I was recently asked by a partner organization to answer a few questions about trauma as a guest blogger and this is a version of what I wrote for them. These are very concise explanations about a very complex topic, but hopefully it will be a good introduction to some of these concepts as well as assist your ability to explain these processes. Naturally, I’m available to explain these phenomenon in more detail in workshops, speaking at conferences, or providing tailored consultations.

What are the differences between trauma, PTSD and stress?
Post-Traumatic Stress Disorder (PTSD) is a medical diagnosis with certain criteria that a person must meet in order to carry this diagnosis. It is common among sexually exploited people, many of whom suffer from “Complex” PTSD which is several degrees of severity worse than “standard” PTSD.

Stress is when one’s physiological and psychological states are challenged by stressors which cause adaptations to our systems. Stress sources can by physiological or psychological. Although stress is at times very difficult to bear, and can compromise our health and well-being, we are eventually able to cope. Stress is not necessarily a bad thing. Stress helps us grow, become stronger, and builds resilience. Sometimes how a person responds to stress can influence the eventual negative or positive impact of stress.

Trauma is stress that overwhelms our natural abilities to cope and adapt such that our psychological and physiological systems are negatively affected and can lead to dysfunction. Trauma, through the release of certain hormones and molecules, can cause structural, chemical, and electrical changes in our brains. It also has impact on the immune system, cellular structure, and other body systems. Trauma is not a defined health disorder; trauma is not a medical diagnosis. However, it can be defined as psychological and physiological damage resulting from an overwhelming experience or series of experiences. Trauma, therefore, is not treated with medication, although traumatized people can suffer from other diagnoses as a result of the trauma which may be alleviated with medication and other therapies.

Does trauma go away? What is the impact of memory?
Traumatic experiences of a person in recovery are in the past, but the impact of trauma distorts a person’s memory such that the person continues to experience that trauma as if it were continuing in the present. This is a function of the disruption of normal memory pathways as well as the disability of someone to self-regulate emotions and thoughts when triggered. In this way trauma “hijacks” the mind and the person loses their sense of self-in-the-present and is now reacting in “trauma time”. Traumatic memories are stored and recalled in ways different from the normal way we store other kinds of memories. Frequently there is no memory of a chronological storyline and the memory is not recalled as if it were in the past, such as a memory about a childhood pet, because the storage locations of traumatic memory aren’t connected to the areas of the brain that organize language, time, and conscious self. This is why giving a statement to law enforcement regarding the concrete facts of an event can be so problematic. The brain simply does not have the connections to give the answers in a coherent form – especially in the way that the questions are usually formulated. A traumatic memory is often “triggered” through the senses and not necessarily recalled through thinking. Sometimes these emotional reactions occur without context because the trigger is yet unidentified. Traumatic experiences are always a part of a person’s story, but one of the goals of trauma therapy is to disconnect the traumatic past from the present. Traumatic memories no longer trigger trauma reactions in present time. Trauma therapy doesn’t necessarily start with an excavation dig into traumatic memories in order to heal them. The memories and triggers are dealt with through a variety of techniques to disrupt the neural pathways of trauma reactions and create new pathways that help people deal with memories in the present.

Is trauma inherited?
Trauma can have generational impacts in several ways. This is a rather complicated phenomenon and not yet thoroughly understood, so only a brief overview is presented here. The field of research in intergenerational trauma is growing and includes studies in communities such as Aboriginal people in Australia, First Nations people in N. America, Holocaust survivors, and Genocide events in several countries. Studies have shown similar patterns in maladaptive behavior, psychological diagnoses, health problems and victimization among different generations.

One way that generational trauma can be described is through psychosocial risks in a community. The psychological distress and symptoms of trauma such as certain behavioral patterns, emotional disruptions, and physical complaints can be seen in multiple generations of families within a particular people group. This can happen through, for example, behavior modeling, narratives spoken and lived, enduring generational poverty, and compromised parenting contribute to trauma symptoms.

www.nature.com

Physiological consequences from generational trauma are also profound. A mother’s biological responses to her traumatic experiences can affect her unborn child’s newborn and childhood development (1). Epigenetics describes the effect of molecular processes that turn genes on or off through environmental stimuli. The genetic material itself is not altered (which would make it “genetic”), but the ways in which the genes work is affected. Studies have also reported that children of parents who experienced Adverse Childhood Experiences (ACEs) can have developmental, cognitive, and social difficulties (2). One study (3) reported that boys with incarcerated fathers has demonstrable epigenetic changes on their genes (shortened telomeres) than boys whose fathers were present in the household. Shortened telomeres increase the risk of damage to the genes, which increases the risk of disease.

A child growing up in a toxic environment is at risk for a high level of Adverse Childhood Experiences (ACEs) (4,5). Included in these are direct physical, sexual, and emotional abuse, but also less direct experiences such as having an incarcerated parent, a parent with a significant mental health disease, or interpersonal violence in the home. ACEs are directly related to increased risk of chronic health diseases in adulthood. (4,5)

The psychological and physiological consequences of intergenerational trauma on children are an important contributor to negative health outcomes. Children born to traumatized people are also therefore already vulnerable to becoming victimized and suffering traumatic experiences themselves. One of the best ways to prevent exploitation and trafficking, is to prevent ACEs.

How does sexual exploitation affect mental health?
The link between sexual exploitation and mental health problems is clear, but also rather complicated. Many people in prostitution struggle with mental health problems before they enter prostitution (which likely facilitated entry) and the negative health effects of prostitution tend to keep them there.

