Trauma Wounds, Dissociation

and Sensory Processing Disorder

A Teleseminar Session with

Robert Scaer, MD
and Dr. Buczynski Buczynski, PhD

The National Institute for

the Clinical Application of
Behavioral Medicine
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www.nicabm.com
Trauma Wounds, Dissociation and Sensory Processing Disorder 2

Trauma Wounds, Dissociation and

Sensory Processing Disorder

Contents:

How the Brain Helps Us to Survive Trauma ............................................ 4

The Importance of the Polyvagel Theory

in our Understanding of Trauma .............................................................. 5

Trauma as Imprisonment of the Mind ..................................................... 7

What Every Practitioner Should Know

about Sensory Processing Disorder ........................................................ 9

A New Concept for Dissociation and

Its Implications for Healing ................................................................... 10

Why Attachment Disorder Is Emerging as

the Core Basis of Vulnerability to Trauma ............................................ 10

A complete transcript of a Teleseminar Session

featuring Robert Scaer, MD and conducted by Ruth Buczynski, PhD of NICABM

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Trauma Wounds, Dissociation and Sensory Processing Disorder 3

Trauma Wounds, Dissociation and Sensory Processing Disorder

with Robert Scaer, MD and Dr. Buczynski Buczynski, PhD

Dr. Buczynski: Hello everyone and welcome to the call. I’d like to say hello to everyone
no matter where you’re calling in from—both from countries all over the world and from
many, many states.

We have all kinds of practitioners on the call tonight—physicians, nurses, psychologists,

social workers, physical therapists, and occupational therapists—we have a wide range
and that’s because this is such an important call today.

First, let me introduce myself. I’m Dr. Dr. Buczynski Buczynski; I’m a licensed
psychologist in Connecticut and President of the National Institute for the Clinical
Application of Behavioral Medicine.

My guest today is my very good friend, Dr. Robert Scaer. He is a physician and board
certified in neurology, and he is the former medical director of Rehabilitation Services
and Mapleton Center in Boulder, Colorado.

Welcome Bob, we’re excited to have you today.

Dr. Scaer: Thank you, Dr. Buczynski. It’s great to be here.

Dr. Buczynski: I also want to tell everyone that Bob is the author of two very important
books. I’ll mention them again briefly at the end of the call, but just in case we run out of
time, he’s the author of The Trauma Spectrum: Hidden Wounds and Human Resiliency,
and also, The Body Bears the Burden: Trauma Dissociation and Disease.

He’s a very good friend of NICABM. Many of our participants are alumni of our annual
Conference each December at Hilton Head Island, SC, and they say that Bob Scaer is the
gold standard on trauma. I think that’s a pretty high endorsement, Bob, so again, welcome
to the call.

We’re going to start today with tapping into your perspective from neurology: how the
brain helps us to survive trauma. Can you help us get started there, and we’ll make that
the foundation of our call today. We’ve got a big agenda, but I think that’s a good place to
start.

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How the Brain Helps Us to Survive Trauma

Dr. Scaer: Sure, we can do that. I define trauma as a life threat in a state of helplessness.
Our brain is strongly wired to protect us from life threats through a series of message
systems in the limbic or mammalian brain that allow us to assess danger and then institute
a self-preservation response.

The brain is wired to do that, and does
so through areas of the brain, such as
mainly the amygdale. This is the fight-
flight center in the mammalian brain,
which helps us assess danger and then
begin a response to overcome it.
“Our brain is strongly wired to protect
us from life threats through a series of
message systems in the limbic brain
that allow us to assess danger and then
institute a self-preservation response.”

The problem is, that at times, one cannot escape the threat and under these circumstances
the brain is wired to initiate what’s called a freeze, or immobility response, which has
some survival benefits in that it allows the animal or the person to not feel the pain of
injuries and also perhaps to fool the predator into thinking that you’re already dead. Some
(threatening) animals are triggered by the immobility response and will ignore you then.

