Complex Post Traumatic Stress Disorder (C-PTSD)

According to research, the traumatic events like car accident, disasters are time limited. If some of the people experience chronic trauma, the behaviour and coping mechanism of such cases becomes severely impaired. The existing diagnosis of PTSD does not include the severe psychological which happens due to repeated or chronic prolonged trauma. Thee are many additional symptoms such as the way people adapt to stressful events changes permanently.

According to the research professors from Harvard University, there is a need to create new diagnosis for Complex PTSD to understand the real effects of long term and repeated trauma. The Complex PTSD symptoms got another name called Disorders of Extreme Stress Not Otherwise Specified (DESNOS). Developmental Trauma Disorder (DTD) are also present in some of the cases specially children who experience chronic trauma.

What is Complex post-traumatic stress disorder?

The complex trauma which is often used as a separate term for CPTSD, is a result of repetitive and prolonged trauma such as child abuse, intimate partner violence, caregiver abandonment, etc. Few other examples are prisoners of war, concentration camp survivors, captivity or entrapment situations can lead to C-PTSD-like symptoms, It includes long feeling of helplessness and deformation of sense of self.

Although there has been some research done and argues by research community, this illness has not been included in American Psychiatric Association’s DSM 5 as well as in World Health Organization’s ICD 10. There has been a proposition to put it in ICD 18 in the year 2018.

The major differences between PTSD and C-PTSD includes captivity, psychological fragmentation, sense of safety, trust, and self-worth are lost, higher tendency to be revictimized. The most important difference is the loss of coherent sense of self.

What additional symptoms in Complex PTSD?

Following are some of the additional symptoms on top of PTSD which patients of C-PTSD may experience:
1. Emotional Regulation – like persistent sadness, suicidal thoughts, explosive anger, inhibited anger, etc.
2. Consciousness – They tend to forget traumatic events, reliving traumatic events, etc.
3. Self-Perception – This is the top differentiator. It will involve person feeling helpless, guilt, stigma, and a sense of being completely different.
4. Relations with Others is suffered – isolation, distrust, etc.
5. Loss of faith
6. Continued sense of hopelessness and despair

Treatment for Complex PTSD

The Standard evidence-based treatments is very effective for PTSD. For treating Complex PTSD the interpersonal difficulties and specific symptoms are required to be addresses. Recovery from CPTSD requires restoration of control and power for the traumatized person. Here the survivors needs to be empowered by healing relationships. They need strong feeling of safety, remembrance, mourning and everyday life.

Self-esteem: How to Help Boys

Adolescence and Teenage years are hard on kids – whether they are boys or girls. It happens equally as well and there is no winner when it comes to low self esteem.

According to latest research in the field of self esteem in kids, the difference in scores on tests of self-esteem among teenage boys and girls is very small. The girls do have self-esteem issues during adolescence. But so do the boys. Adolescence years are equally hard on kids – whether they are boys or girls.

Do Good to Feel Good

If one wants to feel good about self, then he/she has to do something good to feel good about. Doing real and worthwhile things make a person have a positive self esteem and makes him always look upon himself positively. You need to start developing a helpfulness culture in the family where all members help in doing things of one another or may be for people outside home. If you are staying near an elderly neighbor, start with shovelling their walk or mowing their lawn. Get involved in different charitable activities as a family. Raising money for a for a good generic cause also makes a family feel good about themselves. This goes a long way in establishing positive sense of feeling for boys and makes them know that they have earned their positivity.

You should be ready to welcome your son’s friends anytime for doing something fun. Open up your home for the boys to have good time. He will start having confidence on his mother and himself.

Top tips on the boys self-esteem

1. Always set Boundaries and Rules to Follow

Teenagers also needs rules and boundaries just like younger children. Set rules, set expectations that fits your family values and explain them the importance of following them. Make them understood that you expect the rules to be followed regularly and what will follow if it isn’t followed. This makes the boys know that they are values and brings a self-esteem boost for them.

