After a recent training with Dr. Bessel van der Kolk based on his book “The Body Keeps the Score”, I walked away with several take-a-ways. His training reinforced to a greater extent, the science behind attachment and trauma. One study suggested that a child being separated from their primary caregiver was more traumatizing than watching their neighborhood being bombed. He spoke about how essential home environment is as a resiliency factor against PTSD. When we think about it from a brain perspective, this makes total sense. If a child goes out into the world and experiences a traumatic event, their amygdala will fire, their nervous system will respond, and they will enter into fight/flight/freeze mode. If this child is able to come home and run into their caregivers arms and receive comfort, their nervous system will begin to calm down and they will be able to register a feeling of safety and comfort. If this same child comes home to a parent who is passed out from drugs or walks into a home where violence is present, their nervous system will continue to experience dysregulation and they will not gain the tools needed to learn to self sooth. When someone is experiencing chronic and unrelenting trauma, things do not come to an end and they become at war with their body. Often people will turn to drugs, alcohol, food, or sex as a means of regulating their nervous system and finding an end to the inner chaos.

How Is My Trauma Impacting Me Now?

Another key take away was when Dr. Van der Kolk talked about Trauma being about sensations. Often, when someone is traumatized and they go into therapy, they are asked to tell their story in order to not feel so alone and to not need to hold it in. Unfortunately, for trauma survivors, this can do more harm than good. The very act of bringing up traumatic memories can cause someone to become dysregulated and disassociate. Good trauma treatment is about what is happening in the present. Things I want to know as a trauma therapist are what someone is experiencing now, where they feel the trauma in their body now, or how is their trauma impacting their relationships now, and how is the past showing up now. Trauma treatment is about being able to integrate sensations and finding comfort in one’s body. The narrative comes at the end of treatment, not the beginning. Part of the work in trauma therapy is creating new realities and possibilities along with leading patients toward greater affect regulation.

Personality Disorder or Attachment Trauma?

As a therapist specializing in trauma and PTSD, I have worked with a good number of patients over the years who came to me with a diagnosis of Borderline Personality Disorder (BPD). Symptoms of BPD include intense mood swings, impulsive behaviors, a pattern of instability in interpersonal relationships and self image, and self destructive behaviors such as cutting, burning, suicide attempts, or risky sexual behavior. One study suggested that 87% of BPD patients experienced severe trauma prior to age 7. Early childhood trauma is especially challenging because if someone has a relatively positive first 30 years and then experiences a trauma, they will have 30 years of positive experiences to draw on. A child’s brain experiences the majority of its development prior to the age of 7 so if a child is experiencing chronic trauma during this time, their brain does not develop the ability to regulate or self sooth. It is through mirroring and co-regulating with caregivers that we learn to sooth but when this is not available, we are unable to learn these tools. When someone is chronically traumatized, their pre-frontal cortex which is responsible for reasoning, decision making, and executive functioning is offline. When our prefrontal cortex is offline, we make decisions from a lower part of the brain which are more about survival and regulating ourselves. Traumatized people make decisions with emotions rather than logic. While cutting oneself in order to regulate emotions may not appear on the surface to be a rational decision, it makes a lot of sense if it allows someone who’s chronically dysregulated to get some relief. If we take these behaviors away from someone without replacing them with something else, they can feel more dysregulated and feel unable to cope. Again, trauma therapy is about teaching patients how to regulate affect and emotions and find peace within themselves as well as helping people label their internal world.

Can I Get Better?

One of my favorite things about our brain is that we are constantly creating new pathways and forming new connections. I once had a patient who came to me with a severe trauma history that started when she was very young. She was so dysregulated and felt so unsafe in her body that it was almost impossible for her to sit through a session. At times, sitting was too much so we would go for a walk and talk which helped immensely. Throughout our time together, she was able to start feeling more safe in her body which allowed her to feel safer in her relationships. By learning skills such as grounding and tracking, she was able to have more control over her body and find peace within herself. It was only after she was able to feel safe in her body that we were able to begin dissecting her trauma history and she was able to begin healing.