Generalized Anxiety vs. PTSD Anxiety

I have devoted a lot of space on this blog to writing about PTSD, C+PTSD, and healing from trauma.  I’ve been honest about my own journey towards wholeness.  What I share here is an attempt to elucidate the emotional experience behind C+PTSD in specific the anxiety experience.

What I can say for certain about healing from C+PTSD is that it is like a disease that remits and exacerbates.  I can go a year and not devote any time to thinking about the man who abducted and trafficked me, my time in captivity with him, or the events that happened to me therein.  I rarely think of my father or stepmother.  My mother doesn’t come to mind much either in the context of her abusive behaviors.  The domestic violence I experienced in my former marriage is no longer foremost in my mind.  It’s not the people or specific events that dog me now.

So, what is left after you deal with the details and process the events? What is left after therapy because there is something left?

I’ve had a hard time defining the quality of what remains until a friend sent me a link to this article yesterday:

We Can’t Keep Treating Anxiety From Complex Trauma the Same Way We Treat Generalized Anxiety

Vicki Peterson, the author of this article, writes:

No one gets a prize for “worst” depression, anxiety, trauma or any other combination of terrible things to deal with, and no one should suffer alone. With that in mind, there is a difference between what someone who has Complex PTSD feels and what someone with generalized anxiety or mild to moderate depression feels.

For someone dealing with complex trauma, the anxiety they feel does not come from some mysterious unknown source or obsessing about what could happen. For many, the anxiety they feel is not rational. General anxiety can often be calmed with grounding techniques and reminders of what is real and true. Mindfulness techniques can help. Even when they feel disconnected, anxious people can often acknowledge they are loved and supported by others.

For those who have experienced trauma, anxiety comes from an automatic physiological response to what has actuallyalready happened. The brain and body have already lived through “worst case scenario” situations, know what it feels like and are hell-bent on never going back there again. The fight/flight/ freeze response goes into overdrive. It’s like living with a fire alarm that goes off at random intervals 24 hours a day. It is extremely difficult for the rational brain to be convinced “that won’t happen,” because it already knows that it has happened, and it was horrific.

Those living with generalized anxiety often live in fear of the future. Those with complex trauma fear the future because of the past.”

This is absolutely true, and most therapists don’t seem to have a clue that there is a difference.  Perhaps this will help someone reading this…

I live with a smoldering anxiety that never leaves me.  It peaks when I’m happy.  Oddly, it ebbs when I’m too busy to pay attention to what’s going on around me, and I suspect that trauma survivors try to stay so busy because it prevents them from feeling this particularistic type of anxiety.  When I’m struck with the evanescent beauty of a moment, fear creeps in like a thief and begins to steal my joy.  I do not know how to escape any of this.  It might be strange, but I’ve tried to make friends with it.  I’ve wanted to understand it in an effort to defuse it.

As Ms. Peterson has said, I don’t fear because I’m generally anxious.  I do not have an anxious personality.  I fear because of what I’ve known.  Because of my past experiences.  When the worst-case scenario has already happened to you, then who’s to say it won’t happen again? Yes, I’ve survived extreme sexual torture, a kidnapping, human trafficking, and years of abuse in my family of origin.  I was duped by my ex-husband for twenty years and sexually assaulted by him.  My former therapist told me that I could clearly survive anything.  My brain fears that I will have to do it again.  Over and over again.  This is the flavor of anxiety that belongs to trauma survivors.  This is the nature of PTSD and C+PTSD anxiety.

I do practice mindfulness, but becoming mindful does not shut down my anxiety.  It often only makes me more aware that I’m fearful and feeling helpless.  It can promote the very hypervigilance I’m seeking to escape.

The remedy for both anxiety and trauma is to pull one’s awareness back into the present. For a traumatized person who has experienced abuse, there are a variety of factors that make this difficult. First and foremost, a traumatized person must be living in a situation which is 100 percent safe before they can even begin to process the tsunami of anger, grief and despair that has been locked inside of them, causing their hypervigilance and other anxious symptoms. That usually means no one who abused them or enabled abuse in the past can be allowed to take up space in their life. It also means eliminating any other people who mirror the same abusive or enabling patterns.

Unfortunately for many, creating a 100 percent abuser-free environment is not possible, even for those who set up good boundaries and are wary of the signs. That means that being present in the moment for a complex trauma survivor is not fail-proof, especially in a stressful event. They can be triggered into an emotional flashback by anything in their present environment.

It is possible (and likely) that someone suffering from the effects of complex trauma is also feeling anxious and depressed, but there is a difference to the root cause. Many effective strategies that treat anxiety and depression don’t work for trauma survivors. Meditation and mindfulness techniques that make one more aware of their environment sometimes can produce an opposite effect on a trauma survivor.  Trauma survivors often don’t need more awareness. They need to feel safe and secure in spite of what their awareness is telling them.”

Feeling safe and secure, for me, is key.  Safety and security in my relationships and environment seem to be the cure.  I know why feelings of relief and happiness trigger feelings of fear and, sometimes, emotional flashbacks.  My father deliberately cultivated feelings of happiness and relief in me in order to overturn them and further engage in abuse.  He was a pathologically cold man.  My mother’s emotional and personality disorders caused constant instability in our family environment.  As soon as any sort of happiness was achieved, it vanished just as quickly due to her inability to maintain a consistent mood or affect.  She also attempted suicide numerous times.  As soon as any family member felt relief that she might be doing better, she would attempt suicide again or lash out in talionic rage against someone in the family.  Nothing in my family life was ever predictable.  We consistently waited for “the other shoe to drop”.  I grew up on edge.  If there were ever a moment of happiness, I knew that my mother would ruin it.  Or my father.  That has proven to be true over the years.

Consequently, when I feel this rising panic borne of this nebulous but constant fear that follows me everywhere, it isn’t generalized.  It is quite specific, and I find myself saying, “I can’t go back to that.  I can’t do that again.  I won’t do that again.”  And, I feel frozen and terrified as if an old enemy has found me.  I feel a strong urge to cut all ties and run away mixed with a terrible almost existential fear that I will live out my life completely alone.  And, yet, I know that this will all pass.  It is, as I said, like an exacerbation of an autoimmune disease–an autoimmune disease of the mind and soul.

