Difficult pregnancy/difficult birth: increased stress, anxiety, depression, prematurity

• Baby can develop the same struggles - anxiety, aggression

Early hospitalization: medical trauma to the developing brain, lack of touch/nurture

Abuse (physical, sexual, etc.)

Surgery or natural disaster: drastic changes in brain chemistry and brain capacity to process senses

Neglect

Trauma is vast and it affects everyone differently - whether it's abuse, neglect, loss or separation from loved ones, or medical, it has lasting impacts. Trauma exacerbates symptoms of pre-existing disorders and can lead to mental health disorders if not treated. Effects may show up like PTSD symptoms while some can be subtle, insidious or destructive.

• Acute stress disorder (ASD): 3 days up to 1 month after experiencing a traumatic event directly or indirectly.

  • Treating ASD reduces likelihood of developing PTSD

• Post-traumatic stress disorder (PTSD): 4 weeks and beyond after experiencing a traumatic event directly or indirectly

• Complex post-traumatic stress disorder (C-PTSD): Caused by long lasting or repeated trauma, typically the result of childhood trauma

  • Symptoms don't fully match PTSD and are more severe

Brain development is influenced by repeated activation of the stress response and increased release of glucocorticoids. With trauma, brain structure is altered as it adapts to trauma - brain "detours" are formed which lead to less efficient processing. Brain systems are often affected including the limbic system, arousal and endogenous opioid system. This can lead to:

• Impulsivity

• Decreased reaction rates

• Decreased self-regulation

• Impaired executive functioning (working memory, planning, organization, inhibition

• Decreased sensory modulation

• Increased use of amygdala (fear), hyper vigilance

• "Flip your lid" - scientific, survival state, not consciously aware

• Irregular dopamine and cortisol levels

• Increased use of sympathetic nervous system (fight or flight response)

Trauma or prolonged emotional distress can lead to neurological and cognitive changes which can have lasting impacts. Trauma can also lead to physical distress such as fatigue or exhaustion, sleep disorders, nightmares, anxiety, depression, confusion, agitation, blunt affect, numbness

The body sometimes expresses emotional distress through symptoms or dysfunction, even if the individual is unaware of the emotional connection - a concept known as somatization

• GI/urological, cardiovascular, muscle tension, respiratory, dermatological

• Compromised immune system

• Eating disorders

• Increased adrenaline - takes away from other important organs

Trauma has significant effects on behavior and emotions and while many of them appear maladaptive, they come from a place of survival and are normal responses to abnormal events. There are typically two emotional responses - overwhelmed or numb. Numbing is a biological process in which emotions are detached from thoughts, behaviors and memories. This can lead others to believe that the impacts of trauma are less severe than they actually are. Trauma victims often feel ashamed of their symptoms and have a fear of betrayal.

• Anxiety, irritability, fear, shame, sadness, anger, guilt, hopelessness, excessive worry, increased stress, aggression, poor self-regulation and conduct disorder are common for individuals who have experienced trauma

• Difficulty identifying or expressing/controlling emotions, and/or avoidance of emotions

Disassociation happens when a person is in automatic activity to help distance he/she from the experience - it severs connections among a person's thoughts, memories, feelings, and/or actions.

• Signs of this include glazed eyes, flat affect, extended silence or inappropriate actions in context

• This can lead to difficulty with connecting strong emotions to events in the future

Overreactions or inappropriate responses to input are caused by hyper arousal or hyper vigilance along with a low threshold for a startle response

• Triggers are any sensory reminder of a traumatic event (noise, smell, temperature, other physical senses or visual)

Motor

• Children who experienced trauma showed 5-7x greater deficits in gross and fine motor skills than PDMS-2 norms

• Developmental delays, developmental milestones or gaps in development

• ADLs (activities of daily living)

Sensory processing

• Dependent on interconnectedness to environment

Social/emotional

• Attachment formation/bonding

• Peer relationships

• Social withdrawal

• Intergenerational cycles

• Increased resiliency

Cognition

• Educational performance

• Difficulty problem solving

• Language delays

• Poor concentration

• Lack of independent decision making skills - impacts adulthood

Typically, responses to trauma fall under one of four categories (the 4 F's)

• Fight (aggression)

• Flight (run away)

• Freeze (check out)

• Fawn (try to please)

Each individual responds to trauma differently - the response style is less important than the coping skills and ability to participate in occupations.

• Learning healthy coping skills is important for self-regulation, self-esteem, emotional regulation, mindfulness, cognitive restructuring and ability to learn

• Healthy responses to trauma can include or lead to increased bonding with family and community, commitment to a personal mission, volunteerism, revised priorities, and a sense of purpose and meaning

Victims of trauma, especially those who experience it in childhood show profound resiliency - a balance of protective experiences/coping skills vs. significant adversity/risk factors and one's ability to bounce back