Tag Archives: Mental Health

Borderline Personality Disorder – 3 Infographics to Help Explain It.

cropped childhood trauma fact sheet - Borderline Personality Disorder - 3 Infographics to Help Explain It.

The link between the experience of childhood trauma and the later development of borderline personality disorder (BPD) is well established by numerous research studies (click here to read my article on this). The infographic below shows how BPD can affect our behaviour.

The term  AFFECTIVE DYSREGULATION in the table below refers to the great difficulty BPD sufferers have in controlling (or regulating) their emotions (‘affect’ being a word used by psychologists to mean emotions). To read my article on this, click here.

Finally, the word ‘cognitive’ used in the third category of the table below is simply a word used by psychologists to refer to ‘thinking.’

CLICK ON IMAGE TO ENLARGE :

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behavioural symptoms of borderline personality disorder

The infographic below gives details of what BPD is, its symptoms, its causes, how it is diagnosed and how it is treated. Click here to view an excellent documentary on BPD.

CLICK ON IMAGE TO ENLARGE :

imagescabkhrev - Borderline Personality Disorder - 3 Infographics to Help Explain It.

diagram explaining borderline personality disorder

The infographic below shows the chances during their lifetime of a BPD sufferer developing ‘comorbidities’. A comorbidity is a medical condition associated with another condition. For example, the table shows that of those who suffer BPD, 88% will also suffer from anxiety disorder (one of the comorbidities of BPD) during their lifetime.

CLICK ON IMAGE TO ENLARGE :

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comorbidities of borderline personality disorder

 

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

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Copyright 2013 Child Abuse, Trauma and Recovery

Defining Emotional Abuse

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emotional abuse

Different researchers tend to define emotional abuse, or, as it is referred to in the USA, ‘psychological maltreatment’ in different ways. The difficulties with precise definition arise from the fact that several variables need to be considered – including philosophical, scientific, cultural, political and legal factors (Hart et al., 2002).

For example, some researchers differentiate between emotional ABUSE and emotional NEGLECT. Also, whilst some researchers focus upon the ACTIONS OF THE PERPETRATOR  (it should be pointed out that ‘actions’ in this context refer to both acts of COMMISSION and acts of OMMISSION – or, to put it another way, both upon what the perpetrator does and FAILS TO DO), others focus more upon THE EFFECTS UPON THE CHILD. A third complicating factor is that there is often a significant delay between the abuse itself and the disturbed behaviour which results from that abuse.

In the USA, emotional abuse (or ‘psychological maltreatment’) is most frequently, formally defined in the following way :

A repeated pattern of caregiver behaviour or extreme incidents that convey to the children that they are worthless, flawed, unloved, unwanted, endangered or only of value in meeting the needs of another. It includes :

   – spurning

   – terrorizing

   – isolating

   – exploiting/corrupting

   – denying emotional responsiveness

   – neglecting mental health, medical needs and education

The above is the definition is from The American Professional Society on Abuse of Children (APSAC), 1995

Let’s look at what is meant by each of the six items on the above list.

1) SPURNING – this may be verbal or non-verbal and includes belittling, shaming or ridiculing the child, generally degrading him/her or rejecting/abandoning him/her

2) TERRORIZING – this includes placing the child in danger, threatening him/her or generally creating a climate of fear

3) ISOLATING – this can involve placing severe restrictions on the child, preventing developmentally appropriate social interaction and/or separating the child from the rest of the family.

4) EXPLOITING/CORRUPTING – this includes encouraging the child to develop in inappropriate and/or antisocial behaviours and values, such as stealing, abusing others physically or verbally, breaking into houses etc.

5) DENYING EMOTIONAL RESPONSIVENESS – this involves being emotionally unavailable, ignoring the child, failing to express affection, and becoming distant physically and emotionally

6) NEGLECTING MENTAL HEALTH, MEDICAL NEEDS AND EDUCATION – this involves failing to provide and attend to the psychological, medical, cognitive and mental needs of the child.

(1-6 above from Dorosa Iwaniec, 2006)

I hope you have found this post useful. I will continue to look at emotional abuse in later posts.

