Trauma (psychology)

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A psychological injury is referred to as psychological , emotional or mental trauma or psychotrauma ( plural trauma , trauma ; Greek wound , τραύμα). The word trauma comes from the Greek and generally means injury without specifying what caused it. In medicine, the term trauma is used to describe a physical wound that was caused by an accident or violence. This use has been documented since the 19th century. Similarly, in psychology, a strong psychological shock caused by a traumatizing experience is called psychotrauma . The term is not used uniformly and can designate the triggering event, but also the symptoms or the internal suffering that has been caused. Mental trauma plays a central role in the development of mental disorders.

Use of terms

Traumatic events can be, for example, natural disasters , wars, hostage-taking , rape or accidents with the threat of serious injuries. And also, for example, war experiences , kidnappings, terrorist attacks, torture, camp detention, political detention or violent attacks on yourself. These events can cause extreme stress in a person and create feelings of helplessness or horror. The anxiety and stress tension that this causes in people can subside by itself in the majority of those affected, with these people's behavior also changing. Overcoming the trauma made them grow. Richard G. Tedeschi and Lawrence G. Calhoun have defined the term post-traumatic growth for this . In special cases, however, when this increased stress level persists over a long period of time and there is no way to process the experiences adequately, it can lead to the development of sometimes intense psychological symptoms . In around a third of those affected, the painful memory is accompanied by a mental illness that causes additional suffering. The best known of these clinical pictures is the so-called post - traumatic stress disorder (PTSD). But other clinical pictures can also occur after trauma.

There has been an inflationary use of the term in everyday language, and the term trauma is often used in connection with all particularly negative or painful experiences. In the medical or psychological literature, however, this term is defined much more narrowly and refers exclusively to events that could trigger subsequent psychological disorders.

Psychological trauma is the scientific subject of psychotraumatology .

Concepts that deal with overcoming trauma include resilience , salutogenesis, and hardiness .

Definitions

  • Fischer and Riedesser define trauma in their textbook on psychotraumatology (p. 79) as:

"[...] a vital experience of discrepancy between threatening situation factors and the individual coping options, which is accompanied by feelings of helplessness and defenseless exposure and thus causes a permanent shock to the understanding of oneself and the world."

  • The ICD-10 medical classification system and associated diagnostic guides describe the trauma criterion as:

"[...] a stressful event or a situation of shorter or longer duration, with an extraordinary threat or catastrophe-like extent, which would cause deep despair in almost everyone (ICD-10) (e.g. natural disaster or humanly caused catastrophe - man- made disaster - combat deployment, serious accident, observation of the violent death of others or victim of torture, terrorism, rape, mistreatment or other crimes). "

History of the descriptions

Possibly the first description of traumatic events can be found in the Gilgamesh epic , which was written about 5000 years ago: I dreaded the appearance of my friend, I was terrified of death, that I ran into the steppe! ... Oh, how am I supposed to stay silent? Oh, how be silent? My friend I loved has become earth! According to the epic, this is how the Babylonian king describes the death of his friend Enkidu. Further descriptions can be found in the Iliad . Similar accounts exist from the battle of Marathon and in the diaries of Samuel Pepys , who witnessed the great fire of London. He noted in his diary: The darker it got, the bigger the fire appeared, in all corners, on hills, between houses and churches, as far as one could see, the terrible blood-red flame shone up to the city, not like the flame of an ordinary one Fire. We stayed until the fire was seen as a single blood-red arch from this to the other side of the bridge, an arch about a mile long. The sight made me cry. Pepys later noted in his diary that he suffered from insomnia and nighttime fear of the fire. PTSD was posthumously diagnosed several centuries after Pepys' death.

Traumatizing Events

Events that often lead to trauma, or newly designated as "potentially traumatic events", are for example:

Natural disasters, war, combat operations, torture, displacement, terrorist attack, rape, accident with threatened serious injuries, trauma caused by medical interventions, sexual assault or sexualised violence, observation of the violent death of others, death of parents in childhood, loss of the loved one and / or of one's own children, life-threatening illnesses in childhood, pronounced emotional or physical neglect in childhood ... (see also childhood trauma ).

But even less dramatic events can, in the worst case, lead to a person falling into a state of intense helplessness and thereby exceeding one's own coping options. Examples include severe personal attacks and abuse, long-term manipulation, bullying , emotional abuse , neglect , corporal punishment , divorce or separation, confrontation with the consequences of trauma as a helper or traumatizing birth experience .

Whether a situation becomes traumatic depends not only on the external circumstances, but also very much on the internal experience of this event. A buried victim who firmly believes that aid teams will get through to him in time will not yet be under the acute fear of death and the same stress hormone level as a buried victim who feels alone and completely helpless because he is still affected by the rescue measures that have been initiated has not noticed anything. A doctor who is accustomed to seeing severe injuries due to his job does not easily get into a state of helplessness even when he sees a serious traffic accident, but has previously learned to act properly and to distance himself through personal and good contact with other medical students to preserve the suffering of people, to find words for it and can therefore classify this event more quickly. He will not be overwhelmed speechless by the gruesome images of the accident site and he will not feel alone and defenseless at the mercy of these images. Whether a person reacts with a mental disorder due to a traumatic situation and which clinical picture is in the foreground afterwards mostly depends on the personal coping possibilities and many other factors. However, there are also events that almost always lead to a mental illness. After torture, almost nobody recovers on their own, after rape only a quarter of those affected without therapeutic help.

