# Motivation and emotion/Book/2023/Trauma and emotion

* Multimedia presentation (3 min)

## Overview

Trauma describes an experience where a person experiences a threat to their life or wellbeing or witnesses another person's life or wellbeing being threatened. Traumatic experiences can range from traffic accidents, natural disasters (see Figure 1), and war to sexual assault, domestic violence, and witnessing murder. Experiencing events of this nature often results in the individual experiencing significant emotional distress.
Around 20% of people who experience trauma will go on to develop post traumatic stress disorder (PTSD)[factual?], a condition which involves lifelike flashbacks, nightmares, avoidance of trauma related stimuli, and mood difficulties. Trauma has also been linked to a number of psychological disorders including depression, anxiety disorders, and borderline personality disorder (Creamer et al., 2001). Individuals with these disorders typically experience significant emotional difficulties[factual?].
Data from the World Mental Health Survey Consortium, estimated that around 70.4% of the international population has been exposed to trauma on a singular occasion (Benjet et al., 2015). Thus, understanding trauma and its effect on emotion is an important clinical target for research.
* Focus questions
* What is the effect of trauma on emotional regulation?
* What factors influence the effect of trauma on emotional regulation?
* What are the processes underlying the effect of trauma?
* What are the effects of sexual trauma on emotion?

## Emotional dysregulation as a consequence of trauma exposure

Emotional dysregulation is characterised by deficits in an individual’s awareness of their emotions, ability to manage these emotions, and to tailor emotional reactions appropriately to the situation (Bradley et al., 2011). Emotion can be understood as a subjective mental state which typically occurs in reaction to stimuli in the environment (Adolphs et al., 2019). Emotions involve the coordination of behaviour, memory systems, cognitive appraisals, and physiological reactions, and thus when an individual experiences emotional dysregulation, they may exhibit deficits in any of these domains (Dvir et al., 2014). Emotional dysregulation can involve emotion suppression, heightened emotional reactivity, emotional avoidance, and inability to identify one’s emotions (Amstadter & Vernon, 2008). Empirical research has often linked trauma exposure to an increase in emotional dysregulation. Emotional dysregulation is an important clinical target, as increased emotion dysregulation is associated with risky behaviours, and psychopathologies including PTSD, bipolar, personality disorders, depression, and anxiety (Rizeq & McCann, 2023).

