Dysfunctional Tension Reduction Activities Complex PTSD and BPD Sufferers May Use

 

One of the hallmarks of both complex PTSD and borderline persona; disorder (BPD) is a feeling of constant anxiety, agitation and apprehensiveness, As a result of feeling trapped and imprisoned in this distressing state, individuals become desperate to escape it which frequently leads to behaviours that they later regret. Briere et al. (2009) stress the importance of addressing these behaviours, also referred to as TENSION REDUCTION ACTIVITIES when assessing complex trauma. Examples of tension reduction activities  that may be resorted to including the following:

I expand upon these behaviours and their relationship to borderline personality disorder and complex PTSD that has come about as a result of childhood trauma.

COMPULSIVE SEXUAL BEHAVIOUR/HYPERSEXUALITY/EROTOMANIA:

Hypersexuality also referred to as erotomania, or, more straightforwardly, sexual addiction, has been linked to traumatic experiences during the sufferer’s childhood. This does not imply, of course, that all those who suffer childhood trauma will go on to become hypersexual in adulthood, nor that there aren’t other causes (there are – such as some neurological conditions which it is unnecessary for me to go into here). Erotomania can be defined as a persistent and enduring, intensely powerful compulsion to indulge in sexual activity, whether that activity is solitary or with another/ others.

Although it affects females (in such cases, yet another term is sometimes used – ‘nymphomania’) it is more common amongst men. Clearly, it is no easy task to judge when a ‘normal’ sexual appetite escalates to such extremes that it is classified as erotomania; nevertheless, clinicians generally classify sexual addiction as being a pathological condition when it substantially interferes with day-to-day functioning, including friendships, relationships, work and lifestyle in general.

DISSOCIATION: Clinicians regard addiction to sex as a coping mechanism which allows the sufferer to ‘dissociate or, in other words, to mentally ‘escape’ from feelings of intense emotional distress (including clinical depression, severe anxiety and intense loneliness brought about by social isolation).

SYMPTOMS: Symptoms include – – frequent, anonymous sex – frequent use of prostitutes – obsession with online porn/sexually-oriented chatrooms/phone sex – view of others as mere sex-objects – obsessive masturbation (can be even as much as 10-20 times per day) and, at the more severe end of the scale, symptoms may include: – indecent public exposure – voyeurism – bestiality

ROLE OF CHILDHOOD TRAUMA IN THE DEVELOPMENT OF EROTOMANIA: Severe childhood trauma, as we have seen so often in other articles I’ve written for this site, often causes the adult who experienced it to develop conditions that give rise to deep-rooted psychological and emotional distress. Erotomania may then result as a defence mechanism (i.e. the need to dissociate as discussed briefly above). Not infrequently, drink and/or drugs may be used during sexual activity in order to intensify its dissociating effect.

EFFECTS AND TREATMENT: Whilst the sexual activity associated with erotomania may bring temporary relief from emotional pain and suffering, this tends to be heavily outweighed by the negative effects of sexual addiction. The first port of call for the sufferer of erotomania is usually the GP (in the UK). However, because of the sensitive nature of the subject, some prefer to initially see an expert in sexual therapy.

SEX THERAPY:

As we saw above, one reason why those who have suffered childhood trauma may become addicted to sex is that the act of sex helps them to ‘blot out’, or make themselves feel ‘numb to’, or ‘dissociate’ from unbearable emotional pain connected to their early life experiences (for example, those who have suffered severe childhood trauma may go on to develop borderline personality disorder and a major symptom of this condition is a propensity to develop addictions – including sex addiction). Indeed, because most people who suffer from sex addiction are generally unwilling to discuss their problem with others, the fact that they are suffering from it only becomes apparent when then develop a trusting relationship with a therapist who they initially went to see for help with other addictions such as alcoholism or drug abuse.

Alternatively, they may have initially gone to see their therapist in order to seek treatment for depression, anxiety or low self-esteem (all of which are also more common in those with a history of childhood trauma). Currently, sexual addiction is regarded as being similar in nature to addiction to chemical substances because the act of sex seems to have a similar ‘numbing’ effect (see above) on feelings of mental anguish (however, it should be noted that, as a discrete condition, ‘sex addiction’ is not yet  (at the time of writing) included in the Diagnostic And Statistical Manual Of Mental Disorders. Sexual addiction can manifest itself in a number of ways, including :

  • Voyeurism
  • Exhibitionism
  • Fantasies
  • Internet Pornography
  • Sadomasochism
  • Compulsive use of prostitutes

In fact, sexual addiction is NOT the same as simply having a high sex drive (indeed, a high sex drive can be a sign of good psychological health) but involves a compulsive quality that brings about negative results (for the sufferer, those s/he comes into contact with or both). Sexual addiction can seriously, adversely impact upon the individual’s quality of life. For example, it may :

  • cause financial problems
  • result in the spreading of sexually transmitted diseases
  • lead to legal problems
  • impair relationships

Once a person suffering from sex addiction recognizes that s/he has a problem which is significantly spoiling his/her quality of life, seeking help from a therapist can be very helpful. Confiding in a trusted, accepting, empathetic therapist can help to reduce feelings of shame related to the addiction and the therapist can provide advice about how to avoid triggers and how to develop healthier and more functional coping mechanisms to deal with negative feelings. Therapies used to treat sex addiction include cognitive behavioural therapy and psychodynamic therapy (the latter may be more appropriate when the problem is clearly related to childhood issues).

