EMDR – Part II: Is There a Relationship Between Trauma and Mental Illness?

Researchers create “models” of thought as structural ways of explaining a phenomenon. In 2001, Dr. Colin Ross proposed a model of mental illness called the “trauma model”. He argued that psychic trauma, especially in youth, is the most important contributing factor in mental illnesses, especially for patients with multiple diagnosis.  He proposes that chronic childhood trauma is to psychiatry what germs are to general medicine.

Other trauma models, such as John Bowlby’s Attachment Theory, also highlight particularly traumatic factors in early attachment relations. Bowlby noted the negative mental health consequences on infants and young children when a positive relationship with a caregiver does not exist.

The Adverse Childhood Experience (ACE) Study

Research supports the linkage between early experiences of chronic maltreatment and later mental health problems including personality disorders

One important and often overlooked study was conducted by Kaiser Permanente from 1995 to 1997 with over 17,000 participants.  Study members participated in a standardized physical examination and a confidential survey that contained questions about childhood maltreatment and family dysfunction, as well as items detailing their current health status and behaviors. This information was combined with the results of their physical examination.

The ACE Questionnaire contained questions about the respondent’s experiences in the first 18 years of life in the following categories:

1. Abuse

   • Emotional Abuse – swearing, insults put-downs and menacing

   • Physical Abuse – pushed, grabbed, slapped, hit with injury, or had something thrown at

   • Sexual Abuse – touched or fondled in a sexual way, or had you touch their body in a sexual way, or attempted or successfully had oral, anal, or vaginal intercourse with you

2. Neglect

   • Emotional Neglect – Did you feel special, loved, supported and protected by your family?

   • Physical Neglect – Was there enough to eat, clean clothing, doctor visits in your home

3. Parental Separation or Divorce

4. Incarcerated Household Member

5. Household Dysfunction

   • Mother Treated Violently – Your mother pushed, grabbed, slapped, kicked, bit, hit or threatened with a weapon?

   • Household Substance Abuse – Lived with anyone who was a problem drinker or used street drugs?

   • Household Mental Illness – Was a household member depressed, mentally ill or attempted suicide?

The major findings of the Adverse Childhood Events (ACE) Study indicated that almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACE.  The short- and long-term outcomes of these childhood exposures include an array of health and social problems. In fact, as the number of ACE reported increased, the risk for the following health problems increased:

• Alcoholism and alcohol abuse

• Chronic obstructive pulmonary disease (COPD)

• Depression

• Multiple sexual partners

• Sexually transmitted diseases (STDs)

• Liver disease

• Partner violence

• Suicide attempts

• Early sexual activity

• Fetal death

• Teen pregnancies

• Illicit drug use

• Heart disease

• Smoking

Receiving a Diagnosis of PTSD

To receive a diagnosis of PTSD, a person must report being exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence either by direct exposure, witnessing or learning about someone who was exposed to a trauma.

Some of the prominent features of PTSD include:

• Difficulty falling or staying asleep

• Irritability or outbursts of anger

• Difficulty concentrating

• Exaggerated startle response

• Hyper-vigilance

Hyper Vigilance is maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.

Some individuals with PTSD described their experiences as follows:

“I am constantly scanning the environment, constantly looking behind me, It is impossible for me to walk anywhere or even sit in my own home without having to look scan all areas of the environment, especially behind me”.

“It creates paranoia and anxiety that wouldn’t be there if I wasn’t looking out for danger. It has also created self fulfilling prophesies – in an anxious state I have, in the past, asked so many paranoid questions trying to find out if I’m in danger, that the person on the receiving end responds aggressively and fulfills that fear”.

“I am hypervigilant among many things. I am usually armed with some form of weapon or have it within a one arm’s length reach of my position. I do scan my environment. I also scan people as well. I watch the hands and shoulders of the person I maybe talking with in order to telegraph their movements. I am a light sleeper. I wake up in the middle of the night to the slightest noises.

The “Stuckness” of PTSD

The sad irony of PTSD is that the victim is caught between RELIVING the event and AVOIDANCE of the event. “He is forced to relive the original event through intrusive symptoms such as flashbacks, nightmares, panic attacks, and obsessive thoughts. On the other hand, he is compelled to insulate himself from reminders of the trauma through avoidance symptoms such as social isolation, emotional numbing and substance abuse.” (EMDR, Shapiro, 14)

Well-meaning friends and relatives might urge the victim of trauma to “Just get over it and Stop thinking about it!!” Unfortunately, its just not that easy.