Post on 01-Apr-2015
THE TRAUMA THE TRAUMA SPECTRUM AND ITS SPECTRUM AND ITS
CLINICAL CLINICAL IMPLICATIONSIMPLICATIONS
ROBERT SCAER, M.D.ROBERT SCAER, M.D.scaermdpc@msn.comscaermdpc@msn.com
www.traumasoma.comwww.traumasoma.com
THE ROOTS OF THE ROOTS OF TRAUMATRAUMA
A THREAT TO LIFEA THREAT TO LIFE
IN THE FACE OF HELPLESSNESSIN THE FACE OF HELPLESSNESS
THE FIGHT /FLIGHT / FREEZE THE FIGHT /FLIGHT / FREEZE RESPONSERESPONSE
THE FREEZE RESPONSETHE FREEZE RESPONSE
• NUMBING THROUGH ENDORPHINSNUMBING THROUGH ENDORPHINS
• VAGAL (PARASYMPATHETIC) TONEVAGAL (PARASYMPATHETIC) TONE
• BIMODAL SYMPATHETIC / BIMODAL SYMPATHETIC /
PARASYMPATHETIC CYCLINGPARASYMPATHETIC CYCLING
(ACCELERATOR / BRAKE (ACCELERATOR / BRAKE
ANALOGY)ANALOGY)
LESSONS FROM THE WILD:LESSONS FROM THE WILD:
THE CRITICAL IMPORTANCETHE CRITICAL IMPORTANCE
OF DISCHARGINGOF DISCHARGING
THE FREEZE RESPONSETHE FREEZE RESPONSE
FREEZE/IMMOBILIZATIONFREEZE/IMMOBILIZATIONAND SURVIVALAND SURVIVAL
BABY CHICKSBABY CHICKS
NOTNOTIMMOBILIZED IMMOBILIZED IMMOBILIZED IMMOBILIZED IMMOBILIZED IMMOBILIZED
SPONTANEOUSSPONTANEOUS FORCED FORCED RECOVERYRECOVERY RECOVERY RECOVERY
BESTBEST INTERMEDIATE WORST INTERMEDIATE WORSTDROWNINGDROWNING DROWNING DROWNING DROWNING DROWNING SURVIVAL SURVIVAL SURVIVALSURVIVAL SURVIVAL SURVIVAL
ANIMALS THAT DO NOT ANIMALS THAT DO NOT DISCHARGE THE DISCHARGE THE
FREEZEFREEZE• ZOO ANIMALSZOO ANIMALS• LABORATORY ANIMALSLABORATORY ANIMALS• DOMESTIC ANIMALSDOMESTIC ANIMALS• HUMAN ANIMALSHUMAN ANIMALS
Q: WHAT DO THESE ANIMALS HAVEQ: WHAT DO THESE ANIMALS HAVE
IN COMMON?IN COMMON?
A: THEY ALL LIVE IN A CAGE!A: THEY ALL LIVE IN A CAGE!
SENSORY INPUT –
HEAD AND NECK
AMYGDALA EMOTIONALCONTENT
ANTERIORCINGULATE GYRUS
MODULATES AMYGDALA
CEREBRAL CORTEXHYPOTHALAMUS
HPA AXIS
HIPPOCAMPUSDECLARATIVE MEMORYCOGNITIVE MEANING
ORBITOFRONTALCORTEX
ORGANIZES RESPONSETO THREAT
LOCUS CERULEUS
EARLY WARNING
ENDORPHINS IN ENDORPHINS IN TRAUMATRAUMA
• RELEASED IN AROUSAL: STRESS INDUCED RELEASED IN AROUSAL: STRESS INDUCED ANALGESIA (S.I.A.)ANALGESIA (S.I.A.)- INHIBITS MINISTERING TO WOUND, SELF-CARE, - INHIBITS MINISTERING TO WOUND, SELF-CARE, - ALLOWS CONTINUED FIGHT / FLIGHT BEHAVIOR- ALLOWS CONTINUED FIGHT / FLIGHT BEHAVIOR
• MEDIATES FREEZE RESPONSEMEDIATES FREEZE RESPONSE- ANALGESIA INHIBITS PAIN BEHAVIOR- ANALGESIA INHIBITS PAIN BEHAVIOR
- IMMOBILITY PROMOTES SURVIVAL- IMMOBILITY PROMOTES SURVIVAL
MEMORY MECHANISMS MEMORY MECHANISMS IN TRAUMAIN TRAUMA
