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Trauma survivors are susceptible to physical dysfunction and poor behavioral responses. They present with persistent trauma-related symptoms, including dissociation and reliving, which are characteristic of PTSD (van der Kolk, 2015). This paper describes these symptoms and the underlying neurological and psychological processes based on a clinical case illustration.
Physical dysfunctions are common initial trauma-related symptoms. The complaints and reactions of a 22-year-old client – with a history of sexual abuse – give a good illustration of the physical symptoms of trauma. Even screams of children in a playground could startle her and cause anxiety, sweaty palms, and racing heart, which are symptomatic of hyperarousal. In the case, the screams evoked trauma-related sensations of fight or flight in the client, which manifested as startle responses (van der Kolk, 2015). Minor triggers activated these defensive reactions in the client.
Along with trauma sensations or flashbacks that emanate from intrusive thoughts, she also reported experiencing nightmares and chronic sleeplessness. Traumatic experiences can lead to sleep disturbances that persist for years (SAMHSA, 2014). Trauma victims may also present with somatic complaints that lack a clear medical cause. The client reported musculoskeletal pain and urological problems. This shows that there is a relationship between somatic symptoms and trauma. Trauma victims may also present with physical impairments, including respiratory disorders, skin conditions, and cardiovascular complications (Gupta, 2013).
A range of behavioral symptoms results from emotional reactions to traumatic stress. In the case illustrated, the client did not exhibit shame when talking about the subject of domestic violence. This behavior is symptomatic of numbing and dissociation. Van der Kolk (2015) links depersonalization to trauma-related dissociation or an emotional detachment (numbness). In our case, the client’s numbness can be linked to the abuse she suffered in childhood at the hands of her stepfather. Thus, numbness is a strategy for coping with traumatic experiences.
Behavioral reactions are meant to help survivors cope with the aftereffects of trauma. Common behavioral outcomes of traumatic stress reactions include avoidance of trauma reminders, impulsivity, compulsivity, and self-medicating behavior (Cao et al., 2016). In our case, the client had a history of substance use and high-risk behaviors – reckless driving and multiple sexual partners – an indication of impulsivity.
Neurological and Physiological Processes
Traumatic experiences set off a series of biological processes that manifest as physical and behavioral symptoms in the victim. Alterations in the limbic system, which cause hyperarousal, are implicated in PTSD. In the right hemisphere of the brain, the over-activation of the sympathetic nervous system (SNS) evokes a fight/flight reaction, whereby the “sounds and images” related to the traumatic experience are activated (van der Kolk, 2015, p. 45).
Another process occurring in the right brain that contributes to PTSD symptoms is stress hormone activity. Alterations in the hypothalamic-pituitary-adrenal axis due to triggers/flashbacks increase cortisol and adrenaline concentrations, activating the alarm system (SAMHSA, 2014). This explains the re-enacting and reliving of traumatic experiences by traumatized people.
The left hemisphere is the analytical section of the brain. The prefrontal cortex is involved in cognitive processes, while the insula controls self-awareness (van der Kolk, 2015). PTSD patients perceive the trauma as occurring in the present. The self-awareness system of their left hemisphere is deactivated which means that they unaware that they are reliving their past experiences. Therefore, the neurological and physiological processes underlying the symptoms identified from the case illustration are the trauma-related SNS over-stimulation, elevated cortisol/adrenaline levels, and deactivation of the insula.
The case described presented with symptoms of hyperarousal, nightmares, insomnia, somatic disorders, depersonalization, substance use, and high-risk behavior. The biological causes of these physical and behavioral symptoms are related to SNS over-stimulation, stress hormone release, and the deactivation of the left hemisphere of the brain.
Cao, Y., Li, L., Zhao, X., Zhang, Y., Guo, X., Zhang, Y., & Luo, X. (2016). Effects of exposure to domestic physical violence on children’s behavior: A Chinese community-based sample. Journal of Child & Adolescent Trauma, 9(2), 127-135. Web.
Gupta, M. A. (2013). Review of somatic symptoms in post-traumatic stress disorder. International Review of Psychiatry, 25(1), 86-99. Web.
Substance Abuse and Mental Health Services Administration [SAMHSA]. (2014). Trauma-informed care in behavioral health services. Rockville, MD: SMAHSA.
van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. London, UK: Penguin Books.