Trauma and the Developing Brain - College of Education & Human ...

Handout for Trauma, The Developing Brain, Healing and Emotional Regulation Seminars 

Karina A. Forrest-‐Perkins MHR LADC, 2011 

Trauma and the Developing Brain 

The following material on brain development and trauma is primarily from Dr. Bruce Perry and 

www.childtrauma.org. Please feel free to research this website and Dr. Perry’s online course in 

trauma and brain development. 

Copyright 2002 

To understand the connection between substance abuse, high risk behaviors, behavioral 

conditioning with trauma, we must understand: 

• How the brain responds to threat 

o The magnificence of the Brain. It is an amazing organ 

o Delicate balance of neurotransmitter chemicals 

o Maladjustment of chemical balance 

o Infusion of cortisol – paralyzes/freezes frontal lobe activities 

o Stops intended functioning and growth trajectory 

o After cortisol flooding, cortisol returns to sub-‐standard levels which leads to 

depressive episodes and loss of hope 

• How it stores traumatic memories 

o Damaged membrane between lobes of brain – 

o The two sides of the brain are joined at the bottom by the corpus callosum. The 

corpus callosum connects the two halves of the brain and delivers messages 

from one half of the brain to the other. 

• In general, the left hemisphere or side of the brain is responsible for language and 

speech. Because of this, it has been called the "dominant" hemisphere. 

• The right hemisphere plays a large part in interpreting visual information and spatial 

processing. 

• In about one third of individuals who are left-‐handed, speech function may be located 

on the right side of the brain. Left-‐handed individuals may need specialized testing to 

determine if their speech center is on the left or right side prior to any surgery in that 

area. 

• Many neuroscientists believe that the left hemisphere and perhaps other portions of 

the brain are important in language. Aphasia is simply a disturbance of language. 

Certain parts of the brain are responsible for specific functions in language production. 

There are many types of aphasias, each depending upon the brain area that is affected, 

and the role that area plays in language production. 

• There is an area in the frontal lobe of the left hemisphere called Broca’s area. It is next 

to the region that controls the movement of facial muscles, tongue, jaw and throat. If 

this area is destroyed, a person will have difficulty producing the sounds of speech, 

because of the inability to move the tongue or facial muscles to form words. A person 

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with Broca's aphasia can still read and understand spoken language, but has difficulty 

speaking and writing. 

• There is a region in the left temporal lobe called Wernicke's area. Damage to this area 

causes Wernicke's aphasia. An individual can make speech sounds, but they are 

meaningless (receptive aphasia) because they do not make any sense. 

• American Association of Neurological Surgeons 

• How the brain is altered by the traumatic experience. 

All experience changes the brain – good experiences like piano lessons and bad experiences 

like living through a tornado as it destroys your home. This is so because the brain is designed 

to change in response to patterned, repetitive stimulation. And the stimulation associated with 

fear and trauma changes the brain. 

Over the last twenty years, neuroscientists studying the brain have learned how fear and 

trauma influence the mature brain, and more recently, the developing brain. It is increasingly 

clear that experience in childhood has relatively more impact on the developing child than 

experiences later in life. This is due to the simple principles of neurodevelopment. 

The functional capabilities of the mature brain develop throughout life, but the vast majority 

of critical structural and functional organization takes place in childhood. Indeed, by the age 

of three the brain has reached 90 % of adult size, while the body is still only about 18 % of 

adult size. By shaping the developing brain, experiences of childhood define the adult. 

Neurodevelopment is characterized by: 

(1) sequential development and ‘sensitivity’ (the brain "grows" from brainstem to the cortex) 

(2) ‘use-‐dependent’ organization ("use it or lose it"). The mature organization and functional 

capabilities of brain reflect aspects of the quantity, quality and pattern of the somato-‐sensory 

experiences of the first years of life. 

The sequential and use-‐dependent properties of brain development result in an amazing 

adaptive malleability, ensuring that, within its specific genetic potential, an individual’s brain 

develops capabilities suited for the ‘type’ of environment he or she is raised in. 

Simply stated, children reflect the world in which they are raised. If that world is 

characterized by threat, chaos, unpredictability, fear and trauma, the brain will reflect that by 

altering the development of the neural systems involved in the stress and fear response. 

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The Neurobiological Responses to Threat 

When a child is threatened, various neurophysiological and neuroendocrine responses are 

initiated. If they persist, there will be ‘use-‐dependent’ alterations in the key neural systems 

involved in the stress response. These include the hypothalamic-‐pituitary-‐adrenal (HPA) axis. 

In animal models, chronic activation of the HPA system in response to stress has negative 

consequences. Chronic activation may "wear out" parts of the body including the hippocampus, 

a key area involved in memory, cognition and arousal. This may be occurring in traumatized 

children as well. Dr. Martin Teicher and colleagues have demonstrated hippocampal/limbic 

abnormalities in a sample of abused children. 

Another set of neural systems that become sensitized by repetitive stressful experiences are 

the catecholamine systems including the dopaminergic and noradrenergic systems. These key 

neurochemical systems become altered following traumatic stress. The result is a cascade of 

associated changes in attention, impulse control, sleep, fine motor control and other 

functions mediated by the catecholamines. 

As these catecholamines and their target regions (e.g., amygdaloid nuclei) also mediate a 

variety of other emotional, cognitive and motor functions, sensitization of these systems by 

repetitive re-‐experiencing of the trauma leads to dysregulation in many functions. 

A traumatized child may, therefore, exhibit motor hyperactivity, anxiety, behavioral impulsivity, 

sleep problems, tachycardia and hypertension. In preliminary studies by our group, we have 

seen altered cardiovascular regulation (e.g., increased resting heartrate) suggesting altered 

autonomic regulation at the level of the brainstem. In other studies, clonidine, an alpha2 

adrenergic receptor partial agonist has been demonstrated to be an effective 

pharmacotherapeutic agent, presumably by altering the sensitivity of the noradrenergic 

systems. 

Implications of Trauma-‐related Alterations in Brain Development 

All experiences change the brain – yet not all experiences have equal ‘impact’ on the brain. 

Because the brain is organizing at such an explosive rate in the first years of life, experiences 

during this period have more potential to influence the brain – in positive and negative ways. 

Traumatic experiences and therapeutic experiences impact the same brain and are limited by 

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the same principles of neurophysiology. Traumatic events impact the multiple areas of the 

brain that respond to the threat. Use-‐dependent changes in these areas create altered neural 

systems that influence future functioning. In order to heal (i.e., alter or modify trauma), 

therapeutic interventions must activate those portions of the brain that have been altered by 

the trauma. Understanding the persistence of fear-‐related emotional, behavioral, cognitive and 

physiological patterns can lead to focused therapeutic experiences that modify those parts of 

the brain impacted by trauma. 

Our evolving understanding of neurodevelopment suggests directions for assessment, 

intervention and policy. Primary among these is a clear rationale for early identification and 

aggressive, pro-‐active interventions that will improve our ability to help traumatized and 

neglected children. The earlier we intervene, the more likely we will be to preserve and express 

a child’s potential. 

Long Term Effects of Abuse and Trauma 

The American Psychiatric Association’s Diagnostic and Statistical Manual, Revised 

(DSM-‐IV-‐R) defines a “traumatic event” as one in which a person experiences, 

witnesses, or is confronted with actual or threatened death or serious injury, or threat 

to the physical integrity of oneself or others. A person’s response to trauma often 

includes intense fear, helplessness, or horror. 

1 Histories of physical and sexual abuse are commonplace among incarcerated women. 

Women’s violent offences tend to be reactive in nature. As a result, violent crimes 

are more often committed against intimates, not strangers. 

·∙ Of the 68 women serving a life sentence for murdering their intimate partners, the 

majority had been abused by their partners prior to their use of lethal force. 

2 Child sexual abuse has come to be widely regarded as a cause of mental health issues 

in adult life. There is also a considerable overlap between physical, emotional and 

sexual abuse, and children who are subject to one form of abuse are significantly 

more likely to have experienced other forms of abuse. 

