Journal of Traumatic Stress

, Volume 1, Issue 3, pp 273–290 | Cite as

The trauma spectrum: The interaction of biological and social events in the genesis of the trauma response

  • Bessel A. van der Kolk


When Kardiner first described the full syndrome of what is now called PTSD in 1941, he called the trauma response a “physioneurosis,” that is, a mental disorder which affects both the soma and the psyche. Now, more than 40 years later much knowledge has been gained about the biological effects of traumatization. Based on the studies of disruptions of attachment bonds in non-human primates, the animal model of inescapable shock, and numerous studies of traumatized children and adults, we are beginning to understand the nature of the biological changes which underlie the psychological response to trauma. This paper will explore (1) the nature of the biological alterations in response to traumatization, (2) how these biological shifts depend on the maturation of the central nervous system (CNS), cognitive processes, and the social matrix in which they occur, (3) and how these alterations can influence psychopathological and interpersonal processes.

Key words

post-traumatic stress disorder psychobiology attachment hyperarousal memory addiction to trauma 


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  1. Anisman, H. L., Ritch, M., and Sklar, L. S. (1981). Noradrenergic and dopaminergic interactions in escape behavior.Psychopharmacology 74: 263–268.Google Scholar
  2. Bach-y-Rita, G. (1974). Habitual violence and self-mutilation.Am. J. Psychiat. 131: 1018–1020.Google Scholar
  3. Beck, J., and van der Kolk, B. A. (1987). Behavioral correlates of incest histories in chronically hospitalized women.Am. J. Psychiat. 144: 1474–1476.Google Scholar
  4. Blier, P., and de Montigney, C. (1985). Short term lithium administration enhances serotonergic transmission.Eur. J. Pharmacol. 112: 415–418.Google Scholar
  5. Bowlby, J. (1969).Attachment and Loss, Volume I, Attachment Basic Books, New York.Google Scholar
  6. Bowlby, J. (1973).Attachment and Loss, Volume 2, Separation Basic Books, New York.Google Scholar
  7. Bowlby, J. (1984). Violence in the family as a disorder of the attachment and caregiving systems.Am. J. Psychoanal. 44: 9–27.Google Scholar
  8. Brett, E. A., and Ostroff, R. (1985). Imagery and post-traumatic stress disorder: An overview.Am. J. Psychiat. 142: 417–424.Google Scholar
  9. Brown, G. L., Ebert, M. H., and Goyer, P. (1982). Aggression, suicide and serotonin.Am. J. Psychiat. 134: 741–745.Google Scholar
  10. Bryer, J. B., Nelson, B. A., Baker Miller, J., and Krol, P. (1987). Childhood sexual and physical abuse as factors in adult psychiatric illness.Am. J. Psychiat. 144: 1426–1430.Google Scholar
  11. Bunney, W. E., and Garland, B. L. (1984). Lithium and its possible mode of action. In Post, R. M., and Ballenger, J. C. (eds.),Neurobiology of Mood Disorders Williams and Wilkins, Baltimore, pp. 731–743.Google Scholar
  12. Burgess, A. W., and Holstrom, E. (1979). Adaptive strategies in recovery from rape.Am. J. Psychiat. 136: 1278–1282.Google Scholar
  13. Burgess, A. W., Hartmann, C. R., and McCormack, A. (1987). Abused to abuser: Antecedents of socially deviant behavior.Am. J. Psychiat. 144: 1431–1436.Google Scholar
  14. Carmen, E. H., Reiker, P. P., and Mills, T. (1984). Victims of violence and psychiatric illness.Am. J. Psychiat. 141: 378, 379.Google Scholar
  15. Cicchetti, D. (1984). The emergence of developmental psychopathology.Child Dev. 55: 1–7.Google Scholar
