trauma article by van der Kolk, MD

[Guest guest]

Here's an interesting article by Bessel A. van der Kolk, MD

titled " The compulsion to repeat the trauma. "

http://www.cirp.org/library/psych/vanderkolk/

- Edith

[Guest guest]

If you don't have the time to read the entire " The Compulsion to Repeat the

Trauma " paper by Bessel van der Kolk that Edith posted, here are a few

excerpts that deal with some of these topics discussed on ModOasis: family

violence, self blame, hyperarousal, addiction to chaos, somatic

non-cognitive arousal, enmeshment.

VULNERABILITY TO DEVELOP

TRAUMATIC BONDING

At least four studies of family violence40,48,63,132 have found a

direct relationship between the severity of childhood physical abuse and

later marital violence. Interestingly, nonhuman primates subjected to early

abuse and deprivation also are more likely to engage in violent

relationships with their peers as adults.134 as in humans, males tend to be

hyperaggressive, and females fail to protect themselves and their offspring

against danger. Neither sex develops the capacity for sustained peaceful

social interactions.134

People who are exposed early to violence or neglect come to expect it

as a way of life. They see the chronic helplessness of their mothers and

fathers' alternating outbursts of affection and violence; they learn that

they themselves have no control. As adults they hope to undo the past by

love, competency, and exemplary behavior.46,87,145 When they fail they are

likely to make sense out of this situation by blaming themselves. When they

have little experience with nonviolent resolution of differences, partners

in relationships alternate between an expectation of perfect behavior

leading to perfect harmony and a state of helplessness, in which all verbal

communication seems futile. A return to earlier coping mechanisms, such as

self-blame, numbing (by means of emotional withdrawal or drugs or alcohol),

and physical violence sets the stage for a repetition of the childhood

trauma and " return of the repressed. " 1,42,46,137

[...]

BIOLOGIC RESPONSES TO TRAUMATIZATION

Chronic physiologic hyperarousal to stimuli reminiscent of the trauma

is a cardinal feature of the trauma response, well documented in a large

variety of traumatized individuals, including victims of child abuse, burns,

rape, natural disasters, and war.2,78,84,107,133,142 Because of their

decreased capacity to modulate physiologic arousal, which leads to reduced

ability to utilize symbols and fantasy to cope with stress, they tend to

experience later stresses as somatic states, rather than as specific events

that require specific means of coping.142 Thus, victims of trauma respond to

contemporary stimuli as if the trauma had returned, without conscious

awareness that past injury rather than current stress is the basis of their

physiologic emergency responses. The hyperarousal interferes with their

ability to make calm and rational assessments and prevents resolution and

integration of the trauma.142 They respond to threats as emergencies

requiring action rather than thought.

[...]

ADDICTION TO TRAUMA

Some traumatized people remain preoccupied with the trauma at the

expense of other life experiences137,141 and continue to re-create it in

some form for themselves or for others. War veterans may enlist as

mercenaries,128 victims of incest may become prostitutes,47,120,125 and

victims of childhood physical abuse seemingly provoke subsequent abuse in

foster families53 or become self-mutilators143a Still others identify with

the aggressor and do to others what was done to them.21,39 Clinically, these

people are observed to have a vague sense of apprehension, emptiness,

boredom, and anxiety when not involved in activities reminiscent of the

trauma. There is no evidence to support Freud's idea that repetition

eventually leads to mastery and resolution. In fact, reliving the trauma

repeatedly in psychotherapy may serve to re-enforce the preoccupation and

fixation.

ENDOGENOUS OPIATES AND ATTACHMENT

[...] Early disruption of the attachment bond causes longlasting

psychobiologic changes that not only reduce the capacity to cope with

subsequent social disruption but also disturb parenting processes and create

similar vulnerability into the next generation.

[...] Childhood abuse and neglect may cause a long-term vulnerability to be

hyperaroused, expressed on a social level as decreased ability to modulate

strong affect states. " On a continuum from low to high physiologic arousal

there is an optimal level for every organism. The shape of an individual's

optimal stimulation curve may depend on the level of stimulation received

during early experience. " 37 As a result, people who were neglected or abused

as children may require much higher external stimulation of the endogenous

opioid system for soothing than those whose endogenous opioids can be more

easily activated by conditioned responses based on good early caregiving

experiences. These victimized people neutralize their hyperarousal by a

variety of addictive behaviors including compulsive re-exposure to

situations reminiscent of the trauma.

