Surviving Trauma

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Surviving Trauma

• Lenore E. Walker, Ed.D., ABPP
• Diplomate in Clinical Family Psychology
• Nova Southeastern University CPS
• drlewalker_at_aol.com
• Shane Morrow Memorial Lecture
• Metro State College
• Denver Colorado
• Octover 12, 2005

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Definitions of Trauma

• Environmental
• Hurricane, Earthquake, Mudslide,Tsunami
• Situational
• Airplane Crash, Fire, Street shootings
• Terrorism
• War
• Interpersonal
• Domestic Violence, Sexual Assault Exploitation

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Severity

• Type of Incident
• Damage is expected
• Predicted/Prepared
• Controllable
• Relationship to Victim
• One Time or Repeated
• Individual or Mass Trauma
• Support System
• Resilience of Victim (s)

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Psychological Impact from Trauma

• High levels of arousal
• Avoidance of people or places associated with
  violence unless coping strategy
• Vulnerability to become a future victim
• Intrusive memories (Flashbacks, Dreams)
• Fearfulness Panic Attacks
• Distorted meaning to some events
• PTSD symptoms

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Abuse Definitions per APA Presidential Task Force
on Violence Family, 1996

• Acts of physical abuse, sexual abuse, and
  psychological maltreatment chronic situations in
  which one person controls or intends to control
  another persons behavior and misuse of power
  that may result in injury or harm to the
  psychological, social, economic, sexual, or
  physical well-being of family members.

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Definitions, Abuse Pattern and/or Single
Incident

• Domestic violence most often involves a pattern
  of power and control, oppression, and fear
• Domestic violence can involve a single incident
  of abuse
• Children are also victims in 60 cases where
  women are abused by partners

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BATTERED WOMAN SYNDROME

• PTSD Criteria
• Intrusive Memories Reexperience Fragments of
  Prior Battering Events Dissociation
• High Arousal/Anxiety (Fight Response)
• High Avoidance Numbing (Flight Response)
• Depression, Repression, Denial, Minimization
• Disrupted Interpersonal Relationships
• Difficulties with Body Image
• Sexual and Intimacy Problems
• Hypervigilance to Cues of Danger

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PHYSIOLOGICAL RESPONSE CHRONIC PTSD

• Subcortical Areas Regulating Emotion
• Hypothalamic-Pituitary-Adrenal Axis
• Changes in Neurotransmitters receptors
• Elevations in adrenalin noradrenalin,
  glucocorticoids (cortisol), endogenous opiates,
  and dopamine.
• Lower levels of serotonin.
• Mediated by social environmental factors
• Psychopharmacology
• Social Support Factors
• Verbal Psychotherapy

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POWER CONTROL ISSUES

• Possessiveness
• Failure to follow limits
• Intrusiveness
• Entitlement
• Sexual Jealousy Inappropriate Behavior
• Isolation
• Degradation Humiliation
• Financial Control
• Stalking Surveillance
• Using child to gather information
• Alcohol Other Drugs

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Sexual Harassment

• Unwanted sexual behavior must be deliberate
  and/or repeated.
• The most offensive behavior only need happen one
  time.
• More subtle behaviors may be better defined by
  the power difference between the man and the
  woman.
• Exposure to repeated unwanted sexual behavior may
  help define the more subtle sexual harassment
  behavior.

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SEXUAL HARASSMENT BEHAVIORS

• Generalized sexual statements behavior that
  convey insulting or degrading attitudes about
  women.
• Unwanted inappropriate or offensive social
  invitations, sexual overtures, or advances.
• The subtle or overt solicitation of a personal
  relationship or sexual activity by promising
  benefits.
• Unwanted physical contact including touching,
  feeling, pinching, grabbing or kissing.
• Threats of coerced sexual activity.
• Sexual assault.

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SEXUALLY OFFENSIVE BEHAVIOR

• Creates a barrier for women to perform and
  advance in the workplace.
• Emotional effects cause negative impact.
• MORE severe behavior takes FEWER repetitions to
  be defined as harassment.
• LESS severe behavior takes MORE repetitions to be
  defined as harassment.
• MORE negative attitudes MORE discrimination in
  advancement needs LESS repetition to produce
  serious psychological effects.

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EEOC DEFINITION

• Unwelcome sexual advances, requests for sexual
  favors, other verbal or physical acts of a
  sexual nature constitute sexual harassment when
• Submissiveness to such conduct is made either
  explicitly or implies a term or condition of an
  individuals employment.
• Submissiveness to or rejection of such conduct is
  used as the basis for employment decisions
  affecting such individual, or
• Such conduct has the purpose or effect of
  unreasonably interfering with an individuals
  work performance or creating an intimidating,
  hostile, or offensive work environment

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EEOC DEFINITION -2

• Such action must be considered in the context of
  the entire working conditions as stated
• In determining whether alleged conduct
  constitutes sexual harassment, the Commission
  will look at the record as a whole and at the
  totality of the circumstances, such as the nature
  of the sexual advances and the context in which
  the alleged incidents occurred. The determination
  of the legality of a particular action will be
  made from the facts on a case by case basis.