2 Do not Praise too much – be generous

Praising and acknowledging the acts and deeds of children always go as a sure way of building self confidence in children. Tell positive things to your your teens say specific praise. Do not forget to praise them for their efforts since this is what matters and not the results. Let your son know how much you are pleased looking at how hard he has been trying. Always be sincere with your praise since teens after some time will know whether the praises are genuine or not – defeating the whole purpose of praising and pumping them up.

3. Be Supportive During a Conflict

Boys sometimes end up being in middle of a conflict at either school or among friends or team members. Always listen to them and their story before being judgemental about them. The conflicts which they face seems silly to us, but they are very serious for them. Because of teenage years and hormonal changes happening in them. Create a habit and support your child in good and bad equally. Do not budge from taking stand for your child if needed. If they starting feeling that they have a parent to lean on who loves and accepts them is a great confidence booster for them.

How to Deal with a Critical Mom?

There are many ways to look at the mother daughter relation. I is different than mother son relation and father son relation. Mothers are protective, sensitive and critical about the way they treat and love their daughters. So why the relation is so fraught as compared to the one between mothers and sons? The real reason is that boys tend to demand and strive for more separation to find their own identities as compared to girls which gives boys and mother’s relations a sense of separation, whereas the girls tend to come closer and becomes more like their mothers as they grow up – increasing the competition and hidden conflicts. Girls strive to develop a sense of self like their mother rather than against their mothers which causes all the difference of being so critical. It can make the communication with mom more and more frustrating since competition creeps in.

Mom’s are not mean when you find them awake all night or believe so that they are awake. The mothers do not pester their daughters unnecessarily. They are expressing their love and concern, but the way is what it is. You need to train yourself to see what is inside as compared to what is coming outside – nit-picking, criticism, and all those things you don’t like.

How to handle Critical and Meddling Moms

There are many examples where a highly critical mom has been driving crazy people till their own old years. Like one of the person in her 70’s said that her mom criticise her for her skinny legs, non-feminine appearance, body hairs, etc. such that it is haunting her till today everyday. Her mom still in her 90’s tell her daughter to become more sexy and appealing by becoming feminine rather that doing the things like she is doing. Quite a pain, if you put yourself in the daughters shoes who has been suffering due to ever critical mom since last 7 decades.

Here are some of the things which you can do to handle the situation:

1. Focus on things you can change rather than on what you can’t change like your mom and her behaviour. You cannot just have any control on your mother and her emotional blabber. Just accept and think you are responsible for your happiness.
2. Do try to understand that the parents criticism is not about you but about some of their inner feelings which lost during the course of years. The problem of why they are criticizing lies in you parent’s own self-contempt. They should first learn to accept and love themselves and here you go – they will become better and less criticizing.
3. They think you are their extension and do the same self check with you as well. They do not consider you as a separate person rather a part of themselves hence so critical.
4. Parent cannot always be right. They have their own say, but since you are an adult, you can also think and decide on your own. Parents still jhave the same perception about you since you are the same kids for them forever. So relax and take fun in their opinion rather than slogging and sweating out due to their viewpoint.
5. Be assertive with your parent. You are not required to be defensive and make excuses. Be polite and say “I don’t appreciate this”. This can channelize the inner content and the anger outburst is not expelled on to other non-deserving relations like your child or spouse.
6. The more time you spend with people who bring positive energy in you the more are the chances that the critical comments from your mother will fade away. Just balance the time you spend with positive people and negative people. You will be fine. This balance will bring you peace and joy.

Helping your Perfectionist Child Find Balance

The current world is highly competitive and challenging for a youngster and children especially. The tough college admissions process, jobs scenes, ever increasing toughness in doing business are all driving people crazy and unmanageable. These problems in today’s culture of high stakes are not solved until we become a perfectionist. But the problem does not end here. Being a perfectionist is proven to interfere a lot with the child’s ability to achieve goals and shape their futures. In fact, they often struggle with depression, anxiety, and low self-esteem.