Best wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).

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Childhood Trauma and Obsessive-Compulsive Disorder (OCD) Treatment

 

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STOP OBSESSIVE THOUGHTS – CLICK IMAGE ABOVE

In the last 2 posts on this condition I explained what OCD is. In this post, Part 3, I want to consider how it may be treated.

WHAT TREATMENTS ARE NORMALLY GIVEN?

Experts in the field of the treatment of OCD generally recommend cognitive-behavioural therapy (CBT) which is made even more effective if it is combined with medication – usually the medication will be an anti-depressant, although sometimes a benzodiazepam may be used.

Generally speaking, the anti-depressant is a long-term treatment, eg given for perhaps a minimum of a year, and up to a whole life-time, even if symptoms significantly improve (this is done in order to minimize the chances of a relapse occurring).

On the other hand, if the individual with OCD is prescribed a benzodiazepam, this will generally only be taken over a short period of time (eg a period when the symptoms are very acute) in order to minimize the risk of the individual with OCD becoming physically and/or psychologically dependent upon them (as they are addictive).

HOW EFFECTIVE IS TREATMENT?

If studies on the effectiveness of anti-depressants for the treatment of OCD are looked at as a whole, on average individuals with OCD who undergo such treatment significantly improve around about 45% of the time. Whilst any improvement is obviously extremely desirable, in general the improvements individuals make by taking anti-depressant medication are not great enough to eliminate the need for other treatments being given alongside.

As has already been referred to, cognitive-behavioural therapy (CBT) is usually the type of therapy to be used alongside medication – in fact, it is a specific type of CBT which is known as EXPOSURE WITH RESPONSE PREVENTION (which I’ll henceforth refer to as EWRP). As has also been mentioned, if symptoms are extremely severe then benzodiazepam may be prescribed over the short term before the EWRP can take place.

WHAT DOES EWRP ACTUALLY ENTAIL?

We have already looked at  how sufferers of OCD have obsessive thoughts which cause them distress. What EWRP is designed to do is to help the individual TOLERATE SUCH DISTRESS. For, example, one common way in which OCD manifest itself is by making the sufferer inordinately and irrationally fearful of germs. Therefore, s/he may constantly be acutely anxious that his/her hands are ‘dirty’ and that this is potentially ‘highly dangerous’ – this, in turn. leads to constant compulsions to wash their hands in order to relieve their distressing and acute anxiety. However, the sense of relief is extremely ephemeral and the compulsion returns, perhaps leading the afflicted individual to wash his/her hands 100 times a day.

In the above example, the approach EWRP takes is to help the person tolerate the distress that his/her perception of having ‘dirty’ hands causes him/her by encouraging him/her not to wash them for a given period of time. As the person becomes better and more used to the anxiety caused by not washing them, the period of time can be gradually increased. The idea is that the person will become desensitized to the anxiety associated with unwashed hands.

On top of this, CBT can be used to help the individual challenge irrational thoughts which are connected to his/her OCD. For example, in the case described above, the individual could be helped to challenge thoughts such as ‘having any dirt on my hands is highly dangerous’ and to understand that the thought is an enormous exaggeration of any objective danger.

clinical hypnotherapy 468 604 - Childhood Trauma and Obsessive-Compulsive Disorder (OCD) Treatment

STOP OBSESSIVE THOUGHTS – CLICK IMAGE ABOVE

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

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Copyright 2013 Child Abuse, Trauma and Recovery

The Use of Hypnosis to Treat Trauma.

cropped childhood trauma fact sheet - The Use of Hypnosis to Treat Trauma.

Research has shown that hypnosis can be of benefit for individuals suffering from trauma related conditions such as post-traumatic stress disorder (PTSD). Hypnosis is not used in isolation to treat such conditions, but in conjunction with other therapies such as cognitive-behavioral therapy (CBT) and psychodynamic therapy.

