Animal attacks can be terrifying for children (and adults) and have long term effects

Post Traumatic Stress Disorder (PTSD) is a common long-term effect of being a trauma victim, and victims of animal attacks are no exception to this rule.

It is well documented in child welfare reporting that the majority of reported animal attack cases in the U.S. are on children.  According to The Center for Disease Control and the American Veterinarian Association, the highest reported incident rates involve 5-9 year olds, and 77% of those injuries are to the face, neck, and head. This, of course, is particularly terrifying for children, especially considering that the family dog is the aggressor in nearly half of the attacks.

Medical attention is usually the very first action taken when a child is bitten or attacked by a dog or other animal. A dog attack can cause lacerations, punctures, crush injuries, nerve damage, sprain and strain of muscles, infection… and of course, emotional distress.

A 2004 study found that over half of (studied) animal attack victims had symptoms of post-traumatic stress disorder 2 to 9 months after sustaining a dog bite injury. (Citation: Peters, V. et. al. Post-traumatic stress disorder after dog bites in children. J. Pediatrics, 2004, 144, 121-122.)

It’s therefore important that children (and anyone) who have been attacked by animals and exhibit PTSD symptoms are given follow-up psychological treatment.

Peter Levine, an expert in the field of healing trauma with a technique called somatic experiencing, names the following symptoms as common ones in the wake of an animal attack:

• excessive fear
• feeling that the world is a dangerous place
• anxiety
• sensitivity to sounds or light
• difficulty sleeping
• difficulty in defending oneself
• stuck in a pattern of compulsive attack or rage
• stuck in a pattern of running away (difficulty with commitment)
• helplessness
• frequent re-enactments

Interestingly, Levine makes the connection that we are all in fact animals, and that “the involuntary and instinctual parts of the human brain and nervous system are virtually identical to those of other mammals.” He goes on to explain how our own reaction to trauma mimics the Fight, Flight or Freeze response that wild animals instinctually use to survive.

However, it’s important to remember that we are not just animals.

The difference between people and animals lies in the prolonged state of the reaction to an attack. When an animal is no longer in danger, it is able to easily shake off the energy of fear and self-defense. This allows animals to return to their normal state of functioning pretty quickly. On the other hand, people who experience PTSD will suffer the negative effects of an attack long after the attack is over.

Animal attack victims suffering from PTSD may handle threats by reacting inappropriately aggressively (the “fight” response). They may, on the other hand, be in a constant hypervigilant state that prompts them to flee even the most minutely anxiety-provoking circumstances (such as hearing a dog bark in the distance). And in particular, animal attack PTSD sufferers tend to cleave to the “freeze” mentality, opting to numb out or check out when presented with stressful situations, rather than deal with them directly.

Studies show that traumatic events can actually result in neurological damage in children.

Reduced hippocampal activity in children with PTSD can affect their memory permanently.  In one study, “Children between the ages of 10 and 17 were divided into a group with a confirmed diagnosis of post traumatic stress disorder (arising from a variety of traumatizing events) and compared with a group of children with no post traumatic stress disorder. Brain scans (e.g. MRI) were taken simultaneously when subjects completed a test for verbal memory. The test consisted of having subjects read a list of words from one list, then read an additional set of words from another list, and then try to remember which words were on the original list. Compared with children without posttraumatic stress disorder, those with PTSD did poorly on this test, and during testing these subjects also showed considerably less electrical activity in their hippocampus.” (Citation: Carrión, V. et. al., Reduced hippocampal activity in youth with post-traumatic stress symptoms: An MRI study, J. Pediatric Psychology, 2010, in press)

The brutality of nature comes close to home when an animal attacks occurs. Whether it’s the rare tragic incident at a zoo or an all-too-common bite by a neighbor’s dog, being attacked by an animal is a terrifying event that can have lasting effects.

Barking dogs are a very common noise and almost impossible to avoid in daily life. Therefore, victims of animal bite trauma might be constantly reminded of their experience in their everyday lives.