• DECLARATIVE (EXPLICIT) MEM0RYDECLARATIVE (EXPLICIT) MEM0RY- - FACTS AND EVENTSFACTS AND EVENTS
• NON-DECLARATIVE (IMPLICIT)NON-DECLARATIVE (IMPLICIT) MEMORYMEMORY- EMOTIONAL ASSOCIATIONS- EMOTIONAL ASSOCIATIONS
- PROCEDURAL MEMORY- PROCEDURAL MEMORY-SKILLS AND HABITS-SKILLS AND HABITS
- CONDITIONED SENSORIMOTOR- CONDITIONED SENSORIMOTOR
RESPONSESRESPONSES
MEMORY IN TRAUMAMEMORY IN TRAUMA
• TRAUMATIC STRESS: A TRAUMATIC STRESS: A LIFE THREATLIFE THREAT WHILE IN A STATE OF WHILE IN A STATE OF HELPLESSNESSHELPLESSNESS
• THIS LEADS TO THE THIS LEADS TO THE FREEZE RESPONSEFREEZE RESPONSE• DISCHARGE OF THE FREEZE RESPONSE DISCHARGE OF THE FREEZE RESPONSE
ALLOWS “COMPLETION” OF ESCAPE ALLOWS “COMPLETION” OF ESCAPE OR DEFENSE IN PROCEDURAL OR DEFENSE IN PROCEDURAL MEMORY, MEMORY, EXTINGUISHES EXTINGUISHES CONDITIONED CONDITIONED SOMATIC CUESSOMATIC CUES
TRAUMA AS A MODEL TRAUMA AS A MODEL OF CONDITIONING ANDOF CONDITIONING ANDPROCEDURAL MEMORYPROCEDURAL MEMORY
A “CAPSULE” OF PROCEDURAL A “CAPSULE” OF PROCEDURAL MEMORY CUES FOR: MEMORY CUES FOR:
- SOMATOSENSORY,- SOMATOSENSORY, - EMOTIONAL,- EMOTIONAL,
- AND AUTONOMIC “FEELINGS”- AND AUTONOMIC “FEELINGS”- AND EMOTION-LINKED- AND EMOTION-LINKED DECLARATIVE MEMORYDECLARATIVE MEMORYALL PERCEIVED AS BEING ALL PERCEIVED AS BEING
IN THE PRESENT!IN THE PRESENT!
KINDLING / KINDLING / NEUROSENSITIZATIONNEUROSENSITIZATION
THE DEVELOPMENT OFTHE DEVELOPMENT OF
SELF-PERPETUATING SELF-PERPETUATING
NEURAL CIRCUITS NEURAL CIRCUITS
THROUGH THE STORAGE OF THROUGH THE STORAGE OF PROCEDURAL MEMORY CUES PROCEDURAL MEMORY CUES
OF A TRAUMAOF A TRAUMA
DISSOCIATION :DISSOCIATION :THE PERCEPTUAL THE PERCEPTUAL
EXPERIENCE EXPERIENCE OF THE OF THE
FREEZE RESPONSE?FREEZE RESPONSE?
WHAT LIFE EVENTSWHAT LIFE EVENTS
CONSTITUTECONSTITUTE
A TRAUMATICA TRAUMATIC
EXPERIENCE? EXPERIENCE?
PERSONAL EXPERIENCEPERSONAL EXPERIENCE• MILITARY COMBATMILITARY COMBAT• VIOLENT PERSONAL ATTACKVIOLENT PERSONAL ATTACK• KIDNAPPING KIDNAPPING • HOSTAGE TAKINGHOSTAGE TAKING• TERRORIST ATTACKTERRORIST ATTACK• INCARCERATION AS A POWINCARCERATION AS A POW• TORTURETORTURE• NATURAL OR MAN-MADE DISASTERSNATURAL OR MAN-MADE DISASTERS• SEVERE MOTOR VEHICLE ACCIDENTSSEVERE MOTOR VEHICLE ACCIDENTS• CHILDHOOD SEXUAL TRAUMACHILDHOOD SEXUAL TRAUMA
WHY DO THE MAJORITY WHY DO THE MAJORITY OF TRAUMA VICTIMS OF TRAUMA VICTIMS
EXPOSED TO TRAUMA EXPOSED TO TRAUMA NOT DEVELOP PTSD?NOT DEVELOP PTSD?