With that said, what is to be done? Well, I have therapized, read, studied, and pursued many roads over the last twenty years in order to answer that very question, and I’ve had a fair amount of success.  For the survivor of trauma, however, consistently establishing safety and security in your myriad environments and relationships is the number one thing to do to defuse anxiety and flashbacks related to trauma.  This will always be the first and last step.  It is also the first question to ask when you feel that familiar fear rise: “Do I feel unsafe or insecure anywhere in my life or in any relationship?”

I hope that this has been helpful to you.  Ms. Peterson’s article has been very helpful and validating for me.

As always, keep going…

Shalom, MJ

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The Essence of Healing

I wanted to write something germane to your life and process.  Something that might speak to you.  To anyone.  To everyone.  Perhaps this might.

I go to therapy every Tuesday.  I like to think that I’m ‘getting it done’ whatever ‘it’ is, but, as with all sorts of processes, I stalled.  I wasn’t wasting time per se, but I wasn’t hitting it hard.  I’ve been at this for two years now which shocks me.  I want to finish it…whatever ‘it’ is.

Once again, I was in the Hot Seat, and my therapist was looking at me as he does.

“So, what would you like today to be about?” he asked.

I inwardly groaned.  I knew what was on my mind.  Fear.  I was afraid.  I had been feeling dread for a few weeks.  A nameless dread.  A creeping anxiety that would ooze into me and out of me at the same time until I felt paralyzed in both my body and life.  I couldn’t make choices.  It’s not that I couldn’t make good choices.  I couldn’t seem to make any choices.  As much as I’ve learned about cognitive distortions and mindfulness, I still felt caught up in the washing machine of my own inner turmoil.  It wasn’t depression exactly.  It felt like a flavor of anxiety.  A big anxiety.  Generalized.  A suffocating fog that shrouded every area of my life.

I knew what I was afraid of, and I feared that if I talked about it, then I might empower it.  I decided that I didn’t want to talk about it or even give it room; and yet it was taking up all too much room in me.  So, I attempted to name it.

I admitted to my therapist that I was very afraid that I would break apart at some point.  Now that I’ve written it out it seems rather harmless or silly, but that’s not how it feels.  The ‘what if’ questions were dogging me relentlessly.  “What if something happens to me that I can’t recover from? What if I can’t endure the pain? What if I am dehumanized to such a degree that I become a dispirited, soulless, desolate woman? What if something happens that I simply can’t bounce back from?” As soon as these questions begin, I freeze.  I have no answers for them.  I hold my breath.  I begin to feel a profound fear that shuts down my thinking brain and activates my limbic system.  There is no longer any reason.  Only a warped instinct that seeks to hijack all my rational processes and turns me into a reptile.

For months, I thought that if I didn’t acknowledge it, then it might stop.  It did not.  It festered.  I cried trying to describe it.  I thought that perhaps just engaging in the act of sharing my turmoil might lessen the burden.  It did not.

After I had revealed my fears to my therapist, he looked at me quizzically.

“So, you are afraid of breaking? That something might happen to you that is so terrible you will not be able to recover? That you will become a shell of a woman?” he asked.

I nodded.

“Hasn’t that already happened to you?” he asked looking somewhat confused.

“Has it?” I asked beginning to feel confused as well.

“Well, how desolate were you after you returned from being abducted?” he asked.

“Oh my gosh, I was definitely shattered after that,” I said.

“And how empty and in despair were you when you came to see me two years ago?” he asked.

“I was about as low as I’ve ever been,” I admitted.

“How low were you when you cut your father out of your life? And your mother? How much anguish have you known all in all? How existentially destroyed have you felt?”

I had no answer.  I just sat there crying.

“So, it’s pretty clear that you have what it takes to heal, isn’t it?” he asked.

I didn’t consider that.  I didn’t want to consider that.  I felt exhausted.

“There is a limit to how much a person can actually experience in terms of pain.  In terms of physical pain, a person will pass out once that limit is reached.  In terms of emotional pain, you’ve probably reached that.  There isn’t another level to your pain.  You’ve been there.  You’ve done that.  You already know what it’s like, and you’ve already recovered from it,” he explained.

Honestly, I did not know that.  I kept anticipating an exponential increase in emotional pain.

“So, I have what it takes? I don’t need to be fearful that something will break me? I’ve already been faced with the worst and survived it?” I asked feeling suspicious.

“Yes.  Your fear is not based in truth although your past experiences certainly legitimize your anxiety.” he said.

“I’m afraid that I’ll have to do it again.  That something so profoundly terrible will happen to me that I’ll have to rebuild myself yet again, and I’m so afraid of paying the price again.  It is so hard.  It is excruciatingly painful.  I can’t begin to adequately describe how hard it was to come back and try to live again after being abducted and everything that entailed.  After my marriage.  After everything that happened within that relationship,” I cried.

“Do you know that you have what it takes to come back though? Should your worst fears come true? Do you have what it takes?” he asked leaning towards me.

And that’s when I was still.  I sat with the very things that had been paralyzing me.  I went back into the memories of my lowest, most broken places.  The moment when I knew that my captor was going to kill me if I didn’t make a break for it.  The moment in my marriage when I knew I was going to die from an autoimmune disease if I didn’t get out.  What did those moments have in common? How exactly did I survive and make it to where I am now?

Clarity.  In those moments, everything became crystal clear for me.  I felt little to nothing in those moments.  Suddenly, a much deeper instinct came online, and everything came into focus.  I heard a clear voice: “Run.  Get out.  Do whatever it takes.  It’s time.”  And, I did.  Worries about the future fell away.  It was very much like standing in the eye of a storm.  I grew up in East Texas, the land of hurricanes.  When I was a child, I once went outside when the eye of a hurricane was passing over our neighborhood.  The winds had been powerful and violent, and debris, pine needles and branches covered everything within walking distance.  The calm that descended upon us as the eye passed over was chilling.  My mother yelled at me to come inside, but I wanted to experience the ephemeral peace of these legendary storms.  This is comparable to what happened to me when I realized that I had to make big decisions about my own survival be it in life and death circumstances or in abusive relationships.

