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The term ‘fight or flight’ as an evolutionary survival response was coined in the 1920s by psychologist William James and physiologist Carl Lange.  It was suggested that emotions occur as a result of physiological reactions to events. Emotions are not the same as feelings or moods; they are complex reactionary patterns involving experiential, physiological, and behavioural elements. ^[1]

• Experiential – this is a subjective experience or a stimulus, which invokes an emotion.
• Physiological – this is the way that our body reacts to the stimulus. This physiological response is the result of the autonomic nervous system’s reaction to the emotion we’re experiencing.
• Behavioural – this is the actual response to, and expression of, the emotion.

The three elements associated with emotions demonstrate how emotion is far more than a mental state. Emotion can affect our whole body and our health. The fight-flight-freeze response is an automatic response to danger, where strong emotion is invoked.

Fight-Flight-Freeze

The nervous system responses of fight, flight, and freeze are automatic survival actions that all mammals on the planet demonstrate. If you encounter a threat that you feel confident you can face, you respond with ‘fight’. If you encounter a threat that you know you cannot defeat, you will likely respond with ‘flight’. However, sometimes, the body will respond by ‘freezing’.  This is the body’s unconscious decision to protect itself, like when a mouse plays dead when in the clutches of a cat. ^[2]

Freeze is a common response to those in chronic threat situations and who feel unable to protect themselves, such as a child abused in the home. When someone freezes, their body is trying to protect them and has decided it is the best tactic to survive the threat.

During a fight-flight-freeze response, numerous physiological changes occur.

The amygdala is the part of your brain responsible for detecting threat and perceiving fear. If danger is detected, the amygdala sends signals to the hypothalamus, which in turn stimulates the autonomic nervous system. ^[3]

The autonomic nervous system is composed of two parts, the sympathetic and parasympathetic nervous systems.  Depending on which response is dominant at the time will determine how you respond to the threat. The sympathetic nervous system instigates the fight or flight response whilst the parasympathetic stimulates the freeze response.

The autonomic nervous system releases adrenaline and cortisol, which are stress hormones. These hormones are largely responsible for the physiological changes which occur. These responses commonly include:^[4]

• Muscles – your muscles will tense, and be primed to run, or flee. In freeze response, you may go limp or rigidly immobile.
• Heart – your heart rate increases to bring more oxygen to your major muscles and organs.
• Lungs – breathing in fight or flight will speed up to deliver more oxygen to the blood; however, in freeze response, breathing may slow down or become restricted.
• Eyes & Ears – hearing will often become sharper, and attention to your peripheral vision increases to detect threats better.
• Skin – your skin, the largest organ of the body, reacts accordingly, either becoming cold, pale or clammy or increasing in temperature and becoming sweaty.
• Digestion – your gut may tense and become knotted or may loosen and relax, both of which can cause digestive discomfort.
• Pain – fight-or-flight can temporarily reduce your perception of pain.

How a person reacts to a threat is highly subjective and depends on their interpretation of the three emotional elements; experiential, physiology, and behaviour. In one situation, a person may shift between fight, flight, or freeze instinctively.

Trauma and the Freeze Response

A well-regulated nervous system will return to its natural state twenty to thirty minutes after the danger is passed. We see this with animals in the wild who understand how to respond to threats with their bodies effectively. ^[5] They will quite literally shake the energy from their bodies. However, with some individuals who have experienced trauma, and most specifically the freeze response, the traumatic energy can become stored and stuck in their bodies.

Traumatic events can create an exaggerated stress response resulting in an individual perceiving threat where there isn’t any. We all experience fear or being primed to fight if we walk past a gate with a growling dog behind it, a car horn startles us, or a friend jumps out at us. However, after the initial shock, our mind and body should recognise that we are safe, and our nervous system should revert back to a harmonious state.

For those with an exaggerated stress response and who have stored traumatic energy, their reactions to these situations are likely to be inappropriate or exaggerated and will be accompanied by acute emotional and physiological distress.

Feelings of shame and regret are common for trauma survivors who are trapped in the freeze response. It is especially prevalent for survivors of childhood abuse or sexual violence as they may ask themselves why they did not fight back or why they did not run.  These negative thoughts can create a cycle of negativity and low self-worth, which perpetuates the trauma response of freeze within the body and the onset of mood disorders such as anxiety or depression.

An understanding of the freeze response system is key to helping these individuals heal. Tonic immobility^[6] in rape and sexual abuse cases are common responses, and through compassion, an individual can move through the trauma.  Tonic immobility, characterised by profound motor inhibition^[7], comes into play when the threat appears inescapable.  By understanding that their freeze response was not a conscious decision, and through recognising their reactions to a perceived threat in everyday life, it is possible to return the body to regulation.