Research studies have demonstrated that the use of hypnosis as part of the therapy for trauma based conditions can be particularly effective in:

– reducing the intensity and frequency of intrusive, distressing thoughts and nightmares
– decreasing avoidance behaviours (ie avoidance of situations which remind the individual under treatment of the original trauma)
– reducing the intensity and frequency of the mental re-experiencing the trauma
– reducing anxiety, hyper-vigilance and hyper-arousal that the trauma has caused
– helping the individual to psychologically INTEGRATE the memory of trauma in a way which reduces symptoms of dissociation (I have written a post on dissociation which some of you may like to look at)
– helping the individual to develop more adaptive coping strategies

On top of the above benefits, the use of hypnosis has been shown to be very likely to improve the therapeutic relationship between the individual undergoing treatment and the therapist.

However, it is not recommended that hypnosis be used to ‘recover buried memories of trauma’ as this has been shown to be unreliable and it is also likely that the use of hypnosis for this purpose can create FALSE MEMORIES in the person being treated.

Some individuals have been significantly helped by the use of hypnosis as part of their therapy for trauma related conditions such as PTSD in as little as just a few sessions. As one would expect, however, the more complex the trauma related condition is, the longer that effective treatment for it is likely to take.

workbook cover - The Use of Hypnosis to Treat Trauma.

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

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Copyright 2013 Child Abuse, Trauma and Recovery

Large Study Suggests Antidepressants Work No Better than Placebos.

childhood trauma fact sheet18 - Large Study Suggests Antidepressants Work No Better than Placebos.

The pharmaceutical industry makes over 12 billion pounds a year from antidepressant medication. Indeed, millions of adults and children take antidepressants and there are hundreds of thousands of doctors throughout the world who are happy to prescribe them.

However, it has been suspected by many for a long time that a proportion of any beneficial effect given by the taking of antidepressants is due to THE PLACEBO EFFECT (the PLACEBO EFFECT is a phenomenon whereby the patient’s BELIEF that a medication will help causes any improvement in his/her condition, not the drug itself.

A simple example of this would be to give someone who has a headache a dummy pill, such as a sugar pill, and then to tell the person who took it that it will cure his/her headache. Often, the person’s BELIEF the tablet will help him/her then causes an improvement. There is so much evidence of the placebo effect that it is now fully accepted by the scientific community – it is an excellent example of how the mind can affect the body).

A major study has now been undertaken to discover how much of any beneficial effect antidepressants have is not due to the drugs themselves, but, instead, to the placebo effect. The study was led by the academic, Professor Kirsch, from Harvard University.

His method was to take an overview of 38 studies which had already been conducted on the effects of antidepressants (psychologists refer to this as a meta-analysis). The SHOCKING DISCOVERY was that the data showed that antidepressants worked almost no better than placebos.

In other words, giving an individual an antidepressant for his/her depression, according to the extensive data reviewed by Professor Kirsch, is likely to work hardly any better than giving the individual a sugar (or ‘dummy’) pill. In fact, the difference in effect upon lessening depressive symptoms between the sugar pills and the antidepressants was found to be, by careful statistical analysis, CLINICALLY INSIGNIFICANT.

Further investigation of the data revealed that the proportion individuals who were helped more by the antidepressants than by the placebo (and, even then, only in a very minor way) was just 10-15% (those who had the most extreme forms of depressive illness).The majority, then (85-90%), were not helped in a significant way by antidepressants per se anymore than they would have been by a placebo.

Doctors have been made aware of this study, but a survey recently conducted has, worryingly, shown that over half of them did not intend to change the manner in which they prescribed antidepressants.

Whilst criticisms of Professor Kirsch’s study were made, particularly, unsurprisingly, by those who had a vested interest in the pharmaceutical industry, none of them, on analysis, have been shown to carry much weight. Additionally, a study commissioned by the NHS has SUPPORTED Professor Kirsch’s findings.

Despite these alarming findings, 235 prescriptions for antidepressants were made in the USA in 2010, and, in 2011, 47 million were made in the UK.

It is clear that there needs to be a major review of medical policy in relation the prescribing of antidepressants and that alternative ways of treating depression now need to be considered more than ever.

