Trauma and the Challenge
of
Sexual Addiction
SASH
The Society for the Advancement of Sexual Health
National Conference
Boston, MA - September 30 - October 3, 2010
Taruno Steffensen
ICADAC - International Certified Alcohol and Drug Abuse Counselor
SEP - Somatic Experiencing Practitioner
[email protected]
1
Core Assumption I
In the context of trauma, sexual addiction arises not as a pleasure-seeking strategy but as a
survival strategy:
•
To self-soothe and self-regulate
•
As a way to numb hyperarousal symptoms: intolerable affects, reactivity, impulsivity,
obsessive thinking
• In the service of walling off intrusive memories
•
As a way to combat helplessness by increasing hypervigilence and feelings of power and
control
•
To “treat” hypoarousal symptoms of depression, emptiness, numbness, deadening
•
In the service of facilitating dissociation
• As a way to function or to feel safer in the world
Fisher, 2007
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Core Assumption II
How the addictive behaviors have helped trauma patients to survive: that is, which trauma
symptoms are they attempting to treat through their drinking, drugging, eating disorders, and
sexually acting out behaviors. We need to know this information for a number of reasons:
•
First, we need to know because these are precisely the symptoms that will increase once the
patient becomes sober or abstinent
•
We need to know, too, so that we can begin to anticipate other coping strategies they will
need in order to deal with those symptoms as they erupt and threaten to overwhelm
them
• Furthermore, we need to be able to predict when and how the symptoms may potentially
trigger a behavior relapse so that we can help them strengthen the addictions recovery
program they have chosen
• And finally, we also need to know so that we can help the survivor appreciate their
courageous attempts to cope with the effects of the abuse and, from that recognition,
develop sufficient compassion and self-respect to counteract the shame and guilt that is
the inevitable byproduct of their addictions and trauma history
Fisher, 2007
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What is Trauma?
“Trauma is experiencing too much, too fast, too soon.”
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What is Trauma cont?
Trauma is perhaps the most avoided, ignored, belittled, denied,
misunderstood, and untreated cause of human suffering. Although
it is the source of tremendous distress and dysfunction, it is not an
ailment or a disease, but the by-product of an instinctively
instigated, altered state of consciousness. We enter this state - let us
call it survival mode - when we perceive that our lives are being
threatened. If we are overwhelmed by the threat and are unable to
successfully defend ourselves, we can become stuck in survival
mode. This highly aroused state is designed solely to enable shortterm defensive actions; but left untreated over time, it begins to
form the symptoms of trauma.
Peter Levine
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Somatic Experiencing
6
Trauma and the Brain
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Bessel van der Kolk
“The imprint of the trauma is in the limbic system and in the
brainstem: in our animal brains, not our thinking brains”
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The Triune Brain
x
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Pierre Janet
1859-1947
• “[Traumatized] patients ... are
[repeatedly] continuing the
action, or rather the attempt at
action, which began when the
thing happened, and they
exhaust themselves in these
everlasting
recommencements.”
•
1919/25, p. 663
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“Bottom-up, The Hi-Jacked Brain”
Everyday experiences connected to the trauma will trigger
instinctive survival responses: fight, flight, freeze, collapse
and numbing, dissociation, re-enactment behavior. The
client’s animal brain takes over, the ability to think goes “off
line,” & sexually acting out behavior takes place without
conscious intention or judgment, even without awareness!
Janina Fisher, 2007
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Trauma vs. Intimacy
Visual
Cortex
Normal Response
Trauma Response
Amygdala
Fight, Flight or Freeze Response
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Peter Levine
“Trauma originates as a response in the nervous
system, and does not originates in an event. Trauma
is in the nervous system, not in the event.”
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Brief Overview of the
Autonomic Nervous System
The Polyvagal Theory
by
Stephen Porges, PhD
www.stephenporges.com
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The Parasympathetic Nervous System
The Sympathetic Nervous System
Trauma may result in the PNS
staying “on”, which causes it to
superimpose shutdown over the
hyperarousal of the SNS, rather than
discharging its energy.
The SNS gets our whole body ready
for action. It regulates arousal. It
increases activity during times of
stress and arousal – whether positive
or negative. It is active when we’re
alert, excited, or engaged in physical
activity. It prepares us to meet
emergencies and threat.
The Parasympathetic branch acts
like the brake pedal for our nervous
system. It helps us to relax, unwind
and ultimately discharge the arousal
of sympathetic activation.
The Sympathetic branch is like the
gas pedal of our nervous system. It
gives us energy for any action we
plan, and it helps us prepare for
threat.
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The Polyvagal Theory
By Stephen Porges
The Vagus Nerve in three parts, all working
simultaneously:
Ventral Vagal System:
Is part of the Parasympathetic Nervous
System
(Social Engagement/frontal cortex)
Sympathetic Nervous System:
(Fight/Flight, Freeze - Limbic Brain)
Dorsal Vagal System:
Is part of the Parasympathetic Nervous
System
(Freeze/Immobility/Brainstem)
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17
Social Engagement
Safe
Ventral
Vagal
Fight, Flight,
Freeze
Immobility
Sympathetic
Nervous
System
Dorsal
Vagal
System
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Danger
Life Threatening
Edvard Munch
“Scream”
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Autonomic Arousal is Designed to Adapt to Environmental Demands
Sympathetic Hyperarousal
A
R
O
U
S
A
L
easy charge
sympathetic
easy discharge
Window of Tolerance
feelings can be tolerated, able to think and feel
parasympathetic
Parasympathetic Hypoarousal
Foundation of Human Enrichment
Ogden and Minton (2000)
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Autonomic Adaptation to a Threatening World
Stuck on “ON”
Sympathetic Hyperarousal
A
R
O
U
S
A
L
• Hyperactivity
• Panic
• Rage
• Hypervigilance
• Elation/Mania
Window of Tolerance
Optimal Arousal Zone
Stuck on “OFF”
Parasympathetic Hypoarousal
Foundation of Human Enrichment
Fisher, 2006
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•
•
•
•
Depression
Disconnection
Deadness
Exhaustion
How Sexual Addiction Modulates and “Medicate”
Complex PTSD to attempt Self-Regulation
Sympathetic Hyperarousal
Sexually Acting out
A
R
O
U
S
A
L
Window of Tolerance
Optimal Arousal Zone
Sexually Acting in
Parasympathetic Hypoarousal
Foundation of Human Enrichment
Fisher, 2006
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The Challenge of Trauma and Sexual Addiction
Treatment must address the relationship between the trauma and the
addictive behavior: the role of the addictive behavior in “medicating”
traumatic activation, the origins of both in the traumatic past, and the reality
that recovering from either requires recovering from both
Fisher, 2007
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Bibliography
• Van der Kolk, Bessel, (1996) Traumatic Stress. New
York: The Guilford Press.
• Ogden, Pat, (2006), Trauma and the Body. New York:
W.W. Norton & Company, Inc.
• Fisher, Janina, (2008), Addictions and Trauma Recovery
• Porges, Stephen, 2006), How your nervous system
sabotages your ability to relate. www.nexuspub.com
• Levine, Peter, (1997), Waking the Tiger. Berkley, CA,
North Atlantic Books.
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