The ACOA Trauma Syndrome

by Tian Dayton, Ph. D.

  When I see people who cannot find their way back to their emotional set points or a normal range of functioning, I look for fear, stress, or relationship trauma of some kind because these extremes tend to be a direct result of the cumulative effect of trauma. We overreact or under react but we have trouble with “normal”. Overreactions and underreactions send up a signal to me as a therapist that further investigation is merited. I ask myself, Why does this person fear going near to this feeling? Why is she hiding from the feeling either by acting it out, medicating it, or shutting it down? Why is she staying away from that emotional middle ground where she can feel and think about feeling at the same time? What doesn’t she want to feel and why doesn’t she want to feel it?

  Experience Becomes Biology

  While it’s our limbic system that processes our emotions and collects and categorizes information gathered by our senses, it is our thinking brain that elevates that data to a conscious level and converts it into language or pictures that have meaning attached to them. Through this rational thinking of the prefrontal ­cortex, we integrate the disparate fragments of our experience into a coherent whole—a “picture” or “story”—that we can record, remember, and recall. It’s through this rational thinking that we make sense of ourselves and ourselves in relation to others. The limbic system provides content. The prefrontal cortex categorizes that content, gives it a framework, and integrates it into a working model of ourselves and our lives.

  But what happens when that thinking doesn’t take place because the prefrontal cortex was temporarily frozen with fear? Trauma causes the prefrontal cortex to temporarily shut down while still allowing the limbic system to keep going. This means that we continue to record content but we are not making sense of that content. Where do all our feelings go if the thinking brain doesn’t help us to understand them? And what about the images, sounds, smells, tastes, and textures that are part of an experience? Did these things happen? Did they disappear? Where are they? Without the help of the prefrontal cortex, all of that emotional and sensory information gets recorded by the limbic brain/body but remains unprocessed and unconscious. Because the prefrontal cortex was not doing its job of elevating the information to a conscious level and making sense of it, those emotions and sense impressions were stored within us but remain unconscious. In cases such as this, the body remembers but the mind “forgets.” The trauma-related “memories” become part of the vast web of what researchers call a dissociated neural net or the dissociative capsule (Badenbock 2008; Scaer 2005). The feelings and fragments of sensory experience and emotion are in us, but we don’t know just where and how they fit into the total picture.

  Triggers

  But out of sight is not out of mind/body. These limbic memories can be triggered without our awareness. As these memories are unconsciously triggered and replayed, their grooves deepen. Unless we make our unconscious limbic memories conscious so that we can feel, think, and talk about them, so that we can process and become aware of what is inside of us, we can become locked in a recycled memory that does not seem to have a beginning, middle, or an end and deepen its imprint in our mind/body. In his book The Trauma Spectrum: Hidden Wounds and Human ­Resiliency, Dr. Robert Scaer writes:

  When people develop PTSD, the replaying of the trauma (in the mind) leads to [neurological] sensitization. With every replay of the trauma there is increasing distress. In those individuals, the traumatic event, which started out as a social, interpersonal process, develops secondary biological consequences that are hard to reverse once they become entrenched. Because these patients have intolerable sensations and feelings, their tendency is to avoid them. Mentally they “split off” or “dissociate these feelings,” physically their bodies tighten and brace against them. They seem to live under the assumption that if they feel these sensations and feelings those feelings will overwhelm them forever. These are patients who rely on medications, drugs and alcohol to make these feelings go away because they have lost the confidence that they can tolerate them on their own . . . The fear of being consumed by these ­terrible feelings makes them feel that only not feeling them will make them go away (2005).

  Other common ways that people try to get rid of these unconscious, unwanted feelings are by acting them out through behaviors that are destructive to the self, other ­people, or relationships (picking fights, becoming passive aggressive, constant complaining, self-sabotaging behaviors), or by projecting them onto others and disowning them within the self (making them about something that someone else did or a situation or circumstance outside the self), or engaging in process addictions (over- or undereating, risky, or overly frequent sexual liaisons).

