When discussing trauma and grief, we oftentimes hear about the fight-or-flight response of Post-Traumatic Stress Disorder (PTSD), but as trauma research grows, so too does our understanding of how trauma responses emerge from the physiology altered by trauma(s).
It’s important to note that no one theory is right or wrong. Rather, these tools may inform survivors how to better understand their response to environmental triggers, intrusive thoughts, nightmares, or re-traumatization.
3Fs: An example in physiology
In the early history of trauma research, the adaptive survival mode that kicks in response to danger was known as “fight-or-flight.” Stephen Porges’ Polyvagal Theory added the “freeze” response. In his own studies, Porges theorizes that the evolution of the human system also changed the vagal pathway which automatically shifts our system from “rest-and-digest” to “fight/flight/freeze.” This adaptive strategy also allowed humans to respond and regulate social environments (Porges, 2009).
|Fight||Confronting the perceived threat|
|Flight||Fleeing the perceived threat|
|Freeze||Immobilizing in light of the perceived threat|
What exactly is a Vagus nerve?
In brief, the Vagus Nerve is the 10th cranial nerve (nerves that originate directly from the brain and not the spinal cord). This nerve regulates our respiration rate and heart rate, stimulates gut motility and certain secretions of the digestive system, and relaxes/constricts certain muscles in our trunk.
Dr. Porges (2009) proposes that our adaptive behavioral strategies are the result of physiology; therefore, in his theory, we can manually stimulate the vagus nerve to increase vagal tone thereby allowing us to manage fight/flight/freeze.
4Fs: An example in trauma typology
Pete Walker (2014) defines 4Fs from a trauma typology perspective and proposes differential diagnoses of complex PTSD:
|Response Type||Definition||May present as…||Mislabeled as…|
|Fight||posturing against or confronting the perceived threat.||explosive outbursts, anger, defiance, or demanding.||Narcissistic|
|Flight||fleeing or symbolically fleeing the perceived threat by way of a “hyperactive” response.||anxiety, fidgeting, over-worrying, workaholic tendencies, or fidgeting.||OCD|
|Freeze||dissociating in response to the perceived threat.||spacing out, losing time, feeling unreal, brain fog, or feeling numb.||Dissociative Disorder|
|Fawn||Placating the perceived threat in an attempt to forestall imminent danger.||People-pleasing, fear to express self, flattery, “yes” person, exploitable, fear of fitting in||Codependent Disorder|
Walker’s trauma typology proposes that we may experience one or a hybrid of the above, e.g. fight/fawn (mislabeled as borderline), flight/freeze (mislabeled as schizoid), etc. Walker uses this model to explain the personality of childhood trauma survivors in relation to complex PTSD and developmental trauma disorder (neither are currently recognized in the DSM-V).
6Fs: But wait, there’s physiologically more!
Dr. Curtis Reisinger suggested that the fight-or-flight response to stress was simplistic and incomplete (no kidding, we first used “fight-or-flight” in 1915 and have had several emerging theories and treatment strategies since then).
This theory adds the following trauma responses:
|Response Type||Definition||Other Clinical Terms Used|
|Flood||Being flooded with emotions in response to a perceived threat.||Emotional flooding, emotional dysregulation|
|Fatigue/Flop||Feeling tired or sleepy in response to a perceived threat.||Disassociating, numbing|
Dr. Reisinger points out that “sleeping” is often observed in infants who shut down when presented with excess stress. Neonatal Intensive Care Units advocate trauma-informed research and education on how infants may demonstrate stress (appear to shut down, holding breath, gagging, sneezing, yawning, flailing, hyperextension, etc.) and ways in which infants may require supports to self-regulate (moving, grasping, visual locking, hand-to-mouth, suckling, etc.).
Well into adulthood, we continue to re-require strategies and supports to regulate our bodies when encountering traumatic stressors. A “shut down” response in adults may present as disassociation (mind-body disconnection), depersonalization (sensed loss of self or identity), derealization (sensed loss of reality), or numbing (U.S. Department of Health and Human Services, SAMHSA, 2014).
Emotional flooding (or emotional dysregulation) occurs when the survivor experiences an intense barrage of emotions in the presence of a perceived threat.
In addition to survivors, emotional flooding may also be increasingly more common for Autistic individuals and other neurodivergents. Other examples of people who may experience emotional flooding include those with bipolar disorder, borderline personality disorder, ADHD, and Rejection Sensitive Dysphoria.
A Summary on Trauma Responses
The trauma response is not typically a “one and done” process where someone experiences a “fight response.” While the initial reaction may vary, trauma responses are often reported as being variable to the individual (U.S. Department of Health and Human Services, SAMHSA, 2014).
A trauma response can be better depicted as something like a pendulum. Similar to a meltdown, distress symptoms are initially present and require supports for the individual to self-regulate and discharge trauma energy (the internal cocktail of stress hormones that are amped up from trauma and every trigger thereafter).
However, when that need is not satisfied, the person becomes increasingly dysregulated. Without supports to self-regulate the intensity may continue to escalate until eventually coming to a crashing point. Some survivors describe a whole host of emotions and some report pure numbness and disconnect.
It’s also extremely important to recognize that the trauma response is appropriately adaptive when a person’s physiology has been altered by trauma. True trauma work addresses quality of life on an individualized basis, regulation of the environment, skills for developing a relaxed-muscle body, social supports such as accommodations, and recognizing that healing trauma is only one part of the whole individual experience.
Autistic and Neurodivergent Trauma
According to one study, Autistic children and adults “are at an increased risk of developing PTSD following exposure to traumatic life events” (Rumball, Happé, & Grey, 2020). Not only might trauma affect most autistic children and adults, but PTSD can develop traits that may present similarly to Autism.
Subsequently, Autistic Trauma presents itself in such a way that Autistic people may experience the above physiological trauma response coupled with repressed emotions and stims, masking and burn-out particularly in environments that do not provide supports that support both healing and empowering Autistic authenticity.
Porges, S. W. (2009). The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic Journal of Medicine, 76(4 suppl 2). https://doi.org/10.3949/ccjm.76.s2.17
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. (2014). Trauma-informed care in behavioral health services.
Rumball, F., Happé, F. and Grey, N. (2020), Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM-5 and Non-DSM-5 Traumatic Life Events. Autism Research, 13: 2122-2132. https://doi.org/10.1002/aur.2306
Walker, P. (2014). Complex Ptsd: from surviving to thriving: a guide and map for recovering from childhood trauma. Azure Coyote.
Living with PTSD on the Autism Spectrum by Lisa Morgan and Mary Donahue
Accessing the Healing Power of the Vagus Nerve by Stanley Rosenberg
- The 6Fs of Trauma Responses - September 28, 2021
- Neuroception 101: How the mindbody scans and adapts for safety and danger - August 5, 2021