### Common aspects of emotional dysregulation in traumatised individuals

Trauma-exposed individuals have been identified as experiencing particular dysregulation of negative emotions. Amstadter and Vernon (2006) studied the emotional reactions of participants who had been exposed to a variety of trauma types, namely sexual assault, physical assault, transportation accidents, and illness/injury. The study found an increase in guilt, anger, and shame post trauma across all groups. Interestingly, sadness (see Figure 2) only increased post trauma for physical and sexual assault groups. The study results provided strong support for the hypothesis that trauma results in heightened experience of negative emotions. Similarly, Bessel van der Kolk (2015) identified abnormally high levels of anger, guilt, fear, sadness, and shame across many years of therapeutic work with traumatised individuals. Dysregulation of these negative emotions is a particularly important focus area for research, as this dysregulation causes significant distress for traumatised individuals.
Emotion suppression is a particular facet of emotion dysregulation which is common in traumatised individuals. Emotion suppression can be described as ignoring, repressing, or squashing one’s emotions in an attempt to avoid becoming overwhelmed by the emotions (Wastell, 2002). Shepherd and Wild (2014) conducted a study of ambulance workers who had been exposed to trauma, collecting self-report information and measurements of skin conductance responses. The results revealed that participants tended to engage in emotion suppression in response to negative emotions, as opposed to cognitive reappraisal which is considered a healthier and more adaptive form of emotional regulation. Notably, individuals who presented with a higher number of PTSD symptoms engaged in emotion suppression to a larger extent than those who exhibited fewer symptoms. Thus, emotion suppression may be related to development of PTSD, or may be exacerbated by PTSD. Overall, this study found trauma exposed individuals frequently engaged in emotion suppression. The overwhelming emotional content of traumatic experiences serves as a potential explanation for why trauma-exposed individuals may engage in emotion suppression. Emotion suppression may serve as a way for trauma-exposed individuals to avoid experiencing the intense emotions associated with their trauma. Ironically, research has found that emotion suppression leads to a more intense experience of emotion in the long run. Although evidence supports the existence of an increase in emotion suppression following trauma-exposure, the relationship between trauma, emotion suppression, and PTSD is not yet fully understood.
Interestingly, individuals exposed to trauma also exhibit dysregulation of positive emotions. A study by Weiss et al. (2020) found that individuals with PTSD tended to exhibit a lack of acceptance of positive emotions, and often experienced feelings of fear and distrust of these emotions. The study also revealed that these individuals tended to act impulsively and become overwhelmed when experiencing positive emotions. It has been proposed that this phenomenon is a result of physiological arousal associated with positive emotion being appraised as threatening due to its similarity to trauma-related symptoms. For example, an individual who is experiencing accelerated heart rate due to excitement may unconsciously link this physiological occurrence to the increased heart rate they experienced due to anxiety during a traumatic event. Thus, the individual feels a confusing sense of distrust and experience when experiencing excitement. Critically, this study examined a population of trauma-exposed individuals who had developed PTSD, and thus results may not be generalisable to trauma-exposed individuals without PTSD. A study by Berfield et al. (2022), administered self-report measures to 1,160 individuals. Participants included trauma-exposed individuals with PTSD, trauma-exposed individuals without PTSD, and individuals with no trauma exposure. The results revealed significantly increased levels of positive emotion dysregulation in both trauma-exposed populations, compared to the no-exposure population. This increase existed for victims across a majority of trauma types, including both interpersonal and non-interpersonal traumas. This research indicates that trauma often significantly increases dysregulation of positive emotion in trauma-exposed individuals generally, not just those individuals with PTSD.

### Factors contributing to emotional dysregulation following trauma

It is important to note that not all trauma-exposed individuals will consequently experience emotional dysregulation. Thus, it is important to consider the factors influencing emotional dysregulation in the aftermath of trauma.
Firstly, research provides strong support for the hypothesis that interpersonal traumas are more likely to result in emotional dysregulation compared other trauma types (Raudales et al. 2019). Interpersonal traumas include physical and sexual abuse and severe neglect. This type of trauma appears to disrupt adaptive emotion regulation strategies more severely than other traumas, as interpersonal trauma is often chronic, and may disrupt an individual’s ability to seek social support following the trauma. Additionally, interpersonal trauma is often perpetrated by people the victim has some relationship with (e.g., by a parent, family member, friend, or romantic partner), adding an additional element of emotional distress. Victims often maintain their relationship with the perpetrator, and doing so often necessitates adopting maladaptive emotion regulation strategies. For example, a woman who is physically assaulted by her husband may suppress the anger and distress caused by this event in order to maintain a relationship with her husband for the sake of her children.
The developmental timing of trauma-exposure has also been noted to play a key a role in whether or not an individual consequently experiences emotion dysregulation. Mandavia et al. (2016) recruited 2,014 participants in a low socio-economic area of Atlanta, Georgia, United States. Based on analysis of self-report measures, the study identified that individuals who were exposed to trauma during childhood had a higher likelihood of consequently experiencing emotional dysregulation compared to individuals who were exposed to trauma during adulthood. Consolidating this work, Ehring & Quack’s (2010) administered surveys to 616 participants and found that emotional dysregulation was significantly heightened in survivors of chronic interpersonal traumas experienced during childhood, compared to survivors of trauma occurring during adulthood. When considering the mechanisms behind this effect, it is crucial to recognise the developmental tasks accomplished during these years, many of which relate to one’s emotional development.
Attachment theory outlines that the early bonds formed between a child and their primary caregiver have lasting effects across an individual’s lifetime (Bowlby, 1979). This early relationship is a child’s first experience of how to relate with and experience the world and others, and through this relationship, the child learns about how to express, experience, and regulate emotion. These learnings become central to how the individual perceives the world and are likely to carry through to adulthood. Given that childhood trauma often relates to abuse by the child’s parent or primary caregiver, the child’s primary attachment often involves aspects of fear, violence, and maladaptive emotional regulation. Thus, the individual may develop difficulties in emotional regulation. Additionally, in accordance with Bandura's (1977) social learning theory children learn through modelling from those around them. Thus, by experiencing adults around them failing to regulate emotions such as anger and expressing them through violence, children may grow up to replicate this dysregulation (Anderson & Kras, 2008). From this research, it is clear that trauma occurring during childhood has particularly negative effects on emotion opposed to trauma occurring at other developmental stages.
Alongside trauma type and developmental stage, factors such as personal characteristics for example extraversion, agreeableness, openness, conscientiousness and neuroticism shape an individual's beliefs about the safety of the world. Previous life experiences, social support, and emotional development before trauma occurrence are all factors that influence how trauma will affect an individual emotionally. These factors all contribute to whether an individual is likely to experience heightened emotional dysregulation in the aftermath of trauma, but even those individuals who don’t experience emotional dysregulation after trauma are likely to still experience some feelings of distress in the immediate period following a traumatic event.