WHY DO SOME VICTIMS WHY DO SOME VICTIMS EXPOSED TO EXPOSED TO MINORMINOR TRAUMATIC EVENTSTRAUMATIC EVENTS
DEVELOP PTSD?DEVELOP PTSD?
RESILIENCY VS.RESILIENCY VS.VULNERABILITY TO VULNERABILITY TO
TRAUMATRAUMA
OUR PRIOR BURDENOUR PRIOR BURDEN
OF LIFE TRAUMAOF LIFE TRAUMA
CREATES AN ENVIRONMENTCREATES AN ENVIRONMENT
OF VULNERABILITY TO OF VULNERABILITY TO
FURTHER TRAUMATIC EVENTSFURTHER TRAUMATIC EVENTS
THOSE LIFE EXPERIENCES THOSE LIFE EXPERIENCES MOST LIKELY TO MOST LIKELY TO
REPRESENT TRAUMAREPRESENT TRAUMAHAVE HAVE MEANINGMEANING FOR FOR SURVIVAL BASED ON SURVIVAL BASED ON
PAST EXPERIENCEPAST EXPERIENCE
THE ROLE OFTHE ROLE OFDEVELOPMENTALDEVELOPMENTALNEUROBIOLOGYNEUROBIOLOGY
IN RESILIENCE TOIN RESILIENCE TOTRAUMATRAUMA
THE EXPERIENCE-BASED THE EXPERIENCE-BASED DEVELOPMENT OF THE DEVELOPMENT OF THE
BRAINBRAIN• ALLAN SCHORE, 1996: ALLAN SCHORE, 1996: AFFECT AFFECT
REGULATION AND THE ORIGIN OF REGULATION AND THE ORIGIN OF THE SELFTHE SELF
* THE MATERNAL / INFANT DYAD: * THE MATERNAL / INFANT DYAD: FACE-TO-FACE ATTUNEMENT FACE-TO-FACE ATTUNEMENT
FACILITATES DEVELOPMENT OF THE FACILITATES DEVELOPMENT OF THE RIGHT ORBITO-FRONTAL CORTEX, RIGHT ORBITO-FRONTAL CORTEX, WHICH PROMOTES AUTONOMIC WHICH PROMOTES AUTONOMIC REGULATION, AND RESILIENCY TO REGULATION, AND RESILIENCY TO SUBSEQUENT STRESS/TRAUMASUBSEQUENT STRESS/TRAUMA
LEARNED LEARNED HELPLESSNESSHELPLESSNESS
ONCE YOU FREEZEONCE YOU FREEZE
YOU TEND TOYOU TEND TO
FREEZE / DISSOCIATE FREEZE / DISSOCIATE AGAIN!AGAIN!
THE LEGACY OFTHE LEGACY OFIMPAIRED ATTACHMENT IMPAIRED ATTACHMENT AND DEVELOPMENTAL AND DEVELOPMENTAL
TRAUMA:TRAUMA:
A LIFETIME OF A LIFETIME OF
AUTONOMIC AUTONOMIC
AND EMOTIONAL AND EMOTIONAL
DYSREGULATIONDYSREGULATION
10/23/01 R obert C . Scaer, M .D . 79
Autonomic Nervous System in Trauma
Homeostasis
Trauma
Sym
path
etic
(F
ight
/Flig
ht)
Para
sym
path
etic
(Fre
eze
)
FIGURE 8.2: THE AUTONOMIC NERVOUS SYSTEM IN TRAUMA- Tonic input into natural oscillatory systems may lead to increasing oscillations to the extremes of physiologic tolerance. This phenomenon may in part explain the self-perpetuated exaggerated autonomic cycling between arousal and dissociation in PTSD.
IF THE ABSENCE OFNURTURING IF THE ABSENCE OFNURTURING
IS TRAUMATIC STRESS,IS TRAUMATIC STRESS,WHAT ARE WE MISSING HERE?WHAT ARE WE MISSING HERE?