Somatic Experiencing Therapy^[8], which works with the mind and body as one entity, allows people to explore traumatic events whilst gaining joy, resilience, and compassion. Somatic Experiencing aims to connect our minds to bodily sensations. By bringing awareness to how a threat is played out within the body, we can uncover what perceived threats activate our survival response system and how we can deactivate them by renegotiating our reactions.

How we interpret and respond to the world contributes to our quality of life. If you or a loved one are struggling with any aspects we’ve discussed in this article, please get in touch today.

If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

[1] “The Science Of Emotion: Exploring The Basics Of Emotional Psychology | UWA Online”. UWA Online, 2019, https://online.uwa.edu/news/emotional-psychology/.

[2] Schmidt, Norman B. et al. “Exploring Human Freeze Responses To A Threat Stressor”. Journal Of Behavior Therapy And Experimental Psychiatry, vol 39, no. 3, 2008, pp. 292-304. Elsevier BV, doi:10.1016/j.jbtep.2007.08.002. Accessed 12 May 2021.

[3] Robertson, David, and I Biaggioni. Primer On The Autonomic Nervous System. Elsevier/AP, 2012. Robertson, David, and I Biaggioni. Primer On The Autonomic Nervous System. Elsevier/AP, 2012.

[4] Hagenaars, Muriel A. et al. “Updating Freeze: Aligning Animal And Human Research”. Neuroscience & Biobehavioral Reviews, vol 47, 2014, pp. 165-176. Elsevier BV, doi:10.1016/j.neubiorev.2014.07.021. Accessed 12 May 2021.

[5] Payne, Peter et al. “Somatic Experiencing: Using Interoception And Proprioception As Core Elements Of Trauma Therapy”. Frontiers In Psychology, vol 6, 2015. Frontiers Media SA, doi:10.3389/fpsyg.2015.00093. Accessed 12 May 2021.

[6] Heidt, Jennifer M. et al. “Tonic Immobility And Childhood Sexual Abuse: A Preliminary Report Evaluating The Sequela Of Rape-Induced Paralysis”. Behaviour Research And Therapy, vol 43, no. 9, 2005, pp. 1157-1171. Elsevier BV, doi:10.1016/j.brat.2004.08.005. Accessed 12 May 2021.

[7] Volchan, Eliane et al. “Is There Tonic Immobility In Humans? Biological Evidence From Victims Of Traumatic Stress”. Biological Psychology, vol 88, no. 1, 2011, pp. 13-19. Elsevier BV, doi:10.1016/j.biopsycho.2011.06.002. Accessed 12 May 2021.

[8] Brom, Danny et al. “Somatic Experiencing For Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study”. Journal Of Traumatic Stress, vol 30, no. 3, 2017, pp. 304-312. Wiley, doi:10.1002/jts.22189. Accessed 12 May 2021.

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In some cases, the perceived flaw is a natural characteristic of one’s appearance, such as acne, body fat, or one’s hairline. In other cases, the flaw is imagined. Whether real or perceived, the ‘flaw’ that BDD sufferers obsess over causes pervasive and intrusive thoughts, which can cause significant distress.

It is important to note that BDD is not a form of vanity. It is a severe mental health condition that jeopardizes a person’s mental and behavioural health. Many sufferers experience the stigma of vanity related to their obsessions over their appearance. Some may be unwilling to share their experience of BDD with others, even therapists and psychiatrists, out of fear of this stigma. As such, BDD is severely underdiagnosed.^[1] Understanding the impact of BDD is essential for those suffering, their loved ones, and mental health professionals. Rates of suicidality and suicide attempts are high in this population, so effective and timely intervention is vital.^[2]

Who Experiences Body Dysmorphia?

According to Dialogues in Clinical Neuroscience, BDD affects between 0.7 to 2.4 percent of the population.^[3] BDD usually begins in late childhood or early adolescence. It affects people of all genders.^[4] Men are more often affected than women by a subtype of BDD known as muscle dysmorphia, a condition in which the person suffering perceives their body as too small or weak.^[5]

Men, women, and non-binary people are almost equally affected by body dysmorphia. The causes of this condition remain unclear, yet researchers suggest several potential causal factors. These include:

• Abuse
• Bullying
• Perfectionism
• Depression
• Anxiety
• Obsessive-compulsive disorder (OCD)

Anyone can be affected by BDD, so it is essential to recognize the signs and symptoms. Early treatment can help those suffering address the root causes of their condition and work towards a vital perspective shift. Since BDD is known to lead to an increased risk of suicidality, the earlier a person seeks treatment, the better.