3 Between 51% and 98% of public mental health clients diagnosed with severe mental 

illness have trauma histories, 

4 and prevalence rates within substance abuse treatment programs and other social services 

are similar. In children, trauma may be incorrectly 

diagnosed as depression, attention deficit hyperactivity disorder (ADHD), 

oppositional defiant disorder (ODD), conduct disorder, generalized anxiety disorder, 

separation anxiety disorder, and reactive attachment disorder. 

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5 A random community sample found women who reported histories of childhood 

sexual abuse were more likely to have work histories that placed them in the lowest 

socio-‐economic status categories. Abuse in the home can drive women and girls into the streets, 

and lack of housing puts them at further serious risk of physical and sexual violence and early death. 

One study found that 87% of homeless girls and women aged 12 to 19 in British Columbia 

had been abused. 

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1 American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorder, Reviseds (DSM 

IV-‐R) 4th ed. Washington, DC: APA, 2000). 

2 Lise Addario, Six Degrees from Liberation: Legal Needs of Women in Criminal and Other Matters 

(Research and Statistics Report) (Ottawa: Department of Justice, 2002). 

3 Paul Mullen & Jillian Fleming, “Long-‐term Effects of Child Sexual Abuse” (1998) 9 Issues in Child 

Abuse Prevention. 

4 Mueser Goodman et al., “Trauma and post-‐traumatic stress disorder in severe mental illness” (1998) 66 

Journal of Consulting and Clinical Psychology, at 493. 

5 Center for Substance Abuse Treatment. Substance abuse treatment for persons with child abuse and 

neglect issues Treatment Improvement Protocol (TIP) series. Washington, DC: U.S. Government Printing 

Office, 2000). 

6Canadian Research Institute for the Advancement of Women, “New Federal Policies Affecting Women’s 

Equality: Reality Check” (2006) 8 Factsheet. 

RESOURCES: 

Prevent Child Abuse, America 

Prevent Child Abuse (formerly the National Committee to Prevent Child Abuse) is nationally recognized as 

one of the most innovative leaders in child abuse prevention. It has a nationwide network of chapters and 

their local affiliates in hundreds of communities. Through our media campaigns, people are finding ways 

they can help prevent abuse. PCA seeks to equip professionals with the latest, proven prevention approaches 

through training and technical assistance. To find out more about your local affiliate and the national 

program activities contact: 

Prevent Child Abuse America 

200 S. Michigan Avenue, 17th Floor 

Chicago, Illinois 60604-‐2404 

(800) CHILDREN 

Tel: (312) 663-‐3520 

Fax: (312) 939-‐8962 

www.preventchildabuse.org 

mailbox@preventchildabuse.org 

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Prevent Child Abuse Minnesota 

Karina Forrest-‐Perkins MHR LADC 

Executive Director 

www.pcamn.org 

651-‐523-‐0099 

Child Welfare League of America 

CWLA is an association of more than 1,000 public and private nonprofit agencies that assist over 

2.5 million abused and neglected children and their families each year with a wide range of services. 

There have many resources for families and professionals working with traumatized children. 

For more information contact: 

Child Welfare League of America 

440 First Street, NW, Third Floor 

Washington, DC 20001-‐2085 

Tel. (202) 638-‐2952 

FAX (202) 638-‐4004 

http://www.cwla.org/ 

American Professional Society on the Abuse of Children (APSAC) 

APSAC's mission is to ensure that everyone affected by child maltreatment receives the best possible 

professional response. This organization has many useful scholarly and clinical materials focused 

primarily at the professional audience. Caregivers working with abused or maltreated children may find 

this a useful resource, nonetheless. For more information contact: 

APSAC 

407 South Dearborn Street Suite 1300 

Chicago, IL 60605 

http://www.apsac.org/ 

The National Center for PTSD 

The National Center for PTSD is a program of the U.S. Department of Veterans Affairs and carries out 

a broad range of activities in research, training, and public information. The primary focus of the Center 

has been combat veterans and their families. Over the last few years, however, this focus has been expanded. 

There are many useful programs, activities and resources for anyone interested in the effects of 

traumatic stressors. 

The PILOTS database is an electronic index to the worldwide literature on PTSD and other mental-‐health 

sequelae of exposure to traumatic events. It is available to Internet users through the courtesy of Dartmouth 

College, whose computer facilities serve as host to the database. No account or password is required, and 

there is no charge for using the PILOTS database. 

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The National Center for PTSD 

http://www.dartmouth.edu/dms/ptsd/ 

International Society for Traumatic Stress Study (ISTSS) 

The International Society for Traumatic Stress Studies (ISTSS), founded in 1985, provides a forum 

for the sharing of research, clinical strategies, public policy concerns and theoretical formulations on 

trauma in the United States and around the world. ISTSS is dedicated to the discovery and dissemination 

of knowledge and to the stimulation of policy, program and service initiatives that seek to reduce 

traumatic stressors and their immediate and long-‐term consequences. 

ISTSS 

60 Revere Drive, Suite 500 

Northbrook, Illinois 60062 USA 

Phone: 847/480-‐9028; Fax: 847/480-‐9282 

http://www.istss.org 

The Harvard Center for the Developing Child 

http://developingchild.harvard.edu/ 

The Israel Center for the Treatment of Psychotrauma 

The Israel Center for the Treatment of Psychotrauma is a non-‐profit organization dedicated to improve 

the lives of those who suffer from trauma and stress, and their families. The Traumaweb site contains 

information regarding trauma, stress, resiliency and coping, and offers useful advice and self-‐help 

strategies by the center’s professional staff. mail@traumaweb.org 

National Clearinghouse for Child Abuse and Neglect (NCCAN) 

The National Clearinghouse on Child Abuse and Neglect Information is a national resource 

for professionals seeking information on the prevention, identification, and treatment of child 

abuse and neglect, and related child welfare issues. 

NCCAN 

330 C Street, SW 

Washington, DC 20447 

Phone: (800) 394-‐3366 or (703) 385-‐7565 

Fax: (703) 385-‐3206 

http://www.calib.com/nccanch 

nccanch@calib.com 

National Information, Support and Referral Service on Shaken Baby Syndrome 

The Child Abuse Prevention Center of Utah hosts this useful website about Shaken Baby 

Syndrome (SBS). In addition, they publish a quarterly newsletter featuring articles targeted for 

professionals as well as family members that deal with SBS. Articles are written by experts in 

medicine, legal profession, investigative, law enforcement and from parents or family members of 

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victims. The newsletter is avaliable both on-‐line and in print. If you are interested in receiving this 

publication please email them at capcente@ix.netcom.com and they will add you to their mailing list. 

National Information, Support and Referral Service on SBS 

2955 Harrison Blvd., #102 

Ogden, UT 84403 

(801) 393-‐3366 

Fax: (801) 394-‐1781 

http://www.capcenter.org 

capcente@ix.netcom.com 

David Baldwin’s Trauma Information Pages 

These Trauma Pages focus primarily on emotional trauma and traumatic stress, including 

PTSD (Post-‐traumatic Stress Disorder), whether following individual traumatic experience(s) or 

a large-‐scale disaster. New information is added to this site about once a month. The purpose of 

this award-‐winning site is to provide information for clinicians and researchers in the 

traumatic-‐stress field. Baldwin’s interests include both clinical and research aspects of trauma 

responses and their resolution. For example: 

1. What goes on biologically in the brain during traumatic experience and its resolution? 

2. Which psychotherapeutic procedures are most effective for which patients with traumatic 

symptoms, and why? 

3. How can we best measure clinical efficacy and treatment outcome for trauma survivor populations? 

Supportive resources supplement the more academic or research information of interest to clinicians, 

researchers, and students. 