My therapist called those experiences finding “my essence”.  And, that is what I would leave you with.

I am convinced that humans can survive anything, but I have never been interested in survival.  I have always wanted to live a meaningful life, and my definition of a “meaningful life” has evolved over time.  Nonetheless, the idea that we have an essence that is unique to us and cannot be obliterated or annihilated by trauma encourages me.  It is fear of annihilation that was at the root of my profound anxiety.  How much betrayal could I tolerate? How much suffering could I overcome? What if I reach a point when I finally succumb to suffering and am left in desolation for the rest of my life?

I have to ask those questions as I venture into the darkness in therapy because, at times in therapy, we will stand eye to eye with the monsters.  Only you know who your monsters are, but I suspect that we all have at least one.  And, our monsters know our names and our softest spots.  They know how to kill us be it metaphorically or in real life.  Your courage and bravery don’t emerge when you’re on top of the world embracing the joy.  Your courage, your essence, is forged when you’re blinded by the utter darkness of your fear, pain, and suffering, and yet you choose to get up and act even if you are guaranteed nothing but more fear, pain, and suffering.  In my experience, that’s when your essential self lights up, and you can actually start to see again.

I am still wrestling with my anxiety, but it’s getting better.  No one said that the road to building a better life would be easy or even a fair process, but I can state this with certainty.  You will know what you’re made of as you engage in this.

Your essence will come forward, and you’ll find that you were capable of a lot more than you ever thought.

 

 

 

The Event Horizon

I had coffee with a friend tonight.  I think it was just supposed to be an easy “how’ve you been” sort of coffee, but that’s not what it was.

How do I explain this? I have met few people in my life who experientially understand deep trauma, and, realistically, that’s a good thing.  I would rather not meet people who have suffered profound trauma.  The world needs less of that.  I would rather not cause my therapists to acquire secondary trauma just by being my therapist, but it happens.  Seeing one’s therapist cry is not a goal.  It’s painful.

So, my friend and I circumlocuted.  We talked around the subject of our current therapeutic circumstances because neither one of us wanted to actually get down to the nitty gritty.  We know each other’s stories, but neither one of us wanted to discuss details.  We are both neck deep, yet again, in the therapeutic process.  I know why she’s in therapy.  She knows why I’m in therapy.  We’ve both been riding the therapy train on and off for years.  We’re both tired of it.  When does it end? It does end, doesn’t it? Eventually?

What choice, however, do we have? Complex PTSD does not heal itself, and C+PTSD is not the same thing as PTSD.  There are different kinds of trauma.  Acute trauma exists.  It sticks with you for a while.  It’s painful, and it throws a wrench into the physiological works.  I don’t minimize it at all.  Profound trauma, however, that annihilates one’s identity is a different animal.  It changes a personality.  It can change the course of a life.  It can leave a person forever broken if not effectively tended to.

I wish I could understand it.  Why do some people find functionality in the midst of it and others wither and die? Theories abound, but that’s about it.  How is it that some people left Auschwitz, for example, immigrated to America with no family left alive, and started over successfully? How is it that refugees from war torn countries build new lives for themselves after watching family members, friends, and fellow countrymen die in front of them in sometimes very grotesque ways?

I have been a witness to extraordinary violence to both animals and humans, and I will always carry those memories.  That’s what the EMDR will be addressing.  My friend has as well.  She doesn’t know anyone else who has experienced anything close to what she has except me and I her.  And, much to my surprise, she actually understood what I meant by the term the Event Horizon.

What is the Event Horizon? Well, it’s the name I’ve given to an all-encompassing emotional experience that overtakes me out of the blue.  I dread it.  I first experienced it after my ex-husband moved out.  It was very surprising to me.  I was all but elated that I was free from the oppressive circumstances that I had no idea what this emotional shit storm was about.  It felt like a primal fear had taken hold of me, and the overwhelming nature of it was so strong that I felt like I might die.  My friend knew exactly what I was talking about.  She had the same experiences.

Really? I was relieved that I wasn’t alone.  I asked her what she thought this was about.  When I told my therapist about it, he just nodded and said, “It’s trauma.”  Trauma?! Well…I’ve been dealing with profound trauma since toddlerhood.  I’ve never experienced this before.  Why now? Her input? How many rounds of major trauma have I experienced? I’m on my third go-round: 1) Mother and Father 2) Abduction and trafficking 3) Domestic violence.  I think the domestic violence got to me in a special way, hence, the onset of the repeated Event Horizon experiences.

What fuels the Event Horizon experiences? Dread.  Fear.  Panic.  Inordinate grief.  Profound emotional pain.  The brain spins its tales.  All brains tell stories.  Brains do that.  My brain spins nasty tales based on past experiences except my past experiences are so extreme that, when in the midst of one of my Event Horizon experiences, I can’t be reasoned with.  I simply have to white knuckle it until it passes.  The stories my brain throws at me are all plausible based on past experiences.  Unfortunately, I’ve been kidnapped.  I’ve been raped numerous times in the trafficking environment.  I’ve endured the “breaking in” process.  I’ve seen another person murdered.  I’ve endured torture.  I’ve been betrayed by people I trusted implicitly.  These are experiences that are very difficult to process.  They don’t make sense.  They are hard to put meaning to.  What’s more, they profoundly erode one’s ability to trust others, and, honestly, they leave me feeling as if I’m on the outside looking in in terms of social interactions.  That is one of the primary and lasting effects of this type of trauma.  Where does one belong? What is normal in terms of life experiences? I can tell you what is normative for my life experiences.

Intellectually, I know what should be normal and healthy, but, on a deeper level, I wish I had more normative life experiences.

This is exactly why I will forge ahead with EMDR.  All of these life experiences, as bad as they were, can be adaptively processed and should be.  I don’t want to experience the Event Horizon anymore, and I don’t want to maladaptively identify with this trauma any longer either.

So, as I forge ahead, I encourage and even challenge you to do the same.  No matter what your trauma looks like or feels like to you, you don’t have to live a life beholden to it.  I refuse to.  So, I will keep going.  No matter how hard it becomes.