Trauma, through the release of certain hormones and molecules, causes structural, chemical, and electrical changes in our brains. Trauma literally re-wires the brain: reinforcing thinking and behavior patterns that facilitate survival in overwhelming circumstances and deemphasizing connections that facilitate learning and growing. The younger the child the more pronounced the deleterious effects. Bessel van der Kolk describes a brain that is wired for survival, not for learning or developing healthy relationships: “If you feel safe and loved, your brain becomes specialized in exploration, play, and cooperation; if you are frightened and unwanted, it specializes in managing feelings of fear and abandonment.” (6)

Research studies estimate that a high percentage of people (mostly women were studied) in prostitution experience physical, sexual, or emotional abuse or neglect as children. Abused children tend to do poorly in school, be sexually active, distrust adults. Trauma distorts brain connections such that executive function (rational judgement and decision-making) is impaired. The ability to concentrate and problem-solve is reduced. Working memory is also impaired. Emotional dysregulation and distrust in others, is a common finding, leading to maladaptive behaviors. Mental health problems accumulate, which are reflected in social manifestations, such as difficulty to hold regular employment, multiple sexual partners, and incarceration. Many people self-medicate trauma symptoms with drugs and alcohol, furthering complicating social and vocational contacts.

People often (there are myriad reasons) enter prostitution because they are exploited by debtor or “loverboy*”, or they have exhausted other ways of supporting themselves. Prostitution complicates and reinforces lies that perpetuate the cognitive and emotional distortions that keep the exploited from experiencing true personal freedom. The cycle of zero self-worth, self-contempt and self-deception continues to psychologically oppress.

The mental health state of exploited people makes them susceptible to psychological coercion. The phenomenon of psychological coercion in human exploitation is powerful. Traffickers do not need to physically lock people up because psychological restraints are enough. Tactics such as isolation, degradation, threats, and monopolization of perception are used to effectively control someone. “Traffickers… typically employed multiple coercive tactics to deprive the women of their dignity and autonomy and render them dependent. These experiences of psychological abuse, sometimes in combination with physical and sexual violence, subjected victims to extreme stress.” (7) The psychological coercion creates a world in which the victim can survive, and outside that world the victim will not survive. A type of inner slavery is experienced which renders physical restraints unnecessary.

The mental health problems of trauma are complicated by the various physiological consequences. The release of high amounts over a long period of time of stress hormones and chemicals leads to negative physiological impacts on the immune system, cellular structure, and other body systems. Bessel van der Kolk states that: “The body keeps the score …the memory of trauma is encoded in our organs (liver, pancreas, intestines, etc.), gut-wrenching emotions, auto-immune diseases, and skeletal/muscular problems.” (6) Physical manifestations are many and variable and include diabetes, hypertension, gastrointestinal disorders, auto-immune diseases, increased risk of cancer, musculoskeletal disability, chronic pain, etc. Sexual violence experienced by women in prostitution impact biological as well as psychological well-being. The physical pain, as with emotional pain leads people to self-medicate with alcohol and drugs. Perceived and real barriers to health care are another social manifestation of executive function distortion and are another reason for their chronic unnecessary suffering.

Can people heal from Trauma? However, despite all the challenges presented here, people can heal from trauma! Recovery and thriving are possible! It takes a multi-disciplinary team of patient, trauma-informed well-trained professionals and caregivers. Another piece of good news is that a lot trauma, and therefore a lot of people being sexually exploited can be prevented! A growing body of research on the neurobiology of trauma and its impact on our brains and our bodies is helping us understand the complex phenomenon. Mental health professionals are developing and disseminating therapeutic techniques that can help people in the recovery process. There are also more on-the-ground practitioners who are learning about trauma and trauma-informed care in order to facilitate people getting the assistance that they need.

* Loverboys are men who fake a love relationship with a girl or young woman in order to lure or force her into prostitution later.

REFERENCES:
1. Youssef NA, Lockwood L, Shaoyong Su, Guang Hao, Rutten BPF. The Effects of Trauma, with or without PTSD, on the Transgenerational DNA Methylation Alterations in Human Offsprings. Brain Sci. 2018, 8, 83; doi:10.3390/brainsci8050083
2. Schickedanz A, Halfon N, Sastry N, et al. Parents’ Adverse Childhood Experiences and Their Children’s Behavioral Health Problems. Pediatrics. 2018;142(2): e20180023
3. Mitchell C, McLanahan S, Schneper L, et al. Father Loss and Child Telomere Length. Pediatrics. 2017;140(2): e20163245
4. Felitti VJ, Anda RF, et. al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. Am J of Prev Med. vol 14, issue 4, 245-258. 01 May 1998. DOI: https://doi.org/10.1016/S0749-3797(98)00017-8
5. De Bellis MD, Zisk A. The Biological Effects of Childhood Trauma. Child Adolesc Psychiatr Clin N Am. 2014 April ; 23(2): 185–222. doi:10.1016/j.chc.2014.01.002.
6. Van der Kolk B. The Body Keeps the Score. New York: Penguin Books, 2014.
7. Baldwin SB, Fehrenbacher AE, Eisenman DP, Psychological Coercion in Human Trafficking: An Application of Biderman’s Framework. Qualitative Health Research 1 –11. 2014. DOI: 10.1177/1049732314557087.