Simplifying the Complex?

complex-post-traumatic-stress-disorder

 

Well I have booked my first two EMDR counselling sessions for next week and the week after. I also spoke with my counsellor who seemed a lovely, capable person.

We needed to differentiate in our conversation about suffering from PTSD and Complex PTSD.

I suffer from C-PTSD although I also fulfill the symptoms of PTSD as do the vast majority of those who suffer C-PTSD.

“The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms, such as changes in their self-concept and the way they adapt to stressful events.

Dr. Judith Herman of Harvard University suggests that a new diagnosis, Complex PTSD, is needed to describe the symptoms of long-term trauma (1).

Another name sometimes used to describe the cluster of symptoms referred to as Complex PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS) (2). A work group has also proposed a diagnosis of Developmental Trauma Disorder (DTD) for children and adolescents who experience chronic traumatic events (3).

Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met diagnostic criteria for PTSD, Complex PTSD was not added as a separate diagnosis classification (4). However, cases that involve prolonged, repeated trauma may indicate a need for special treatment considerations.

What additional symptoms are seen in Complex PTSD?

An individual who experienced a prolonged period (months to years) of chronic victimization and total control by another may also experience the following difficulties:

  • Emotional Regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
  • Consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body (dissociation).
  • Self-Perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
  • Distorted Perceptions of the Perpetrator. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
  • Relations with Others. Examples include isolation, distrust, or a repeated search for a rescuer.
  • One’s System of Meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.

What other difficulties are faced by those who experienced chronic trauma?

Because people who experience chronic trauma often have additional symptoms not included in the PTSD diagnosis, clinicians may misdiagnose PTSD or only diagnose a personality disorder consistent with some symptoms, such as Borderline Disorder.”

I mention these points because I have found that my wife, who has PTSD, reacts in very different ways to me and has different symptoms although I have PTSD as well as part of my C-PTSD.

I have a history, for example, of disassociating when very very distressed or angry which is linked to C-PTSD not PTSD. It is a maladaptive survival strategy and coping mechanism from childhood which is not longer required today. It once allowed me to abruptly distance myself from emotional turmoil. To cut myself off from what was happening around me, as if it wasn’t happening. This is often done in the face of extreme trauma/abuse.

I have other symptoms different from my wife too.

If you have been following this blogsite you will have appreciated some of my constant subject areas such as insecure attachment, co-dependency, emotional dysregulation, negative self schemata, and emotion processing deficits.

It appears that much of this actually comes under the umbrella diagnostic criterion of C-PTSD. This is actually a good thing as I can seek treatment for much of the difficulties of my past at the same time. It may and probably will take longer than your average PTSD therapy but I am hoping it will be worth it.

“Cook and others describe symptoms and behavioural characteristics in seven domains:[13][14]

  • Attachment – “problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to other’s emotional states, and lack of empathy”
  • Biology – “sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems”
  • Affect or emotional regulation – “poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes”
  • Dissociation – “amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events”
  • Behavioural control – “problems with impulse control, aggression, pathological self-soothing, and sleep problems
  • Cognition – “difficulty regulating attention, problems with a variety of “executive functions” such as planning, judgement, initiation, use of materials, and self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with “cause-effect” thinking, and language developmental problems such as a gap between receptive and expressive communication abilities.”
  • Self-concept – “fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self”.

Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization as children as well as prolonged trauma as adults. This early injury interrupts the development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or older siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon.[7][15]

This can become a pervasive way of relating to others in adult life described as insecure attachment. The diagnosis of …PTSD do not include insecure attachment as a symptom. Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant risk of revictimization.[16]

Six clusters of symptoms have been suggested for diagnosis of C-PTSD.[5][17] These are (1) alterations in regulation of affect and impulses; (2) alterations in attention or consciousness; (3) alterations in self-perception; (4) alterations in relations with others; (5) somatization, and (6) alterations in systems of meaning.[17]

Experiences in these areas may include:[4][18][19]

  • Variations in consciousness, including forgetting traumatic events (i.e., psychogenic amnesia), reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation), or having episodes of dissociation.
  • Changes in self-perception, such as a chronic and pervasive sense of helplessness, paralysis of initiative, shame, guilt, self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings
  • Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator (caution: victim’s assessment of power realities may be more realistic than clinician’s), becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge, idealization or paradoxical gratitude, a sense of a special relationship with the perpetrator or acceptance of the perpetrator’s belief system or rationalizations.
  • Alterations in relations with others, including isolation and withdrawal, persistent distrust, a repeated search for a rescuer, disruption in intimate relationships and repeated failures of self-protection.
  • Loss of, or changes in, one’s system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.”

