Several years ago, I was sitting on my couch, enjoying the silence that only a parent of small children can appreciate. The digital clock on our DVD player told me I was up too late, but the stillness of that hour was a refuge to my ears and soul. The silence was immediately interrupted by the sound of our sliding glass door being unlatched. The sound was familiar to me, for many times I had found myself on the outside of this locked door while my children delighted in the success of their game from the inside. This time, though, I immediately felt that this familiar sound was not safe. With my heart pounding in my chest, I sprung to my feet, and, as I raced past the door, my eyes scanned the door’s track. My fears were momentarily alleviated when I saw the wooden stick securely in place, acting as a second barrier. I flew up the stairs and into my kitchen, knowing I needed to check our upstairs slider. I scanned the dark room, my fears intensifying when I noticed a small amount of money sitting on the kitchen island in plain view of the glass pane. With what felt like the poise and grace of a track star jumping hurdles, I grabbed the money off the counter and slid the lock closed on the kitchen door. I paused briefly while deciding what to do next.
Sounding the Alarm
Most people are vaguely familiar with our instinctual response to danger: fight, flight or freeze. For those unfamiliar, this physiological reaction to perceived danger occurs in all animals, from house cats to human beings.
Information comes into the brain from various sensory organs and is sent to the Thalamus. The Thalamus asks itself, “Am I safe?” The Prefrontal Cortex and other thinking areas of the brain, then consider this information and ask themselves, “Is this sound or sight familiar to me? What should I do in response?” After processing the information, the Prefrontal Cortex sends a signal to the Amygdala.
The Amygdala, a small almond-shaped structure highly responsive to sights and sounds, is the area of the brain that contributes to emotional processing. It is responsible for quickly recruiting many areas of the brain when a threat is perceived. If it perceives danger, it instantly “sounds the alarm” to the Hypothalamus. The Hypothalamus is like a command center. This area of the brain communicates with the rest of the body through the Autonomic Nervous System (ANS).
ANS is a network of nerve fibers that extend throughout the body connecting the brain with various organs and muscle groups in order to coordinate the two branches of this response. Two main nervous systems immediately spring into response: the sympathetic and parasympathetic.
Preparing for Battle
The sympathetic branch activates the fight or flight response. It is, essentially, the body’s natural heating system. Adrenaline rushes through the body, getting the muscles ready for emergency battle. Surface blood vessels constrict so any bleeding will be minimized. Vision heightens as pupils constrict. Breathing and heart rate speed up as more oxygen is channeled to the muscles. All nonessential processes, such as digestion, cease, in order to optimize the body’s output. The body sometimes even unloads extra weight by emptying the bladder or bowels. The brain is preparing to fight or flee, so you can fight harder, run faster, see better, and breathe easier than you normally would. All of this happens in a fraction of one second.
These experiences, like the click of the lock on the sliding glass door and the actions that followed, are then carefully stored in the Hippocampus. The Hippocampus catalogs these experiences in the long-term memory to be recalled when needed, attaching memories to the emotions and senses that went with them. For instance, it will link a memory of camping to the smell of campfire smoke. Later, when that person smells campfire smoke, the feeling of that particular camping experience returns along with the smell.
The second ANS responder is the Parasympathetic System. The Parasympathetic System is essentially the cooling system. It tells the body, “OK, you can relax now. The danger has passed. No need to be on red-alert anymore.” It slows down the heart, dilates the pupils, and stimulates digestion. It returns the body to its normal state.
Trauma is danger. If the trauma is prolonged, extreme or repetitive, it can actually physically injure the brain. The brain can eventually learn to bypass the rational part of itself, creating hyper-vigilance. The pathways from the Thalamus to the Amygdala become worn and familiar. The best analogy is that the Amygdala stays in the alert state so long that it gets “stuck,” because danger is always lurking. This puts a glitch in the body’s ability to heat and cool.
