A definition of trauma.
IRCT defines trauma as an event or series of events such as abuse, maltreatment, neglect or tragedy that causes a profound experience of helplessness leading to terror.
Trauma is defined by Perry (2011) as ‘a psychologically distressing event that is outside the range of usual human experience, often involving a sense of intense fear, terror and helplessness.’
An alternative explanation is that:
‘Trauma happens when any experience stuns us like a bolt out of the blue; it overwhelms us, leaving us altered and disconnected from our bodies. Any coping mechanisms we may have had are undermined, and we feel utterly helpless and hopeless. It is as if our legs are knocked out from under us.’ (Levine, 2006).
It is acknowledged that every child experiences stress in some ways and in some time and this can be a positive experience if the child has the appropriate support. A child may also experience a crisis and this can be challenging for the child but with positive relational processing, any impact of the crisis can be limited. Some children experience trauma. We know that from early infancy through to adulthood, trauma can alter the way we perceive ourselves, the world around us, and it can change how we process information and the way we behave and respond to our environment (Cozolino, 2006).
Traumatic stress is caused by exposure to or witnessing of extreme and potentially life threatening events. Traumatic exposure may be brief in duration (e.g. an accident), or involve prolonged, repeated exposure (e.g. sexual abuse). The former has been referred to as “Type I” trauma and the latter as “Type II” trauma (Terr, 1991). Knowledge of traumatic stress – how it develops, how it presents, and how it affects the lives of those who suffer with it – may be the first step towards being able to interact positively with those affected by it.
Traumatic experiences, and our responses to them, vary widely and therefore it is essential to use a trauma continuum (de Thierry, 2013) to describe how mild or severe a traumatic experience is. The trauma continuum can help all those who work with children to use a common language, which consequently enables a child to receive appropriate interventions that are suitable for their level of traumatic response. The trauma continuum begins with Type I trauma- single incident trauma and goes through to Type II trauma through to Type III which is pervasive, interpersonal, multiple traumatic experiences.
A single incident traumatic experience can be limited in its negative effect when the child’s context includes positive, consistent attachment figures who provide positive relationships where the trauma can be processed.
The trauma continuum needs to be considered together with the parenting capacity continuum, which illustrates how great the impact of a traumatic experience may be depending on the context of the child’s every day experience.
The most damaging trauma is one of interpersonal experience where the primary care giver is also the source of trauma, such as abuse or neglect or violence from the parent. It is in this context that the child is essentially held hostage by the very people who and should be their greatest protector and source of comfort. The abuse, torture or neglect is often continuous, and the child does not experience it necessarily as abuse or neglect, but rather ‘did I nearly die?’ This is the most profound and potentially damaging experience. It is not surprising that children who have had these experiences can only recover from them and move on from living with a baseline of terror and helplessness for the rest of their lives, IF they can find some resolution due to an appropriate long term intervention. This terror may manifest in a number of ways, such as appearing angry, or sad, or withdrawn, or they may appear to have behavioural difficulties. The adults in their lives need to respond to these manifestations recognising that they are actually terrified. These children need the adults around them to provide physical and emotional containment for their terror.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) field trial for posttraumatic stress disorder (PTSD) demonstrated that the age at which children are first traumatized, the frequency of their traumatic experiences, and the degree to which caregivers contribute to the event being traumatic, all have a profound impact on the extent of their psychological damage. This is expressed in problems with self-regulation, aggression against self and others, problems with attention and dissociation, physical problems, and difficulties in self-concept and capacity to negotiate satisfactory interpersonal relationships