For the roughly hundred people who wake up each day during surgery, this has been a nightmare come true. A 2003 article in USA Today1 divulged that a study conducted that year exposed this high number of surgical “wake-ups.” “Anesthesia failure that allows a patient to wake up during surgery, paralyzed and unable to cry for help” is an understandably terrifying and traumatizing risk of even minor surgery. It can indeed lead to Post Traumatic Stress Disorder (PTSD).

Aside from anesthesia mishaps, trauma can occasionally result from a wide variety of other medical incidents including surgery (in general), high fevers, dental procedures, and prolonged immobilization as a result of injury.

Additionally, intense medical situations can further exacerbate an existing condition or trigger an acute episode. According to Primary Psychiatry, “Anxiety disorders, depression, bipolar disorder, schizophrenia, and personality disorders may all flare up during the post-operative period, leading to psychiatric consultation.”

Primary Psychiatry also says that: “Posttraumatic stress disorder (PTSD) is also common after surgery, particularly after traumatic injuries, but is underrecognized and undertreated. Previous research has evaluated these and other issues in surgical patients.” As you might expect, Medical PTSD is most common in patients who underwent emergency surgery as a result of a traumatic event such as a car accident, a fire, or an assault. Therefore, it can be difficult to ascertain whether the PTSD came about as a result of the original traumatic incident, the medical procedure, or both.

Now for the good news, at least on the anesthesia front: in recent years the Food and Drug Administration has approved and begun to advocate the use of a device called a BIS monitor, which translates a patient’s brainwaves into an indicator of how sedated they are at any moment during surgery. This device can be used to indicate when a patient is truly sedated and unable to consciously experience the procedure.

Citations:

1.     http://www.usatoday.com/news/health/2003-10-12-surgery-usat_x.htm

2.     http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=1067

Recently, I had the profound fortune of attending a lecture with Dr. Bessel van der Kolk on trauma, during which he compared the impact of 9/11 to Hurricane Katrina. Dr. van der Kolk is one of the world’s leading research experts in the field of PTSD. He is particularly known for his work with the consequences of trauma and stress – both from a neurological standpoint and a psychological one – and has written numerous books on this topic.

Dr. van der Kolk was showing us a photograph of people on the Brooklyn Bridge on that fateful day in 2001. The burning twin towers were in the backgrounds, and all of these people were running away from them, toward their homes in Brooklyn. He pointed out that naturally, they were running in the direction of the places they perceived as safe: their own neighborhoods, where they had family, friends, and community to comfort them. We all remember 9/11 vividly. Three-quarters of Americans donated to the 9/11relief effort. Our country rallied together to support those affected by this horrible tragedy. As the media described, community and municipal departments acted quickly to provide healing resources to 9/11 survivors post-event.

In 2003 – two years after 9/11 happened – New York Magazine reported that “probably half the city’s firefighters have gone into therapy-6,100 uniformed people have received counseling through the department. The department now has 60 full-time counselors instead of the 9 it employed before September 11.” Victims of Katrina, in contrast, tended to be low-income and minority civilians without access to supportive counseling and other such resources as they tried to psychologically cope with the epic disaster they had witnessed. Governmental and FEMA resources were focused on crowd control, housing, and tangible issues.

Dr. van der Kolk talked about how, as a result of Hurricane Katrina, victims were forced to flee their homes, some of them permanently. Refugees from New Orleans numbered in the thousands. Many were displaced to other cities and even states as everything they perceived as familiar was eaten alive by the hurricane and its aftermath. And this was only if they could get out. During Katrina, those who did not or could not escape fast enough were trapped in a drowning city, without the ability to run for refuge. Their fight/flight/freeze responses were presumably on high alert for a prolonged period of time. Emergency airlifts strapped down many trapped New Orleans residents and carried them out of the city, stacking them like cordwood to fly them to safety in new and unfamiliar places. In many cases, victims never saw their homes and communities again. Additionally, while those who experienced 9/11 in New York were painted as national heroes in the press, the victims of Hurricane Katrina were labeled as just that: victims. (Of course, one has to consider the fact that one situation was a terrorist attack, the other, a natural disaster.)

