PROFILE OF A TRAUMA VICTIM

By Robert Grant, Ph.D.

Copyright 1993

All Rights Reserved

Caution--- none of the following symptoms and behaviors, in isolation, characterizes a trauma victim. It is the combination or overall profile that is suggests of a history of trauma.

Profile of an Abusive Family--- Generational Issues

• Parents and or grandparents who carry unresolved/negative childhood experiences, such as abuse, neglect, extreme hardship, or the premature death of a parent.
• Parents or grandparents who were unable to deal with the stresses of poverty, unemployment and the lack of family support or education.
• Abuse occurring across several generations.
• Personality problems or psychiatric disorders among relatives (on both sides of the family tree).

Key Parental Behaviors, Attitudes and Histories

• Terrorizing a child by leaving and/or threatening to leave (abandon) or kill the child. 
• Ignoring the child by, e.g., refusing to get him/her medical care or leaving him/her along for long periods of time.
• Isolating the child by taking him/her out of school, not allowing him/her to participate in certain activities such as sports and sabotaging the child’s efforts to succeed, emancipate and make friends.
• Corrupting the child by forcing him/her to participate in a variety of illegal and immoral activities.
• Depreciatory attitudes towards persons of the opposite sex and children.
• Poor parenting skills.
• The existence of family violence, usually directed at the most vulnerable members of the family, e.g., either the wife or youngest child.
• The existence of alcohol and drug problems. This is one of the most common factors in an individual’s abusive history. Substance abuse on the part of a caretaker increases the chance of abuse considerably. Likewise, anyone who took care of the child while the parent(s) is out or drinking could have been an abuser.
• Exploitive parents --- parents who made children responsible for household duties and child care long before a child was developmentally ready.
• Unfulfilled marriages --- children are often turned to in order to fill in the emotional and sexual gaps of a marriage. This also involves a breaching of generational boundaries. Spousification and emotional incest are two variations on this theme.
• Culturally, economically, educationally and psychologically disadvantaged families are under great stress and at risk to “act out” and/or abuse.
• Fundamentalist families characterized by strict religious, political or personal ideologies, and which impose harsh sanctions for deviation from the ideal, are prime abuse candidates.
• The use of corporal punishment as a means of discipline. Bruises or other significant injuries to the skin, bones and internal organs, along with the frequency and intensity of punishment, are strong indicators of abuse. Physical abuse often starts under the guise of punishment. In addition, being forced to do things beyond a child’s ability, e.g., cook at the stove when s/he is not tall enough to safely do so or stay in one position (in the corner) for hours, are also physically, as well as emotionally, abusive.
• Institutionalized family members or relatives, e.g., who have been in jail, orphaned or put in a mental hospital.
• Intergenerational problems, such as broken marriages, sexual or physical acting out, and abuse are also significant. Looking backwards in all branches of the family tree, as well as forwards, to nieces/nephews (as well as their children) often reveals the effects of abuse that have been passed on through the generations.
• Financial problems are often indicative of job failures, impulsive spending, and various addictions, such as alcohol, and gambling.
• Chronic illnesses (physical or psychological), usually means long-term stress for the caretaking family or caretaking individual. Increased stress may lead to some forms of abuse or neglect, especially in regard to children.
• Any parent growing up in a culture permeated by war or civil strife (such as China during the Cultural Revolution) or who served in a war, was a prisoner of war or was in a concentration camp may be suffering from untreated PTSD. Chances of violence in this house are greatly increased.
• Those who consistently look after a child, in addition to the parents or primary caregivers, e.g., baby-sitters, stepfathers, mothers, brothers and sisters, along with foster parents, grandparents, coaches, teachers, clergy/religious, siblings or older kids in the neighborhood, often had opportunities to abuse. The psychological histories of such individuals are very important to obtain.

Family Sexual History

• Illicit sexuality in the family,  prevalence of pornography in the household, out-of-wedlock pregnancies, incest (even if only witnessed by a child), affairs, molestation of children (one’s own as well as other children); parent(s) leaving home and having binges in regard to alcohol, sexual affairs, shopping and gambling etc…).
• Sibling abuse is typically the result of an adult having initiated an older child into precocious sexual act or behavior.
• Interactions with a parent(s) or others that were overtly or subtly sexual or seductive. Subtle examples are verbal stimulation, obscene phone calls, exposing a child to a naked adult, voyeurism and exposing a child to pornographic magazines or videos. Overt examples are fondling, confusing touches, oral intercourse, attempted intercourse, and exploitation of children through prostitution or pornography.
• Scrupulous attention to anything sexual. Shame and guilt regarding anything sexual, by an individual in question or other family member, is highly suggestive of some kind of sexual injury. The existence of any irrational or over-determined behavior or attitude, in regard to sexuality, on the part of an individual or other family member, is highly suggestive of abuse and/or of someone who has sustained abuse in the past.
• Experiences of feeling guilty, ashamed, dirty and aroused in regard to sex often speak to formerly abusive events.

