Trauma, Attachment, and Stress Disorders: Rethinking and Reworking Developmental Issues

The rapid technological discoveries and advances in neuroscience that began in the 90’s have changed our perceptions about the origins of health, emotional and psychological stress, chronic physical illnesses and their healing. We now know that brain development is an experience-dependent social process that can override genetics. Knowledge of the brain’s plasticity, immaturity at birth and capacity for life-long change, emphasizes the central role of early life experience in triggering stress disorders.

These stress disorders include PTSD (Post Traumatic Stress Syndrome), depressive disorders, anxiety disorders, learning disabilities and chronic physical health problems. The new brain technology helps us understand the difference between normal stress responses that return to a state of regulation and traumatic stress responses that do not normalize. It also gives us reason to believe that neurological change from illness and disability to wellbeing is possible throughout life.

How does experience shape the brain and both cause and repair stress disorders?

At birth, the brain, which is command central for the body, is its most undifferentiated organ with a plasticity that enables the brain to create new neural circuitry throughout life. New brain imaging resources including electroencephalogram (EEG), quantitative EEG studies (QEEG), positron emission tomography (PET), single photon emission computed tomography (SPECT) and functional MRI (fMRI) show us that throughout life, the brain remains capable of renewing its structure and function and does so as a result of experience—especially social experience. The traumatic neural dysregulation caused by early life trauma mirrors that of traumatic dysregulations caused by overwhelming events experienced later in life. Stress symptoms range from those of PTSD, to depression, anxiety, learning problems, social disorders and chronic physical health problems.

A child’s brain is so socially attuned that unspoken communication shapes its development to a remarkable degree. The brain’s amazing plasticity at this stage of development sets a lifelong template for thoughts, feelings, behavior and a variety of stress related disorders. Moreover, because the brain remains flexible throughout life, nonverbal communication retains the capacity to change. Studies in people over age ninety show us images of mature brains that continue to produce new neural pathways at a time when older pathways are dying. The same experiential and social factors that profoundly shape the brain initially can also be instrumental in repairing the causes and symptoms of stress related disorders.

How does early-life trauma impact development?

Attachment, the emotional bond formed between an infant and its primary caretaker, profoundly influences both the structure and function of the developing infant’s brain. Failed attachment, whether caused by abuse, neglect or emotional unavailability on the part of the caretaker, can negatively impact brain structure and function, causing developmental or relational trauma. Early-life trauma affects future self-esteem, social awareness, ability to learn and physical health. When the attachment bond goes well, neurological integration develops normally, and relationship brings the expectation of safety, appreciation, joy and pleasure. If the attachment bond was unsuccessful and traumatizing, neural dysregulation and memories of a failed relationship become the basis for adult expectations of intimacy. Fortunately, relationships with secure adult partners can bring about emotional healing in insecure partners.

Attachment isn’t the only thing that creates early-life trauma. Neurological dysregulation, brought about by neurologically disabling experiences in the womb and at birth, is also traumatizing and interferes with the attachment bond. If the dysregulation isn’t severe, a good attachment can help bring about neurological regulation in a dysregulated baby. To learn more about infantile attachment read the article Parenting: Attachment, Bonding and Reactive Attachment Disorder.

There is a correlation between early trauma and resiliency or vulnerability to highly stressful experiences later in life. People who have been traumatized as infants and young children are more at risk for traumatic experiences later in life. In helping people who have become traumatized, we don’t need to be neuroscientists but we do need to use interventions that change the brain.

How does traumatic response differ from a normal stress reaction?

Stress is an essentially normal response to feeling overwhelmed or threatened. Fight, flight and freeze are survival responses that developed to protect us from danger. In moments of stress, hormones release and, as our heartbeat speeds up and blood pressure increases, we breath quicker, move faster, hit harder, see better, hear more accurately, and jump higher than we could only seconds earlier. If we’re nervously driving at high speed on the freeway at night, we can respond more effectively to unexpected hazards because we are exceptionally alert. These neurological and physiological changes enable us to better protect ourselves in the moment. But once the danger has passed, our nervous systems calm down and we return to a state of equilibrium or neurological balance. Positive stress can produce feelings of exhilaration and opportunity. Not all people experience stress in the same way. One person’s exhilarating challenge may be another’s terrifying experience.