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PSYCHOLOGICAL DATA ABOUT CHILDREN EXPOSED TO
DOMESTIC VIOLENCE
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BASIC BEHAVIORAL INDICATORS OF EXPOSURE TO FAMILY
VIOLENCE

• Females
• Submission Self-Blame
• Pessimism
• Identify with Victim
• Help Peers
• Social Withdrawal
• Depression
• Poor Social Skills
• Acceptance of Undeserved Hostility

• Males
• Aggression Tactics
• Manipulate,Cajole, Coerce others
• Identify with Aggressor
• Lack of Empathy
• Bully Peers
• Temper Tantrums
• Disrespect Hostility to Loved One

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TYPICAL CHILD PTSD

• Avoidance or Numbing
• avoidance of people, places, things
• unwilling/difficult to talk
• Spacing out/trying not to think
• no/limited memory about event
• decreased interest in activities
• developmental skill regression
• regression to mastered fears (dark)
• withdrawal and unusual shyness
• rarely smiles, mostly sad

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CHILD PTSD - 2 -

• Expressions of Re-experiencing
• Repetitive talking about trauma
• preoccupying intrusive thoughts, recollections,
  or images of event
• Flashbacks
• Nightmares night terrors
• Intense psychological distress at exposure
• Post traumatic play that is compulsive without
  anxiety reduction
• Symbolic Reenactment in Play

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CHILD PTSD - 3 -

• Autonomic Hyperarousal
• Difficulty falling and staying asleep, night
  terrors, sleep walking)
• Irritability, argumentative, impulsivity, temper
  outbursts, and aggression
• Distractibility and concentration
• Hypervigilance to signs of danger
• Worry and nervousness
• Exaggerated startle and jumpiness
• Somatic complaints (headaches, nausea,
  stomachaches, vision
• Loss of appetite and eating problems

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CHILD PTSD by AGE-1

• INFANTS (0-36 months)
• Hypervigilance, exaggerated startle,
  developmental regressions, clinging behavior,
  body dysregulation, nightmares, delayed speech.
• Pre-School (3-5 years)
• Avoidant symptoms
• Intense Attachment Problems
• Poor Social Skills

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CHILD PTSD BY AGE- 2

• School-Age (5-10)
• Regression in toilet habits
• Poor language skills
• Ostracism by peers
• Attentional disorders
• School failures
• Less consolidation of memories
• Obsessional retelling of details
• Excessive emotional arousal
• Hyperalertness and fears
• Dangerous Behavior
• Sense of foreshortened future

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CHILD PTSD BY AGE - 3

• Adolescents (13-16)
• Similar to adult PTSD
• Antisocial behaviors (truancy, sexual acting out,
  drugs)
• Dangerous reenactments of trauma
• School failures
• Attentional problems
• Poor peer relationships
• Inconsistent limits and boundaries
• Rage escalates if not permitted contact with
  peers.
• Dissociation from self community

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RISK RESILIENCY IN CHILDREN EXPOSED TO DV

• RESILIENCY
• Consistent Parenting
• Positive Reinforcement
• High Education
• Good Peer Contacts
• Family Advocate
• Positive School
• Optimistic Outlook
• Sibling Relations

• RISK
• Exposure to Abuse
• High Conflict
• Depression in Mom
• Violence Attitudes
• Inconsistent Discipline
• Poverty
• Frequent Moves
• Alcohol Other Drug

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DYNAMICS OF PERPETRATORS

• POWER CONTROL BATTERERS
• MENTALLY ILL BATTERERS
• Schizophrenic Spectrum Disorders
• Affective Disorders
• Obsessive-Compulsive Disorders
• Sex Offenders
• Substance Abusers
• ANTI-SOCIAL PERSONALITY DISORDERED VIOLENT
  CRIMINALS

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COBRAS PIT BULLS

• Dependant
• More impulsive
• Engulfing Intimacy
• Fear of Abandonment
• Feel Vulnerable
• Thinks he is Victim
• Distorted Self View
• More Passionate
• More Isolation
• Heart Rate Up

• Control/Intimidation
• Push/Pull Intimacy
• Emotional Abuse
• Most Frightening
• Macabre Charisma
• Harder to Leave
• Choose Partners
• Lie in Wait Plan
• Independent
• Lower Heart Rate

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RISK ASSESSMENT ABUSERS

• MacArthur Variables
• Violence Risk Actuarials
• Sex Offender Risk Actuarials
• Hare PCL-R
• Lethality Check Lists
• Alcohol Other Drug
• Malingering Tests

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What Can We Do?

• Sensitivity to Multicultural Diversity Issues
• Use Appropriate Assessment Tools
• Proper Interpretation of Standardized Assessments
• Lawsuits
• Discrimination in Educational Placement
• Larry P Bell Curve History
• Employment Issues
• Walmart
• Hewlett Packard
• Sexual Harassment/Discrimination
• Quid Pro Quo Hostile Workplace Environment
• Civil Rights Discrimination
• NJ State Troopers Profiling
• Reproductive Rights
• Teen Notification Cases

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Stage 1

• Lasts Around 4 to 12 weeks
• Physiological Psychological Changes
• Psychotherapy not that Useful
• Crisis Intervention
• Critical Incident Stress Management
• Impact on those Directly Exposed those First
  Responders

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Crisis Intervention

• Stage 1
• Protection Security
• Basic Needs
• Food, shelter, clothing, money
• Stabilization of Emotions
• Special Needs
• Integration of Event

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Critical Incident Stress Management

• Stabilization
• Information
• Support
• Debriefing
• Cognitive
• Emotional
• Secondary Traumatization for First Responders

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PSYCHOTHERAPY

• Culturally Competent
• Trauma Specific
• Strength-Based
• Cognitive Behavioral
• Emotional Re-Regulation
• Support Systems
• Group
• Family

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Adjuncts to Therapy

• EMDR
• Aroma Therapies
• Physical Activity
• Walking, running, gym workout
• Help to Others
• Organized Sports
• Support Groups

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Objectives

• Stabilization
• Integration
• Memory consolidation
• Cognitive restructuring
• Regulate emotions
• Support strengths
• Develop new life patterns