Historical trauma

Historical trauma (also known as transgenerational trauma ) is understood to be a psychological trauma that spans several generations and still affects children and grandchildren, even though they themselves were not exposed to the traumatic experience. Slavery is one such example . Further reasons for historical trauma are wars , genocide , dispossession of population groups, inaccessibility of higher education for certain population groups or other forms of discrimination. Historical trauma can lead to the fact that one day expedient behaviors are continued, although they are no longer expedient in the new times. It can happen, for example, that a population group that was withheld from education still has a deep distrust of the education system in the present. Joy DeGruy postulated a Post Traumatic Slave Syndrome (PTSS) , which is caused by the historical trauma of slavery.

Collective trauma

Collective trauma is such trauma that affects everyone, most, or at least many people within a society. Examples are the medieval plague or mass rape, such as during the genocide in Rwanda . The 9/11 attacks are viewed by some as a collective trauma for the United States.

Extent of trauma

The risk of post-trauma disorder and the severity of the disease depend on various factors.

Risk and protective factors

Previous trauma (for example, previously experienced abuse in childhood), a young age at the time of the trauma, level of education or gender turned out to be risk factors. However, these factors contribute to a later trauma to a far lesser extent than the event factors and the influencing factors after the actual trauma. The effect of protective factors is also known as resilience . Resilience or protective factors have a mitigating effect after trauma on the development of symptoms and trauma-related disorders.

Event factors

The more difficult the stressful situation was (e.g. extent of damage or number of deaths), the greater the probability of developing a trauma-related disorder. It is also greater in the case of long-term trauma (e.g. repeated sexual attacks within the family) than in the case of one-off trauma (e.g. train accident). Therefore, trauma is classified based on event factors. A distinction is made between type I and type II trauma based on the duration of the trauma: Type I trauma is characterized by a sudden event that is clearly limited in time and in which there is either an acute danger to the life of one's own person or that of others exists or is subjectively accepted. Type II trauma, on the other hand, consists either of a series of individual events or of a long-lasting traumatic event (such as, for example, trauma in childhood by the family).

Furthermore, a distinction is made between accidental and interpersonal trauma. Accidental traumas are randomly occurring traumatic events that are beyond the control of humans, such as natural disasters or unintentional car accidents. In contrast, interpersonal trauma ( English: man made disaster ) are those that were caused deliberately by one or more other people.

Interpersonal and type II trauma usually have more serious consequences than accidental or type I trauma. In addition, type II trauma is associated to a significantly higher degree with the occurrence of a complex post-traumatic stress disorder .

Event factors Type I trauma
(one-time / short-term) 		Type II trauma
(repeated / long-term)
interpersonal trauma
(man made) 		sexual assault
physical violence
criminal violence (e.g. robbery) 		prolonged or repeated sexual and / or physical violence
child abuse
experience of war, torture, political imprisonment
accidental trauma Traffic accidents
natural disasters 		long lasting disasters

In addition, a distinction can be made between the following types of trauma:

  • Medical trauma: in the case of serious, life-threatening or severely life-shortening illnesses or illnesses that result in chronic disability, as well as after serious, very stressful medical interventions or treatment processes, or in the case of severe permanent damage to body and health following medical treatment errors.
  • Job- related trauma : job-related trauma, e.g. B. Rescue workers, police officers, etc.
  • Secondary trauma: (sometimes and not without controversy also used synonymously with the term: ' compassion fatigue' ): work-related traumatization, e.g. B. with psychotherapists who work empathically psychotherapeutically with clients and are often confronted with emotionalizing descriptions of highly stressful trauma events.
  • Spectator trauma ( bystander trauma ): the traumatic event does not affect you yourself, but you experience it as a witness.
  • individual versus collective trauma : trauma that one person has experienced alone versus trauma that several people have experienced at the same time (e.g. flight conference accident in Ramstein , accident at the Love Parade 2010 ).

However, a precise classification is not always sensible and not always possible, although in the last instance it is not absolutely necessary.

Personal factors

For the consequences of the traumatizing event, not only the external (objective) intensity of the experienced event, but especially the internal (subjective) perception is important. With regard to age, there is a U-shaped course. Very young people and the elderly are more likely to get the disease. Middle-aged is the least likely.

Initial response

The reaction of the individual during the traumatic event or immediately after it only allows a limited prediction of the severity of the trauma-related disorders. For example, if the person was able to retain a slight sense of autonomy during rape or torture , the symptoms were less pronounced than in a control group whose members gave up on themselves. If dissociation ( derealization and depersonalization phenomena) occurs during the traumatizing event, the extent of the trauma increases.

