The Body Keeps the Score

by Bessel van der Kolk MD

  19.D. Church, et al., “Single-Session Reduction of the Intensity of Traumatic Memories in Abused Adolescents After EFT: A Randomized Controlled Pilot Study,” Traumatology 18, no. 3 (2012): 73–79; and D. Feinstein and D. Church, “Modulating Gene Expression Through Psychotherapy: The Contribution of Noninvasive Somatic Interventions,” Review of General Psychology 14, no. 4 (2010): 283–95. See also www.vetcases.com.

  CHAPTER 5: BODY-BRAIN CONNECTIONS

  1.C. Darwin, The Expression of the Emotions in Man and Animals (London: Oxford University Press, 1998).

  2.Ibid., 71.

  3.Ibid.

  4.Ibid., 71–72.

  5.P. Ekman, Facial Action Coding System: A Technique for the Measurement of Facial Movement (Palo Alto, CA: Consulting Psychologists Press, 1978). See also C. E. Izard, The Maximally Discriminative Facial Movement Coding System (MAX) (Newark, DE: University of Delaware Instructional Resource Center, 1979).

  6.S. W. Porges, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation, Norton Series on Interpersonal Neurobiology (New York: WW Norton & Company, 2011).

  7.This is Stephen Porges’s and Sue Carter’s name for the ventral vagal system. http://www.pesi.com/bookstore/A_Neural_Love_Code__The_Body_s_Need_to_Engage_and_Bond-details.aspx

  8.S. S. Tomkins, Affect, Imagery, Consciousness (vol. 1, The Positive Affects) (New York: Springer, 1962); S. S. Tomkin, Affect, Imagery, Consciousness (vol. 2, The Negative Affects) (New York: Springer, 1963).

  9.P. Ekman, Emotions Revealed: Recognizing Faces and Feelings to Improve Communication and Emotional Life (New York: Macmillan, 2007); P. Ekman, The Face of Man: Expressions of Universal Emotions in a New Guinea Village (New York: Garland STPM Press, 1980).

  10.See, e.g., B. M. Levinson, “Human/Companion Animal Therapy,” Journal of Contemporary Psychotherapy 14, no. 2 (1984): 131–44; D. A. Willis, “Animal Therapy,” Rehabilitation Nursing 22, no. 2 (1997): 78–81; and A. H. Fine, ed., Handbook on Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice (Academic Press, 2010).

  11.P. Ekman, R. W. Levenson, and W. V. Friesen, “Autonomic Nervous System Activity Distinguishes Between Emotions,” Science 221 (1983): 1208–10.

  12.J. H. Jackson, “Evolution and Dissolution of the Nervous System,” in Selected Writings of John Hughlings Jackson, ed. J. Taylor (London: Stapes Press, 1958), 45–118.

  13.Porges pointed out this pet store analogy to me.

  14.S. W. Porges, J. A. Doussard-Roosevelt, and A. K. Maiti, “Vagal Tone and the Physiological Regulation of Emotion,” in The Development of Emotion Regulation: Biological and Behavioral Considerations, ed. N. A. Fox, Monographs of the Society for Research in Child Development, vol. 59 (2–3, serial no. 240) (1994), 167–86. http://www.amazon.com/The-Development-Emotion-Regulation-Considerations/dp/0226259404).

  15.V. Felitti, et al., “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 14, no. 4 (1998): 245–58.

  16.S. W. Porges, “Orienting in a Defensive World: Mammalian Modifications of Our Evolutionary Heritage: A Polyvagal Theory,” Psychophysiology 32 (1995): 301–18.

  17.B. A. Van der Kolk, “The Body Keeps the Score: Memory and the Evolving Psychobiology of Posttraumatic Stress,” Harvard Review of Psychiatry 1, no. 5 (1994): 253–65.

  CHAPTER 6: LOSING YOUR BODY, LOSING YOUR SELF

  1.K. L. Walsh, et al., “Resiliency Factors in the Relation Between Childhood Sexual Abuse and Adulthood Sexual Assault in College-Age Women,” Journal of Child Sexual Abuse 16, no. 1 (2007): 1–17.