Trauma has occurred when symptoms have developed and have become visible. One type of trauma results from natural disasters such as earthquakes, tornados or hurricanes, forest fires, floods, volcanic eruptions, landslides, or tsunamis. These types of experiences are particularly insidious because they tend to traumatize large populations of people at once, and can result in epidemics of Survivor Guilt along with other PTSD symptoms.

Like many causes of trauma, natural disasters can be sudden and overwhelming. The most immediate and typical reaction to a calamity is shock, which at first manifests as numbness or denial. Quickly—or eventually—shock can give way to an overemotional state that often includes high levels of anxiety, guilt or depression.

If victims have lost their loved ones or their homes, they may feel helpless. This can be exacerbated if they have to live in shelters without support from relatives or friends for extended time periods. However, living with other survivors can be a time to reconnect, talk about the event with others, and help to reframe the event. Being able to help another survivor can reduce helplessness, and may start the healing process.

Natural disasters in particular can bring victims a feeling of being betrayed by “their god,” which can result in a loss of faith.  Making peace with “the divine” might be one step toward healing and gaining faith back.

It’s hard to predict when PTSD will set in with a survivor of a traumatic natural disaster. Some victims seem at first perfectly (or even abnormally) fine, only to be beset with symptoms later on.  Survivors are recommended to seek professional guidance if they find themselves unable to regain control of their lives or if they continue to suffer from PTSD symptoms for more than a month.

Victims do not need to have experienced a disaster firsthand in order to suffer from PTSD. As an example, an emigrant from Haiti living abroad at the time of the recent earthquake could be profoundly affected by the countless hours of television coverage of the disaster, especially if they still had family living in Haiti at the time of the event who they were unable to contact or gain information about.

It’s very important with natural disaster trauma that the victim give himself time to heal and pass through an appropriate mourning process. Only by processing the experience over a realistic period of time is healing possible.

Over the next few months, I’ll touch upon the most common types of trauma and the ones I see most frequently in my practice. You can also read a longer version of this article on Examiner, Psychology Today, and Womens Radio (published 3/3/10).

Chronic pain is defined as prolonged physical pain that lasts for longer than the natural healing process should allow. This pain might stem from injuries, inflammation, or neuralgias and neuropathies (disorders of the nerves), but some people suffer in the absence of any of these conditions. Chronic pain can debilitate one’s ability to move with ease, may hinder their normal functioning, and the search for relief can lead to pain medication addictions, which compound the problem. Chronic pain is also often accompanied by feelings of hopelessness, depression and anxiety.

Many people are already familiar with the fact that emotional stress can lead to stomachaches, irritable bowel syndrome and headaches, but might not know that it can also cause other physical complaints and even chronic pain. One logical reason for this: studies have found that the more anxious and stressed people are, the more tense and constricted their muscles are, over time causing the muscles to become fatigued and inefficient. More subtly, one might develop psychosomatic symptoms or stress-related symptoms because of unresolved emotional issues. These are not new discoveries; researchers have studied the mind/body interrelationship for several decades because of the importance of this link.

Experts have noticed that experiencing a traumatic event can have an impact on the development of pain. In fact, approximately 15-30% of patients with chronic pain also have PTSD. Peter Levine, an expert on trauma, explains that trauma happens “when our ability to respond to a perceived threat is in some way overwhelming.” Most researchers disagree on a precise definition of trauma, but do agree that a typical trauma response might include physiological and psychological symptoms such as numbing, hyperarousal, hypervigilance, nightmares, flashbacks, helplessness, and avoidance behavior.

During a traumatic event, the nervous system goes into survival mode (the sympathetic nervous system) and sometimes has difficulty reverting back into its normal, relaxed mode again (the parasympathetic nervous system). If the nervous system stays in survival mode, stress hormones such as cortisol are constantly released, causing an increase in blood pressure and blood sugar, which can in turn reduce the immune system’s ability to heal. Physical symptoms start to manifest when the body is in constant distress.