The Trauma Victim

• A child who lives in fear of his/her life or for someone else’s, e.g., a parent or sibling, is often carrying some form of trauma.
• Quality of emotional treatment on day-to-day basis in the home is important to look at, e.g., being criticized, threatened, invalidated or ignored on a regular basis.
• Individual memories and the nature of the parental rationalizations used to explain certain events (which are irrational, fuzzy and vague) could be suggestive of abuse. The victim’s memories will stay vague until witnessed and validated by an understanding other.
• Age entered the seminary/convent or went away to school is important. If around 13, it may have been an attempt to get away from the abusive family.

Physical Presentation of a Trauma Victim

• Schizoid-looking presentation:

• Glazed stare
• Intense, bulging or frightened eyes

• Flat affect --- little appropriate emotion when telling certain parts of story, especially in regard to painful and highly charged material.
• Rational, logical, intellectual, analytical, always “in the head,” or flighty and constantly in motion. These styles may be indicative of repressive and dissociative attempts to stay away from painful material.
• Control is a paramount need for most trauma victims and is exhibited throughout many aspects of their lives, right down to steering conversations away from certain topics.
• Rigid body, along with discomfort in the body, may be suggestive of an abused body.

Memory

• Selective and partial amnesia, in regard to recent and especially childhood events. Large portions of the victim’s childhood often cannot be remembered.
• Periods of unaccounted-for time and repeated accounts of the past that do not match.
• Confabulation utilized to fill in the gaps of one’s memory.
• General feelings associated with childhood are either absent or anxiety provoking (without knowing why).
• Reaction to hearing accounts of others having happy childhoods is often one of sadness or fear.
• Thinking about the past is avoided.
• The myth of a happy childhood is preserved. Interrogation reveals only a few positive stories that can be accounted for.
• Fear of feelings --- the victim doesn’t trust or know his/her own feelings, opinions and perceptions. Considerable self-doubt exists on all levels of his/her personality.

Defenses Against Remembering

• Out-of-body experiences and the ability to “numb out” (in the past as well as in the present). If this ability still persists, it is a very strong indicator of traumatic abuse, and the existence of powerful dissociative capabilities.
• Intrusive and repetitive thoughts.
• Avoidance of certain situations, stimuli and people.
• Thinking process characterized by: 

• Denial 
• Doublethink (able to carry two contradictory thoughts at the same time) (Herman 1992)
• Repression
• Distortion
• Displacement
• Turning against the self
• Identifying with and protecting those who hurt the victim
• Sublimation
• The use of various compulsive rituals

• Absence of friends. Closest connections are often to real or fictional characters, e.g., in literature, contemporary music and film. Coping with life stressors has been through creative and spiritual outlets, such as music and art.

Medical and Behavioral History of a Victim Childhood

(Wess 1987)

• Infants and Toddlers

• Physical Signs

• Trauma to genitals or mouth; genital or urinary irritation and/or venereal disease.
• Other bruises, burns or injuries.
• Unexplained sore throats may be indicative of oral sex.
• Unusual or offensive odors, vaginal or penile discharge, and vaginal, penile or rectal bleeding or laceration.
• Complaints of discomfort or pain in the genital or rectal areas.
• Foreign bodies in the vagina, urethra or rectum.

*If an infant is a problem baby, colicky or anxious then such a child may be abused or living in an abusive home (Grant 1993).

• Socio-Emotional Behavioral Signs

• Intense fear of people in general or of a specific place or person.
• Abrupt changes in behavior.
• Sleep disturbances (bed-wetting, nightmares, insomnia).
• Withdrawal and/or depression.
• Developmental delays.

• Preschool Children

All of the above signs and:

• Physical Signs

• Bed-wetting.
• Wetting and/soiling the pants.
• Regressive behavior (e.g., thumb sucking).
• Hyperactivity.
• Somatic complaints --- chronic headaches, abdominal pain, constipation.

