Archives for: T.R.A.U.M.A.

Complex Traumatic Stress

Posted on December 6, 2011 by sheryl

When the trauma you have experienced is prolonged, repeated, and extensive, there is an additional layer to understand.  Examples of this are child molestation over months or years, child abuse over an extended period of time, war zone and gang style combat, people held on concentration camps, cult survivors, and domestic violence survivors.  In addition to all the symptoms listed for PTSD (see definitions of Post Traumatic Stress), complex PTSD also includes:

  1. Your emotions seem to have a life of their own and you have difficulty managing them, difficulty managing anger, self-destructive behaviors (e.g. suicide, addictions, – Veterans are two times at a greater risk and account for one in four suicides within the U.S), difficulty modulating sexual involvement and impulsive risk-taking.
  2. Changes in awareness (amnesia, short periods of zoning out, depersonalization).
  3. Body issues (how your body is holding the trauma)
    • Digestive system problems
    • Chronic pain
    • Cardiopulmonary symptoms
    • Sexual symptoms
  4. Self perception is off
    • Chronic guilt, shame and self-blame
    • Feeling that you are permanently damaged
    • Feeling ineffective
    • Feeling like nobody understand you
    • Minimizing the importance of the traumatic events in your life (since the trauma went on so long, “ You see, I’ve gotten used to all that and I’m fine, it’s just that I lost my job last week….”)
  5. Alternations in perception of the perpetrator
    • Adopting the distorted beliefs of the perpetrator about yourself, others, and what happed as true
    • Idealizing the perpetrator
    • Preoccupation with hurting the perpetrator
  6. Change in relations with others
    • Inability to trust
    • Re-victimizing yourself, (asking for another tour of duty)
    • Victimizing others (harming spouse or children)
  7. Changes in systems of meaning (how you see life, others, your spirituality)
    • Despair, hopelessness
    • Loss of beliefs that previously sustained you.

In my experience treating victims of early childhood abuse, the memory of the abuse may be completely locked away for several years, but these symptoms of complex Trauma persist.  If your trauma was repeated over an extended period of time, the effects may be deeper in your body and deeper in your emotional responses.  This does not mean that they cannot be reached and treated, they can.  We won’t erase the memory completely, but it won’t monopolize the keys to  your life.  We’ll find a way to put that memory on the back seat and teach it to be quiet.  You can get the keys to your life back.

To your recovery, however that unfolds for you.

Posted in PTSD, T.R.A.U.M.A., Trauma | Leave a comment

The Oh Shit Factor

Posted on December 5, 2011 by sheryl

We have specific, agreed-upon definitions of Post Traumatic Stress (see previous posts), but I like Roger Solomon’s “Oh Shit” definition best.  It is from an unpublished manuscript “Dynamics of Fear” from 2001.  (Described in The PTSD Workbook by Dr. Mary Beth Williams and Dr Soili Poijula)

  1. Here comes trouble (You become aware of a threatening situation.)
  2. Oh, Shit! (You become aware of your vulnerability; you may feel weak and not in control)
  3. I’ve got to do something. (You realize you have to act to survive or gain control over the situation; you acknowledge the reality of the danger.  You make a transition from an internal focus on vulnerability to an external focus on danger.  But if you focus solely on the danger you tend to feel even weaker and more out of control.)
  4. Here I go. (This is your moment of commitment; you have the resolve to act whether instinctual or planned; you mobilize tremendous strength; your mind becomes focused and clear and you have increased awareness and control.  You act. Often without thinking further,)
  5. Oh, Shit! (After the event is through and you’ve survived, it is normal to return to feelings of “oh, shit!”  You can give yourself credit for all that you did do to respond in the other stages,)

Five questions that are helpful during the second “Oh Shit” stage, and are part of a standard trauma recovery debriefing:

  1. What happened?
  2. Why did it happen? (Sometimes there just isn’t an answer to this question, even though your mind, which is good at noticing cause and effect will create one out of the ethers – such as “My husband died of the heart attack because I didn’t fix our usual matzo ball soup on Friday”)
  3. Why did I react the way I did then?
  4. Why am I behaving the way I am now?
  5. What will I do if this happens again?

