Individualized nature of traumatic experiences and treatment

Trauma

'the processing of traumatic experience is highly individualistic, and cannot easily be captured with simple diagnostic labels" (McFarlane and Van der

Kolk, 1996: 562).

Traumatic experiences vary significantly from person to person, the result of many different social and cultural factors as well as individual preferences and physiological factors. One can't simply ascribe a common treatment protocol to all patients undergoing a traumatic experience, because there have not been developed any specific tools that are successful in treating traumatic experiences for every person. Rather, the successful treatment of traumatic events begins with close exploration of the nature of trauma including its symptomology and pathology as well as examination of its psychiatric impact on patients.

For the most part trauma is often associated with post traumatic stress disorder. Though this is a far reaching consequence of traumatic experience affecting a majority of patients, it is not the only factor that need be considered when examining trauma from a clinical perspective. Rather researchers should be focusing their efforts on examining the traumatic experience outside of post traumatic stress to examine the entire nature of trauma on an individual's well being.

Researchers for some time have been examining the experience of trauma as it relates to individuals and group populations. A large body of evidence exists that suggests that the experience of trauma is highly individualized. The symptoms and experiences of trauma are difficult to study in a laboratory setting, thus the research available on traumatic experiences generally is contingent on subjective memories and observations of patients that have undergone traumatic events over time (Van der Kolk & Fisler, 1995:1). Studies suggest that trauma is unique and the experience of trauma can't be generalized to a population as a whole, but rather must be examined from an individual perspective.

Analysis of Trauma Experiences and Symptomology/Pathology

The analysis of trauma is complex at best. To understand trauma one must first examine the prevalence of trauma and its impact on society. Research suggests that a majority of individuals will experience some form of trauma at one point or another during their lives (Holman, 2000:808). Trauma by its nature is a stressful event that often presents differently depending on an individual's unique coping mechanisms. To a large degree it is not certain how exactly patients will respond to trauma.

The nature and manifestation of traumatic memories and experiences have been studied by numerous psychological researchers over time; most have concluded that traumatic are difficult to study because they can't necessarily be approximated within a laboratory study (Van der Kolk & Fisler, 1995:1). Thus researchers must rely on subjective experiences and recollections of trauma to measure individual reactions and latent symptoms, and these recollections are often tainted or diluted with time (Van der Kolk & Fisler, 1995:1).

Given the limited resources in a laboratory setting for collecting information on traumatic experiences, there are few options for exploring traumatic experience outside of collecting retrospective reports from people who have experienced trauma, through "post-hoc" observations or through provoking flashback of traumatic memories in people that have been traumatized (Van der Kolk & Fisler, 1995:1).

These recollected experiences vary from person to person, not simply based on cultural or social factors, but also on individual coping mechanisms, personalities, support systems and personal perceptions of the traumatic experience as a whole; a physician can't' simply predict how any one person will react to trauma; rather they must rely on accurate clinical assessment and careful analysis of the patient's responses, pathology and demeanor to assess a patients well being and condition (Holman, 2000:803).

Studies conducted of the traumatic experiences of individuals indicate that people's perceptions of trauma are highly varied, and their recollections of significant traumatic events vary substantially, and often do not reflect the true symptomology or pathology of the trauma 100% (Christianson, 1992: 309; Van der Kolk & Fisler, 1995:1). Rather people tend to consolidate memory and relate it to personal or cultural experiences, and accurate recall over time generally is said to decline (Van Der Kolk & Fisler, 1995:1). Symptoms and pathological consequences of trauma are more easily examined from a biological perspective, where the actual biological and physiological effects of the trauma may be analyzed and measured based on the impact they have on an individuals physiological and day-to-day functions (Van der Kolk & Fisler, 1995:1).

Research has been conducted with regard to memories of culturally impacting traumatic events, and suggest that people generally distort these memories over time as well (Van der Kolk & Fisler, 1995:1). This suggests that the symptoms of trauma may fade with time. Research also suggests that trauma can result in extremes of memory retention and forgetting, that "terrifying experiences may be remembered with extreme vividness or totally resist integration" (Van der Kolk & Fisler, 1995:1).

Many patients disassociate their experiences at the moment of trauma, where they in effect compartmentalize their experience so that elements of the traumatic experience are stores as fragments in their mind (Nemiah, 1998; Van der Kolk & Fisler, 1995). According to Janet "forgetting the event which precipitated the emotion has frequently been found to accompany intense emotional experiences in the form of amnesia" (Janet, 1925, 1607; from van der Kolk & Fisler, 1995).