Health promoting factors (resources)

The support of the social environment and the recognition as a victim can have a positive influence on the course of a post-traumatic stress disorder. It is also helpful if the traumatized have the possibility of interpersonal embedding and can communicate about what they have experienced ( disclosure ). A psychological construct developed by Aaron Antonovsky (1987) is called the sense of coherence . This means the ability to mentally classify, understand and give meaning to the traumatic event. Reports from survivors of the concentration camps indicate that such an active mindset was helpful in coping.

Symptoms and behaviors

The symptoms of trauma can be divided into three groups: intrusion , constriction and vegetative overexcitation .

The symptoms represent a self-healing attempt by the psyche, in which an attempt is made to resolve the trauma by oscillating between confrontation and constriction.

Intrusive symptoms

  • repeated, inevitable memories or involuntary thinking about or compulsively dealing with the event ( intrusive thoughts)
  • Daydreams or nightmares related to the event
  • Flashbacks : through certain key stimuli ( triggers ) the memory of the previous trauma is re-awakened, the person experiences the traumatic event again as if it were happening again

External or internal intrusions ( triggered by key stimuli ) can sometimes cause disproportionately violent reactions, such as panic attacks .

Constrictive symptoms

  • Dissociation : a separation of perception and affect , a mechanism by which an unconscious attempt is made to escape the intrusions and the associated reactions. Depersonalization and derealization can arise as special forms of dissociation .
  • Inability to remember the traumatic events or certain details (as a psychological protective mechanism against non-integrable, painful memories due to ( dissociative ) (partial) amnesia ( repression ))
  • Emotional numbness (to love ability to rejoice or to mourn is restricted, and to utter emotional numbness ( Numbing ) or depression )
  • Avoidance behavior: Try to avoid everything that might remind you of the trauma ( Avoidance ):
    • thoughts and feelings
    • Place where the trauma occurred
    • People related to the event
    • People or place similar to the traumatic event
    • in nightmares try to avoid falling asleep (deliberately keeping awake)
  • Mental anticipation of the worst in order to avoid unintentional memories of the trauma on the one hand, and to prevent re-traumatization on the one hand. This can also be experienced by the environment as a kind of permanent pessimism.
  • Feelings of helplessness and being at the mercy, loss of self-confidence and a previously existing feeling of basic security and security in one's own life and basic trust in life and fellow human beings
  • Loss of previous beliefs about the world and oneself and about the meaning of life; Development of an emotional distance from other people and the world, feelings of alienation
  • Inability to speak about the events or properly word the events and feelings

Overexcitation

  • a vegetative overexcitation (also hyperarousal ) in the form of a chronic permanent stress reaction: A physiological stress reaction takes place in an acute dangerous situation through the activation of the sympathetic nervous system as part of the fight-or-flight reaction , which usually occurs within minutes to hours after the Load event reduces again. For non-integrated traumatic memories this reaction is independent of objective dangers permanently from further and is typically associated with physiological symptoms such as palpitations , tremors , nausea , dizziness , agitation , increased nervousness and chronic tension accompanied
  • often chronic sleep disorders
  • Hypervigilance , a persistently elevated, tight wakefulness or wakefulness
  • Even if traumatized people are constantly restless and nervous internally, they can show strong controlling behavior externally (since the trauma was experienced as an extreme loss of control)
  • Furthermore, the constant stress can lead to concentration difficulties , memory problems and increased irritability

Depending on the type and duration of the trauma, it can happen that these symptoms resolve on their own some time after the traumatizing event (spontaneous remission ) and the traumatic experience can normally be integrated into the life cycle . In most cases, especially in the case of severe trauma, trauma in childhood or in people with little resilience (psychology) , integration of the trauma through self-healing powers alone cannot be restored even after a long time and trauma - related disorders develop (see below ). These can also only become noticeable months or years after the traumatic event and may be associated with altered brain activities and neuroanatomical changes.

Sequelae

Post-trauma disorders range from feelings of suffering and anxiety to serious psychological disorders , psychosomatic complaints and pain disorders . The scientific investigation of the origins, effects and therapeutic options of trauma is one of the tasks of psychotraumatology .

Development of post-traumatic disorders

Due to the unpredictability of the traumatizing events, it is hardly possible to examine the emotional, cognitive and neurobiological states of the affected people before and after the trauma. As a result, the mechanism that leads to the development of the trauma-related disorders is largely unknown. It is also becoming apparent that post-trauma disorders are the result of both physiological, psychological and social processes. Despite this difficulty, a number of psychological abnormalities and neuronal changes were found in several studies in traumatized people, and attempts were made to develop models based on these results that can explain the development of trauma-related disorders.

Memory model

During traumatization, the massive release of neurohormones leads to a malfunction of the hippocampus formation, the task of which is to collect newly arriving sensory impressions from the various sensory organs and to embed them in an overall autobiographical context. Due to the traumatic malfunction, the spatial and temporal recording is massively disturbed. As a result, the sensory impressions from the different sensory organs are perceived by the patient disconnectedly as acoustic, visual, olfactory and kinesthetic information fragments, which are not "hippocampal" (" explicit memory" ( LeDoux )) fed into the consciousness and stored, but " amygdaloid " ( “ Implicit memory”) remain fragmented. During a flashback , this fragmented memory content is then retrieved.