With the Parasympathetic System, the “cooling system,” being essentially turned off, the filing system of the Hippocampus stays mostly “offline,” so the Hippocampus fails to put the right time stamp on all the events. Traumatic events are fragmented, disconnected memories. Those memories become corrupt and filled with gaps. The body keeps sensing danger and sending out stress response signals as if the person is continually living in the traumatic moment.
PTSD & Complex PTSD
A single traumatic event can cause Post Traumatic Stress Disorder (PTSD). The longer the vigilant state lasts, the higher the chances of permanent damage which can lead to what many experts now distinguish as Complex PTSD. The PTSD sufferer is unable to distinguish danger from safety of a current event. Current, safe events trigger flashbacks and other strange memories or emotional signals, so the brain keeps retriggering itself into the hyper-alert state. Each new challenge and event seems as dangerous as the last.
TRAUMA’S PREVALENCE IN CHILDREN
Trauma’s consequences are intensified in children because their brains are still forming and they have fewer reference points stored in the Hippocampus. In the US, approximately 3 million children are reportedly abused or neglected each year [1]; at least 15 out of every 1000 children in the United States have substantiated histories of abuse.
TRAUMA’S PREVALENCE IN ADULTS
Women are twice as likely as men to develop PTSD. In a random sample of 1,225 females, 18.4% reported a history of childhood sexual abuse, 14.2% reported physical abuse, and 24.1% reported having been emotionally abused during childhood. [2] In a national survey, 27% of women and 16% of men had a history of childhood sexual abuse. [3]
TRAUMA IN TRAFFICKED WOMEN
Trafficked women are two times more likely than a solider in a war zone to have Post-Traumatic Stress Disorder, [4] and 68% of female sex trafficking victims meet the clinical criteria for posttraumatic stress disorder. [5]
6 CRITERIA FOR A PTSD DIAGNOSIS [6]
The person goes through or sees something that involves threat of serious injury or death. The person responds to this with intense fear, helplessness or horror.
The person then relives this traumatic event through dreams or recollections. He or she can behave as if the trauma is actually happening right then and can react strongly to events that even resemble the original trauma.
The person tries desperately to avoid this, and to avoid anything associated with the trauma. He or she may not even remember the trauma, yet may still react strongly to certain stimuli.
The person often has difficulty sleeping and concentrating. He or she may be hyper-vigilant.
The person experiences prolonged responses lasting longer than one month.
The person experiences significant distress in daily life.
PTSD is immobilizing. It is not misdirected thinking, or sign of weak character. It most certainly is not something one can “just get over.” Very real consequences exist for those who suffer from the effects of trauma, including panic attacks, insomnia, and depression. Many sufferers also experience relational and social effects, including retaliation or ostracism, leading to additional complexities. So, if you are inclined to work with victims of trauma, including those exploited for commercial sex, do your due diligence to understand its effects. Get trained, be patient and compassionate, and be in it for the long haul.
Citations
Wang C, Daro D. Current trends in child abuse reporting and fatalities: the results of the 1997 annual fifty state survey. Washington (DC): Center on Child Abuse Prevention Research, National Committee to Prevent Child Abuse; 1997.
Felitti V, Anda R, Nordernberg D, Willimason D, Spitz A, Edwards V, et al. Relationship of childhood abuse to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med 1998;14:245 – 58.
Finkelhor D, Hotaling G, Lewis I. Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors. Child Abuse Negl 1990;14:19 – 28
Melissa Farley, Isin Baral, Merab Kiremire, Ufuk Sezgin, “Prostitution in Five Countries: Violence and Post traumatic Stress Disorder” (1998) Feminism & Psychology 8 (4): 405-426; Farley, Melissa et al. 2003. “Prostitution and Trafficking in Nine Countries: An Update on Violence and Posttraumatic Stress Disorder.” Journal of Trauma Practice, Vol. 2, No. 3/4: 33-74; and Farley, Melissa. ed. 2003. Prostitution, Trafficking, and Traumatic Stress. Haworth Press, NY.
U.S. Department of State (2005)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). Washington, DC: Author.