If someone has experienced a trauma prior to their current injury or trauma, old memories can potentially be triggered, exacerbating the effects of the newer trauma. Dr. Bessel van der Kolk, a well-known trauma researcher, explains; “Research has shown that, under ordinary conditions, many traumatized people, including rape victims, battered women and abused children, have a fairly good psychosocial adjustment. However, they do not respond to stress the way other people do. Under pressure, they may feel (or act) as if they were traumatized all over again.”

Often, physical pain functions to warn a person that there is still emotional work to be done, and it can also be a sign of unresolved trauma in the nervous system. Even if one has grieved and processed the emotional impact of a trauma, the nervous system might still unwittingly be in survival mode.

Maggie Phillips, author of Reversing Chronic Pain, writes: “Whether or not trauma was connected to the event or condition that originated their pain, having a chronic pain condition is traumatizing in and of itself.”

Since trauma has been found to have a strong correlation to chronic pain, a combination of psychotherapy and physical therapy would be the most logical pain management option for stress and chronic pain relief. Maggie Phillips states that imagery is a more effective intervention than verbal therapy, because trauma tends to impair the language and the mind’s organizational capacities. Psychotherapy that uses imagery, addresses the nervous system, and facilitates cognitive behavioral therapy is recommended.

To tackle the physical aspect of chronic pain, Mindy Marantz, director of the Healthwell clinic in San Francisco, suggests focusing on alignment in the body, as well as posture that supports organized alignment. Additionally, she advises to address potential inflammation, and provides strategies to help calm the nervous system such as Craniosacral therapy or Feldenkrais Movement Re-education. “These both will help ‘stoke’ the lymphatic system, which in turn helps diminish the effects of fluids that pool as a result of injury. Lymphatic massage as well as compression wraps and education help bring this often overlooked pathway to recovery to patients’ attention.”

Beginning a daily program of walking can help to mobilize the muscles and is the best way to stimulate the lymph system to do its job and oxygenate injured muscles. The International Association for the Study of Pain concluded that acupuncture is also effective in long term chronic pain reductions related to musculoskeletal pain.

PTSD and chronic pain are often connected, and both must be addressed in order to help a person be fully functional again. Although one might not be aware of the lingering effect of the trauma, or believe that the traumatic event has been put behind them, the body could be clinging to unresolved issues. Relevant psychotherapy can help to resolve the physical problems.

Compassion Fatigue

Medical professionals such as physicians, nurses, psychotherapists, and emergency workers, who help traumatized patients may develop their own Post Traumatic Stress Disorder (PTSD) symptoms as an indirect response to their patient’s suffering. This phenomenon has been referred to as compassion fatigue, vicarious traumatization or secondary traumatic stress.

A survey showed that “86.9% of emergency response personnel reported symptoms after exposure to highly distressing events with traumatized people” . . . [and] . . . “90% of new physicians, between 30 to 39 years old, say that their family life has suffered as a result of their work”. When health care professionals struggle with their responses to the trauma suffered by their patients, their mental health, relationships, effectiveness at work, and their physical health can suffer.

Caregivers who reported experiencing compassion fatigue, expressed such feelings as, “I frequently dissociated and felt that I walked around in an altered state. I didn’t realize that I had been in a gray space all year. That had sort of creeped in” and “It got to the point where I would feel physically sick before the appointment and feeling nauseous.” Others described that they picked up their client’s symptoms and explained that they had “tightness in the exact same spot” as their clients and continued to carry the sensation sometimes for days. One psychotherapist expressed, “I am the empathy lady from the old Star Trek episode and get may be 45 % hit of what my patients might be feeling 100% of.”

The helpers symptoms, frequently unnoticed, may range from psychological issues such as dissociation, anger, anxiety, sleep disturbances, nightmares, to feeling powerless. However, professionals may also experience physical symptoms such as nausea, headaches, general constriction, bodily temperature changes, dizziness, fainting spells, and impaired hearing. All important warning signals for the caregiver that need to be addressed or otherwise might lead to health issues or burnout.