  These fragmented memories that contain valuable information about our experience and ourselves become hidden from view. And until we make them conscious, parts of our inner world, parts of who we are and why we do what we do, can remain a mystery to us.

  SIX

  The Traumatized Self:

  Falling Apart on the Inside

  When you’re born, a light is switched on, a light which shines up through your life. As you get older the light still reaches you, sparkling as it comes up through your ­memories. And if you’re lucky as you travel forward through time, you’ll bring the whole of yourself along with you, gathering your skirts and leaving nothing behind, nothing to obscure the light. But if a Bad Thing happens, part of you is seared into place and trapped forever at that time. The rest of you moves onward, dealing with all the todays and tomorrows, but something, some part of you, is left behind. That part blocks the light, colors the rest of your life, but worse than that, it’s alive. Trapped forever at that moment, and alone in the dark, that part of you is still alive.

  —Michael Marshall Smith, Only Forward

  Situations that explode our sense of what “normal” is can leave us feeling shaken and shattered. They can also leave us with a fragmented sense of our inner world. Significant traumatic moments may remain unprocessed within us due to the phenomenon of psychic numbing or the mind’s urge to throw frightening circumstances out of conscious awareness at the very same time that it is recording emotions and sense impressions that are part of that very experience.

  A Mind/Body Picture of PTSD

  It has long been recognized that the disturbing experience of war can produce reactions of shell shock or battle fatigue causing those who experience them to suffer both personally and in relationships long after they return home. Professionals in the mental health field began to recognize that children who grew up with adverse childhood experiences exhibited many of the same post-traumatic stress disorder (PTSD) symptoms that returning Vietnam war veterans exhibited (van der Kolk 1987). Following are some of the mind/body phenomena that underlie PTSD and cause it to have long-term impact.

  Problems with Self-Regulation

  The loss of neuromodulation (the ability to regulate moods) that is at the core of PTSD can lead to emotional dysregulation. Traumatized people tend to go immediately from stimulus to response without being able to first figure out what makes them so upset. They tend to experience intense fear, anxiety, anger, and panic in response to even minor stimuli. This can make them either overreact and intimidate others, or shut down and freeze (van der Kolk 1994).

  Dysregulation involves both the mind and the body. We move from states of hyperarousal (that may include heart pounding, sweating, increased adrenaline, shortness of breath, dry throat, or shaking) to shutting down. Our emotions run strong when traumatic moments from our past are triggered in our present; we can have racing thoughts and disruptive imagery that dance along the surface of our mind. Because we experience these emotions and sensations in our bodies and because they are actually physical, we may want to swing into some form of action. Then, if action seems futile or impossible, we shut down; we go numb. This is the trauma dance: high intensity reactions followed by shutting down. Twelve-step programs have a
colloquial expression for this cycling, referring to it as “black-and-white thinking.” We move from one extreme to the other and have trouble holding an intelligent center.

  Hypervigilance/Anxiety

  Hypervigilance is a symptom of PTSD and refers to the experience of being constantly tense and on guard. People experiencing this symptom of PTSD tend to scan their environment and relationships for signs of potential danger or repeated relationship insults and ruptures (van der Kolk 1987). At extreme levels, hypervigilance may appear similar to paranoia. The ­individual is constantly trying to read the faces of those in the environment in order to protect themselves against perceived pain or humiliation. Unfortunately, this hair-trigger reactivity can lead to perceptions of problems that do not exist, and, inadvertently, to their development, or to an exaggeration of problems that might have been easily managed.

  Van der Kolk describes hypervigilance as an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats (van der Kolk 1987). Hypervigilance can also be accompanied by physical symptoms such as a state of increased anxiety, which can cause exhaustion, abnormally increased arousal, or a high responsiveness to stimuli. People experiencing hypervigilance may become preoccupied with studying their environment for possible threats, causing them to lose connections with their family and friends. They will overreact to loud and unexpected noises, become agitated in highly crowded or noisy environments, and may have a difficult time getting to sleep or staying asleep (van der Kolk 1987).

