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Why Complex PTSD Sufferers May Avoid Eye Contact

A study by Lanius  et al. was conducted to cast light upon why many with individuals suffering from posttraumatic stress disorder (PTSD), including those suffering from complex-PTSD, often find it excruciatingly uncomfortable every time the rules of social etiquette compel them to make eye to eye contact with another human being (I, myself once attempted to circumvent this problem by deliberately buying a pair of glasses with lenses that were by far the wrong strength for me so that, whilst, to whomever it was I was required, as the law of social norms decrees, to make eye contact, I appeared to be doing so in the conventionally stipulated manner,  in fact, all that my eyes were actually meeting with was a comfortingly, non-threatening blur).

Returning to Lanius’ et al.’s experiment :

The experiment consisted of two groups :

1) Survivors of chronic trauma

2) ‘Normal’ controls

What Did The Experiment Involve?

Participants from both of the above groups were subjected to brain scans whilst a making eye to eye contact with a video character in such a way as to mimic real life face to face  contact.

What Were The Results Of The Experiment?

In the case of the ‘normal’ controls (i.e. those who had NOT suffered significant trauma), the simulated eye to eye contact with the video character caused the are of the brain known as the PREFRONTAL CORTEX to become ACTIVATED.

HOWEVER:

In the case of the chronic trauma survivors, the same simulated eye contact with the video character did NOT cause activation of the PREFRONTAL CORTEX. Instead, the scans revealed that, in response to the simulated eye contact, the part of the chronic trauma survivors’ brains that WAS ACTIVATED was a very primitive part (located deep inside the emotional brain) known as the PERIAQUEDUCTAL GRAY.

 

 

INTERPRETATION OF THESE RESULTS :

The prefrontal cortex helps us judge and assess a person when we make eye contact, so we can determine whether their intentions seem good or ill.

However, the periaqueductal gray  region is associated with SELF-PROTECTIVE RESPONSES such as hypervigilance, submission and cowering.

Therefore, we can infer that those with PTSD / complex PTSD may find it hard to make eye contact because their brains have been adversely affected, as a result of their traumatic experiences, in such a way that, when they make eye contact with another person, the ‘appraisal’ stage of the interaction (normally carried out by the prefrontal cortex) is missed out and, instead, their brains, due to activation of the periqueductal region, cause an intensely fearful response.

This constitutes yet another example of how severe and protracted childhood trauma can damage the physical development of the brain.

 

Link : Lanius et al’s study.

 

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

Hartman’s 12 Stages Of Post-Traumatic Stress Disorder (PTSD)

12-steps_ptsd_diagram

Hartmans twelve stages

I have written extensively on this site about how severe and chronic childhood trauma can lead to the development of post-traumatic stress disorder (PTSD) in adulthood (see the PTSD section on the main menu). This is also sometimes referred to as complex post-traumatic stress syndrome (CPTSD). In order to understand the theoretical difference between PTSD and CPTSD, click here.

In connection with PTSD, the writer and researcher, Hartman, has proposed a model of how the terrible mental illness can progress over time, involving the afflicted individual going through 12 painful steps.

The 12 Steps Of Post-Traumatic Stress Disorder (PTSD):

  1. Acute anxiety
  2. Depression
  3. Resentment
  4. Anger
  5. Fear
  6. Anxiety
  7. Feelings of worthlessness
  8. Shame
  9. Guilt
  10. Confusion
  11. Pain
  12. Activating events / Triggers

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

Four Very Common Reactions To Childhood Trauma

 

Research has shown that there are four main characteristics that children who have suffered significant childhood trauma very frequently display. These are:

1) Repetitive Behaviours

2) Repeated Memories

3) Specific Trauma Related Fears

4) A Profoundly Altered View Of Other People, The Future, And Life In General

Let’s look at each of these in turn:

1) Children who have experienced significant trauma frequently act out their trauma in repetitive and obsessive ‘play’. I place the word ‘play’ in inverted commas as it is devoid of any ‘fun’ element; it is also often referred to by psychologists as ‘post-traumatic play.’

The reason for this ‘play’ is believed to be an unconscious attempt to mentally process and emotionally master the trauma that they experienced.

