“The greater the trauma, the greater the risk for alcohol abuse… drug use, depression, suicide attempts, and other negative outcomes. Clearly, we cannot begin to address the totality of an individual’s healthcare, or focus on promoting health and preventing disease, unless we address trauma.”
(Rosenberg, 2011, p. 428).
As we age, our bodily functions, thoughts, behaviours and emotions will change; Trauma speeds up the aging process. Scientists can actually “see” this acceleration on a cellular level. Studies suggest that trauma survivors have an increased risk of developing cardiovascular disease and Type 2 diabetes (Wolf, 2016). Women who have experienced trauma tend to have shorter lifespans than their counterparts who have not experienced trauma (Lohr, et al., 2015). Trauma a woman suffers in childhood can continue to impact her health and well-being as she ages.
The term neurodegenerative disease refers to a range of diseases that result in the destruction of the brain and nervous system, including: Alzheimer’s disease, Huntington disease, and Parkinson’s disease. A woman’s risk of being affected by neurodegenerative disease increases dramatically as she grows older (Neurodegenerative Diseases, 2019). Many neurodegenerative diseases are associated with dementia (ONDRI Diseases, 2019).
When memory and cognition problems are severe enough to interfere with a woman’s daily life, the impairment is classifiable as dementia (“What is Dementia,” 2019). A woman with dementia might be disoriented. She might struggle for words, forget names. She might become aggressive, experience decreased interest in social activities, or be suspicious of others (“10 Warning Signs,” 2019).
It’s possible for an older woman’s dementia to be compounded by trauma that she has survived or is experiencing. Perhaps she’s being abused by a partner or family member. It’s especially difficult for women with dementia to access support services as they’re less able to communicate and navigate systems.
Compare the two brain images below. The first image depicts a healthy brain, while the second shows the brain of a person with dementia. Note how much smaller the brain on the right is. Note too how the ventricles – cavities in the brain – are enlarged in the brain on the right. Reduced brain volume is characteristic of many types of dementia.
Food for Thought:
A Traumatic Brain Injury (TBI) is any injury to the brain that’s caused by an outside physical force and includes injuries which are penetrating, such as a bullet piercing the skull, or a closed head injury such as force from a blunt object or jolt to the head from a surface such as the wall.
For women who have experienced physical violence, the most common sites of injury are the face, head, and neck. Attacks to this area are likely to result in injuries to the brain, however these injuries often go undiagnosed and untreated due to the lack of research and knowledge focused on TBI and violence within relationships. A woman can sustain a TBI without losing consciousness and may not have immediate obvious symptoms. No single test can confirm a diagnosis of TBI, or concussion, which is a type of TBI (Traumatic Brain Injury and Concussion, 2012-2017).
Injury to the brain can also result from strangulation or asphyxia – when oxygen is prevented from flowing to the brain by an outside force, even for brief periods with minimal force. Some resources such as the J. Campbell Danger Assessment use the language of “choking” as survivors often use this term rather than “strangulation”. The trachea may also be restricted during strangulation and combined with asphyxia can quickly cause unconsciousness. A woman may seem fine after she is strangled, not fully recall the event, have no visible external injuries and still die days or weeks later due to tears in the carotid artery and respiratory complications like pneumonia and embolisms.
A woman who has been strangled is likely to be at high risk of physical harm and lethality from her perpetrator.
Signs may include voice changes, difficulty/painful swallowing, hyperventilation, difficulty breathing, chin abrasions, scratches, abrasions, scrapes, redness/bruising on neck, petechiae (tiny red spots indicating ruptured capillaries), ligature marks, neck swelling, memory loss, and vomiting.
In particular, a woman who has sustained multiple TBIs throughout her life may experience impacts including: memory issues, headaches, fatigue, learning difficulty, decreased cognitive flexibility, general distress, depression, anxiety, irritability, problems with communication and other symptoms commonly associated with PTSD as a result of the trauma to her brain.
Concentration and impulse-control can be impacted. A woman with TBI might express emotion that doesn’t match the situation she’s in. Her vision and coordination might suffer. She could have seizures. One or any combination of these effects can interfere with her ability to escape a dangerous situation and access trauma related services.
It is difficult to distinguish between symptoms related to PTSD versus TBI and a woman may be experiencing symptoms related to both PTSD and TBI (Henderson, 2016). Navigating the overlap and interplay between PTSD and TBI can be especially challenging to a woman who lives with both conditions (Lash, 2018).
Though screening for TBI may not be within the scope of your position, recent research suggests a promising practice may include supporting survivors of violence as though they may have a TBI, even if there is no diagnosis. This involves repeating information, setting aside extra time for appointments, sharing information at a slow pace, helping the woman create personalized plans for carrying out follow-up tasks and offering reminders without judgement or frustration (Valdera, 2003).
Substance use may increase an older woman’s risk of experiencing further trauma, especially in certain locations and situatoins (Fairbrother, 2004). Harm reduction approaches focus on reducing risk while contextualizing a woman’s choices related to substance use within the trauma and discrimination she has experienced throughout her life, and intergenerationally.
Anxiety: PTSD can go hand in hand with other anxiety disorders like generalized anxiety disorder, social anxiety disorder, panic disorder and obsessive compulsive disorder.
Depression: Research shows that close to half the people diagnosed with PTSD also suffer from or have suffered from depression (Tull, 2018).
Psychosis: Studies suggest that a significant proportion of psychotic disorders arise as a response to trauma, and that a woman can experience PTSD-like symptoms in response to having experienced psychotic episodes (Morrison, Frame & Larkin, 2003).
Some women who have survived trauma use substances to cope with the impacts of trauma. Consumption of certain substances – including alcohol – causes the brain to release dopamine, a neurotransmitter that contributes to feelings of pleasure. Substances can offer a woman temporary relief from distress, but the relief comes at a high price. The woman may become dependent on substances; her substance use may lead her into situations where she is at risk of suffering further trauma.
Grief is a shock that unfolds in phases – the immediate, acute pain of loss, and the extended mourning period afterwards. Grief activates the stress response and causes areas of the brain that regulate emotion to become underactive. In the immediate aftermath of loss, a woman might be tearful, sleepless, irritable. Her memory might suffer. Grief can compromise a woman’s immune system so that she’s more vulnerable to illness.
In the past, grief and trauma were mainly thought of as separate, but recent thinking sees them as entities that interact. Complicated grief (sometimes called traumatic grief) involves a bereaved person suffering from stress and despair that remain at acute levels for longer than a year. About 9% of older women who have been bereaved experience complicated grief (Shear et. al, 2014).
Complicated grief is debilitating. A woman who suffers from it will be preoccupied with intense yearning for the deceased person – yearning that impedes her ability to function in her daily life. Symptoms of complicated grief include: numbness; feelings of purposelessness and living in a fog; a sense that life is empty; a fragmented sense of trust/security.
Neurobiological markers of complicated grief include higher than normal levels of the stress hormone cortisol, and greater activation of the nucleus accumbens (a key brain region involved in pleasure and addiction) when looking at pictures of the deceased person (O’Connor, 2019; Regehr & Sussman, 2004).
Both survivors of trauma and women experiencing complicated grief may describe feeling as though their head is “in a fog.”
Food for Thought: