Written by Megan Bronson RN, MSN, CS on August 20, 2019
Many adults burned as children feel that a part of them never came back, referring to the feeling of loss of self and emotional numbness that occurs when trauma and traumatic loss are not resolved. To go on with life, the child buries the trauma and moves on, appearing resilient and unaffected, while in reality the effects of the unprocessed trauma and loss are deeply affecting their lives.
Dissociation refers to cutting off one’s feelings, perceptions, and memories of the event. Younger children will most often use a dissociative response in an attempt to cope with the overwhelming experience of trauma. Unresolved and unprocessed trauma and loss negatively affect the ability to be happy, intimate, trusting, and spontaneous in life.
Unresolved trauma and traumatic loss often present as one or more of the following:
Obsessive thinking and compulsive behaviors
Substance abuse and dependence
Problems with intimacy and relationships in general
Illnesses affecting mind and body
Aggression, hostility, irritability, controlling
Burn Trauma and Coping Ability
Burn trauma overwhelms the coping ability of strong and functional adults and children, whose ability to process and integrate traumatic feelings and events is not yet fully developed.
The most overwhelming emotions related to traumatic events are fear and a sense of helplessness. Because children often experience the painful and intrusive treatment of a burn injury as still being in danger, the overwhelming coping ability goes on for sometime after the initial burn injury. The necessary yet painful and frightening treatment prolongs the extreme stress a child must endure. Children may also interpret the necessary dressing changes, tubing, and debridement as punishment, further confusing their perception.
The Foundation of Psychological Development
The development of the human personality and psychology is similar to the building of a house. In the building of a house, the care with which the foundation is laid will determine the solidness and the structural strength of the completed house. All parts of the house rest on the foundation, just as all parts of the personality are built on the sequential developmental stages of childhood.
Inadequate or incomplete achievement of developmental tasks often occurs after trauma. It is essential to consider the developmental stage the person was in when the burn injury occurred.
Erik Erickson, author of Childhood and Society, described a model of development in which each developmental stage of childhood builds upon the previous one in the psychosocial development of the child. Each stage presents a challenge to the child, and how well that challenge is mastered will determine how fully the child is able to progress to the next developmental stage. Failure to accomplish the developmental task of one stage therefore affects all subsequent stages.
The following are the developmental stages and the tasks of each of these stages as described by Erickson:
Age: First year;
Developmental Conflict: Basic trust vs. mistrust;
Developmental Task: Hope and trust;
Failure to Achieve: Fear, pessimism, difficulties with trust
Age: 2–4 years;
Developmental Conflict: Autonomy vs. shame and doubt;
Developmental Task: Self esteem, sense of control, ability to exercise restraint;
Failure to Achieve: Loss of a sense of control, feeling out of control
Age: 4–5 years;
Developmental Conflict: Initiative vs. guilt;
Developmental Task: To initiate one’s own direction, sense of purpose, and direction;
Failure to Achieve: Fear of punishment, overcompensating by showing off
Age: 6–11 years;
Developmental Conflict: Industry vs. inferiority;
Developmental Task: Intellectual, social, physical competence;
Failure to Achieve: Sense of inadequacy and inferiority
Age: Adolescent 12-14 years;
Developmental Conflict: Identity vs. role confusion;
Developmental Task: Relationships with peers, search for identity;
Failure to Achieve: Role confusion
Age: Young Adult 15-17 years;
Developmental Conflict: Intimacy vs. isolation;
Developmental Task: Ability to form satisfying and long-standing attachments;
Failure to Achieve: Loneliness and isolation
Trauma disrupts the mastery of these developmental tasks. Many burn centers now recognize the importance of considering the developmental stage of the child and incorporate interventions that decrease the impact of the prolonged stress of acute burn treatment on the developing child.
Fear Trapped in Trauma
In my experience working with people who have suffered extreme traumatic events, such as burn injury, one of the most common problems with healing trauma is finding a way to process the fear trapped in the trauma. It is this trapped fear that is at the root of post-traumatic stress symptoms.
In Too Scared to Cry: How Trauma Effects Children and Ultimately Us All, Lenore Terr, MD, describes the following fears that are common in children after trauma:
Fear of another more frightening event
Fear of separation
Fear of death
Fear of helplessness
Often, unresolved fear unconsciously drives a trauma survivor’s life. The resolution of fear is therefore essential to recovery and healing. Journaling, support groups, and peer support, such as Phoenix SOAR, are helpful places to process unresolved feelings. It can also be helpful to find an individual counselor who has experience and training in helping survivors of trauma and traumatic loss to assist in this process or healing and recovery.
Moving Out of Fear
Adults burned as children can use Erickson’s developmental model to identify the effect that their burn injury had on their own developmental process. Once identified, they can begin to work on renegotiating and mastering these developmental stages.
The overriding goal of processing trauma based fear is to move out of the fear and on with life. Taking a class, taking the risk to make a new friendship, letting go of what cannot be changed, and embracing life—all of these contribute to moving out of survival mode and into life and living.
Dise-Lewis, J. (May/June 2001). A Developmental Perspective on Psychological Principles of Burn Care. Journal of Burn Care and Rehabilitation, 22:255–260.
Erickson, E. (1963). Childhood and Society. New York, London: WW. Norton and Company.
Terr, L.C. (1990). Too Scared to Cry: How Trauma Effects Children and Ultimately Us All. New York: Harper Collins.
Megan Bronson RN, MSN, CS, is a registered nurse and psychotherapist, specializing in grief, trauma, and traumatic loss. She is a frequent presenter at World Burn Congress and is on the professional advisory board of The Phoenix Society.