  2.A. C. McFarlane, “The Long‐Term Costs of Traumatic Stress: Intertwined Physical and Psychological Consequences,” World Psychiatry 9, no. 1 (2010): 3–10.

  3.W. James, “What Is an Emotion?” Mind 9: 188–205.

  4.R. L. Bluhm, et al., “Alterations in Default Network Connectivity in Posttraumatic Stress Disorder Related to Early-Life Trauma,” Journal of Psychiatry & Neuroscience 34, no. 3 (2009): 187. See also J. K. Daniels, et al., “Switching Between Executive and Default Mode Networks in Posttraumatic Stress Disorder: Alterations in Functional Connectivity,” Journal of Psychiatry & Neuroscience 35, no. 4 (2010): 258.

  5.A. Damasio, The Feeling of What Happens: Body and Emotion in the Making of Consciousness (New York: Hartcourt Brace, 1999). Damasio actually says, “Consciousness was invented so that we could know life”, p. 31.

  6.Damasio, Feeling of What Happens, p. 28.

  7.Ibid., p. 29.

  8.A. Damasio, Self Comes to Mind: Constructing the Conscious Brain (New York, Random House Digital, 2012), 17.

  9.Damasio, Feeling of What Happens, p. 256.

  10.Antonio R. Damasio, et al., “Subcortical and Cortical Brain Activity During the Feeling of Self-Generated Emotions.” Nature Neuroscience 3, vol. 10 (2000): 1049–56.

  11.A. A. T. S. Reinders, et al., “One Brain, Two Selves,” NeuroImage 20 (2003): 2119–25. See also E. R. S. Nijenhuis, O. Van der Hart, and K. Steele, “The Emerging Psychobiology of Trauma-Related Dissociation and Dissociative Disorders,” in Biological Psychiatry, vol. 2., eds. H. A. H. D’Haenen, J. A. den Boer, and P. Willner (West Sussex, UK: Wiley 2002), 1079–198; J. Parvizi and A. R. Damasio, “Consciousness and the Brain Stem,” Cognition 79 (2001): 135–59; F. W. Putnam, “Dissociation and Disturbances of Self,” in Dysfunctions of the Self, vol. 5, eds. D. Cicchetti and S. L. Toth (New York: University of Rochester Press, 1994), 251–65; and F. W. Putnam, Dissociation in Children and Adolescents: A Developmental Perspective (New York: Guilford, 1997).

  12.A. D’Argembeau, et al., “Distinct Regions of the Medial Prefrontal Cortex Are Associated with Self-Referential Processing and Perspective Taking,” Journal of Cognitive Neuroscience 19, no. 6 (2007): 935–44. See also N. A. Farb, et al., “Attending to the Present: Mindfulness Meditation Reveals Distinct Neural Modes of Self-Reference,” Social Cognitive and Affective Neuroscience 2, no. 4 (2007): 313–22; and B. K. Hölzel, et al., “Investigation of Mindfulness Meditation Practitioners with Voxel-Based Morphometry,” Social Cognitive and Affective Neuroscience 3, no. 1 (2008): 55–61.

  13.P. A. Levine, Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body (Berkeley: North Atlantic Books, 2008); and P. A. Levine, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness (Berkeley: North Atlantic Books, 2010).

  14.P. Ogden and K. Minton, “Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory,” Traumatology 6, no. 3 (2000): 149–73; and P. Ogden, K. Minton, and C. Pain, Trauma and the Body: A Sensorimotor Approach to Psychotherapy, Norton Series on Interpersonal Neurobiology (New York: WW Norton & Company, 2006).

  15.D. A. Bakal, Minding the Body: Clinical Uses of Somatic Awareness (New York: Guilford Press, 2001).