David Baldwin’s Trauma Information Pages 

http://www.trauma-‐pages.com 

Red Cross 

The American Red Cross has a long history of helping children, families and communities 

recover from disasters. This experience has resulted in an increasing awareness of the need for 

quality mental health education and preventative approaches to minimize the long-‐term effects of 

traumatic disaster. With special experience for trauma resulting from natural disasters, this 

organization has a network of mental health professionals capable of immediate response to help a 

community organize and focus their resources following traumatic events. One of the primary 

partners in this effort is the Disaster Mental Health Institute in South Dakota. Either of these resources 

are excellent places to start. 

The Red Cross 

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http://www.redcross.org/ 



Disaster Mental Health Institute 

University of South Dakota -‐ SDU116 

414 East Clark Street 

Vermillion SD 57069-‐2390 

E-‐mail: dmhi@usd.edu 

Resources on Assessment 

Collaborative Family Healthcare Coalition (CFHC) is a diverse group of physicians, nurses, 

psychologists, social workers, family therapists and other health care workers, working in both 

primary and tertiary care settings, who study, implement, and advocate for the collaborative 

family health care paradigm. 

CFHCC 

40 W. 12 th Street 

New York, NY 10011-‐8604 

(212) 675-‐2477 

http://www.cfhcc.org 

NEW -‐ Childstats.gov offers easy access to federal and state statistics and reports on 

children and their families, including: population and family characteristics, economic security, 

health, behavior and social environment,and education. 

http://www.childstats.gov/ 

The Barr-‐Harris Children's Grief Center in Chicago, Illinois is dedicated to helping children 

facing the pain of death, divorce, separation, or abandonment. This unique Center has many 

useful resources including an excellent web site. This site has an excellent bibliography of 

professional and personal resources for this issue. Included is a list of books for children. 

The Barr-‐Harris Children’s Grief Center 

Institute for Psychoanalysis 

122 S. Michigan Ave., Suite 1300 

Chicago, IL 60603 

http://www.barrharris.org 

Amanda the Panda provides support to grieving children and their families through a variety 

of services. Extensive support is provided to children who are grieving the death of a family 

member through accident, illness, suicide, or homicide. This support is provided through weekend 

camps, support groups, home visits, fun days, school presentations, holiday cheer boxes, pen pal 

programs, Halloween and Christmas parties, birthday cards and remembrances, on the anniversary 

of the death. All services are provided at no cost to children and families served. 

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Amanda the Panda 

http://www.amandathepanda.org 

or contact: 

JoAnn Zimmerman 

1000 73 rd Street, Suite 12, 

Des Moines, IA 50311 

jzpanda@netins.net 

(515) 223-‐4847 

FAX: (515) 223-‐4782 

Julie’s Place is a unique web site developed by a young woman who lost her sister in 

a traumatic event. This site is designed to help siblings of dealing with traumatic loss. It has areas 

listing other resources, a place for siblings to e-‐communicate using a message board, and a list 

of personal narratives. This site is likely to be very helpful to older children and adolescents. 

Julie’s Place 

http://www.juliesplace.com 

OTHER REGIONAL RESOURCES ON LOSS AND GRIEVING: 

The Dougy Center 

P.O. Box 86852 

Portland, Oregon 97286 

www.dougy.org 

Fernside, A Center for Grieving Children 

2303 Indian Mound Avenue 

Cincinnati, Ohio 45212 

(513) 841-‐1012 

www.fernside.org 

Center for Loss and Life Transition 

3735 Broken Bow Road 

Fort Collins, CO 80526 

www.counselingforloss.com 

Bo's Place 

5501 Austin 

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P.O. Box 271165 

Houston, Texas 77277-‐1165 

Phone: (713) 942 -‐ 8339 

Fax: (713) 942 – 2252 



PROTECT is a national pro-‐child, anti-‐crime membership association founded on the belief 

that our first and most sacred obligation as parents, citizens, and members of the human species 

is the protection of children from harm. Protect and its members are committed to building a powerful, 

nonpartisan force for the protection of children from abuse, exploitation and neglect. Members believe 

that this must be done through a determined single-‐issue focus, a meaningful mainstream agenda 

and the use of proven modern political strategies. 

www.protect.org 

46 Haywood Street, Suite 315, Asheville, NC 28801 

phone: (828) 350-‐9350 -‐ email: info@protect.org 

Child Welfare Training Resources Online Network is designed to assist the child welfare training 

community to identify and share training resources, activities, curricula, and materials aimed at 

enhancing the skills and qualifications of the child welfare workforce. By serving as a central repository 

and conduit for child welfare training information from across the United States, the Project 

facilitates the connection of trainers and practitioners to resources and services that meet their 

training needs. The CWTR Project is managed by the National Clearinghouse on Child Abuse and 

Neglect Information, a service of the Children's Bureau. 

Child Welfare Training Resources Online Network 

National Clearinghouse on Child Abuse and Neglect Information 

330 C Street, SW 

Washington, D.C. 20447 

1-‐800-‐394-‐3366 

http://www.childwelfaretraining.org 

(go to "National Organizations" and then scroll through their alphabetical list of resources) 

Office of Juvenile Justice and Delinquency Prevention (OJJDP), Department of Justice is the division 

of the Justice Department dedicated to the shaping and enacting federal policy regarding the areas of 

juvenile justice. As it carries out this mission, the OJJDP is works with states and other non-‐government 

agencies and organizations to develop programs to prevent and control juvenile delinquency. 

The OJJDP website has a wealth of information regarding the prevalence of problems as well as 

the documentation of promising intervention programs. OJJDP has been a primary sponsor of the 

successful home-‐visitation models, the Safe Kids/Safe Streets project, Safe Start programs and 

the community policing initiatives taking place in many communities. 

OJJDP 

810 Seventh Street, NW, 


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(202) 307-‐5911 

Fax: (202) 307-‐2093 

http://ojjdp.ncjrs.org 

E-‐mail: askjj@ojp.usdoj.gov 



Parents and Teachers Against Violence in Education: Project NO SPANK 

This is an advocacy organization that has documented and catalogued materials 

related to the issue of physical discipline. For any individual or group interested in reading 

about the research regarding the adverse impact of physical discipline and spanking, this is 

the site to start with. Remember, this is an advocacy organization; this site will clearly and 

strongly present their positions. 

Project No Spank 

P.O. Box 1033 

Alamo, CA 94507-‐7033 

(925) 831-‐1661 

Fax: (925) 838-‐8914 

E-‐mail: ptave@silcon.com 

http://www.nospank.net 

New Haven Child Development-‐Community Policing Project: (CD-‐CP) 

This is an innovative program which is a collaborative project of the Yale Child Study Center, 

the New Haven Police Department, local schools and the Connecticut child protective services. 

This project is designed to provide the immediate mental health needs of child crime victims and 

witnesses. By creating special training opportunities, mental health providers and police officers 

share expertise and address the complex needs of children exposed to violence. This is an effective 

and unique program. The OJJDP is helping other communities create similar innovative collaboratives. 

CD-‐CP Program 

Suite 212 

47 College Street 

New Haven, CT 06510 

(203) 785-‐3377 

Family Violence Research Laboratory of University of New Hampshire (FRL) 

This organization is a pioneer in conducting research and education in the area of domestic 

and violence in childhood. Since 1975, the Family Research Laboratory (FRL) has devoted itself 

primarily to understanding family violence and the impact of violence in families. This organization 

and its website are a highly recommended resource for quality research, reviews and thoughtful 

policy and practice recommendations. 

As public and professional interest in family violence has grown, so has the need for more 

reliable knowledge. The FRL has tried to fill that need in a variety of ways: through comprehensive 

literature reviews, new theories, and methodologically sound studies. Researchers at the FRL 

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pioneered many of the techniques that have enabled social scientists to estimate directly the 

scope of family violence. These efforts have brought international recognition to the FRL. 