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SUBSTANCE ABUSE:

For example, let’s consider alcoholism:

 

Childhood Trauma And Alcoholism

When childhood trauma remains unresolved (i.e. it has not yet been worked through and processed with the help of psychotherapy), alcoholism may result (together, frequently, with aggressive behaviour).

Indeed, it has been suggested that unresolved traumatic events are actually the MAIN CAUSE of alcoholism in later life. The trauma may have its roots in:

– the child having been rejected by the parent/s
– too much responsibility having been placed upon the child

As would be expected, it has also been found that adult risk of both alcoholism and depression increases the greater the number of traumatic events experienced and the greater their intensity.

Children who grow up in alcoholic households have also been found to be at greater risk of becoming alcoholics themselves in adulthood, but this appears to be due to the fact that, as children with alcoholic parent/s, they are more likely to have experienced traumatic events than children of non-alcoholic parents, rather than due to them modelling their own behaviour regarding drinking alcohol upon that of their parent/s.

 

Furthermore, the more traumatic events experienced during childhood (of a physical, emotional or sexual nature), the more intensely symptoms of ANGER are likely to present themselves later on.

In research studies on childhood trauma, the degree of trauma experienced (and it is obviously not possible to quantify this with absolute precision) is often measured using the CHILDHOOD TRAUMA QUESTIONNAIRE (Fink et al., 1995) which identifies EMOTIONAL INJURIES and PARENTAL NEGLECT experienced during childhood and adolescence.

PSYCHODYNAMIC THEORIES:

These view alcoholism as A MEANS OF COPING WITH ANXIETY. Studies suggest that an alcoholic adult is about ten times more likely to have experienced physical violence as a child and about twenty times more likely to have experienced sexual abuse. Lack of peace in the family during childhood is also much more frequently reported by adults suffering from alcoholism, as are: EMOTIONAL ABUSE, NEGLECT, SEPARATION AND LOSS, INADEQUATE (eg distant) RELATIONSHIPS and LACK OF PARENTAL AFFECTION.

IMPLICATIONS FOR THE TREATMENT OF ADULT ALCOHOLICS:

Psychotherapy to help the individual suffering from alcoholism resolve his/her childhood trauma may improve treatment outcomes and reduce the likelihood of relapse. Further research is being conducted to help to confirm this.

 

ALCOHOL DEPENDENCE :

 

There is no precise definition of ‘alcohol dependence’, but it is generally agreed between experts that it usually includes the following features:

– a pattern of daily drinking

– being aware of a compulsion to drink alcohol

– changes in tolerance to the amount of alcohol that can be consumed (in the first stage, tolerance increases, but, eventually, tolerance actually reduces again)

– frequent symptoms of withdrawal from alcohol (commonly referred to as a ‘hangover). Symptoms of this may include: nervousness, shaking, tenseness, agitation (or feeling ‘jittery’ and ‘on edge’), feelings of tension, feelings of sickness/nausea

– finding relief from some or all of the above symptoms by consuming more alcohol

– during any periods of abstinence, finding that the features of dependence on alcohol soon re-emerge

It should be noted that individuals who are considered to have become dependent on alcohol may not have all of the symptoms noted above; however, the more symptoms one possesses, the more seriously dependent upon alcohol one is likely to be. The intensity of these symptoms of alcohol dependence will also vary considerably between individuals.

 

 

STRATEGIES FOR THE REDUCTION OF ONE’S ALCOHOL INTAKE :

– cut out at least some drinking sessions (eg lunchtime drinking) and, ideally, find something else to occupy the time to act as a distraction (such as actually eating lunch!)

– during drinking sessions, alternate between soft drinks and alcoholic drinks

– avoid drinking environments / the company of people who may pressure you to drink, during periods that you have decided to stay alcohol-free

– if people who are likely to encourage you to drink cannot be avoided, plan how you will resist their influence

– add generous amounts of non-alcoholic mixers to alcoholic drinks where possible, but drink at the same speed as you would if the alcohol were less diluted (or slower!)