Fight for the life you want.  That’s a fight you and I will never regret.

Getting Triggered

I thought I might document what a triggered response looks like.  Why? Well, for a few reasons.

I have PTSD of the long-term variety.  I wish it were acute, but it isn’t.  I can contain like a pro.  I can hide my emotional suffering and mask very well while internally boiling over like a pot of pasta.  I’m very skilled at “riding the wave”, but, when you’re triggered, it takes a lot of insight to know that this is what’s happening to you because your thinking brain is no longer in charge.  A much older part of your brain is calling the shots when you get triggered.

I learn by experience and through other people’s experiences–through their narratives.  It also encourages me because hearing other people’s stories reminds me that I’m part of a common experience.  I’m not alone.

So, let’s dive in, shall we? Let’s talk about it.

The Trigger.

I’ve been triggered all weekend.  How did it begin? It started earlier in the week.  The stage was being set.  

I had an epiphany in therapy.  I saw a rather grand deception that my ex-husband had perpetrated upon me, and my mind made a connection.  My mother had done the same thing.  I was duped twice.  In a terribly cruel way.  I spent an hour in my bedroom quietly falling apart (I am a secret cryer).  It wasn’t one of those easy cries either.  It was the full-body, ugly, heaving cry.  You know the type.  Where you feel like your soul and body are going to split from the pain and the interstitial space will form a black hole and consume you from the inside out?

I felt defeated.  Utterly erased.  I felt ontologically insignificant and alone.  Betrayed? That wasn’t the right word, but that could qualify it to a degree.  When I am in the middle of these types of emotional events, I do not like to be found out.  I feel far too vulnerable.  I fear vulnerability.  That comes from having been deceived and wounded too many times by people close to me.  I can’t let myself be seen like that, but, as I was pulling myself up and out of my personal darkness, my phone rang.  A person who is very close to me was calling.

“I’ll fake it.”

And, I managed to hide it well except for that tell-tale stuffy nose.

“Why is your nose stuffy? Are you getting sick?”

“No…”

“Allergies?”

“Uh…no…”

Silence.  He’s putting two and two together.

“Honey…talk to me…”

I didn’t want to talk.  This is my darkness.  And my darkness is like a black gravity.  I can barely escape the event horizon.  I would never subject another person to it.  I did what I deign never to do.  I talked, and I felt too wide open.  Too vulnerable.  I can barely regulate that particular feeling.  I began to feel terrified.  Like I couldn’t defend myself or hide.

This is the beginning of feeling triggered for me.  The beginning of flight or fight. Why?

When I was very young and up until my adult years, both my parents would use very personal information against me for the purpose of emotional blackmail and humiliation.  My ex-husband would use my personal information differently.  He would pretend to feel close to me and then withdraw both physically and emotionally sometimes for months at a time claiming that he was overwhelmed after he had insisted that I share what was bothering me.  In all these instances, I was blamed and made to feel somehow defective.  He actually accused me of being broken implying that no one else could tolerate me but him.  This is a common abuser’s tactic.

My solution at the time? The Rules.  Never tell anyone the truth about yourself.  Never show weakness.  Never ask for help.  Never let anyone see you cry.  Always appear ‘fine’.  Never give anyone anything that they can use against you.  What is this an example of?

“When triggers hit, they’re usually unexpected and beyond your control.

And what usually happens next, right after the trigger: You react with old ‘defenses’ or ‘survival strategies’ that are no longer helpful or healthy (if they ever were), and that only make things worse.” (1in6/Getting Triggered)

After doing what non-PTSD folks do and telling the truth, I became hypervigilant, and I couldn’t self-regulate well.  I experienced something of a vulnerability hangover.

What happened next?

My close friend went away for the weekend after talking to me every day, and I’ve heard nothing from him for three days.  Rationally, this feels normal.  To my hypervigilant brain, this felt a little too much like what my ex-husband would do to me, and I tripped and landed on my amygdala.

I became triggered.

“The trigger is always real. By definition, a trigger is something that reminds you of something bad or hurtful from your past. It ‘triggers’ an association or memory in your brain.

But sometimes you are imagining that what’s happening now is actually like what happened back then, when in reality it’s hardly similar at all, or it just reminds you because you’re feeling vulnerable in a way you did when that bad thing happened in the past.

Just as triggers range from obvious to subtle, sometimes we’re aware of them and sometimes we’re not. Your body may suddenly freak out with a racing heart and feeling of panic, but you have no idea what set off that reaction. You may suddenly feel enraged in a slightly tense conversation, but be unable to point to anything in particular that made you angry. Sometimes you can figure it out later (for example in therapy), and sometimes not.

Also, though we may not realize that we just got triggered, or why, it can be obvious to someone who knows us well, like a partner, friend, or therapist. When you feel comfortable doing so, with someone you really trust, it can be very helpful to talk over situations where you seemed to over-react.

Triggers that involve other people’s behavior are often connected to ways that we repeat unhealthy relationship patterns learned in childhood. Things that other people do – especially people close to us and especially in situations of conflict – remind us of hurtful things done to us in the past. Then we respond as if we’re defending ourselves against those old vulnerabilities, hurts, or traumas.” (1in6/Getting Triggered)

My ex-husband would go on trips, and I wouldn’t hear from him for the entire time.  He would return and treat me like a roommate.  My mother ignored me for almost five years.  My being as transparent and open as possible was something I tried to model in my relationships with them, and it was always used against me.  I found myself spinning out.

“The power of a trigger depends on how closely it resembles a past situation or relationship, how painful or traumatic that situation or relationships was, and the state of your body and brain when the triggering happens.

Reactions can be big and fast, or creep up on you slowly.

If you’re feeling very calm and safe, the reaction will be much less than if you’re feeling anxious and afraid. If you’re feeling little support or trust in a relationship, your reactions to triggering behaviors by the other person will be much greater.

A trigger can bring out feelings, memories, thoughts, and behaviors.

Other people might have no idea that you’ve been triggered, but you could be struggling with terrible memories in your head. Or you could suddenly have all kinds of negative thoughts and beliefs about the other person and/or yourself, like, ‘I never should have trusted her,’ ‘Every woman will stab you in the heart,’ ‘What a loser I am,’ etc.