FRL 

126 Horton Social Science Center 

Durham, NH 03824-‐1888 

(603) 862-‐1888 

Fax: (603) 862-‐1122 

E-‐mail: mas2@christa.unh.edu 

http://www.unh.edu/frl 

Zero to Three is a national, nonprofit organization located in Washington, D.C., dedicated 

solely to advancing the healthy development of babies and young children. Founded in l977 by 

top developmental experts, ZERO TO THREE disseminates key developmental information, trains 

providers, promotes model approaches and standards of practice and works to increase public 

awareness about the significance of the first three years of life. 

Zero to Three 

734 15th Street, NW, Suite 1000 


(202) 638-‐1144. 

http://www.zerotothree.org 

PACT, An Adoption Alliance A nonprofit 501(c)(3) organization begun by two adoptive parents 

in 1991, Pact has developed a national reputation for excellence in serving all members of the 

adoption triad. Each year, Pact offers educational events attended by more than 1500 individuals, 

provides -‐ free of charge -‐ over 1000 crisis consultations to birth parents, and consults with 

hundreds of potential adoptive parents. Top priority is given to programs especially designed to 

support and inform adopted children and adopted adults of color. 

PACT 

3450 Sacramento Street Suite 239 

San Francisco, CA 94118 

(415) 221-‐6957 

(510) 482-‐2089 FAX 

e-‐mail: info@pactadopt.org 

http://www.pactadopt.org 

Attachment Parenting International is a coalition of concerned individuals, professionals, 

and grassroots organizations. They advocate special "attachment parenting" methods to 

develop and fulfill a child's need for trust, empathy, and affection in order to create secure and 

enduring relationships. This organization feels that attachment parenting, in conjunction with 

support groups can not only strengthen families but provide a simple and cost-‐effective model 

to aid in the prevention of child abuse, behavioral disorders, criminal acts, and other serious social 

problems. 

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Attachment Parenting International 

1508 Clairmont Place 

Nashville, Tennessee 37215 

(615) 298 4334 

http://www.attachmentparenting.org 

Resources on the Brain 

Society for Neuroscience is the world's largest organization of scientists and physicians 

dedicated to understanding the brain, spinal cord and peripheral nervous system. This site 

has a number of very useful materials for professionals without specific expertise in the 

neurosciences. The educational programs and materials are well written, clear and accurate; overall 

an excellent resource. 

Society for Neuroscience 

11 Dupont Circle, N.W., Suite 500 

Washington D.C. 20036 

(202) 462-‐6688 

http://www.sfn.org 

info@sfn.org 

The Human Brain: Dissections of the Real Brain 

You really want to see what the brain looks like? This site has a well-‐presented 

dissection of the human brain. It is a useful way to see what these areas really look like. 

Visit this site and admire the work of Terence H. Williams, M.D., Ph.D., D.Sc.. Nedzad 

Gluhbegovic, M.D., Ph.D. and Jean Y. Jew, M.D. 

http://www.vh.org/Providers/Textbooks/BrainAnatomy/BrainAnatomy.html 

The Amazing Human Brain and Human Development -‐-‐ A Free, Online Course 

Course author and instructor Dr. Bruce Perry, M.D., Ph.D. has created brief lessons with practical 

information to help professionals and caregivers understand this and other interesting topics. 

Participants can discuss course content with fellow students and Dr. Perry online via the message 

boards. The self-‐paced courses are offered at no cost to participants. Simply register as a 

student at www.ChildTraumaAcademy.com, enroll in the course or courses of your choice and 

return to complete each lesson at your leisure 

Enroll now! 

http://www.childtrauma.org 

Brainy Babies: Build & Develop Your Babys Intelligence 

By Robin Fancourt, M.R.C.P. F.R.A.C.P. 

In this ground-‐breaking new book, Dr. Robin Fancourt takes the reader on a fascinating journey, 

from conception through the early years, that unravels the mysterious process of how babies 

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learn, understand and relate to others, become confident and succeed. By understanding how 

the brain works, we can enrich the lives children in so many ways. 

Dr. Robin Fancourt is a pediatrician with a special interest in young children, and those abused, 

neglected and disadvantaged. She has held several important positions, from President of DSAC 

(Doctors for Sexual Abuse Care) to founding and being the inaugural chairperson of Children's 

Agenda, a national organization providing advocacy for children. She is also an executive member 

of the council for ISPCAN (International Society for the Prevention of Child Abuse and Neglect). 

Dr. Fancourt has also been central in the setting up of BrainWave, a national trust to disseminate 

information and lobby parliament for resources for early childhood. 

Available online through Penguin Books Australia 

http://www.penguin.com.au/ 

ISBN: 0140296921 

The Traumatic Stress Institute/ Center for Adult and Adolescent Psychotherapy is located 

in South Windsor, Connecticut and has a dual mission: (1) to promote understanding and 

improve treatment of traumatic stress and (2) to promote psychology as a discipline and profession. 

This Institute has developed some very useful resources for professionals struggling with 

secondary traumatic stress. 

The Traumatic Stress Institute/ 

Center for Adult and Adolescent Psychotherapy 

22 Morgans Farms Road 

South Windsor, Connecticut 06074 

(860) 644-‐2541 

http://www.tsicaap.com 

The Traumatology Institute is the home of psychologist, Dr. Charles Figley, a pioneer in the 

field of compassion fatigue or secondary trauma. Dr. Figley is the founding Editor of the Journal 

of Traumatic Stress and has written many articles and books on compassion fatigue or secondary 

traumatic stress. 

The Traumatology Institute 

School of Social Work 

Florida State University 

C2500 University Center 

Tallahassee, Florida 32306-‐2570 

(850) 644-‐4751 

http://learningforlife.fsu.edu/traumatology 

International Society for Traumatic Stress Studies (ISTSS), founded in 1985, provides a forum 

for the sharing of research, clinical strategies, public policy concerns and theoretical formulations 

on trauma in the United States and around the world. ISTSS is dedicated to the discovery and 

15



dissemination of knowledge and to the stimulation of policy, program and service initiatives that 

seek to reduce traumatic stressors and their immediate and long-‐term consequences. 

ISTSS 

60 Revere Drive, Suite 500 

Northbrook, Illinois 60062 USA 

(847) 480-‐9028 

Fax: (847) 480-‐9282 

http://www.istss.org 

National Council of Juvenile and Family Court Judges 

The National Council's began in 1937 when a group of leading judges sought to bring 

together judicial officers working with in Juvenile and Family Courts. The purpose was two-‐fold: 

to focus attention on the concept of a separate tribunal for children and to encourage the development 

of essential treatment programs for children with special needs. 

Juvenile law has changed dramatically since then, and so, too, has the National Council. 

Increased awareness and sensitivity to children's issues have given the Council the insight 

to provide meaningful assistance to judges, court administrators and related professionals 

in whose care the concerns of children and their families have been entrusted. Consequently, 

the Council is not only the nation's oldest judicial membership organization, it is also the largest. 

NCJFCJ 

P.O. Box 8970 

Reno, NV 89507 

(702) 784-‐6628 

(702) 784-‐4858 Fax 

http://www.ncjfcj.unr.edu/ 

National Association of Counsel for Children (NACC) is a non-‐profit professional 

membership organization dedicated to quality representation and protection of children in 

the legal system. The purpose of the NACC is to assist attorneys and other professionals 

in their work with children in the legal system. At the same time, the NACC carries out a Policy 

Agenda designed to improve the legal system for children. 

NACC 

1825 Marion Street, Suite 340 

Denver, CO 80218 

888/828-‐NACC 

advocate@NACCchildlaw.org 

http://naccchildlaw.org/ 

ABA Center on Children and the Law 

16



Established in 1978, the ABA Center on Children and the Law's mission is to improve children's 

lives through advances in law, justice, knowledge, practice, and public policy. Its work includes: 

• Strengthening laws, policies, and judicial procedures affecting children 

• Researching and disseminating information on laws, policies, and practices affecting children/families 

• Enhancing skills and competence of legal professionals in children's proceedings 

• Educating non-‐attorneys on child-‐related law and its impact on their work 

• Increasing public awareness of law and justice related to children 

• Stimulating and assisting activities and projects on children and the law 

Center on Children and the Law 

740 15th Street, NW 


(202) 662-‐1720 

(202) 662-‐1755 Fax 

http://www.abanet.org/child/home.html 

This page on the their website is particularly useful as a resource. 

http://www.abanet.org/child/links.html 

What Exactly Is Trauma? 