But the problem with this process is that if helplessness occurs, and the normal recovery
from the freeze response doesn’t occur, which is actually kind of a discharge of
autonomic and physical somatic energy, then we have a conditioned response whereby
all the body memories -- we call them procedural memories -- and sensations of that
experience are stored in the survival brain.

(And that’s important) because the survival brain has to learn with each threatening
experience what’s dangerous and build up a repertoire of survival-based instincts and
capacities.

If you freeze and don’t get rid of that energy, that will be stuck in your brain as a
conditioned survival response, but a false response. The storage of those false, procedural
responses or procedural memories is basically the structure of trauma.

Dr. Buczynski: So, one thing that I think is

“The storage of those false important is that we used to teach stress and trauma
responses or procedural as fight-flight, but now we’re looking at it as fight-
memories is basically the flight-freeze, and that’s been for the last 20 years.
structure of trauma.” Would you say, Bob, that we’ve kind of isolated the

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freeze response and can I give you credit as the discoverer of the freeze response?

Dr. Scaer: Oh, I wish you could, but this preceded me by some time. I got into the trauma
field later than that. It’s been recognized for some time by people like Seligman in his
book Helplessness, and by Walter Cannon even back 30 or 40 years ago. So people were
aware of this. They weren’t aware of it’s implications in that it may be the source of
trauma….

Dr. Buczynski: So what we’re saying is that after the trauma is through, there needs to be
a discharge of the freeze response, and if there isn’t, that’s more likely to be where trauma
would set-in in a dysfunctional sort of way.

Dr. Scaer: That’s right.

Dr. Buczynski: Can we continue with our foundation here and talk some about
the polyvagal theory? Why is the polyvagal theory becoming so important to our
understanding of trauma?

The Importance of the Polyvagel Theory in our Understanding of Trauma

Dr. Scaer: Well, the vagus nerve is the tenth cranial nerve, and it’s got a center in the
brain stem, or the reptilian brain, and it is what runs the freeze response.

There are two vegal nuclei: one is the dorsal vagal nucleus, which is the reptilian brain,
and that is the engine or origin of the freeze response, so it’s a deeply parasympathetic
state.

The ventral vegal, or bottom of the vegus nerve was evolved in mammals to regulate
energy conservation because mammals are fast—that’s how they evolved. It allows them
to be fast. But you need to conserve energy if you’re a mammal because you burn it very
fast. So, the ventral vagal mammalian nucleus has evolved to conserve energy and allows
the animal to assess the reality, or the danger, and not to go off half-cocked every time
into a full blown flight response if a threat isn’t that great.

Dr. Buczynski: Okay, so the brain is helping us evaluate danger and through that process,
we’re determining whether we need to act on it by fleeing, by fighting, or by freezing,
and if that doesn’t take place in a proper manner, the freeze response sets-in with its
dysfunctional way and that affects future memory.

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Dr. Scaer: When you’re frozen, and let’s say because of

your continued state of helplessness, you don’t get rid of
“The discharge of
that energy of that fight-flight response... The discharge of
the freeze response completes the act of self-preservation
the freeze response
in the unconscious mind...and it’s over. There are no completes the act
residuals in survival because as far as that part of the brain of self-preservation.”
is concerned, you’ve survived and the event is over.

And if that doesn’t happen, and it can be subtle, you can freeze because you’re shamed:
for instance, the blush that you have when you’re terribly shamed is part of the dorsal
vagal freeze response and the discharge there may be just a subtle little shudder or
completion that wouldn’t be that obvious. So it may not be as dramatic as I’ve explained,
but in either case, discharge wipes out that memory from survival because you don’t
need it anymore.

Dr. Buczynski: And when that discharge hasn’t taken place in a proper way, we then
have an experience where that sets-in and affects our future way of assessing danger or
our future way of assessing options.

Dr. Scaer: Exactly. There are a lot of ways to describe this. You could say that trauma is
a corruption of the mind or a corruption of memory because those stored memories are
false memories—the event is over, but the survival brain thinks the event is continuing to
be present.