Much has been written about the disadvantages of stressful lifestyles that keep us running on overwhelm and create constant physiological stimulation so that our bodies are kept from returning to a quieter calmer state of balance. But social and lifestyle changes can usually restore physiological and psychological balance. This is not the case when someone becomes traumatizedTraumatization is stress frozen in place –locked into a pattern of neurological distress that doesn’t go away by returning to a state of equilibrium. Traumatization promotes ongoing disability that can take many mental, social, emotional and physical forms. Like normal stress, trauma is also experienced differently by different individuals.

What are the common links between both high- and low-impact experiences that trigger traumatic responses?

Trauma and loss are parts of life. It is not what happens to us but how we react to it that determines whether or not a life-threatening experience or a series of less intense experiences will, in fact, be traumatizing. The more vulnerable the organism, the more it is at risk for the neural dysregulation that can follow traumatic experiences. Whether dysregulation follows an intense event described with symptoms of PTSD or a seemingly benign event or series of events with symptoms like depression, anxiety or relationship disorders, emotionally traumatizing events contain three common elements:

  • It was unexpected;
  • The person was unprepared; and
  • There was nothing the person could do to prevent it from happening.

What kinds of experience can be traumatic?

The ability to recognize emotional trauma has changed radically over the course of history. Until recently psychological trauma was noted only in men after catastrophic wars. The women’s movement in the sixties broadened the definition of emotional trauma to include physical and sexual abuse of women and children. Now, the impact of psychological trauma has extended to experiences that include

  • Natural disasters, such as earthquakes, fires, floods, hurricanes, etc.
  • Physical assault, including rape, incest, molestation, domestic abuse and
    serious bodily harm
  • Serious accidents, such as automobile or other high-impact scenarios
  • Experiencing or witnessing horrific injury, carnage or fatalities

Other often overlooked potential sources of psychological trauma include

  • Falls or sports injuries
  • Surgery, particularly emergency, and especially in first 3 years of life
  • Serious illness, especially when accompanied by very high fever
  • Birth trauma
  • Hearing about violence to or sudden death of someone close

Traumatic stress in childhood can be caused by a poor or inadequate relationship with a primary caretaker. Sources of this developmental or relational trauma result from

  • Forced separation very early in life from the primary caregiver
  • Chronic mis-attunement of a caregiver to a child’s attachment signals (“mal-attachment”)
  • Reasons such as neurological physical or mental illness, depression, grief or unresolved trauma
  • Neurological disruption caused by experiences in the womb or during birth

Research also shows that emotional trauma can result from such common occurrences as

  • An auto accident
  • The breakup of a significant relationship
  • A humiliating or deeply disappointing experience
  • The discovery of a life-threatening illness or disabling condition, or other similar situations

Traumatizing events can take a serious emotional toll on those involved, even if the event did not cause physical damage.

What are signs and symptoms of developmental or relational trauma?

Insecure attachments influence the developing brain, which in turn affects future interactions with others, self-esteem, self-control, and the ability to learn and to achieve optimum mental and physical health. Symptoms can include the following:

  • Low self esteem
  • Needy, clingy or pseudo-independent behavior
  • Inability to deal with stress and adversity
  • Lack of self-control
  • Inability to develop and maintain friendships
  • Alienation from and opposition to parents, caregivers, and other authority figures
  • Antisocial attitudes and behaviors
  • Aggression and violence
  • Difficulty with genuine trust, intimacy, and affection
  • Negative, hopeless, pessimistic view of self, family and society
  • Lack of empathy, compassion and remorse
  • Behavioral and academic problems at school
  • Speech and language problems
  • Incessant chatter and questions
  • Difficulty learning
  • Anxiety
  • Depression
  • Apathy
  • Susceptibility to chronic illness
  • Obsession with food: hordes, gorges, refuses to eat, eats strange things, hides food
  • Repetition of the cycle of maltreatment and attachment disorder in their own children when they reach adulthood

What overarching principles aid professionals with attachment and trauma issues?