A trauma is a psychologically distressing event that is outside the range of usual human 

experience. Trauma often involves a sense of intense fear, terror, and helplessness. 

Trauma should not be confused with stress. As we will learn later, stress is an inevitable 

component of everyone's life. Trauma is an experience that induces an abnormally intense and 

prolonged stress response. 

Simply by signing up for this course, you have expressed an interest in childhood trauma and 

perhaps count yourself or someone you love among the statistics cited above. Maybe you know 

a child who is a victim of childhood trauma, or are an adult still grappling with your own 

experience. 

No matter what brings you here, take a moment now and identify someone or some event in 

your life or work that makes this issue real. While you take this course, your own experiences 

with traumatic events and with children or families impacted by trauma will provide the true 

context for learning. 

17



Introduction to Childhood Trauma 

Traumatic experiences can have a devastating impact on a child, altering his or her physical, 

emotional, cognitive, and social development. In turn, the impact on the child has profound 

implications for his or her family, community and, ultimately, all of us. Caregivers, childcare 

providers, teachers, law enforcement, child protection workers, social workers, judges, nurses, 

pediatricians, and mental health service providers all will work with traumatized or maltreated 

children. 

Now that we have reviewed some of the disheartening information, let's hear some good news. 

With treatment, the effects of childhood trauma can be alleviated. Early and aggressive 

treatment of traumatized children decreases risk for developing PTSD and other trauma-‐related 

problems seen later in life. 

Treatments usually incorporate three elements: 

1. Review and recollection of the traumatic experience 

2. Information about the normal and expected processes of post-‐traumatic functioning 

3. Focus on specific symptoms 

Despite the positive effects we know treatment has on trauma sufferers, the unfortunate 

reality is that most traumatized children do not get any help whatsoever. There is a dangerous 

belief among adults that children are "resilient" and can weather trauma naturally. Those 

children who do get services often have limited access and brief contacts. Early and sustained 

treatment for children who have suffered trauma is important if the long-‐term effects are to be 

avoided. 

The Alarm Reaction 

The human body and human mind each have a set of very important and very predictable 

responses to threat. Threat may come from an internal source, such as pain, or an external 

source, such as an assailant. One common reaction to danger or threat has been labeled the 

"fight or flight" reaction. In the initial stages of this reaction, there is a response called the 

alarm reaction . 

Think about what happens when you feel threatened. Your racing heart, sweaty palms, nausea, 

and sense of impending harm are all symptomatic of this alarm reaction. 

18



When a person perceives a threat, the initial stages of a complex, total-‐body response will 

begin. The brain orchestrates, directs, and controls this response. The more threatened an 

individual feels, the further their brain and body will be shifted along an arousal continuum in 

an attempt to ensure appropriate mental and physical responses to the challenges of the 

threat. The cognitive (thinking), emotional, and behavioral functioning of the individual will all 

reflect this shift along the arousal continuum. 

During the traumatic event, all aspects of the individual's functioning change, including feeling, 

thinking, and behaving. For instance, someone under direct assault abandons thoughts of the 

future or abstract plans for survival. At that exact moment, all of the victim's thinking, 

behaving, and feeling is being directed by more primitive parts of the brain. 

A frightened child in a threatening situation doesn't focus on the words being spoken or yelled; 

instead, he or she is busy attending to the threat-‐related signals in their environment. The 

fearful child will key in to nonverbal signs of communication, cues such as eye contact, facial 

expression, and body posture, or proximity to the threat. 

The internal state of the child also shifts with the level of perceived threat. With increased 

threat, a child moves along the arousal continuum from vigilance through to terror. (See the 

above graph for different possible response scenarios.) 

The Arousal Continuum 

The arousal continuum is characterized by many physiological changes. Under threat, 

sympathetic nervous system activity increases in a gradual fashion. Heart rate, blood pressure, 

and respiration are altered during the arousal response. Glucose stored in muscle is released to 

prepare the large skeletal muscles of your arms and legs for either a fight or a flight. 

19



These changes in the central nervous system cause hypervigilance; under threat, the child tunes 

out all non-‐critical information. These actions prepare the child to do battle with or run away 

from the potential threat. 

This total body mobilization -‐-‐ the fight-‐or-‐flight response -‐-‐ has been well characterized and 

described in great detail for adults. These responses are highly adaptive and involve many 

coordinated and integrated neurophysiological responses across multiple brain areas, including 

the brainstem nuclei responsible for autonomic nervous system regulation. 

What Does Hyperarousal Really Mean? 

Hyperarousal is a multi-‐dimensional process characterized by both mental and physical 

changes. These include an increase in the activity of those parts of the central and peripheral 

nervous system responsible for the perception and processing of potentially threatening 

information . This graded response also involves action. 

During the hyperarousal process, many physiological systems required for survival are activated 

(e.g., stress response hormones such as cortisol and adrenaline). The many physiological 

changes during hyperarousal will influence the way a person thinks, feels, and acts. 

The Psychology and Physiology of Trauma 

The fight-‐or-‐flight response is a well-‐characterized reaction to danger, as we've already 

discussed. A second common reaction pattern to threat is dissociation. Dissociation is the 

mental mechanism by which one withdraws attention from the outside world and focuses on 

the inner world. 

It is increasingly clear that responses to threat can vary tremendously from individual to 

individual. This second major adaptation response to threat involves an entirely different set of 

physiological and mental changes, yet does not fall under the heading of either fight or flight. 

Many common and "normal" mental and emotional states such as anxiety, dissociation, or 

anger are experienced by most of us to some degree. When any one of these becomes 

pervasive and ever-‐present, however, it begins to interfere with the rest of one's life. This can 

happen with dissociation and anxiety. When it does wBecause of their small size and limited 

physical capabilities, young children do not usually have the fight-‐or-‐flight option in a 

threatening situation. When fighting or physically fleeing is not possible, the child may use 

avoidant and psychological fleeing mechanisms that are categorized as dissociative. 

Dissociation due to threat and/or trauma may involve a distorted sense of time or a detached 

feeling that you are observing something happen to you as if it is unreal -‐-‐ the sense that you 

may be watching a movie of your life. In extreme cases, children may withdraw into an 

elaborate fantasy world where they may assume special powers or strengths. 

20



Like the alarm response, this "defeat" or dissociative response is graded along a continuum. The 

intensity of the dissociation varies with the intensity and duration of the traumatic event. 

(Remember that even when we are not threatened, we use dissociative mental mechanisms, 

such as daydreaming, all of the time.) During a traumatic event, all children and most adults use 

some degree of dissociation. However, some individuals will use, or experience trauma that 

induces dissociation as a primary adaptive response. 

For most children and adults the adaptive response to an acute trauma involves a mixture of 

hyperarousal and dissociation. During the actual trauma, the child feels threatened and the 

arousal systems will activate. With increased threat, the child moves along the arousal 

continuum. At some point along this continuum, the dissociative response is activated and a 

host of protective mental (decreased perception of anxiety and pain) and physiological 

responses (decreased heart rate) occur (see Figure 3-‐4 below). 


The following points are an overview of human response to threat and trauma. Don't worry if 

you don't grasp all the concepts at first reading. We will be discussing these issues in greater 

detail as we move through our course. Consider this a preview of sorts. 

• The brain mediates threat with a set of predictable neurobiological, neuroendocrine, 

and neuropsychological responses. 

• These responses may include different survival strategies -‐-‐ ranging from fighting or 

fleeing to giving up or surrendering. 

• There are multiple sets of neurobiological and mental responses to stress. These vary 

with the nature, intensity, and frequency of the event. Different children may have 

unique and individualized sets of responses to the same trauma. 