Perfectionist kids can be divided into two categories – one as underachievers and second as overachievers. The first one tend to be paralysed by their perfectionism and could not make decision or try new things because they are too afraid to fail. Overachievers always relentlessly try new things and perform them perfectly.

When the achievers achieved something, they set the goals higher and higher. the realisation of being perfect does not come easy and although it comes, it becomes more and more difficult to choose between being perfect and the most effective strategy for getting things done.

Here are top signs of a Perfectionist child
Check on these questions for your child and find if they are overachievers or underachievers.

1. Are they Fear failure?
2. Do they believe that doing mistakes is not good?
3. Do your child feel comfortable with criticism or disapproval?
4. Thinks that if he gets C, it is end of world for him or her.
5. Have some solid rules of his/her own to abide with?

Ways to Support a Perfectionist Child

1. Teach your children to focus the efforts and process instead of results and outcome. Explain them that the journey is equally important as the goal.
2. Help your kids understand the meaning of learning from mistakes. The perspective should be mistakes are learning opportunities.
3. Challenge your child’s definition and standards for success. Explain that the world will not end because the result was not perfect.
4. If you see anxiety in them for something, talk with them about the efforts, outcome, etc. Check for their expectations and make them set realistic goals.
5. Ask your child what they are afraid of and what is the worst which can happen. This way, you will be able to understand your child’s expectations and fear.
6. Help them prioritise the tasks which will help them focus only on those which are well worth focusing and spending energy on. You will remove many of the tasks from their perfection list by this simple exercise – greatly reducing their burden.

Ways to Help ADHD Children Make Friends

ADHD as we know affects a child ability to socialise and interact with anyone. It becomes difficult for the child to make friends. They need help in making and keeping up friends. Parents and support group can create a huge difference by just supervising from distance. They do not have to get on your legs to make this happen and it can be done just by guidance.

Different ways to help ADHD kids make friends

See the tips below to find how you can coach and guide the ADHD child in social interaction and friends making exercise.

1. Know the core of the problem – You need to observe the situation before thinking about any solution. Children with ADHD often commit social behaviour mistakes because they do not know how they are looked upon by their peers. Discuss with them what went wrong and why all of this is happening. Do not provide negative feedback since it will affect his/her self-esteem.

2. Watch your child carefully – The ADHD kids tend to pick fights and verbal arguments with other kids. See what and where they are and closely monitor them. You need to intervene if things are going out of control for your kid.

3. Missing Cues, Lacking Skills – Children with ADHD tend to miss out many things in a friendship. Making and keeping friends needs skills like talking, listening, sharing, being empathetic, etc. In ADHD children, these skill do not come naturally. hence they struggle a lot in this area. This further causes kids to lose self-confidence.

4. Talking to your child’s teacher can also help. The teacher can pair up your child with some child who is more accommodating and accepting. The fiends can be from the same hobby set as well.

5. You can also consider counselling as well. Find out some good Parenting Coach, who can give practical tips on how to help your child interact with others, etc. It can also help the ADHD child build communication skills, and become resilient.

OCD Honesty and Hyper-Responsibility

OCD – Obsessive Compulsive Disorder has many manifests which ranges from hypersensitivity which is very common to other behaviour like hyper-responsibility, lying and honesty. The inflated sense of responsibility, and honesty becomes too much to handle and often leads the person to suffer even more.

Hyper-Responsibility and OCD

The inflated sense of responsibility makes the person believe that they are controlling the things which are happening in the world, although they have very little control on their surroundings. There could be many ways in which the hyper-responsibility starts showing its effects. In some cases it shows in terms of the relations to other’s feelings. The person thinks that they are responsible for everyone else’s happiness, and all the times neglects their own feeling. Sometimes, people think that their presence can hurt others, so they isolate themselves from their friends and peers. Another symptoms of responsibility going out of control is people start giving charity and that too an exorbitant amount. All the mails are generally answered by checks and stop saving any money for themselves. They think the world can be saved by their charity.