You think that you’re in the past, and any event that replicates that memory will send you
into a fight and flight response in an exaggerated fashion even though that’s a symbolic
cue and not a real danger.

That responsiveness to past events as being present is

“That responsiveness
to past events as
being present is
what characterizes
trauma and all
these memories
are the evolving
structure of
trauma.”
what characterizes trauma and even many of the parts of
the PTSD diagnosis—flashbacks, startling in response
to a sound, seeing a red car and going into a fight-flight
response because you were hit by a red car 10 years ago;
all these false memories are the evolving structure of
trauma, and actually as I said in one chapter of my book,
they are an imprisonment of the mind by events of the
past.
Dr. Buczynski: Okay. I was about to ask you why you
refer to trauma as an imprisonment of the mind…

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Trauma as Imprisonment of the Mind

Dr. Scaer: Because your survival memory bank is full of a lot of false information and
you’re stuck in that past state if you’re a trauma victim, little cues will keep erupting that
replicate old subtle traumatic memory that hasn’t been resolved. Every time that happens,
you’re thrust into that past trauma. You lose track of the present moment, and you’re
imprisoned by the past.

This is typical of cases where trauma has

been multiple, and as we’ll see, especially “Little cues will keep erupting
typical of cases where trauma has occurred that replicate old subtle
early in childhood because that sets the pattern traumatic memory that hasn’t
that continues the restoring of cue-based old been resolved and you’re
memories, amplifying them, and growing them, imprisoned by the past.”
and keeping you more and more stuck in the
past.

Dr. Buczynski: Let’s talk about neurosensitization just a bit.

Dr. Scaer: Yes, neurosensitization, the popular

“This process of repeated
exposure to internal cues
is the basis for the self-
perpetuation of trauma
once it’s been established.”
term for that is kindling (wood that catches fire
easily), was discovered in the 60’s when scientists
stimulated rat brains to see where messages
went and the animals developed epilepsy, which
persisted forever.

This process of sensitization by repeated exposure to internal cues is the basis for the
self-perpetuation of trauma once it’s been established, and it’s a critical concept for many,
many things. It defines many of the states of trauma and as I write and talk about, it also
defines many of the physical syndromes and diseases of trauma.

Dr. Buczynski: What do you mean by the physical diseases?

Dr. Scaer: There are specific diseases that I call diseases of kindling and they’re familiar
to any psychotherapist.

One of them is Sensory Processing Disorder, where sensations are corrupted by the fact
that they always seem to link to an old traumatic cue and you become sensitized to all
sorts of things.

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Many of your complex trauma victims—those

who’ve had severe childhood trauma and have “Victims of early childhood
adult complex trauma, including multiple chemical trauma will have a
sensitivities, environmental allergies, sick building
relative decrease in the
syndrome, sensitivity to sound, etc., these are all
size of the hippocampus,
syndromes of kindling or sensitization that you see in
so many of your complex trauma victims. It explains
the conscious memory
the fact that they tend to kindle anything in their life center of the brain.”
that goes on for long enough.

Dr. Buczynski: Let’s talk a little bit about how trauma changes and damages the brain.

Dr. Scaer: Well, trauma has been shown to cause shrinkage of certain areas of the brain.
In other words, victims of early childhood trauma will have a relative decrease in the size
of the hippocampus, which is the declarative or conscious memory center of the brain.

It’s interesting also that trauma is linked to the

“The medical system really
doesn’t have a way to
handle the diagnosis of
disorders of regulation.”
endocrine system, and early in trauma, cortisol,
the stress hormone, is increased. Prolonged
exposure to cortisol also causes atrophy of the
hippocampus.

Interestingly, in late trauma, cortisol tends to be lowered; it’s kind of a hallmark for
complex or late trauma. It’s not because the adrenals are affected; they’re normal, but
the hypothalamic-pituatary-adrenal axis is very dysregulated, meaning that it tends to
overreact.

