Surviving Childhood: An Introduction to the Impact of Trauma

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Lesson 3: After the Trauma: The Costs of Coping
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After the Trauma: The Costs of Coping

After the trauma passes, the child remains. While the mental and physical adaptations used during a traumatic event will slowly subside, there will be residue from the experience. Indeed, for some children, this post-traumatic period is filled with more confusion, emotional pain, distress, and fear. In about 50 percent of the children who have experienced a severe traumatic event, these symptoms become so severe that the children develop serious post-traumatic stress disorders.

This lesson is about the development of these symptoms and what you can do to help children in the post-traumatic period.

Children Re-Experience Trauma

For almost all children, a traumatic experience will play itself out repeatedly in their minds, even after the event has ended. The thoughts, emotions, and feelings of being out of control and threatened will be re-experienced, as will the fear, anxiety, and pain associated with the event. Each time the child has an intrusive thought, a nightmare, or reenacts the event through play, the emotional or affective memory of being in the midst of the threatening event is evoked.

Figure 3-1: How memory is stored in the brain.
Figure 3-1: How memory is stored in the brain.
Figure 3-2: Trauma and memory.
Figure 3-2: Trauma and memory.

A classic set of predictable symptoms and physical changes is evident in the acute post-traumatic period because of memory. Not only can children remember the facts and narrative details of the event, they can recall and relive the emotional and physiological changes that were present in the alarm reaction. In effect, the child has both emotional and state memories from the traumatic event, causing a state of hyperarousal.

This hyperarousal may be characterized by an increased startle response, increased muscle tone, a fast heart rate (tachycardia) and/or elevated blood pressure. Even at rest in the weeks following a traumatic event, children and adolescents often exhibit signs of physiological hyperarousal, such as tachycardia, despite outwardly normal behaviors. The inability to move back down the arousal continuum has profound implications for the child's long-term functioning, which we'll discuss shortly.

Persistent physiological and emotional distress is both physically exhausting and emotionally painful. Because of the pain, discomfort, and emotional and physiological "memories" associated with these recurring intrusive thoughts, a variety of protective avoidance mechanisms are used to escape reminders of the original trauma. These include active avoidance of any reminders of the trauma and the mental mechanisms of numbing and dissociation.

Exercise: Where are different memories stored in the brain?

Reexamine Figure 3-2 at the beginning of this section and correlate it with David's story in Figure 3-3 above. Which specific parts of David's brain are stimulated by his father's presence or scent? Have you ever had a strong reaction yourself to an odor, without having cognitive memories to associate with your response? Or have you ever smelled something that inexplicably brought back an old memory of smelling that same scent elsewhere? If you are able to remember particulars, what part of your brain is at work? Why are the lower parts of the brain often referred to as "primitive?"


State and affect memories elicited in a non-conscious state:

David is a 9 year-old boy. From age 2 through 6, he was sexually abused by his father. This abuse induced severe physical injuries. At age 6 he was removed from the family.

At age 8, he was seriously injured in a fall. He suffered from serious brain injury resulting in a coma state for 8 months following the injury.He continues to be difficult to arouse and is non-verbal. He exhibits no form of meaningful communication. In the presence of his biological father, he began to scream, moan, and his heart rate increased dramatically; audiotapes and the scent of his father elicited a similar response. These "memories" are stored in lower parts of the brain and do not require cognitive memory or consciousness to be expressed.

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