  16. Christie, M. J., and Chesher, G. B. (1982). Physical dependence on physiologically released endogenous opiates.Life Sci. 3): 1173–1177.Google Scholar
  17. Coe, C. L., Mendoza, S. P., and Smotherman, W. P. (1978). Mother-infant attachment in the squirrel monkey: Adrenal responses to separation.Behav. Biol. 22: 256–263.Google Scholar
  18. Coe, C. L., Glass, J. C., and Wiener, S. G. (1983). Behavioral, but not physiological adaptation to repeated separation in mother and infant primates.Psychoneuroendocrinology 8: 401–409.Google Scholar
  19. Cohen, M. R., Pichas, D., and Dubois, M. (1982). Stress induced plasma beta endorphin immunoreactivity may predict postoperative morphine.Psychiat. Res. 6: 7–12.Google Scholar
  20. Coid, J., Allolio, B., and Rees, L. H. (1983). Raised plasma metenkephalin in patients who habitually mutilate themselves.Lancet 545–546.Google Scholar
  21. Colt, E. W., Wardlaw, S. L., and Frantz, A. G. (1981). The effect of running on plasma beta endorphin.Life Sci. 28: 1637–1640.Google Scholar
  22. Delaney, R., Tussi, D., and Gold, P. E. (1983). Long-term potentiation as a neurophysiological analog of memory.Pharm. Biochem. Behav. 18: 137–139.Google Scholar
  23. Dobbs, D., and Wilson, W. P. (1960). Observations on the persistence of traumatic war neurosis.J. Ment. Nerv. Dis. 21: 40–46.Google Scholar
  24. Eich, J. E. (1980). The cue dependent nature of state dependent retrieval.Memory Cog. 8: 157–168.Google Scholar
  25. Emde, R. N. (1982).The Development of Attachment and Affiliative Systems Plenum Press, New York.Google Scholar
  26. Fabre-Nys, C., Meller, R. E., and Keverne, E. G. (1982). Opiate antagonists stimulate affilitate behavior in monkeys.Pharmacol. Biochem. Behav. 6: 653–659.Google Scholar
  27. Field, T. (1985). Attachment as psychobiological attunement: Being on the same wavelength. In Reite, M., and Field, T. (eds.),The Psychobiology of Attachment and Separation Academic Press, Orlando, Fla.Google Scholar
  28. Field, T. and Reite, M. (eds.), (1985).The Psycho-Biology of Attachment and Separation Academic Press, Orlando.Google Scholar
  29. Fish-Murray, C., Koby, E., and van der Kolk, B. A. (1987). The effect of abuse on children's thought. In van der Kolk, B. A. (ed.),Psychological Trauma American Psychiatric Press, Washington DC.Google Scholar
  30. Freud, S. (1919). Introduction to psychoanalysis and the war neuroses. InComplete Psychological Works, Volume 17 (Strachy, J., ed. and trans.), Hogarth Press, London, 1959.Google Scholar
  31. Freud, S. (1920).Beyond the pleasure principle, inComplete Psychological Works, Standard edition, Volume 18 (Strachey, J., ed. and trans.), Hogarth Press, London, 1959.Google Scholar
  32. Gold, P. E., and Zornetzer, S. F. (1983). The mnemon and its juices: Neuromodulation of memory processes.Behav. Neural Biol. 38: 151–189.Google Scholar
  33. Green, A. H. (1978). Self-destructive behavior in battered children.Am. J. Psychiat. 135: 579–582.Google Scholar
  34. Grinker, R. R., and Spiegel, J. J. (1945).Men under Stress McGraw-Hill, New York.Google Scholar
  35. Helzer, J. E., Robins, L. N., and McEvoy, L. (1987). Post-traumatic stress disorder in the general population.N. Engl. J. Med. 26: 1630–1634.Google Scholar
  36. Hendin, H., Pollinger Haas, A., and Singer, P. (1983). The influence of precombat personality on post-traumatic stress disorders.Comp. Psychiat. 24: 530–534.Google Scholar
  37. Herman, J. (1985): Histories of violence in an outpatient clinic.Am. J. Orthopsychiat. 57: 137–141.Google Scholar
