Alienation after Trauma

Even though I had friends, I was still lonely.

My friends didn’t understand my reactions.

There was a huge void inside me.

These are some of the ways that survivors describe feeling alienated after trauma, particularly after intimate violence such as sexual assault or domestic violence.

Several years ago, we developed the Trauma Appraisal Questionnaire (TAQ), which measured alienation and other common posttraumatic appraisals (such as self-blame and shame). The alienation scale included items that reflected survivors’ experiences of being disconnected from themselves and others.

Over the years, we observed that alienation was linked with many different forms of psychological distress; whereas, other reactions, such as shame, are linked with specific kinds of distress. For example, feeling more alienated was associated with worse PTSD, depression, and dissociation symptoms. Yet, shame was linked specifically to PTSD and not to depression or dissociation. The links between alienation and posttraumatic symptoms showed up in adult and adolescent survivors of child abuse as well as domestic violence survivors.

The recurring pattern led us to ask if alienation might play a particularly important role in more severe and complex trauma responses. Thus, we tested whether alienation could distinguish people with similar trauma histories who have had different symptom trajectories as part of a collaboration with Dr. Rafaele Huntjens (University of Groningen, Holland) and Dr. Martin Dorahy (University of Canterbury, New Zealand). In a sample of people diagnosed with either PTSD or Dissociative Identity Disorder (DID), alienation appraisals distinguished the two groups. Specifically, the group diagnosed with DID reported more severe alienation than people diagnosed with PTSD. This work suggested that alienation may play a role in initiating and/or maintaining serious and complex responses to trauma.

Yet, we were left wondering if the TAQ alienation items might just be measuring something about social support, loneliness, or even just a more general difficulty identifying emotions (called alexithymia) – each of which could also be linked with posttraumatic distress. If something like social support could better explain symptoms than alienation, that would change how to make sense of the implications of the findings for coping and healing.

And that’s how we get to this issue’s new research finding!

Rachel McIlveen and Dr. Donncha Hanna brought a team together in Northern Ireland for a study that involved 100 college students as well as 93 adults seeking services who had survived trauma (McIlveen et al., 2019). They asked participants questions about trauma history, alienation, social support, loneliness, and alexithymia while also measuring PTSD and depression symptoms.

They found that alienation was associated with posttraumatic stress in both the student and clinical samples, even when they took into account social support, loneliness, and alexithymia. (You can read  about the study here.) This finding suggests that there is, indeed, something important about the feelings of disconnection that survivors experience for understanding psychological distress that can’t be explained by these other factors, such as loneliness.

These findings make me think about the actions that advocates take every day to communicate – in big and small ways – to survivors that they are not disconnected; that they are not alone; that someone does understand.

And then I think back to the Denver Triage Study, which looked at the impact of community-coordinated responses to domestic violence several years ago. Women who got phone calls from victim advocates after domestic violence had less severe PTSD and depression symptoms than women who did not receive phone calls more than a year after the violence occurred. But, the women who got the phone calls didn’t necessarily talk to the advocates who called or seek out services. So, why did a phone call make a difference?

For some women, the phone call reassured them that they were not alone. I recall a woman describing that she hadn’t answered the call or called the advocate back. Yet, she said that the call meant something to her. Because of the call, she knew people in the community cared about the violence she had survived; people cared what had happened to her; and she had somewhere to turn later as needed.

All these years after the Denver Triage Study, I can’t help but wonder if the simple dignity and humanity of someone reaching out after violence can lessen the alienation that survivors feel. And in turn, help them cope and heal in the aftermath of violence.

Reference
McIlveen, R., Mitchell, R., Curran, D., Kyer, K., Corry, M., DePrince, A.P., Dorahy, M. & Hanna, D. (advance online, November 2019). Exploring the relationship between alienation appraisals, trauma, posttraumatic stress and depression. Psychological Trauma: Theory, Research, Practice, and Policy. http://dx.doi.org/10.1037/tra0000523