Women and adolescent girls come to Timberline Knolls Residential Treatment Center because an illness has profoundly impacted their lives. We often discover that whether the disorder is an addiction to heroin or it involves an unhealthy relationship with food, at the very core of the illness resides some type of trauma. In fact, more than 90% of our residents have experienced trauma in their lifetimes.
Our multi-disciplinary treatment team has expertise in treating women suffering from a broad range of traumatic experience. In addition to the recovery principles found in the 12-step program, we utilize dialectical behavior therapy (DBT) which offers the tools and skills necessary to achieve recovery. DBT is so critical to our treatment approach, that our staff campus-wide receives training in order to help residents in everyday situations. Similarly, the staff is trained in principles of Somatic Experiencing (SE) to better understand and help our residents heal.
What Is Trauma?
Trauma is defined as any injury, whether physically or emotionally inflicted. In psychiatry, trauma refers to an overwhelming experience that is physically and emotionally painful, distressful, or shocking, which often results in lasting effects. In medicine, trauma refers to a serious or critical bodily injury, wound, or shock.
In the behavioral health field, trauma is separated into two categories: discrete traumas (sometimes called big “T” trauma) and chronic, insidious traumas (sometimes called little “t” trauma). Basically, these categories are predicated on frequency and severity. Discrete trauma is a highly identifiable and catastrophic event. This includes severe physical abuse, rape, extreme injury, witnessing violence, or an unexpected death of a relative or friend. Vivid and explicit memories usually, but not always, surround this type of trauma.
Chronic trauma is less about one identifiable event and more about reoccurring painful situations or experiences. This would include ongoing parental criticism, childhood neglect, being bullied or teased, or experiencing alcoholism, another addiction or mental/medical illness in the family. The ongoing nature and the more “acceptable” aspect of this type of trauma often makes it more difficult to identify and treat.
Trauma is the experienced emotional and physiological aftermath of an event(s), whether it is big “T” or little “t.” Importantly, it is not the event that determines whether something is traumatic to someone, but the individual’s experience of the event. All trauma shares certain elements in common such as that it was unexpected, the person was unprepared, and there was nothing the person could do to prevent it from happening. But again, it is how an individual experiences the event that will determine the level of ongoing symptoms after the trauma. For example, imagine two people witnessing a terrible car accident in which a person is killed. One of these individuals may return home that evening, describe what transpired to a spouse, then continue on with life as usual. Although clearly impacted, this person was not traumatized by the experience. Conversely, the second person due to myriad factors such as past experiences or a predilection toward depression may suffer extreme trauma related to the experience. If this continues for more than three months, it is considered post-traumatic stress disorder or PTSD.
Post-traumatic stress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. While many have suspected its existence throughout history, it was only legitimized as a valid condition five years after the end of the Vietnam War.
Estimates hold that about 30% of people exposed to trauma will develop PTSD. The rates are higher for women than for men.
Risk factors for PTSD include:
- lack of social support
- lack of public acknowledgment or validation of what happened
- vulnerability from previous trauma, interpersonal violation, especially by trusted others
- coping by avoiding or displaying feelings — seeing feelings as a weakness
- actual or symbolic loss — of previously held beliefs, illusions, relationships, innocence, identity, honor or pride Signs and Symptoms of PTSD When an individual suffers from PTSD, physical, emotional and cognitive symptoms are often very identifiable. Interpersonal relationships are usually profoundly impacted by the presence of this disorder.
Signs & Symptoms
Physical Signs of Trauma:
- Unexplained sensations including pain
- Sleep and eating disturbances
- Low energy
- Increased arousal
- Depression and fear
- Anxiety and panic
- Numbness, irritability, anger
- Feeling out of control
- Decrease in concentration
- Memory lapse
- Difficulty with decisions
Behavioral Signs & Effects:
- Substance abuse
- Eating disorders
- Impulsive, self-destructive behavior
- Dissociation Changes in interpersonal relationships:
- Isolation, avoidance, social withdrawal
- Sexual disruption
- Feeling threatened, hostile, argumentative
Re-experiencing the trauma:
- Intrusive thoughts
- Sudden emotional and or physical flooding Co-occurring Disorders
Most people admit to residential treatment with more than one issue. This is certainly the case when trauma is involved. In fact, PTSD is only occasionally the reason a woman or girl initially comes to Timberline Knolls Residential Treatment Center. She may have anxiety, depression, self-injury, addiction, anorexia or bulimia; only after a thorough evaluation is conducted can we fully ascertain the degree of trauma she has experienced in her life and how it relates to her current diagnoses.
Co-occurring Issues with Trauma
The signs and symptoms of PTSD clearly indicate how difficult it is to live with this devastating disorder. It comes as no surprise that a person would strive to mitigate extreme depression or anxiety, sleeplessness or crippling emotions through alcohol or drug use. When any drug is misused over a long period of time, dependency will result.
Eating disorders are only about food on the surface. On a deeper level, they are about coping with painful thoughts and emotions. A female may restrict food intake, binge and purge, or routinely consume enormous quantities of food without purging; regardless of the approach, it is essentially the same thing: she is using unhealthy food-related behaviors to achieve a desired end. The desired end usually involves memory, emotion or sensation. Say a woman experiences a big “T” trauma such as extreme sexual violation. In the months and even years that follow, she is haunted by memories of this highly traumatic event. She begins restricting food intake. This serves many purposes; initially intense hunger occupies her thoughts, leaving little room for horrific memories. In time, this ongoing hunger will numb all feelings, which is considered extremely positive by her. Additionally, as vast weight loss occurs, her body loses female characteristics such as breast and hips – she becomes gender neutral. If this woman had harbored any irrational thought that her “womanliness” had played a part in the rape, she is indirectly ensuring that such a violation will not reoccur.
Most people think of trauma as purely physical; however, a traumatic event strikes hard at a woman or girl’s soul. For example, a girl may experience a little “t” trauma such as ongoing bullying. The nasty teasing is relentless, unfair, even frightening at times; she did nothing to cause it and can’t understand why it is happening. In an environment such as this, innocence erodes, along with the perception that the world is a safe place or even the most elementary concept that people are inherently good. If all this transpires, it is no wonder that hopelessness would ultimately metamorphose into clinical depression or exaggerated fear would translate into an anxiety disorder, even agoraphobia.
Trauma Treatment at Timberline Knolls
PTSD rarely resolves on its own; that’s why it is so important for a woman or girl to get the treatment for trauma she needs. The extraordinary benefit of coming to Timberline Knolls is that we address all co-occurring disorders simultaneously. As we treat the trauma related to rape, we address the anorexia; as we deal with the impact of childhood bullying, we treat the depression. Additionally, since the implications of trauma are so vast, we treat the entire person: her mind, body, soul and spirit. We provide healing and restoration to every aspect of a woman’s being; and we do so in an environment where only females are treated. This provides an extra level of comfort and safety to those who have experienced trauma, especially if the event involved the opposite sex.
Along with individual and group sessions, residents participate in experiential therapies that include art, dance and yoga. Each of these therapeutic strategies offers something that talk therapy cannot. Art provides a creative new outlet to express her thoughts and feelings, and yoga and dance movement therapy allow her to experience her body in a whole new and incredibly positive way.
In addition to treating the resident, we extend treatment to her family. Whether it is the family of origin, or family by marriage, if a woman or girl has been negatively impacted by trauma, family members have too. We believe the family also deserves our attention and care.