The trauma spectrum: The interaction of biological and social events in the genesis of the trauma response

Abstract

When Kardinerfirst described the full syndrome of what is now called PTSD in 1941, he called the trauma response a 'physioneurosis," that is, a mental disorder which affects both the soma and the psyche. Now, more than 40 years later much knowledge has been gained about the biological effects of traumatization. Based on the studies of disruptions of attachment bonds innon-human primates, the animal model of inescapable shock, and numerous studies of traumatized children and adults, we are beginning to understand the nature of the biological changes which underlie the psychological response to trauma. This paper will explore (I) the nature of the biological alterations in response to traumatization, (2) how these biological shifts depend on the maturation of the central nervous system (CNS), cognitive processes, and the social matrix in which they occur, (3) and how these alterations can influence psychopathological and interpersonal processes. 274van der Kolk fects both the soma and the psyche. Noting that sufferers from PTSD continue to live in the emotional atmosphere of the traumatic event, he ascribed to them an enduring vigilance for and sensitivity to environmental threat. A stressor becomes traumatic when it overwhelms both psychological and biological coping mechanisms. This paper will examine how closely the psychological and biological dimensions of traumatization are intertwined and explore (1) the nature of the biological alterations in response to traumatization, (2) how these biological shifts depend on the maturation of the central nervous system (CNS), cognitive processes, and the social matrix in which they occur, (3) and how these alterations can influence psychopathological and interpersonal processes. THE NATURE OF THE BIOLOGICAL SHIFTS ASSOCIATED WITH TRAUMAPost-traumatic stress disorder has been described as phasic alteration between intrusive and numbing responses (Lindemann, 1942;Horowitz, 1976). This consistent pattern of hyperarousal alternating with numbing has been noticed following such a vast array of different traumas, such as combat, rape, kidnapping, spouse abuse, natural disasters, accidents, concentration camp experiences, incest, and child abuse, that it is reasonable to assume a biological substrate . Contemporary research suggests that the intensity of the initial physiological response to the trauma is the most significant predictor of long-term outcome (Kilpatrick et al., 1985;Holen, 1987;McCahill et al., 1979). Freud (1919) may have been on the mark when he postulated that "the traumatic neurosis [is] a consequence of an extensive breach being made in the protective shield against stimuli." During the second world war, Grinker and Spiegel(l945) observed that the severity of "combat fatigue" was related to what we now understand to be symptoms of catecholamine depletion, such as masked face, cogwheel rigidity, and tremor. Kolb (1987) has recently reviewed the numerous studies which demonstrate increased autonomic arousal in combat veterans with PTSD. The enduring nature o...

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