THE UNRECOGNIZEDTHE UNRECOGNIZEDSOURCESSOURCES
OF TRAUMAOF TRAUMA
UNRECOGNIZED SOURCESUNRECOGNIZED SOURCESOF TRAUMAOF TRAUMA
• PREVERBAL TRAUMAPREVERBAL TRAUMA• PEDIATRIC AND ADULT PEDIATRIC AND ADULT
MEDICAL MEDICAL TRAUMATRAUMA• CULTURALLY ENDORSED CULTURALLY ENDORSED
TRAUMATRAUMA• ““LITTLE TRAUMAS”LITTLE TRAUMAS”
FETAL SENTIENCEFETAL SENTIENCE
• CAPABLE OF CLASSICAL CAPABLE OF CLASSICAL HABITUATION HABITUATION AND CONDITIONINGAND CONDITIONING
• TACTILE, AUDITORY, OLFACTORY TACTILE, AUDITORY, OLFACTORY LEARNINGLEARNING
• RECOGNITION LEARNING OF RECOGNITION LEARNING OF MUSIC/SOUNDS/VOICES/RHYMESMUSIC/SOUNDS/VOICES/RHYMES
• PLAY/AGGRESSION BEHAVIOR OF PLAY/AGGRESSION BEHAVIOR OF FETAL FETAL TWINSTWINS
INTRAUTERINE TRAUMAINTRAUTERINE TRAUMA
• INCREASED FETAL PULSE / BP WITH INCREASED FETAL PULSE / BP WITH MATERNAL AROUSAL MATERNAL AROUSAL
• DEFENSIVE FETAL REACTIONS TO DEFENSIVE FETAL REACTIONS TO AMNIOCENTESIS AMNIOCENTESIS
• INCREASED FETAL ENDORPHINS ANDINCREASED FETAL ENDORPHINS ANDCORTISOL WITH FETAL CORTISOL WITH FETAL
NEEDLINGNEEDLING• LOW BIRTH WEIGHT WITH FREQUENT LOW BIRTH WEIGHT WITH FREQUENT
PRENATAL ULTRASOUND AND PRENATAL ULTRASOUND AND THIRD TRIMESTER MEDICATIONSTHIRD TRIMESTER MEDICATIONS
• LOW BIRTH RATE WITH MATERNAL LOW BIRTH RATE WITH MATERNAL DISTRESSDISTRESS
THE NEONATAL ICUTHE NEONATAL ICU
• TUBES: BREATHING, SUCTIONING, TUBES: BREATHING, SUCTIONING, FEEDINGFEEDING
• NOISE, BRIGHT LIGHTS, NOISE, BRIGHT LIGHTS, ISOLATIONISOLATION
• PAIN: TRACHEOSTOMIES, MAJOR PAIN: TRACHEOSTOMIES, MAJOR SURGERY, ARTERIAL / SURGERY, ARTERIAL /
VENOUS VENOUS PUNCTURES / PUNCTURES / CUTDOWNSCUTDOWNS
NEONATAL ICU OUTCOMESNEONATAL ICU OUTCOMES• 283 PREMIES ASSESSED AT 30 MONTHS283 PREMIES ASSESSED AT 30 MONTHS
* 19% SEVERELY DELAYED * 19% SEVERELY DELAYED DEVELOPMENTDEVELOPMENT
* 11% MODERATELY DELAYED* 11% MODERATELY DELAYEDDEVELOPMENTDEVELOPMENT
* 10 % SEVERE NEUROMOTOR * 10 % SEVERE NEUROMOTOR DISABILITYDISABILITY
* 7 % BLIND* 7 % BLIND* 8 % SEVERE HEARING LOSS* 8 % SEVERE HEARING LOSS* OVERALL, 49% WITH DISABILITY, * OVERALL, 49% WITH DISABILITY,
23% WITH SEVERE DISABILITY23% WITH SEVERE DISABILITY
THE AMERICAN WAY OF THE AMERICAN WAY OF BIRTHINGBIRTHING
• THE OBSTETRICALTHE OBSTETRICAL DELIVERY ROOMDELIVERY ROOM* * INDUCTIONINDUCTION