Principles of thought:

  • In personal and social health, emotional/psychological trauma stands out as a primary predictor of future mental, emotional, learning and physical problems.
  • While some degree of stress may be beneficial to the organism, trauma creates an ongoing threat that has profound influence on the developing brain and development in general
  • Emotional trauma is often linked to attachment issues
  • Emotional trauma is more likely to be caused by neglect (depression, grief, trauma) rather than abuse
  • The separation between mental and physical health is no longer creditable.
  • Social and life-style factors profoundly influence both cause and cure of mental and emotional disability, and there is an abundance of solid sociological research to support this conclusion.

Principles of practice:

  • Young children depend on primary caretakers for brain regulation and development. Therefore, treating the parent is the most efficient way to treat the child.
  • Brain change is a social process triggered by physical and emotional experience.
  • Physical and emotional experiences are engaged by nonverbal forms of communication, including eye contact, facial expression, tone of voice, posture, touch, intensity and timing or pace.
  • The nonverbal right-brain-to-right-brain process that creates reparatory change requires us as professionals to follow, moment by moment, our physical and emotional experiences in addition to our conscious reflections.

What do professionals need to know when working with relational trauma?

Why traditional talk therapy isn’t sufficient for healing relational trauma

Traditional psychotherapy can, but often does not, work with the intention of changing the brain –and brain change from dysregulation to regulation is the goal of therapeutic intervention for traumatized individuals. In order to accomplish this change, the following need to occur:

  • Physical sensing in the body
  • Affective emotions are felt and communicated
  • Communication is nonverbal
  • Advice, interpretation, and problem solving are kept to a minimum
  • Playfulness is encouraged
  • Disconnection is valued as an opportunity for repair

How somatic psychotherapy (with trauma) differs from traditional body work.

The senses are a gateway to regulation, finding equilibrium and creating safety in the body. Traditional body work is usually done by a trained practitioner whose primary concern is the physical body. Most often, the client lies on a table and the practitioner touches the body. Somatic psychotherapy engages the body but doesn’t necessarily have to include touch. Somatic psychotherapy may or may not involve touch. Somatic psychotherapy

  • Begins with awareness
  • Focuses on sensation
  • Names the affective experience
  • May or may not include touch

Why nonverbal cues play such an important role in therapy

Non-verbal cues are estimated to be responsible for 80 percent of what helps the client feel safe in therapy. Subtle cues are picked up from the clients’ body language, tone of voice, etc., and transmitted back as nonverbal understanding that the therapist knows of the client’s deepest experiences. 

What the importance of reciprocal play is

Reciprocal play is a natural spontaneous way to connect nonverbally and create an experience of safety. In addition to creating neurological safety, playful interaction breaks down differences including age, sex and role. Reciprocal play is an equalizing dance that soothes, calms, and creates the context for mutuality and connection. Interactive play:

  • Releases endorphins,
  • Stimulates interactive brain to brain resonance
  • Facilitates pendulation between dysregulation and regulation
  • And it’s fun!

Why disconnect or conflict offers an opportunity for repair and growth

Disconnect (conflict/disagreement) is an opportunity for deep repair – for learning to regain trust in others. There is little growth without chaos, so we need the disruption that leads to repair. Parenting is about disruption and repair, over and over again. And later life relationships are tested and strengthened by their ability to absorb differences.

Tips for therapists who have been trained in more traditional therapies:

  • Incorporate a more body-oriented approach
  • Practice neurological self-regulation and teach it
  • Appreciate the value of conflict in therapy –use it, don’t avoid it
  • Base your communication process on nonverbal cues
  • Focus on the relational element for brain change
  • Take cues from the client: client leads, not therapist
  • Introduce playfulness into the therapeutic process