How is developmental trauma different from other trauma, in the brain?

Okay, I'm on a roll with these mini videos today. Another question kind of doing like Q and A stuff today. So another question asked a fair amount and I do workshops on this actually question about developmental trauma and how it differs from non developmental trauma, the adult based is one way to think of it. Or single incident trauma. How is that different in the brain? So, so developmental trauma of the brain versus non developmental trauma of the brain. Okay, so this is a big one. There's so many pieces of information about this. So first of all, know that this has been extensively studied. So there's so much to share. So much I know. I do sometimes one day workshops just on developmental trauma in the brain because. And of course then treatment implications and approaches because there's so much going on with developmental trauma. One way to think about it though is that developmental trauma versus non developmental trauma, it's not that the areas impacted in the brain are going to be different. It's still going to be your main players. So main players including, but not limited to amygdala, insula, hippocampus, prefrontal cortex, the cingulate, especially the anterior cingulate cortex, these are going to be the same areas. You're gonna see hypothalamus stuff, you're gonna see hypothalamus stuff, issues with the basal ganglia. I mean, those are some other areas that are still important. These are all like, what, top 10 or so areas. So it's gonna be the same. The same areas of the brain, I would say, with developmental trauma, think of it more like this. So the deficits that are created in these areas, so whether it's hyperactivated, under activated, if the area gets big, if it gets smaller, you know, there's structural changes. It's more about severity with developmental trauma. So you're oftentimes, not always, but oftentimes looking at more severe deficits or more pronounced brain changes than if you have a developing brain that has no trauma until the age of about maybe 27 or so, when your brain finishes developing and then you have a trauma, it is going to look different. The other thing to know is that trauma at different times looks bad. Pretty different in the brain potentially. So wherever the trauma happens, whatever age in development, age 2, age 10, age 18, whatever time it happens, it has the potential to in some way disrupt development from that point on. Okay, so we call developmental trauma, you know, like this childhood pervasive trauma. And we think of it as being maybe, I don't know, birth to like think 18. But I don't really know where it ends. But, but know that developmental trauma, even in and of itself as a term is, is very, very broad because developmental trauma at one is super different than we know, like around 11 or so. Okay. It's gonna be really, really, really different. So know that at whatever point that the trauma or abuse or it might be neglect. Right. Neglect has profound effects. At whatever point in time that that happens. It's that development after that time may be impacted, not with everyone all the time in exactly the same way. So maybe somebody's in a Romanian orphanage, horrible situation for the first two years of life and they may not show any deficits at all. I mean, who knows? I don't know. But it's that whenever the disruption happens, whenever the trauma, neglect happens, we know from that point on it could impact the brain's developmental trajectory. So the earlier the abuse, the trauma, the neglect, the more question marks we have after that. So that's the way to think of it. Kind of reminds me, actually. So I'm increasingly doing some forensic work and sometimes I'll consult with attorneys about, you know, what to expect in different scenarios. And I give an example without any identifying information, but was consulted with actually out of state attorneys, multiple who were wondering about what would the impact be on a nine month old, okay. Who had suffered a certain type of neglect. They were wondering what could be expected. So there was going to be maybe a lawsuit involving this and what could they expect with the child. And of course, attorneys are like, you know, tell me, tell me what this is and then tell me how we fix it. Which answer is not always that clear. Right. But what I ended up recommending, and actually I was consulting with another psychologist who's helping out with it, the conclusion was, is, you know, if this happens to a child and you really wanted to know the impact, you'd probably need to get them evaluated one to two times a year, all the way, maybe until around age 30 or so. That's how you'd catch what might be happening that may or may not be a result of that thing when the child was nine months old. Okay. So I know I'm not giving a lot of firm answers here. Let me just give you a couple of examples, maybe a few examples of what can happen. Okay. So I don't want to make people overly nervous about this, like this is what's going to happen, because actually we just, we just don't know. But one thing that can happen with developmental trauma is if it's really early, if it's maybe preverbal or maybe before, around the age of two, it can actually impact the right hemisphere's development. So the first two or so years of life is all right hemisphere and right hemisphere is attachment and attunement. So it's all about forming secure attachment with caregivers. That's not the only critical period for attachment, first two years, but it's the first and it's really arguably the most major attachment critical period. Okay, so if there's a lot of neglect, needs are not being met for the age of two, then you might see some disruptions on the right hemisphere's development, which could also potentially impact or delay the left hemisphere's development as well as impact the connection between the two brain hemispheres called the corpus callosum. So we know the corpus callosum may not actually form to be as strong when there's pervasive developmental trauma. Some people sometimes. Okay, so that's one thing. Another thing is that throughout childhood, and this is not just before the age of two, but all through childhood, your amygdala hopefully is shedding or pruning its neurons. So the amygdala is that smoke alarm or smoke detector of the brain that detects fear and threat and danger. So in an infant, the amygdala is pretty darn active, and rightfully so, because everything is actually really dangerous and scary when you're a little kid or you're an infant. So these amygdalae are like on fire, right? Firing all the time. And this is why two year olds have tantrums. But we hope that, you know, moving into age 40, you have fewer tantrums. And actually a part of why that's the case is that your amygdala prunes the neurons so it's really active. And a lot of neurons are contributing to that activation. What happens with secure attachment and when there's not abuse and there's not neglect is the amygdala is smart. It actually learns that it being that active all the time, it's overkill. It doesn't need it. It figures out, hey, our needs are being met. Most of the time, things are pretty secure, pretty stable, pretty safe, pretty predictable, which is a lie, right? But it's a delusion that we all need when we're two years old. So what happens is the brain intelligently starts to shape itself to fit the environment. And that's really what a healthy brain is, is a brain that fits the environment it's in. So the amygdala figures out this is overkill, and then what does it do? It starts to shed the neurons and that leads to a more balanced, regulated, less active at baseline amygdala. Okay. So that you can grow up and feel calm, so that you can self soothe when you get really upset. You know how to stop being really upset. Maybe not stop, but you know, you, you can cope, you can soothe, you can calm down. With individuals who've had. And this, this isn't just again, by the age of one or two, this can be through adolescence, right. Some pretty severe trauma. It can really disrupt that pruning process. So the amygdala may not be pruning. It may be that early neglect or abuse impacting the right hemisphere. Then it can impact left hemisphere development, leading to under activation of different areas long term in the left hemisphere. That long story short can result in withdrawal behaviors and negative emotions. And that's because the right hemisphere is dominant. If the left hemisphere doesn't fully develop, doesn't fully activate, then you don't engage in as many approach behaviors, you don't experience as many positive emotions. That's largely left hemisphere stuff. I know it's an overgeneralization, but generally. Okay, so that might be when you get recommended to go to a psychiatrist and do something called tms. Transcranial Magnetic Stimulation. And TMS can do a lot of things, but one of the things that it can do is stimulate that left hemisphere. The other thing I'll mention there's so many things to mention about developmental trauma is that it has been linked to prefrontal deficits. So prefrontal cortex right here, sometimes thought of as a massive thinking center of the brain. It does a whole lot of stuff. It's involved in executive functioning and things like that. The center areas kind of where your personality is and self awareness more the outside areas more about focus, concentration, can be awareness of other people, connection to other people. The long story short on this is that developmental trauma has been associated with under activation in multiple areas of the prefrontal cortex. So that might mean attentional difficulties. That's why increasingly kids with adhd, you want to get them assessed for trauma. I'm not saying it's not adhd, but these deficits could really be linked to trauma that has not been treated, can lead to difficulty reading emotions of others or connecting with other people. So I just feel like there's a wall between them and others. Can be hard to put into words, but there's just kind of a wall there and it's hard to really get through that wall to fully engage or fully connect with others. And if the trauma was pervasive enough and early enough, it might affect some of these more midline areas of the prefrontal cortex that are involved in sense of self and identity formation. So it's interesting to me that if you look at the criteria for borderline personality disorder, one of the symptom clusters is that unstable sense of identity about who the person is or not really knowing who they are. And I always link that back to pervasive, usually complex developmental trauma where the child essentially did not learn that. It's basically what happens, but it's actually associated with some prefrontal deficits. And this stuff by no means is stuff that can't be addressed in therapy with a lot of different therapies, emdr, other exposure based therapies, other evidence based therapies, like cognitive therapies. We know somatic therapies are really on the rise, like somatic experiencing other somatic techniques. And not everything always has to be new. I mean, look at the evidence behind psychodynamic psychotherapy or psychoanalytic psychotherapy for ptsd. This is pretty good evidence for a lot of stuff, actually. So there's a lot of ways that we can manage this. There's a lot of ways that we can treat this. And so I, I think it's really, really helpful. I would just say that with developmental or complex trauma, we have to calibrate our expectations. Sometimes with some of these therapies, we see these miracle results. And I know I don't help this sometimes in my demos when I do workshops, because I'll do these demos with people from the audience who are usually licensed mental health clinicians. And we do EMDR exposure work, like the phase four work, and their distress goes from an 80 to 80, 10 and like 15 minutes. And oh my gosh, look at the miracle of EMDR. And yes, that can be the case, but I would just say that, you know, when it's not a demo where somebody is, you know, somebody who's an expert in EMDR is doing it with another clinician and it's like a, you know, a person without mental health training with extremely intense distressing traumas, and maybe it's not one, maybe it's like 50, you know, just kind of calibrate your expectations. Not saying that it won't work, but that you're not gonna go as quickly. I'd say don't expect miracles, like in one session. And I know, I know those videos exist. I know again, my videos kind of send that message even sometimes. My demos. But really when we're doing it in real life with, with clients that are, you know, real people and have their own complexities, yeah, we have to be willing to take our time and think of it really as a process. So a little bit off topic here, but yeah, developmental trauma, it is different. It is treatable. I'm always very helpful about it. Hopefully it's helpful for you to know a little bit about the differences, but know that in terms of the treatment approach, it's not going to be super, super different with developmental trauma and non developmental trauma. The main thing that I think is emphasized a lot in the developmental trauma that's not emphasized as much with non developmental trauma is attachment based work. So really taking an attachment based perspective in emdr, you can check out Laurel Parnell's attachment focused emdr, some modifications to the original eight phase model that might be helpful to.