* * FETAL MONITORING FETAL MONITORING * FORCEPS * FORCEPS * SUCTION DELIVERY* SUCTION DELIVERY* C-SECTIONS* C-SECTIONS* NEONATAL SUCTIONING * NEONATAL SUCTIONING * HEEL STICKS, EYE * HEEL STICKS, EYE MEDS MEDS * COLD, BRIGHT, NOISY ENVIRONMENT * COLD, BRIGHT, NOISY ENVIRONMENT * SEPARATION / ISOLATION* SEPARATION / ISOLATION
THE AMERICAN WAY OF THE AMERICAN WAY OF BIRTHINGBIRTHING
• MATERNAL ANESTHESIA AND SLOW MATERNAL ANESTHESIA AND SLOW INFANT DEVELOPMENTINFANT DEVELOPMENT
• INCREASED RATE OF JUVENILE INCREASED RATE OF JUVENILE BEHAVIORAL PROBLEMS AND BEHAVIORAL PROBLEMS AND CRIMINAL VIOLENCE IN MALES CRIMINAL VIOLENCE IN MALES WITH NON-BRAIN INJURY RELATED WITH NON-BRAIN INJURY RELATED
BIRTH COMPLICATIONSBIRTH COMPLICATIONS
PEDIATRIC MEDICAL TRAUMAPEDIATRIC MEDICAL TRAUMA• 1986 - PATENT DUCTUS SURGERY 1986 - PATENT DUCTUS SURGERY
WITHOUT WITHOUT ANESTHESIA DISCONTINUEDANESTHESIA DISCONTINUED• 1988 - 1988 - AMAAMA : : INFANTS CAN FEEL PAININFANTS CAN FEEL PAIN - -
RECOMMENDS SURGICAL ANESTHESIARECOMMENDS SURGICAL ANESTHESIA• 1990’s - FIRST ANESTHESIA USED IN1990’s - FIRST ANESTHESIA USED IN
PEDIATRIC ICU’SPEDIATRIC ICU’S• 1997 – 1997 – AMAAMA: RECOMMENDS ANALGESIA: RECOMMENDS ANALGESIA
FOR CIRCUMCISIONFOR CIRCUMCISION• PRESENT: ANALGESIA NEEDS OF PRESENT: ANALGESIA NEEDS OF
PREMIES, PREMIES, NEONATES AND INFANTS NEONATES AND INFANTS ADDRESSEDADDRESSED
PEDIATRIC MEDICAL PEDIATRIC MEDICAL TRAUMATRAUMA
• PEDIATRIC E.R., ANESTHESIA, PEDIATRIC E.R., ANESTHESIA, SURGERY AND SURGERY AND HOSPITALIZATIONHOSPITALIZATION
* ISOLATION AND PHYSICAL * ISOLATION AND PHYSICAL RESTRAINTSRESTRAINTS
* INADEQUATE PAIN MANAGEMENT* INADEQUATE PAIN MANAGEMENT* ETHER ANESTHESIA* ETHER ANESTHESIA* IGNORAL AND ISOLATION FROM * IGNORAL AND ISOLATION FROM
CARE-GIVERSCARE-GIVERS* THE FEAR INSTILLED BY ISOLATION * THE FEAR INSTILLED BY ISOLATION
IN A IN A TERRIFYING ENVIRONMENTTERRIFYING ENVIRONMENT
PEDIATRIC MEDICAL PEDIATRIC MEDICAL TRAUMATRAUMA
• CIRCUMCISIONCIRCUMCISION* * CIRCUMCIZED MALES HAVE A CIRCUMCIZED MALES HAVE A
GREATER PAIN RESPONSE TO GREATER PAIN RESPONSE TO SUBSEQUENT IMMUNIZATION SUBSEQUENT IMMUNIZATION SHOTS THAN NON-CIRCUMCIZED SHOTS THAN NON-CIRCUMCIZED MALESMALES
* USE OF EMLA CREAM * USE OF EMLA CREAM EFFECTIVEEFFECTIVE
ADULT MEDICAL TRAUMAADULT MEDICAL TRAUMA
• THE SURGICAL THEATERTHE SURGICAL THEATER- - SMELLS, SOUNDS, MASKED FACES, IGNORAL OF SMELLS, SOUNDS, MASKED FACES, IGNORAL OF THE THE PATIENT, A STATE OF NAKED HELPLESSNESSPATIENT, A STATE OF NAKED HELPLESSNESS
- PRE-OP ANXIETY AND POST-OP COMPLICATIONS- PRE-OP ANXIETY AND POST-OP COMPLICATIONS
