Category Archives: Ptsd/cptsd Articles

Symptoms Of Dissociation : Mild And Severe

symptoms of dissociation

If we have suffered significant childhood trauma, we may, as adults, frequently find ourselves in various states of dissociation, ranging from mild to severe. Indeed, dissociation is a key feature of complex posttraumatic stress disorder (Cptsd).

What Is Meant By The Term ‘Dissociation’?

Dissociation is a symptom of the effects of childhood trauma which we developed as a defense mechanism in order to better equip us to cope with the emotionally painful and destructive environment in which we grew up. It is a way of mentally escaping and psychologically cutting off from reality; it is sometimes colloquially referred to as ‘zoning out’ or ‘tuning out’.

Dissociation And Flooding :

We are particularly likely to dissociate when we feel overwhelmed, or ‘flooded’, by stress and psychological threat. Symptoms of dissociation can range from mild to severe. I outline examples of such symptoms below:

symptoms of dissociation

Mild symptoms include:

– feeling in a daze (sometimes referred to as ‘mind fog’),

– feeling utterly exhausted, numb and soporific for no obvious reason,

– finding oneself tongue-tied when trying to talk about difficult experiences (as if experiencing a kind of mental block).

 

More severe symptoms include:

– amnesia for certain events, or large periods of time, in one’s life (for example, I have no memory whatsoever of large chunks of my childhood) – such ‘dissociative amnesia’ far exceeds normal forgetfulness.

time loss : an individual may suddenly find him/herself in a particular place, with no memory of how s/he got there, unable to remember anything that has occurred in the recent past (eg the last few hours or days)

feeling very out of control (eg uncontrollably angry)

– periods of apparent deafness (at my first school, when things were at their worst at home between my parents, at times I did not respond to my name being called out in class – the school thought I was suffering from deafness; in fact, though, the cause was deep psychological trauma. This is certain as it became apparent this ‘deafness’ only occurred when the class was discussing parents/family matters or associated topics).

symptoms of association

 

Dissociation And Switching:

Some people dissociate when under extreme stress (ie when ‘flooded’, see above) in a way that almost resembles ‘changing personality’; this is referred to as ‘switching’.

In fact, it is NOT a literal switch of personality, but a switch of ego states/states of consciousness sometimes referred to by psychologists as ‘parts’ or ‘alters.’

Studies suggest that nearly all people who suffer such switching have experienced severe early life trauma. It is NOT a genetic disorder.

When a person switches due to stress, they switch from the ego state/state of consciousness/part/alter that s/he relies on for his/her day-to-day functioning to the ego state/state of consciousness/part/alter that is normally dissociated/’kept in a separate compartment’ in mind (it is this separation that allows the individual to function daily, by preventing the feelings in the dissociated part from interfering in it).

This dissociated part contains profoundly painful trauma related feelings such as fear, shame and anger.

 

Can dissociation be treated?

The short answer is, YES.

Individuals can be helped by becoming aware of the link between their childhood trauma and the dissociated part of their mind that they switch to when under severe stress.

As well as this, individuals suffering from dissociation can be enormously helped by learning the skills of mindfulness. Mindfulness, essentially, helps a person to live in the present/the ‘here and now’, rather than staying trapped in the past.

RESOURCES :

Excellent site about MINDFULNESS – mindfulness.org

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childhood trauma and homosexuality

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2017 Child Abuse, Trauma and Recovery

Complex Trauma : Some Important, Lesser Known Facts

Complex trauma facts

Complex Trauma : Lesser Known, Important Facts.

  • The majority of individuals who come into contact with mental health services have a history of complex trauma (Bloom, 2011)
  • The ‘Adverse Childhood Experiences‘ (ACE) study found that on a daily basis GPs see patients who are suffering from the effects of complex trauma but do not realize that this is the fundamental problem; instead, the patient is diagnosed according to the particular symptom (such as anxiety or addiction) presenting at the time of the consultation. Because of this, the root problem often remains unaddressed.
  • Complex-PTSD is more common than ‘ordinary’/single incident PTSD and its effects more wide-ranging.