• Two primary adaptive response patterns in the face of extreme threat are the 

hyperarousal continuum (defense -‐-‐ fight or flight) and the dissociation continuum 

(freeze and surrender response). Each of these response sets activates a unique 

combination of neural systems. 

21



• These response patterns are somewhat different in infants, children, and adults -‐-‐ 

though they share many similarities. Adult males are more likely to use hyperarousal 

(fight or flight) response, while young children are more likely to use a dissociative 

pattern (freeze and surrender) response. 

• In general, the predominant adaptive style of an individual in the acute traumatic 

situation will determine which post-‐traumatic symptoms will develop: hyperarousal or 

dissociative. 

Exercise: Catalog Your Alarm Response Patterns 

Think back to the last time you felt threatened in some way and your alarm state was activated. 

Perhaps you were walking down a dark street one night and heard footsteps close behind you. 

Perhaps you were attending a football game one afternoon when some beer-‐swilling fans next 

to you began a fight with a fan of the opposing team seated in the row behind you. 

Pick two or three events from your life where you felt some element of threat. For each, make 

two columns. In the first column, list the emotional and mental changes you remember -‐-‐ for 

example, a sense of unreality, intense fear, or tuning out the world. In the other, list the 

physical symptoms such as racing heart, sweaty palms, or light-‐headedness. What physical 

symptoms do you recall emerging as your brain sent the signal to your body that a threat was 

near? Did you want to run? Did you feel an adrenalin surge in preparation for possible self-‐ 

defense? 

Visualize your body and make a mental list, from head to toe, of every physiological response to 

the perceived threat that occurred. 

This can illustrate two key points: 1) you probably had a slightly different set of adaptive 

changes in each event and 2) the mental (i.e., psychological) and body (i.e., physiological) 

changes are interrelated, interdependent, and, in fact, components of the same 

neurophysiological response to threat. It is not useful or accurate to think of "psychological" vs. 

"physical" responses. 


Different children have different styles of adaptation to threat. Some children use a primary 

hyperarousal response, while others adapt a primary dissociative response. Most children, 

however, adopt some combination of these two adaptive styles. 

In the fearful child, a defiant stance is often seen. This is typically interpreted as a willful and 

controlling child. Rather than understanding the behavior as related to fear, adults often 

respond to the "oppositional" behavior by becoming angrier and even more demanding. 

22



The child, over-‐reading the nonverbal cues of the frustrated and angry adult, feels more 

threatened and moves from alarm to fear to terror. These children may end up in a primitive 

"mini-‐psychotic" regression or in a very combative state. Their behavior of the child reflects 

their attempts to adapt and respond to a perceived (or misperceived) threat. 

Hyperarousal 

Continuum 

Dissociative 

Continuum 

Regulating 

Brain Region 

Cognitive 

Style 

Internal 

State 

REST VIGILANCE RESISTANCE 

Crying 

REST AVOIDANCE COMPLIANCE 

Robotic/detached 

NEOCORTEX 

Cortex 

When the Trauma Ends 

CORTEX 

Limbic 

LIMBIC 

Midbrain 

DEFIANCE 

Tantrums 

AGGRESSION 

DISSOCIATION 

Fetal Rocking FAINTING 

MIDBRAIN 

Brainstem 

BRAINSTEM 

Autonomic 

ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE 

CALM AROUSAL ALARM FEAR TERROR 

As the traumatic event ends, the phase known as the acute post-‐traumatic period begins. 

During this time, the mind and body slowly move back down the arousal or dissociative 

continuum. The child moves from the brink of terror through fear, alarm, and, with time and 

support, back to calm (see Figure 2-‐2 above). Heart rate, blood pressure, and other 

physiological adaptations normalize. 

If a child can move back down the arousal continuum, his or her brain will resume baseline 

(pre-‐trauma) styles of thinking, feeling, and behaving. Hypervigilance decreases and the mental 

mechanisms related to attention begin to normalize as well. The child that has dissociated will 

begin to pay attention once again to external stimuli. 

Conversely, the child that has been completely focused on external cues related to threat will 

actually pay attention once again to internal stimuli (e.g., feelings, thoughts, sensing their 

pounding heart, or noticing the cut on their leg from diving under a desk during a shooting). 

Making Sense of the Event 

During this acute post-‐traumatic period, the child will now perceive the sense of fear and 

anxiety. This is when they will actually feel the fear associated with the trauma. The 

individual will begin to process and think about what has happened, attempting to make 

sense out of the events just experienced. Because the traumatic event is so far out of the 

23



normal range of experience, there will be a variety of mental attempts to process and 

"master" this event. 

The traumatic event will play itself out in the mind of the child again and again. A host of 

intrusive images related to the trauma may swamp the child's thinking. This set of re-‐living and 

re-‐experiencing phenomena may include telling the story over and over again to friends. The 

child may act this event out in play and drawings (see below) or experience intrusions 

(flashbacks or nightmares). In essence, these children have created memories of the traumatic 

memory. 

Living With Created Memories 

The death of a loved one, for example, is a trauma that can influence memory. Over the six 

months following the loss, children (as well as adults) will often experience unusual visual, 

auditory, or tactile sensations. A child may think they hear the deceased person's voice, or they 

think they saw them in a crowd, or out of the corner of their eye they may see their reflection 

in a window. At bedtime or when awakening, these misperceptions are more common. 

Such "memories" may be disturbing to parents, caregivers, and the child. The child needs to be 

reassured when these memories of the loved one occur. These "visions" are often interpreted 

in context of a religious belief system ("They came back to tell me it was OK" or "They are still 

with me"). This can be important for the child and there is no reason to undermine these 

feelings. These "hysterical materializations" are common and often mislabeled as visual or 

auditory hallucinations. 

These types of memories are complex. Traumatic memory involves the storage and recall of 

information at several levels. The brain stores not only traditional cognitive information, such 

as who, what, when, and where, but also emotional information: feelings such as fear, dread, 

and sadness. 

The old adage that "the body remembers" is referring to motor-‐vestibular information. An 

example of this might consist of a memory of the body's position during the rape. Finally, the 

brain contains a state memory, such as vigilance or physiological hyperarousal. 

A Difficult Process 

The normal and predictable mental mechanisms that are used to process all experiences will, at 

times, fail in the attempts to master and understand a traumatic event. Because traumatic 

events have features that are so outside the range of normal experience, there are very few 

internal experiences with which to judge or make sense out of the event. 

The more outside the range of the normal experience and the more life-‐threatening the 

experience, the more difficult it will be for the normal mental mechanisms to work efficiently to 

24

Nov. 19, 2007 



process and master that experience. The inability to control elements of the traumatic event, or 

the intrusive thoughts that follow, lead to a set of predictable mental and physiological 

responses. 

Trauma may alter the stress response, even in healthy people, Cornell study shows 

By Susan Lang 

Researchers have known for years that psychological trauma that results in post-‐traumatic stress disorder (PTSD) 

or depression can change how a person responds to stress. Now, Cornell researchers report that rapes, sudden 

deaths of loved ones, life-‐threatening accidents and other such traumas may result in long-‐term changes even if 

the survivor doesn't develop a clinical disorder. 

"The findings suggest that there may be persistent differences in the stress response in some trauma-‐exposed 

people, even if they do not exhibit PTSD or depression or both, and even if their trauma was years in the past," 

said Barbara Ganzel, Cornell M.S. '99, Ph.D. '02, a lecturer in human development in Cornell's College of Human 

Ecology. 

Ganzel led a team of Cornell researchers, whose study is published in a special issue of the Journal of Traumatic 

Stress on the biology of trauma. They assessed a group of women before and after they took their medical 

admissions tests (MCATs), a stressful experience for most people. Measuring levels of a stress hormone in saliva 

(cortisol), they found that women who had experienced trauma earlier in life (but who did not have PTSD or 

major depression) had lower levels cortisol leading up to and after the MCAT exam. 

