1. Trauma 101:
Understanding the
neurobiology of
dysregulation.
Presented by:
Sophia Deborah Erez, MS, LPC, MFT
Shared Hope International
November 30, 2011
Slide by Sophia Deborah Erez © 2008 520.302.5859

2. Our objectives:
Slide by Sophia Deborah Erez © 2008 520.302.5859

3. What are your perceptions of trauma?
Slide by Sophia Deborah Erez © 2008 520.302.5859

4. Trauma
Susto Rape trauma syndrome
Ataque de nervios Battered women’s syndrome
Railway Spine Chronic interpersonal trauma
Soldiers heart Chronic developmental trauma
Battle fatigue Complex trauma
War combat syndrome Disorders of extreme stress not
Shell shock otherwise specified (DESNOS).
War neuroses Coming soon DSM V . . .
Posttraumatic stress disorder
(PTSD)
Complex PTSD
Slide by Sophia Deborah Erez © 2008 520.302.5859

5. DESNOS
“The DSM IV Field Trial supported the notion that trauma,
particularly trauma that is prolonged, that first occurs at an early age and
that is of an interpersonal nature, can have significant effects on
psychological functioning above and beyond PTSD symptomatology.
These effects include:
problems with affect dysregulation
aggression against self and others
dissociative symptoms
somatization
character pathology
These various symptoms tend to cluster into distinct patterns and
to be highly interrelated” (van der Kolk, Roth, Pelcovitz, Sunday and
Spinnazzola, 2005).
Slide by Sophia Deborah Erez © 2008 520.302.5859

6. DESNOS
Early interpersonal traumatization gives rise to more complex posttraumatic
psychopathology than later interpersonal victimization.
These symptoms occur in addition to PTSD symptoms and do not necessarily
constitute a separate cluster of symptoms.
The younger the age of onset of the trauma, the more likely one is to suffer from the
cluster of DESNOS symptoms, in addition to PTSD.
The longer individuals were exposed to traumatic events, the more likely they were
to develop both PTSD and DESNOS.
DESNOS symptoms, rather than PTSD, may cause patients to seek treatment.
(van der Kolk, Roth, Pelcovitz, Sunday and Spinnazzola, 2005).
Slide by Sophia Deborah Erez © 2008 520.302.5859

7. Chronic Victimization
• Alterations in emotional regulation. May include persistent
sadness, suicidal thoughts, explosive anger, or inhibited anger.
• Alterations in consciousness. Includes forgetting traumatic
events, reliving traumatic events, or having episodes in which one
feels detached from one's mental processes or body.
• Changes in self-perception. May include helplessness, shame,
guilt, stigma, and a sense of being completely different from other
human beings.
Slide by Sophia Deborah Erez © 2008 520.302.5859

8. Chronic Victimization
•Alterations in how the perpetrator is perceived. Examples
include attributing total power to the perpetrator, becoming
preoccupied with the relationship to the perpetrator, or
preoccupied with revenge.
•Alterations in relations with others. Examples include isolation,
distrust, or a repeated search for a rescuer.
•Changes in one's system of meanings. May include a loss of
sustaining faith or a sense of hopelessness and despair.
Slide by Sophia Deborah Erez © 2008 520.302.5859

9. Sophia’s definition:
“A chronic dysregulation of the Nervous
System resulting from the neurological,
biological, psychological and social
adaptations necessary for survival
when a human being is confronted with
a perceived life threatening experience
and/or a perceived absence of life
promoting experiences.”
Slide by Sophia Deborah Erez © 2008 520.302.5859

10. Trauma (dysregulation) is:
•A normal reaction to an
abnormal experience.
•In the perception of the
experience-not an event.
•A biological response.
Slide by Sophia Deborah Erez © 2008 520.302.5859

11. Trauma (dysregulation) is:
•Necessary for survival.
•Can be about what didn’t
happen as much as about
what did happen.
Slide by Sophia Deborah Erez © 2008 520.302.5859

12. Key Points!
• It is our “humanness”
that makes us vulnerable
• This biology is shared
between across all
cultures, languages, etc.
Slide by Sophia Deborah Erez © 2008 520.302.5859

13. Common symptoms of
dysregulation:
•Self-destructive behavior •Psychomotor agitation
•Flashbacks •Chronic pain
•Startle hypervigilence •Numbing
•Nightmares •Intrusive memories
•Hyperarousal •Amnesia
•Insomnia •Hypoarousal
•Irritability •Decreased interest
•Anxiety •Hopelessness
•Panic attacks •Depression
Slide by Sophia Deborah Erez © 2008 520.302.5859

14. Dysregulation can occur in the
absence of:
•Control
•Knowledge
•Time
•Support
•Good enough parenting
•General sense of safety in the world
•Good enough affect regulation skills
•Experience of repair in relationships
Slide by Sophia Deborah Erez © 2008 520.302.5859

15. Dysregulation can occur in the
presence of:
•Fear
•Horror
•Belief that death is imminent
•Shame
– I am not worthy
– I am not loveable
Slide by Sophia Deborah Erez © 2008 520.302.5859

16. Trauma Terminology . . .
•“Big T”
•“little t”
•Cumulative Trauma
•Shock Trauma
•Developmental Trauma
•Complex Trauma
•etc . . .
Slide by Sophia Deborah Erez © 2008 520.302.5859

17. and the important difference.
• Adult trauma
changes the adult’s
relationship with
themselves and the
world.
• Developmental
trauma changes the
child’s character and
personality.
Slide by Sophia Deborah Erez © 2008 520.302.5859

18. How does trauma present?
Note. From Complex trauma in children and adolescents (p. 32), by National Child Traumatic Stress Network, 2003.
Retrieved April 9, 2006, from http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/ComplexTrauma_All.pdf
Slide by Sophia Deborah Erez © 2008 520.302.5859

19. ren and adolescents (p. 32), by National Child Traumatic
9, 2006, from Slide by Sophia Deborah Erez © 2008 520.302.5859
dfs/edu_materials/ComplexTrauma_All.pdf

20. Symptoms
“valiant neurobiological attempts to cope
with the trauma: self-injury and
suicidality, risk-taking, re-enactment
behavior, caretaking and self-sacrifice, re-
victimization, and addictive behavior.”
Janina Fisher
Working with the Neurobiological Legacy of Early Trauma
Slide by Sophia Deborah Erez © 2008 520.302.5859