Signs of Body Dysmorphia

Common BDD signs and symptoms to look out for in yourself or a loved one include:

• Preoccupation with a perceived flaw in one’s appearance
• Stating that one is ugly or has a significant defect in ones appearance
• Believing that others are thinking or talking about the perceived flaw
• Frequently trying to fix or hide the perceived flaw in a way that is compulsive and difficult to control
• Comparing one’s appearance to others
• Frequent seeking of reassurance about one’s appearance
• Perfectionism
• Seeking multiple cosmetic procedures to little or no satisfaction
• Social withdrawal

BDD can cause significant distress to the person suffering. Preoccupation with, and dislike of, one’s appearance can be stressful and time-consuming. Those suffering are likely to engage in avoidant behaviours such as social withdrawal and missing school or work due to their difficult feelings and obsessions about their appearance. Many spend excessive time in the mirror worrying about and trying to change their appearance. The distress associated with BDD can lead to deterioration of one’s physical, psychological, professional, and social health.

Those suffering from BDD may focus on one specific body part or multiple. The specific body part in question may change over time. In general, people with BDD tend to fixate on the following body parts:

• Skin (wrinkles, acne, blemishes)
• Hair (hairline, baldness, thinness)
• Muscle size and tone
• Genitalia
• Breast size and shape
• Face (nose, teeth, shape of face)

Body Dysmorphia as A Trauma Response

There is a recent but growing understanding of the connection between BDD and past trauma. A recent study published in Child Abuse & Neglect explored the prevalence of BDD in adults who had experienced childhood trauma.^[6] The study found that over 75 percent of participants, all of whom struggled with BDD, had experienced some form of neglect or abuse in childhood. Emotional neglect prevailed as a significant risk factor for BDD, alongside other forms of abuse, such as physical and sexual abuse.^[7]

The connection between BDD and childhood trauma is not surprising. Trauma, particularly childhood trauma, leaves a lasting and debilitating imprint on a person’s psyche. Children who experience physical, sexual, or emotional abuse are severely wounded at the time of the abuse. That wound often endures and is carried into adulthood.^[8]

When children experience abuse, especially abuse perpetrated by a caregiver, a person on whom the child relies for love, security, and validation, they learn destructive, harmful lessons about their worth and value as a person.

Children are at a crucial stage of development and may struggle to objectively understand the fault in the caregiver’s actions. They are likely to internalize the abuse, ultimately blaming themselves. This self-blame manifests as deep shame and guilt about their existence.^[9] The abused child may grow up to loathe themselves, which can manifest as a distorted body image and unyielding attempts to change oneself.

BDD as A Maladaptive Coping Mechanism

BDD often co-occurs with other mental and behavioural health conditions, such as depression, anxiety, OCD, and eating disorders.^[10] When BDD is associated with past trauma, it may be understood as a means of coping with one’s traumatic past. The obsession and fixation on one’s perceived flaw may serve to distract the individual from the emotional pain of their trauma.

The condition is not helped by the unrealistic standards set by the beauty industry. Women, in particular, are inundated with messages through media and advertising of the ideal body or skin type. Brands relentlessly offer products and cosmetic services that claim to make a person ‘beautiful’. However, such beauty is typically shallow and in accordance with arbitrary societal standards of beauty. Dissatisfaction with one’s appearance is profitable for the beauty and cosmetic industry.

Treatment for Body Dysmorphia

When BDD arises from early psychological wounds, treatment must take into account the trauma and not focus on the BDD symptoms alone. Real, lasting recovery from BPD requires clients to look beyond the standard of beauty they follow and to take a deep dive into their traumatic past. BDD sufferers can benefit from the support and guidance of a mental health professional trained in trauma-informed care.

Trauma-informed care for people struggling with BDD would involve trauma-focused cognitive behavioural therapy (TF-CBT).^[11] TF-CBT helps clients by addressing deeply held thoughts and beliefs about one’s value and self-worth. It identifies these beliefs and explores the feelings and behaviours that arise as a result. TF-CBT helps clients shift their trauma-based thought patterns and promotes positive and affirming reasoning and emotional responses.^[12]

Conclusion

Body dysmorphia (body dysmorphic disorder, BDD) is a debilitating mental health condition that affects millions worldwide. There has been a recent increase in understanding of the connection between BDD and unresolved childhood trauma. Trauma-informed care may help clients struggling with BDD address the roots of their condition and heal from the destructive patterns of thoughts and behaviour that characterize BDD.

^[1] Bjornsson, Andri S et al. “Body dysmorphic disorder.” Dialogues in clinical neuroscience vol. 12,2 (2010): 221-32. doi:10.31887/DCNS.2010.12.2/abjornsson

^[2] Bjornsson, Andri S et al. “Body dysmorphic disorder.” Dialogues in clinical neuroscience vol. 12,2 (2010): 221-32. doi:10.31887/DCNS.2010.12.2/abjornsson

^[3] Bjornsson, Andri S et al. “Body dysmorphic disorder.” Dialogues in clinical neuroscience vol. 12,2 (2010): 221-32. doi:10.31887/DCNS.2010.12.2/abjornsson

^[4] Mufaddel, Amir et al. “A review of body dysmorphic disorder and its presentation in different clinical settings.” The primary care companion for CNS disorders vol. 15,4 (2013): PCC.12r01464. doi:10.4088/PCC.12r01464

^[5] Phillips, Katharine A. Understanding Body Dysmorphic Disorder. Oxford University Press, 2009.