Complex trauma

  • Whilst complex-PTSD is closely linked to the sufferer’s having experienced some form of child abuse (emotional, sexual or physical) it also occurs when a parent/parents/primary carers are in some way inadequate or deficient due to trauma they themselves experienced as children that remains unresolved. In this way, the ill-effects of childhood trauma can be constantly passed on from generation to generation. So, for example, the abuse a child suffers may stem from the abuse his/her grandfather suffered at the hands of his’/her (the same child’s) great-grandfather.
  • Medical Trauma – even routine operations and surgeries can traumatize the child, especially if they involve immobilization or anesthesia (Levine, 2010)
  • Hypoarousal – this is essentially the opposite of hyperarousal and occurs as a psychological defense mechanism in response to extreme ongoing stress/ trauma – it involves what might colloquially be called an emotional shutdown, or, more technically,’dissociation‘.  Unfortunately, GPs may mistakenly diagnose such a condition as depression (Rothschild, 2011) [TO READ MY ARTICLE : 2 OPPOSITE WAYS THE CHILD RESPONDS TO STRESS : HYPERAROUSAL AND DISSOCIATION, CLICK HERE]’
  • Inability to ‘move on’ – some individuals, suffering from the effects of complex trauma, are told by others that they should ‘just move on’ with their lives. However, this ‘advice’ (though it is usually more of a criticism) is based upon a failure to understand that a person cannot simply ‘move on’ from trauma until the trauma has been resolved. Indeed, invalidating or undermining the effect of the traumatized individual’s traumatic experiences is highly likely to compound his/her suffering.
  • To end on an optimistic note : even though the development of the child’s brain may be adversely affected by the experience of complex trauma (eg the development of the amygdala), the fact that the brain has a property known as neuroplasticity means such individuals can still be optimistic about their prospects of recovery.

RESOURCES :

Complex traumaComplex trauma

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Signs Of Recovery From Complex-PTSD

According to Peter Levine, an expert on the adverse effects of childhood trauma on our adult lives and the complex post traumatic stress disorder that can result, typically there develops various signs in victims that may indicate the recovery process is underway. The main signs of recovery that Levine identifies are as follows :

1) A REDUCTION IN THE NUMBER, AND INTENSITY, OF EMOTIONAL FLASHBACKS THAT WE EXPERIENCE (an emotional flashback is when an event occurs in our lives that triggers similar painful emotions to those we experienced as a child in relation to our traumatic experiences – such flashbacks may result in regressive behaviour such as extreme, uncontrollable, childlike tantrums. For example, if we had a cold and rejecting father who was always denigrating us, we may over-react when we are criticized by our boss at work).

2) WE BECOME LESS SELF-CRITICAL (those who have suffered childhood trauma very frequently, and erroneously, blame themselves for their terrible childhood experiences and/or internalize the negative view parents/primary carers had of them when they were children – to read my article on how a child can falsely come to see him/herself as ‘bad’ and how this inaccurate self-view may be perpetuated, click here).

3) WE BECOME LESS ‘CATASTROPHIZING’ (many who suffer childhood trauma develop into adults prone to extremes of negative thinking, often referred to as cognitive processing errors.’ One such cognitive processing error is that we may be prone to ‘catastrophizing’ which means we tend to always expect the worst and to interpret situations in their worst possible light. Often, too, we attribute the worst possible intentions and motivations to the behaviour of others. As we begin to recover, this tendency diminishes).

4) WE START TO FIND IT EASIER TO RELAX (one of the worst aspects of my illness was a perpetual, tormenting feeling of the most intense agitation making anything even vaguely approaching relaxation utterly impossible, every medication was tried – and failed; even electro-convulsive shock therapy (ECT) was tried on several different occasions over the years – again, utter failure. When we finally do start to recover, however, the ability to relax gradually returns).

5) WE BECOME LESS DEPENDENT UPON OUR LEARNED DEFENSE MECHANISMS (it is very common for those of us who have experienced childhood trauma to develop into adults who feel very vulnerable to being hurt or exploited by others if we ourselves were hurt and exploited by our parent/s or primary-carer/s during our early lives. In order to protect ourselves, we may have unconsciously learned to develop certain defense mechanisms such as aggression  or avoidance. As we recover, however, we find we become less reliant on these psychological defenses, according to Levine.

6) OUR RELATIONSHIPS WITH OTHERS START TO IMPROVE AND WE BECOME LESS INTIMIDATED BY SOCIAL SITUATIONS (another common outcome of significant childhood trauma is that we can find, in adulthood, that we are quite inept when it comes to forming and maintaining relationships with others. We may, too, find social situations very intimidating, and, even, develop social phobia. A sign of recovery, however, is an easing of such interpersonal difficulties).

 

FOUR MAIN STEPS ALONG THE ROAD TO RECOVERY :

Levine states that the main steps to recovery are as follows :

1) PSYCHOEDUCATION

2) REDUCING SELF-CRITICISM

3) GRIEVING FOR OUR CHILDHOOD LOSSES

4) ADDRESSING ‘ABANDONMENT DEPRESSION’

Let’s look at each of these in turn :

1) The first step, according to Levine, is psycheducation (which is sometimes referred to as ‘bibliotherapy‘. This involves learning about our psychological condition and becoming aware of how it is linked to our adverse childhood experiences. Levine also emphasizes the usefulness of learning about mindfulness).