Researchers and authors such as Babette Rothschild, Charles Figley, Laurie Anne Pearlman and Karen Saakvitne, and B. Hudnall Stamm have recognized that medical personnel and psychologists may experience trauma symptoms similar to those of their clients. They speculate that the emotional impact of hearing traumatic stories could be transmitted through deep psychological processes within empathy. Further, Babette Rothschild hypothesizes that it is the unconscious empathy, the empathy outside awareness and control that might interfere with the well being of the caregiver.

Hearing and witnessing horrific stories of abuse and other traumas can be very stressful and trauma experts have found that self-care techniques, both psychological and somatic, can reduce susceptibility to the internalization of traumatic stress and compassion fatigue. Bernstein indicates that paying attention to and being aware of physiological signals and somatic counter transference such as “dizziness, emptiness, hunger, fullness, claustrophobia, sleepiness, pain, restlessness, sexual arousal, and so forth” can be an important method of preventing and managing compassion fatigue. Somatic countertransference entails the psychotherapist’s reaction to a client with bodily responses such as sensations, emotions, and images that can only be noticed through body awareness. Since somatic countertransference is often neglected in both the literature and in the caregiver’s training, many are not aware of the somatic countertransference elicited in the helper-patient relationship.

Reducing compassion fatigue means not fighting the symptoms but working with  feelings which occur during and after the interactions with the traumatized patient. One psychotherapist shared;  “If I start to not feel my body, I pause and just take a moment.” There is a lot to take in. Giving oneself permission to take a break for a short time and taking care of oneself, may not only help the caregiver but may also provide a role model of self-care for the patient. Taking a break might be just to stop and feel one’s body, asking the patient to slow down, taking a deep breath, or making a small movement, which are forms of regulating the nervous system and decreasing the stress of working with traumatized patients.

Since caregivers commonly dissociate, staying connected or reconnecting to one’s identity and physical presence has been rated as very important as well. Some professional helpers use visual or kinesthetic reminders of their lives outside of their work. Visual reminders might be placing pictures of family, certificates, and favorite artwork in the office. Whereas kinesthetic reminders bring awareness back to the body and might be accomplished by feeling one’s feed on the floor, intentionally fiddling with a wedding ring or holding the office chair. One caregiver expressed, every time she closes the office door she uses the door as a kinesthetic reminder and says, “This is my life outside and that’s where I’m entering.”

Studies have also shown that the attitude toward life such a sense of humor, self confidence, being curious, focusing on the positive, and feeling gratitude ranked high in being helpful in treating traumatized people. Additionally, support, supervision, balancing work and private life, relaxation techniques, and vacation time have been useful.

Research indicates that caregivers are not immune to trauma and might experience compassion fatigue. A better understanding and knowledge about this phenomenon as well as self care techniques that include both psychological and somatic tools can help caregivers to more effectively deal with patients’ sufferings.

Susanne Babbel, MFT, PhD is a licensed marriage and family therapist, somatic psychotherapist, and workshop leader in San Francisco. If you would like further information on this topic please visit her website: www.bodyconversations.com

Dr. Babbel:

I often ask my clients who suffer from depression and/or anxiety to get a neurotransmitter test to make sure their concerns are not based on some kind of nutritional deficits. Could you briefly explain 1) what neurotransmitters and Beta Endorphins are, 2) how they relate to depression and anxiety and 3) what to look for in a neurotransmitter test?

Barbara Clark:

Neurotransmitters:
The center of the nervous system is the brain, which contains over 100 billion specialized cells called neurons. The nervous system also contains very important chemical messengers called neurotransmitters. The brain uses neurotransmitters to tell the heart to beat, the lungs to breathe, and the stomach to digest. Neurotransmitters are also necessary for thought processes, emotions, and other essential body functions including sleep, energy, and fear.