  16.There are innumerable studies on the subject. A small sample for further study: J. Wolfe, et al., “Posttraumatic Stress Disorder and War-Zone Exposure as Correlates of Perceived Health in Female Vietnam War Veterans,” Journal of Consulting and Clinical Psychology 62, no. 6 (1994): 1235–40; L. A. Zoellner, M. L. Goodwin, and E. B. Foa, “PTSD Severity and Health Perceptions in Female Victims of Sexual Assault,” Journal of Traumatic Stress 13, no. 4 (2000): 635–49; E. M. Sledjeski, B. Speisman, and L. C. Dierker, “Does Number of Lifetime Traumas Explain the Relationship Between PTSD and Chronic Medical Conditions? Answers from the National Comorbidity Survey-Replication (NCS-R),” Journal of Behavioral Medicine 31 (2008): 341–49; J. A. Boscarino, “Posttraumatic Stress Disorder and Physical Illness: Results from Clinical and Epidemiologic Studies,” Annals of the New York Academy of Sciences 1032 (2004): 141–53; M. Cloitre, et al., “Posttraumatic Stress Disorder and Extent of Trauma Exposure
as Correlates of Medical Problems and Perceived Health Among Women with Childhood Abuse,” Women & Health 34, no. 3 (2001): 1–17; D. Lauterbach, R. Vora, and M. Rakow, “The Relationship Between Posttraumatic Stress Disorder and Self-Reported Health Problems,” Psychosomatic Medicine 67, no. 6 (2005): 939–47; B. S. McEwen, “Protective and Damaging Effects of Stress Mediators,” New England Journal of Medicine 338, no. 3 (1998): 171–79; P. P. Schnurr and B. L. Green, Trauma and Health: Physical Health Consequences of Exposure to Extreme Stress (Washington, DC: American Psychological Association, 2004).

  17.P. K. Trickett, J. G. Noll, and F. W. Putnam, “The Impact of Sexual Abuse on Female Development: Lessons from a Multigenerational, Longitudinal Research Study,” Development and Psychopathology 23, no. 2 (2011): 453.

  18.K. Kosten and F. Giller Jr., ”Alexithymia as a Predictor of Treatment Response in Post-Traumatic Stress Disorder,” Journal of Traumatic Stress 5, no. 4 (October 1992): 563–73.

  19.G. J. Taylor and R. M. Bagby, “New Trends in Alexithymia Research,” Psychotherapy and Psychosomatics 73, no. 2 (2004): 68–77.

  20.R. D. Lane, et al., “Impaired Verbal and Nonverbal Emotion Recognition in Alexithymia,” Psychosomatic Medicine 58, no. 3 (1996): 203–10.

  21.H. Krystal and J. H. Krystal, Integration and Self-Healing: Affect, Trauma, Alexithymia (New York: Analytic Press, 1988).

  22.P. Frewen, et al., “Clinical and Neural Correlates of Alexithymia in Posttraumatic Stress Disorder,” Journal of Abnormal Psychology 117, no. 1 (2008): 171–81.

  23.D. Finkelhor, R. K. Ormrod, and H. A. Turner, (2007). “Re-Victimization Patterns in a National Longitudinal Sample of Children and Youth,” Child Abuse & Neglect 31, no. 5 (2007): 479-502; J. A. Schumm, S. E. Hobfoll, and N. J. Keogh, “Revictimization and Interpersonal Resource Loss Predicts PTSD Among Women in Substance-Use Treatment, Journal of Traumatic Stress, 17, no. 2 (2004): 173–81; J. D. Ford, J. D. Elhai, D. F. Connor, and B. C. Frueh, “Poly-Victimization and Risk of Posttraumatic, Depressive, and Substance Use Disorders and Involvement in Delinquency in a National Sample of Adolescents,” Journal of Adolescent Health, 46, no. 6 (2010): 545–52.

  24.P. Schilder, “Depersonalization,” in Introduction to a Psychoanalytic Psychiatry, no. 50 (New York: International Universities Press, 196), p. 120.

  25.S. Arzy, et al., “Neural Mechanisms of Embodiment: Asomatognosia Due to Premotor Cortex Damage,” Archives of Neurology 63, no. 7 (2006): 1022–25. See also S. Arzy et al., “Induction of an Illusory Shadow Person,” Nature 443, no. 7109 (2006): 287; S. Arzy et al., “Neural Basis of Embodiment: Distinct Contributions of Temporoparietal Junction and Extrastriate Body Area,” Journal of Neuroscience 26, no. 31 (2006): 8074–81; O. Blanke et al., “Out-of-Body Experience and Autoscopy of Neurological Origin,” Brain 127, part 2 (2004): 243–58; and M. Sierra, et al., “Unpacking the Depersonalization Syndrome: An Exploratory Factor Analysis on the Cambridge Depersonalization Scale,” Psychological Medicine 35 (2005): 1523–32.

