[Psychology and psychobiology of childhood trauma]

Exposure to overwhelming stress often determines how people subsequently organize their perceptions of themselves and of others. Traumatic experiences at different developmental levels have different effects on cognitive, affective and biological self-organization. Acute or chronic exposure to trauma may be expressed as Post Traumatic Stress Disorder (PTSD), dissociative disorders, somatic disturbances and alterations in perception of self and others. These disorders involve (a) the involuntary repetitive re-living of the trauma in thoughts, images, somatic states or behaviors, (b) attempts to avoid dealing with reminders of the past, (c) problems with the modulation of physiological responses to subsequent stress, and (d) a loss of capacity to engage in love and work with pleasure and satisfaction. The display of extremes of emotional distress, or of bizarre or disorganized behaviors, easily obscures the fact that current problems may have their origins in past trauma. The recognition that many psychiatric patients organize much of their lives around repetitive patterns of re-living and warding off traumatic memories, reminders and affective states, may help clinicians understand their symptoms as misguided attempts to regain a sense of control and safety, rather than as bizarre behaviors that need to be merely controlled. Since safe attachments appear to be the primary way in which children learn to regulate internal state changes, the negotiation of interpersonal safety needs to be the first focus of treatment. Since the labeling and categorization of emotional states is one of the principal areas of functioning that is disrupted by developmental trauma, treatment needs to include learning how to use words to understand and interpret feelings in general and stressful events, in particular. Since distrust and lack of social safety are critical parts of developmental trauma, structure and predictability are essential. Identifying specific trauma-based perceptions and expectations and learning how to negotiate the fulfillment of one's emotional needs are critical aspects of effective treatment.