2) The second step is to, in Levine’s phrase, ‘shrink our inner critic.’  In other words, we need to gradually learn how to stop taking such a negative view of ourselves and of everything we do – one effective therapy which can help us to achieve this is cognitive behavioural therapy (CBT). (To read my related article, entitled :‘How The Child’s View Of Their Own ‘Badness’ Is Perpetuated’, click here).

3) The third step, says Levine, is to grieve for our childhood losses. These losses may include our missing out on feelings of safety, security, simple childhood happiness and a care-free state of mind as well as a loss of any self-esteem we may have once had. To read my article about coming to terms with childhood losses, click here). Levine suggests that this process may take up to two years.

4) The final step is to address what Levine calls the core issue, namely our ‘abandonment depression.’ An important part of this step is also to learn how to be self-compassionate. (To read my article about abandonment issues which may we may develop as a result of childhood trauma, click here).

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Crying Helps Re-Engagement With Authentic Feelings

As a child, even well into my teens, I cried extremely frequently. Usually this was alone at home, but, on occasion, at my prep school (which I attended until I was eleven) I was removed from the class for crying (there was little compassion on offer from the teachers) when I was particularly upset about what was going on at home.

Once, even, to my acute embarrassment and shame (at the time), I started to cry (or quietly whimper) in a second year (now it would be called Year Eight)  English class at my secondary school when I was about thirteen, desperately trying to conceal this inconvenient outburst of emotion from both my teacher and classmates.

Also, at about fifteen years of age, I once even rushed upstairs at home after one of my frequent arguments with my family and shut myself in my bedroom wardrobe where I stubbornly and emphatically insisted upon remaining (not that anyone encouraged me to come out), sobbing copiously, for a not inconsiderable period of time. It is quite clear to me, and, presumably, will be to the reader, too, that my emotional development had been arrested at a much younger age.

William Wordsworth, in his poem ‘Ode : Intimations Of Immortality From Reflections On Early Childhood‘, refers to ‘thoughts  that  often lie too deep for tears‘ and, when one is especially afflicted by profound depression and/or traumatized, this line of poetry is often most apposite  – one simply becomes numbed and internally deadened by the sheer intensity of one’s chronic and unrelenting mental suffering. In such a condition, as a psychological defense, all feelings and emotions shut down ; however desperately one wants to cry, one is unable to do so.

Something deep in our soul is blocked or frozen.

Being Finally Able To Cry Can Be A Breakthrough Moment In The Process Of Recovery :

The psychotherapist, Pete Walker, in his excellent book entitled : Complex Trauma – From Surviving To Thriving, explains how finally being able to cry after a long period of emotional numbness (emotional numbness is a key feature of complex post traumatic stress disorder) can signify a major turning point in the recovery process, marking our re-engagement with our long suppressed feelings.

Relevant Research :

There also exists a body of research supporting the idea that crying is beneficial. For example, the biochemist, W. Frey, reports that crying helps to rid the body of chemicals that are produced by stress and, therefore, when we cry, by lowering the concentration of these chemicals within our biological system, we reduce our stress levels ; this not only makes us feel better mentally but also has physical benefits (for example, by lowering our blood pressure).

Also, research carried out by Gracanin et al at the University of  Tilburg in the Netherlands supports the idea that crying can improve mood.

Conclusion :

Unfortunately, males in our society are often discouraged from crying on the erroneous grounds that it is ‘weak’ or ‘unmanly’. In fact, though, crying can be of immense therapeutic value, particularly when one has been feeling emotionally ‘dead inside’ for a long period of time due to having experienced severe trauma.

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

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Prolonged Exposure Therapy And Posttraumatic Stress Disorder (PTSD)

Major symptom of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (cPTSD)click here to read about the difference between these two conditions – are fear, anxiety and even terror induced by :

– situations related to the traumatic experience

– people related to the traumatic experience

– places related to the traumatic experience

– activities related to the traumatic experience

Prolonged Exposure Therapy Involves Two Specific Types Of Exposure To Trauma-Related Phenomena :

a) In Vivo Exposure

b) Imaginal Exposure

In Vivo Exposure :

Prolonged exposure therapy works by encouraging the individual with PTSD / cPTSD, in a supportive manner, very gradually, to confront these situations / people / places / activities whilst, at the same time, feeling safe, secure and calm. Because this part of the therapy involves exposure to ‘real life’ situations / people / places / activities it is called in vivo exposure.

