Biology of memory and childhood trauma.
Examples have been presented of children's behaviors that demonstrate the trauma-learning pattern of re-enactment, repetition, and displacement. They become persistent parts of the symptom complex of PTSD. The encapsulation phase occurs when the trauma event occurs and symptoms present themselves, but the events as yet are undisclosed. The trauma-specific behavior patterns, the general hyper-arousal symptoms, and the avoidant, numbing symptoms persist; the emerging disruptive behaviors are not linked to the traumatic event and reactions to the trauma. The response of the child's social and interpersonal context to the internalizing or externalizing behaviors post-trauma, continue shaping the internal cognitive schema of the child. When the child is unable to link ongoing, self-defeating, disruptive behavior to trauma experience, the underlying fear persists. This interferes with the child's ability to modulate emotions either through altering the persistence of refractory, self-limiting cognitive schema or the inability to use new experience to develop and grow. The flexibility of children to discriminate new information may be lost; the children are either numb to new information or hyperalert and perceive danger. Issues for treatment include children's distress over memories of the trauma and the lack of capacity to learn and develop from new interpersonal experiences. It has been our experience that nurses first must help the child relearn flexibility through self-observation, the element of self-soothing and calming behaviors, processing of new information, and strengthening of social relationships. With new and strengthened personal resources, the child then is able to begin to process the traumatic memories.
Burgess
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University of Pennsylvania School of Nursing, Philadelphia 19104-6096, USA.
Hartman
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Clements
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D000293:Adolescent; D001143:Arousal / Q000502:physiology; D002540:Cerebral Cortex / Q000503:physiopathology; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology; D003674:Defense Mechanisms; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008016:Life Change Events; D008032:Limbic System / Q000503:physiopathology; D008297:Male; D008568:Memory / Q000502:physiology*; D010343:Patient Admission; D011613:Psychotherapy; D012153:Retention, Psychology / Q000502:physiology; D013313:Stress Disorders, Post-Traumatic / Q000451:nursing / Q000503:physiopathology* / Q000523:psychology