  38. Holen, A. (1987).The long term psychological effects of an oil rig disaster, Paper presented at the fourth annual conference of the Society for Traumatic Stress Studies, Baltimore.Google Scholar
  39. Horowitz, M. J. (1976).Stress Response Syndromes Jason Aronson, New York.Google Scholar
  40. Janal, M. N., Colt, E. W. D., Clark, W. C. and Glusman, M. (1984). Pain sensitivity, mood and plasma endocrine levels in man following long-distance running: Effects of naloxone.Pain 19: 13–25.Google Scholar
  41. Jacobs, W. J., and Nadel, L. (1985). Stress-induced recovery of fears and phobias.Psychol. Rev. 92: 512–531.Google Scholar
  42. Kardiner, A. (1941).The Traumatic Neuroses of War P. Hoeber, New York.Google Scholar
  43. Kelly, D. D. (1982). The role of endorphins in stress-induced analgesia.Ann. N. Y. Acad. Sci. 398, 260–271.Google Scholar
  44. Kihlstrom, J. F. (1984). Conscious, subconscious, unconscious: A cognitive perspective. In Bowers, K. S., and Meichenbaum, D. (eds.),The Unconscious Reconsidered Wiley, New York.Google Scholar
  45. Kilpatrick, D. G., Vernonen, L. J., and Best, C. L. (1985). Factors predicting psychological distress in rape victims. In Figley, C. (ed.),Trauma and Its Wake Brunner/Mazel, New York, pp. 113–141.Google Scholar
  46. Kolb, L. C., and Multipassi, L. R. (1982). The conditioned emotional response: A subclass of chronic and delayed post-traumatic stress disorder.Psychiatric Annals 12: 979–987.Google Scholar
  47. Kolb, L. (1987). Neuropsychological hypothesis explaining post-traumatic stress disorder.Am. J. Psychiat. 144: 989–995.Google Scholar
  48. Konner, M. (1982). Biological aspects of the mother-infant bond. In Emde, R. N., and Harmon, R. J. (eds.),The Development of Attachment and Affiliative Systems Plenum, New York.Google Scholar
  49. Kraemer, G. W. (1985). Effects of differences in early social experiences on primate neurobiological-behavioral development. In Reite, M., and Field, T. (eds.),The Psychobiology of Attachment and Separation Academic Press, Orlando, Fla.Google Scholar
  50. Kraemer, G. W., Ebert, M. H., Lake, C. R., and McKinney, G. W. (1984). Hypersensitivity to d-amphetamine several years after early social deprivation in rhesus monkeys.Psychopharmacology 82: 266–271.Google Scholar
  51. Kramer, M., Schoen, L. S., Kinney, L. (1984). The dream experience in dream disturbed Vietnam veterans. In van der Kolk, B. A. (ed.),Post-traumatic Stress Disorder: Psychological and Biological Sequelae American Psychiatric Press, Washington D. C.Google Scholar
  52. Krystal, H. (1968).Massive Psychic Trauma International Universities Press, New York.Google Scholar
  53. Krystal, H. (1984). Psychoanalytic views on human emotional damages. In van der Kolk, B. (ed.).Post-traumatic Stress Disorder: Psychological and Biological Sequelae APA Press, Washington D. C., pp. 1–28.Google Scholar
  54. Laudenslager, M., Capitano, J. P., and Reite, M. (1985). Possible effects of early separation on subsequent immune function in adult macaque monkeys.Am. J. Psychiat. 142: 862–864.Google Scholar
  55. Lindemann, E. (1942). Symptomatology and management of acute grief.Am. J. Psychiat. 101: 141–148.Google Scholar
  56. Lindy, J. (1987).Vietnam, a Case Book Brunner/Mazel, New York.Google Scholar
  57. Lipper, S., Davidson, J. R. T., and Grady, T. A. (1986). Preliminary study of carbamezapine in post-traumatic stress disorder.Psychosomatics 27: 849–854.Google Scholar
  58. MacLean, P. D. (1985). Brain evolution relating to family, play, and the separation call.Arch. Gen. Psychiat. 42: 505–417.Google Scholar