The below serenity prayer says it all for the inflating sense of responsibility among OCD sufferers:

God grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.

Lying and OCD

Another manifest of OCD is lying and often to hide the Obsessive nature about many things. Like one of the kid always lied about his hunger and appetite, making excuses of being tired, etc. The real reason was OCD which made him think that there are finger prints all over the walls and places. These people even though diagnosed with OCD, always lies and say, they are fine, although deep inside they have some thought of obsessive nature. The children lie about taking medicines, all the things which are related to disease and its cure can be lied for. It can be fear of being found out, the fear of what others will think, OCD sufferers lie a lot and it is one of the major manifest of the symptoms.

Honesty and OCD

The above manifest of OCD on Lying has another dimension as well in the form of Honesty. Many of the OCD sufferers has a honesty issues as part of their disorder. They are so afraid of lying that daily they review their entire day within their minds to ensure all what they said was true or not. They many a times accept all the wrongdoing as well as things which they do not do, thinking they might have done it accidentally. Their sense of honesty comes along with hyper-responsibility to keep their loved ones and the world, of course, safe and protected. They have a heightened sense of morality as well.

The Connection Between OCD Psychosis

OCD or obsessive-compulsive disorder has some traditional symptoms which assumes that the patient is aware about the obsessions or compulsions are excessive and they are more than the normal range of feelings. It is often present in the category where the person suffering knows about the condition he is in., i.e. Neuroses. There are some points of contention though. The patients of OCD displays varying degree of insight into their condition. DSM-IV (American Psychiatric Association, 1994) has some mention to this where it is stated that there are cases of people “with poor insight” who “for most of the time” while experiencing an OCD episode do not recognise about their compulsion being excessive or unreasonable. ICD-10 (World Health Organisation, 1992) has no mention of such obsessional symptoms in the presence of schizophrenia.

There are many cases where person suffering from OCD is also diagnosed with some form of borderline Psychosis. Here the OCD is present along with out of touch with reality behaviour. The person suffering is not fully aware about their reactions/behaviour and actions being unreasonable or non-realistic. Psychosis makes anyone think about schizophrenia, although the doctor never mentioned this name. But psychosis in itself is a big symptom of schizophrenia, making things tougher for people who are less aware. The connection of OCD here with psychosis can be described in one line as OCD with poor insight.

People with OCD with Poor Insight

Most of the time people with OCD knows that they are suffering from some kind of obsession which is not normal and there is certain amount of hyper criticality in their behaviour. They are aware that if they tap a wall for 5 times is not going to change anything, but they still do it. They although could not control it, but they are aware about it.

On the contrary if there is OCD with poor insight, such people do not clearly believe that they are irrational or illogical in any way. They think their thoughts and behaviours are not unreasonable, and consider the obsessions and compulsions as normal and stay safe behaviour. The important inclusion in DSM5 says it all. As per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, OCD should be seen with good or fair insight, poor insight, or delusional beliefs.

Why it is important to differentiate OCD with Psychotic Disorders?

The answer to this question lies in the fact that the treatment of Psychotic disorder has some drugs and therapies which enhances the symptoms of OCD. They tend to induce or exacerbate OCD. There are many side effects as well both firm physical and mental aspects.

There is a lot of work for caregivers here to find the comorbid existence of OCD with Psychosis due to obvious readons like the presence of Depression with ADHD. Do not jump to conclusions and specially think about the treatment you think would be suitable for the comorbid conditions. The treatment options of one condition can adversely affect the other condition.

How to help people handle perfection urge?

Perfection is good, but it is good if it is not impacting your life and making you go nuts over getting things in perfect shape and order. Nothing in this world is going to change if things are not done the way you would have thought them to be. So relax, take a break and leave that perfection nature making good amount of breathing space for you and people near you.

Here are some of the top ways and tips to combat the urge of being perfect.