  Numbing of Responsiveness/Emotional Constriction

  Numbing is a natural part of the trauma response and may mean that those who have experienced trauma have a restricted range of feelings that they are comfortable experiencing and expressing.

  Aware of their difficulties in controlling their emotions, traumatized people seem to spend their energies on avoiding distressing internal sensations, instead of attending to the demands of the environment. In addition, they lose satisfaction in matters that previously gave them a sense of satisfaction and may feel “dead to the world.” This emotional numbing may be expressed as depression, as anhedonia and lack of motivation, as psychosomatic reactions, or as dissociative states. In contrast with the intrusive PTSD symptoms, which occur in response to outside stimuli, numbing is part of these patients’ baseline functioning. In children, numbing has been observed among elementary school children attacked by a sniper, among witnesses to parental assault or murder, and among victims of physical or sexual abuse. They become less involved in playful social interactions, and often are withdrawn and isolated. After being traumatized, many people stop feeling pleasure from exploration and involvement in activities and they feel that they just “go through the motions” of everyday living. Emotional numbness also gets in the way of resolving the trauma in psychotherapy: they give up on recovery and it keeps them from being able to imagine a future for themselves (van der Kolk 1994).

  Somatic Disturbances: Body Aches and Pains

  When a person is unable to experience or act on powerful emotions, those emotions may be experienced somatically as back pain, chronic headaches, muscle tightness or stiffness, stomach problems, heart pounding, or headaches. People traumatized as children may suffer from alexithymia—an inability to translate somatic sensations into feelings such as anger, happiness, or fear. This failure to translate somatic states into words and symbols causes them to experience emotions simply as physical problems (Saxe et al 1994).

  Learning Difficulties

  Physiological hyperarousal interferes with the capacity to concentrate, attend, and learn from experience. Aside from amnesias about aspects of the trauma, traumatized people often have trouble remembering ordinary events as well. Easily triggered into hyperarousal by trauma-related stimuli, along with a compromised ability to attend and pay attention, they may display symptoms of attention deficit/hyperactivity disorder.

  Unresolved grief can also contribute to learning disabilities. In a study of bereaved adults with learning disabilities, only about half were known to have attended the funeral of their deceased ­parent (Hollins and Sinason 2000). As a group, these bereaved adults demonstrated more psychopathology and behavioral disturbances, including irritability, anxiety, adjustment difficulties, and depression than the controls. Nearly three-quarters of them were unaware of any connection between blocking their grief and their learning issues. A follow-up of this study group after five years pointed to the likelihood of delayed and/or prolonged grief in many people with learning disabilities, particularly those who had not had a bereavement-related intervention (Bonell-Pascual et al 1999), such as a funeral. This doesn’t mean that all losses require intervention, only that loss needs to be somehow felt and processed; funerals, friends, and family can be sufficient supports if not avoided. But family traumas, such as addiction, divorce, or dysfunction, often go unacknowledged and without bereavement.

  Sleep Problems

  Adults and children with hyperarousal and a loss of neuromodulation may experience sleep problems, both because they are unable to still themselves sufficiently to go to sleep and because they are fearful of having traumatic nightmares. Many traumatized people report dream-interruption insomnia: they wake themselves up as soon as they start having a dream for fear that the dream will turn into a trauma-related nightmare. They are also liable to exhibit hypervigilance, an exaggerated startle response, and restlessness.

  Aggression, Anger, or Rage Against Self and Others

  Issues with anger and aggression are part of the PTSD syndrome; ACoAs can carry resentments that morph into problems with anger management, rage issues, acting out behaviors, passive aggression, or self-medicating. They may not even know they are angry; that anger may be quite unconscious and ­unprocessed.