Hormonal stress system:

Traumatized patients show an increased activity of the noradrenergic stress system compared to healthy people . This leads to the accompanying symptoms such as insomnia , lack of concentration , overexcitation or nervousness . Some studies suggest that the secretion of cortisol may be decreased and the sensitivity of the glucocorticoid receptors increased.

Primary mental disorders

Common psychological disorders after trauma include:

Adjustment disorder

Mental stress reactions that are triggered by events that do not correspond to the medical definition of the trauma are diagnosed as adjustment disorders. The events are more about the death of a loved one or a distressing divorce. The adjustment disorder lies in the border area between an understandable disturbance due to a difficult life event and a tendency to depression and anxiety in the patient.

Acute stress reaction

In the case of an acute stress reaction , the symptoms immediately follow the stressful event. An acute stress reaction typically lasts for a few hours or days (sometimes weeks).

Post-traumatic stress disorder

One speaks of a post- traumatic stress disorder if the symptoms that have occurred persist after more than four weeks and then persist for a longer period of time, thus indicating a chronic course. If the symptoms persist for a further eight months, it can no longer be expected that the post-traumatic stress disorder will spontaneously and completely resolve.

Complex Post Traumatic Stress Disorder

Since around 2000, the term complex post- traumatic stress disorder (CPTBS) has become increasingly popular in connection with multiple traumas and their more extensive psychological and interpersonal consequences , and this traumatization often requires a different therapeutic approach. A similar phenomenon was described as permanent personality change after extreme stress , which is also expressed through multiple traumas and permanent changes in individual and interpersonal behavior patterns that may be caused by this.

Secondary mental disorders

Trauma increases the risk of developing almost all other mental illnesses. These include:

Specific phobias , obsessive-compulsive disorder and eating disorders are often not seen as a secondary mental disorder, but trauma is understood as an indirect risk factor for the development of one of these mental disorders. Even with the borderline personality disorder and dissociative identity disorder traumatic events are viewed as a major factor.

Further consequences of trauma

Sexual violence can lead to various disorders of sexuality and the sensation of pleasure (both in the form of inhibition and exaggeration); Torture, on the other hand, is often associated with idiopathic pain later on .

Trauma therapy

Trauma therapy is aimed at patients who have been exposed to a traumatic event. These often need - in addition to the support of relatives or friends - professional help for emotional stabilization and for processing and integrating the split off, traumatic memory contents in order to avoid long-term or chronic complaints and physical and psychological secondary diseases as far as possible. Therefore, it should as soon as possible in accordance with a psychotherapist or -therapeutin are visited, the extensive special especially after severe trauma trauma therapeutic training and experience corresponding to the respective forms of therapy has the trauma therapy.

Psychotherapeutic treatment

Every major psychotherapy school has developed its own approaches to treating traumatic disorders, such as: B. Methods of cognitive behavioral therapy or behavioral therapy and psychodynamic methods.

The aim of psychotherapeutic procedures is to come to an orderly processing of the trauma or trauma and thereby either limit or control or resolve the symptoms typical of trauma. After severe trauma, it is important to start appropriate trauma therapeutic treatment as early as possible, as this can reduce the risk of long-term effects and chronic residual symptoms. The treatment decision should be made dependent on the severity and type of trauma, the main symptoms, as well as any clinical comorbidity of the person concerned, and if necessary, expert help should be sought in choosing a suitable therapist.

Psychoanalytic Procedures

In addition to the specific therapy methods for individual trauma-reactive disorders, such as post-traumatic stress disorder, psychoanalysis focuses on a higher-level understanding of trauma in treatment. In psychoanalysis , the unconscious effects of trauma are examined and attempts to treat. Psychoanalysis understands transference as the fact that the patient unconsciously transfers his own previous experiences with his caregivers to the analyst in the form of fixations and repetitions. The latter actualize themselves in the therapeutic relationship as “transference neurosis” and can then be gradually reduced and treated through resistance analysis and interpretation. However, promoting this transference neurosis in a targeted manner in trauma therapy is contraindicated, since a neutral attitude on the part of the therapist unconsciously increases the trauma patient's tendencies to blame himself or promotes the recurrence of stressful memories of the incident, which may have a retraumatising effect. Instead, there is a need for an "interactive understanding" of the therapeutic relationship. Relationship work requires the therapist to oscillate flexibly between identification and distancing; the countertransference should be viewed as an interaction process and an aid to understanding for the therapist. Special “traps” in the transference process of trauma therapy must also be taken into account, such as the unconscious “relationship test of the patient for possible abuse by the therapist” etc. A competent handling of transference and countertransference may be necessary. a. also necessary because trauma therapists are in danger of being traumatized on their behalf. This happens through direct flooding with trauma material when the area is too close and through indirect infiltration of the cognitive protective wall when the distance is too great. According to the AWMF S3 guidelines, no specific recommendation is made for psychoanalytical procedures for trauma treatment.