  26.A. A. T. Reinders, et al., “Psychobiological Characteristics of Dissociative Identity Disorder: A Symptom Provocation Study,” Biological Psychiatry 60, no. 7 (2006): 730–40.

  27.In his book Focusing, Eugene Gendlin coined the term “felt sense”: “A felt sense is not a mental experience but a physical one. A bodily awareness of a situation or person or event; Focusing (New York, Random House Digital, 1982).

  28.C. Steuwe, et al., “Effect of Direct Eye Contact in PTSD Related to Interpersonal Trauma: An fMRI Study of Activation of an Innate Alarm System,” Social Cognitive and Affective Neuroscience 9, no. 1 (January 2012): 88–97.

  CHAPTER 7: GETTING ON THE SAME WAVELENGTH, ATTACHMENT AND ATTUNEMENT

  1.N. Murray, E. Koby, and B. van der Kolk, “The Effects of Abuse on Children’s Thoughts,” chapter 4 in Psychological Trauma (Washington, DC: American Psychiatric Press, 1987).

  2.The attachment researcher Mary Main told six-year-olds a story about a child whose mother had gone away and asked them to make up a story of what happened next. Most six-year-olds who, as infants, had been found to have secure relationships with their mothers made up some imaginative tale with a good ending, while the kids who five years earlier had been classified as having a disorganized attachment relationship had a tendency toward catastrophic fantasies and often gave frightened responses like “The parents will die” or “The child will kill herself.” In Mary Main, Nancy Kaplan, and Jude Cassidy. “Security in Infancy, Childhood, and Adulthood: A Move to the Level of Representation,” Monographs of the Society for Research in Child Development (1985).

  3.J. Bowlby, Attachment and Loss, vol. 1, Attachment (New York Random House, 1969); J. Bowlby, Attachment and Loss, vol. 2, Separation: Anxiety and Anger (New York: Penguin, 1975); J. Bowlby, Attachment and Loss, vol. 3, Loss: Sadness and Depression (New York: Basic, 1980); J. Bowlby, “The Nature of the Child’s Tie to His Mother 1,” International Journal of Psycho-Analysis, 1958, 39, 350–73.

  4.C. Trevarthen, “Musicality and the Intrinsic Motive Pulse: Evidence from Human Psychobiology and Rhythms, Musical Narrative, and the Origins of Human Communication,” Muisae Scientiae, special issue, 1999, 157–213.

  5.A. Gopnik and A. N. Meltzoff, Words, Thoughts, and Theories (Cambridge: MIT Press, 1997); A. N. Meltzoff and M. K. Moore, “Newborn Infants Imitate Adult Facial Gestures,” Child Development 54, no. 3 (June 1983): 702–9; A. Gopnik, A. N. Meltzoff, and P. K. Kuhl, The Scientist in the Crib: Minds, Brains, and How Children Learn (New York: HarperCollins, 2009).

  6.E. Z. Tronick, “Emotions and Emotional Communication in Infants,” American Psychologist 44, no. 2 (1989): 112. See also E. Tronick, The Neurobehavioral and Social-Emotional Development of Infants and Children (New York, WW Norton & Company, 2007); E. Tronick and M. Beeghly, “Infants’ Meaning-Making and the Development of Mental Health Problems,” American Psychologist 66, no. 2 (2011): 107; and A. V. Sravish, et al., “Dyadic Flexibility During the Face-to-Face Still-Face Paradigm: A Dynamic Systems Analysis of Its Temporal Organization,” Infant Behavior and Development 36, no. 3 (2013): 432–37.

  7.M. Main, “Overview of the Field of Attachment,” Journal of Consulting and Clinical Psychology 64, no. 2 (1996): 237–43.

  8.D. W. Winnicott, Playing and Reality (New York: Psychology Press, 1971). See also D. W. Winnicott, “The Maturational Processes and the Facilitating Environment,” (1965); and D. W. Winnicott, Through Paediatrics to Psycho-analysis: Collected Papers (New York: Brunner/Mazel, 1975).