Top tips for Handling Urge of Perfection

1. You need to expose your worries – You need to be talking about your worries and what will happen if the things are not perfect. You can talk to your parent, spouse, friends, co-workers, etc. This will help you build the emotional definition to all your worries and you will get a different perspective of things. The exposure will help you in getting in terms of your worries and recude them to a great extent.

2. Change your perspective about the outcome. Think that out of many outcomes and possibilities, there is only one dire consequence which you are too much worried about. If you judge the possible outcomes and think rationally about the perspective, you will be able to counter the urge of perfection.

3. Try and examine the evidence against your worst fear. Let us assume that you think if your shirt is not pressed perfectly you will have a big set back. Now try doing this one day and try to wear a wrinkled shirt. Check on your day and find out what went bad and what not. For all the things that went bad are worth so much of anxiety you are picking up in life due to this? Check on your own.

4. Mistakes and failures are opportnity to learn and move on. Have this thinking and start improving yourself rather than spending days and nights worrying about the final goal and its outcome. It’s not always the case that your worst nightmares come true. Have faith and move on.

5. Keep your focus on learning new things and skill, rather than being the best in everything you do. Every person in this world cannot be Pele and Ali at the same time. You cannot be a movie star and a Governor at the same time.

6. Take help to find the faults and unhealthy logic in your thinking. You can discuss with support groups, professionals and therapists if you cannot find solace in your relatives, or family members.

7. Watch movies and read boooks on how people have struggled and had multiple failures before they eneded up doing something which brought changes in people’s lives. There are many such personalities which helped us in every possible aspect of life and they taught an important lesson too – that things do not come easy. There are failures, mistakes, set backs and hardships along the way. And not all the stories are part of books and movies – there are cases where the end result was not that bright. And I mean it, these cases are far too many, than you think.

Get rid of the negative self-talk

You can be your own worst enemy. Negative critical messages you say to yourself can rev up your stress, hold you back, and take you down!

Negative self-talk are messages like:

  • “You’re stupid.”
  • “You can’t do anything right!”
  • “You’re ugly.”
  • “What a loser.”
  • “You’ll never amount to anything.”

The messages in your head may be generated from low self-esteem or be repeats of messages voiced by flawed parents.

All too often, parents who don’t deal with their own shortcomings put them onto their children.

If you were repeatedly put down by a parent or other important adult—that was their stuff, not yours.

I noticed that I would say “You’re stupid” whenever I was disappointed in something I thought or did.

That message had haunted me for years but letting myself hear it clearly led me to being able to banish it from my inner repertoire.

In bringing the message up from my subconscious to my conscious in such a clear way I knew immediately where the message came from. My mother sent me that message in a myriad of ways including saying “You’re so stupid!”

I also realized “I’m not stupid.” This was mom’s stuff. She had her attributes but she had an 8th grade education and—as she would say about other people but not herself—she was not the sharpest knife in the drawer.  Mom overcompensated for her own ignored inadequate feelings by putting me down.

I developed a system for countering the message.

I came up with a list of evidence that I’m not stupid.

Whenever I heard “You’re stupid” in my head, I would say to myself “Reality check.” Then I would recount the list of evidence that I’m not stupid.

Eventually, I didn’t need to use all the items on my evidence list before I would feel myself snap out of feeling inadequate.

A short time later, I didn’t need the list anymore. Just saying “Reality check” would undo the “You’re stupid” message.

And soon, “You’re stupid” went away.

I had been rid of the “You’re stupid” message for over 20 years when one of my sisters told me she too had been haunted by “You’re stupid.”

I said to her “You too?” to express my surprise.  And she replied “With our mother, how could you not.”