Medication

In the case of certain disorders or from a certain severity of the symptoms, drug therapy for the trauma-related disorders can be considered. In this case, psychotropic drugs are used in addition to psychotherapy . Psychotropic drugs influence the balance of neurotransmitters in the brain and thereby interfere with the patient's brain functions. However, since none of these drugs have a causal effect, they cannot replace psychotherapeutic trauma therapy, but in some cases they can prepare or accompany it. The selection of the respective drug is symptom-oriented and depends on the complaints that are in the foreground.

Critics complain that medication in trauma patients is often a helpless reaction by doctors to relieve the symptoms of the suffering patient with medication and that a subsequent discontinuation of the medication after the crisis has been overcome is often no longer risked. Drug treatment can also lead to the fact that trauma therapeutic therapies are not started or are suitable too late, thus increasing the risk of post-traumatic stress disorder with chronic residual symptoms.

Impact on life

The effects of trauma often have a profound impact on the lives of those affected. This is the one marked by strategies to avoid , on the other hand, it is by flooding in (avoidance and intrusion) , including of alternating antagonistic symptoms. On the one hand, those affected spend an enormous amount of energy on avoiding everything that is connected with the traumatic situation and that would remind them, of repressing or splitting off the events (dissociation) . On the other hand, they experience the situation again in nightmares or are haunted with full force by flashbacks , which suddenly attack them and which in their intensity can equal the traumatic experience.

The memories cannot be suppressed in the long run either - they continue to work unconsciously and can lead to psychosomatic complaints . "The body keeps the score" - the body does not forget, writes Bessel van der Kolk . Even a long time after the traumatizing event, memories of it can suddenly haunt those affected (latency and afterwardness). Triggers are often so-called triggers , i. In other words, certain situations or even just moods, places, faces or smells bring the traumatic situation back into consciousness.

This constant alternation between avoidance and reminder (intrusion) is described by most researchers as an excruciating trauma symptom. However, there is also the interpretation of Reddemann and Sachsse (2004), who see it as part of the coping process. The dissociation is then a mechanism of self-protection: the unbearable memories and images are split off again and again until those affected are sufficiently stable to deal with them.

Special traumatizations

War trauma and war trauma children

"In the trauma, the memory of good internal caregivers [...] as empathetic mediators between self and environment falls silent," said the two scientists Leuzinger-Bohleber and Andresen in their final report on a pilot project to care for traumatized refugees.

Traumatizations caused by war experiences ( war trauma ) represent a particularly high risk of developing post-traumatic stress disorder (presumably after torture or torture-like and severe sexual or early childhood (multiple) traumatizations). In addition to the direct effects of the war (e.g. bombing, physical injuries, direct experience of war violence, suffering, death, atrocities), the consequences of the war (e.g. separation of families and caregivers, loss of home, malnutrition, decline in poverty, existential Fears) contribute to the development of trauma-related secondary disorders. In addition to soldiers on the frontline, children in particular represent a risk group with regard to the development of trauma-related disorders due to their age-related higher vulnerability. However, the needs and needs of children in the chaos of war are often ignored, as attention is focused on the soldiers' ability to work and their symptoms. The long-term consequences of war traumatization in childhood can only show up as a PTSD late manifestation from the age of 60 if aging brings additional burdens (e.g. retirement, children leave the house, death of the partner). Even in the 21st century, psychotherapy for war trauma children of the Second World War is being sought and offered. Even war trauma passed on (unconsciously) to the next generation was found.

Traumatization of children in hospitals

Until the 1970s and 1980s, toddlers in hospitals were only allowed to visit their parents at very restrictive visiting hours, which in infants and toddlers led to hospitalism (also known as deprivation syndrome), attachment disorders (e.g. reactive attachment disorders), early childhood regulatory disorders (e.g. B. Excessive screaming in infancy ), neglect or abandonment trauma with immediate and long-term consequences: The children sometimes did not recognize their parents, did not become so deeply involved in relationships or they clung to a greater extent. In adulthood, it can then influence social behavior and partnership-based attachment behavior (e.g. insecure-ambivalent, insecure-avoiding or disorganized BV instead of secure BV). This can trigger partnership conflicts, tension, stress, fear of loss and breakups. After losing the partner again in adulthood, the trauma of abandonment in early childhood can be reactivated.

Child abuse

Traumatizations in childhood can be caused, among other things, by physical violence , sexual abuse with and without penetration , but also by physical or emotional neglect or emotional abuse. The harmfulness of the last two forms of abuse is often not given sufficient attention in society. Animal experiments have shown that the emotional experience in the first few years of life causes structural neuronal changes (interconnection patterns in the prefrontal-limbic circuits) in the brain, which remain lifelong. Violent trauma in childhood and adolescence - regardless of whether it is one-off or long-term - often leads to profound disorders in the personality of the victims that go beyond the symptoms of general post-traumatic diseases. Childhood trauma increases the risk of physical and / or mental illness throughout life. When growing up for a long time in a violent family or social environment, the traumatization also has an effect in the form of an educational character, which is later reflected in a specifically formed structure of thought, feeling, action, communication and values. Since the personality is more stable in adulthood, stronger traumatisation is usually necessary here in order to produce the same effects on the personality structure; In principle, however, adults can develop the same sequelae as children and adolescents.