Not everyone who experiences trauma will go on to suffer from PTSD. There are many factors that determine whether a trauma victim will develop PTSD, including their level of coping skills, resiliency, exposure, and the severity of any prior trauma. However, what has not been much talked about is the importance of community support in an individual’s mental recovery from a natural disaster or terrorist event. Access to external resources, the support of others -both moral and logistical – and the media portrayal of a situation are all components on the road to healing. We rely not just on our loved ones and our immediate family, but our entire community and culture, when recovering from a major traumatic social event. The likelihood of a survivor experiencing PTSD as a result of a trigger event depends not just on the event itself, but on the ensuing circumstances and the cultural reaction to the event.

I recently attended a 9/11 memorial ceremony here in California. As an imported 65-pound piece of the Twin Towers was put in place in front of our own fire department, the message “We are standing here as a unit” was the predominant theme. Survivors were remembered, and their pain was acknowledged, sending the message to all of the victims that they were are are not alone. I thought of the endless stories of my own clients who only wanted — despite their personal trauma — to have their emotional pain acknowledged. What if our community acknowledged and felt that it was a part of the solution? What if we had more such ceremonies and gave the message “you are not alone”?
Citations:

http://en.wikipedia.org/wiki/Bessel_van_der_Kolk

http://nymag.com/nymetro/news/sept11/2003/n_9189/index1.html

The OVW reports that a woman is assaulted or beaten every nine seconds in the U.S. Domestic violence is the leading cause of injury to women in this country. Every day, at least three U.S. women are killed by their partners. ⁴

But the truth is, women are not the only victims of domestic violence.  Similar to child abuse, domestic violence allows an abuser in a position of power to prey on the person in the relationship who has less power. In a man/woman relationship, this is often the woman, but it’s important to note that all types of people (men, women, straight, gay) can be abusive… and can also be abused.

Batteredmen.com claims that 835,000 men are abused each year, and offers a comprehensive web site full of resources and information: http://www.batteredmen.com/ In my own practice, I have counseled several men who were victims of abuse in their relationships.

Regardless of their gender or sexual preference, those who experienced abuse as children are more likely to become abusive themselves in adult intimate relationships. Lenore Walker’s theory of The Cycle of Abuse explains how patterns of abusive behavior endure. Domesticviolence.org describes The Cycle of Abuse like this: ⁵

1.     An initial abusive incident occurs (can be sexual, physical, or emotional)

2.     Tension builds, with the abuser trying to quell their violent tendency and the abusee trying to “keep the peace” until finally, another incident happens

3.     Make-up: the abuser apologizes, often promising never to do it again or, conversely, trying to shed blame by saying that the victim “asked for it” or is “making a big deal out of nothing”

4.     Calm: both parties act as if nothing is wrong, and do their best to ignore the mounting problem

This cycle can repeat itself endlessly, with the victim playing a prescribed role that is just as predictable as the perpetrator’s.  Eventually, the “Make-up” and “Calm” stages get shorter and the abusive stages often get longer. After a period of time, it’s not uncommon for victims of domestic violence (like victims of all types of abuse and trauma) to develop the symptoms of Post Traumatic Stress Disorder (PTSD). And because studies have proven that those who suffer from PTSD can be inclined toward violence, the cycle of abuse repeats itself through generations and is hard to break. For victims for whom domestic violence leads to PTSD, they struggle with a long-term psychological disorder that can be challenging to diagnose and conquer.

According to the report “Women, Domestic Violence, and Posttraumatic Stress Disorder (PTSD)” by Margaret J. Hughes and Loring Jones, “The severity of the violence, the duration of exposure, early-age onset, and the victim’s cognitive assessment of the violence (perceived degree of threat, predictability, and controllability) exacerbate the symptoms.” This report also found that women who resort to taking refuge in shelters as a result of domestic violence are at a higher risk for PTSD than other victimized women. In any given shelter, they found, 40-84% of the residents are victims of domestic violence. ¹

A.A.R.D.V.A.R.C. — An Abuse, Rape, and Domestic Violence Aid and Resource Collection —lists battering as the single major cause of injury to women. Domestic abuse is more prevalent than even injuries sustained in accidents. ² Domestic violence tends to be repetitive and endurance-based. The physical effects of this type of trauma on its victims is often obvious and acute: lacerations, bruises, broken bones, head injuries, internal bleeding, chronic pelvic pain, abdominal and gastrointestinal complaints, frequent vaginal and urinary tract infections, sexually transmitted diseases, and HIV. ³ But it can also manifest over the long term as chronic physical problems like arthritis, hypertension, and heart issues. Existing medical conditions can similarly be aggravated by sustained physical abuse.