The other thing about trauma is that it’s primarily a syndrome of exaggerated abnormal
regulation of many systems—emotional, endocrine, and even the immune system is
abnormally regulated and cyclically very unstable.

Dr. Buczynski: And highly reactive?

Dr. Scaer: Over-reactive. Any input into any of the systems

results in a sudden and rather dramatic cycling of the system.
“Sensory
Many of the chronic diseases of trauma are primarily diseases Processing
of regulation. They don’t have any end points. You can’t find Disorder is a
a lab test that proves them and as a result, many of them are prime example
thought to be psycho-somatic. of kindling in a
traumatized child.”
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The medical system really doesn’t have a way to handle the diagnosis of disorders of
regulation.

Dr. Buczynski: That’s so fascinating. There’s so much that we could do there, but we
probably should move on to getting a little more into Sensory Processing Disorder. What
do you think is important for every practitioner to know?

What Every Practitioner Should Know about Sensory Processing Disorder

Dr. Scaer: Well, this syndrome is a new syndrome. It derived from Sensory Integration
Disorder proposed by Margaret Ayers in occupational therapy in the 1990’s. It related to
children who seemed very dysregulated and inattentive.

In fact, it ties closely to ADD and ADHD. These kids

“Once SPD was
showed exquisite abnormal hyper-sensitivity to any
kind of stimuli: sound, touch, vision; they were over experienced in
responsive to almost all sensory stimuli, and then there childhood, it becomes
was a group of them that was under responsive—where a typical feature of that
they simply sought sensory stimuli and were very hyper- person’s adaptability
active, intrusive, scratched themselves, and tried to seek throughout their life.”
sensory stimuli.

So like everything else, it is a dysregulation both with hyper-sensitivity and hypo-

sensitivity to all of the sensations of the body.

As time evolved, people began to realize this correlated with early childhood trauma and
that these kids were in fact kindled, and Sensory Processing Disorder is a prime example
of kindling or sensitization in a traumatized child.

Then they found that these syndromes, if you followed people, stayed throughout their
adult life. Once SPD was experienced in childhood, it becomes a typical feature of that
person’s adaptability throughout their life span. This is basically a syndrome which is
based on kindling and has this life span effect on a person’s perception of their sensory
input.

Dr. Buczynski: Bob, along with

“When a person is dissociated, that, let’s focus on a new concept for
they’re out of body, confused, numb; dissociation and its implications for
they are in the freeze response.” healing.

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A New Concept for Dissociation and Its Implications for Healing

Dr. Scaer: I define dissociation as what we perceive when we’re in the freeze. In other
words, when a person is dissociated, they’re out of body, confused, numb; they are in the
freeze response. They’re in a dorsal vagal state, that is, in the freeze.

And since the dorsal vagal nucleus is the engine for all of the visceral function, when
you’re chronically dissociated, you tend to have these syndromes of visceral (gut, heart,
and lung) problems that we see with folks with trauma.

Dissociation, I define as a capsule or a state which is composed of all the unconscious

body or procedural memories that accompanied a traumatic event, especially an
overwhelming one, or one that was repeated constantly.

An example of the latter would be combat in war,

where combat is repeated over and over again. And “When you are
all the memories, sights, images, tastes, and smells dissociated, you’re living
of those traumatic events are stored in unconscious in the past with all of the
memory in a very precise and accurate fashion. That features of that state
includes the physical sensations, the autonomic state, being replicated and
and the emotional state (rage, terror, fear) - all of these typical of prior trauma.”
are stored in a common state.

Anytime one experiences a cue of any part of that state, the whole capsule emerges and
you are dissociated. You are in the past, and not in the present moment.

And these capsules tend to take over what we call the present moment, which is a
measure of our consciousness.
So when you are dissociated, you’re not conscious. You’re living in a state in the past
with all of the features of that state being replicated and typical of prior trauma. I think
that’s what dissociation is.