Trauma and attachment

Children who have been traumatized by caregivers are significantly more likely to show an insecure-ambivalent, an insecure-avoidant or a disorganized attachment style. However, children also showed similar behaviors when their attachment figures did not deal with traumatic experiences. The attachment research deals with the relationship between trauma of the parents and a bond uncertainty of small children. Because of this transgenerational transmission of trauma, it is important when examining children with attachment disorders (e.g. "secure base distortion" ) to analyze the parent-child interaction through detailed direct and video observation and to adopt a two-generation perspective . In the case of children of traumatized mothers who have been diagnosed with post-traumatic stress disorder , it is important to ensure that trauma experiences are passed on to other generations ( see also: Parents and ancestors with PTSD ).

The parenting program SAfE - Safe Education for Parents for Parents- to-be, developed by child psychiatrist Karl Heinz Brisch , aims to develop parental sensitivity . This is intended, among other things, to prevent one's own negative attachment experiences from being passed on to the next generation.

In adults who show symptoms of trauma for which no cause can be found, there may be a transgenerational transmission of trauma: trauma can be passed on to the next generations with lasting consequences through silence - in order to hide it from others and not burden them with it.

Other terms

Salutogenesis

The concept of salutogenesis goes back to Aaron Antonovsky . During his time at the Applied Social Research Institute, Antonovsky was engaged in studies of women born in Central Europe between 1914 and 1923. Some of them were concentration camp survivors. He noticed that 29% of the women who had previously been interned were not impaired in their health despite this trauma. This observation led him to the question of which characteristics and resources had helped these people to maintain their (physical and mental) health under the conditions of the concentration camp imprisonment and in the years afterwards - in general: How does health arise? Antonovsky brought the question of the origin of health to science. Andrei and Vanya are considered a developmental case study. The twins were banished to the basement by their stepmother at a young age and beaten. When they were freed at the age of seven, they could not speak and did not understand the meaning of images. The twins were taken from their father and stepmother and later adopted. In a loving environment, they managed to catch up on their intellectual and emotional lag. They have fully recovered from their early life experiences.

Sequential trauma

In a long-term study of Jewish war orphans, psychiatrist Hans Keilson showed that the way children were treated in the years following the traumatic event had a greater impact on the development of trauma symptoms than the triggering event itself, Keilson described this process as sequential trauma.

Post-traumatic maturation

Some traumatized people are convinced that the traumatic event has led to a personal maturation process for them in the long term and that they no longer want to miss the experience gained from it. Even if studies have shown that this can only be objectively understood for a minority of the traumatized, this can be an important additional target value for treatment.

Revictimization

If a traumatized person experiences violence again at a later point in time, one sometimes speaks of revictimization . However, the use of this term should be viewed critically from a psychological and ethical point of view (see revictimization ).

Resilience

Despite pronounced traumatic stress, some sufferers remain largely healthy or at least recover relatively quickly. This “psychological resilience” is known as resilience . Untreated trauma can lead to drastic, very stressful secondary diseases that may last for a lifetime or negatively affect a person's biography. However, this is not necessarily the case, as the long-term study by Emmy Werner has shown. From this long-term study it is known that a stable caregiver is usually the most important and most important help for a traumatized person. In some cases, resilience can even increase in the longer term after trauma.

See also

literature

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  • Peter Fiedler : Dissociative Disorders and Conversion. Trauma and trauma treatment. 2nd Edition. Beltz, Weinheim 2001, ISBN 3-621-27494-4 .
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  • Judith Hermann: The scars of violence. Understand and overcome traumatic experiences. Junfermann, Paderborn 2003, ISBN 3-95571-624-4 .
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  • Ulrich Sachsse , Ibrahim Özkan, Annette Streeck-Fischer (eds.): Traumatherapy - What is successful? 2nd Edition. Vandenhoeck & Ruprecht, Göttingen 2004, ISBN 3-525-45892-4 .
  • Annette Streeck-Fischer, Ulrich Sachsse, Ibrahim Özkan: Perspectives in trauma research . In: Annette Streeck-Fischer (Ed.): Body, Soul, Trauma. Biology, clinic and practice . Vandenhoeck & Ruprecht, Göttingen 2001, ISBN 3-525-45868-1 , pp. 12-22 .
  • Sefik Tagay , Ellen Schlottbohm, Marion Lindner: Post-traumatic stress disorder: diagnosis, therapy and prevention. Kohlhammer, Stuttgart 2016, ISBN 978-3-17-026069-6 .
  • Bessel van der Kolk: The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Penguin, New York 1994, ISBN 0-670-78593-8 .
  • Ralf Vogt: Psychotrauma, State, Setting. Psychosozial Verlag, Giessen 2007, ISBN 978-3-89806-582-5 .
  • Wolfgang Wöller: Trauma and personality disorders. Schattauer, Stuttgart / New York 2006, ISBN 3-7945-2446-2 .