And often, it’s the emotional component of domestic violence that leads to a chronic state of PTSD. Being abused by someone who should be trustworthy and nurturing leads many women to feel abandoned, betrayed, even crazy. Depression is by far the most common symptom of domestic violence, and it’s also one of the chronic effects of PTSD caused by abuse. The feeling of helplessness and hopelessness that many victims fall prey to has a profoundly undermining effect on their mental and emotional wellbeing.

And because abusers often exacerbate the harmfulness of their abuse by refusing their partners access to adequate medical and psychological care — and even withholding such care as a further form of abuse — it is often extremely challenging for victims of domestic violence to escape the cycle of abuse. Even those of who have managed to move on from crippling abusive relationships can suffer the aftershocks of abuse — on other words, PTSD — for many years. PTSD from abuse is characterized by symptoms such as flashbacks, intrusive imagery, nightmares, anxiety, emotional numbing, insomnia, hyper-vigilance, and avoidance of traumatic triggers.

Extracting oneself from a domestic violence situation can be extremely challenging. If you are a previous victim of domestic violence and you suspect that you are suffering from the delayed symptoms of PTSD, I encourage you to contact a psychotherapist who specializes in domestic violence. If you are in a situation where you are currently experiencing domestic violence — or even if you are unsure and want to learn more — a great place to start is The National Domestic Violence Hotline: http://www.thehotline.org/

Or call:

1.800.799.SAFE (7233) 1.800.787.3224 (TTY)
(Anonymous and confidential help 24/7)

Citations:

¹ http://pdfcast.org/pdf/women-domestic-violence-and-posttraumatic-stress-disorder-ptsd

² http://www.aardvarc.org/dv/effects.shtml

³ Jones & Horan, 1997 and Bohn & Holz, 1996

⁴ http://domesticviolencestatistics.org/

⁵ http://www.domesticviolence.org/cycle-of-violence/

According to U.S. Department of Health and Human Services statistics for 2006, approximately 905,000 U.S. children were found to have been maltreated that year, with 16% of them reported as physically abused (the remainder having suffered sexual abuse or neglect.)¹ In other studies, it’s been noted that approximately 14-43% of children have experienced at least one traumatic abusive event prior to adulthood.² And according to The American Humane Association (AHA), an estimated 1,460 children died in 2005 of abuse and neglect. ³

How is child abuse defined?

The AHA defines child physical abuse as “non-accidental trauma or physical injury caused by punching, beating, kicking, biting, burning or otherwise harming a child.” ³ However, it can be challenging to draw the line between physical discipline and child abuse. When does corporal punishment cease to be a style of parenting and become an abusive behavior that is potentially traumatizing for its child victims in the long-term?

A recent episode of the popular television show Dr. Phil (http://drphil.com/shows/show/1545/) featured a woman whose extreme disciplinarian tactics later resulted in her arrest and prosecution for child abuse. A featured video showed her forcing her young adopted son to hold hot sauce in his mouth and take a cold shower as punishment for lying. Audience members were horrified — as was Dr. Phil — but the woman insisted that she couldn’t find a better way to control her child. Many child abusers are not aware when their behavior becomes harmful to a child or how to deal with their own overwhelm before they lose their tempers.

At its core, any type of abuse of children constitutes exploitation of the child’s dependence on and attachment to the parent. Another therapeutic term that is used in conjunction with child abuse is “interpersonal victimization.” According to the book Childhood victimization: violence, crime, and abuse in the lives of young people by David Finkelhor, interpersonal victimization can be defined as “…harm that comes to individuals because other human[s] have behaved in ways that violate social norms.” ⁵This sets all forms of abuse apart from other types of trauma-causing-victimization like illness, accidents, and natural disasters.