DISCLAIMER – DO NOT DISCONTINUE ANY MEDICATION WITHOUT FIRST SEEKING EXPERT MEDICAL ADVICE.

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Best Wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).

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How I Went from 1/4 Million Pounds in Bank to Homeless Hostel in a Few Months (or Just What the Doctor Ordered).

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I started this blog about four months ago, and, recently, have reflected on the possibility that it is really just one long exercise in self-justification. After all, I’ve made mistakes in life. One mistake that many would consider particularly inexplicable was how I managed to lose just over a quarter of a million pounds in a few short months:

I will not repeat my psychiatric history, which I have already outlined in the short post entitled: MY OWN STORY; suffice it to say, over the years, I have had the following diagnoses: unipolar depression, bipolar depression, anxiety disorder, OCD (related to self-harming -don’t ask), alcohol dependency, asperger’s syndrome (suspected but not officially diagnosed) and, for good measure, it was decided that borderline personality disorder be tossed into this already alarmingly toxic mix. OK, different psychiatrists have different opinions – it’s an inexact science. One thing we can all probably agree on, however, is that I wasn’t in overwhelmingly good psychological shape.

Let me cut to the chase. My father died about five years ago. The relationship I had with him, from my early teens, I suppose, was a tortured one. I watched him die, very unpleasantly, from cancer, which was made all the more painful for the ambivalence I had always felt towards him. After his death, my symptoms worsened, notwithstanding the fact he had left me over a quarter of a million pounds.

 

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The money took about six months to come through. The day it entered my account, I remember, I felt flat and empty. My strongest emotion, certainly, was guilt.

Apart from renting a flat, I bought nothing material with the money. My depression was such that nothing I could have bought would have had the slightest elevating effect upon my mood.

In order to divert myself, I started playing online poker. This was a great distraction. It made me feel something. It took me to a different mental realm. Just me, the cards and the bets. Nothing else existed. Soon I was putting down a thousand pounds a hand. I went down 50,000. I had to win it back. Down another 50,000. Well, now I’ve got no choice: I MUST win it back. Down to my last 30,000. OK, I might not be able to win it all back. Just get back up to 100,000.

Finally, the stark message came up on the screen : YOU HAVE INSUFFICIENT CREDIT FOR THIS BET.

I remember, after I’d played my last bet and lost everything, I went and sat on the sofa, lit a cigarette, and felt a strange, yet profound, sense of release and relief  – something, in fact, akin to elation.

It had been cathartic. Expensive, but cathartic.

The psychiatrist working with me at the time wrote to Ladbrokes (who I had lost the lion’s share of the money to on their online gambling site) as he felt they had failed in their duty of care to protect vulnerable people from being exploited by their site. However, after protracted correspondence they started to send me letters intimidating me out of my claim and refused to return a penny.

Losing the money also led me to losing the flat and all my possessions. I didn’t have the money to put them in storage, let alone a flat to accommodate them.

 

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A couple of months of intense fear followed; the council warned me that, due to my, arguably, irresponsible behaviour, I might be officially deemed ‘intentionally homeless’, which would fully relieve them of any responsibility towards me whatsoever. I faced street homelessness.

In the end, however, I was placed into a hostel for people with psychiatric disturbances and behavioural problems. The support there was excellent and I was put in contact with other extremely skilled professionals.

After nearly two years in the hostel system, I finally, you will be relieved to hear, obtained a very nice flat, in which I now sit, pensively typing away at my keyboard.

David Hosier.

Founder of childhoodtraumarecovery.com

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Childhood Trauma: Mental Illness and Responses to Stigma.

‘You must be the change you wish to see in the world.’
– Mahatma Ghandi

As mental illness is dictated by a combination of environmental and genetic factors, it can happen to absolutely anyone. Even individuals a long way into adulthood, who have previously always enjoyed good mental health, can suddenly be plunged into a severe clinical depression by a single traumatic life event. Nobody is immune. Mental illness HAS NOTHING TO DO WITH PERSONAL FAILINGS.