Usually the child is not consciously aware that s/he is repeatedly acting out the traumatic experience through the post-traumatic play. This is made clear by the fact that the child may repeatedly carry out the ‘play’ activity that relates to the original trauma even if s/he has no verbal memory of the traumatic event/s themselves.

Post-traumatic_play

 

Above : Post-traumatic Play.

2) Repeated memories of the trauma are vivid, intrusive and distressing. Usually, they are visual, but may also be aural (relating to hearing), tactile (relating to touch) or, even, (if relevant), olfactory (relating to smell).

Such intrusive memories are particularly likely to occur just before the child falls asleep. However, they may also occur in other contexts, such as at school in the classroom, leading often to dissociative states.

Repeated memories may also take the form of nightmares. Often such nightmares will represent the trauma in a highly disguised form.

3) Specific fears relating directly to the traumatic experience also usually occur. To take a simple example, if a child is seriously injured by being knocked down by a motorbike s/he may come to fear the sound of motorbikes revving their engines.

Also, however, children frequently develop more general fears after a significantly traumatic experience. For example, they may develop fears of the dark, being alone or of strangers etc.

4) Children who have suffered significant trauma often develop an extremely restricted view of their own future and become devoid of ambitions, hopes and dreams; they also often assume their lives to come will be filled with yet further traumatic experiences.

They also frequently develop a lack of basic trust in others and develop feelings of helplessness and a general lack of autonomy (Erickson).

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

 

Factors that Influence the Severity of Effects of Child Abuse

childhood trauma

The degree to which a person who suffers abuse during childhood is damaged by the experience will depend upon a number of different factors.

Those who research such factors have split them into two groups :

1) RISK FACTORS – these are factors connected to the abuse that are likely to increase the emotional damage it causes

2) PROTECTIVE FACTORS – these are factors that are likely to reduce the emotional damage the abuse causes

THE FACTORS INFLUENCING THE SEVERITY OF EFFECTS OF ABUSE :

– if the child confides in somebody about the abuse, the response of that person is of great importance : if the child is made to feel shame over what has happened, or his/her complaint is minimized or not taken seriously, the damage done by the abuse is likely to be very significantly increased. If, on the other hand, the child’s complaint is taken seriously and s/he is offered emotional support and understanding, the effects of the abuse are likely to be reduced.

– the effects of abuse will tend to be increased if the abuser has a particularly close relationship with the child. This includes parents, step-parents or other primary carers in a position of trust and responsible for the welfare of the child.

– the age of the child is also of importance ; in general terms, the younger the child is when the abuse is occurring, the more psychological damage the child is likely to incur.

– another highly relevant factor concerns the duration of the abuse – the longer it went on, the more harmful its effects are likely to be

– the severity of the abuse is also clearly relevant ; the greater the severity, the greater the psychological distress caused,

– the form that the abuse takes is another vital consideration eg physical, sexual, emotional or neglect? Recent research is starting to indicate that emotional neglect may be particularly damaging, due, of course, to the child’s fundamental need to be shown warmth, affection and love. Being deprived of these things can have particularly serious consequences.

– finally, it is very important to consider the relationships the child has with people other than the abuser. If the child has good emotional support from people outside the family (eg friends, teachers etc) and/or has some family members who express love and affection towards him/her (eg grandparents, siblings), this can make the child more resilient and protect him/her from the worst effects of the abuse.

CONCLUSION :

Each case, however, is unique and the above factors interact in highly complex ways which cannot be precisely measured ; therefore, it is difficult to predict with any degree of accuracy how specific individuals will be affected by their traumatic experiences. Each case needs to be evaluated on its own particular merits.

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

Types of Abuse and Their Effects : An Infographic

effects of child abuse

effects of childhood trauma

The infographic below illustrates different types of child abuse together with some of the effects of such abuse :

 

CLICK ON IMAGE TO ENLARGE

what is child abuse

effects of child abuse

CLICK ON IMAGE TO ENLARGE

The Vicious Cycle of Adult Problems Stemming from Childhood Trauma

childhood trauma

‘WE NEED TO SEE THE SYMPTOMS WE HAVE AS A RESULT OF OUR CHILDHOOD TRAUMA LESS AS THE RESULT OF SOME CHARACTER FLAW, AND MORE AS THE RESULT OF HAVING SUFFERED EXTREME AND PAINFUL EXPERIENCES WHEN WE WERE LEAST ABLE TO COPE WITH THEM. BY CONSIDERING THE IDEA THAT OUR SYMPTOMS COULD BE SEEN AS NORMAL REACTIONS TO ABNORMAL AND TRAUMATIC EVENTS IN CHILDHOOD, IT IS POSSIBLE TO USHER IN THE IDEA OF CHANGE.’