This is so important because avoiding these situations / people / places / activities, whilst reducing the individual’s anxiety in the short-term, in the longer-term simply perpetuates, and, potentially, intensifies, his/her fear of these things.

Imaginal Exposure:

The therapy also involves the PTSD / cPTSD sufferer talking over details and memories of the traumatic experience in a safe environment and whilst in a relaxed frame of mind (the therapist can help to induce a relaxed frame of mind by teaching the patient/client breathing exercises and/or physical relaxation techniques; hypnosis can also be used to help induce a state of relaxation). Because this part of the therapy ‘only’ involves mental exposure to the trauma (i.e. thinking about it in one’s mind), it is called imaginal exposure and can help alleviate intense emotions connected to the original trauma (e.g. fear and anger).

Both in vivo and imaginal exposure to the trauma-related stimuli are forms of desensitizing and habituating the patient / client to them, thus reducing his/her symptoms of PTSD / cPTSD.

How Effective Is Prolonged Exposure Therapy?

Prolonged exposure therapy is a type of cognitive behavioural therapy (CBT) and research into the treatment of PTSD suggests it is the most effective treatment currently available.

What Is The Duration Of The Treatment?

The length of time a patient / client spends in treatment varies in accordance with his/her needs and his/her therapist’s particular approach. However, the usual duration of the treatment is between two and four months, comprising weekly sessions of approximately ninety minutes each.

On top of this, the patient / client will need to undertake some therapeutic exercises/activities in his/her own time, set by the therapist as ‘ homework assignments’. These assignments will include listening to recordings of imaginal exposure therapy sessions.

RESOURCES :

The National Center For PTSD has developed a PROLONGED EXPOSURE APP, or PE APP. Click here for further information and download instructions.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

 

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Why Is Physical Illness More Common In PTSD Sufferers?

If we have suffered from significant childhood trauma leading to the development of post traumatic stress disorder (PTSD) in our adult lives this also puts us at increased risk of developing various unpleasant physical symptoms. This is because the trauma has had chemical effects in our brain (leading to our PTSD) which can have knock-on adverse effects upon our body. I provide examples of the kind of symptoms that may result below :

SYMPTOMS :

  • increased rate of heartbeat
  • stomach / digestive problems
  • rapid and shallow breathing (often referred to as hyperventilation)
  • shaking / trembling / tremors / localized muscle spasms
  • feeling faint / light-headedness
  • sweating

DISEASES AND DISORDERS :

A positive correlation exists between the incidence of post traumatic stress disorder (PTSD) in a population and the incidence of certain physical diseases and disorders (shown below) in that same population. However, further research needs to be conducted in order to ascertain whether having post traumatic stress disorder (PTSD) increases one’s risk of suffering these conditions or whether having such conditions makes one more vulnerable to developing post traumatic stress disorder (PTSD).

Some of the diseases and disorders associated with PTSD are as follows :

  • cardiovascular disease
  • increased probability of suffering from heart attacks
  • IBS (irritable bowel syndrome)
  • headaches
  • certain autoimmune disorders (eg those causing problems with the skin)
  • pregnancy complications
  • miscarriage
  • preterm contractions
  • obesity

 

Above : PTSD physically, biologically and chemically alters the brain – these changes may lead to physical symptoms, diseases and disorders in some sufferers, on top of the immense psychological pain and suffering it causes all who are unfortunate enough to have the condition.

 

Why Do Such Links Between PTSD And These Disorders Exist?

Various theories have been put forward in an attempt to explain why such links between PTSD and physical disorders such as those listed above exist.

  1. Increases in stress hormones such as cortisol over time have an adverse physical effect upon the heart and cardiovascular system.
  2. PTSD can lead to unhealthy ways of trying to cope with mental pain and suffering such as excessive drinking, excessive smoking and the ingestion of dangerous narcotics and overeating (so-called ‘comfort eating’) all of which, in turn, can lead to declining physical health.
  3. PTSD sufferers tend also to be seriously depressed and therefore lethargic – this can mean that PTSD sufferers take very little physical exercise leading to a greater likelihood of developing physical health problems.
  4. PTSD causes a change in the balance of chemicals in the brain and these changes, in turn, may cause yet further changes adversely affecting the immune system and various bodily organs.
  5. Changes in certain chemicals that negatively affect the mind also adversely affect the stomach.

 

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David Hosier BSc Hons; MSC; PGDE(FAHE).

 

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Complex – PTSD : Why Is It Becoming More Common?