To get rid of negative self-talk take these steps:

  1. Begin to notice it. Pay attention to what you say to yourself. Rather than push it away, bring it up to full awareness and hear the message clearly. Possibly write it down so you’ve really got it.
  1. Counter the message. The phrase “Reality Check” worked for me as a signal to counter the message. That may work for you too. Whether or not you use that signal, you want to challenge the message and provide yourself with evidence to the contrary. It may be helpful to write out the evidence.
  1. Replace negative with positive. Possibly replace the negative message with its positive counterpart. “You’re stupid” can be replaced with “You’re not stupid” “You’re smart” “You can do this” “Academics aren’t your thing but there’s more to smart than school grades” or something else that empowers you.

Exercise

Reflect on whether you have any negative self-talk.

Where did that message come from?

How has the message gotten in your way?

Use the steps to practice riding yourself of the counterproductive message.

Anxiety Symptoms: Woman share her own experience

We feel anxiety emotionally and we feel anxiety physically.

Anxiety symptoms can be both emotional and physical.

What anxiety feels like emotionally?

Anxiety is a fearful feeling that seems to get a hold of you and not let go.

It can drive you to act in a demanding or irrational way as you attempt to get relief from the fear. Or it can narrow your world as you reduce your exposure to situations that stimulate the fear.

The emotional side of anxiety can be felt as:

  • fear,
  • apprehension,
  • tension,
  • agitation,
  • angst,
  • stress,
  • uneasiness,
  • worry,
  • nervousness,
  • a sense of impending doom,
  • trepidation,
  • foreboding,
  • panic, or
  • being trapped, controlled, or overwhelmed.

Where your anxiety falls on this list of emotion descriptions may be determined by how intense the anxiety is at any given time. (For example, panic is more intense than worry.)

What anxiety feels like physically?

The physical side of anxiety can also be felt at different intensities, from an uneasy jittery physical feeling that accompanies worry, to full bore panic that feels like you are dying.

In fact, panic sends many people to emergency rooms because it can mimic the symptoms of a heart attack.

When anxiety hits its most intense form it is often called a panic attack. (Some call it an anxiety attack, but I think that panic attack is a better label. I see anxiety as less intense than a panic attack.)

A panic attack is very intense for a time—at least 10 minutes—but then usually subsides within an hour. After the panic feeling is reduced, an anxious feeling can remain, but the severity of physical symptoms is not as great as during the panic attack.

Physical symptoms of anxiety can include:

  • muscular tension, aches, and pains,
  • headaches,
  • upset stomach,
  • gastrointestinal problems (diarrhea, constipation, gas),
  • loss of appetite or increased appetite,
  • sweating,
  • trembling or shaking,
  • dry mouth,
  • feeling hot or cold,
  • hyper energy or low energy,
  • a lethargic worn-out feeling,
  • weakness in legs,
  • sleep disturbance (difficulty getting to sleep or staying asleep),
  • inability to relax,
  • brain fog or difficulty concentrating,
  • hypersensitivity to noise or touch, or
  • a closed down feeling in throat.

Physical symptoms of a panic attack can include any of the above plus:

  • chest pain,
  • increased heart rate,
  • shortness of breath,
  • extreme nausea,
  • extreme shift in body temperature, or
  • feeling faint or light-headed.

My own experience

I have experienced two panic attacks myself. They definitely are no fun.

Panic attacks are scary multiplied: they are caused by something scary and they are scary.

My first panic attack lasted about a half hour. It was spurred by my receipt of a threatening email from an ex-boyfriend. The panic reduced when I called someone to help me deal with the situation and I felt more secure.

The second panic attack occurred about a week later when I received another email in which his threats escalated. That attack lasted for about an hour. During that attack, I laid down on the floor because I was worried that I might pass out and I figured if I passed out on the floor at least I wouldn’t fall and hurt myself.

After the second attack, I took myself to a hypnotherapist friend. She fixed me up and I never had another panic attack.

I think that my personal experiences with anxiety and panic, combined with my professional education and experience as a counselor, give me an insight into anxiety that is more complete than most.

I know that my clients are often relieved to discover that I have experienced panic first hand and so have an understanding of what they have been through.