What do we notice in the aftermath of developmental trauma in orphans?
Dr Bessel van der Kolk is a professor of psychiatry, Boston University Medical School and diagnoses children with a history of multiple chronic traumatic events at an early age with “complex trauma”.
He refers to a study that indicated a high correlation between adverse childhood experiences and adult promiscuity, domestic violence, drug and alcohol abuse, cigarette dependence, depression, suicide attempts, obesity, and PTSD to mention a few.
These adults have been exposed as children to eg, abandonment, betrayal, physical and sexual assaults, threats of bodily harm, emotional abuse, witnessing violence, and in certain cases death and a subjective experience of rage, fear, defeat, and shame.
A triggered pattern develops that manifests in repeated dysregulation of their response to trauma which develops in a roller coaster of affect and emotion, somatic and physiological responses, behavioural responses, self-harming and cutting, cognitive trauma of not understanding what is happening in their environment, and confusion which results in dissociation and depersonalization of losing a sense of self. Interpersonal relationships result in being overly dependent and clinging, being oppositional, being either distrustful or compliant and then hate and shame.
Life expectations contain distrust in being cared for or loved, loss of trust in social agencies, social justice, and future victimization is inevitable.
Functional Impairment is noticed on familial, peer, legal, and educational levels. Constant trauma results in a state of freeze which mostly manifests on cognitive and scholastic levels and these children appear dumb until they are exposed to warmth, acceptance, and safety, and appropriate treatment which triggers their real potential.
Dr Ruth Lanius, MD, Ph.D. one of the leading clinical neuroscience researchers in the study of the traumatized brain noted the long-term damage caused to the brain by trauma, panic, and PTSD, in the life of the individual.
Life is experienced via the sensory organs such as smell, vision, taste, hearing, touch. The pathway of unwanted incidences starts at the reptilian brain, after which sensory processing occurs, and it is then transferred to the limbic system which elicits an emotion. The physical experience and emotion are finally translated to the cortex which is responsible for safety and self-protection ensuring survival and which can include defensive behaviour of fight, flight, or freeze which implicates being cut off from the world and from what he feels inside, resulting in detachment or dissociation.
Dr Ruth Lanius refers to dissociation or scrambling of the brain. Which is the stage of personality development, extending from about three or five years of age to the beginning of puberty, during which sexual urges appear to lie dormant.
The scrambling of the brain starts with dissociation as the brain circuits have to adapt to and compensate for what happens to the individual all the time. When there is a hindrance of the bodily experience of the outside world starting at the reptilian brain, and transferred to the temporal lobe it does not reach the prefrontal cortex which helps us to know, experience, understand where it should be interpreted and enhance a protective action but then it gets stuck and results in a shutdown, a freezing response or apathy.
So due to constant adaptation and compensation, the prefrontal cortex is protected against being bombarded. The scrambling is a protective or dampening process as it does not allow all the sensory experience to be interpreted at the same time as the brain cannot tolerate it. The scrambling is a compensatory process and is kept away from surfacing. The memories, therefore, are suppressed and surface in the form of flashbacks whenever the person has a sensory experience or a reminder of the traumatic event such as smelling alcohol, hear a familiar but threatening voice, etc. So the brain goes back to fear-gear
Treatment
Dr van der Kolk noted that unfortunately, medications take the place of helping children to acquire the skills that are necessary to deal with their uncomfortable physical sensations and to process traumatic experiences. Medication often further numbs their experiences.
The other dilemma is whether to keep the children in the care of people and institutions who may be the source of hurt, threat, abandonment, or on the other hand expose them to separation distress by removing them from familiar environments and people to whom they are attached, but who are likely to cause further damage.
Dr van der Kolk focuses on 3 primary means of treatment:
- To develop a safe space removed from the trauma
- To undergo psychotherapy, play therapy as well as occupational therapy helping them to integrate the body and mind
- As traumatized children experience trauma-related hyperarousal (highly tense and hyper-vigilant) or numbing (frozen) that manifest on a deep somatic level, treatment should enhance a feeling of being in charge, enhance a feeling of safety, calmness, and promote being goal orientated. Chronically traumatized children tend to suffer from distinct alterations in states or levels of consciousness, including amnesia, dissociation, depersonalization and derealization, flashbacks and nightmares of specific events, school problems, difficulties in attention regulation, disorientation in time and space, and sensorimotor developmental disorders.
Neurofeedback is highly recommended not to cure a fundamental cortical problem but to calm the brain down and enhance alpha activity that secures calm focus. Neurofeedback (NF) is regarded as an augmentative and beneficial modality of treatment in conjunction with other therapies such as psychotherapy, speech therapy, occupational therapy, focus on nutrition, and psychiatric support.
Dr Annemie Peché
082 3356 133 /011 675 6138