1. Simple and Complex Trauma: Assessment and Treatment Kevin J. Drab, M.A., M.Ed., LPC, NBCCH, CAACD, CEMDRT Behavioral Counseling & Training, 418 Stump Road, Suite #208, Montgomeryville, PA 18936 Tel: (215) 527-2904 Fax: (215) 699-3382 e-mail: [email_address] web site: http://BCTPRO.com

7. Trauma-Informed Care Most individuals seeking public behavioral health services and many other public services, such as homeless and domestic violence services, have histories of physical and sexual abuse and other types of trauma-inducing experiences. These experiences often lead to mental health and co-occurring disorders such as chronic health conditions, substance abuse, eating disorders, and HIV/AIDS, as well as contact with the criminal justice system. .

8. Trauma-Informed Care When a human service program takes the step to become trauma-informed, every part of its organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma affects the life of an individual seeking services. Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization

10. TRAUMA Traumatic events are shocking and emotionally overwhelming situations. It is natural for people who experience or witness them to have many reactions. Some of these are intense fear, horror, numbness, or helplessness. There are many dimensions of trauma, e.g., magnitude (life or harm threat, betrayal, loss, etc.), complexity, frequency, duration, predictability, and controllability, which when combined with subjective appraisal make arriving at an objective definition of trauma difficult.

12. Trauma It is very common for people to experience anxiety, terror, shock, and upset, as well as emotional numbness and personal or social disconnection. People often cannot remember significant parts of what happened, yet may be plagued by parts of memories that return in physical and psychological flashbacks. Nightmares of the traumatic event are common, as are depression, irritability, Sleep disturbance, dissociation, and feeling jumpy.

13. Trauma Some of the problems people encounter after traumatic events are part of the diagnosis of Acute Stress Disorder (ASD). ASD describes experiences of dissociation (e.g., feelings of unreality or disconnection), intrusive thoughts and images , efforts to avoid reminders of the traumatic experiences , and anxiety that may occur in the month following the end of the events. When these experiences last more than 1 month after traumatic experiences have stopped, they are described by the diagnosis of Post-Traumatic Stress disorder (PTSD). ASD is highly predictive of subsequent PTSD, and its validity as an actual discrete diagnosis (from PTSD) is very much in question.

15. Individual differences in these genes or brain areas may only set the stage for trauma without actually causing symptoms. Environmental factors, such as childhood trauma, head injury, or a history of mental illness, may further increase a person's risk by affecting the early growth of the brain. Also, personality and cognitive factors, such as optimism and the tendency to view challenges in a positive or negative way, as well as social factors, such as the availability and use of social support, appear to influence how people adjust to trauma.

17. Adriana – Rawadan genocide survivor

28. Gina – Iraqi veteran, childhood trauma

34. Normal Healthy Mental Condition Present Awareness and Identity Memory Memory Memory Associated Memory Content

35. Trauma Behavior Images Thoughts Body Memories Emotions Sounds Identity/ Ego State Taste Dissociated Traumatic Memory Material

36. TRIGGER Present Awareness and Identity Memory Memory Memory Associated Memory Content Behavior Images Thoughts Body Memories Emotions Sounds Identity/ Ego State Taste Dissociated Traumatic Memory Material Walling Off Process Intrusions Intrusions Intrusions

37. Structural Dissociation in Individual’s Personality Apparently Normal part of personality (ANP) – “as if personality,” presents as functional and whole, but is not. Emotional Part of Personality (EP) – also referred to as “survivor mode.” Trapped in traumatic memories and reactions. There can be more than one EP. Different, more or less divided psychobiological systems that are not sufficiently cohesive or coordinated within an individual’s personality.