 

As I research C-PTSD it seems this disorder describes many of my symptoms and behaviours very accurately and there is also reportedly a high co-occurrence with C-PTSD and alcoholism and addiction.

http://insidethealcoholicbrain.com/2015/12/13/do-the-12-steps-help-with-post-traumatic-stress-disorder/

I will be interested in how it “treats” my addictive behaviours too as I believe much of these addictive behaviours were borne out on childhood traumas and abuse.

In other words, the symptoms of C-PTSD and other related areas like attachment, co-dependency, abuse, maltreatment, neglect and other adverse circumstances appear to affect the human brain in similar ways and each contribute to an increase in addiction severity.

I wonder in some ways if I will be treating the “roots of all my troubles” in more ways than one.

I will keep you posted as best I can. It will no doubt be painful at times. I am glad to have made start anyway.

I will post before the first two sessions are done of the following areas

What is EMDR?

Treating C-PTSD with EMDR?

How does EMDR work?

 

Until then?

 

 

 

 

Original Link

http://www.ptsd.va.gov/professional/PTSD-overview/complex-ptsd.asp

References

  1. Herman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
  2. Ford, J. D. (1999). Disorders of extreme stress following war-zone military trauma: Associated features of Posttraumatic Stress Disorder or comorbid but distinct syndromes? Journal of Consulting and Clinical Psychology, 67, 3-12.
  3. van der Kolk, B. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401-408.
  4. Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for Posttraumatic Stress Disorder.Journal of Traumatic Stress, 10, 539-555.

 

I Am What I Have Been Looking For.

  1. Do you find yourself needing approval from others to feel good about yourself? Yes_____ No_____
  2. Do you agree to do more for others than you can comfortably accomplish? Yes_____ No_____
  3. Are you perfectionistic? Yes_____ No_____
  4. Or do you tend to avoid or ignore responsibilities? Yes_____ No_____
  5. Do you find it difficult to identify what you’re feeling? Yes_____ No_____
  6. Do you find it difficult to express feelings? Yes_____ No_____
  7. Do you tend to think in all-or-nothing terms? Yes_____ No_____
  8. Do you often feel lonely even in the presence of others? Yes_____ No_____
  9. Is it difficult for you to ask for what you need from others? Yes_____ No_____
  10. Is it difficult for you to maintain intimate relationships? Yes_____ No_____
  11. Do you find it difficult to trust others? Yes_____ No_____
  12. Do you tend to hang on to hurtful or destructive relationships? Yes_____ No_____
  13. Are you more aware of others’ needs and feelings than your own? Yes_____ No_____
  14. Do you find it particularly difficult to deal with anger or criticism? Yes_____ No_____
  15. Is it hard for you to relax and enjoy yourself? Yes_____ No_____
  16. Do you find yourself feeling like a “fake” in your academic or professional life? Yes_____ No_____
  17. Do you find yourself waiting for disaster to strike even when things are going well in your life?  Yes_____ No_____
  18. Do you find yourself having difficulty with authority figures? Yes_____ No_____

http://www.k-state.edu/counseling/topics/relationships/dysfunc.html

Answering “Yes” to these may indicate some effects from family dysfunction. Most people could likely identify with some of them. If you find yourself answering “Yes” to over half of them, you likely have some long-term effects of living in a dysfunctional family. If you find yourself answering “Yes” to the majority of them you might consider seeking some additional help.

child_pic3

While  I have been waiting to start EMDR therapy (don’t ask!?) I have been exploring my childhood with my wife.

As opposed to simply talking about the past, I have been allowing the sometimes painful emotions to come up from past episodes in my life. Instead of intellectually distancing myself from these mainly traumatic or abusive events from the past, I have been simply allowing myself to feel these emotions however painful. And boy have some of them been painful!

It was my father’s anniversary of this very premature death last week, 28 years since he left this mortal coil. He died at a pivotal point in my life. I had just left home and started University, the future promised so much.

A lot of my future problems were not helped by not having a father figure to “guide” me in some ways or to square some parts of the past perhaps?

Who knows?

I can’t believe how much I grieved his anniversary this year. In fact, I cried on and off for two full days which is something I could never do before.

I wasn’t crying for him nor myself but for our shared loss. I just sat there and cried when I needed too, for the bottom of my heart. It didn’t kill me. Didn’t make me want to run away.

