If we have been unfortunate enough to have suffered severe and protracted childhood trauma and have, as a result, developed emotional and behavioural problems (which, in some cases may have led to diagnoses of borderline personality disorder or complex posttraumatic stress disorder) it is, to put it mildly,’ most unhelpful to be told or expected to ‘just get over it.’
A key reason why this is the case is that, if we are chronically exposed to high levels of stress in our early life, it can harm the way in which our brain develops, both in terms of its physical structure and in terms of its functioning. Examples of critical brain regions that may be adversely affected include (amongst many others) the AMYGDALA and the PREFRONTAL CORTEX.
Such damage can mean that, essentially, we become stuck in ‘fight or flight’ mode and in a state of constant anxiety, fear and hypervigilance, as if perpetually on ‘red-alert.’ We may also lack self-control in the context of social behaviour, have poor impulse control, and have difficulties with decision-making, planning and setting / achieving goals. Our brain, in effect, becomes wired for fear and hyper-alert to threat detection so that we find ourselves in a perpetual state of apprehension and even terror.
Furthermore, if we were not sufficiently emotionally soothed by our primary carer when we were distressed in early life and we have, as a consequence, failed to internalize self-soothing behaviours, we are likely to find it very hard to ‘self-soothe’ and to calm ourselves down when upset. An inability to self-soothe’ in a normal way may also make us prone to outbursts of anger (it has been hypothesized that one function of anger may be to soothe emotional pain (e,g, Seltzer) ; indeed, when we are angry, one hormone produced is norepinephrine which acts as an analgesic).
As a result of ongoing childhood trauma, which the brain can interpret (usually on an unconscious level) as a threat to our very survival, we are likely to develop (again, usually on an unconscious level) various psychological defence mechanisms (including immature/psychotic defence mechanisms) and survival behaviours which may benefit us in the short-term (i.e. when we are living in the traumatic environment) but harm us in the long-term (i.e. if they become ingrained and continue to dominate our lives when we are no longer living in the former traumatic environment).
An example is that our psychological development may become arrested or regress. An illustration of this would be a teenager who, when distressed, demonstrates toddler-like tantrums in a desperate (usually unconscious) way of expressing his / her overwhelming need for emotional support and comfort. And, in relation to ‘arrested development,’ it has been suggested that those whose childhood trauma was so severe that they have gone on to develop borderline personality disorder (BPD), in many respects, remain (in the absence of effective therapy), stuck at a much earlier stage of psychological development than their chronological age suggests they should be at.
Also, because of possible damage to the amygdala and the associated perception of being perpetually under threat and in danger, as well as difficulty controlling emotional responses, the individual, objectively speaking, may give the impression of dramatically overreacting to stressors that others might easily be able to take in their stride (indeed, research suggests that those who have gone on to develop borderline personality disorder as a result of their childhood trauma are prone to over-reacting to facial expressions). And, because of their inability, as previously mentioned, to self-soothe, such outbursts may be very long-lasting and difficult to extinguish.
Another defence mechanism/survival behaviour that may be displayed is called ‘dissociation’ (often colloquially referred to as ‘zoning out’). Dissociating / ‘zoning out’ is a way of trying to cope with unbearable feelings. Dissociation can be an unconsciously driven process (when a person ‘spaces out’ without deliberately intending to) or deliberately induced (e.g. via alcohol and other drugs).
There exists a growing school of thought that the kind of survival mechanisms described above can sometimes lead to a misdiagnosis, particularly a misdiagnosis of ADHD (for example, dissociation can be mistaken for being deliberately inattentive; difficulty controlling behaviour and mood fluctuations may be viewed as wilful disruptiveness, and hypervigilance may be seen as distractability. If the child is, due to such misinterpretations, then diagnosed as suffering ADHD when, in fact, he or she is suffering from the effects of severe trauma (and may, for example, in fact, be suffering from complex PTSD), this can prevent the child from receiving the most appropriate and effective treatment.
Traumatized children desperately need to feel safe, secure and emotionally supported and, if therapy is necessary, the earlier it is provided the better the child’s outcome is likely to be.
The good news is that therapies such as dialectical behaviour therapy (originally developed to help individuals with borderline personality disorder) can be extremely effective, even for those who have suffered very severe, early life trauma. Indeed, it is now known that, even if the brain’s development has been impaired due to the effects of growing up in a toxically stressful environment, this can be reversible due to a quality the brain is now known to retain throughout life known as ‘neuroplasticity.’
Seltzer, L Paradoxical Strategies in Psychotherapy : A Comphrehensive Overview and Guidebook. Wiley Series on Personality Processes
David Hosier BSc Hons; MSc; PGDE(FAHE).