* INCREASED THIOPENTAL AND CIRCULATORY * INCREASED THIOPENTAL AND CIRCULATORY COLLAPSECOLLAPSE
* POST-OP AGITATION* POST-OP AGITATION
* POST-OP SOMATIC SX: SLEEP DISTURBANCE, * POST-OP SOMATIC SX: SLEEP DISTURBANCE,
PERSISTENT PAIN, BOWEL COMPLAINTSPERSISTENT PAIN, BOWEL COMPLAINTS
ADULT MEDICAL TRAUMAADULT MEDICAL TRAUMA
• AWAKENING UNDER ANESTHESIAAWAKENING UNDER ANESTHESIA
* 30-35,000 CASES / YEAR IN U.S.* 30-35,000 CASES / YEAR IN U.S.* USUALLY UNDETECTED* USUALLY UNDETECTED* OVERWHELMING HELPLESSNESS* OVERWHELMING HELPLESSNESS* PTSD: MAJOR NIGHTMARES, FLASHBACKS, * PTSD: MAJOR NIGHTMARES, FLASHBACKS,
AROUSAL, PHOBIAS. VIVID DECLARATIVE MEMORYAROUSAL, PHOBIAS. VIVID DECLARATIVE MEMORY* SOMATIC SX.: COMPARABLE TO WHIPLASH* SOMATIC SX.: COMPARABLE TO WHIPLASH* PARTIAL AWAKENING WITHOUT MEMORY MAY * PARTIAL AWAKENING WITHOUT MEMORY MAY
EXPLAIN POST-OP AGITATION AND UNEXPLAINED EXPLAIN POST-OP AGITATION AND UNEXPLAINED CHRONIC PAIN BASED ON PROCEDURAL MEMORYCHRONIC PAIN BASED ON PROCEDURAL MEMORY
MEDICAL MEDICAL TECHNOLOGY:TECHNOLOGY:
TRAUMA BY THE TRAUMA BY THE CAREGIVERCAREGIVER
““I CAN’T FIND I CAN’T FIND ANYTHING WRONG, ANYTHING WRONG,
BUT WE’D BUT WE’D PROBABLY BETTER PROBABLY BETTER
GET AN MRI”GET AN MRI”
ORDERING TESTS TO ORDERING TESTS TO AVOID MEDICAL / AVOID MEDICAL / LEGAL LIABILITYLEGAL LIABILITY
NEW TECHNOLOGY AND NEW TECHNOLOGY AND THE TRAP OF THE THE TRAP OF THE “UNEXPLAINED” “UNEXPLAINED” ABNORMALITYABNORMALITY
THE INFALLIBILITY OF THE INFALLIBILITY OF TECHNOLOGY AND TECHNOLOGY AND
“EFFORT AFTER “EFFORT AFTER MEANING”MEANING”
REJECTION OF THE REJECTION OF THE PATIENT IF THE PATIENT IF THE
TESTS ARE NORMAL:TESTS ARE NORMAL:““IT MUST BE IT MUST BE
PSYCHOLOGICAL”PSYCHOLOGICAL”
THE DILEMMATHE DILEMMA OF AN OF AN
IMPERFECT SCIENCE IMPERFECT SCIENCE
THE INSIDIOUS THE INSIDIOUS REINFORCEMENT OF REINFORCEMENT OF
THE FEAR OF ILLNESS THE FEAR OF ILLNESS BY THE MEDIA AND BY THE MEDIA AND PHARMACEUTICAL PHARMACEUTICAL
INDUSTRYINDUSTRY
GOVERNMENT ANDGOVERNMENT ANDTHE MEDIATHE MEDIA
• THE POLITICS OF FEAR: THE COLD THE POLITICS OF FEAR: THE COLD WAR AND THE WAR ON WAR AND THE WAR ON
TERRORTERROR• LESSONS FROM VIETNAM: LESSONS FROM VIETNAM: IMAGES IMAGES
OF WARFAREOF WARFARE• THE VISUAL MEDIA: IMAGES OF THE VISUAL MEDIA: IMAGES OF
HORROR AND THE POWER OF HORROR AND THE POWER OF TRAUMATIC REENACTMENT TRAUMATIC REENACTMENT
- - THE APPEAL OF C.S.I.THE APPEAL OF C.S.I.