• Socio-Emotional Behavioral Signs

• Sudden changes in behavior.
• Child’s direct or coded statement indicating sexual hurt.

• Sexualized Behaviors

(This especially needs to be considered in light of normal sexual development.)

• Excessive masturbation.
• Sexualized kissing, thrusting.
• Sexual acting out with siblings or peers.
• Precocious knowledge of sexual activity.
• Excessive sexual curiosity.

• School-Aged Children

All of the signs above and:

• Disturbed peer interactions.
• Changes in school performance: inability to concentrate, drop in grades, tardiness and truancy.
• Mistrust of adults in general.
• Depression, withdrawal, sadness and listlessness.
• Sleep disorders, such as nightmares, insomnia.
• Avoidance of physical activity and undressing.

• Adolescents

All of the above signs and:

• Self-destructive and suicidal thoughts, self-inflicted injuries.
• Eating disorders.
• Delinquent behavior and/or running away.
• Drug and alcohol abuse.
• Early pregnancy.
• Prostitution, promiscuity, or other unusual sexual behaviors.

(end of Wess 1987)

Other General Child Indicators

• Loss of appetite or increased eating
• Crying and whining for no apparent reason
• Attention problems
• Hyperactivity
• Fear of adults or wanting to spend inordinate time with an adult
• Fear of dark
• Early pregnancy

Other Adolescent Indicators

• Impaired peer relations
• Social isolation
• Improved or decreased grades
• Passivity or lack of assertiveness
• Fighting
• Arson
• Homophobia
• Early marriages
• Self-mutilation
• Seductive behavior
• Excessive masturbation
• Dissociative experiences
• Suicidal thoughts and gestures

Adult Medical and Behavioral History

Medical complaints of long duration and unresponsive to medical treatment, e.g., swallowing, stomach, rectal or joint pain. Certain victims learn to live with and accept these difficulties with a certain “belle indifference” (Freud 1966), such as:

• Gastrointestinal (abdominal pains, appetite disorders, constipation) problems
• Swallowing problems
• Rectal problems
• Vaginal problems
• Skeletal tension and pain
• Ankle pain (which can be the result of bondage)
• Wrist pain (which can be the result of bondage)
• Neck pain
• Shoulders problems
• Back pain
• Stomach pain
• Chest pain
• Heart problems
• Headaches (often migraine)
• Pelvic pain
• Jaw problems
• Asthma

Intrusive Effects of Trauma

• Flashbacks --- intrusive thoughts, dreams, daydreams and fantasies.
• Somatic memories without ideational correlate---hysterical feelings, panic attacks, and convulsive and involuntary muscle twitches and spasms.
• Reaction to visual fragment or flashback is usually one of disbelief, that is, “That couldn’t be. I must be making it up.”
• Auditory flashbacks---hearing voices or sounds out of contest.
• Experiencing feelings of terror and panic, along with the existence of certain phobias, for no identifiable reason.
• Suicidal attempts or ideation, along with feelings that life is just a pastime!
• Self-destructive behaviors, e.g., driving relationships away, seeking abuse, self-inflicted wounds (cutting, burning, maiming oneself).
• Explosive or angry outbursts!
• Sleeping difficulties---sleep, instead of being a time of relief and comfort, becomes a time of heightened anxiety, nightmares and startle responses. Trouble getting to sleep, early awakenings, sleepwalking and a strong need for pillow and teddy bears to sleep with to obtain comfort, along with various addictions to things soft and cuddly. All of these are suggestive of an abusive history or early neglect.

Psychiatric Symptoms of Trauma

• Depression, anxiety and hypervigilance, as well as a simultaneous abhorrence ad fascination with violence or violent sex. Trouble concentrating, panic attacks, former psychiatric diagnoses and unsuccessful treatment of various psychiatric disorders such as schizophrenia; borderline personality, sociopathy, anxiety disorder, panic disorders and fugue states. Amnesia of traumatic events, along with experiences of depersonalization/derealization, is also common.
• Feelings of helplessness or paralysis of initiative, shame, guilt, self-blame, sense of defilement, sense of difference from others (special, weird, can’t be understood by others or of being an inhuman identity) and irrational fears round out the traumatic profile.
• Sexual history, especially between the ages of 2 through 12, is quite important. Looking for sexual play behavior with other children, acting out, compulsive behavior (e.g., masturbation or inappropriate sex games with kids) and compulsive sexual fantasies.
• The existence of precocious sexual activity or knowledge, i.e., of things or activities that only an adult should know. This is usually indicative of someone having introduced the child to precocious sexual activity.
• Molestations, rapes to self or other that one remembers or witnessed!
• An individual’s style of relating sexually, e.g., as asexual, hypersexual, phobic, homosexual, bisexual or homophobic. Gender confusion, cross-dressing and desires to undergo a sex change are also significant.
• The nature of one’s sexual fantasies is often indicative of abuse and is often a reenactment of early abuse. If these fantasies are repetitive, rigid, fixed and occur over the course of a lifetime, they often speak to unresolved abuse.
• Sexual disorder---frigidity, impotence or various sexual addictions/perversions.
• Sexual acting out (promiscuity).

