Trauma is not just in your head — Understanding how your body holds trauma

Trauma and other stress-related concerns reveal themselves in different ways, based on our unique experiences. If you feel as though your life has been or is now being impacted by trauma, it can be helpful to understand how trauma works. The definition of trauma is two-fold. It can be a particular traumatic event or a series of events, but also a description of the resulting symptoms. For example, your recent traffic accident might be the traumatic incident. The ensuing symptoms might include vivid nightmares about driving down the same highway. As a result, you now avoid travel on that highway because it activates discomfort in you, leading to more nightmares in addition to other disturbing symptoms.

Debilitating trauma and stress can result from these frightening and uncontrolled events, such as an accident, exposure to combat situations, a natural disaster, abuse, assault or violence, the loss of your home or the death or disability of a loved one. It can also be associated with personal and professional relationship issues or unanticipated or unwelcome life events. Discrimination, bullying, losing a job or living in poverty are also sources of trauma and stress. Any of these situations can affect us deeply, leading to uncomfortable or debilitating symptoms.

The clinical criteria for post-traumatic stress disorder begin with witnessing or directly experiencing disturbing or painful events, family or friends’ exposure to these traumatic events or frequent exposure to the effects of trauma on others. Other symptoms that may indicate you are suffering from the effects of trauma include unexpected or expected memories of the event, nightmares, or dissociation episodes, such as flashbacks, in which you feel like you are reliving the event, The flashbacks may surface spontaneously, prompting you to avoid thoughts, people, places or situations that remind you of the event. Perhaps you refuse to revisit a city where you were mugged or eat in a restaurant where you had a bitter fight with your partner. If you are a veteran of active combat, you may avoid being around fireworks or other loud noises. You may notice physical symptoms such as increased heart rate or a tightness in your chest when reminded of the event. As a trauma survivor, you may have negative thoughts about yourself or the world, forget important things about the traumatic event, feel hopeless about life or blame yourself for what happened. You may limit time spent with others or lose interest in your usual activities. You may be irritable, have difficulty concentrating or experience sleep problems. Any of these symptoms and the accompanying loss of control can be debilitating and lead to hopelessness.

Trauma informed therapy acknowledges that trauma is stored in the body, as the brain’s amygdala, the center of the flight, fight or freeze response, stays in an active mode long after the event occurs. Because of this, trauma survivors can re-experience their trauma, almost as though it is currently happening. Because the brain is not able to tell the difference between the past and present, the body can feel like it is under attack, fighting unseen enemies or circumstances. Trauma creates immobilization (literally, the “freeze” option), in which muscles are resistant to moving. Because this happens, effective trauma treatment must include the body as well as the brain.

There are many effective methods to work with the physical and emotional effects of trauma. Increasing levels of calm and focus can be achieved over time with work on breathing techniques, exercise, yoga, meditation and, when tolerable, soothing touch, such as massage. Creating a safe and secure place at home or in a therapist’s office can be extremely helpful. Supportive relationships with trusted family, friends, a therapist, a spiritual or religious advisor, or a therapy animal, such as a dog or cat, are important. Identifying and labeling uncomfortable body sensations can lead to acceptance and an understanding of those sensations and help you to begin learning the skills to ground yourself in the here-and-now. There are a many specific treatments for trauma such as Prolonged Exposure therapy, a form of Cognitive Behavioral Therapy, used to psychologically process trauma memories to minimize symptoms, EMDR (Eye Movement Desensitization and Reprocessing) which integrates the traumatic experience into a less threatening memory, and Somatic Experiencing which concentrates on processing the physical sensations of trauma. The treatment protocol of Bessel van der Kolk, M.D., a pioneer for the past 30 years in trauma treatment, has been used successfully, integrating body awareness and brain science to remedy the consequences of trauma. 

Ambiguous Loss — Finding comfort when your grief is complicated

Grief is difficult to navigate for all of us. It is generated by varied circumstances and can take many forms. We often associate grief with the death or loss of someone we deeply love or care about, but we can also grieve when faced with the loss of expected outcomes, a change in the health of others or ourselves, a perceived difference in the security and safety of our environment or after disturbing events. Many of these experiences fall under the heading of “ambiguous loss,” a term coined in the 1970s by University of Minnesota professor emeritus Pauline Boss. Dr. Boss used the term to describe the emotional reaction of families or friends of military personnel missing in action, who dealt with the paradox of the simultaneous “absence and presence” of their loved ones. Ambiguous loss is a relational disorder caused by the lack of facts or closure surrounding the loss of something loved or dear to us. 

We now use this term when describing loss that takes a psychological form, rather than a physical state, such as loved ones who are born with or develop neurological disorders, mental health disorders or substance abuse problems. It can also refer to empty nest syndrome, relationship changes, such as divorce, breakups or estrangement or coping with a change in our physical abilities. 

Loss that involves a primarily physical change rather than emotional or mental change can also be ambiguous: death, with or without a body to mourn, such as a soldier missing in action or a loved one’s disappearance or abduction. An immigrant’s loss of her or his homeplace, parental or spousal abandonment, or the loss or use of a limb or a physical ability would also fall in to this category.

Ambiguous loss frequently involves long-term grieving and adjustment but is considered a normal process. We can live with the sadness of loss for long periods of time. We can and will grieve in our own way and for as long as necessary. Experiencing ambiguous loss does not mean that there is something wrong with us. The disorder it brings to our lives originates outside of our own bodies and minds and is susceptible to comfort from others and community-based interactions.