““LITTLE TRAUMAS”LITTLE TRAUMAS”• MOTOR VEHICLE ACCIDENTSMOTOR VEHICLE ACCIDENTS• PARENTAL ALCOHOLISM AND PARENTAL ALCOHOLISM AND
MENTAL ILLNESSMENTAL ILLNESS• RACIAL, GENDER AND JOB RACIAL, GENDER AND JOB
DISCRIMINATIONDISCRIMINATION• VIOLENCE IN THE MEDIA AND VIOLENCE IN THE MEDIA AND
ENTERTAINMENTENTERTAINMENT• BULLYING IN SCHOOLSBULLYING IN SCHOOLS• PERSONAL DEBTPERSONAL DEBT• THE INSURANCE INDUSTRYTHE INSURANCE INDUSTRY• THE LEGAL SYSTEMTHE LEGAL SYSTEM
TRAUMATIC TRAUMATIC REENACTMENTREENACTMENT
• SEXUALLY MOLESTED BOYS: SEXUALLY MOLESTED BOYS: INCREASED INCREASED DRUG ABUSE,DRUG ABUSE,
VIOLENCE VIOLENCE AND AND CRIMINAL CRIMINAL BEHAVIORBEHAVIOR
• 14 JUVENILES CONDEMNED TO 14 JUVENILES CONDEMNED TO DEATH: DEATH:
12 12 PHYSICALLY ABUSEDPHYSICALLY ABUSED, 5 , 5 SODOMIZEDSODOMIZED
TRAUMATIC TRAUMATIC REENACTMENTREENACTMENT
• CHILDHOOD SEXUAL ABUSE: CHILDHOOD SEXUAL ABUSE: HIGHER HIGHER ADULT INCIDENCE OF ADULT INCIDENCE OF RAPE, RAPE, SPOUSAL ABUSE, SPOUSAL ABUSE, PROSTITUTION, PROSTITUTION, POSING FOR POSING FOR PORNOGRAPHYPORNOGRAPHY
• SELF MUTILATION: CHILDHOOD SELF MUTILATION: CHILDHOOD HISTORY OF HISTORY OF PHYSICAL AND PHYSICAL AND SEXUAL ABUSE, MULTIPLE SEXUAL ABUSE, MULTIPLE
SURGICAL PROCEDURESSURGICAL PROCEDURES
REEXPERIENCING REEXPERIENCING AND THEAND THE
ANNIVERSARY ANNIVERSARY SYNDROMESYNDROME
TRAUMATIC ATTACHMENTTRAUMATIC ATTACHMENT
• ABUSIVE PARENT / CHILD BONDINGABUSIVE PARENT / CHILD BONDING• ABUSIVE SPOUSE / VICTIM ABUSIVE SPOUSE / VICTIM
BONDINGBONDING• KIDNAPPED VICTIM / CAPTOR KIDNAPPED VICTIM / CAPTOR
BONDINGBONDING• WE SEEK THE NEGATIVE WE SEEK THE NEGATIVE
CHARACTERISTICS OF OUR CHARACTERISTICS OF OUR CAREGIVERS IN OUR MATESCAREGIVERS IN OUR MATES
ENDORPHINS AND ENDORPHINS AND TRAUMATIC REENACTMENTTRAUMATIC REENACTMENT
• VICTIMS OF TRAUMA VICTIMS OF TRAUMA SEEKSEEK REEXPOSURE REEXPOSURE TO TO SITUATIONS SIMILAR TO OLD SITUATIONS SIMILAR TO OLD TRAUMA TRAUMA TO ACHIEVE ENDORPHIN TO ACHIEVE ENDORPHIN RELEASE, AS RELEASE, AS WELL AS “COMPLETION”WELL AS “COMPLETION”
““THE COMPULSION TO REPEAT THE THE COMPULSION TO REPEAT THE TRAUMA”TRAUMA”
ENORPHINS AND ENORPHINS AND TRAUMATIC REENACTMENTTRAUMATIC REENACTMENT
• ENDORPHINS MEDIATE HUMAN ENDORPHINS MEDIATE HUMAN ATTACHMENT AND BONDINGATTACHMENT AND BONDING
• LOSS OF MATERNAL BONDING AND LOSS OF MATERNAL BONDING AND SOCIAL SUPPORT:SOCIAL SUPPORT:
* DECREASED ANTERIOR * DECREASED ANTERIOR CINGULATE OPIATE RECEPTORS (THE CINGULATE OPIATE RECEPTORS (THE CINGULATE INHIBITS FEAR CINGULATE INHIBITS FEAR CONDITIONING)CONDITIONING)
* SEEKING ENDORPHINS THROUGH* SEEKING ENDORPHINS THROUGH
TRAUMATIC REENACTMENTTRAUMATIC REENACTMENT
ENDORPHINS AND ENDORPHINS AND TRAUMATIC REENACTMENTTRAUMATIC REENACTMENT• SELF-MUTILATION, SELF-STARVING: SELF-MUTILATION, SELF-STARVING:
INCREASED OPOIDS, WITH INCREASED OPOIDS, WITH RELIEF FROM AROUSALRELIEF FROM AROUSAL• REWARDS OF POST-TRAUMATIC REWARDS OF POST-TRAUMATIC
REUNION AFTER ABUSEREUNION AFTER ABUSE• REWARD SYSTEMS IN EXTREME REWARD SYSTEMS IN EXTREME
SPORTS AND ENDURANCE SPORTS AND ENDURANCE ATHLETICSATHLETICS
ENDURANCE AND ENDURANCE AND EXTREME SPORTSEXTREME SPORTS
• ? HIGHER INCIDENCE OF CHILDHOOD ? HIGHER INCIDENCE OF CHILDHOOD TRAUMA IN HIGH ENDURANCE TRAUMA IN HIGH ENDURANCE
SPORTS ATHLETESSPORTS ATHLETES• RESTORATION OF DEPRESSED RESTORATION OF DEPRESSED
ENDORPHIN LEVELS THROUGH ENDORPHIN LEVELS THROUGH EXTREME EFFORTEXTREME EFFORT
• ““FEARLESS”: TRAUMATIC FEARLESS”: TRAUMATIC REENACTMENT THROUGH REENACTMENT THROUGH
RISK-TAKINGRISK-TAKING
GENDER ISSUES IN TRAUMAGENDER ISSUES IN TRAUMA• DISSOCIATION AT THE TIME OF DISSOCIATION AT THE TIME OF TRAUMA TRAUMA
A A MAJOR PREDICTOR OF PTSDMAJOR PREDICTOR OF PTSD• INCIDENCE OF DISSOCIATION INCIDENCE OF DISSOCIATION ANDAND PTSD PTSD
MUCH HIGHER IN WOMEN (3:1)MUCH HIGHER IN WOMEN (3:1)• PERRY: ANTHROPOLOGICAL PERRY: ANTHROPOLOGICAL
IMPLICATIONS OF THE FREEZE IMPLICATIONS OF THE FREEZE RESPONSERESPONSE• A MODEL FOR VIOLENCE IN MALESA MODEL FOR VIOLENCE IN MALES• ENDORPHIN HABITUATION AND ENDORPHIN HABITUATION AND KINDLINGKINDLING
REENACTMENTREENACTMENTIN DAILY LIFEIN DAILY LIFE
• MATURATIONAL ARREST IN MATURATIONAL ARREST IN TRAUMATRAUMA
• OUR CHOICE OF MATESOUR CHOICE OF MATES• OUR CHOICE OF CAREERSOUR CHOICE OF CAREERS• OUR CHOICE OF RECREATIONOUR CHOICE OF RECREATION• OUR CHOICE OF SUBSTANCESOUR CHOICE OF SUBSTANCES
CONCLUSIONSCONCLUSIONS• MANY NEGATIVE LIFE EVENTS, IF MANY NEGATIVE LIFE EVENTS, IF EXPERIENCED IN A STATE OF EXPERIENCED IN A STATE OF HELPLESSNESS ASSUME THE HELPLESSNESS ASSUME THE DEFINITION DEFINITION OF TRAUMAOF TRAUMA• SUCH EXPERIENCES MAY BE SUCH EXPERIENCES MAY BE CULTURALLY CULTURALLY DETERMINED, AND DETERMINED, AND CONSIDERED TO BE CONSIDERED TO BE “NORMAL”“NORMAL”• INEXPLICABLE BEHAVIOR MAY INEXPLICABLE BEHAVIOR MAY REFLECT UNCONSCIOUS REFLECT UNCONSCIOUS RECAPITULATION RECAPITULATION OF PRIOR OF PRIOR TRAUMATRAUMA