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):
Many people, after suffering a terrible trauma, find that, once they have got through it and started to recover from its damaging psychological effects, they eventually reach a stage whereby they are able to use their adverse experiences to develop them as a person in highly positive ways that benefits both themselves and society at large. This has been termed by psychologists posttraumatic growth.
After experiencing trauma comes a slow process of recovery (assuming effective therapy is sought); the length of time recovery takes will depend both upon the type, intensity and duration of the trauma, as well as the age the individual was when s/he experienced the trauma, and also the affected individual’s personal characteristics, temperament and genetic make-up.
Once the person who experienced the trauma is able to manage his/her painful and distressing emotions more effectively, finds memories of the trauma less difficult to cope with, and is able to function reasonably well on a day to day basis, a transition can start to take place in which the person begins the process of moving on from recovery into posttraumatic growth. Ideally, this period of growth and development should be guided and facilitated by an appropriately qualified and experienced therapist.
The process of posttraumatic growth involves taking stock of what happened and analysing its significance. The American Psychological Association identify ten key elements that the process involves :
1) re-establishing meaningful relationships with other people
2) accepting that change is an inevitable part of life
3) setting goals and starting to move towards them
4) taking decisive action
5) working on developing a positive self-view
6) learning from the past
7) good self-care
8) developing an optimistic outlook
9) seeking out opportunities for self-discovery
10) seeing crises as challenges rather than as insurmountable obstacles
As we have seen in several of the previously published articles on this website (eg click here), severe childhood trauma can lead to the development of post traumatic stress disorder (PTSD). If you are concerned you might suffer from the condition, it is important to seek advice from a relevantly qualified mental health professional.
However, if you want to find out if you have symptoms which PTSD can cause, you may find it interesting and useful to look at the list of items below and count up how many apply to you. REMEMBER, THE TEST DOES NOT REPLACE A PROFESSIONAL MEDICAL ASSESSMENT AND DIAGNOSIS.
SELF-REPORT POST TRAUMATIC STRESS DISORDER (PTSD) TEST :
(score 1 point for each item you answer YES to)
1) Have you been exposed to a traumatic event or events?
2) Did the trauma cause you to experience feelings of intense fear/ horror and powerlessness/impotence/helplessness
3) Does it sometimes feel as if you are reliving or re-experiencing the trauma (ie flashbacks)
4) Do you experience nightmares which are associated with the trauma that you experienced
5) Did the traumatic experience involve you witnessing serious injury/death or did it involve you being seriously injured/threatened with death?
6) Do you have thoughts or mental images related to the trauma which are intrusive, difficult to control and hard to dispel from the mind?
7) When something reminds you of the trauma, or you find thoughts about it intruding on your mind, does it cause serious distress?
8) Do you avoid things that remind you of the trauma? Examples include activities, people and places
9) Do you find you have less interest in activities that you used to enjoy?
10) Are you unable to remember something significant that occurred during the trauma (this is sometimes referred to as repression)
11) Do you try to avoid speaking about what happened during the trauma?
12) Do you find yourself more irritable than you were before the trauma occurred and that you get angry much more often?
13) Do you suffer from insomnia (such as finding it hard to get off to sleep and/or waking too early)?
14) Has your concentration become impaired since the trauma?
15) Do you find you no longer wish to interact with others as much as you did prior to the trauma and that you now have difficulty trusting other people?
16) Do you fear that, because of the trauma you suffered, it will significantly, negatively impinge upon your future life in areas such as career, relationships and life span?
17) Has your ‘startle response’ become more sensitive since the trauma?
18) Have the symptoms that you’ve experienced since the trauma lasted for a minimum of one month so far?
19) Since the trauma, do you find it harder to feel emotions (eg feeling ‘numb’ for much of the time) and/or harder to display emotions to others?
20) Do you feel hypervigilant (ie feel as if you are constantly on ‘red alert’) for much of the time and constantly have a sense of impending disaster?
21) Have what used to be your everyday routines been disrupted by how you now feel (eg social life, work)?
A guide to interpreting your score :
0-3 It is not likely that you have PTSD
4-9 It is likely you have PTSD
10 + It is very likely you have PTSD
DISCLAIMER – This does NOT provide you with a diagnosis, it is just a guide. If you suspect you have PTSD, or a related condition, you are strongly advised to seek the relevant professional advice.
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Individuals who have suffered severe childhood trauma may, as a result of it, later suffer from Post-Traumatic Stress Disorder (PTSD),or similar condition. Some professionals advocate a relatively new technique which aims to address this; it is known as Eye Movement Desensitisation and Reprocessing (EMDR).