Becoming comfortable with uncertain or undeserved circumstances surrounding a loss is challenging but can provide a sense of relief for those left behind. That being said, grief can become depression when it takes over our daily functioning and prohibits us from taking care of ourselves and moving forward with our lives. This is the time when our grief should be examined by meeting with a therapist or participating in a therapy group. Seeking outside support is especially important for caretakers, who face emotional up and downs while witnessing the loss of a patient’s functioning mind and/or body due to disease or accident while managing their physical symptoms at the same time. 

Saying Good-bye to Your Child and Hello to Your Teenager — Living through your child’s transition to the teenage years.

Whether it happens precisely on your child’s 13th birthday or months before or after that event, things will change as your child becomes a teenager. Some children go from being extroverted and carefree, sharing every detail of their lives, to surly, strangely dressed beings that acknowledge family members only to ask for food or money on the way to their room. Children who lived for family activities become adolescents who shun any suggestion of spending time together. Formerly quiet homebodies begin to spend endless hours on social media with friends but refuse to appear in public with parents, step-parents or siblings.

Family members often feel confused and shut out of their children’s lives, just at the moment they feel their guidance is more necessary than ever. “How will my child negotiate the trials of middle or high school without my help?” “Are they being bullied?” “How do I know if they are failing classes, taking drugs, being bullied or having sex if I can’t get them to say more than a couple of words a day?” There seem to be endless scenarios to worry about. 

Living with a newly hatched teenager is different for each family. There is no “normal.” In the same vein, what works for one child or one family may not work for others. Here are a few strategies families can employ to make the challenging process of raising a child to be an adult less painful. They center around communication, boundaries and negotiation. 

Communication
The relationship you have already developed with your child will be the basis for the relationship you have with them as a teenager. A teenager may be more sensitive about sharing information about their life, whether it be school issues or social situations. That is normal and, as a parent, you may want to probe carefully to discover the new boundaries that may have emerged. If queries about school are answered with “everything is fine,” you may need to trust that is the truth, unless you hear from a teacher, administrator or coach that there is a problem.

Teenagers may feel like they are being interrogated when confronted with all the questions parents want to ask. Casual, spontaneous chats may be less intrusive and the best way to initiate conversation and create stronger bonds with your teenager. Concentrate on a few things that are interesting to them, such as music, sports, politics, video games or a favorite class or school activity. Signaling to your teen that you are open to talking about a wide range of topics can open up a deeper level of communication between the two of you. Transparency about your experiences in life, positive and negative, creates a safe and accepting environment for them to share their own concerns.

Finally, try not to yell at your teenager if you are angry, as tempting as it may be. A 2014 study in the Journal of Child Development found that homes with regular shouting incidents can lead to lower self-esteem and higher rates of depression for the children or adolescents living there. Assisting the maturation process in an adolescent means approaching conflict in a way that models adult skills of problem solving and respectful discussion. If your anger needs an outlet, debrief with your partner or spouse, a good friend, a therapist or spiritual advisor. You can also decompress with a pleasurable or relaxing activity, such as exercise, reading, hobbies or meditation. Though they may try hard to conceal it, your teenager is watching and learning from you. Try your best to model the behavior you expect from them.

Boundaries
Friends can be a sticky subject of conversation. Teenagers’ social lives are sometimes dramatic and chaotic and not always shared with parents. Allow your teenager to have privacy regarding social situations. Spending more time in their room on social media, playing video games, reading or doing more schoolwork than they did as children is common and are reasonable ways of gaining independence from the family. Be gentle with inquiries but alert for signs of real issues. Pervasive sadness, appetite changes, sleeping issues and unusual or prolonged periods of isolation might be problematic, as is excessive anxiety about academics, and/or a lack of interest in completing school work or participating in activities they once enjoyed. A reluctance or refusal to attend school is significant and troubling changes in social activities are also fair game for questions, as is evidence that substance abuse might be occurring. 

Negotiation
Balancing your teen’s need for empowerment and freedom with your expectations of family participation is difficult. Parents, step-parents and guardians need to understand and accommodate their teenager’s need for independence, while teenagers have a responsibility to participate as a family member. Different strategies work for different families. The key is a combination of discussion and negotiation. Expectations for both sides should be expressed and discussed, with consensus as the goal. Perhaps your teenager wants to spend less time with younger siblings or grandparents to accommodate studying needs or social events and you are not happy about that. Many families negotiate a set number of family events that the teenager agrees to attend. Curfews can be discussed and determined, depending on the event. Family dinners can be made a priority, if that is a good time to have family members catch up with each other. Special events between parents and teens should be regularly scheduled along with activities that include all family members, if possible. Negotiation need not be difficult, but, with practice, a familiar and friendly way to respect your teen’s independence while requesting their continued interaction with the family.

It is challenging to let go of our children so that they can become adults. The relationship you nurtured for over a decade with your little one is undergoing transformation and a sense of loss or grief may surface. Enabling your teenager to begin exploring who they are, separate from their family, will inspire confidence and promote healthy adult functioning. They will experience and learn from failure as well as success. Throughout the process, your relationship with them can deepen in a new and fulfilling way, encompassing mutual respect, trust and love that will endure for the rest of your lives.