^[6] Didie, Elizabeth R et al. “Childhood abuse and neglect in body dysmorphic disorder.” Child abuse & neglect vol. 30,10 (2006): 1105-15. doi:10.1016/j.chiabu.2006.03.007

^[7] Didie, Elizabeth R et al. “Childhood abuse and neglect in body dysmorphic disorder.” Child abuse & neglect vol. 30,10 (2006): 1105-15. doi:10.1016/j.chiabu.2006.03.007

^[8] Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons with Child Abuse and Neglect Issues. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2000. (Treatment Improvement Protocol (TIP) Series, No. 36.) Chapter 1—Working With Child Abuse and Neglect Issues. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64904/

^[9] Tanzer, Michal et al. “Self-Blame Mediates the Link between Childhood Neglect Experiences and Internalizing Symptoms in Low-Risk Adolescents.” Journal of child & adolescent trauma vol. 14,1 73-83. 29 Apr. 2020, doi:10.1007/s40653-020-00307-z

^[10] Grant, Jon E, and Katharine A Phillips. “Recognizing and treating body dysmorphic disorder.” Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists vol. 17,4 (2005): 205-10. doi:10.1080/10401230500295313

^[11] Phillips, Katharine A, and Jamison Rogers. “Cognitive-behavioral therapy for youth with body dysmorphic disorder: current status and future directions.” Child and adolescent psychiatric clinics of North America vol. 20,2 (2011): 287-304. doi:10.1016/j.chc.2011.01.004

^[12] Cohen, Judith A, and Anthony P Mannarino. “Trauma-focused Cognitive Behavior Therapy for Traumatized Children and Families.” Child and adolescent psychiatric clinics of North America vol. 24,3 (2015): 557-70. doi:10.1016/j.chc.2015.02.005

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While our preferences are our own and may not be problematic, spending too much time alone can become an issue. If you find yourself spending more and more time alone because you believe others don’t understand you or that you will struggle to connect, you may be experiencing one of the more subtle symptoms of trauma. Perhaps you avoid social situations such as dinner at a friend’s house or a party as something there might remind you of a memory you would rather not think about, one that you may fear or are uncomfortable with. Or perhaps you are reluctant to reach out to others because you believe that you should be completely independent and not need anyone else. If any of these sound familiar, you could be experiencing social withdrawal – a common symptom that many people experience following a single or multiple traumatic events.^[1]

Social withdrawal involves avoiding people, places, and hobbies or activities you once enjoyed because you find it challenging to engage with others without feeling distressed, uncomfortable, or overwhelmed.^[2] While it is healthy to spend some time alone, it is also important to connect with others. Social withdrawal may be subtle to begin with, but can gradually progress into social isolation. This can make a person completely avoid friends and family and spend all of their time alone. Continuous social withdrawal tends to create a vicious cycle of isolation and loneliness as the more time you spend alone, the less you feel you can connect with others, which makes you want to spend even more time alone.

However, many people aren’t aware that we socialise to avoid threats – if we are safe and feel looked after then we are less likely to come under attack. According to Porges’ Polyvagal theory, this is the first response on our ‘ladder’ of threat responses. Trauma informs how we respond to threats, and how fast we move through this cycle. This means that trauma survivors often find themselves anxious, scared, combative, or shut-down in social situations. Clearly, people want to avoid this, which can result in social withdrawal.

Social withdrawal and isolation can make it difficult to engage in healthy coping behaviours during times of stress, which itself can be caused by isolation.^[3] When social withdrawal is a symptom of trauma, and the person suffering does not have a social support system in place, or simply avoids engaging with that system, then they may experience some of the more adverse effects of social withdrawal and isolation. These include:

• Loneliness
• Strained relationships
• Substance misuse and abuse
• Sleep issues
• Depression

Research has found that loneliness can be detrimental to our physical, emotional, behavioural, and mental health.^[4] Morese et al. define social withdrawal as ‘voluntary isolation prolonged in time that involves the cessation of any form of social relationship and contact with people and the outside.’^[5] Humans are naturally social creatures, so when our desire and eventually our ability to socialise diminishes, we are subject to a range of adverse health effects. Following a prolonged period of social withdrawal and isolation, our sense of connection to others deteriorates and we are likely to find some other way of feeling connection and meaning. For some, this can be substance use or behavioural addiction.

A person may use substances to cope with feelings of loneliness, emptiness, or shame, but any relief gained by substance use is temporary and these feelings will soon return. If the person continues to engage in this maladaptive coping behaviour, they are highly likely to develop a substance dependence. This is characterised by a need to intake their substance of choice on a regular basis to feel normal. Dependence can then progress into addiction, which can be complex to treat and further exacerbates the mental health condition or underlying trauma that contributed to social withdrawal and other maladaptive coping behaviours in the first place.