– CHARTED CLINICAL PSYCHOLOGIST AND EXPERT ON EFFECTS OF CHILDHOOD TRAUMA.

People who have suffered childhood trauma frequently go on to develop multiple problems in adult life which tend to build up over the long-term. A range of difficulties like the ones given in the fictional scenario below would not be untypical:

Losing interest in school and unable to concentrate resulting in leaving at age 15 ; becoming disruptive and difficult leading to home-life problems, so leaving home at 16 ; this could then lead to homelessness or insecure housing (eg sleeping on friends’ sofas) ; depression and unsettled life style and lack of direction could then lead to abuse of drugs and alcohol ; unable to hold down job for long (eg due to having problems getting on with authority figures (stemming from problems with relationship in childhood with parent/s) and inability to accept criticism (eg becoming angry and aggressive when criticized, this, again, stemming from earlier relationship with parent/s, perhaps because they were physically abusive leading to a an intense need to ‘stand up for self’ and protect self).

The above example of how life can unravel as a result of childhood trauma, a whole string of problems feeding in to one another and compounding one another, are likely, too, to be underpinned by feelings of LOW SELF-ESTEEM, EMOTIONAL INSTABILITY and EMOTIONAL SCARS, A POOR SENSE OF OWN IDENTITY, AN INABILITY TO TRUST AND ‘PUT DOWN ROOTS’ – all these factors, also, stemming from the problematic childhood.

imagesCAEH7Z1BimagesCA24B8VY

STOPPING THE VICIOUS CIRCLE : The key to BREAKING OUT OF THE VICIOUS CYCLE IS TO BECOME AWARE AND RECOGNIZE THAT OUR PROBLEMS IN ADULT LIFE HAVE THEIR ROOTS IN OUR DISTURBED CHILDHOOD. By doing this, we can begin to understand that our unhelpful behaviours are rooted in our disturbed childhood and start to discard them. By understanding the enormous, destructive impact the past has – up until now – had upon our life, we can begin to loosen the past’s invidious grip on us.

We need to understand that our traumatic childhood experiences have affected how we THINK, FEEL and BEHAVE as adults. Apart from all the potential effects I have already described, our disturbed childhood is likely, too, to have had a VERY ADVERSE IMPACT UPON THE RELATIONSHIPS WE HAVE HAD, SO FAR, IN ADULTHOOD, perhaps due to feelings of FEAR, SHAME, FRUSTRATION, MOOD DISORDERS, ANXIETY and DEPRESSION. Again, these symptoms will almost certainly have their roots in our adverse childhood experiences.

LEARNING NEW WAYS OF COPING : Because our childhood experiences, the effects of which then become compounded by the adult experiences we have which stem from these childhood experiences, we are likely to have suffered EXTREME EMOTIONAL DISTRESS in our adult life, at worst leading to such horrors as compulsive self-harm and suicide attempts. Due to such intolerable distress, we are likely to have turned, in desperation, to any WAYS OF COPING possible. Often, these will have been unhelpful in the long-term and will have made matters yet worse. The coping mechanisms may have included alcohol abuse, drug abuse, withdrawal from society etc. These coping mechanisms may have become habits which we find difficult to change. We may, too, have become so enmeshed in the damaging life-style we now find ourselves in, it is difficult to step back and reassess why we are suffering our futile, negative, repeating pattern of thoughts, feelings and behaviour.

Often, the only viable option will be to seek therapy and start the process of stepping back, understanding how our lives have become as they have, stop blaming ourselves and feeling bad about ourselves, and, gradually, seek new and more positive ways of approaching life.

We may have come to see the personal characteristics we have displayed up until now (our anxiety, our depression, our bleak outlook, our problematic relationships etc, etc) as just ‘who we are.’ This, though, is a mistake which will only perpetuate matters. We need to detach these SYMPTOMS of our traumatic childhood from our TRUE IDENTITY. We may need to realize we are not ‘bad’ even though are childhood experiences and the symptoms they have caused may have made us (FALSELY) believe that we were ‘bad’.

