Reconceptualizing the influence of empathic capacity and emotional numbing on perceptions of social support in female survivors of interpersonal violence: An initial investigation into the implications of neurophysiology for trauma recovery

An estimated 80 percent of individuals living in the United States have experienced at least one traumatic event during their lifetime, with nearly one in eight developing symptoms of Posttraumatic Stress Disorder (PTSD) as a result (Breslau & Kessler, 2001). Prevalence rates, however, are higher among females, particularly female survivors of interpersonal trauma (Kessler, 2000; Olff, Langeland, Draijer, & Gersons, 2007; Tolin & Foa, 2006). Of the numerous factors that influence PTSD, social support has been identified as one of the foremost predictors of both symptom severity and duration (Brewin, Andrews, & Valentine, 2000; Ozer, Best, Lipsey, & Weiss, 2003). However, research routinely assesses social support based solely on subjective measures of perceived support and has yet to elucidate whether individuals with PTSD have the neurophysiological capacity to accurately perceive and maintain available support networks. Following trauma, the compromised ability of the prefrontal cortex to optimally regulate affective processing centers of the brain, accompanied by the dysregulation of an individual's autonomic nervous system, underlie the hyperarousal and affective numbing characteristic of PTSD (Garfinkel & Liberzon, 2009; Glover, 1992; Ogden, Minton, & Pain, 2006; Porges, 2011; Siegel, 1995; van der Kolk, 2006). Further still, such dysregulated neurological functioning occurs in tandem with a maladaptive cascade of regulatory hormones known to influence social functioning as well as empathy (Hurlemann et al., 2010; Porges, 2003; Seng, 2010; Steuwe et al., 2012). In this way, neurophysiological corollaries of trauma may inhibit an individual's ability to both experience and express empathy, preventing survivors from recognizing and drawing upon the viable social support available to them (Nietlisbach & Maercker, 2009). As such, the present study explored the relationship between PTSD symptom severity, emotional numbing, empathy, and perceived social support in female survivors of interpersonal trauma. Findings revealed that the difficulties in empathy experienced among survivors were directly related to PTSD symptom severity. However, such impairments appeared to be dictated by the survivor's degree of emotional numbing rather than the severity of the PTSD symptoms specifically. Emotional numbing, and difficulty perceiving or expressing positive emotions in particular, was found to also predict perceptions of social support. Furthermore, although empathy exhibited a direct relationship with perceived support, impairments in empathy did not mediate the relationship between positive emotional numbing and perceptions of the social support availability and valence as originally hypothesized. However, the severity of a survivor's comorbid depression appeared to confound nearly all of the relationships between the study variables. Nevertheless, emotional numbing, a condition common to both depression and PTSD, continued to show a strong relationship with empathy even when accounting for depression. Such insights have marked implications on the way counselors understand and work with female survivors of interpersonal trauma and suggest that experiences of emotional numbing and comorbid depression should be central foci in early therapeutic interventions. Interventions aimed at regulating the autonomic nervous system have shown success in alleviating both emotional numbing and struggles with depression and may be appropriate in this regard. The need to assess for and work with symptoms of emotional numbing and depression early in therapy may serve to enhance empathic capacity in survivors, facilitate the development of a strong therapeutic relationship and cultivate the interpersonal resources necessary for lasting change and healing to occur. Future research will serve to expand the many potential advantages that such findings can have on better conceptualizing the influence of interpersonal trauma on a survivor's ability to experience and express empathy and a full range of emotional experiences and benefit from the positive social support that exists around her.