However, stigma connected to mental illness is still far from uncommon. Others can stigmitize those of us who have suffered mental illness, and turn their backs in disdain and contempt with a feeling of smug, self-satisfied superiority, due to their lack of education on the matter; also, however, some people who suffer mental illness (having internalized society’s often less than compassionate take on the condition) can, in effect, self-stigmitize: because mental illness often causes negative thinking patterns and feelings of wortlessness, it is all too easy for us to fall into the trap of compounding our suffering by feeling bad about being mentally ill (we may see ourselves as weak, for example). In other words, we may add a kind of additional, unnecessary layer to our distress: feeling bad about ourselves for feeling bad about ourselves, as it were. This has been referred to by some psychologists as METAWORRYING.

It is, of course, generally easier to alter the way that we feel about ourselves than it is to change the way others feel about us; ignorance, after all, can have a dispiritingly tenacious quality. Therefore, a good place to start in the fight against stigma is to change how we see ourselves for having experienced mental illness: we need, in short, to stop stigmitizing ourselves.

TACKLING STIGMITIZATION BY SOCIETY:

Whilst stigmitization by society, as I have said, still, obviously, exists, attitudes are improving all the time with greater public education and more and more individuals, with a prominent public profile, willing to talk openly about their own experience of mental illness (most notably, perhaps, in the UK, the writer, actor and comedian – and probably a lot of other things I can’t currently call to mind – Stephen Fry, who suffers bipolar disorder).

Progress has been made in society in relation to racism and homophobia, and, it would seem, there is no obvious reason why similar progress should not be made in relation to society’s attitude towards those unfortunate enough to experience mental illness.

THE FIRST STEP:

The first step we can all make, as I have suggested, is to stop blaming ourselves, and feeling bad about ourselves, for having suffered psychological difficulties (hence the reference to the quote by Ghandi at the top of this post!).

If you would like to learn more about fighting the stigma surrounding mental illness you may wish to pay a visit to www.shift.org.uk to see what they are doing in their campaign in relation to this. The campaign, for those who are interested, is run by The National Institute for Mental Health, UK.

I hope you have found this post of interest. You can, of course, follow this blog, leave a comment (to which I’ll reply as soon as I am able) or share it (see relevant icons to click). New posts are added at least twice per week. It is also able to follow me on TWITTER (@traumarecover) for immediate notification of each newly published post.

Best wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2013 Child Abuse, Trauma and Recovery

Research on Transcranial Magnetic Stimulation as a Treatment for Trauma.

Transcranial magnetic stimulation is normally abbreviated to TMS. Essentially, this treatment works by delivering short pulses of magnetic energy (which are generated by a hand held device that contains an electro-magnetic coil) to specific brain regions. It is a non-physically invasive therapy and the smallish, relatively simple device is merely guided over the relevant areas of the patient’s head by the doctor.

Research has already shown that the treatment can significantly reduce depressive symptoms in patients and early indicators are that it may also be of benefit to individuals suffering from the effects of trauma.

In order to help you visualize the simplicity of the procedure, imagine a hair-dryer being moved over the head – the only difference is that, rather than warm air being delivered,essentially painless, magnetic pulses are delivered instead.

HOW DOES TMS WORK?

I have already stated that the procedure is essentially painless (although some patients report that it has induced in them a headache) so the magnetic pulses are delivered whilst the patient is fully conscious. The procedure generally takes about twenty minutes. The magnetic pulses work by altering the way in which the brain cells communicate with each other (or, to put it more technically, the electrical firing between the brain’s neurons is altered) in the specific brain regions at which the treatment is directed. Research into the treatment has so far suggested that it may:

– reduce symptoms of depression
– reduce symptoms of anxiety – reduce the intensity of intrusive traumatic thoughts – help to reduce social anxiety by reducing avoidance behaviours

POSSIBLE SIDE EFFECTS:

Unfortunately, TMS cannot be administered to those individuals who have been fitted with a pacemaker (or, for that matter, have had any other metal implanted in their body). Also, it cannot be administered to those who suffer from epilepsy in most cases.

In rare cases, TMS may induce seizures or manic episodes.

Anyone considering the treatment should discuss it with their doctor.