WHAT IS EMDR?
The therapist administering EMDR will first examine the issues related to the individual’s psychological difficulties and, also, help him/her develop strategies to aid in relaxation and deal with stress. After this, the therapist encourages the individual to recall particular traumas, whilst, simultaneously, manipulating his/her eye movements by instructing him/her to follow the movements the therapist is making with a pen, or similar object, in front of the individual’s face). The theory is that this will facilitate the individual in effectively reprocessing his/her traumatic experiences, thus alleviating psychological distress.
THIS SOUNDS A LITTLE ODD; WHAT IS THE RATIONALE BEHIND EMDR AND, HOW, EXACTLY, IS IT THOUGHT TO WORK?
My first reaction to hearing about this particular therapy was that it sounded somewhat strange. However, the rationale behind EMDR is that disturbing memories from childhood need to be PROPERLY PROCESSED by the brain in order to alleviate symptoms associated with having experienced childhood trauma (eg PTSD, as already mentioned); this is because the view is taken that it is the UNRESOLVED TRAUMA that is the cause of the psychiatric difficulties the individual who presents him/herself for treatment is suffering. Those professionals who recommend the therapy believe that the EYE MOVEMENTS INDUCED BY THE THERAPIST IN THE INDIVIDUAL BEING TREATED LEAD TO NEUROLOGICAL AND PHYSIOLOGICAL CHANGES IN THE BRAIN WHICH AID IN THE EFFECTIVE REPROCESSING OF THE TRAUMATIC MEMORY, and, in this way, ameliorates psychological problems from which the individual had been suffering.
WHAT ARE THE STAGES INVOLVED IN EMDR THERAPY?
These are briefly outlined below:
1) The first stage is the identification of the specific memory/memories which underlie the trauma.
2) Next, the individual is asked to identify particular negative beliefs he/she links to the memory (e.g. ‘I am worthless’)
3) Then, the individual being treated is asked to replace the negative belief with a positive belief (e.g .’I am strong enough to recover’ or ‘I am a person of value with potential to have a bright future’ etc)
4) In the fourth stage, the therapist moves a pen (or similar object) in various, predetermined motions in front of the individual’s face and he/she is instructed to follow the movements with his/her eyes (e.g repeatedly left and right). Whilst this is going on, the therapist instructs the individual to simply, non-judgmentally observe his/her own thoughts, letting them come and go freely and without trying to influence them in any way – just to accept them, in other words, and let them happen.
5) This procedure is repeated several times.
Each time the process is undertaken, the therapist asks the individual being treated to rate how much distress he/she feels – this continues until his/her self-reported level of distress becomes very low. Similarly, each time the process is undertaken, the individual is asked to report how strongly he/she now feels he/she believes in the positive idea given in stage 3 (see examples provided above); therapy is only concluded once the level of reported belief becomes very high.
N.B. The therapy is actually more involved than this, so the above should only be taken as a brief outline. There are, too, different variations of procedure outlined above which can be employed within the EMDR range of therapies available.
EMDR CAN HELP UNBLOCK TRAUMATIC INFORMATION HELD IN THE BRAIN AND HELP US TO HEALTHILY INTEGRATE IT INTO OUR LIFE STORY AS A WHOLE :
When we suffer severe trauma we are not able to fully mentally process what it is that has happened to us and the trauma becomes mentally entrenched – in other words, what happened to us becomes locked or ‘stuck’ in our memory network. The effect of this may include us experiencing various symptoms such as irrational beliefs, painful emotions, anxiety and fears, flashbacks, nightmares and phobias. It may well also cause blocked energy and greatly reduce our self-efficacy.
When we experience events that trigger memories of the trauma, images, sounds, physical sensations and beliefs which echo the original experience of the trauma cause our perception of current events to be distorted.
EMDR (Eye Movement Desensitization and Reprocessing) can unblock this traumatic information and thus allow us to healthily mentally integrate it with our other life experiences and our life story as a whole.
Trauma can occur in the form of SHOCK TRAUMA and DEVELOPMENTAL TRAUMA. Shock trauma consists of a sudden threat which is overwhelming and/or life threatening – it occurs as a single episode such as a violent attack, rape or a natural disaster. Developmental trauma, on the other hand, refers to a series of events which occur over a period of time. These events GRADUALLY ALTER THE PERSON’S NEUROLOGICAL SYSTEM to the point that it REMAINS IN THE TRAUMATIC STATE. This, in turn, can cause interruption in the child’s long-term psychological growth. Experiences which can lead to developmental trauma include : abandonment by parent, long term separation from parent, an unsafe environment, an unstable environment, neglect, serious illness, physical and/or sexual abuse or betrayal by a care giver.