– avoid falling into social traps that tend to encourage drinking, such as participating in a large, hard-drinking group of people who are buying ’rounds’ for one another where a ‘group mentality’ is likely to predominate.

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AGGRESSION:

The experiment described below represents one theory about how childhood trauma (in this case, separation from the mother, may contribute towards a tendency towards violence in adult life.

A recent Swiss study by Marquez et al. (2013) has looked at the effects of trauma on ‘adolescent’ rats. It was found that those rats who were exposed to trauma (fear and stress-inducing stimuli) suffered adverse PHYSICAL EFFECTS ON THE BRAIN (specifically, the PREFRONTAL CORTEX). This, in turn, leads to them displaying significantly more aggressive behaviour than non-traumatized rats.

Effect Of Separation From Mothers :

A very similar effect has been found to occur in young rats SEPARATED FROM THEIR MOTHERS.
Furthermore, ‘adolescent’ rats exposed to trauma also develop ANXIETY and DEPRESSION type behaviours. They were found to also have increased activity in the brain region known as the AMYGDALA (which is linked to FEAR and VIOLENCE in humans). Additionally, they developed abnormally high levels of TESTOSTERONE ( a hormone which, in humans, is linked to AGGRESSION and VIOLENCE). Even the rats’ DNA was found to be affected by the trauma (specifically, MAOA genes). These genes act to break down SEROTONIN (a brain chemical, or neurotransmitter) and damage to it leads to too much serotonin being broken down which, in turn, leads to aggressive behaviour.

Comparison With Adult Rats :

However, ADULT RATS exposed to trauma did not undergo the same behavioural changes, so:

THE RESEARCH SUGGESTS IT IS TRAUMA IN EARLY LIFE, RATHER THAN IN ADULTHOOD, WHICH HAS ESPECIALLY DEEP EFFECTS ON THE CHEMISTRY AND PHYSICAL STRUCTURE OF THE BRAIN, THAT LEADS TO A PROPENSITY FOR AGGRESSIVE BEHAVIOR.

 

CONCLUSION:

To what degree can we apply these findings to the effects of childhood trauma in HUMANS?

In fact, the findings I’ve outlined above mirror very accurately findings from studies on humans; this suggests that similar physiological processes are going on in both rats and humans as a result of early trauma.

Studies on non-human primates have also given rise to very similar findings.

It is hoped that such research showing that physiological effects of early trauma seem to underlie the development of a greater propensity towards violence and aggression will help lead to drugs being developed that can reverse these physiological effects and therefore reduce levels of aggression in individuals affected by early trauma. With this aim in mind, further human and non-human studies are being conducted.

 

SUICIDE:

 

Those who have suffered severe and chronic childhood trauma are at an increased risk of ending their lives by suicide than the average. Indeed, an astonishing ten per cent of those suffering from borderline personality disorder, or BPD (a severe mental illness linked to childhood trauma) die by their own hand.

I myself made a suicide attempt, at the peak (or should that be trough?) of my illness which left me in a coma in intensive care for five days.

So, apart from those suffering from BPD, which other groups of individuals are at a heightened risk of committing suicide?

At greatest risk, as one would imagine, are individuals who are mentally ill – nine out to ten people who die by suicide are suffering from a diagnosable mental illness.

Of the mentally ill, those suffering from schizophrenia or bipolar disorder are especially at risk (like those suffering from BPD, one in ten with either of these mental health conditions eventually commits suicide).

 

Hopelessness:

Of course, whilst about ten per cent of those suffering severe mental illnesses such as BPD, bipolar disorder and schizophrenia end their lives by suicide, we need not be mathematical geniuses to deduce from this that 90℅ do not. So what tips people in these groups over the edge?

Research suggests that the main predictor of an individual with severe mental illness committing suicide is if they also experience a profound sense of hopelessness. Like me, when I made the suicide attempt I referred to above, they feel that their intolerable mental pain will never end, that every day will be a day of intense psychological suffering and turmoil, and that there is absolutely no way out whatsoever.

An aspect of the tragedy is, of course, that a person’s state of mind can make the individual believe 100℅ that things can never get better when, objectively, this is not the case. There are many who can vouch for this, happily, from their own former bitter experiences.

Rejection:

Feeling rejected by family, friends and society, in general, is another important predictor of suicide.

Impulsivity:

Whilst some suicide attempts are methodically planned (as my own was), others are made on impulse. It follows, of course, that those who have an impulsive type personality (impulsivity is often a feature of BPD) are also at higher risk.

Being Male:

About twice as many men die by suicide than women.

However, unsuccessful suicide attempts are approximately twice as likely to be made by females than by males.