## Neurobiological mechanisms underlying the effect of trauma on emotion

[Provide more detail]

### Abnormal functioning of the amygdala and prefrontal cortex

Abnormal functioning of the amygdala and prefrontal cortex has been implicated in the dysregulation of emotions observed in traumatised individuals. The amygdala (see Figure 3) is an important brain structure in the limbic system which plays a key role in processing fear (Maddox et al. 2019). When presented with potentially threatening stimuli, the amygdala acts to appraise the stimuli and determine whether a fear response is appropriate. On the other hand, the prefrontal cortex is an area of the frontal lobe responsible for more complex cognitive and emotional processing. The prefrontal cortex engages in extensive coordination of information from a variety of brain regions and synthesises this information to regulate our thoughts and emotions. The medial prefrontal cortex is particularly relevant to fear processing. In healthy individuals, the medial prefrontal cortex typically acts to regulate the fear response of the amygdala (Andrewes & Jenkins, 2019).
A study by Williams et al. (2006) examined the role of the amygdala and prefrontal cortex in emotional experience following trauma, by presenting individuals with fearful face stimuli. The study found that the amygdalas of individuals with PTSD tended to exhibit more heightened arousal to fear stimuli than non-traumatised individuals. Furthermore, a lack of activity in the medial prefrontal cortex was observed. This lack of activity represents a decrease in inhibition of the amygdala’s fear response, and thus a heightened experience of fear. Notably, this study utilised a sample of individuals with PTSD, so results may not be generalisable to all trauma-exposed individuals. This research provides a potential explanation for dysregulation of fear in individuals with PTSD.
Adding to these findings, Weiss (2007) found that sexually abused children with PTSD actually had decreased volume in the prefrontal cortex due to neuronal atrophy in this region. The study linked facets of emotional dysregulation such as numbing and dissociation to these neuronal deficits in the prefrontal cortex, as well as re-emphasising the role of the of the prefrontal cortex in observed heightened fear responses. These findings may further explain the particularly strong impact of childhood trauma on emotional dysregulation, as trauma may act to impair neuronal development that typically occurs at this time. Both these studies highlight the presence of neurobiological abnormalities underlying emotional dysregulation in individuals with PTSD, however further research is needed to confirm whether these same abnormalities exist in trauma-exposed individuals who do not develop PTSD.