This is all a function of a decade in recovery, the ability to do something I couldn’t do before.  To sit with very painful emotions and just allow them to come and go.

I was told in early recovery that I would properly grieve the loss of loved ones, particularly my parents, as my recovery went on (they both passed on while I was drinking) but this was more than that.

I was not only grieving my father’s passing but also grieving my dysfunctional childhood.

According to a rather excellent book I have been reading recently  Healing the Child Within by Charles L. Whitfield, M.D.    we need to grieve our pasts in order to heal the past and move form a False Self to a more integrated True Self.

The false self may also be called the co-dependent self, unauthentic self or public self.

To quote and para phrase from this book ” Our false self is a cover up.  It is inhibited, contracting and fearful…It is envious, critical, idealized, blaming, shaming and perfectionistic.”

“Alienated for the True Self, our false self is other-orientated, i.e., focuses on what it thinks others want it to be…doesn’t know how it feels or does know and has censured these feelings as “wrong” or “bad”.

Our false self tends to be the “critical parent”…It pretends to be “strong” or even “powerful”. Yet its power is only minimal…it is in reality usually fearful, distrusting and destructive.”

“…our co-dependent self tends to repeatedly act our unconscious,  often painful patterns…it feels separate…we feel numb, empty or in a contrived state. We do not feel real, complete, whole or sane.  At one level or another, we sense that something is wrong, something is missing.

Paradoxically, we often feel like this false self is our natural state, the way we “should be”….”

In the next blog I will look at how this False Self is formed in our childhood interaction with our parents.

So how do we become the True Self?

Via a process of grieving according to this insightful book.

“A trauma is a loss…we experience a loss when we are deprived of or have to go without something that we have had and valued, something that we needed… or expected.

Minor losses or traumas are so common and subtle that we often do not recognize them as being a loss. Yet all of our losses produce pain or unhappiness: we call this train of feelings grief.

When we allow ourselves to feel  these  painful feelings, and when we share the grief with safe and supportive others, we are able to complete  our grief work and thus be free of it.”

I will blog on the actual grieving process in later blogs.

The purpose ultimately of this grieving process is to return one to the True Self. What does he mean by this? Again we can see by quoting and para-phrasing some extracts from this book.

“Our Real Self is spontaneous, expansive, loving, giving and communicating. Our True Self accepts ourselves and others. It feels, whether the feelings may be joyful or painful.  And it expresses those feelings. Our Real Self accepts our feelings without judgement and fear…

Our Child Within is expressive, assertive, and creative. It can be childlike in the highest, most mature, and evolved sense of the word…taking pleasure in receiving and being nurtured…

By being real, it is free to grow…

…when we are our True Self, we feel alive. We may feel pain in the form of hurt, sadness, guilt or anger, but we nonetheless feel alive.

Or we may feel joy, in the form of contentment, happiness, inspiration or even ecstasy.

…we tend to feel current, complete, real, whole and sane.”

I have had increasing flickers of these real emotions  on a daily basis the longer my recovery has gone on. It is great to see these as the real me.

It is certainly the me I want to be and will continue to strive to be.

The light at the end of the destination is me.

I am what I have been looking for.

 

This book is well worth reading if you also believe you were reared in a dysfunctional family and have suffered the shame-based trauma ever since.

This and other similar books were written in the 1980s and it is kinda strange there seems to have been a lot less in recent years as they describe shame-based family trauma so well.

It may be that these books need to be explored via neuroscience and neuro-psychology to update the effects family trauma has on the developing brain and how this maps onto later addictive behaviours, especially as my false self sounds kinda like my alcoholic and addicted self.

It is a real message of hope. When reading this book,  parts of my psyche that I have always labelled alcoholic could equally be reappraised as being this false self created for me via a co-dependency fostered in my own dysfunctional family.

It was suggested to me 8 years ago that I check out this Adult Child stuff but I resisted it.

It is only via researching neuroscience and seeing the demonstrable effects of child mistreatment that this stuff all kinda makes sense now. Certainly in a way I never understood before.

Perhaps I was not ready to understand. Perhaps the time is now to fully get to grips with my past.

When I say my past, this is not completely accurate as the past lives on in this false self. This false self is a negative, mal-adaptive self schema which I inherited from my parents and they probably inherited something similar from their own parents?

 

Healing The Child Within Discovery and Recovery For Adult Children of Dysfunctional Families by Charles L. Whitfield, M.D.