Blog updated the 1st & 3rd Fridays of every month!
August 16th, 2013
Recently I contributed to an article on recovery from bulimia posted on Beliefnet. If you’d like to check out what I and several other eating disorder professionals had to say on the subject, just follow this link:
The article was written by by Margarita Tartakovsky who frequently posts on eating disorder issues in her column, Weightless, at Psych Central (psychcentral.com).
Hope you’re enjoying these last days of summer!
June 20th, 2013
In my last post, “Eating Disorders and Complex PTSD”, I described complex PTSD and listed some of the experiences typical of adults with this unresolved trauma disorder. Since the treatment of complex PTSD is often different from what people are expecting, today I’d like to walk you through some treatment basics.
Treatment for complex PTSD is typically planned to occur in three stages:
- Safety and stabilization In this stage you develop the skills and capacity for tolerating difficult emotions that emerge in trauma treatment and in life. Along with this comes greater ability to manage eating disorder symptoms and other symptoms, such as drinking or drugging, that represent failed efforts at emotion regulation. Issues such as self care will also be addressed. A lot of attention will be paid to the quality of the relationship with your therapist since the early trauma likely involved your relationship with caregivers, what’s called attachment trauma.
- Direct trauma treatment This is the stage in which you directly address trauma memories and work to resolve them. “Resolution” means, among other things, that trauma experiences no longer cause you to be distressed or symptomatic in the present.
- IntegrationIn this final stage of trauma treatment, you are helped to develop life skills trauma may have robbed you of, such as the capacity to assert yourself or establish healthy boundaries in relationships. You are also supported in developing a sense of personal agency, that is, the ability to think about how you’d like your life to be, to set goals for making it happen, and mobilizing yourself to implement your goals. Widening your network of social connection and your engagement in the larger community is another important part of this stage of treatment. Through all of this is woven an increasing capacity to experience yourself and your life in a coherent, organized way—there’s an executive “you” that can see the bigger picture and sense how the pieces fit together.
There are aspects of this three-stage plan that may be disappointing and upsetting for some of you. For instance, you may want to know why, if you are coming for trauma treatment, you can’t just jump right in and go to work on your trauma memories. Often it’s taken a while to get your difficulties diagnosed as trauma, during which time you’ve experienced a lot more pain and suffering. Why not just rip off the bandage right away and get it over with? It’s understandable. But it’s precisely the wrong way to go. Here are a few reasons why:
- Early trauma resulting in complex PTSD means you had experiences that overwhelmed your capacity to cope. Delving into those experiences without having the chance to develop better coping skills is highly likely to reproduce the original overwhelm; in other words, to re–traumatize you.
- Complex PTSD means early trauma has taken up lodging in your nervous system, the part that’s responsible for warning you about danger. This system has become exquisitely sensitized, such that it’s sending you alarm signals all the time, even when nothing threatening is happening. This can be harrowing to live with. You may have learned to numb out or dissociate as a way to protect yourself from the flood of feelings. Perhaps you live most of the time now in a deadened state, or perhaps you cycle between overwhelmed feelings and deadening or dissociation. A severely dysregulated nervous system is a hallmark of complex PTSD. Getting it to function on a more even keel is a first order of business so you can start to feel better and function better.
Another wish or expectation that is generally disappointed in the treatment for complex trauma is the desire for a quick fix. Goodness knows, when you’ve suffered since childhood, you’re entitled to it. If only it were possible! Sadly a number of people give up altogether or jump from treatment to treatment, holding out for instant relief. What you can realistically expect is that when you dig in with the work of treatment, little by little things will start to get better.
A third common wish or expectation that people bring to treatment for complex trauma is that treatment will somehow be done to them rather than in collaboration with them. This makes sense to me because chronic early trauma is likely to leave you feeling helpless about your ability to make things happen in your life. As it turns out, the growing sense of “I can” that develops from collaborative work with your therapist is an important part of the healing you will experience. Learning to tolerate small steps and incremental improvement will make a big contribution to establishing that “I can” sense of yourself.
Chronic early trauma undermines the development of a sturdy, secure self and trust in relationships with other humans. Treatment for this kind of trauma aims at repairing the internal and interpersonal damage done and building up the structures inside that will allow you to relate to yourself and the world in a more confident and resilient way. It’s going to take longer than you hoped it would, but you’ll never make a better investment.
