the other hand, includes insults, mockery, and verbal humiliation that seek to undermine the dignity of the person being targeted.

Undoubtedly, these experiences can become traumatic depending on the degree of harassment and isolation to which the victim is subjected.

A candid look at bullying from the educational environment

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In general, motherhood confronts us with many things, especially unresolved issues. Sometimes, through the experience of being mothers, we realize how we were treated, or not treated, as children, and we can awaken memories that we had "hidden" under the rug of time and avoidance. Our parenting style, the bond we establish, our capacity for mental processing—everything that is fundamental to raising children, everything that makes us "good enough" mothers—can be tremendously affected if we have unresolved trauma.

Some phobias are rooted in a traumatic event that has led to strong avoidance and irrational fear . It's even possible that this fear has generalized, and that the avoidance of a specific thing has spread to other things or situations unrelated to the original traumatic event. The literature refers to traumatic conditioning as a way in which the association between the trigger of irrational fear and our anxiety-provoking reactions can be established.

Over the years, accompanying people who have experienced terrible situations, I've found that the common denominator is always "just being there." It's not so much about helping with something specific, asking a lot of questions, or taking over everything; it's simply about being present . There's no need to say anything; enduring silence is usually harder for the person offering support than for the one suffering. Talk if the person needs it, but don't give advice or explain your own experiences; don't hijack their pain.

It's also important to seek help for ourselves , because it's not a straight path and can be tiring and difficult. Therefore, it's important to have our own space and to have someone explain clearly what our loved one is dealing with.

Living with trauma

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There are many high-quality training programs available. Choosing one over another will depend on several factors: the time available, financial resources, and the desired approach. Training the entire facility to provide trauma -informed care is not the same as training only mental health professionals in trauma-focused therapies.