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Flattery to the Rescue

by Haley Herbert

art by Yixin Jia



Fight, Flight, Freeze, Fawn?

Picture this: you are out hiking in the woods with your friends when, suddenly, a bear stops you in your tracks. What would your initial reaction be? Do you run, fight back, or find yourself frozen in place? When in immediate danger, many people are aware of the three key reactions: fight, flight, and freeze. The basic fight or flight reaction consists of the urge to fight back or flee in response to a threat. Freezing occurs when a person’s reaction is to remain in place. All of these reactions have complex neurobiological bases rooted in early survival mechanisms. But what happens when these systems are altered in some way? The fawn response is the tendency to use social appeasement as a means to minimize risk. When aggression or flight are not viable solutions, fawning can be used to maximize chances of survival. Fawning, in comparison to the other threat responses, may be a learned reaction following trauma.


Disrupting the Norm: Fear Responses After Trauma

Fight, flight, and freeze reactions are easier to distinguish when discussing an immediate threat to safety or connectedness, like our hiking example. However, there are many scenarios where these basic reactions can go awry. For instance, repeated traumatic experiences put individuals at risk for dysregulation of the threat response systems.

For diagnosing mental health disorders, including those encompassing trauma, the United States typically uses the Di - agnostic and Statistical Manual (DSM), currently in its fifth edition. However, the International Classification of Diseases (ICD), currently in its eleventh edition, is used in other parts of the world [1]. The ICD provides further subclassification for chronic experiences of trauma that the DSM lacks. Because of this, this article focuses on classifications from the ICD rather than the DSM.

These repeated traumatic experiences are connected to a par - ticular diagnosis in the ICD-11: complex PTSD (c-PTSD). Rather than just one traumatic trigger event, c-PTSD is char - acterized by repeated, inescapable traumas [1]. As an example, Sam is a hypothetical child who has undergone extensive childhood maltreatment, including abuse and neglect. Because of their background and their current lived experiences, Sam has been diagnosed by a licensed therapist with c-PTSD. Sam fits all of the basic criteria for c-PTSD, including reliving the emotional experiences of trauma. These symptoms manifest as chronic nightmares, avoidance symptoms, such as feeling dis - connected from their peers, and hyperarousal or increased sensitivity to loud noises and startles. They often feel numb or irritable, which is indicative of affect dysregulation. Sam also has a negative self-concept, disclosing to their therapist that they feel a great sense of shame about their childhood and often feel worthless. Lastly, they have difficulty trusting people when making new friends, creating interpersonal difficulties in their life. Affect dysregulation, negative self-concept, and difficulty in relationships are three key diagnostic symptoms of c-PTSD, leading to Sam’s diagnosis [1].

c-PTSD manifests as a result of atypical fear response symptoms [2]. Hyperarousal symptoms include experiences such as difficulty sleeping and concentrating, irritability, and hypervigilance, or a greater awareness of and reaction to fear-inducing stimuli. Hypervigilance can be thought of as an overactivation of the fight/flight systems, where people with c-PTSD are hyper-responsive and aware of incoming stimuli [2]. Repeatedly activating the threat response network leads to heightened reactivity within the brain’s fear response network. Thus, the neural system becomes overly responsive to threats in order to detect and manage events similar to those that created the original traumas.

In c-PTSD, the threat response system is in overdrive. When presented with an everyday startle, such as a loud noise, Sam’s response may be dramatic and pronounced. This increased sensitivity is also linked with emotional dysregulation, such as the irritability that Sam is experiencing [3]. Ultimately, traumatic experiences alter threat response systems.


What is Fawning?

Although the fight, flight, and freeze response systems encompass bodily reactions, recent research has explored a framework involving social interaction. Fawning is the use of social appeasement mechanisms to de-escalate a situation [4]. People who fawn are attempting to establish a sense of safety by mirroring what is expected and desired of them. While many people naturally engage in people-pleasing mechanisms, fawning occurs when a person feels a sense of danger [4]. While a person might feel the need to appease someone that they’re close with during an everyday conversation about favorite television shows, musical artists, or even mutual friends, this would not be considered fawning because there is no perceived threat. Appeasement is a de-escalation process in which a trapped victim under serious threat attempts to socially appease their abusers [4]. This mechanism is used in situations where hostile defense and aggression—reactions we typically associate with fight/ flight reactions—would be impossible or unbeneficial. In these situations, victims have essentially been forced to accept their situation but are, sometimes involuntarily, attempting to minimize their risk [5]. Fawning can range from lower-scale cognitive mechanisms such as feeling genuine fear and submission toward dominant individuals and reacting accordingly to more complex and conscious cognitive processes to feign submission [5].

Fawning often presents in those who have experienced interpersonal trauma. Chronic interpersonal trauma may result in a dysfunctional framework of relationships, especially when this trauma occurs during key developmental years [6]. Let’s return to our earlier example of Sam, a hypothetical child who has experienced chronic maltreatment. When in active danger, Sam may attempt to fawn or “appease” their caregivers to minimize the abuse that they experience. Even years after the developmental abuse has occurred, appeasement has been found as a reaction among abuse victims [6]. Fawning may be critical to understanding how people who have experienced chronic interpersonal trauma are able to get through these situations and why these reactions may persist once the threat is gone.


Neurobiology of Fight/Flight/Freeze

Each of these reactions can be considered an innate survival mechanism. Many different models have been proposed to understand the neural bases of these threat responses. The polyvagal theory posits that there is a fundamental drive for a sense of safety and that the nervous system has a cascaded, hierarchical system to achieve it, which is largely centered around the vagus nerve [7]. The vagus nerve is the largest of the nerves that pass through the brain and consists of mostly sensory fibers [7, 8]. The autonomic nervous system (ANS) is a part of the body that carries messages to the brain and spinal cord and controls physiological processes

including heart rate, blood pressure, digestion, and sexual arousal [9]. According to the polyvagal theory, threat reactions can be split into three stages rooted in the development of the ANS and reactions of the vagus nerve that are associated with different behavioral responses [10].

The first of these stages is known as the social communication stage. It is the most developed stage, associated with mammalian development, and is responsible for social engagement [10]. The vagus nerve is connected to other cranial nerves that are largely responsible for facial expression and vocalization, both of which are core components for social engagement [7, 11]. Eventually, mammals evolved to produce a biological coating around their nerves, which increased the speed of signal transmission and facilitated faster social responses via the vagus nerve [7]. It is believed that mammals developed this ability to encourage positive social behaviors, ultimately furthering procreation. The connection between the vagus nerve and components of social responses allows this stage to center around social interactions and feelings of connectedness.

The next stage is known as the mobilization stage. This stage is associated with fight or flight behaviors due to its activation of a subcomponent of the ANS, the sympathetic nervous system, resulting in increased heart rate and metabolic output [10]. This activation promotes mobilization and escape behaviors [7]. In this stage, once a threat is perceived, the body responds by preparing for action. Activating hormones such as adrenaline and noradrenaline are released, which trigger bodily responses like increasing heart rate [12]. Such a response either delivers more oxygen to muscles to increase energy supply or constricts blood vessels to minimize blood loss [12].

The final stage is known as the immobilization stage. This stage is responsible for immobilization behaviors such as freezing or fainting and is considered the most primitive stage [10]. This stage may be responsible for what we consider a “freeze” response, where the body attempts to conserve energy [10]. Evolutionarily, freezing is thought to minimize risk by minimizing detection [13]. In a predator-prey relationship, one can imagine freezing as beneficial in situations where the prey has detected their predator, but the predator is unaware of them. If the prey has not been detected, but they attempt to either flee or fight back, they may be drawing attention to themselves, ultimately increasing risk [13]. Freezing also allows time for an individual to appraise a situation, helping them to understand and evaluate the present threat [13]. Freezing is an organism’s last attempt to achieve safety.

All of these stages work together to facilitate a sense of safety. These responses are ordered in a hierarchy, where higher-level reactions supersede the lower-level reactions [7]. However, when higher levels do not provide a sense of safety, the body returns to lower, more primitive responses [7]. In this way, the stages can be thought of as a ladder. When our safety needs are not met, we start at the bottom of the ladder: the immobilization stage. Once we begin to feel safer, we climb up the ladder to the mobilization stage. Finally, when we feel safe enough, we climb to the top of the ladder: the social communication stage. We remain here until something in our environment shifts our perception of safety. When the mechanisms at the social communication stage fail to keep us safe, we move down to more primitive stages until we can establish this sense of safety. People move back and forth between these stages every day, climbing up and down the ladder depending on their perception of danger at any given point.

While some scientific critiques exist of the specific neural mechanisms behind these reactions, the broader idea of structural cascades is not subjected to these same criticisms and is critical to understanding human responses to threats [7, 14].