### Serotonin depletion

Serotonin depletion has been observed in traumatised individuals (Corchs et al., 2009). This is another possible mechanism by which traumatised individuals experience difficulty regulating their emotions. Serotonin is a neurotransmitter which is typically released in response to stress and acts to reduce the experience of anxiety and low mood in these times. For individuals who have experienced trauma, ongoing stress related to this event (including reliving of memories, nightmares, and flashbacks) can lead to excessive and chronic release of serotonin in many brain areas. This excessive and ongoing release of serotonin eventually results in serotonin depletion in the brain (Harvey et al., 2009). Due to this depletion, the brain is no longer able to appropriately release serotonin in response to future stressful experiences. The individual is then more at risk of experiencing feelings of dysphoria and anxiety in these times, as serotonin is not able to dampen these emotions. Thus, serotonin depletion is a potential mechanism underlying emotional dysregulation of sadness and anxiety in traumatised individuals.

## Focus area: What is the effect of sexual trauma on emotion?

Sexual assault is a highly prevalent form of trauma and is often empirically posited to cause significant levels of emotional difficulty compared to other trauma types. Sexual trauma has negative implications for individuals across physical, interpersonal, sexual, and moral domains. Research conducted by Villalta (2019) on a population of female adolescent sexual assault victims found evidence of particularly severe disruption of these individuals emotional regulation compared to other trauma types. Sexual assault is physically intrusive, and often results in stress related to contraction of STDs and potential of pregnancy. Societal assignment of moral value to virginity and innocence also increases the shame and distress experienced by sexual assault victims (Ouhmad, 2023). Furthermore, sexual assault victims are more likely to face scepticism and victim-blaming, as well as to experience a sense of self-blame than survivors of other trauma types (Ullman, 2014). According to data obtained by the US Department of Justice, 45% of reported rapes were perpetrated by an acquaintance of the victim (Truman & Planty, 2012). When sexual assault is perpetrated by an acquaintance, this adds an additional layer of betrayal and distress to the trauma, and may be a factor contributing to a more negative emotional experience.
Walker et al. (2021) examined research relating to anger following sexual assault in both male and female populations. This study found that male survivors of sexual trauma exhibited increased levels of anger following the trauma, suggesting a dysregulation in this emotion. This increase in anger is likely to cause disruption and distress for the individual. Female survivors of sexual assault were not found to exhibit this same effect. In fact, female trauma-exposed participants tended to express lower levels of anger in response to unwanted sexual advances than the control group. This seems to reflect a sense of learned helplessness developing. Learned helplessness is a phenomenon occurring in individuals who learn to expect suffering and believe it to be inescapable. Individuals with a sense of learned helplessness are rendered unable to avoid suffering even when there may be an adaptive way to escape the suffering (Seligman, 1972). This phenomenon may explain why female victims of sexual assault are less likely to react with anger and resist future unwanted sexual advances. Decreased anger in female victims following sexual assault may also be a manifestation of emotion suppression, which may have created a difficulty understanding one’s own feelings in the circumstances of an unwanted sexual experience. In these ways, learned helplessness and emotion suppression increase the risk of re-traumatization for female sexual assault victims.

## Conclusion

Empirical research shows us that individuals who have experienced trauma typically experience difficulty regulating their emotions. Specifically, experiencing a traumatic event often results in heightened emotional reactivity to negative emotions, increased emotion suppression, and distrust of positive emotions. Although these aspects of emotion dysregulation are common in traumatised individuals, not all individuals will experience these effects, and the intensity of these effects varies across individuals. Research shows that trauma type and developmental timing of exposure are highly influential in determining whether traumatised individuals experience dysregulation, though other factors also contribute. Research examining the neurobiological mechanisms of emotional dysregulation following trauma has highlighted the role of abnormalities in the amygdala and prefrontal cortex, as well as dysfunction of cortisol and serotonin systems. It is clear that experiencing a traumatic effect can have long-term negative effects on an individual’s emotions. Given that these effects are largely maladaptive and can mediate the relationship between trauma and serious psychopathologies, finding ways to reduce the negative effects of trauma on emotion is vital for improving outcomes for traumatised individuals.