  9.As we saw in chapter 6, and as Damasio has demonstrated, this sense of inner reality is, at least in part, rooted in the insula, the brain structure that plays a central role in body-mind communication, a structure that is often impaired in people with histories of chronic trauma.

  10.D. W. Winnicott, Primary Maternal Preoccupation (London: Tavistock, 1956), 300–305.

  11.S. D. Pollak, et al., “Recognizing Emotion in Faces: Developmental Effects of Child Abuse and Neglect,” Developmental Psychology 36, no. 5 (2000): 679.

  12.P. M. Crittenden, “IV Peering into the Black Box: An Exploratory Treatise on the Development of Self in Young Children,” Disorders and Dysfunctions of the Self 5 (1994): 79; P. M. Crittenden, and A. Landini, Assessing Adult Attachment: A Dynamic-Maturational Approach to Discourse Analysis (New York: WW Norton & Company, 2011).

  13.Patricia M. Crittenden, “Children’s Strategies for Coping with Adverse Home Environments: An Interpretation Using Attachment Theory,” Child Abuse & Neglect 16, no. 3 (1992): 329–43.

  14.Main, 1990, op cit.

  15.Main, 1990, op cit.

  16.Ibid.

  17.E. Hesse, and M. Main, “Frightened, Threatening, and Dissociative Parental Behavior in Low-Risk Samples: Description, Discussion, and Interpretations,” Development and Psychopathology 18, no. 2 (2006): 309–343. See also E. Hesse and M. Main, “Disorganized Inf
ant, Child, and Adult Attachment: Collapse in Behavioral and Attentional Strategies,” Journal of the American Psychoanalytic Association 48, no. 4 (2000): 1097–127.

  18.Main, “Overview of the Field of Attachment,” op cit.

  19.Hesse and Main, 1995, op cit, p. 310.

  20.We looked at this from a biological point of view when we discussed “immobilization without fear” in chapter 5. S. W. Porges, “Orienting in a Defensive World: Mammalian Modifications of Our Evolutionary Heritage: A Polyvagal Theory,” Psychophysiology 32 (1995): 301–318.

  21.M. H. van Ijzendoorn, C. Schuengel, and M. Bakermans-Kranenburg, “Disorganized Attachment in Early Childhood: Meta-analysis of Precursors, Concomitants, and Sequelae,” Development and Psychopathology 11 (1999): 225–49.

  22.Ijzendoorn, op cit.

  23.N. W. Boris, M. Fueyo, and C. H. Zeanah, “The Clinical Assessment of Attachment in Children Under Five,” Journal of the American Academy of Child & Adolescent Psychiatry, 36, no. 2 (1997): 291–93; K. Lyons-Ruth, “Attachment Relationships Among Children with Aggressive Behavior Problems: The Role of Disorganized Early Attachment Patterns,” Journal of Consulting and Clinical Psychology, 64, no. 1 (1996), 64.

  24.Stephen W. Porges, et al., “Infant Regulation of the Vagal ‘Brake’ Predicts Child Behavior Problems: A Psychobiological Model of Social Behavior,” Developmental Psychobiology 29, no. 8 (1996): 697–712.

  25.Louise Hertsgaard, et al., “Adrenocortical Responses to the Strange Situation in Infants with Disorganized/Disoriented Attachment Relationships,” Child Development 66, no. 4 (1995): 1100–6; Gottfried Spangler, and Klaus E. Grossmann, “Biobehavioral Organization in Securely and Insecurely Attached Infants,” Child Development 64, no. 5 (1993): 1439–50.

  26.Main and Hesse, 1990, op cit.

  27.M. H. van Ijzendoorn, et al., “Disorganized Attachment in Early Childhood,” op cit.

  28.B. Beebe, and F. M. Lachmann, Infant Research and Adult Treatment: Co-constructing Interactions (New York: Routledge, 2013); B. Beebe, F. Lachmann, and J. Jaffe (1997). Mother-Infant Interaction Structures and Presymbolic Self‐ and Object Representations. Psychoanalytic Dialogues, 7, no. 2 (1997): 133–82.