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Tufts OpenCourseware
Author: Bessel van der Kolk, M.D.

Main points

  1. Effects of trauma on cognitive, psychological and interpersonal functioning
  2. The range of adaptations to trauma early in the life cycle, including the loss of affect regulation; chronic destructive relationships towards self and others; dissociation and amnesia; somatization; and chronic characterological problems, such as self-blame, guilt, shame, chronic distrust and identification with the aggressor
  3. The assessment of patients with chronic PTSD (Post Traumatic Stress Disorder) and the development of appropriate phase-oriented treatment plans depending on the clinical symptomatology of the traumatized child or adult

Adaptations to trauma in early life cycle

  1. Loss of affect
  2. Chronic destructive relationships
  3. Dissociation and amnesia
  4. Somatization
  5. Chronic characterological problems: self blame, guilt, shame, distrust
  6. Identification with aggressor

Assessment of patients with chronic PTSD

  1. Symptom-based treatments in phase-oriented assessment

Conditioned emotional reactions

  1. Images and events trigger memories of trauma that are otherwise repressed


  1. Knowledge of a terrifying experience without knowing it
  2. Memories can be hidden
  3. Sensations can be puzzling until associated with the hidden memories
  4. Suppressed memories may be product of psychiatrist, not actual events

Biological models of trauma and memory

  1. Amygdala – tags incoming experiences with emotions
  2. Hippocampus – files experiences into long-term memory
  3. In trauma, the hippocampus may be unable to categorize and thus mis-assign information so that it is difficult to retrieve
  4. If amygdala is aroused, stress hormones are released; changes how memories are stored, e.g., information will stay as perceptual (smells, sights, sounds)
  5. Psychiatrists may ask about details to jog memory. Accumulation of sensory info helps patient recall the event
  6. Traumatic memories are stored on the right side of the brain


  1. 2-4 million women are battered/year
  2. 1500 women murdered by intimate partners/year
  3. 20-30% of women have history of abuse


  1. Arousal and fear increase amygdala activity and cortisol levels
  2. Frightened animals have abnormal amygdala hippocampus pathways
  3. Information that comes to hippocampus can be incomplete
    1. mainly sensory content
  4. During trauma, amygdala on right side of brain lights up in Broca’s area and loses perfusion
  5. Can’t talk while in shock

Consequences of childhood maltreatment

  1. 30% of abused children have language or cognitive impairment
  2. 22% have a Learning Disorder
  3. 25% will require special education services
  4. 50% have trouble in school

Risk factors for PTSD

  1. 4-12 x risk of alcoholism, depression, drug abuse, suicide
  2. 2-4 x risk of smoking, poor self-rated health, STDs
  3. 1.6-2.9 x risk for 10 leading causes of death
  4. 1.5 x risk of physical inactivity and obesity
  5. The higher the number of Adverse Childhood Experiences, the more likely you are to have these problems

Three "As"

  1. Attachment: increased or decreased
  2. Attention dissociation
  3. Arousal-impulsivity: aggression towards self and others


  1. Go home: disrupts pathological amygdala-hippocampus connection
  2. Dorsal lateral prefrontal cortex imagines multiple outcomes: how we could do it better next time
  3. Turns off in trauma; unable to imagine the image differently
  4. Triggers panic reaction, bad feelings, sympathetic nervous system stimulation
  5. Inability to move away from traumatic situation
  6. Study (Osterman et al., Gen Hosp Psych, 1998): PTSD after waking up during surgery
    1. acknowledgement of trauma recovery
    2. denial of trauma PTSD