Recovery from Social Withdrawal, Isolation, and Other Trauma-related Symptoms

The symptoms of trauma can significantly diminish a person’s quality of life. As mentioned earlier, those who have been through traumatic experiences and then go on to withdrawal socially, ultimately isolating themselves from friends, families, and the community as a whole, are subject to a range of adverse health effects stemming from feelings of loneliness and a tendency to engage in maladaptive coping/survival behaviours. To reduce the severity of social withdrawal and isolation, professional help should be sought. Therapy is available to help clients suffering from the symptoms of trauma better understand their past experiences and integrate them into their present-day lives.

Multiple treatment modalities for trauma and poor mental health are available at Khiron Clinics. Approaches range from Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to Somatic Experiencing (SE), to Eye Movement Desensitisation and Reprocessing (EMDR). These approaches and more available at Khiron are effective in restoring clients living with trauma back to normal and functional health.^[6]

To reduce the severity of and tendency towards social withdrawal, its root causes must be addressed. Until we resolve our trauma, it will continue to drive our thoughts and behaviour. By reaching out for professional help, you give yourself the best chance at regaining some control over your life, which will allow you to make healthier, informed decisions.

If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources

^[1] Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/

^[2] Pineles, Suzanne L et al. “Trauma reactivity, avoidant coping, and PTSD symptoms: a moderating relationship?.” Journal of abnormal psychology vol. 120,1 (2011): 240-6. doi:10.1037/a0022123

^[3] Bhatti, Adnan Bashir, and Anwar Ul Haq. “The Pathophysiology of Perceived Social Isolation: Effects on Health and Mortality.” Cureus vol. 9,1 e994. 24 Jan. 2017, doi:10.7759/cureus.994

^[4] Hämmig, Oliver. “Health risks associated with social isolation in general and in young, middle and old age.” PloS one vol. 14,7 e0219663. 18 Jul. 2019, doi:10.1371/journal.pone.0219663

^[5] Morese, Rosalba et al. “Social Withdrawal And Mental Health: An Interdisciplinary Approach”. Social Isolation – An Interdisciplinary View, 2020. Intechopen, doi:10.5772/intechopen.90735. Accessed 10 Nov 2020.

^[6] Shapiro, Francine. “The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences.” The Permanente journal vol. 18,1 (2014): 71-7. doi:10.7812/TPP/13-098

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• Strained relationships
• Unhealthy relationships
• Behavioural addictions
• Substance use disorder
• Dependence on others
• Anxiety and depression

Daydreaming itself is not problematic. We all do it, and it can help us exercise our imagination and explore our private responses to life and its events. However, as is the case with any trauma symptom, and any substance or behavioural addiction, daydreaming and fantasy is problematic when it becomes a compulsion and interrupts our normal daily well-being and functioning.^[1]

When you are only daydreaming about a different future but not doing the actions or tasks that will get you there, then daydreaming is maladaptive. Below are some common ways in which we fantasise or daydream about our lives changing for the better.

Wanting to Save/Be Saved 

Many of us engage in rescue fantasies, particularly in romantic relationships, where we believe we can be a knight in shining armour for our romantic interest and save them from their situation, to be praised and seen as a hero in our fantasy world.^[2] Alternatively, we may imagine that we will be rescued by someone – a person will come along and make us happy by changing our current situation.

Both types of rescue fantasy can be harmful and counterintuitive to authentic, healthy intimate connections. The fantasy may seem to come true in the short-term. Still, over time as our situations change we may continue to place these heroic expectations on ourselves or on our partners – these are often unrealistic or impossible to live up to. Over time, the need or desire to replay that fantasy returns, and the person we once believed we saved, or saved us, seems to change and we seek other people to play these characters in a vicious and destructive fantasy cycle.

Hoping Others Change

As children, we are virtually powerless. We don’t have a wide range of choices available to us to make changes in our environment or our living situation because we are dependent on the adults in our lives. This sense of powerlessness may be appropriate for the child but becomes a problem if we carry this perceived sense of powerlessness into adulthood, feeling like you can’t do anything to make your life different. Many of us seek out ways to make others change so that we can feel better, and feel hopeless or helpless when we realise we can’t change anyone else. The reality is that as adults, we need to take responsibility for our own needs – we need to recognise what we need for ourselves and show up differently in ourselves of our own accord.

Seeking External Validation

In childhood, seeking validation from others is a regular aspect of development, and as we grow up we do move through many environments in which external validation is normalised, such as in school, in sports, in our family – we get praise or criticism externally. As an adult, our responsibility to ourselves is to internalise the feeling of validation, that we are good enough in the absence of external validation. This is so that we can feel good when it seems the world does not show up for us. This doesn’t mean that we don’t feel good when we achieve something in the outside world, such as a promotion at work or a compliment from our partner, but when those types of validation are not happening that we don’t sink into a depression or believe that we are unworthy.