Reactions to triggers can be very dramatic and rapid, like lashing out at someone who says the wrong thing or looks at you the wrong way. In these cases, your brain has entered a ‘fight or flight’ state and the part of your brain that you need to think clearly, to remember your values and what’s important to you, and to reflect on your own behavior, is effectively shut down.

But responses to triggers can also creep up on you, playing out over hours and days, and get worse over time.” (1in6/Getting Triggered)

I am still in a triggered mindspace.  Thoughts like this are ruling my brain:

  • “I should have never said anything.”
  • “I want to run away.”
  • “There is no point…”
  • “I can’t do this…”
  • “I will be alone for the rest of my life.”

If you examine those thoughts, then you can observe that these thoughts are all examples of “flight”.  I am trying to run away in my brain, and, currently, I can’t seem to put a stop to it.  Why? Because I’m triggered.

The good news? I’m not expressing any of this externally.  I’m observing this.  I’m trying not to judge it.  I feel physically ill.  I’ve had a seven-day migraine, and I’m now taking prednisone which may be contributing to my elevated mood.  Prednisone does contribute to mood regulation and lability.

This is how triggers can come about.  This is what they look like in the moment.  What can we do about them because, to be honest, they are a pain in the ass?!

Here is some excellent advice:

A stress response can trigger avoidance in the form of denial, dissociation, bingeing, substance abuse, self-harm, and other behaviors in an effort to get rid of feelings. These avoidance behaviors, in turn, can trigger stress responses inside because they are reminders of old efforts to deal with painful feelings. The stronger the response, the stronger the impulses to avoid. The effort spent avoiding leaves little energy to manage day-to-day life, and the result is increased stress responses that increase impulses to avoid. What a mess!

Fortunately, self-regulation skills can help you to tolerate (sit with) and control intense feeling states that have led to avoidance or dissociation in the past. You can learn to feel and control the intensity of your emotions to reduce avoidance. This will help reduce the frequency and intensity of traumatic stress symptoms and experiences. This handbook will teach you the relationship between dissociation, numbing, avoidance, and traumatic stress, and will help you to replace old, currently problematic coping (e.g., dissociation, avoidance, etc.) with conscious, more effective methods of coping (Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress, p.28)

Check out Dr. Jim Hopper’s website, Mindfulness and Kindness.

And this book:

Overcoming a Sense of a Foreshortened Future

I have been thinking about this idea of The Reboot, which I wrote about in my previous post.  Clearly, I’m not entirely empty in my old noggin.  I had an actual thought and pondered it, too! Have I ever felt like this before in my life?  Why, yes, I have!

After I graduated from college I felt a lot like I do now.  Aimless.  Anxious.  A bit scared.  That’s a good question to ask by the way: “Have you ever felt like this before?” It helps you gain insight into what’s going on internally and responsively.  We often know a lot about ourselves with the advantage of hindsight.  Looking back upon my 22 year-old self, I know exactly why I felt so untethered and aimless after I graduated.  I can blame that lesser known symptom of PTSD called ‘a sense of a foreshortened future’.  I’ve written a few blog posts on this topic over the years.  It has dogged me relentlessly, and I’ve never been able to fully shake it off.  It’s very difficult to even describe how it feels.

I think that the best way to describe what living with a sense of a foreshortened future feels like is to relate it to the concept of object permanence.  Object permanence is the term used to describe the concept that objects exist even though they can no longer be seen or heard.  This is why, for example, babies love the game peek-a-boo.  Very young infants have not yet developed object permanence so they, therefore, do not know that their mother, for example, exists when they cannot see or hear her.  Peek-a-boo must then be a very thrilling game for babies if you think about it.

Apply the concept of object permanence to your own concept of survival.  Imagine playing a metaphorical game of peek-a-boo with your life.  One day your sense of security is in front of you.  The next day it’s gone.  Another day, it’s been given back to you.  Another day, it’s vanished.  This endless game of “Will I live or will I die?”, or at least a perceived sense of dying, begins to define one’s reality.  Nothing is permanent.  Security and a sense of being loved, the most coveted and needed objects, are never permanent.  What happens to a person who lives like this? If a person can develop Stockholm Syndrome in as little as 72 hours which shows just how little it takes to completely break down a personality, then what do you suppose happens to the neural networks of a person’s brain who is exposed to long-term trauma?

“Children learn their self-worth from the reactions of others, particularly those closest to them. Caregivers have the greatest influence on a child’s sense of self-worth and value. Abuse and neglect make a child feel worthless and despondent. A child who is abused will often blame him- or herself. It may feel safer to blame oneself than to recognize the parent as unreliable and dangerous. Shame, guilt, low self-esteem, and a poor self-image are common among children with complex trauma histories.
To plan for the future with a sense of hope and purpose, a child needs to value him or herself. To plan for the future requires a sense of hope, control, and the ability to see one’s own actions as having meaning and value.  Children surrounded by violence in their homes and communities learn from an early age that they cannot trust, the world is not safe, and that they are powerless to change their circumstances.  Beliefs about themselves, others, and the world diminish their sense of competency.  Their negative expectations  interfere with positive problem-solving, and foreclose on opportunities  to make a difference in their own lives. A complexly traumatized child may view himself as powerless, “damaged,” and may perceive the world as a meaningless place in which planning and positive action is futile. They have trouble feeling hopeful. Having learned to operate in “survival mode,” the child lives from moment-to-moment without pausing to think about, plan for, or even dream about a future. ” (The Effects of Complex Trauma)

What can we learn from this in order to overcome something as complex as a diminished future orientation? I think that asking questions of ourselves is the place to start:

  • How do I feel about myself (do I feel worthless or inherently bad?)
  • How would I rate my self-esteem?
  • What is my self-image like?
  • Do I blame myself for any past mistreatment or abuse? Do I make excuses for the person or people who hurt or neglected me? (e.g. “Well, s/he had a hard life.” or “They didn’t mean to do what they did.”)
  • Do I feel hope about my future?
  • Do I feel that my present actions can affect change somewhere as in what I do matters?
  • Do I feel like what I say or do matters?
  • Do I feel powerless?
  • Do I feel competent? Do I feel capable?
  • Do I feel like damaged goods? Do I feel broken? Has anyone ever told me that I was broken?
  • Do I feel like no matter what I do it won’t make a difference anyway so why bother?