TREATMENT IMPLICATIONS

[...]It is important to keep in mind that the only reason to uncover the

trauma is to gain conscious control over the unbidden re-experience or

re-enactments. Prior to unearthing the traumatic roots of current behavior,

people need to gain reasonable control over the longstanding secondary

defenses that were originally elaborated to defend against being overwhelmed

by traumatic material such as alcohol and drug abuse and violence against

self or others. The trauma can only be worked through after a secure bond is

established with another person. The presence of an attachment figure

provides people with the security necessary to explore their life

experiences and to interrupt the inner or social isolation that keeps people

stuck in repetitive patterns. Both the etiology and the cure of

trauma-related psychological disturbance depend fundamentally on security of

interpersonal attachments. Once the traumatic experiences have been located

in time and place, a person can start making distinctions between current

life stresses and past trauma and decrease the impact of the trauma on

present experience.137

SUMMARY

[...]Chronic physiologic hyperarousal persists, particularly to stimuli

reminiscent of the trauma. Later stresses tend to be experienced as somatic

states, rather than as specific events that require specific means of

coping. Thus victims of trauma may respond to contemporary stimuli as a

return of the trauma, without conscious awareness that past injury rather

than current stress is the basis of their physiologic emergency responses.

Hyperarousal interferes with the ability to make rational assessments and

prevents resolution and integration of the trauma. Disturbances in the

catecholamine, serotonin, and endogenous opioid systems have been implicated

in this persistenence of all-or-nothing responses.

People who have been exposed to highly stressful stimuli develop

long-term potentiation of memory tracts that are reactivated at times of

subsequent arousal. This activation explains how current stress is

experienced as a return of the trauma; it causes a return to earlier

behavior patterns. Ordinarily, people will choose the most pleasant of two

alternatives. High arousal causes people to engage in familiar behavior,

regardless of the rewards. As novel stimuli are anxiety provoking, under

stress, previously traumatized people tend return to familiar patterns, even

if they cause pain.

[...]

The only reason to uncover traumatic material is to gain conscious control

over unbidden re-experiences or re-enactments. The presence of strong

attachments provides people with the security necessary to explore their

life experiences and to interrupt the inner or social isolation that keeps

them stuck in repetitive patterns. In contrast with victimized children,

adults can learn to protect themselves and make conscious choices about not

engaging in relationships or behaviors that are harmful.

trauma article by van der Kolk, MD

> Here's an interesting article by Bessel A. van der Kolk, MD

> titled " The compulsion to repeat the trauma. "

>

> http://www.cirp.org/library/psych/vanderkolk/

>

> - Edith

>

>

>

>

>

> Send questions and/or concerns to ModOasis-owner

> " Stop Walking on Eggshells, " a primer for non-BPs, can be ordered via

1-888-35-SHELL () and for the table of contents, go to:

> http://www.BPDCentral.com

>

>

>

[Guest guest]

Thanks for the synopsis. Very helpful.

Sylvia

> If you don't have the time to read the entire " The Compulsion to

Repeat the

> Trauma " paper by Bessel van der Kolk that Edith posted, here are a

few

> excerpts that deal with some of these topics discussed on

ModOasis: family

> violence, self blame, hyperarousal, addiction to chaos, somatic

> non-cognitive arousal, enmeshment.

>

> VULNERABILITY TO DEVELOP

> TRAUMATIC BONDING

>

> At least four studies of family violence40,48,63,132 have

found a

> direct relationship between the severity of childhood physical

abuse and

> later marital violence. Interestingly, nonhuman primates subjected

to early

> abuse and deprivation also are more likely to engage in violent

> relationships with their peers as adults.134 as in humans, males

tend to be

> hyperaggressive, and females fail to protect themselves and their

offspring

> against danger. Neither sex develops the capacity for sustained

peaceful

> social interactions.134

>

> People who are exposed early to violence or neglect come to

expect it

> as a way of life. They see the chronic helplessness of their

mothers and

> fathers' alternating outbursts of affection and violence; they

learn that

> they themselves have no control. As adults they hope to undo the

past by

> love, competency, and exemplary behavior.46,87,145 When they fail

they are

> likely to make sense out of this situation by blaming themselves.

When they

> have little experience with nonviolent resolution of differences,

partners

> in relationships alternate between an expectation of perfect

behavior

> leading to perfect harmony and a state of helplessness, in which

all verbal

> communication seems futile. A return to earlier coping mechanisms,

such as

> self-blame, numbing (by means of emotional withdrawal or drugs or

alcohol),

> and physical violence sets the stage for a repetition of the

childhood

> trauma and " return of the repressed. " 1,42,46,137

>

> [...]

>

> BIOLOGIC RESPONSES TO TRAUMATIZATION

>

> Chronic physiologic hyperarousal to stimuli reminiscent of

the trauma

> is a cardinal feature of the trauma response, well documented in a

large

> variety of traumatized individuals, including victims of child

abuse, burns,

> rape, natural disasters, and war.2,78,84,107,133,142 Because of

their

> decreased capacity to modulate physiologic arousal, which leads to

reduced

> ability to utilize symbols and fantasy to cope with stress, they

tend to

> experience later stresses as somatic states, rather than as

specific events

> that require specific means of coping.142 Thus, victims of trauma

respond to

> contemporary stimuli as if the trauma had returned, without

conscious

> awareness that past injury rather than current stress is the basis

of their

> physiologic emergency responses. The hyperarousal interferes with

their

> ability to make calm and rational assessments and prevents

resolution and

> integration of the trauma.142 They respond to threats as emergencies

> requiring action rather than thought.

>

> [...]