Seeking Quick Fixes

As children, we do not usually have much patience regarding the desire to feel good or not to feel bad. We want results immediately. When we carry this into adulthood, we continue to seek quick fixes that can be destructive to our health, such as unhealthy relationships or the use of substances for the sake of any kind of connection, or to escape our thoughts and feelings. We need to cultivate an acceptance of delayed gratification so that we can make responsible and mature choices that help us reach our long term goals.

The Importance of Healing from our Emotional Wounds

Early emotional wounds can disconnect us from reality^[3] and cause us to seek out alternate universes and situations in which we are happy or in which we had never experienced our deep pain. Understandably, people seek relief from their pain, especially if that pain has been carried into adult life from childhood. However, continually fantasising or daydreaming about a better life can distract us from any real, present opportunities to make a positive change. If we want to come back to reality and live our lives in the present moment – the only place where we can experience real joy and fulfilment – then we must seek help and treatment for our emotional wounds.

Various therapies are available to help survivors of trauma build the strength and resilience to face, reframe, and integrate their past traumatic experiences into the present life so that they no longer need to escape. Trauma can be effectively approached through therapies such as Trauma-Focused Cognitive Behavioural Therapy^[4] (TF-CBT), in which therapist and client explore the ‘cognitive triangle’ – the thought, feelings, and behaviours that characterise our life and our personal outcomes. Eye Movement Desensitisation and Reprocessing (EMDR) can help clients heal from their trauma by supporting them in staying present and grounded in the moment as they explore their trauma memories and narrative.^[5] Somatic Experiencing (SE) is also a popular trauma-healing approach, as it supports clients in reconnecting with and exploring the physical sensations associated with their traumatic memories.^[6]

Recovery from trauma is not an overnight journey. It takes time and conscious effort, as well as compassionate care and support. However long it takes, beginning the healing journey yields far better personal outcomes than not taking the journey at all.

If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources

^[1] Soffer-Dudek, Nirit, and Eli Somer. “Trapped in a Daydream: Daily Elevations in Maladaptive Daydreaming Are Associated With Daily Psychopathological Symptoms.” Frontiers in psychiatry vol. 9 194. 15 May. 2018, doi:10.3389/fpsyt.2018.00194

^[2] Farrell, Kirby. “Love, Loss, And Heroic Rescue”. Psychology Today, 2016, https://www.psychologytoday.com/us/blog/swim-in-denial/201604/love-loss-and-heroic-rescue. Accessed 11 Nov 2020.

^[3] Lahousen, Theresa et al. “Psychobiology of Attachment and Trauma-Some General Remarks From a Clinical Perspective.” Frontiers in psychiatry vol. 10 914. 12 Dec. 2019, doi:10.3389/fpsyt.2019.00914

^[4] Cohen, Judith A, and Anthony P Mannarino. “Trauma-focused Cognitive Behavior Therapy for Traumatized Children and Families.” Child and adolescent psychiatric clinics of North America vol. 24,3 (2015): 557-70. doi:10.1016/j.chc.2015.02.005

^[5] Shapiro, Francine. “The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences.” The Permanente journal vol. 18,1 (2014): 71-7. doi:10.7812/TPP/13-098

^[6] Brom, Danny et al. “Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study.” Journal of traumatic stress vol. 30,3 (2017): 304-312. doi:10.1002/jts.22189

The post The Subtle Effects of Trauma – Living in a Fantasy appeared first on Khiron Clinics.

• Acute (or ‘simple’ trauma)
• Chronic trauma
• Complex trauma

This blog will examine the second category – chronic trauma. It will explore what happens to the body on a physical level when chronic trauma occurs, and some of its most common causes and symptoms.

The term ‘chronic trauma’ is sometimes interchanged with ‘complex trauma’. Both conditions share similarities. Both are types of post-traumatic stress disorder (PTSD) and require professional treatment for a person to heal. Chronic trauma refers to Post-traumatic Stress Disorder, while complex trauma refers to a more severe form of PTSD, known as Complex PTSD, or C-PTSD.

Trauma and the Nervous System

When we experience a threatening event (i.e. something that puts our life in danger, either real or perceived), our nervous system reacts by entering survival mode.^[1] Signals originating in the amygdala, a small structure in the brain, tell our muscles to get ready for mobilisation (fight or flight). If the threat cannot be fought or ran from, as is the case for a child experiencing abuse in the home, the nervous system utilises its third threat response – freeze.^[2] This involves an emotional and psychological shut down to prevent the psyche from becoming too overwhelmed. Though freeze has a survival function, it is maladaptive when it persists. For survivors of chronic trauma, the nervous system remains frozen in its threat response, making even safe environments and people seem threatening.