Anything that disempowers you in the present will detract from your ability to see into your future.  It keeps your mind looking into your past.  You become locked into a past/present paradigm because the mind, from what I have understood, wants to solve the unsolvable problems .  And, what are these unsolvable problems?

  • mother/hate
  • father/abuse
  • uncle/sex
  • grandmother/neglect
  • teacher/shame
  • grandfather/violence

We are supposed to be loved and nurtured by the adults in our lives so that we can grow up to reach and even exceed our potential.  The mind will never be able to resolve and overcome the impossible and diametrically opposed realities that we knew.  There are no answers for them.  There is no way to balance these equations.  Then what? We get stuck in an endless feedback loop of shame, self-blame, sickness, and slow deterioration seeking attachment because we are made for attachment, and, yet, we can’t.  We survive.  In the now.  Stuck in the past because we need to find an answer.  We must fill in the variables.  Solve the problems.  Do we exist outside of what we experienced? Are we defined by these bad experiences? Are we permanent? Is anything that anyone says even real or believable?

Who are we anyway?

It is like living in a constant identity crisis.  Until we find a way to stop the cycle.

How do you put a stop to this and begin imagining a future? Oh, isn’t that the question!

I can only speak for myself.  If you were exposed to complex trauma for an extended period of time, then I would suggest taking those questions to a therapist trained in dealing with trauma.  Not every therapist is equipped to help you.  I would also suggest meditating on the idea that you do have a future.  There is time ahead of you.  Also, there is no rush to figure it all out today.  Whatever dreams you may have held dear at some point in your life might still be possible, and, before you naysay, ponder this.  Even if it takes you ten or twenty years to accomplish something, don’t be so quick to give it up.

The time is going to pass anyway–whether you pursue your desires or not.

The question then is: What do you want to do while the time passes? You do have a say even if you feel like you don’t.  This is how you begin to overcome a sense of a foreshortened future.  It’s not easy.  In fact, it might be incredibly daunting.

It is, however, oh so possible.

Further Reading:

Effects of Complex Trauma

 

 

 

 

 

 

Abandoning the Self

I live in Minnesota.  I overheard someone say once that we work for our seasons.  That’s an oddly funny thing to say, but, if you live here, then you’ll understand the meaning in that sentiment.

As a seasonal change approaches, the current weather patterns seem to want to hold on almost as if they have a personality.  Summer just won’t leave! It’s sticking around in October like a bad guest! And yet the warm temperatures seem to loiter in the atmosphere in spite of midnight frosts.  We all begin to assume that this year Old Man Winter will stay in his cave.  This will be the year that Minnesota tricks winter.  Halloween approaches and the kids are wearing short sleeves! We’ve done it!

And then it happens.  The cold suddenly appears and refuses to go.  Just like that.  Where did all the lovely warmth go? No transition? No warning shot across the bow? Darkness at 5:30 and frigid mornings? I guess winter didn’t forget us after all.  Shoot..

This is how I’ve experienced relational changes as well.  Everything seems to be fine.  It’s all going along smoothly, and then suddenly it’s not.  One person becomes emotionally distant or cold or angry or withdrawn, and there was no warning; or if there was, then the warning was missed.  You’re left wandering around in the desert of abandonment wondering what happened? Where did all that lovely relational warmth go? Why is it suddenly cold?

The only conclusion? I must have done something wrong.

But what happens when the other person has left the relationship be it through the Silent Treatment, functional dissociation, emotional neglect, or actual physical abandonment? What does one do then?

That’s a damn good question.

I am in this situation at present.  In my marriage.  My husband has severed the emotional and physical connections between us by way of what looks like functional dissociation, emotional neglect, and certain passive aggressive behaviors.  At this point, he hardly speaks to me.

I have no control over his behavior.  What can I control? Myself.  What has become fascinating to me is my internal world and thought life during this very uncomfortable and painful season.  Initially, I felt adrift and confused.  I felt like everything was my fault although I couldn’t figure out what I’d done wrong.  I found myself saying, “This feels so familiar.  I don’t like this.”  I observed latent PTSD responses quicken and come to the surface.  I began startling easily again.  I was very anxious and edgy.  I was not sleeping well.  I started having nightmares.  I would retreat into the bathroom to cry.

Clearly, what was happening in this relationship reminded me of something I had experienced prior.  Something traumatic.  I hated to admit it to myself, but I knew exactly what felt familiar.  My husband was reminding me of my father.  I could scarcely accept it.

What I am describing here is called an emotional flashback.  A few days ago, I went looking for any shred of information to help me understand the machinations of an emotional flashback in the context of PTSD, and I discovered a treasure trove.  A therapist specializing in treating PTSD and C+PTSD has written numerous articles on this dynamic as well as other aspects of C+PTSD.  I have spent that last few days reading through them, and I want to refer you to them.

According to Mr. Walker in his article Emotional Neglect and Complex PTSD, emotional neglect is the core wound of C+PTSD:

Minimization about the debilitating consequences of a childhood
rife with emotional neglect is at the core of the PTSD denial onion.   Our recovery efforts are impeded until we understand how much of our suffering constellates around early emotional abandonment around the great emptiness that springs from the dearth of parental loving interest and engagement, and around the harrowing experience of being small and powerless while growing up in a world where there is no-one who’s got your back. Many survivors never get to discover and work through the wounds that correlate with this level, because they over-assign their suffering to overt abuse and never get to the core issue of emotional abandonment.  As stated above, this is especially true when they dismissively compare their trauma to those who were abused more noticeably and more dramatically. [This is particularly ironic in light of the fact that some individuals can suffer a modicum of active abuse without developing PTSD, if there is one caretaker who does not emotionally neglect them]. (Walker, Emotional Neglect and Complex PTSD)

If his thesis is true, then repeated exposure to emotional neglect could trigger emotional flashbacks.  I have seen this in other people.  Why have I not seen this in myself as it pertains to one of my core relationships?