>

> ADDICTION TO TRAUMA

>

> Some traumatized people remain preoccupied with the trauma

at the

> expense of other life experiences137,141 and continue to re-create

it in

> some form for themselves or for others. War veterans may enlist as

> mercenaries,128 victims of incest may become prostitutes,47,120,125

and

> victims of childhood physical abuse seemingly provoke subsequent

abuse in

> foster families53 or become self-mutilators143a Still others

identify with

> the aggressor and do to others what was done to them.21,39

Clinically, these

> people are observed to have a vague sense of apprehension,

emptiness,

> boredom, and anxiety when not involved in activities reminiscent of

the

> trauma. There is no evidence to support Freud's idea that repetition

> eventually leads to mastery and resolution. In fact, reliving the

trauma

> repeatedly in psychotherapy may serve to re-enforce the

preoccupation and

> fixation.

>

> ENDOGENOUS OPIATES AND ATTACHMENT

>

> [...] Early disruption of the attachment bond causes longlasting

> psychobiologic changes that not only reduce the capacity to cope

with

> subsequent social disruption but also disturb parenting processes

and create

> similar vulnerability into the next generation.

>

> [...] Childhood abuse and neglect may cause a long-term

vulnerability to be

> hyperaroused, expressed on a social level as decreased ability to

modulate

> strong affect states. " On a continuum from low to high physiologic

arousal

> there is an optimal level for every organism. The shape of an

individual's

> optimal stimulation curve may depend on the level of stimulation

received

> during early experience. " 37 As a result, people who were neglected

or abused

> as children may require much higher external stimulation of the

endogenous

> opioid system for soothing than those whose endogenous opioids can

be more

> easily activated by conditioned responses based on good early

caregiving

> experiences. These victimized people neutralize their hyperarousal

by a

> variety of addictive behaviors including compulsive re-exposure to

> situations reminiscent of the trauma.

>

> TREATMENT IMPLICATIONS

>

> [...]It is important to keep in mind that the only reason to

uncover the

> trauma is to gain conscious control over the unbidden re-experience

or

> re-enactments. Prior to unearthing the traumatic roots of current

behavior,

> people need to gain reasonable control over the longstanding

secondary

> defenses that were originally elaborated to defend against being

overwhelmed

> by traumatic material such as alcohol and drug abuse and violence

against

> self or others. The trauma can only be worked through after a

secure bond is

> established with another person. The presence of an attachment

figure

> provides people with the security necessary to explore their life

> experiences and to interrupt the inner or social isolation that

keeps people

> stuck in repetitive patterns. Both the etiology and the cure of

> trauma-related psychological disturbance depend fundamentally on

security of

> interpersonal attachments. Once the traumatic experiences have been

located

> in time and place, a person can start making distinctions between

current

> life stresses and past trauma and decrease the impact of the trauma

on

> present experience.137

>

> SUMMARY

>

> [...]Chronic physiologic hyperarousal persists, particularly to

stimuli

> reminiscent of the trauma. Later stresses tend to be experienced as

somatic

> states, rather than as specific events that require specific means

of

> coping. Thus victims of trauma may respond to contemporary stimuli

as a

> return of the trauma, without conscious awareness that past injury

rather

> than current stress is the basis of their physiologic emergency

responses.

> Hyperarousal interferes with the ability to make rational

assessments and

> prevents resolution and integration of the trauma. Disturbances in

the

> catecholamine, serotonin, and endogenous opioid systems have been

implicated

> in this persistenence of all-or-nothing responses.

>

> People who have been exposed to highly stressful stimuli develop

> long-term potentiation of memory tracts that are reactivated at

times of

> subsequent arousal. This activation explains how current stress is

> experienced as a return of the trauma; it causes a return to earlier

> behavior patterns. Ordinarily, people will choose the most pleasant

of two

> alternatives. High arousal causes people to engage in familiar

behavior,

> regardless of the rewards. As novel stimuli are anxiety provoking,

under

> stress, previously traumatized people tend return to familiar

patterns, even

> if they cause pain.

>

> [...]

>

> The only reason to uncover traumatic material is to gain conscious

control

> over unbidden re-experiences or re-enactments. The presence of

strong

> attachments provides people with the security necessary to explore

their

> life experiences and to interrupt the inner or social isolation

that keeps

> them stuck in repetitive patterns. In contrast with victimized

children,

> adults can learn to protect themselves and make conscious choices

about not

> engaging in relationships or behaviors that are harmful.

>

>

> trauma article by van der Kolk, MD

>

>

> > Here's an interesting article by Bessel A. van der Kolk, MD

> > titled " The compulsion to repeat the trauma. "

> >

> > http://www.cirp.org/library/psych/vanderkolk/

> >

> > - Edith

> >

> >

> >

> >

> >

> > Send questions and/or concerns to ModOasis-owner

> > " Stop Walking on Eggshells, " a primer for non-BPs, can be

ordered via

> 1-888-35-SHELL () and for the table of contents, go to:

> > http://www.BPDCentral.com

> >

> >

> >