Addressing Trauma in Patients

There are many different methods for addressing a specific traumatic incident, including Traumatic Incident Reduction (TIR) and Thematic Trauma Incident Reduction (TIR) (Ditrich, et. al, 2000, p.1). TIR is traditionally used to address themes related to trauma including the feelings, emotions and attitudes a patient might be feeling; it requires that clients are talk through an incident several times to engage traumatic memories and is generally considered a client centered approach toward treatment (Ditrich, et. al, 2000, p. 1). This method has been shown to be effective regardless of an individual's background and recollected traumatic experiences. Though not widely adopted at present, this form of therapy offers one solution for the clinical practice and treatment of trauma patients of varying backgrounds. This treatment can be highly individualized to address unique patient needs.

The implications for clinical practice are many as a result of the information gained in this analysis. Generally screening for traumatic events should include an analysis of an individual's cultural and social background to assess whether or not the person may be at increased risk for additional psychiatric phenomena other than that associated with the trauma. A physiological examination at the initial moment of trauma or shortly thereafter would benefit patients by allowing accurate assessment of the clinical manifestation of trauma to the persons body and physical state. Generally a close evaluation of the individual's perception of trauma and recollection of specific factors and details regarding the traumatic event will have to be analyzed over time, so that treatment may be modified to address patients changing needs with regard to their experience over time.

Treating patients will have to remain highly individualistic in nature based on the literature presented. This is evidenced by the large body of information that still supports the notion that the experience of trauma is highly individualistic even when similar traumatic events have occurred across varying populations.

There are certain populations that have been identified as higher risk with regard to psychiatric complications resulting from trauma, outside of post traumatic stress disorder which is common to most patients. Treatment approaches within the clinical setting thus might be more specialized so that they focus on the individual needs of members in high risk groups including females and individuals from low socio economic environments, who may or may not have access to health care. In general however, one may conclude that individual therapy is most effective in treating trauma patients regardless of background or experience.

References:

Ditrich, Anne M., Baranowsky, Anna B., Devich-Navarro, M., Gentry, J.E., Harris, C.J.,

Figley, C.R. (2000). "A Review of Alternative Approaches to the Treatment of Post Traumatic Sequelae." Traumatology. Volume VI, Issue 4, Article 2. [online] October 22, 2004: http://www.fsu.edu/~trauma/v6i4/v6i4a2.htm

Christianson, S.A. (1992). "Emotional stress and eyewitness memory: A critical review."

Psychological Bulletin, 112, 284-309.

Holman, EA, Silver RC, Waitzkin, H. (2000). "Traumatic life events in primary care patients: a study in an ethnically diverse sample." Archive of Family Medicine, 9: 802-810. [online] October 23, 2004, http://archfami.ama-assn.org/cgi/content/abstract/9/9/802?ijkey=24d8af7e8eff85cb2b3ca11282afc944113b8c64& keytype2=tf_ipsecsha

Janet, P. (1925). "Psychological Healing," Vols. 1-2. New York Macmillan, (Original

Publication: Les Medications Psychologiques, vols. 1-3. Paris, Felix, Alcan, 1919). From Van der Kolk & Fisler, 1995.

Nemiah, J.C. (1998). Early concepts of trauma, dissociation and the unconscious: Their history and current implications. Chapter in: D. Bremner & C. Marmar (Eds.), Trauma, memory and dissociation (pp. 1-26). Washington, DC: American Psychiatric Press.

Palinkas, Lawrence A. (2000). "Social, Cultural and Clinical Dimensions of Traumatic

Experiences of Primary Care Patients." Archives Family Medicine, 9: 812-813. Available: http://archfami.ama-assn.org/cgi/content/full/9/9/812

Palinkas, Lawrence A. (1995). "Health under stress: Asian and Central American

refugees and those left behind: introduction" Social Science medicine, 40: 1591-1596. Available: http://archfami.ama-assn.org/cgi/content/full/9/9/812

Van Der Kolk, Bessel A. & Fisler, Rita. (1998)."Dissociation and the Fragmentary

Nature of Traumatic Memories: Overview and Exploratory Study." HRI Trauma Center and Harvard Medical Center. [Online] Trauma Pages. 20, October 2004: http://www.trauma-pages.com/vanderk2.htm