Web links

Wiktionary: Trauma  - explanations of meanings, word origins, synonyms, translations
  • S2 guideline : Diagnosis and treatment of acute consequences of psychological trauma. AWMF register number 051/027; Full text (PDF) accessed on February 25, 2018.

Individual evidence

  1. ↑ DORSCH Lexicon of Psychology
  2. ↑ trauma. In: Friedrich Kluge, edited by Elmar Seebold: Etymological dictionary of the German language. 24th, revised and expanded edition. Walter de Gruyter, Berlin / New York 2001, ISBN 3-11-017473-1 .
  3. ↑ Sefik Tagay , Ellen Schlottbohm, Marion Lindner: posttraumatic stress disorder: diagnosis, treatment and prevention. Kohlhammer, Stuttgart 2016, ISBN 978-3-17-026069-6 .
  4. ^ Werner Stangl : Lexicon for Psychology and Education . University of Linz, accessed on August 10, 2011.
  5. ↑ a b G. Flatten, U. Gast, A. Hofmann, Christine Knaevelsrud , A. Lampe, P. Liebermann, A. Maercker, L. Reddemann, W. Wöller: S3 - Guideline Posttraumatic Stress Disorder. (PDF). In: Trauma & Violence. Volume 3, 2011, pp. 202-210.
  6. ↑ Tanja Zöllner, Lawrence G. Calhoun, Richard G. Tedeschi: Trauma and personal growth. In: Andreas Maercker, Rita Rosner (Hrsg.): Psychotherapy of post-traumatic stress disorders. Thieme Verlag, Stuttgart 2006, pp. 36–45.
  7. ↑ Gottfried Fischer, Peter Riedesser: Textbook of Psychotraumatology . E. Reinhardt, Munich 1998, ISBN 3-8252-8165-5 .
  8. ↑ The ICD-10 - Classification of Mental and Behavioral Disorders - Clinical descriptions and diagnostic guidelines . (PDF; 1.3 MB)
  9. ↑ Stephen Joseph: What does'nt kill us . Hachette Digital Publishers, 2011, p. 19.
  10. ^ RJ Daly: Samuel Pepys and post-traumatic stress disorder. In: The British Journal of Psychiatry. 143 vol., 1983, pp. 64-68.
  11. ↑ a b Luise Reddemann, Cornelia Dehner-Rau: Trauma: Recognize consequences, overcome them and grow with them; an exercise book for body and soul . 3rd, completely revised Edition. TRIAS, Stuttgart 2008, ISBN 978-3-8304-3423-8 .
  12. ↑ Joy Degruy: Post Traumatic Slave Syndrome. America's Legacy of Enduring Injury and Healing, Uptone Press, 2005.
  13. ^ Hans-Jürgen Wirth: 9/11 as a Collective Trauma and other Essays on Psychoanalysis and Society. Psychosozial-Verlag, 2004.
  14. ↑ a b Dagmar Härle: Trauma and coaching Recognizing trauma signals and acting professionally. Junfermann Verlag, Paderborn 2018, ISBN 978-3-95571-696-7 .
  15. ↑ a b c d e Andreas Maercker: Post-traumatic stress disorders. 4th, completely revised and updated edition. Springer, Berlin 2013, ISBN 3-642-35067-4 .
  16. ↑ a b c Andreas Maercker: Trauma and post-traumatic disorders . 1st edition. Munich 2017, ISBN 978-3-406-69851-4 .
  17. ↑ a b In the DSM-V occupational confrontation with traumatic events in criterion A4 taken directly: "The other indirect exposure, Which We added to the DSM-5 as Criterion A4, conc erns professionals w ho have never been in direct danger, but who learn about the consequences of a traumatic event day-in and day-out as part of their professi onal responsibilities. "(Friedman, 2013). Examples are not only rescue workers and emergency physicians who are direct witnesses of traumatic events and their consequences and who are confronted with death and dying or are exposed to life-threatening dangers even in action, but also, for example, trauma therapists who only indirectly confront a traumatic event through their clients' stories become. However, this view is controversial and in the scientific literature the latter is usually referred to separately under the terms “secondary trauma” or “vicarious trauma” (e.g. Bride, Robinson, Yegidis & Figley, 2004, Canfield 2005; Pearlman & Saakvitne 1995 Kadambi & Truscott 2004; Dickes 2001), which is sometimes not clearly differentiated from the terms: "compassion fatigue" or "compassion fatigue" (e.g. Bober & Regehr 2006; Figley 1995 & 2002; Salston & Figley 2003; Stamm & Figley 1996) or even used synonymously.
  18. ↑ Andreas Maercker : Post-traumatic stress disorders. 2013, p. 36, Psychological Models.
  19. ↑ Andreas Maercker: Post-traumatic stress disorders. 2013, p. 37, Psychological Models.