  Another manifestation of unprocessed anger is depression. ACoAs may turn their anger against themselves and become listless, isolated, and sullen. Or they may act it out; they become the screw-up and blow up their own lives. They drink, drug, cut, or fall apart, engaging full-out in self-destructive behaviors that undermine their happiness and success. All of these are ways of not feeling the anger they carry.

  Numerous studies have demonstrated that both adults and children who have been traumatized are likely to turn their aggression against others or themselves. Being abused as a child sharply increases the risk for later delinquency and violent criminal behavior. In one study of 87 psychiatric outpatients we found that self-mutilators invariably had severe childhood histories of abuse and/or neglect. There is good evidence that self-mutilative behavior is related to endogenous opioid changes in the CNS secondary to early traumatization. Problems with aggression against others have been particularly well documented in war veterans, traumatized children and in prisoners with histories of early trauma (van der Kolk et al 1991).

  Learned Helplessness

  When we feel that nothing we can do will affect or change the situation we’re in, we may develop learned helplessness. We may lose some of our ability to take actions to affect change (Peterson, Maier, and Seligman 1995). As a technical term in animal and human psychology, learned helplessness refers to a state of collapse in which one behaves helplessly, even when the opportunity is restored to help one’s self by avoiding a dangerous or harmful situation.

  Research studies found that the strongest predictor of a depressive response to a situation is a perceived lack of control over a circumstance. Illustrating this point are experiments done with people performing mental tasks while there is distracting noise. Those who had access to and could use a switch to turn off the noise had improved performance, even though they rarely bothered to do so. Simply knowing this option was available was enough to substantially counteract its distracting effect (Blumenthal et al 1999).

  Making positive choices builds resilience and makes it less likely that those affected by adverse circumstances w
ill develop PTSD. Even participating in cleanup efforts of one’s environment after a disaster builds resilience. Children who are trapped in dysfunctional homes benefit by making choices to better their lives in small ways; babysitting to get out of the house and earn some money and having extracurricular activities, friends, or programs to attend where they can feel safe, can all reduce the feeling of being trapped and helpless. Recovery for ACoAs is also a way of beginning a choice-making process that will counter the effects of learned helplessness.

  Intrusive Reexperiencing

  Traumatized people may experience past trauma intruding into their “normal” consciousness in a variety of ways—through memories, dreams, distress responses, or flashbacks. They may have flashes of traumatic imagery, overpowering emotions, or feel defined by what happened to them and fearful of a repetition of anything like it occurring again. Remembrance and intrusion of the trauma is expressed on many different levels, ranging from flashbacks; mood swings; somatic sensations, or body aches; nightmares; interpersonal reenactments, including transference repetitions; personality characteristics; and pervasive themes that play out in one’s life.

  Dissociation/Memory Disturbances

  Extreme fear such as that experienced by CoAs can cause them to “leave their bodies,” to feel they do not “live in their own skin,” so to speak. There may be an experience of “derealization”—or feeling as if they or the world is not “real”—and “depersonalization”—feeling as if they are losing their identity or adopting a new identity. Dissociation can involve a feeling of disconnection from the body or surroundings, either momentary or lasting ones. Dissociation may also involve “losing time” or experiencing amnesia regarding entire traumatic events or significant periods of them.

  The person who dissociates has “difficulty tolerating and regulating intense emotional experiences. This problem results in part from having had little opportunity to learn to soothe oneself or modulate feelings, due to growing up in an abusive or neglectful family, where parents did not teach these skills” (Rauch, Metcalfe, and Jacobs 1996; van der Kolk and Fisler 1996). When we feel overwhelmed with intense emotion that we cannot regulate, we psychically and emotionally disconnect from the situation that is overwhelming us while still staying physically in it. We zone out, and “depersonalization, derealization, amnesia and identity ­confusion can all be thought of as efforts at self-regulation when affect regulation fails. Each psychological adaptation changes the ability of the person to tolerate a particular emotion, such as feeling threatened” (ibid).