Depressive and anxiety disorders are among the most common neurotransmitter-related conditions. Neurotransmitters are chemicals that relay signals between nerve cells, called “neurons”. They are present throughout the body and are required for proper brain and body functions. Serious health problems, including depression and anxiety, can occur when neurotransmitter levels are too high or too low.

Every neurotransmitter behaves differently. Some neurotransmitters are inhibitory and tend to calm, while others are excitatory and stimulate the brain. Deficiencies involving the central nervous system’s neurotransmitters – serotonin and norepinephrine- appear to be involved in the development of depressive disorders. Disruptions in other neurotransmitters, like GABA (the central nervous system’s primary inhibitory neurotransmitter), epinephrine, glutamate and histamine may be associated with anxiety disorders.

Environmental and biological factors – including stress, poor diet, neurotoxins, or genetics – can cause imbalances in the levels of neurotransmitter chemicals in the brain. These imbalances can trigger or exacerbate depressive symptoms.

Endorphins:
Endorphins are endogenous opioid polypeptide compounds. They are produced by the pituitary gland and the hypothalamus in vertebrates during strenuous exercise, excitement, pain and orgasm and they resemble the opiates in their abilities to produce analgesia and a sense of well being. Endorphins work as “natural pain relievers “and they are actually a complex of at least fifteen potent brain and body chemicals that all amplify pleasure and make pain tolerable. Endorphin depletion is caused by physical or emotional pain, or both.  You could have been born with an endorphin deficiency, too much stress may drain the endorphins, and typically women have lower endorphin levels than men. Taking a supplemental blend of the 9 essential amino acids under the supervision of a health care provider, a good multivitamin, B vitamins and eating a protein-rich diet (proteins are precursors to amino-acids) can help get the endorphins into a more balanced state. Ideally these steps need to be supervised by an appropriate health care provider.

Neurotransmitter test:
There are laboratories who do urine testing for neurotransmitter (Neuro Science, www.neuroRelief.com) and there are laboratories who have testing available for blood platelet serotonin and catecholamines

(Vitamin Diagnostics) www.integrativepsychiatry.net/blood_platelet_neurotransmitter_test.html

Emotional Reactions:

_    You feel shame and not worthy
_    You overreact or are overemotional
_    You feel great sadness or anxiety on a regular basis
_    You have a very strong inner critic
_    You are afraid to be abandoned and feel lonely
_    You avoid certain situations
_    You can not feel emotions and are often numb
_    You lack confidence and self esteem
_    You have mood swings

Physical Symptoms:

_    Your body may stay in alert and stress mode until it knows it is safe (Hyperarousal)
_    You have a hard time relaxing and do not know how to settle down (Constriction)
_    You have difficulty sleeping and have nightmares
_    You have body image and weight problems
_    Your memory is not fully functioning
_    You feel numb and cannot feel your body (dissociation)
_    You are suffering from chronic pain
_    Skin disorders
_    Constipation

Relationship Patterns:

_    You may have developed specific patterns that you keep repeating
_    You try to control your partner, friends and family
_    You have a hard time saying no, setting limits or boundaries
_    Relationships can be difficult for you
_    You feel disconnected and detached

If you recognize yourself in these examples, you might have an unresolved traumatic experience.

Trauma symptoms can be expressed days, months, or even years after the traumatic event. Symptoms may suddenly arrive through a trigger in the environment and might appear as emotional, cognitive, or physical reactions. Sometimes the mind is not able to make sense of the internal signals, especially when the person has experienced an overwhelming event or stressful situation. The mind might continue to communicate to the nervous system the necessity to prepare to flee, fight, or freeze. Adrenaline is disbursed and the cycle might perpetually continue until the body-mind perceives that it is safe and recognizes it can rest.

If not addressed these can turn into long-term symptoms such as:

•    Panic attack
•    Avoidance behavior
•    Addictions
•    Risk taking behavior
•    Constant dissociation
•    Memory loss
•    Midlife crisis and fear of dying
•    Self-harming behavior
•    Obsessive or lack of sexual feelings
•    Feeling disconnected