The effects of developmental trauma include damaging the child’s sense of self. self-esteem, self-definition and self-confidence. Also, the child’s sense of safety and security in the world will be seriously undermined. This makes it far more likely that the individual will experience further trauma in life as an adult as his/her sense of fear and helplessness remain unresolved.
EMDR works by allowing the locked or ‘stuck’ traumatic information to be properly, mentally processed. This leads to the disturbing information becoming psychologically resolved and integrated.
HOW DOES EMDR ACTUALLY WORK?
EMDR is based on the idea that it is our memories which form the basis of our PERCEPTIONS, ATTITUDES and BEHAVIOURS. Because, as we have already established, traumatic memories fail to be properly processed they lead to these perceptions, attitudes and behaviours becoming DISTORTED and DYSFUNCTIONAL. In effect, the trauma is too large and too complex to be properly processed so it remains ‘STUCK’ and DYSFUNCTIONALLY STORED. This often leads to MALADAPTIVE ATTEMPTS TO PROCESS AND RESOLVE THE INFORMATION CONNECTED TO THE TRAUMA SUCH AS FLASHBACKS AND NIGHTMARES (Sharpio, 2001).
When this problem occurs it is EMDR which is being increasingly turned to allow effective processing and mental healing to occur. I will look in more detail at what EMDR involves in later posts.
WHAT DO EVALUATION STUDIES OF EMDR THERAPY SUGGEST ABOUT ITS EFFECTIVENESS?
A recent meta-analysis of evidence (ie an overview of a large number of particular, individual studies of EMDR) supported the claim that it is effective, as have other meta-analyses. However, some researchers have suggested that it is not the EYE MOVEMENT PART of the therapy which is of benefit, but only the act of repeatedly recalling traumatic memories which is the effective component (based on the idea that these repeated mental exposures, under close supervision and in a supportive and safe environment, of the traumatic memories alone facilitates their therapeutic reprocessing).
In response to this criticism, its exponents (and there are many professionals who are), regard the EYE MOVEMENT COMPONENT of the therapy as ESSENTIAL in giving rise to the NECESSARY NEUROLOGICAL CHANGES which allow the EFFECTIVE REPROCESSING OF THE TRAUMA; these proponents also emphasize that the therapy only requires short exposures to the traumatic memory/memories, thus giving it an advantage over therapies which utilize far more protracted exposures.
Research into EMDR is ongoing.
eBooks :
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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).
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) :
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.
In my last post I mentioned it might be useful to look at some coping mechanisms one may wish to make use of in the recovery stage from childhood trauma and it is to some of these that I now turn.
There are two main types of coping mechanisms:
1) Those which are helpful in the short-term, but unhealthy in the long-term.
2) Those which are useful in the long-term (but can take more effort and discipline).
Examples of the first include: drinking too much, use of illicit drugs, gambling, over-eating and taking anger out on others (and, almost always, later regretting it).
Examples of the second are: going for a walk, talking things over with a friend, having a relaxing bath or listening to music.
It should be pointed out that the strategies in the first category tend to leave the person with a lower sense of self-worth over time whereas the opposite tends to be the case with the kinds of strategies mentioned in the second category.
The key is to gradually reduce the use of the coping strategies in category one and gradually increase the use of the coping strategies in category two. This can take time.
BREATHING EXERCISES:
Another coping strategy is very simple but very effective (when I first learned this one I was dubious that something so simple could help and was surprised when it did) is to learn ‘controlled breathing’.
Under stress, we tend to HYPERVENTILATE (this refers to the type of breathing which is rapid and shallow) which has the physiological (and indeed psychological) effect of making us feel much more anxious. CONTROLLED BREATHING, on the other hand (breathing DEEPLY, GENTLY and EVENLY THROUGH THE NOSE) has the physiological (and, again, psychological) effect of calming us down. It is recommended by experts that with controlled breathing we should take 8-10 breaths per minute (breathing in AND out equates to ONE breath). With pratise, this skill can become automatic.
FORMING SUPPORTIVE RELATIONSHIPS:
Survivors of childhood trauma often find it difficult to form lasting relationships in adulthood (sometimes related to anger-management issues, volatility, inability to trust others and other problems). However, those who can form such relationships tend to have a much better outcome.
My next post will look at ways to help overcome difficulties in building and sustaining relationships.
