Updated: Mar 28, 2020
When I was born, I was given up for adoption. It would take me nearly thirty years to understand how much this has affected me. Speaking as a fellow sufferer and an enthusiastic researcher, I know that developmental trauma comes with challenges not necessarily faced by those enduring adulthood shock trauma. It has taken me nearly five years of working with Somatic Experiencing (SE) to become regulated enough to write such a blog post.
In SE and several other forms of somatic psychotherapy, we place a great emphasis on feeling bodily sensation. But why is this exploration and acceptance of sensation necessary for working with developmental trauma and PTSD?
Implicit Memories (yay!?)
To answer, let’s look at some of the differences and similarities between developmental trauma (DT) and acute trauma occurring post-childhood that is often associated with PTSD. To begin, both of these afflictions have unconscious implicit memory at their core. Although implicit memories are varied, and far more complicated than what I am about to say, it will suffice to think of implicit memories as those stored in the muscles and nerves, and are beyond our conscious recollection (Levine, 2015; van der Kolk, 2014).
When a threatening event occurs and we are powerless to stop it, the vast amount of nervous system charge that was conjured to counter the threat is not used. This charge lives on in our muscles and nerves as a type of implicit recollection called procedural memory. The procedure, in this case, was supposed to be our defensive action, but as that was not carried out, our body holds an imprint of this failed procedure as a bodily memory. Our body remains tense, fearful, and ready for defense, oftentimes years after the threat is gone. The maladaptive ways we cope with unresolved charge become pathology (Kain & Terrell, 2018).
Exploring bodily sensation is essential to working with this type of memory because, well, that is where this memory lives. Implicit memories reveal themselves to us through sensations, motor impulses, and emotions (Levine, 2015). However, there are some important differences between those associated with DT and acute trauma.
DSM-V messes up, again.
The origin of these differences is reflected in the recent alterations to the PTSD diagnosis in the DSM-V. A most unfortunate change to the criteria has occurred (especially considering the American Psychiatric Association rejected adding a Developmental Trauma Disorder to the DSM-V). All psychosocial stressors have been removed, and only acute events that count as “traumatic” are those involving “actual or threatened death, serious injury, or sexual violence” (Pai, A.; Suris, A.M.; North, 2017). . So, while these sort of episodic shock traumas occurring after childhood are undoubtedly horrific, they do not necessarily come with the same challenges associated with DT.
DT experts, Kathy Kain and Stephen Terrell point out that the most commonly used criteria for differentiating DT and adult onset shock trauma is that DT occurs in the first three years of life, with some experts arguing for that range going up to five years of age (Kain & Terrell, 2018; Perry, 2006). When a traumatic event occurs this early, healthy development of the brain and nervous system is disrupted.
Imagine you are building a table from the bottom up. But as you are constructing the legs of the table, a few of them get cracked and bent. Consequently, when it is time to attach the legs to the tabletop, they do not fit properly. Alas, building the table must continue in spite of this. Now, three of the weak table legs are haphazardly attached, the table is wobbly, and the top is unlevel and warped. This is roughly the plight of those suffering from DT.
This growth disruption is significant because the most rapid rate of brain development happens in the first three years of life. A huge number of synapses are created to allow for a strong awareness of the environment and hypersensitivity to external input (Huttenlocher & Courten, 1979). Whether it is built sturdy or not, the table is being built, and rapidly.
As my therapy began to take off, and I developed an increased tolerance for physical sensations, I discovered a profound sense of autonomic dysregulation, fear, and insecure attachment. In actuality, they were always there. It was only now that I could feel their presence through the language of implicit memory: sensation, emotion, and impulses. Whereas before I could only understand that my table was severely wobbly, I could now see the broken legs and feel the failed fastenings. Let us look at these core challenges of developmental dysregulation, fear, and insecure attachment, each in turn, and how somatic psychotherapy can work to heal them.
Autonomic dysregulation is not exclusive to DT. However, developmental dysregulation is unique and presents a far greater clinical challenge than that typically associated with acute trauma. Autonomic dysregulation occurs when our attempts to deal with threat are thwarted (as we discussed earlier). On a neuroanatomical level, this happens because our autonomic nervous system (ANS) has a hierarchy of functioning platforms. Dr. Stephen Porges’s work has contributed greatly to our better-than-ever understanding of this process.
Stephen Porges' Polyvagal Theory and the Importance of Social Engagement
Our first line of defense against threat is our social engagement system. When in danger, we scan the environment for help, and reach out for it if it is available. Associated with this impulse is the neural platform of the ventral vagal nerve, which calms the heart rate, promotes relaxed alertness, and fosters social connection. Phylogenically, this inhibitory capability is unique to mammals and developed to compensate for our longer gestation periods. When this level of defense is thwarted, we may lose our ability to orient to our environment, or fail to recognize friend from foe. It is important to know (and to remember for later) that the ventral vagal social engagement system is the healthiest form of autonomic regulation we have available to us. The ones that follow can be taxing and are meant to be time-limited forms of protection.
During a threat, if no one is around to help, our phylogenically older sympathetic nervous system kicks in. Our heart rate and respiration increases, pupils dilate, and our arms and legs ready for fight or flight. Thwarted sympathetic responses are common, and can leave us chronically braced for fight, or regularly looking for the exit sign. High levels of anxiety and aggression are signs of thwarted protective responses at this level.