Why Attachment Disorder Is Emerging as the

Core Basis of Vulnerability to Trauma

Dr. Scaer: We’re beginning to see that early childhood abnormal attachment is correlated
with many of the physical and mental illnesses that we see now.

There’s a study by Vincent Felitti, the Adverse Child Events Study that was done in the

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1990’s, and it’s still going on, where he correlated the negative life experiences with adult
mental and physical problems and diseases.

The correlation was astounding and proportionate to the severity of the early mild childhood
trauma. This began with the work of Alan Shore and Dan Siegel in the 90’s and early 2000’s
with his book, Redeveloping Mind, and Shore’s book, Affect Regulation and Development of the
Self.

We’re beginning to see recognition that the subtle nuances

“It’s becoming more
and more supported
that those early
months of experiences
in our infancy shape
us for a whole life
span with regard to
our resiliency and our
vulnerability.”
of the relationship of the mother and the infant change the
brain in a way that either fosters resiliency, or prevents it
throughout the life span.
This has led to a resurgence of interest, and this goes back
20 to 30 years, but it’s becoming more and more supported
by numerous studies by different people, suggesting that
those early months of experiences in our infancy shape us
for a whole life span with regard to our resiliency and our
vulnerability.

Dr. Buczynski: Even though you can’t predict who’s going to experience trauma, and people
who’ve had wonderful childhoods might later on have car accidents or go to war or be exposed
to some kinds of violence, is there a critical factor about their vulnerability to the reaction of the
trauma?

Dr. Scaer: Exactly. That’s how I got into this field—I was running a rehab center and I saw
thousands of motor vehicle accidents with terrible outcomes.

When I came across the concept of trauma, and most of these folks had PTSD as well, I started
to do family histories and childhood histories on all these people in my chronic pain program
and in these whiplash victims, I found that the common denominator was child abuse in all of
these people, and it as absolutely predictable.

So, early on I realized that the early life experience is

what determines our resiliency or vulnerability throughout “The absence of attunement,
the life span. even within the first days or
weeks of the infancy, has
Dr. Buczynski: What about people who’ve had avoidant an effect on developing
attachment? Not so much that they experienced abuse, but resiliency to trauma.”
they experienced an apathetic or avoidant parent.

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Dr. Scaer: That still produces trauma and vulnerability. The absence of attunement, even
within the first days or weeks of the infancy, it has a deleterious effect on developing
resiliency to trauma.

Alan Shore discusses the growth of the right or orbital frontal cortex. During the early
months of life, in those infants who have been nurtured effectively by their mothers, that
frontal cortex is the master regulator of the emotional brain and the autonomic brain.
It grows proportionate to the degree of contact with the mother in a bonding fashion in
infancy.

There’s direct objective evidence for

“This early period of time is the fact that this early period of time is
absolutely critical for the absolutely critical for the development of
development of the regulated brain.” the regulated brain.

Dr. Buczynski: Bob, outside of soldiers, let’s go into the medical field. We’ve got a lot of
listeners, who aren’t necessarily psychotherapists, but they’re physicians, nurses, and so
forth—a wide range of specialties. Do you think there are many patients who may be or
may have had an MI, myocardial infarction (heart attack) who then go into PTSD?

Dr. Scaer: It’s interesting. I talk about the diseases of stress and the diseases of trauma.
The diseases of trauma are primarily functional or psycho-somatic disorders. They’re
disorders of regulation and diseases that don’t seem to have an endpoint that you can
measure.

However, during trauma, one also is exposed at times to elevated levels of cortisol and
also to depressed levels of cortisol. One begins to see the application of those states to
things like heart disease, hypertension, diabetes, and a variety of diseases that are referred
to as diseases of stress or high cortisol states.

So we have a whole spectrum of disorders that in some

way have to do with the alterations of the brain and the “Almost all of the
hypothalamus and the pituitary adrenal axis on the body, and systems that
we begin to say that life’s trauma is in part the root for just seem predisposed
about all diseases. to most of the
diseases are in
Cancer is a state probably released by a suppressed or some way affected
depressed immune system, that’s why it’s much more by negative life
common the older we get. Our immune systems begin to experiences.”
fail and we get a higher incidence of cancer. Almost all of

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the systems that seem predisposed to most of the diseases are in some way affected by
negative life experiences.