Thinking of these self-preservation responses in practice, let’s apply this to a more tangible example. Imagine you are a high schooler having an enthusiastic conversation with your family at the dinner table. Here, you are starting in the social communication stage, feeling socially connected and engaged. All of a sudden, your family brings up your latest report card. You struggled immensely in school this term, and your family is deeply disappointed. Suddenly, your sense of social connection begins to fall away, and you begin to fear punishment. Your heart rate begins to speed up and you start breathing faster. The dinner table no longer feels safe and you are feeling the urge to leave the conversation. Now, you have entered the mobilization stage. Eventually, your parents decide to issue a punishment: a one-week grounding from seeing your friends. Upon hearing the news, you retreat to your room, alone, feeling upset and knowing that you cannot fight back against your parents’ rules. At this point, you have entered the immobilization stage. We move through the three stages of the polyvagal theory every day, consistently assessing stressors and threats and reacting accordingly.


Neurobiology of Fawning

When presented with a threat, the initial response is to fall into the second stage of the polyvagal theory, the mobilization stage associated with fight/flight behaviors. However, in the case of appeasement, similar to freezing, escape is viewed as impossible. Normally, a system would then fall to the third stage, the immobilization stage. However, this is not the case with fawning. In these cases, fawning is considered a special activation strategy where both the fight/flight systems and the social engagement systems are activated. Returning to the ladder example, individuals engaging in a fawn response are caught in between stages, keeping one hand on the rung of social engagement and one foot on the rung of mobilization behaviors. The social engagement system, in these cases, is also responsible for automatically activating the ventral vagus nerve, responsible for key social communication, to turn off fight/flight social cues and appear calm [4].

Let’s return to the example of a high schooler being confronted about bad grades at the dinner table. Instead of our original example, let’s consider Sam, our hypothetical child who has experienced chronic maltreatment. At this point, Sam has been put into an adoptive home. Sam, because of the interpersonal nature of their maltreatment, now engages in a fawn response instead of the standard fight, flight, and freeze responses. Under this framework, we start at the social communication stage. They feel connected to their new family and engaged in social conversation. Then, their family brings up the report card from the previous semester. Instead of immediately entering the fight or flight stage, they balance between the social communication and the mobilization stage. They begin to talk to their adoptive parents, trying to minimize the situation and appease them. Rather than just accepting their responsibility for the situation and moving forward with their conversation, the child tries their best to appease their adoptive parents at the expense of themselves. They do not place boundaries, and overcommit themselves to work beyond reasonable amounts of time in the following semester. They do not feel secure in themselves and do not think that they are good enough. Here, chronic trauma has altered Sam’s response to social interactions that appear as a threat. Sam has engaged in fawning due to the lack of perceived escape and abuse history.

Through the polyvagal theory and the stages that it proposes for social communication and fawning, we can see the potential neurobiological bases of fawning. There are many other scenarios other than Sam’s that could set the stage for fawning reactions. After prolonged dysregulation of the systems responsible for threat response, fawning may be an adaptive response designed to minimize risk using prosocial mechanisms.


Implications for Treatment

There are several problems with the way that c-PTSD is currently treated. As there is not a current diagnostic label in the US for repeated traumatic experiences, c-PTSD is often treated with the same treatment mechanisms as PTSD [15]. Exposure-based treatments include imaginal exposures, where patients are asked to imagine and recount their trauma, eventually resulting in reduced physiological

and mental arousal. Another type of exposure-based treatment is in vivo exposure, where patients are asked to confront distress-inducing stimuli face-toface [15]. Currently, exposure-based treatments are some of the most common treatments for PTSD, including c-PTSD [16]. However, research has shown that those with c-PTSD do not benefit from exposure-based treatments to the same degree as those with PTSD, suggesting that treatments need to be adaptive to the individuals they are meant to serve [16].

A common theory for this phenomenon is thought to arise from the uniquely interpersonal nature of c-PTSD. As a result, a better understanding of the fawn response and appeasement may facilitate better treatment for c-PTSD. Appeasement may be the source of the chronic interpersonal struggles found in some individuals experiencing c-PTSD, making it critical for creating more effective treatment mechanisms [5]. By addressing the fawn response and the interpersonal nature of a patient’s trauma head-on, we could better address many of the interpersonal struggles that those with c-PTSD face. In order for research to be funded and conducted, c-PTSD needs to be recognized as an official diagnosis in the United States. Once this is accomplished, more research needs to be completed on specific mechanisms of appeasement, the fawn response, and its connection to the polyvagal theory, allowing for more effective treatments for c-PTSD.


REFERENCES:

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