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.

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.

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.

Complex PTSD and the Realm of Dissociation

 

“Louise often feels like part of her is “acting.” At the same time, “there is another part ‘inside’ that is not connecting with the me that is talking to you,” she says. When the depersonalization is at its most intense, she feels like she just doesn’t exist. These experiences leave her confused about who she really is, and quite often, she feels like an “actress” or simply, “a fake.”

― Daphne Simeon (Feeling Unreal: Depersonalization Disorder and the Loss of the Self, New York, NY, US: Oxford University Press; 2006)

The majority of the clients I treat have been exposed to repeated traumatic episodes and threats during childhood. For many of these men and women their heinous histories of emotional, psychological and sexual abuse at the hands of trusted caregivers, have led to their suffering from complex PTSD. C-PTSD is more complicated than simple PTSD as it pertains to chronic assaults on one’s personal integrity and sense of safety, as opposed to a single acute traumatic episode. This chronic tyranny of abuse results in a constellation of symptoms, which impact personality structure and development.

The symptom clusters for C-PTSD are:

  • Alterations in Regulation of Affect and Impulses
  • Changes in Relationship with others
  • Somatic Symptoms
  • Changes in Meaning
  • Changes in the perception of Self
  • Changes in Attention and Consciousness

When one is repeatedly traumatized in early childhood, the development of a cohesive and coherent personality structure is hindered. Fragmentation of the personality occurs because the capacity to integrate what is happening to the self is insufficient. The survival mechanism of dissociation kicks in to protect the central organizing ego from breaking from reality and disintegrating into psychosis. Hence, fragmented dissociated parts of the personality carry the traumatic experience and memory, while other dissociated parts function in daily life. Consequentially, profound symptoms of depersonalization and dissociation linked to c-ptsd manifest. (Herman JL. Trauma and Recovery. New York: BasicBooks; 1997)

Dissociative disorders are conditions that involve disruptions or breakdowns of memory, awareness, identity or perception. In the context of severe chronic abuse the reliance on disassociation is adaptive as it succeeds in reducing unbearable distress, and warding off the threat of psychological annihilation. The dissociative disorders a survivor of chronic trauma presents with vary and are inclusive of dissociative identity disorder (formerly multiple personality disorder), dissociative amnesia, Dissociative fugue, and depersonalization disorder. Identify confusion is also deemed a by-product of dissociation and is linked to fugue states when the traumatized person loses memory of their past and concomitantly, a tangible sense of their personal identity. (Onno Van der Hart, Ellert R.S. Nijenhuis, Kathy Steele Dissociation: An Insufficiently Recognized Major Feature of Complex PTSD, Journal of Traumatic Stress, 2005, 18(5))

 

 

The treatment process for those afflicted with c-ptsd and attendant dissociative disorders is extensive and comprehensive. Depending on the severity of the repetitious traumas, even in progressed stages of recovery a client may find himself grappling with persistent feelings of detachment and derealization. Given that the brains mediation of psychological functions is dramatically compromised by the impact of chronic trauma, this neurobiological impact may be a strong contributing factor regarding lingering dissociative symptoms in survivors of c-ptsd. When a child’s brain is habitually set to a fear response system so as to survive daily threat, brain cells are killed and the inordinate production of stress hormones interferes with returning to a state of homeostasis. Turning to dissociative states to relieve the pain of hyperarousal, further exacerbates the effective use of one’s executive functions, such as emotional regulation and socialization. Accordingly, neuroimaging findings reveal that cortical processing of emotional material is reduced in those presenting with c-ptsd and an increase in amygdala activity, where anxiety and fear responses persists.

 

In spite of the harrowing repercussions of prolonged traumatic abuse and neglect, those suffering from c-ptsd and dissociative disorders profit from working through overwhelming material with a caring seasoned professional. Treating the sequelae of complex trauma means establishing stabilization, resolving traumatic memory and achieving personality (re)integration and rehabilitation. Integrating and reclaiming dissociated and disowned aspects of the personality is largely dependent on constructing a cohesive narrative which allows for the assimilation of emotional, cognitive, and physiological realities. And finally when fight/flight responses diminish and an enhanced sense of hope and love for self and others results from years of courageous pain staking hard work, the survivor reaps the rewards of this capricious and harrowing journey; one’s True Self.

Parental Alienation: A risk factor for depression

Parental alienation is a family dynamic in which one parent engages in many of the 17 primary parental alienation strategies, behaviors likely to foster a child’s unjustified rejection of the other parent. Not all children are susceptible to this form of emotional manipulation, but some are.

When successful, the PA strategies can result in a child claiming to hate and fear a parent who has done nothing to warrant the child’s vitriol, fear, and hostile rejection. Over the past ten years I have conducted a number of research studies on adults who were exposed to PA strategies when they were children. In each study I and my colleagues have found a statistically significant association between exposure to parental alienation in childhood and depression in adulthood.

These findings have been replicated in studies in New York, Texas, US national samples, and in Italy. The findings have been replicated with various depression inventories, and in different age groups. Even high school students will report higher depression when exposed to PA strategies. This association can be understood in light of attachment theory in that the child exposed to PA is being forced to forgo a relationship with an attachment figure and to deny that the loss the relationship has any meaning. The child is denied the opportunity to make meaning of the loss, which is a known risk factor for depression. In one of my studies, a respondent reported that when he was a young boy he came home from school one day and found an unknown man in his living room. His mother announced that this was his new daddy since the old daddy was a bad man.

For the next forty years the boy was not allowed to talk about his father, ask what happened to him, or even refer to him as “Daddy.” Unable to make sense of what happened and forbidden to process the loss, this young boy grew up to experience a multitude of problems as an adult, including depression. Another respondent in that same study told how her father would come to visit every Sunday but she was not allowed to open the door to greet him. In fact, she was forced to stand inside the house yelling at her father through the door to go away and never come back. When the father stopped trying to spend time with her, she was devastated and shared with me that many days – even years later – she felt so sad she couldn’t get out of bed.

What I have learned from stories like these as well as from my statistical studies is that parental alienation is a form of emotional abuse of children and it is, therefore, associated with may negative outcomes for children, including but certainly not limited to depression. Adults who had his experience as children should become educated about parental alienation in order to have a framework for understanding what happened to them.

Likewise, mental health professionals working with such adults should be informed about the phenomenon of parental alienation so that they can be as helpful as possible to this vulnerable population.