Surviving a major disaster or suffering major burns are readily identifi able as severe traumatic events that may lead to the development of acute psychological distress and/or chronic psychological morbidity. However, so too can more commonplace traumatic events such as motor vehicle accidents (MVAs) or assaults. A PTE may affect not just those directly involved but potentially also those witnessing or confronted by the event.
Research has shown that it is the perception of the individual that determines if the PTE was traumatic or not – not a witness or a clinician. This is further highlighted by evidence that even under the most extreme circumstances many individuals do not develop PTSD, whilst an individual with sufficient vulnerability may develop PTSD after what appears an event of low magnitude; factors such as coping style and locus of control are also important. Therapy then must aim to clear the unresolved distress and disorder whether or not the precipitating event would be experienced by anyone else as adverse. This is likely the case for childhood adverse events, as experiences of loss or humiliation that are readily brushed off by one person may haunt another for decades and impair functioning in one or more life domain.
Chronic adversity in early life, with hypervigilance for threats to survival and to boundary intrusions, accompanied by extremes of terror, isolation, obstructed rage, pain, disgust and shame, are likely the non-conflict childhood equivalent of persistent and intense stress exposure. The impact on a developing and maturing brain suggests that almost invariably the post-traumatic response is both complex and polysymptomatic requiring approaches incorporating stabilisation, resourcing, processing and integration simultaneously throughout the therapy process to enable healing.
The concepts of Type 1 and Type 2 trauma were proposed by Terr (1991) and remain highly influential definitions for categorising PTEs into single sudden events, well-defined and more public trauma (e.g., motor vehicle accidents; type 1), and multiple, serial trauma often of different types frequently occurring over protracted periods and committed covertly by person(s) close to the individual, who is often (but not always) a child (e.g., neglect, abuse; type 2). Herman (1992) noted that “ . . . in contrast to the circumscribed traumatic event, prolonged, repeated trauma can occur only when the victim is in a state of captivity, unable to flee, and under control of the perpetrators.”
It is clear the PTEs experienced by children are largely in their immediate social environment, and that such families likely have other risk factors. Whilst many factors (such as chronicity, physical violation or betrayal of trust) contribute to the number, complexity and severity of post-trauma symptoms experienced by children, the exposure to a greater breadth of types of victimisation is particularly influential in the development of complex disorders (Finkelhor et al., 2009). Children who experience abuse may be less able to calibrate the severity of the threat in terms of survival; the complete withdrawal of the attention of a benign caregiver in itself could pose a major survival threat. In terms of the basic mammalian affects (Panksepp, 1998), PANIC/GRIEF stimulate SEEKING of attachment and any adult, no matter how otherwise abusive, may appear better than none to the infant. In CRM, the core survival terror encountered relates directly to the affectively loaded thought “ I am going to die” or less directly through: “ I am not loved by my parents”, “I do not exist” or “ I am a failure as a human being”. The child does not have the developed emotion regulation capacities of a mature adult with a fully developed neocortex. For example, the ability to use cognitive reappraisal for the regulation of emotions increases with the capacity of the individual to engage the left ventrolateral prefrontal cortex as they mature (McRae et al., 2012).
(Excerpted from) The Comprehensive Resource Model: Effective Therapeutic Techniques for the Healing of Complex Trauma, written by Lisa Schwarz, Frank Corrigan, Alastair Hull and Rajiv Raju, published by Routledge, 2017