Don’t fret if your answers to these questions don’t make sense – they probably won’t.  Just know that in time, when your body is healed and your brain is strong again and not continually flooded with fight or flight chemicals, that you will make sense of your life again

To your recovery, however that unfolds for you.

Posted in PTSD, T.R.A.U.M.A., Trauma | 1 Comment

What are the Unusual Responses to Trauma?

Posted on December 2, 2011 by sheryl

Of course, if you experience something that involved intense fear that left you in a daze, it will take a while to re-orient yourself.  Acute stress can resolve itself with care, but if symptoms last more than a month, then we’ll be talking about Post Traumatic Stress (PTSD).  (Originally, it was called Post traumatic Stress Disorder, but more the more we study the phenomenon, the more we realize that it is a medical problem, treatable, common, and I personally reject the language of “Disorder”)

To help you sort it all out, here’s some symptoms to keep an eye on:

  1. You have recurring and intrusive distressing memories of the event, including images, thoughts, or perceptions.  An Iraq Veteran said “There just wasn’t enough cocaine, or marijuana or hard liquor that would take the sharp edges off the images in my mind.”
  2. You have recurring nasty dreams of the event and often night sweats in response.
  3. You feel and/or act as if the event was still recurring, and you have a sense of reliving the experience.  (The truth is, that your body doesn’t know the difference between an actual event, and a vivid memory of the event – it produces the same adrenaline, and other chemicals intended to help you run away or fight).
  4. You experience intense distress when triggered by anything that resembles an aspect of the event (such as sights, smells, sounds, dates).  A rape victim couldn’t make sense of her nausea and shaking knees whenever she saw red roses, until she was able to recall that there were roses in the wallpaper in the room where she was raped.
  5. Your world gradually gets smaller as you avoid thoughts, feelings, conversations, activities, places or people that might cause you to remember the trauma.
  6. You can’t remember an important aspect of the trauma.  (I’ve helped victims through hypnosis to recall specific aspects of the event to support the law enforcement people to track down a perpetrator.  However, this type of early intentional recall must be done in the hands of a trained hypnotherapist who is also a traumatologist to avoid re-injury through the recall).
  7. You feel detached or estranged from others and your ability to feel emotion is restricted.  At the beginning, when those feelings are way too intense, it’s a valuable defense mechanism to clamp down on your ability to feel at all.  This can change in time when you’re ready, since the feelings of love, joy, and peace are also inaccessible at this point.
  8. You may have an increased physical arousal that causes:
  • Difficulty falling or staying asleep
  • Irritability or outbursts of anger (a young, newly married childhood abuse victim was surprised when his wife of one week insisted he get help for his ‘anger’ issues.)
  • Difficulty concentrating (Following her accident “Sarah”, a young, bright woman was barely able to figure out that if someone handed her five dollars for a $4.50 charge, what the change should be)
  • Hyper vigilance – overly watchful
  • Downright jumpy at every little noise/smell/words/….

Please know that even though these symptoms have stopped you cold, all of them are treatable, and your brain, your body chemistry, your ability to enjoy your life is still out there waiting for you.

Here’s to your recovery, however that unfolds for you.

Posted in PTSD, T.R.A.U.M.A., Trauma, Uncategorized | 2 Comments

Seven Key Factors of Traumatic STRESS

Posted on December 1, 2011 by sheryl

There are lots of experiences that we all have that we define as stressful – more bills than money, baby urp just before the guests arrive, divorce, dog poop on your best shoes.  None of these however, are part of what we call traumatic stress.  To help you find yourself on a very large continuum of stress to traumatic stress, here are seven key factors to consider:

  1. You experienced, witnessed, or were confronted with an event or events that involved actual or threatened death or serious injury, or a threat to you own physical integrity or that of others.
  2. Your response involved intense fear, helplessness, or horror.
  3. You felt numb, detached, or emotionally nonresponsive.
  4. You had reduced awareness of your surrounding (you were in a daze).
  5. You experienced a sense that the world is unreal or that you are detached from  a part of your environment; you experienced unfamiliarity with what were previously familiar places –  sort of got “lost in your own life”.
  6. You experienced depersonalization – a disoriented perception of your body, identity, or self, perhaps with an out-of-body experience or feeling of being in two places.
  7. You experienced a type of amnesia – the inability to recall one or more important aspects of what happened to you.