Dr. Buczynski: I was also thinking that perhaps we could look at a cardiac event as a
cause of trauma.

Dr. Scaer: Absolutely. Most diseases of that sort are traumatizing. There are two issues.
One is the threat to life that the disease poses, and that’s intrinsically traumatizing unless
one has the support system to mitigate that, which means to provide you a safe place to
experience this.

And then we get into our system of medical care, which

“We have created a is another topic I’m not sure you want to go into, but I am
system of medicine very passionate about it in that we have created a system
that creates of medicine that creates helplessness in the patient in
helplessness in order to control the situation, and that, by itself, makes it a
the patient in traumatizing environment.
order to control the
situation, and that, I think almost all surgical procedures which are terrifying
by itself, makes are traumatizing, and I found that diagnosing, especially
it a traumatizing when diagnosing breast cancer in my female patients, is
overwhelmingly traumatizing. It has many implications—
environment.”
obviously death is one, but disfigurement is another.

I think most of any diagnoses like that will be traumatizing and a lot of it can be
mitigated by the presence of caregivers at the time by providing information and control,
but unfortunately it doesn’t happen all the time.
Dr. Buczynski: I think it’s an important thing to think about and for us here to talk about.
Usually we think of trauma as more about violence and abuse, incest and so forth, but I
think folks in hospitals probably have patients who are so ill, other symptoms are being
addressed first, and should be of course, but there also are the makings of underlying
PTSD.

Dr. Scaer: I think our medical system needs

to be enlightened as to the fact that any
illness will contain elements of trauma and
how that is handled throughout the course
of treatment will determine how that patient
heals. Frankly, I think our current system of
medicine is the gorilla in the living room of
“Any illness will contain elements
of trauma and how that is
handled throughout the course
of treatment will determine how
that patient heals.”

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our cultural trauma.

Dr. Buczynski: I wish we had more time to talk, Bob. I just want to thank you for
your life’s work and thank you for being a part of this. You’ve made such an important
contribution to our understanding of trauma.

Dr. Scaer: Thank you. It was a pleasure for me, too.

Dr. Buczynski: Everyone take good care and goodnight.

References:
Felitti, Vincent, MD. Adverse Child Events Study. Felitti VJ. Belastungen in der
Kindheit und Gesundheit im Erwachsenenalter: die Verwandlung von Gold in Blei. Z
psychsom Med Psychother 2002; 48(4): 359-369, ongoing from 1990.

Seligman, Martin E. P. Helplessness: On Depression, Development, and Death. San

Francisco: W.H. Freeman, 1975.

Shore, Alan. Affect Regulation and the Origin of the Self: The Neurobiology of
Emotional Development. Psychology Press, 1999.

Siegel, Daniel. The Developing Mind: How Relationships and the Brain Interact to
Shape Who We Are. The Guilford Press, 2001.

Tinker, Bob. Through the Eyes of a Child - EMDR in Children. W. W. Norton &
Company, 1999.

Van der Kolk, Bessel A., MD: Alexander C. McFarlane, and Lars Weisaeth. Traumatic
Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. The
Guilford Press, New York, NY, 1996.

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Trauma Wounds, Dissociation and Sensory Processing Disorder 15

Robert Scaer, M.D. received his B.A. in Psychology, and his M.D.
degree at the University of Rochester. He is Board Certified in Neurol-
ogy, and has been in practice for 39 years, twenty of those as Medical
Director of Rehabilitation Services at the Mapleton Center in Boulder,
CO. His primary areas of interest and expertise have been in the fields of
brain injury and chronic pain, and more recently in the study of traumatic
stress and its role in all mental illness, as well as in physical symptoms
and many chronic diseases

Dr. Scaer is a beacon of light for many trauma patients

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