I had planned to title this "A Definition of PTSD".
But then I realized that my efforts here could be confused
with a technical medical definition. And, what I am wanting
to do is to give you more of the flavor of what it is like
to live in the aftermath of childhood trauma. If you read
the titles of my articles, listed on the articles page, you
can get a pretty good idea of the sort of issues that someone
with PTSD encounters within himself or herself every hour
of every day. I should add that people whose trauma occurred
later in life very often suffer with PTSD and struggle with
many of the same issues.
Trauma creates within us enormous fear and loss. Part of the
technical definition of PTSD in the Diagnostic and Statistical
Manual (DSM-IV) of the American Psychiatric Association states
that "the person experienced, witnessed, or was confronted
with an event or events that involved actual or threatened
death or serious injury, or a threat to the physical integrity
of self or others." These threats come in many forms
ranging all the way from an actual homicidal attempt against
the person to neglect that leaves the person feeling like
they don't exist or like their existence is in question due
to the failure to be provided with the essentials of life.
No matter what form the threat comes in, it of-course causes
fear and loss.
This fear and loss may not be consciously experienced, especially
in the case of what I call traumatic neglect. Life to that
child may seem "normal" because there is nothing
dramatic that is happening to call the child's attention to
the fact that something very important and essential to survival
and to healthy emotional development is missing. But the threat
is nevertheless very real. The extreme case of this is children
in understaffed orphanages who die not because of abuse, exposure
or lack of being provide with adequate nutrition, but rather
due to the lack of adequate emotional nurturing. Those who
don't actually die, live on to develop PTSD because the fear
and loss in these situations are very real.
Fear and loss in turn cause reactivity. For people with PTSD,
reactivity occurs continually. All of experience is perceived
through the filter of the person's trauma. Consequently there
are a myriad of triggers throughout the person's day-to-day
events. Any one of these triggers or a combination of them
can set off a reactive cycle. By a reactive cycle, I mean
that with PTSD when one is triggered there is more than a
simple stimulus-response mechanism that comes into play.
Each person with PTSD has literally thousands of triggers.
Each one of these triggers is based on an association to some
aspect of one or more traumatic events. These associations
can be central to and part and parcel of the trauma, such
as encountering a person who was the perpetrator of some abuse.
But more commonly associations are based on resemblance, such
as seeing a vehicle similar to the one that hit you. Or it
may be something that is tangential to and/or subliminal to
the traumatic event, for example, the color of sand, just
the color by itself without any actual sand, may be triggering
to those who have fought in the desert. Triggers can involve
any one or more of the senses, sights, sounds, textures, smells
or tastes, separately or in combinations.
Reactivity takes many forms. Reactions may simply be vague
feelings or they may bring on strong emotions. They cover
the gamut of emotions and the whole range of intensity from
mild to severe. They frequently involve physical sensations.
There are a whole variety of these including such things as
a lump in the throat, a sense of pressure or tension, headaches
of all kinds, tics, spasms, clenching of jaw or fists or other
muscles groups, all manor of aches and pains, itching, twitching,
flinching, etc. Reactions frequently bring with them thought
processes. These can be very nebulous and vague or very clear
and specific. The thoughts may be mild or strong, e.g. ranging
from a vague misgiving about someone who reminds one of a
perpetrator to a strong dislike of that person or anything
in between.
The reactivity of any given person with PTSD is determined
and shaped by the nature of the trauma that they suffered.
For example, someone who was sexually abused will most generally
have symptoms of a sexual nature of one sort or another. These
can take a whole variety of forms including sexual dysfunction,
avoidance and abstinence, and excessive or bizarre sexual
behavior. Needless to say these people generally have great
difficulty forming a normal healthy long-term sexual relationship
with a committed partner. If a person was physically abused
part of their reactivity at times may actually include sensations
of pain and they will probably have reactions that involve
the fear of being hurt or they may become violently angry
when they think or fear that someone else, especially a child
is being hurt.
Trauma is not just the actual external events that happened
to the person, but also the internal physiological responses
to those events and the interpretations that the person gave
to those events. For this reason, I believe that there is
no such thing a "simple trauma". There is simple
physical trauma, but emotional trauma is always complex. Unfortunately
this means that for people with PTSD, the solution to the
trauma must necessarily also be complex. This is why there
are so many different schools of thought about trauma treatment
and such a variety of therapeutic techniques for treating
trauma. My philosophy is to try a variety of approaches, figure
out which ones work for you and do those.
Excessive reactivity of one sort or another is the most diagnostically
indicative sign of someone having PTSD. It is also, quite
often, the most annoying and troubling aspect of having PTSD.
It interferes with having a more pleasant and satisfying life
in a variety of ways. We tend to misinterpret everything because
of looking at things through the lens of our trauma experiences.
Then we tend to react to those interpretations and base our
behaviors on those reactions. Consequently we very often find
our self feeling badly and behaving badly. And this never
helps our situation and can be extremely damaging at times.
Childhood trauma creates fragmentation. During the trauma
we dissociated in order to get through the experience. Part
of us stayed present to the experience and part of us checked
out. I think most people have had the experience of driving
along and then suddenly realizing that they do not remember
the last stretch of road. They weren't present to the experience
consciously and yet they were driving the car and did not
run into something or off the road. The conscious part of
them was checked out, dissociated, in a trance. This is a
very common experience and something that everyone is capable
of. People who experienced childhood trauma learned to do
this early and became very skilled at it. They became so skilled
in fact that they became able to do it automatically without
even trying and without a conscious awareness that they were
doing it. And in fact the more trauma they experienced the
more they did it until they created multiple fragments. The
extreme case of this is of course the person with multiple
personalities each of whom having a separate identity.
I have referred to PTSD as a "fear-based economy".
Growing up in an environment in which there is physical and
psychological threat to us and/or to others around us, it
is easy to see how we could develop lots of fears and fearfulness
in general. Growing up with parents who neglected us physically
and/or emotionally, it is also easy to see how we could develop
lots of fears and fearfulness. Many of us became shy and introverted
as children in response to these fears. Others of us were
more discriminating and were only fearful of certain types
of people and certain types of circumstances. Others of us
developed bravado to hide our fears. But any way you slice
it these fear repeatedly and dramatically interfere with our
functioning. They constitute yet another way that PTSD is
a problem and yet another challenge to overcome in the aftermath
of trauma.
The threat and danger that we experienced also created in
us a sense of helplessness. This sense of helplessness for
most of us comes and goes although some of us experience this
all the time. Over the years we have developed ways of compensating
for our basic core feelings of helplessness. We have made
ourselves hyper-competent. We have forced ourselves to excel.
We have learned martial arts. We carry guns, mace or other
defensive weapons. We have become expert marksmen. On the
other hand, some of the things that make us feel helpless
have been addressed by programming them out or our lives.
We stay out of relationships. We only work in certain kinds
of settings or we don't work at all. We only associate with
certain kinds of people. Or we don't socialize at all.
Living in the aftermath of childhood trauma is not a pretty
picture. And painted all on one canvass like this it can seem
enormously overwhelming and discouraging. However, as we deconstruct
it and reconstruct it a little bit at a time, we can gradually
overcome more and more of the effects of trauma and live more
and more functional and fulfilling lives. May it be so for
you my friend.
John C Flanagan, LCSW
818 NW 17th Avenue, Suite 7
Portland, OR 97209-2327
503-228-7574
www.johncflanaganlcsw.com
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