Know that all these responses to a horrifying event are natural and normal, and can create a medical condition that is known as Post Traumatic Stress.  I have treated wonderful, strong, successful people who suffered from severe car accidents, childhood molestation, rape, cancer diagnosis, and national disasters or were blind-sided with divorce papers.  It doesn’t matter if anyone else considers your experience normal, survivable, and tells you to “just get on with your life”, if that event stopped you in your tracks, you deserve support to put the pieces of your life back together, and that can be done.

To your recovery, however that unfolds for you.

Posted in PTSD, T.R.A.U.M.A., Trauma, Uncategorized | 1 Comment

The Hurricane Stopped my Business; the accident stopped my LIFE!

Posted on November 30, 2011 by sheryl

Trying to sort out the WHY of your reaction to a trauma, it helps to understand how various causes of trauma might impact you differently.  While a hurricane causes enormous damage and makes the national news, getting thrown through the air by a moving vehicle while you’re crossing the street unravels your life in an entirely different way.

What we know is that the amount of preparation time you have prior to the event can often produce less of an impact.  Usually have several days to prepare, to gather resources, to decide how you will react.  We also know that while a trauma from natural causes creates enormous logistical challenges, the emotional impact can be less, especially if one doesn’t loose a home, belongings, pets, or loved ones.  The reaction from trauma from natural causes can be less.  However, if that expected hurricane caused you physical, emotional and spiritual pain, damaged your property, and you witnessed death and devastation, you have a natural acute stress reaction.

On the other hand a car accident hits you with no preparation and is human-caused and the amount of damage done directly to you is physical, emotional and in some ways spiritual, as in  “Why do bad things happen to good, God-loving people?”

There is a lot of self-judgments often around your incapacity to get on with your life.  While research can validate why some events effect one person more than another, the simple fact is that if you are experiencing any of the symptoms of post traumatic stress, then you are experiencing the symptoms of post traumatic stress and it really doesn’t matter if your neighbor isn’t, or doesn’t understand why you won’t come to book club this year.

What matters is that you find help, that you find someone who understands you and can support you as you find you way back to the joyful, fulfilling life you deserve.

To your recovery, however that unfolds for you.

Posted in Causes of PTSD, PTSD, T.R.A.U.M.A., Trauma | Tagged , , | Leave a comment

The Family Factor

Posted on November 29, 2011 by sheryl

How exactly does your family of origin affect the impact of Trauma?

What we know is that people from families that are unstable are more likely to suffer intensely when trauma of any kind happens to them.  By unstable, we’re talking about a household where a parent has a psychiatric disorder and the life of the child is unpredictable because the parent’s reactions are unpredictable.  This also refers to a childhood with many separations, economic problems or family violence are also part to the family factor.  All these circumstances decrease one’s ability to feel competent and resourceful in the face of trauma.

 

Similar to this background piece, is the absence of social support to help out.  Many people who come from unstable homes don’t have the skills to create a social support system, since the trust of parents is lacking.

If you are feeling like you “should” be getting over it, but just can’t, maybe you started the fight without any tools necessary to do battle (with the cancer diagnosis, with the hurricane, with the attack).  For you, it was an unwinnable fight.  Not to worry, it’s never too late to develop those resources and to find your own way to feel competent an resourceful.

Recovery is an option.

Here’s to your journey, unfolding in just the right way for you.

Posted in PTSD, T.R.A.U.M.A., Trauma | Tagged , , | 1 Comment

Defining T.R.A.U.M.A.

Posted on November 1, 2011 by sheryl

Knowing what trauma is and experiencing trauma are two entirely different situations.  Engaging in any form of media (TV news, Hollywood stories, radio news, even written fiction) allows some of us to create a distance between our own feelings and what is being discussed.  We can watch news and movies about earthquakes, murders, plane crashes, hurricanes, floods, assaults, robberies, rapes, Columbine shootings, WLD (Weapons of a little Destruction), terrorist attacks and statistics on heart attacks, breast cancer, strokes, fibromyalgia or Sudden Infant Death and still go on with breakfast, our commute, our meetings of the day, evenings with friends, and kissing the kids goodnight.

