Trauma and Depression1

In his introduction, the moderator said that past trauma may predispose to depression, suicidal behavior, and substance abuse. Dysregulation, fragile self-esteem, somatization, and internalized aggression frequently occur after trauma. Mania, delinquency and antisocial behavior may mask depression. Traumatic loss of nurturing, protecting objects may lead to depression with helplessness and extreme pessimism.

Object loss, especially where the relationship has been ambivalent, often results in depression, especially in parental loss in childhood. Having suffered a tremendous blow to narcissism and self-esteem, the child is unable to effectively mourn. Depression in childhood may appear in derivative form in being overly serious, clinging, being a ‘cry baby’ or in somatic disturbance like eating disorders and insomnia. In children, such loss may arrest development at the time and level of the experience. Adult depression following trauma is primarily characterized by sadness and grief, helplessness and hopelessness depending on the severity of the loss.

Sudden loss of a significant other or part of the self may be more traumatic since there has been no preparation, no time for anticipatory defense and mourning.

There is no trauma without loss, and no loss that is not potentially traumatic. Traumatic self or object loss impairs the sense of trust, safety, self-confidence, and self-reliance. The primary affect of trauma is anxiety, the primary affect of object loss is depression, but, clinically, the affects of loss and trauma often coalesce. There is usually a fantasy reunion with, as well as resentment toward, the lost object for no longer being available. Severe bodily damage and multiple object loss as in a train wreck or war may lead to a shattered self, and traumatic ego damage. Depression follows from aggregate losses of self, object, and the former object world and supportive social structure.

Caroline Garland said that, when there has been a clear external traumatic