In addition, they found that the women who had experienced trauma kept a negative mood after the test, 

compared with other women, whose moods lifted significantly after the exams. 

Ganzel suspects that the stress response system in these women have compensated or changed over time. The 

trauma-‐exposed women showed lower rather than higher levels of cortisol, Ganzel theorized, because "stress 

initially boosts cortisol output but after the stressor is over, cortisol falls below normal. These data suggest that, 

in some people, it may fall below normal and stay there, or that it develops a chronic tendency to dip lower than 

normal under stress." 

The other co-‐authors are John Eckenrode, Pilyoung Kim, Elaine Wethington, all in human development at Cornell; 

25



Eric Horowitz '07; and Elise Temple, formerly of Cornell and now at Dartmouth College. 

The research was supported by the College of Human Ecology, the Family Life Development Center and the 

Laboratory for Developmental Cognitive Neuroscience at Cornell, as well as by the National Institute of Mental 

Health. 

Reduced PTSD Symptoms Lead to Reduced Substance Abuse, but Not the Other Way Around 

A new study from researchers at C.C.N.Y. (City College of New York) examined the connection 

between improvements in posttraumatic stress and improvement in substance abuse over the 

course of time in 353 women diagnosed with both conditions. 

Participants were randomly assigned to 12 sessions of either trauma-‐focused treatment or 

health education. Assessments were made on the PTS and the substance use during treatment 

at 1 week and posttreatment after 3, 6, and 12 months. 

Subjects showing no improvement, an improvement in the substance use only, or a total, global 

improvement early on, tended to maintain their original diagnosis over time; but subjects 

initially exhibiting improvement in their PTSD symptoms were significantly more likely to 

transition into a global response over time, indicating that they maintained their PTSD 

improvement, and that it was associated with subsequent improvements in substance use. 

Additionally, trauma-‐focused treatment was significantly more effective than the health 

education method in achieving substance use improvement, but only among those who were 

heavy substance users at baseline and had achieved significant PTSD reductions. 

This study concludes that reductions in PTSD severity were more likely to be associated with 

substance use improvement, but that it did not work the other way around: reductions in 

substance abuse did not lead to improved PTSD symptoms. These results support the self-‐ 

medication model of coping with PTSD symptoms, and an empirical basis for integrated 

interventions for improved substance use outcomes in patients with severe symptoms. 

Citation: Hien DA, Jiang H, Campbell AN, Hu MC, Miele GM, Cohen LR, Brigham GS, Capstick C, 

Kulaga A, Robinson J, Suarez-‐Morales L, Nunes EV. Do treatment improvements in PTSD severity 

affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA’s 

Clinical Trials Network. American Journal of Psychiatry. 2010 Jan; 167(1):95-‐101. 

Kathleen Young, Psy.D. 

http://www.leadershipcouncil.org/1/res/brain.html 

26



Mission Statement 

The Leadership Council is a nonprofit independent scientific organization composed of 

respected scientists, clinicians, educators, legal scholars, journalists, and public policy analysts. 

Our mission is to promote the ethical application of psychological science to human welfare. 

We are committed to providing professionals and laypersons with accurate, research-‐based 

information about a variety of mental health issues and to preserving society's commitment to 

protect its most vulnerable members. 

Goals 

• To develop a coalition among professionals within the scientific community, the legal 

system, the political system and the media to provide professionals and laypersons with 

accurate information about mental health practice and research which helps insure 

access to the highest quality of care. 

• To promote healing for trauma victims and their families. 

• To promote and disseminate high quality scientific and medical research concerning the 

prevalence and consequences of child abuse and other forms of interpersonal violence 

in the general population. 

• To promote public awareness of effective treatment for the psychological and 

physiological after-‐effects of interpersonal violence and other traumatic experiences in 

children and adults. 

• To provide officers of the court, the media, and public policy-‐makers with the latest 

scientific information on issues which may affect the public health and the safety of 

society's most vulnerable members, including children and those suffering from mental 

disorders. 

• To correct misinformation on psychological science used to serve vested interests or 

used as evidence in important cases affecting legal rights related to mental health 

issues. 

• To improve coordination among professionals, develop guidelines, encourage research, 

further interdisciplinary professional education, and provide guidance, support, and 

encouragement for professionals in the field of traumatic studies. 

(Basic Handout to use in your organization) 

What Is Traumatic Stress? 

Traumatic stress 

Traumatic events are shocking and emotionally overwhelming situations. It is natural for people 

who experience or witness them to have many reactions. Some of these are intense fear, 

horror, numbness, or helplessness. These events might involve actual or threatened death, 

27



serious injury, or sexual or other physical assault. They can be one-‐time occurrences, such as a 

natural disaster, house fire, violent crime, or airplane accident, or they can be ongoing, 

repeated, and relentless, as is often the case in combat or war. Child abuse and neglect, and 

other forms of domestic violence are additional examples of this. Most often trauma is 

accompanied by many losses. Unfortunately, traumatic events are quite common. 

Reactions to traumatic events vary considerably, ranging from relatively mild, creating minor 

disruptions in the person's life, to severe and debilitating. It is very common for people to 

experience anxiety, terror, shock, and upset, as well as emotional numbness and personal or 

social disconnection. People often cannot remember significant parts of what happened, yet 

may be plagued by parts of memories that return in physical and psychological flashbacks. 

Nightmares of the traumatic event are common, as are depression, irritability, sleep 

disturbance, dissociation, and feeling jumpy. 

Some of the problems people encounter after traumatic events are part of the diagnosis of 

acute stress disorder (ASD). ASD describes experiences of dissociation (e.g., feelings of unreality 

or disconnection), intrusive thoughts and images, efforts to avoid reminders of the traumatic 

experiences, and anxiety that may occur in the month following the end of the events. When 

these experiences last more than a month after traumatic experiences have stopped, they are 

described by the diagnosis of post-‐traumatic stress disorder (PTSD). 

Other equally uncomfortable problems or symptoms may exist with or instead of PTSD. For 

example, a traumatic event often challenges the person's sense of personal safety and control, 

leaving him or her feeling less secure and more vulnerable. Physical health may suffer as well, 

and individuals may notice increased feelings of fatigue, headaches, and other physical 

symptoms. Many people traumatized in childhood also experience revictimization (being 

harmed again) or aggression, identity disturbance (a feeling that you don't know who you are), 

bodily problems such as illnesses or aches and pains without detectable physical cause 

(somatization), difficulty staying on an even keel emotionally, and relationship problems. 

What can be helpful after trauma? 

It can be helpful to stay connected to natural support systems, whether they are friends, 

coworkers, family, neighbors, other familiar groups, personal beliefs, or community. Taking care 

of basic needs is important after trauma. This includes trying to get enough sleep, eating well, 

exercising, drinking enough water and juice, and avoiding alcohol and caffeine. Keeping to 

routines and activities if possible, and finding ways to assist someone else, can be helpful for 

many. And it is particularly important to know you can ask for help. 

How to decide whether you need help 

People who have had traumatic life experiences cope the best way they can with their 

memories and painful effects. For many people, reactions gradually diminish. Some find it 

helpful to talk about what happened and their feelings, to get support from people who can be 

trusted, or to be involved in other activities that help them to reconnect with people and find 

28



meaning in their lives. But for some people, the symptoms and disturbing reactions persist or 

even worsen. This can lead people to find ways to cope that are not so helpful, such as 

withdrawing from friends and family, using drugs or alcohol, or avoiding activities that are 

empowering. It is important to consider seeking help if important areas of life, such as 

relationships, work, or school, are being affected by traumatic stress. Likewise, people who 

become more and more depressed or anxious or for whom the use of alcohol or other drugs 

increases significantly may need treatment. Some traumatized people speak over and over 

about traumatic events without relief of symptoms. These people may benefit from treatment. 