If fighting or fleeing prove impossible or ineffective, we revert to our oldest form of self-protection: the freeze state. Our heart rate lowers, our brain floods with endogenous opioids, and our muscles may brace and then go limp. Neurologically, this state is related to the dorsal vagal nerve and can be thought of as an equivalent to the emergency brake in a car. If we use the emergency brake to halt a speeding automobile, the gas keeps running and the car is severely taxed. Or if we go into total collapse and fear keeps us from thawing, we can learn to use this numb, reserved state chronically. Such is the nature of a thwarted freeze response.
It's hard to be a baby.
Now, there are two huge problems for infants and toddlers when it comes to addressing threat and self-regulating. First, they do not have access to the first line of defense: the ventral vagal form of regulation. The ventral vagal nerve is myelinated, meaning it is coated in fat to increase its rate of functioning. Unfortunately, it is not yet myelinated when we are born. The most rapid time of myelination for the ventral vagal nerve occurs in the first six months of life, with this myelination continuing heavily over the next few years (Porges, 2011). This means babies literally do not have the capacity to regulate themselves using this platform. They rely on the regulatory capacity of their primary caregiver to do it for them. Thus begins the complete interweaving of one’s regulatory capacity and attachment system.
Without access to healthy self-regulation, the presence of a regulating relationship is essential. Therefore, any discrepancies within such a relationship become the traumatic event. This can happen if the primary caregiver is non-attuned, distracted, dysregulated, neglectful, or abusive. It bears remembering that this is not the only form of trauma infants can endure. Medical procedures, falls, and unforeseen separations from parents can all have a traumatic impact on a little one. No matter the event, the trauma comes when the baby reverts to the sympathetic nervous system and/or the dorsal vagal freeze response to protect themselves.
This leads us to their second problem: fight and flight tend to be of little use when you are 16” tall and cannot walk. For this reason, the only sympathetic response available to the baby is screaming for attention. And if this does not solve the problem, or the problem is the person whom they would normally scream for (80% of infant maltreatment happens at the hands of primary caregivers), they learn to use the freeze response for regulation (Streeck-Fisher & van der Kolk, 2000). The use of this system-taxing form of regulation is especially detrimental for infants. Remember, the baby’s neural platforms are developing at a rapid rate through the profound process of neuroplasticity. This means that the neural pathways (in this case, the unhealthy forms of regulation) being used are the ones that stick.
This is what makes developmental dysregulation so challenging: it is foundational. It becomes the baseline of operations for a person’s ANS. And the longer they operate from this type of dysregulation, the more neural pathways develop to support it. Therefore, when you have a forty-two-year-old woman come into your office, and she has been using a dorsal vagal freeze state for four decades, it takes a while to get to those broken table legs.
In my own SE work, it took well over a year of exploring sensation and emotion for me to get an accurate sense of how dysregulated I was. During its origin, this type of foundational dysregulation becomes what we call in SE coupled with intense fear. Once again, coupling fear and dysregulation is not known only to those struggling with DT. But fear resulting from early childhood trauma is once again unique and clinically operose.
In our early years, our care providers help us develop discernment between what is exciting and what is dangerous (Kain & Terrell, 2018). The ball is rolled towards us, and our parents smile and laugh. The neighbor’s snarling dog approaches us in the yard, and our parents react with concern and alarm. For an infant, both of these events will come with sympathetic arousal. With our parents’ help, we learn to discern that not all forms excitation are dangerous. Babies do not learn this cognitively. The baby’s underdeveloped frontal cortex is not yet engaged with that level of learning. We learn this via our five sense perceptions and their impact on what Porges refers to as the baby’s sixth sense: their internal felt sense, known as interoception.
Interoception and Neuroception - Our Earliest Barometers
The infant’s internal sensations cue them to everything from hunger and exhaustion to, you guessed it, danger. Our five senses and interoception inform what Porges calls neuroception (Porges, 2007). Neuroception refers to neural clusters that develop around the perception of safety and threat. If we think back to the foundationally dysregulated baby who relies on a freeze response, we could bet their sense of neuroception would develop to be inaccurately skewed towards danger.
The threat may lead to a freeze state marked by flaccid muscles and collapse. These become chronic due to ineffective completion of the protective response. Chronic flaccid muscles and fearful sense of collapse send afferent impulses back to the brain (85% of fibers in the vagus nerve are afferent) that are interpreted by the brain as the presence of another threat. This positive feedback loop of fear and dysregulation has quite the negative impact on the baby’s development. Once again, fear associated with DT comes from a neurologically foundational place—all the more challenging to reach.
Attachment Theory - No Longer a "Theory"
Thinking back to the baby’s complete dependence on their caregiver for regulation, it is easy or more like, down-right obvious) to understand how strongly a child’s attachment system can be effected by early rupture and trauma. Whether the trauma originated from a the parent’s neglect and/or abuse, or the simple fact that when something traumatic happened no one was there to protect the infant, all early trauma is relational. Insecure attachment patterns, such as avoidance, anxious-ambivalence, and disorganization, develop as a masterful (although eventually maladaptive) regulation strategy by the infant. These adaptations add another devastating element to DT that those with acute trauma PTSD might not suffer. Therefore, in therapy we must work with the client’s specific attachment adaptation in conjunction with the dysregulation and fear.
And you may have guessed, I suspect it is much more efficient to work with them in the language they speak: sensation! Developmental trauma, and PTSD are both sad, and workable conditions. But they are not totally alike. There is hope in knowing these differences. Our body has not forgotten, and our body knows how to heal.