Causes of Chronic Trauma

Chronic trauma refers to trauma that has occurred following a series of events (unlike acute trauma, which refers to trauma following a single event). These events have happened multiple times, and include experiences such as^[3]:

• Prolonged child abuse
• Prolonged exposure to war and combat
• Repeated sexual abuse
• Direct experience of or exposure to ongoing domestic violence
• Exposure to repeated natural disasters

Survivors of chronic trauma usually require extended treatment, as the pain and symptoms that result can be severe and protracted.

Symptoms of Chronic Trauma

The symptoms of PTSD can sometimes take years to come to the surface, unlike acute trauma, symptoms of which show up in a matter of weeks.

Chronic trauma often causes those experiencing it to engage in maladaptive coping behaviours. The symptoms themselves can be a significant source of distress and can be so overwhelming that the person feels compelled to take some kind action against them. Common actions observed in chronic trauma survivors include:

• Denial
• Avoidant behaviours, such as social withdrawal or substance abuse
• Rationalisation

The symptoms of chronic trauma are intense and disruptive to normal daily functioning. In combination with maladaptive behaviours, survivors are likely to experience^[4]:

• Anxiety
• Depression
• Sadness
• Confusion
• Anger, rage, violent outbursts
• Over-reactions to normal events
• Impaired or distorted memories
• Low self-worth
• Fatigue
• Sleep problems
• Distorted perception of one’s environment (believing one is under threat when they are safe, misreading of others’ facial expressions)
• Nightmares, flashbacks

The above symptoms can be self-perpetuating, meaning that when a person experiences them, the very experience causes the symptoms to intensify. To cope and restore some sense of normality without professional treatment, survivors of chronic trauma are likely to engage in unhealthy and destructive behaviours, such as^[5]:

• High-risk behaviour (unprotected sex with multiple partners, reckless driving)
• Sexual avoidance
• Violence
• Unhealthy relationships
• Substance abuse

Treatment for Chronic Trauma

Chronic trauma significantly impacts a person’s quality of life,  affecting everything from work and school performance, to interpersonal relationships, to general motivation, and interest in life. Not only does it wear away at a person’s physical and psychological well-being, it also increases the risk of further physical and psychological damage as a result of destructive coping behaviours. Substance abuse is common among chronic trauma survivors and can lead to serious financial and legal issues, strained relationships, and even death.

To overcome chronic trauma, professional treatment is required. The good news is that treatment is available, and can help clients restore their lives back to health and normality.

Typical treatment options for chronic trauma include^[6]:

• EMDR (Eye Movement Desensitisation and Reprocessing)
• Somatic Experiencing
• Trauma-Focused Cognitive Behavioural Therapy (TFCBT)
• Medication

As mentioned earlier, trauma impacts the nervous system’s ability to regulate itself, which makes exploration of the trauma narrative and the ability to tolerate the associated distress difficult. EMDR and Somatic Experiencing help clients by improving regulation of the nervous system and better preparing clients to explore their trauma narrative.

Cognitive Behavioural Therapy and medication help clients recover from chronic trauma by reducing trauma symptoms and strengthening the client’s ability to tolerate distress.

The Importance of Support Networks in Recovery from Trauma

An important aspect of recovery from chronic trauma is the availability and accessibility of a strong support network. Trauma can make a person extremely isolated, where it seems that nobody quite understands the difficulties and challenges associated with the condition. To reduce this sense of loneliness and prevent unhealthy isolation, survivors of chronic trauma are often encouraged to engage in social support groups with others who have been through similar experiences. Support networks offer clients a chance to feel heard, validated, and deeply understood. This sense of acceptance and connection can make a huge difference to therapeutic outcomes, and reduce the risk that a person will engage in maladaptive behaviours such as substance abuse.

Get in touch

If you have a client, or know of someone who is struggling to heal from psychological trauma, including Chronic Trauma,  reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours)

Sources

^[1] Harvard Health. 2011. Understanding The Stress Response – Harvard Health. [online] Available at: <https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response> [Accessed 23 October 2020].

^[2] Schmidt, N., Richey, J., Zvolensky, M. and Maner, J., 2008. Exploring human freeze responses to a threat stressor. Journal of Behavior Therapy and Experimental Psychiatry, 39(3), pp.292-304.

^[3] nhs.uk. 2018. Post-Traumatic Stress Disorder (PTSD) – Complex PTSD. [online] Available at: <https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/complex/> [Accessed 23 October 2020].

^[4] Adaa.org. 2020. Symptoms Of PTSD | Anxiety And Depression Association Of America, ADAA. [online] Available at: <https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/symptoms> [Accessed 23 October 2020].

^[5] Adaa.org. 2020. Symptoms Of PTSD | Anxiety And Depression Association Of America, ADAA. [online] Available at: <https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/symptoms> [Accessed 23 October 2020].