CONCLUSION : AN IMPORTANT NOTE OF CAUTION:

Those who played a part in causing the childhood trauma (parents, step-parents, siblings etc) will often ENTER A STATE OF DENIAL to PROTECT THEMSELVES FROM THEIR OWN GUILT. It will often suit them to regard you as ‘innately bad’, and to regard this ‘badness’ as having nothing whatsoever to do with their treatment of you. Freud, of course, would regard this as a flagrant example of the psychological defense mechanism known as PROJECTION. I am inclined to concur.

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

Childhood Trauma: Complex Post Traumatic Stress Disorder (with Questionnaire).

 

complex post traumatic stress disorder questionnaire

Survivors of extreme trauma often suffer persistent anxiety, phobias, panic, depression, identity and relationship problems. Many times, the set of symptoms the individual presents with are not connected to the original trauma by those providing treatment (as certainly was the case for me in the early years of my treatment, necessitating me to undertake my own extensive research, of which this blog is partly a result) and, of course, treatment will not be forthcoming if the survivor suffers in silence.

Any treatment not linked to the original trauma will tend to be ineffective as THE UNDERLYING TRAUMA IS NOT BEING ADDRESSED. Also, there is a danger that a wrong diagnosis may be given; possibly the diagnosis will be one that may be interpreted, by the individual given it, as perjorative (such as a personality disorder).

ptsd

Individuals who have survived protracted and severe childhood trauma often present with a very complex set of symptoms and have developed, as a result of their unpleasant experiences, deep rooted problems affecting their personality and how they relate to others. The psychologist, Kolb, has noted that the post-traumatic stress disorder symptoms survivors of severe maltreatment in childhood might develop ‘may appear to mimic every personality disorder’ and that ‘severe personality disorganization’ can emerge.

Another psychologist, Lenore Terr, has differentiated between two specific types of trauma: TYPE 1 and TYPE2. TYPE 1 refers to symptoms resulting from a single trauma; TYPE 2 refers to symptoms resulting from protracted and recurring trauma, the hallmarks of which are:

– emotional numbing
– dissociation
– cycling between passivity and explosions of rage

This second type of trauma response has been referred to as COMPLEX POSTTRAUMATIC STRESS DISORDER (COMPLEX PTSD) and more research needs to be conducted on it; however, an initial questionnaire to help in its diagnosis has been developed and I reproduce it below:

COMPLEX PTSD QUESTIONNAIRE

1) A history of, for example, severe childhood trauma

2) Alterations in affect regulation, including
– persistent dysphoria
– chronic suicidal preoccupation
– self-injury
– explosive or extremely inhibited anger (may alternate)
– compulsive or extremely inhibited sexuality (may alternate)

3) Alterations in consciousness, including
– amnesia or hypernesia for traumatic events
– transient dissociative episodes
– depersonalization/derealization
– reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

4) Alterations in self-perception, including
– a sense of helplessness or paralysis of initiative
– shame, guilt and self-blame
– sense of defilement or stigma
– sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

5) Alterations in perceptions of perpetrator, including

– preoccupation with relationship with perpetrator (includes preoccupation with revenge)
– unrealistic attribution of total power to perpetrator (although the perpetrator may have more power than the clinician treating the individual is aware of)
– idealization or paradoxical gratitude
– sense of special or supernatural relationship
– acceptance of belief system or rationalizations of perpetrator

6) Alterations in relations with others, including

– isolation and withdrawal
– disruption in intimate relationships
– repeated search for rescuer (may alternate with isolation and withdrawal)
– persistent distrust
– repeated failures of self-protection

7) Alterations in systems of meaning
– loss of sustaining faith
– sense of hopelessness and despair

Why Is Complex PTSD Becoming More Common?

And the incidence of complex PTSD 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 (Complex PTSD) :

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 (e.g. 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.

Anyone who feels their condition may be reflected by the above is urged to seek professional intervention at the earliest opportunity.

Related post :  Complex  PTSD Treatment

RESOURCES :


Above eBook, Childhood Trauma And Its Link To CPTSD, now available on Amazon for immediate download. Click here.

 

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