  20. ↑ a b Ulrich Sachsse: Trauma-centered psychotherapy: theory, clinic and practice . Schattauer, Stuttgart 2009, ISBN 978-3-7945-2738-0 .
  21. ↑ Andreas Maercker: Post-traumatic stress disorders . Springer, Berlin / Heidelberg 2013, ISBN 978-3-642-35068-9 , pp. 284 .
  22. ↑ Clemens Hausmann: Introduction to Psychotraumatology . UTB-Verlag, 2006, p. 50/51, accessed on August 10, 2011.
  23. ↑ Annegret Boos: Overcoming trauma . Dissertation . University of Trier, 2004, p. 10.
  24. ↑ a b Michaela Huber: Trauma and the consequences. Trauma and trauma treatment . 5th edition. Part 1. Junfermann, Paderborn 2012, ISBN 978-3-87387-510-4 .
  25. ↑ a b Guido Flatten, Ursula Gast, Arne Hofmann , Christine Knaevelsrud , Astrid Lampe, Peter Liebermann, Andreas Maercker, Luise Reddemann, Wolfgang Wöller: Post-traumatic stress disorder: S3 guidelines and source texts . Schattauer, Stuttgart 2013, ISBN 3-7945-2923-5 .
  26. ↑ Ulrich Sachsse, Birger Dulz: Trauma-centered psychotherapy theory, clinic and practice . Schattauer, Stuttgart 2009, ISBN 978-3-7945-2738-0 .
  27. ↑ Karin Mlodoch: Violence, Flight - Trauma? Foundations and controversies of psychological trauma research . Göttingen 2017, p. 53.
  28. ^ Bessel van der Kolk : The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. New York 1994, cit. according to Karin Mlodoch: violence, flight - trauma? Foundations and controversies of psychological trauma research . Göttingen 2017, p. 54.
  29. ↑ Luise Reddemann / Ulrich Sachsse: Trauma-centered psychotherapy: theory, clinic and practice. Stuttgart 2004.
  30. ↑ Karin Mlodoch: Violence, Flight - Trauma? Foundations and controversies of psychological trauma research . Göttingen 2017, p. 55.
  31. ^ Marianne Leuzinger-Bohleber , Sabine Andresen : STEP-BY-STEP. Final report on the step-by-step pilot project for the care of traumatized refugees in the initial reception facility “Michaelisdorf” in Darmstadt . Ed .: Hessian Ministry for Social Affairs and Integration. August 2017 ( kcgezinswetenschappen.be [PDF; 7.3 MB ; accessed on July 3, 2020]).
  32. ↑ Trauma in children and adolescents from war experiences. ( Memento of the original from May 10, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. WhyWar.at. Retrieved November 14, 2011. @1@ 2Template: Webachiv / IABot / www.whywar.at
  33. ↑ kriegskind.de - project for the therapy of war traumatized . Retrieved November 14, 2011.
  34. ↑ The Inherited Trauma - The Children of the War Children . evangelisch.de Retrieved November 14, 2011.
  35. ↑ Angela Moré: The unconscious passing on of trauma and entanglements of guilt to subsequent generations . (PDF; 353 kB; 34 pages). In: Journal for Psychology. Volume 21, 2013, issue 2.
  36. ↑ DS Schechter , E. Willheim: Disturbances of attachment and parental psychopathology in early childhood. Infant and Early Childhood Mental Health Issue. In: Child and Adolescent Psychiatry Clinics of North America. 18 (3), 2009, pp. 665-687.
  37. ↑ DS Schechter , SW Coates, T. Kaminer, T. Coots, CH Zeanah, M. Davies, IS Schonfield, RD Marshall, MR Liebowitz, KA Trabka, J. McCaw, MM Myers: Distorted maternal mental representations and atypical behavior in a clinical sample of violence-exposed mothers and their toddlers. In: Journal of Trauma and Dissociation. Volume 9, No. 2, 2008, pp. 123-149.
  38. ↑ Udo Baer, ​​Gabriele Frick-Baer: How trauma affects the next generation - examinations, experiences, therapeutic aids . 4th edition. Semnos Verlag, Neukirchen-Vluyn 2014, ISBN 978-3-934933-33-0 .
  39. ↑ F. Schliehe, H. Schaefer, R. Bushman Steinhage, S. Döll: promote active health . Association of German Pension Insurance Institutions, 2000.
  40. ^ Raymond Lemay: Resilience, the Developmental Model and Hope. In: The Crucial Times. Volume 34, 2005, pp. 5-6.
  41. ↑ Jarmila Koluchová: Severe Deprivation in Twins: a Case Study. In: Journal of Child Psychology and Psychiatry. Volume 12, No. 2, 1972, pp. 107-114, doi: 10.1111 / j.1469-7610.1972.tb01124.x
  42. ↑ Hans Keilson: Sequential Traumatization in Children. Enke Verlag, Stuttgart 1979, ISBN 3-432-90111-9 .