It is this statement that I want to share almost more than any other:

Emotional neglect, alone, causes children to abandon themselves, and to give up on the formation of a self. They do so to preserve an illusion of connection with the parent and to protect themselves from the danger of losing that tenuous connection. This typically requires a great deal of self-abdication, i.e., the forfeiture of self- esteem, self-confidence, self-care, self-interest, self-protection. (Walker, Emotional Neglect and Complex PTSD)

This is a stunning statement because it doesn’t just apply to children.  This applies to adults as well.  I sent this article to a friend last night who has worked with survivors of myriad forms of abuse.  I asked her, “How many survivors do you know who can’t spend money on themselves? How many don’t take care of themselves? How many have poor boundaries? How many don’t make decisions in their best interest? How many have little to no self-esteem?” Her answer? “Almost all.”  And, of course, how many were abused as children in some way even through emotional neglect which is perhaps the weightiest of all forms of abuse albeit covert.

I was once listening to two survivors talk about how they never spend money on themselves.  They feel terribly guilty about it. Everyone else came first.  They were laughing about it and declaring this as if it were a badge of pride.

“I don’t spend a dime on myself!”

“Oh, well, neither do I!”

“Well, I only go to Goodwill to get my clothes!”

“Oh, well, I just patch mine up!”

The idea that self-esteem, self-protection, self-care, self-interest, and self-confidence as values that are relevant and appropriate because they cultivate dignity were foreign and even dismissed.  Perhaps even shunned! Why? Because you can’t have a developed sense of self if you believe that your identity has to be sacrificed for a relationship to succeed.  That is exactly what happens when you live in an abusive relationship, and emotional neglect is abuse as is longterm exposure to passive aggressive behavior because that is another form of emotional neglect.  So what is done in an attempt to stay in and preserve such a relationship? The self is abandoned.

The result of this self-abandonment?

Emotional intelligence and its cohort, relational intelligence, never get to develop, and children never learn that a relationship with a healthy person can become an irreplaceable source of comfort and enrichment. Moreover, the appropriate management of the normal emotions that recurrently arise in significant relationships is never modeled for them. Emotional intelligence about the healthy and functional aspects of anger, sadness, and fear lies fallow.

Moreover the receptor sites for receiving love and caring from others often lay dormant and undeveloped. Emotionally abandoned children often devolve into experiencing all people as dangerous, no matter how benign or generous they may in fact be. Anyone can automatically trigger the grown-up child into the deeply grooved patterns of perfectionism and endangerment engendered by their parents. Love coming their way reverberates threateningly on a subliminal level. If, from their perspective, they momentarily “trick” someone into seeing them as loveable, they fear that this forbidden prize will surely be taken away the minute their social perfectionism fails and unmasks some normal flaw or foible. (Walker, Emotional Neglect and Complex PTSD)

What is to be done about it?

It is important to emphasize here that real intimacy, and the healing comfort it alone can bestow, depends on showing up in times of vulnerability –and eventually, and most especially, in the flashbacked-times of feeling trapped in the fear, shame and depression of the abandonment melange.  In this vein, I had to painstakingly practice for years showing up in my pain and abstaining from my childhood default positions of running or hiding or camouflaging with substances whenever I was in the grips of the fear, shame or depression of the abandonment melange. How else would I ever have learned that I was loveable and acceptable in all aspects of my experience, not just in the social perfectionism of my people-pleasing codependence?

And of course, like most survivors, I was ignorant at first that I was experiencing the emotional pain of the abandonment melange; how could I help but conceal it? Yet, even after considerable de-minimization of my childhood abuse/neglect picture, I still remained convinced for a long time that everyone but my therapist [who in deep flashbacks, I also recurrently distrusted] would find me abhorrent if I presented myself authentically in such condition…Effective recovery does typically involve working at various levels at the same time. De-minimization is a lifetime process, and remembering a crucial instance of being abused or neglected may occasionally impact us even more deeply on subsequent remembering as we more fully apprehend the hurt of particularly destructive parental betrayals. (Walker, Emotional Neglect and Complex PTSD)

There is a phrase for this in DBT–distress tolerance.  We have to dedicate ourselves to learning to tolerate emotional distress so that we can consistently show up in our lives while feeling our pain without, as Walker said, defaulting to maladaptive coping strategies.  Personally, I like to use functional dissociation.  It works, but it is a form of resisting the pain which only leads to prolonged suffering.  We need to follow the breadcrumbs of pain in order to find the source so that we can ultimately deal with it.

Ultimately, Walker asserts that it is possible to recover from Complex PTSD:

There is also growing evidence that recovery from Complex PTSD is reflected in the narrative a person tells about her life. The degree of recovery matches the degree to which a survivor’s story is complete, coherent , emotionally congruent and told from a self- sympathetic perspective. In my experience, deep level recovery is often reflected in a narrative that places emotional neglect at the core of the understanding of what one has suffered and what one continues to deal with. It is a very empowering accomplishment to really get the profound significance of childhood emotional neglect – to realize in the moment how a flashback into bewilderment, panic, toxic shame, helplessness, and hopelessness is an emotional reliving of the dominant emotional tone of one’s childhood reality. Like nothing else, this can generate self-compassion for one’s child-self and one’s present-time self, kick-starting the process of resolving any given flashback. This also assuages emotional neglect by providing the self with the essential missed childhood experience of receiving empathy in painful emotional states instead of contempt or abandonment. This, in turn, proves that there has been significant deconstruction of the learned, unconscious habit of pervasive self-abandonment. (Walker, Emotional Neglect and Complex PTSD)

Validation, validation, validation with a huge dose of self-validation.  In this context, it is vital that we begin to see where we are living with crazymaking, accusations, denial, and manipulation.  It is very hard to construct a proper narrative of events when the people closest to you are questioning your perceptions and gaslighting you.  This is where a skilled therapist can be invaluable.  We aren’t born knowing how to act or what to do in the context of relationships.  We aren’t even born knowing what is best for us or what our goals should be.  So much of how we react in the present is informed by unresolved past events.