June 9th, 2013
If you have an eating disorder, you may also have a condition called complex PTSD. Complex PTSD is a type of unresolved trauma. It occurs when the trauma is not a one-time thing but an ongoing experience. Battered wives may develop complex PTSD. So may prisoners of war or torture victims. People who have eating disorders and complex PTSD probably had ongoing trauma during childhood. Common sources are abuse, neglect (including emotional neglect), so-called “frightening or frightened caregivers”, repeated medical trauma, and peer trauma.
Let’s stop here to define some basic terms:
Trauma is any experience that overwhelms a person’s ability to cope at the time it occurs.
PTSD (Posttraumatic Stress Disorder) occurs when the trauma cannot be integrated, that is, psychologically ”digested”. Such a failure of coping mechanisms is likely if: 1) you felt helpless when the trauma occurred, and 2) you dissociated the experience.
Dissociation is your mind’s instinctive effort to protect you from being overwhelmed by aspects of the trauma by keeping them out of conscious awareness. Here’s the problem with this arrangement: trauma experience that hasn’t been psychologically digested gets stashed in your nervous system such that it feels like the threat is always there. Reminders cause, or threaten to cause, reliving rather than remembering. As such they also threaten to recreate the original terror, an experience called hyperarousal, which has both emotional and physical symptoms. People with PTSD attempt to contain hyperarousal by shutting down and numbing. PTSD is characterized by chronic cycling between hyperaroused and shut-down states.
Complex PTSD, particularly when it is the result of chronic trauma in childhood, is not fully described by the definition for simple PTSD. This is primarily because of the likely disturbance in the relationship to caregivers. This is known as attachment trauma. We now know that the ability to access a comforting caregiver in moments of distress is essential to the survival and well-being of infants and children. The security this provides lays a foundation for feeling secure in oneself and in the world of other people for a lifetime.
When the caregiver is also the source of threat, this creates an impossible bind for children—the need to reach out and the simultaneous need to get away — which they will likely resolve by dissociating. The chronic experience of threat and the broad use of dissociation inevitably interfere with creating a unified sense of self and with ongoing development. Energy is being diverted to survival. Occurring at this stage of life, the ongoing trauma and attempts to contain and survive it become interwoven with the very fabric of personality.
Below is a list of experiences typical of people with complex PTSD.
- You are depressed, often filled with hopelessness and despair. You struggle with suicidal feelings and impulses.
- You are hypervigilant. You expect the trauma to happen again. You live with a constant feeling of threat.
- You frequently feel shut down or numbed out, symptoms that are intended to help you manage chronic fear and distress.
- Gaps in awareness that result from dissociation interfere with constructing a coherent, organized experience of yourself and the world.
- Your self-image is marked by self-blame and a sense of badness or unworthiness, often resulting in the experience of unbearable levels of shame.
- You feel estranged from other people, an outsider to normal experience.
- You find it extremely difficult to manage your emotions or cope with stress.
- You rely on behaviors such as addictions, eating disorders and/or self– injury to soothe and calm yourself.
- You are stuck in a chronic sense of “I can’t” — what clinicians call “learned helplessness”.
- If abused as a child, you are highly vulnerable to becoming a victim again. For example, in at least one study, 2 out of 3 of women who had been subject to incest later became victims of rape.
- While longing for the love, protection and rescue you lacked as a child, a part of you, perhaps an unconscious part, expects all intimate relationships to fail, betray, injure or disappoint you. You are prone to forming relationships with abusive people.
- You experience relationship options in black and white terms. For example: if you’re not the victim, you’re the perpetrator; if you don’t have total control, you have no control; if you’re not shaming someone, you’ll be the one being shamed; and so forth.
- You have difficulty standing up for yourself, asserting your needs, setting limits or realizing your personal agenda.
- You have lots of aches and pains resulting from unconscious attempts to “bury” your trauma history in your body.
- You have more than your share of medical problems. According to the CDC, the more adverse childhood experiences a person has had, the more likely he or she is to develop heart disease, cancer, stroke, diabetes, skeletal fractures, and liver disease.
If you identify with many of the items on this list, I welcome you to check back for my next post, “What to Expect from Treatment for Complex PTSD”. Treatment for complex PTSD can be a challenge, but more and better approaches are developing all the time.