 

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

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Childhood Trauma and Self-harm. Part 1.

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Many research studies (eg Arnold, 1995) have demonstrated a link between having been abused as a child and self-harm. In one study,84% of individuals who self-harmed reported that childhood trauma had contributed to their condition.

WHAT IS SELF-HARM?

The following are examples:

-skin cutting
-skin burning
-compulsive skin picking
-self-hitting
-self-biting
-hair pulling
-interfering with wound healing
-swallowing foreign objects
-pulling off nails

Whilst it sounds counterintuitive, self-harm is fundamentally a COPING MECHANISM born out of trauma and a profound sense of powerlessness.

‘PAIN-EXCHANGE’.

Self-harm has been described as a kind of ‘pain-exchange’. This means invisible, extreme emotional pain is converted into visible, physical wounds. After a period of self-injury individuals report feeling calmer and more able to cope. Self-injuring causes the brain to release ‘natural pain killers’ which may have the twin effect of diminishing psychological pain. A further theory is that, due to an individual’s self-loathing (see later in the post), self-injury acts as a form of self-punishment which the individual consciously or unconsciously believes s/he deserves.

Typically, people who self-harm are emotionally fragile and highly sensitive to rejection.

INDIRECT SELF-HARM.

Not all self-harm is direct. Indirect methods include:

-substance misuse
-gambling
-extreme risk taking
-anorexia/bulimia
-staying in an abusive relationship

With these, the damage is not immediate, but, rather, they are physically and/or psychologically damaging over the long-term.

TYPES OF CHILDHOOD TRAUMA ASSOCIATED WITH SELF-HARM.

The following have been found to be associated with self-harm:

-physical/sexual/emotional abuse
-loss of primary care giver (eg through divorce)
-having ’emotionally absent’ parent/s
-growing up in a chaotic family (eg due to parental mental health problems)
-being raised in the care system
-role reversal in child-parent relationship (eg child acting as a disturbed parent’s counsellor)

Furthermore, many who self-harm have NEGATIVE CORE BELIEFS such as the following:

-I am bad/evil
-I am worth nothing
-I shouldn’t have been born
-I’m never good enough
-I don’t deserve to be happy
-I’m unlovable
-I’m inferior
-I don’t fit in anywhere
-there’s something wrong with me

Such beliefs lead to: SELF-LOATHING and EXTREME LOW SELF-ESTEEM. This in turn leads to emotional distress which can trigger acts of self-harm such as those illustrated in this post. My next post will look at ways we can minimize our risk of self-harming.

51pkuyi0l8l  bo2204203200 pisitb sticker arrow clicktopright35 76 aa278 pikin4bottomright 6922 aa300 sh20 ou02  - Childhood Trauma and Self-harm. Part 1.sssddd11 - Childhood Trauma and Self-harm. Part 1.hhh - Childhood Trauma and Self-harm. Part 1.

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Best Wishes, David Hosier BSc(Hons); MSc; PGDE(FAHE).

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Copyright 2013 Child Abuse, Trauma and Recovery

My Own Story : A Brief Overview.

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My own childhood was highly chaotic and traumatic.

I started to suffer severe emotional problems very early on (for example, when I was 8 the teachers at the prep school I was at thought I had gone deaf, so I was taken to see my GP. It transpired, however, that there was nothing at all wrong with my ears, rather, the problem was psychological in origin: I had been ‘retreating into my own inner world’). Psychiatrists term this ‘dissociation’, which is a topic I refer to in my posts in the EFFECTS OF CHILDHOOD TRAUMA category.

As an adolescent I became deeply depressed and my behaviour became erratic, compounded by heavy drinking.

In adulthood, I became very ill indeed. I was hospitalized many times with depression so acute in nature I underwent electro-convulsive shock therapy (ECT) during more than one admission.

I made several suicide attempts, one of which left me in a coma on life-support for five days in intensive care.

It is these experiences which motivate me in my study of childhood trauma, its effects and what one can do to help oneself recover. I am fortunate in having a relevant academic background which helps facilitate this.

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

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Copyright 2013 Child Abuse, Trauma and Recovery