Once any one of those acts happens, you are either a direct victim (it happened to you) or you were a secondary victim (it happened to someone you love or you witnessed the event), you become a victim.  Those caregivers who serve this population also are vulnerable to the effects of T.R.A.U.M.A.  In my early days as a psychotherapist, my first patient who was recovering from severe, prolonged childhood sexual abuse, needed tell her story as she was in the process of recovering lost but life impacting memories.  For months I listened to stories much worse that I had ever heard or seen in any media.  I was falling into my own tar pit of dark, unsafe, suspicious and required my own psychotherapy sessions with my supervisor to move out of that secondary victim place.

What response one has to an event experienced or witnessed is at the core of the definition of traumatic stress.  In some situations, the reaction is increased adrenaline, a fight response, an accessing of one’s resources and strengths and one responds with a sense of victory.

However, just in the research on learned helplessness, if there is literally nothing one can do to avoid the effects of the event, then the body and mind learn that one is a helpless victim and the response is horror, shock, terror, or even a sense that the event wasn’t real.

Some people remember all the details like I did when I got my initial cancer diagnosis, or when I heard about President Kennedy being shot (yes, I do remember that, even though I was really, really young).

Some do not.  I have supported victims of extreme and recent sexual abuse who blocked out so much of the details that they were not able to give police enough of a description of the perpetrators to help in the investigation.  (In this case, careful, thoughtful hypnosis allowed a recall of significant faces and places without re-truamatizing the victim).

Although psychotherapists have a clinical definition of what constitutes traumatic stress, for our purposes, anything that causes a shift from good, promising, safe, and sunny and in an instant to awful, doomed, scary and dark and, worse yet, promises a recurrance of those feelings -  falls into a trauma.  It’s the reaction to the event that defines the significance of the event.

T: The
     R: Reaction
           A: After
                     U: Unbelievably
                                M: Mortifying (to kill, or destroy the vitality of life)
                                           A: Acts

Here’s to the return of those good, promising, safe, and sunny days to come.

Posted in Frozen in Fear, PTSD, T.R.A.U.M.A., Trauma | Tagged , , , , | Leave a comment

The T.R.A.U.M.A. shift

Posted on October 31, 2011 by sheryl

There is a lot of awareness about  PTSD, thanks largely to the Veteran’s Administration when they recognized that our soldiers returning from active duty often can’t seem to move forward in their lives.

PTSD (Post Traumatic Stress Disorder) isn’t just about soldiers getting night sweats dreaming about the horrors they watched or experienced. It’s about enduring a very difficult event. I prefer to think of T.R.A.U.M.A. as an acronym:

T: The
     R: Reaction
           A: After
                     U: Unbelievably
                                M: Mortifying
                                           A: Acts

Here’s a couple definitions of mortify that are strong enough to be part of the acronym:

  1. To cause to experience shame, humiliation, or wounded pride; humiliate.
  2. It originally meant “to kill,” then “to destroy the vitality or vigor of”

No one can limit what creates enough stress for a reaction to be long lasting, beyond the adrenaline required to survive the event.  For me, the first time I heard my name and the word “cancer” in the same sentence was one of those.  Even though it’s been over ten years since the event, I still remember where I was sitting, what the doctor was wearing (tan shoes, no tie, photo of a boat on the wall, red apolstered chairs, just a hint of after shave).  I have never been back to that office or that doctor again.

For others, the event might be the death of a loved one, witnessing a car accident, hearing about OR experiencing a hurricane, hearing about 9/11, as well as the events most acknowledged – rape, mugging, loss of a limb, war.

In all these examples, the critical thread is that the response to the event destroys the vigor of life or life energy.  One moment life is good, promising, safe, and sunny and in an instant it is awful, doomed, scary and dark and, worse yet, promises a recurrance of those feelings.

The first step in moving through a T.R.A.U.M.A. is recognizing the impact, what to notice in your own life or in the life of those you love.  See tomorrow’s post for what might shift in that life force.

If you have your own experience of a shift from good/promising to scary/doomed, please do share whatever part of your experience that is right for you today.

Posted in Frozen in Fear, Just Stuck, PTSD, T.R.A.U.M.A., Trauma | Tagged , , | Leave a comment