The Paradox Of Getting ‘Better’:

Those suffering from severe depression, at their illest, may be so lacking in motivation, and so close to being in a catatonic state, that they wish to die but cannot muster the mental energy required to end their lives (they may, too, in such a state of illness, lack the requisite planning and decision-making abilities necessary). Paradoxically, it is sometimes only when such depressive symptoms start to lift slightly that they find themselves able to make a suicide attempt.

 

 

The Link Between Childhood Trauma and Future Suicide Attempts.: A Study

A particular study, carried out by Dube et al. (2001), which involved gathering data related to this issue, found that those most seriously affected by childhood trauma were a staggering 51 Xs (i.e. 5100%) at greater risk of suicide attempts as a teenager compared to those who had experienced a settled childhood.  As an adult, they were found to be at 30Xs (i.e. 3000%) greater risk of attempting suicide compared to their more fortunate contemporaries.

Other findings in the study by Dube et al were that about 67% of adult suicide attempts were linked to the experience of childhood trauma, and, also, that about 80% of teenage suicide attempts were connected to the experience of childhood trauma.

THE SPECIAL ADVERSE EFFECT OF EMOTIONAL ABUSE :

The same study also found that the type of abuse that was most strongly predictive of the individual who experienced it making suicide attempts in later life was emotional abuse.

OTHER TYPES OF ABUSE FOCUSED UPON BY THE STUDY :

Dube et al. also found many other types of abuse to be powerfully correlated with an increased risk of suicide. These were :

– domestic violence

– loss of a parent (e.g through divorce or abandonment)

– a family member in prison

– parent with mental illness (e.g. depression

– parent with addiction

– physical neglect

– emotional neglect

– physical abuse

– verbal abuse

POSSIBLE ACTIONS TO TAKE IN LIGHT OF ABOVE FINDINGS :

Given the above facts, it is necessary to ask what may be done to address this tragic problem. I provide some suggestions below :

– more training for those who work with children about the effects of childhood trauma and how best to treat these effects

– more education to be given to the public in general about the effects of childhood trauma

– rather than expelling or suspending ‘difficult’ children, schools should keep them in education and provide the appropriate counselling and/or other professional support

– respond more sensitively and compassionately to ‘problem behaviour’ (or, ‘acting out’) by young people, both in schools and other application environments.

 

SELF-HARM:

 

Those who sought to stigmatize the very serious and distressing psychological condition known as borderline personality disorder, or BPD, used to like (and perhaps still do) to put forward the theory that self-harming behaviour in those suffering from BPD is ‘merely’attention-seeking (ridiculous when one considers the stark and brutal fact that one in ten people suffering from BPD end up dying by suicide; a statistic which is bewilderingly, and, in my view, disgracefully, often conveniently overlooked).

Clearly, suicide is the ultimate form of self-harm; however, at times of stress, those with BPD often engage in other forms of self-harm which include: cutting the skin, picking at skin to prevent healing, burning the skin with cigarettes/lighters/matches etc, hitting oneself, and even banging one’s head against a wall or jumping from dangerous heights.

Whilst the idea of self-harm is difficult for mentally healthy individuals to understand, science (see theory two, below) is now beginning to shed further light upon why BPD sufferers in distress may do it. I outline two of the theories which have been put forward below :

 

THEORY ONE – SELF-PUNISHMENT THEORY :

Those who have suffered severe childhood trauma, and have subsequently gone on to develop BPD, very often have been conditioned/brainwashed to view themselves as a ‘bad’ person.’ It is, therefore, possible that the self-harming behaviour which the majority of those who suffer from BPD sadly carry out may be DRIVEN BY AN INTERNAL, UNCONSCIOUS NEED TO PUNISH THEMSELVES DUE TO DEEP SEATED FEELINGS OF SELF-HATRED AND SHAME.

 

THEORY TWO  – THE RELIEF FROM INTENSE EMOTIONAL PAIN THEORY :

When an individual inflicts physical harm upon him/herself, NEUROPEPTIDES are released in the brain (Stanley et al.); these are molecules which help neurons (brain cells) communicate with one another, and, in so doing, they influence our behaviours, thoughts and feelings. One important group of neuropeptides are OPIOIDS and these are thought to help explain why individuals might self-harm.  But why should this be so?

The answer is that research has found that individuals who suffer from BPD tend to have ABNORMALLY LOW LEVELS OF BASELINE OPIOIDS. Because opioids act as natural pain-killers (in connection with both physical and emotional pain), and physical harm to the body causes more of them to be released, it is possible individuals in severe emotional pain self-harm to BOOST THEIR LEVELS OF OPIOIDS AND THUS REDUCE THE INTENSITY OF THE EMOTIONAL PAIN FROM WHICH THEY ARE SUFFERING.

Other neuropeptides released into the body as a result self-harming behaviour, and which may also help explain why BPD sufferers are driven to inflict self-injury are oxytocin and vasopressin.

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

Psychologist, researcher and educationalist.

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