Treatment options 

There are many types of treatment for traumatic stress, from individual therapy to support 

groups. Interpersonal, relational, and psychodynamic psychotherapies, which focus on the 

meaning of trauma and how it has affected relationships, may help people understand the 

source of their current problems and how these relate to their traumatic experiences. For 

some, medication can be effective. Also, anxiety management, cognitive therapy (focusing on 

thoughts and beliefs), and exposure therapy (helping the person confront painful memories and 

situations that are realistically safe although still frightening, through talking about or imagining 

them) are helpful for reducing PTSD and related reactions. A combination of psychotherapy and 

medication is often helpful for depression and anxiety following traumatic experiences. 

No single treatment is effective for everyone, and it may take time to find the right treatment. 

There also may be difficult periods in any treatment. Therefore, it is important to find a trained 

psychotherapist or physician, preferably one with experience treating people with traumatic 

stress, who can work together with the survivor to find a treatment approach that makes sense 

for the individual. A comfort with language, cultural considerations, and style of expression may 

enhance rapport in treatment. 

Where to go for help 

For people who wish to consider psychotherapy, a family doctor, clergy person, local mental 

health association, state psychiatric, psychological, or social work association, or health insurer 

may be helpful in providing a referral to a counselor or therapist with experience in treating 

people affected by traumatic stress. 

For more information about traumatic stress or the International Society for Traumatic Stress 

Studies, call 847-‐480-‐9028. 

Brief Checklist of Trauma Symptoms 

Check the symptoms below that you experience (that may or may not be related to a traumatic 

event) and make notes as needed: 

29



I experienced or witnessed a traumatic event during which I felt extreme fear, helplessness, or 

horror. 

The event happened on (day/month/year)_______________. 

What happened?________________________________________. 

• 1) I have symptoms of re-‐experiencing or re-‐living the traumatic event: 

o Bad dreams or nightmares about the event or something similar 

o Behaving or feeling as if the event were actually happening all over again (this is 

known as having flashbacks) 

o Having a lot of emotional feelings when I am reminded of the event 

o Having a lot of physical sensations when I am reminded of the event (e.g., my 

heart races or pounds, I sweat, find it hard to breathe, feel faint, feel like I'm 

going to lose control) 

• 2) I have symptoms of avoiding reminders of the traumatic event: 

o Avoiding thoughts, conversations, or feelings that remind me about the event 

o Avoiding people, places, or activities that remind me of the event 

o Having difficulty remembering some important part of the event 

• 3) I have noticed that since the event happened: 

o I have lost interest in, or just don't do, things that used to be important to me 

o I feel detached from people; I find it hard to trust people 

o I feel emotionally "numb" and I find it hard to have loving feelings even toward 

those who are emotionally close to me 

o I have a hard time falling or staying asleep 

o I am irritable and have problems with my anger 

o I have a hard time concentrating 

o I think I may not live very long and feel there's no point in planning for the future 

o I am jumpy and get startled easily 

o I am always "on guard" 

• 4) I experience these medical or emotional problems: 

o Stomach problems 

o Intestinal problems 

o Gynecological problems 

o Weight gain or loss 

o Chronic pain (e.g., in my back, neck, pelvic area (in women)) 

o Problems getting to sleep 

o Problems staying asleep 

o Headaches 

o Skin rashes and other skin problems 

o Irritability, a quick temper, and other anger problems 

30



o Nightmares 

o Depression 

o Lack of energy, chronic fatigue 

o Alcoholism and other substance use problems 

o General anxiety 

o Anxiety (panic) attacks 

o Other symptoms such as: ______________________________ 

Other questions that you may want to ask your doctor or counselor: 

• "What do people have to do to recover from PTSD?" 

• "Why do I have PTSD and other people don't?" 

• "Does having PTSD mean that I'm crazy or mentally ill?" 

• "What will happen if I go for treatment?" 

• "How long will treatment last?" 

• "What will be the likely effects of treatment?" 

• "What should I tell my spouse/partner/other family members about PTSD?" 

• If medication treatment is discussed, you may want to ask some of these questions: 

• "How is this medication supposed to help me?" 

• "How will it affect my symptoms?" 

• "How long will I have to take it?" 

• "Can I stop it if I don't like it?" 

• "How will we know if it is working?" 

• "What will happen if it doesn't work?" 

• "What are the side effects of the medication?" 

• "How will it affect the other medications that I'm taking?" 

• "Why do I need to go for counseling if I'm receiving medication treatment?" 

• "How will medication treatment fit in with my PTSD counseling?" 

• "How will medication affect my substance abuse recovery?" 

Again, if you think you have PTSD, or even just some of the symptoms, it is important for you 

to let your primary care physician know. This information is invaluable for planning your 

medical treatment. It can also help your doctor provide you with appropriate referrals for 

other services (e.g., to a psychologist, a therapist, social worker, child abuse protective 

services, lab tests, etc.). 

31



TSC-‐40 

How often have you experienced each of the following in the last two months? 

0 = Never 3 = Often 

1. Headaches 0 1 2 3 

2. Insomnia (trouble getting to sleep) 0 1 2 3 

3. Weight loss (without dieting) 0 1 2 3 

4. Stomach problems 0 1 2 3 

5. Sexual problems 0 1 2 3 

6. Feeling isolated from others 0 1 2 3 

7. "Flashbacks" (sudden, vivid, distracting memories) 0 1 2 3 

8. Restless sleep 0 1 2 3 

9. Low sex drive 0 1 2 3 

10. Anxiety attacks 0 1 2 3 

11. Sexual overactivity 0 1 2 3 

12. Loneliness 0 1 2 3 

13. Nightmares 0 1 2 3 

14. "Spacing out" (going away in your mind) 0 1 2 3 

15. Sadness 0 1 2 3 

32



16. Dizziness 0 1 2 3 

17. Not feeling satisfied with your sex life 0 1 2 3 

18. Trouble controlling your temper 0 1 2 3 

19. Waking up early in the morning and can't get back to 

sleep 

0 1 2 3 

20. Uncontrollable crying 0 1 2 3 

21. Fear of men (women) 0 1 2 3 

22. Not feeling rested in the morning 0 1 2 3 

23. Having sex that you didn't enjoy 0 1 2 3 

24. Trouble getting along with others 0 1 2 3 

25. Memory problems 0 1 2 3 

26. Desire to physically hurt yourself 0 1 2 3 

27. Fear of women 0 1 2 3 

28. Waking up in the middle of the night 0 1 2 3 

29. Bad thoughts or feelings during sex 0 1 2 3 

30. Passing out 0 1 2 3 

31. Feeling that things are "unreal” 0 1 2 3 

32. Unnecessary or over-‐frequent washing 0 1 2 3 

33



33. Feelings of inferiority 0 1 2 3 

34. Feeling tense all the time 0 1 2 3 

35. Being confused about your sexual feelings 0 1 2 3 

36. Desire to physically hurt others 0 1 2 3 

37. Feelings of guilt 0 1 2 3 

38. Feelings that you are not always in your body 0 1 2 3 

39. Having trouble breathing 0 1 2 3 

40. Sexual feelings when you shouldn't have them 0 1 2 3 

34



Trauma Symptom Checklist -‐ 40 (TSC-‐40) 

Subscale composition and scoring for the TSC-‐40 The score for each subscale is the sum of the 

relevant items, listed below: 

Dissociation: 7,14,16,25,31,38 

Anxiety: 1,4,10,16,21,27,32,34,39 

Depression: 2,3,9,15,19,20,26,33,37 

SATI (Sexual Abuse Trauma Index): 5,7,13,21,25,29,31 

Sleep Disturbance 2,8,13,19,22,28 

Sexual Problems 5,9,11,17,23,29,35,40 

TSC-‐40 total score: 1-‐40 

The results are indicators only. Only after a safe therapeutic relationship has been established 

should a diagnosis be made. 

(Briere Trauma Screen) 

If you have any further questions, please contact: 

Karina Forrest-‐Perkins MHR LADC 

Executive Director 

Prevent Child Abuse Minnesota 

651-‐523-‐0099 ext 117. 

Kforrest-‐perkins@pcamn.org 

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