We have seen from numerous other articles that I have published on this site that severe and prolonged childhood trauma can lead to the development of complex post traumatic stress disorder, or complex-PTSD, in adulthood (to learn about the difference between post traumatic stress disorder [PTSD] and complex post traumatic stress disorder [Complex-PTSD] read my previously published article here).

And the incidence of CPTSD is increasing. What are the possible reasons for this increase in the prevalence of this very serious psychiatric disorder?

First, it is possible that as the general population and clinicians become more aware of the existence of the disorder and its link to childhood trauma it is becoming increasingly reported and diagnosed. However, there are several other possible explanations and I examine these briefly below :

POSSIBLE REASONS FOR THE INCREASE IN PREVALENCE OF COMPLEX POST TRAUMATIC STRESS DISORDER (CPTSD) :

1) Growing up in unstable environments :

More and more young people are growing up in unstable environments. Increasing rates of divorce and separation means that a higher and higher number of children and adolescents are growing up in single parent households (to read my article about the possible effects of divorce upon the child, click here).

2) Reduction in social support systems :

Research shows that a lack of social support makes individuals much more vulnerable to the adverse effects of stress. And, today, children tend to have less access to others who could provide them with emotional support than has been the case in the past due to, for example :

  • communities that are not as close-knit as in the past
  • less contact with wider family (eg aunts, uncles, grandparents) than in the past as wider family members are becoming more geographically dispersed than in past

3) Increase in number of working mothers :

This can lead to infants having inconsistent early care as they me be shuttled around from day-care to nursery care to babysitters and so on possibly leading to a variation in quality of care and less opportunity for the infant to develop his/her bond with the mother

4) Parental preoccupation with their careers :

In a ‘go-getting’ society, in which status and wealth are of fundamental importance to many people, individuals are becoming very driven, even obsessively driven, in connection with their careers, sometimes leading to workaholism; this leaves such persons with less time to interact in any really meaningful way with their offspring or leads to such exhaustion that they simply do not have enough energy left over for such meaningful interactions.

5) Unhelpful effects of media :

Young people are becoming increasingly obsessed with media, such as computer games and so on, which leaves them with less time for psychologically nourishing face-to-face interaction with friends and family.

6) Unhelpful effects of living in  consumer society :

Society has become increasingly obsessed with acquiring consumer goods and the accumulation of these is often linked in people’s minds to their ‘status’ and ‘worth as a human being.‘ Such attitudes may lead young people to develop false values which in turn may aggravate psychological problems.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Vital Environmental Factors That Can Prevent Recovery From PTSD And BPD

secondary victimization

If, as a result of childhood trauma, we have developed post traumatic stress disorder (PTSD) or borderline personality disorder (BPD) our post-traumatic environment can have an extremely strong impact upon our chances of recovery. I list some particularly important factors below :

  • LACK OF SUPPORT FROM FRIENDS, FAMILY AND THE WIDER COMMUNITY / SOCIETY

If we are not provided with such support, but, instead, are shunned and ignored, it is highly likely that our feelings of worthlessness, vulnerability and isolation will be intensified.

Support needs to be non-judgmental, empathic and validating both of our emotional pain and also of our interpretation of how our adverse experiences have affected us.

Also, those providing the support need to be ’emotionally literate’ (i.e. able and willing to discuss feelings and emotions in a compassionate and understanding manner)

  • NOT BEING BELIEVED

Obviously, if people we talk to about our traumatic experiences don’t believe what we are saying or believe we are exaggerating the seriousness of what happened to us (or the seriousness of the effect it has had upon us) our psychological condition is likely to be severely aggravated : our lack of self-esteem, sense of despair, sense of worthlessness, sense of unlovability, feelings of isolation and any feelings of anger, bitterness and resentment we may have are all likely to be severely intensified.

  •  SECONDARY VICTIMIZATION

We need to avoid those who would cause us secondary victimization. Secondary victimization occurs when those who ought to be helping us instead harm us further. Indeed, the example of not being believed (see above) is one such form of secondary victimization.

Other examples of secondary victimization include :

having a doctor who minimizes / trivializes the seriousness of what has occurred to us and its effects

– being stigmatized by society for having developed a psychiatric condition

– being shunned and ostracized by friends / family due to our condition

– being made to feel ashamed in connection with what has happened to us and its effects

– having the vulnerable nature we have developed as a result of our mental condition exploited by an intimate partner (the risk of this is especially high as those who have suffered significant abuse in their early lives are frequently (on an unconscious level) driven to seek out intimate partners who are likely to abuse them further (this is sometimes referred to as a repetition compulsion).

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

 

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