Tag: disorders

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.