It becomes a chicken/egg problem.  Am I upset now because of what this person is doing to me, or am I upset now because this event reminds me of something that was done to me in the past? Everything is now amplified, and I’ve lost my perspective.  Would I be this upset if this simply felt like an isolated incident rather than an incident attached to a series of familiar events happening to me all over again?

Learning to stay present by cultivating a mindfulness practice, developing curiosity around behaviors and choices so that we can ask questions like the aforementioned, and building a safe and supportive community even if it’s only a therapist are steps that we can take so that we can engage in a dynamic and active recovery process.

Valuable Tools:

 

 

 

 

 

 

PTSD and DESNOS

Recovery is something I have talked about on this blog.  A lot.  If we have experienced an iota of abuse or trauma in our lives, then we will have to commit to the process of healing and recovery.  That’s life.  That’s how we clean up our metaphorical rooms (See Cleaning Up Messes).

I carry around a diagnosis of PTSD.  PTSD isn’t supposed to be longterm.  One experiences a traumatic event.  How one handles that experience is what often leads to the PTSD diagnosis.  Studies have revealed that the size of one’s hippocampus often determines how one bounces back from a trauma (Hippocampal volume and resilience in PTSD).  One person can witness or experience the same act of violence as another person yet process the event differently.  Person A might get over it.  Just a bad memory and a weird story to tell at a bar one day.  Person B might not get over it at all and end up on medications and in therapy with PTSD.  All because Person A’s hippocampus was bigger than Person B’s.  The good news here is that one of the richest sources of neurogenesis in the brain lies in the hippocampus.  Engage in a healing process and take advantage of that neurogenesis.  The nature of the trauma also matters as does the age at which the trauma occurred.  A car accident or a natural disaster is very different from trauma within a familial or intimate relationship.

So, what is PTSD exactly?

“For an individual to be diagnosed with PTSD, he or she must: have experienced an event in which the life, physical safety, or physical integrity of the patient or another person was threatened or actually damaged; and the patient must have experienced intense fear, helplessness, or horror in response; continue to re-experience the traumatic event after it is over (e.g., flashbacks, nightmares, intrusive thoughts, and emotional and physiological distress in the face of reminders of the event); seek to avoid reminders of the event (e.g., avoidance of thoughts, feelings, and conversations about the event; avoidance of people, places, and activities that are associated with the event; difficulty recalling aspects of, or the totality of the event; diminished interest in formerly pleasurable activities; feelings of detachment; and a sense of a foreshortened future); exhibit signs of persistent arousal (e.g., difficulty with sleep, increased irritability, concentration problems, scanning of environment for danger, and heightened startle responses).” (Toni Luxenberg, PsyD, Joseph Spinazzola, PhD, and Bessel A. van der Kolk, MD)

What about Complex PTSD (C+PTSD) or DESNOS, Disorders of Extreme Stress, Not Otherwise Specified? What is that all about? This feels somewhat nebulous.  Let’s talk about it for a moment.

DIAGNOSTIC CRITERIA FOR
DISORDERS OF EXTREME STRESS
(DESNOS)
I. Alteration in Regulation of Affect and Impulses
(A and 1 of B–F required):
A. Affect Regulation
B. Modulation of Anger
C. Self-Destructive
D. Suicidal Preoccupation
E. Difficulty Modulating Sexual Involvement
F. Excessive Risk-taking
II. Alterations in Attention or Consciousness
(A or B required):
A. Amnesia
B. Transient Dissociative Episodes and
Depersonalization
III. Alterations in Self-Perception
(Two of A–F required):
A. Ineffectiveness
B. Permanent Damage
C. Guilt and Responsibility
D. Shame
E. Nobody Can Understand
F. Minimizing
IV. Alterations in Relations With Others
(One of A–C required):
A. Inability to Trust
B. Revictimization
C. Victimizing Others
V. Somatization
(Two of A–E required):
A. Digestive System
B. Chronic Pain
C. Cardiopulmonary Symptoms
D. Conversion Symptoms
E. Sexual Symptoms
VI. Alterations in Systems of Meaning
(A or B required):
A. Despair and Hopelessness
B. Loss of Previously Sustaining Beliefs

It is possible to have both DESNOS (or C+PTSD) and PTSD at the same time.  Why does this matter? Consider a story like this:

“Awareness of the characteristic backgrounds of individuals who meet criteria for DESNOS will aid in effective case conceptualization and treatment planning. Often these individuals have histories of a large variety of traumatic events, spanning years and even decades. Such individuals may not have had discrete traumatic experiences so much as ongoing, chronic exposure to untenable environments. An example of a typical DESNOS history would be a woman who reports that she was never held as a child and was sexually abused throughout her childhood by her alcoholic father, who also physically assaulted her mother in her presence. Even when sober, her father frequently called her names and insulted her intelligence, attractiveness, and capabilities. As an adolescent, she may have witnessed the serious injury of several friends during a drunk-driving accident. As an adult, this woman may have been raped and had a series of emotionally and physically abusive partners. A history of chronic traumatization, however, will not always lead to the development of DESNOS symptomatology.” (Toni Luxenberg, PsyD, Joseph Spinazzola, PhD, and Bessel A. van der Kolk, MD)

 Now consider this:

“In the National Comorbidity Study carried out by Kessler and colleagues, it was found that while approximately one fifth of all individuals diagnosed with PTSD did not meet the criteria for another diagnosis, the remaining 79% met criteria for at least one additional disorder, and a full 44% met the criteria for at least three other diagnoses For a substantial proportion of traumatized patients the diagnosis of PTSD captures only limited aspects of their psychological problems. The combination of post-traumatic symptoms represented by DESNOS and PTSD criteria, rather than by PTSD alone, causes people to seek psychiatric treatment.” (Toni Luxenberg, PsyD, Joseph Spinazzola, PhD, and Bessel A. van der Kolk, MD)

This certainly drives the point home that exposure to trauma leaves a mark.  It changes humans sometimes for the better part of their lives.  What is to be done about it?

There is a lot that can be done about it.

Please allow me to introduce you to some excellent articles I found this morning.

May they inspire you to continue moving forward if you count yourself among those learning to thrive after trauma.

Resources:

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