^[6] Gielkens, E., Sobczak, S., Rossi, G., Rosowsky, E. and van Alphen, S., 2018. EMDR as a Treatment Approach of PTSD Complicated by Comorbid Psychiatric, Somatic, and Cognitive Disorders: A Case Report of an Older Woman With a Borderline and Avoidant Personality Disorder. Clinical Case Studies, 17(5), pp.328-347.

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Trauma can be defined in many ways and manifest differently for everyone. A contributing factor to the feeling of trauma, for many people, is the feeling of helplessness. Traumatic situations are situations which are entirely out of our control, which leaves us feeling out of control of our own lives in some way. Trying to grasp the reality of a trauma is like trying to hold onto grains of sand in the wind. Our symptoms of trauma manifest as struggle to find control and make sense of that which makes no sense, the traumas which have occurred in our lives.

Train drivers are deeply affected by the tragedies which can take place on their tracks. Too literally, they are on a train that cannot be stopped, at least, not in time to prevent the death of someone who has decided to take their life on the tracks. Each part of the scenario is deeply disturbing, distressing, and traumatizing for train workers. Not only to they have to watch the event happen, they are first to assess the situation once the train stops and witness the carnal damage.

Fairfax Media spoke with train drivers about their experiences and the trauma they go through due to the sometimes shocking nature of their jobs. Train drivers spot to feeling shocked, full of self-doubt, and guilt. There’s nothing a train driver can do but hit the breaks and lay on the horn. After a suicide on the tracks has been cleared with police, a train driver has to immediately return to their job: driving the train. As one train driver explained “…you have to put one foot in front of the other and keep moving.” Without time to process trauma, the trauma simply sits in the mind and the body. Since the stress of a potential hit is very real for train drivers, they live as though they are in survival mode every day, anticipating the next uncontrollable, helpless, tragic trauma.

Find the solution you’re looking for in trauma treatment. Through effective residential treatment, Khiron House helps you find the path you need toward health and wellness in recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

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Families suffered tremendous tragedy, loss of loved ones, neighbors, and friends. Surviving residents lost everything they owned and have been in an upwards battle to rebuild their lives. More than a year later, researchers are looking at the mental states of those involved in the fires and have found a strong presence of PTSD, post-traumatic stress disorder.

According to a report by the National Health System, more than two-thirds of surviving adults, or adults who were affected by the fires, have needed treatment for PTSD, cites The Guardian. The report is being prepared for the Royal Borough of Kensington and Chelsea, the article states. PTSD is not reserved only for direct survivors of a traumatic event like the fires at Grenfell Tower. Secondary trauma for those who were onlookers or nearby residents had a rate of PTSD risk between 26% and 48%. Tertiary trauma is also a risk, for investigators assigned to the case, people watching the events transpire on television, or the extended family members of those lost.  

The numbers do not represent diagnoses of PTSD but the high risk of developing PTSD and certainly the effects of being impact by such severe trauma. Recovery plans are being made to provide psychological service to the entire community impacted by the fires.

Trauma is most often the root cause of many emotional, behavioral, and mood disorders. Until you can heal your trauma, you will find great difficulty finding the healing you need to live a life of recovery, health, and wellness. At Khiron House, we provide effective residential treatment and cutting edge therapies which seek to transform mind, body, and spirit from the effects of trauma. Call us today for information. UK: 020 3811 2575 (24 hours) USA: (866) 801 6184 (24 hours).

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“As we practice moving into the present moment this way,” Pema Chodron writes in Comfortable With Uncertainty, “we become more familiar with groundlessness, a fresh state of being that is available to us on an ongoing basis.” Feeling ungrounded is not what someone who is recovering from trauma necessarily wants to be familiar with because feeling groundless, feeling uncertain, feeling unattached, are states all to familiar for those living as a trauma survivor, or in recovery from trauma. Chodron emphasizes that there is a flip side to this process of letting go- “This moving away from comfort and security, this stepping out into what is unknown, uncharted, and shaky- that’s called liberation.”

It seems ironic to think that someone who has lived in uncertainty as a result of trauma wouldn’t want to do whatever is necessary to find certainty, safety, and security in their lives, especially when considering that many do through destructive means. Letting go of harmful survival mechanisms means letting go of some of the only foundations of security trauma survivors have been able to hold onto for a long time. The idea of stepping into groundlessness again is more terrifying because of the illusion of security survival mechanisms have provided. What we come to learn in trauma recovery is that by letting go and taking great leaps of faith, we are able to find the truest security and safety in our lives through healthy means. We trust our care providers, build a network of supporters, and find a peaceful way to live safely in an uncertain world.

Trauma is most often the root cause of many emotional, behavioral, and mood disorders. Until you can heal your trauma, you will find great difficulty finding the healing you need to live a life of recovery, health, and wellness. At Khiron House, we provide effective residential treatment and cutting edge therapies which seek to transform mind, body, and spirit from the effects of trauma. Call us today for information. UK: 020 3811 2575 (24 hours) USA: (866) 801 6184 (24 hours).

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