Sexual Abuse - Why You Don't "Just Get Over It" (trauma therapy helps), part 2

You aren't broken.

Trauma and complex PTSD caused by sexual abuse and rape are underdiagnosed and often misdiagnosed as something else. (Bipolar, Borderline and PTSD - What's the Difference?) That's because trauma from years ago can cause so many different problems in adult life, referred to as "symptoms", which don't always fit neatly into a diagnostic box.  It has been estimated that of people who seek treatment for mental health problems, as many of 90% have an underlying trauma.

Symptoms of trauma and PTSD:

trauma, PTSD, sexual abuse, childhood sexual abuse
  • insomnia
  • compulsive behavior patterns
  • overreactions and sudden floods of emotion
  • self-destructive and impulsive behavior
  • uncontrollable reactive thoughts
  • inability to make healthy professional or lifestyle choices
  • dissociative symptoms (“checking out”)
  • feelings of shame, despair, hopelessness
  • feeling permanently damaged or “broken”
  • a loss of previously sustained beliefs
  • inability to maintain friendship or other relationships
  • sexual problems
  •  hostility and arguments with family members, employers or co-workers
  • social withdrawal
  • feeling constantly threatened and that you always have to be on guard
  • substance abuse

In part one of this blog I talked about the different parts of the brain and how they hold trauma - the Reptilian Brain (fight/flight/freeze/submit response), the Old Mammalian Brain (images, emotions, non-verbal memory) and the Thinking Brain or prefrontal cortex (verbal memory, analytical, decision making functions). Each part has a specific function that tries to protect us from the damage of a traumatic experience.

The Reptilian Brain is the most primitive part of the brain and evolved first. This is where our survival instincts live. When sexual abuse or rape occurs, there are a couple of immediate defense mechanisms that are deployed that help you live through the moment when you perceive that your life is being threatened. The active defenses are fight and flight and use the cortisol response so beautifully described by Robert Sapolsky in his book Why Zebras Don't Get Ulcers.  Either run away from the danger or fight back at it. If the abuse happened when you were a child you may not have been able to run away and you certainly weren't equipped to fight back. Rape victims often have a similar experience - they aren't able to fight back or run away. In these cases, the passive defenses are deployed.

Freeze and submit are the passive defenses. Freeze is the "deer in the headlights" experience - you literally can't move, but inside your thoughts and emotions are a storm of activity. Submit is another defense, like when the antelope goes limp in the lion's jaws. The submit option is to play dead, to give up. The Reptilian Brain is telling you that if you play dead, you might be overlooked and might just survive the encounter. 

Sexual abuse survivors hold these primitive defense mechanisms in their body memory.

When you get triggered cortisol goes rushing through your body and one of the 4 primitive defenses shows up - whichever one you experienced at the time of the original trauma.  You may not even realize that you have been triggered, but you will experience either a flood of emotions or complete absence of them (dissociation). You may find yourself lashing out at someone who doesn't really deserve it (fight), running away from a person or a situation that could be enjoyable (flight), feeling frozen in a moment unable to speak or move or react (freeze), or going limp and having zero energy, unable to take any action at all (submit).  This comes from the Reptilian Brain, and there's nothing rational about it. The Thinking Brain isn't even part of the equation yet. Sound familiar?

Trauma is a visceral, emotional experience. Therefore it makes sense that the memories are held in The Old Mammalian Brain - the place that non-verbal memories are stored. Images, smells, sounds, emotions. That's why, for example, the color yellow might trigger a freeze moment for a person who was abused in a yellow room or by someone wearing yellow. Again, the Thinking Brain has little to do with it.

So what does the Thinking Brain have to do with processing Trauma?

The Thinking Brain is the most evolved part of the brain. That's where you evaluate options, make decisions, try to make sense of painful experiences and try to cope with them. When someone tells you to "just get over it" they are talking to your Thinking Brain and telling that part of you to ignore the signals from Reptilian Brain and Old Mammalian Brain. This just doesn't work. The Thinking Brain is very good at helping you cope with the pain, but it can't make it go away.

Healing from sexual abuse and rape requires integration of signals from the Reptilian Brain, the Old Mammalian Brain and the Thinking Brain. 

It requires that you deal with each of these important parts of you. Each part is responsible for a different function and "speaks" a different language, and so you have to speak to these parts in their native tongue. Reptilian Brain speaks instinct. Old Mammalian Brain speaks images and emotions. Thinking Brain speaks insights and stories. Traditional psychotherapy talks only to the Thinking Brain. This can help you put the story together, but can't help you process the pain, the images and the triggers.

Read part 3 of this post for more information on how to integrate and heal these different parts of the trauma experience.