History of Addictive Behaviors

• Addiction is often the only way one can cope with the devastating Central Nervous System (CNS) disturbances brought on by trauma, i.e., constant anxiety, tension, fear, terror and feelings of worthlessness. Substance abuse is usually a screen for a traumatic history.
• Obtaining a detailed history of drug and alcohol abuse, e.g., the periods of exacerbation (often refer to periods of abuse or when memories of abuse were triggered and tried to break into conscious awareness).
• Work addiction is usually a way to flee from the effects of abuse. It also is an attempt to build self-esteem.
• Any adult behavior which is addictive or rigid in nature, such as smoking, gambling, coffee and drug addiction, pornography, cruising, and masturbation, is often used to cope with the effects of trauma. Most trauma victims have multiple addictions. Victims have learned that depending on things is much safer and more dependable than relying on people.
• Eating disorders---obesity, anorexia and bulimia.

Problems as an Adult

• Lack of joy in living.
• Self depreciation---condemning self-references such as “dummy,” “idiot,” “whore,” “slob,” and so on when making a mistake or feeling guilty.
• Low self-esteem, in regard to looks, intelligence and talent.
• Self-sabotage---preventing the chance of happiness or success on most levels of one’s life.
• Sexual problems---frigidity, impotence, disgust towards sex, compulsivity or hypersexuality.
• Psychological problems of all varieties, ranging from anxiety disorders to panic attacks.
• Physical ailments.
• Trouble handling, modulating, trusting and understanding feelings.
• Career

• Confusion over career choices.
• Lacking confidence in job situation.
• Difficulties fitting into work world, achieving, absenteeism, inconsistency, and low productivity.
• Prone to exploitation.
• Personality conflicts.
• Compulsive achieving.
• Frequent change of jobs.

• Preoccupation with perpetrator, including revenge. Homicidal impulses or actions. Delinquent or antisocial behavior.
• Living primarily in the present, while having little sense of the future or the repercussions of one’s actions.
• Impulsivity in many areas of one’s life, e.g., in regard to food, alcohol, money, sex and putting oneself in danger of contracting sexually transmitted diseases such as AIDS.
• Feelings of powerlessness in the face of authority.

Interpersonal Issues

Relations to others are characterized by isolation and withdrawal, frequent disruptions, repeated searches for a rescuer, persistent distrust, repeated failures to self-protect, and senses of helplessness and despair. Trouble maintaining relationships: getting used or having to be in complete control are common, as are fears of being dependent and abandoned. Other areas of difficulty are:

• Setting boundaries
• Trusting
• Fear of betrayal
• Codependency
• Avoidance of people (agoraphobia)
• Suspicion/paranoia
• Being rigid and controlling
• Excessive risk-taking---in the case of ministers, often in the name of the Lord.

Spiritual Symptoms (Moran 1991)

• Inability to pray.
• Irrational fear of God.
• Sense of impending punishment by God for unknown reasons.
• Unable to relate to masculinity in God or Jesus because he is male (in males or females who were abused by males).
• Lack of direction for spiritual journey; feeling lost or hopeless (end of Moran).
• Loss of faith and belief in God.
• Alienation from church.
• Mistrust of church leaders.
• Feelings of being bad, sinful or in league with the devil.

Other Relevant Areas

• Persistent dreams, fantasies, daydreams, images/thoughts/feelings of a disturbing nature.
• History of seeking ministry near violence. A detailed history of mission and ministry experience will often reveal an attraction to traumatic environments and abusive work relationships!
• Working with physically or sexually abused populations, such as prostitutes, children or any victims of violence, now or in the past, can be indicative of a traumatic history. Projective identification, i.e., an unconscious identification with those who suffer as one once did, is often the motive for working with such populations!