  59. Maier, S. F., Davies, S., and Grau, J. W. (1980). Opiate antagonists and long term analgesic reacton induced by inescapable shock in rats.J. Comp. Psychol. 105: 3–46Google Scholar
  60. Maier, S. F., and Seligman, M. E. P. (1976). Learned helpnessness: Theory and evidence.J. Exp. Psychiat. Gen. 105: 3–46.Google Scholar
  61. Malloy, P. F., Fairbank, J. A., and Keane, T. M. (1983). Validation of a multimethod assessment of post-traumatic stress disorders in Vietnam veterans.J. Consult. Clin. Psychol. 51: 4–21.Google Scholar
  62. McCahill, T. W., Meyer, L. C., and Fishman, A. M. (1979).The Aftermath of Rape Heath, Lexington, Mass.Google Scholar
  63. Mitchell, D., Osborne, E. W., and O'Boyle, M. W. (1985). Habituation under stress: Shocked mice show non-associative learning in a T-maze.Behav. Neur. Biol. 43: 212–217.Google Scholar
  64. Neisser, U. (1967).Cognitive Psychology Prentice Hall, Englewood Cliffs, N. J.Google Scholar
  65. Newman, J. D., Murphy, M. R., and Harbough, C. R. (1982). Naloxone-reversible suppression of isolation call production after morphine injections in squirrel monkeys.Soc. Neur. Abstr. 8: 940.Google Scholar
  66. Panksepp, J. (1980). Brief social isolation, pain responsivity and morphine analgesia in young rats.Psychopharmacology 72: 110–112.Google Scholar
  67. Panksepp, J., Sivey, S. M., and Normansell, L. A. (1985). Brain opioids and social emotions. In Reite, M., and Field, T. (eds.),The Psychobiology of Attachment and Separation Academic Press, Orlando, Fla., pp. 3–49.Google Scholar
  68. Pattison, E. M., and Kahan, J. (1983). The deliberate self-harm syndrome.Am. J. Psychiat. 140: 867–872.Google Scholar
  69. Piaget, J. (1970).Structuralism Basic Books, New York.Google Scholar
  70. Pitman, R., Orr, S., Laforgue, D., and DeJong, J. (1987). Psychophysiology of PTSD imagery in Vietnam combat veterans.Arch. Gen. Psychiat. 44.Google Scholar
  71. Pitman, R., Orr, S., van der Kolk, B., and Greenberg, M. Opioid mediated stress induced analgesia in Vietnam Veterans with PTSD (submitted for publication).Google Scholar
  72. Pynoos, R. S., and Eth, S. (1985). Developmental perspective on psychic trauma in childhood. In Figley, C. R. (ed.),Trauma and Its Wake Brunner/Mazel, New York.Google Scholar
  73. Putnam, F. W., Guroff, J. J., and Silberman, E. K. (1986). The clinical phenomenology of Multiple Personality Disorder.J. Clin. Psychiat. 47: 285–293.Google Scholar
  74. Rainey, J. M., Aleem, A., Oritz, A., Yaragani, V., Pohl, R., and Berchow, R. (1987). Laboratory procedure for the inducement of flashbacks.Am. J. Psychiat. 144: 1317–1319.Google Scholar
  75. Rajecki, D. W., Lamb, M. E., and Obmascher, P. (1978). Toward a general theory of infantile attachment: A comparative review of aspects of the social bond.Behav. Brain Sci. 3: 417–464.Google Scholar
  76. Reite, M., Short, R., and Seiler, C. (1981). Attachment, loss and depression.J. Child Psychol. Psychiat. 22: 141–169.Google Scholar
  77. Richardson, J. S., and Zaleski, W. A. (1983). Naloxone and self-mutilation.Biol. Psychiat. 18: 99–101.Google Scholar
  78. Sapolsky, R., Krey, L., and McEwen, B. S. (1984). Stress down-regulates corticosterone receptors in a site specific manner in the brain.Endocrinology 114: 287–292.Google Scholar
  79. Sherman, A. D., and Petty, F. (1980). Neurochemical basis of the action of antidepressants on learned helplessness.Behav. Neurol. Biol. 30: 119–134.Google Scholar
  80. Shore, J. H., Tatum, E. L., and Vollmer, W. M. (1986). Psychiatric reactions to disaster: The Mount St. Helens experience.Am. J. Psychiat. 143: 590–595.Google Scholar
  81. Shoularsh, J. (1987).Combat addiction, Paper presented at the Fourth Annual Meeting of the Society for Traumatic Stress Studies, Baltimore.Google Scholar
  82. Simpson, C. A., and Porter, G. L. (1981). Self-mutilation in children and adolescents.Bull. Menn. Clin. 45: 428–438.Google Scholar
  83. Spiegel, D. (1981). Vietnam grief work using hypnosis.Am. J. Clin. Hypnosis 24: 33–40.Google Scholar
  84. Spitz, R. (1945). Hospitalism: An inquiry into the genesis of psychiatric conditions in early childhood.Psychoanalytic Study Child 1: 53–74.Google Scholar
  85. Squire, L. R. (1987).Memory and the Brain Oxford University Press, New York.Google Scholar
  86. Stoddard, F. (1985).Stress disorders in burned children and adolescents, Paper presented at the Annual Meeting of the American Psychiatric Association, Dallas.Google Scholar
  87. Strian, F., and Klicpera, C. (1978). Die Bedeuting psychoautonomische Reaktionen im Entstehung und Persistenz von Angstzustanden.Nervenartzt 49: 576–583.Google Scholar
  88. Tennes, K. (1982). The role of hormones in mother-infant transactions. In Emde, R. N., and Harmon, R. J., (eds.),The Development of Attachment and Affiliative Systems Plenum, New York, pp. 75–80.Google Scholar
  89. Terr, L. (1979). Children of Chowchilla, a study of psychic trauma.Psychoanalytic Study Child 34: 547–623.Google Scholar
  90. Terr, L. (1983). Chowchilla revisited: The effects of psychic trauma four years after a school bus kidnapping.Am. J. Psychiatry 140: 1543–1550.Google Scholar
  91. van der Kolk, B. A. (1983). Psychopharmacological issues in post-traumatic stress disorder.Hosp. Comm. Psychiat. 34: 683–691.Google Scholar
  92. van der Kolk, B. A. (1987).Psychological Trauma American Psychiatric Press, Washington D. C.,Google Scholar
  93. van der Kolk, B. A., Blitz, R., Burr, W., Sherry, S., and Hartmann, E. (1984). Nightmares and trauma.Am. J. Psychiat. 141: 187–190.Google Scholar
  94. van der Kolk, B. A., and Ducey, C. P. (1984). Clinical implications of the Rorschach in post-traumatic stress. In van der Kolk, B. A. (ed.),Post-traumatic Stress Disorder: Psychological and Biological Sequelae American Psychiatric Press, Washington, D. C.Google Scholar
  95. van der Kolk, B. A., Greenberg, M. S., Boyd, H., and Krystal, J. (1985). Inescapable shock, neurotransmitters and addition to trauma: Towards a psychobiology of post-traumatic stress.Biological Psychiat. 20: 314–325.Google Scholar
  96. van der Kolk, B. A., Herman, J. L., and Perry, C. (1987).Traumatic antecedents of borderline personality disorder, Paper presented at the Fourth Annual Meeting of the Society for Traumatic Stress Studies, Baltimore.Google Scholar
  97. Visintainer, M. A., Volpicelli, J. R., and Seligman, M. E. P. (1982). Tumor rejection in rats after inescapable shock.Science 216: 437–439.Google Scholar
  98. Weiss, J. M., Glazer, H. I., Pohorecky, L. A.,et al. (1975): Effects of chronic exposure to stressors on subsequent avoidance-escape behavior and on brain norepinephrine.Psychosom. Med. 37: 522–524.Google Scholar
  99. White, S. H., and Pillemer, D. B. (1979). Childhood amnesia and the development of a socially accessible memory system. In Kihlstrom, J. F., and Evans, F. J. (eds.),Functional Disorders of Memory, Hillsdale, N. J.Google Scholar

Copyright information

© Plenum Publishing Corporation 1988

Authors and Affiliations

  • Bessel A. van der Kolk
    • 1
  1. 1.MMHC Trauma CenterHarvard Medical SchoolBoston

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