Finkelhor goes on to explain: “Child victimizations do not fit neatly into conventional crime categories. While children suffer all the crimes that adults do, many of the violent and deviant behaviors engaged in by human[s] to harm children have ambiguous status as crimes. The physical abuse of children, although technically criminal, is not frequently prosecuted and is generally handled by social-control agencies other than the police and criminal courts. ” ⁵

What happens to abused children?

In some cases—depending on the number of reports made, the severity of the abuse, and the available community resources—children may be separated from their parents and grow up in group homes or foster care situations, where further abuse can happen either at the hands of other abused children who are simply perpetuating a familiar patterns or the foster parents themselves. In 2004, 517,000 children were living in foster homes, and in 2005, a fifth of reported child abuse victims were taken out of their homes after child maltreatment investigations. ⁶ Sometimes, children do go back to their parents after being taken away, but these statistics are slim. It’s easy to imagine that foster care and group home situations, while they may ease the incidence of abuse in a child’s life, can lead to further types of alienation and trauma.

How does child abuse turn into Post Traumatic Stress Disorder?

For children that have suffered from abuse, it can be complex getting to the root of childhood trauma in order to alleviate later symptoms as adults. The question is, how does child abuse turn into Post Traumatic Stress Disorder later in life? What are the circumstances that cause this to happen in some cases and not others?

Statistics show that females are much more likely than males to develop PTSD as a result of experiencing child abuse.  Other factors that help determine whether a child victim will develop PTSD: ⁷

• The degree of perceived personal threat
• The developmental state of the child (some professionals surmise that younger children, because they are less likely to intellectually understand and interpret the effects of a traumatic situation, may be less at risk for long-term PTSD)
• The relationship of the victim to the perpetrator
• The level of support the victim has in his day-to-day life as well as the response of the caregiver(s)
• Guilt — A feeling of responsibility for the attack (“I deserve it”) is thought to exacerbate the changes of PTSD
• Resilience and the innate ability to cope of the individual
• The child’s short-term response to abuse (for instance, an elevated heart rate post-abuse has been documented as increasing the likelihood that the victim will be later suffer from PTSD)

Carolyn Knight wrote a book called Working With Adult Survivors of Childhood Trauma that states: “Trauma, by definition, is the result of exposure to an inescapably stressful event that overwhelms a person’s coping mechanisms. (van der Kolk 1987, 25)” ⁶ She points out that an important aspect of an event (or pattern of events) is that it exceeds the victim’s ability to cope and is therefore overwhelming. A child should not have to cope with abuse, and when abuse occurs, a child is not equipped psychologically to process it. The adults in their lives are meant to be role models on how to regulate emotions and provide a safe environment.

According the American Academy of Child & Adolescent Psychiatry, some of the particular symptoms of child PTSD include: ⁸

• Frequent memories and/or talk of the traumatic event(s)
• Bad dreams
• Repeated physical or emotional symptoms whenever the child is confronted with the event
• Fear of dying
• Loss of interest in activities
• Regular physical complaints such as headaches or stomachaches
• Extreme emotional reactions
• Trouble sleeping
• Irritability, anger, violence
• Difficulty concentrating
• Constant or often clingy or whiny behavior and regression to a younger age
• Increased vigilance or alertness to their environment

Once a child has grown to be an adult, however, symptoms of PTSD can become more subtle as he or she learns how to cope with this in day-to-day life. The symptoms of PTSD can be quite general and can mimic other disorders: depression, anxiety, hypervigilance, problems with alcohol and drugs, sleep issues, and eating disorders are just a few. Many have problems in their relationships and trusting another person again. Many even end up in abusive relationships and find themselves re-enacting the past.

Community support is a vital tool in preventing child abuse and the PTSD that can result from it. If you suspect that you or a loved one is suffering from child abuse, please report it to your local Child Protection Services — or the police, if a child is in immediate danger. The longer that abuse continues, the higher the risk of causing severe symptoms.

For more information about actions to take if you suspect a case of child abuse, visit the Dreamcatchers website. [http://dreamcatchersforabusedchildren.com/abuse/report-abuse/?gclid=CI_Xlur5xqcCFQImbAodXEJAEQ]

If you or a loved one may be suffering from delayed effects of trauma due to childhood abuse, I encourage you to make a therapy appointment with someone who specializes in  trauma and who can put you on a path of healing.

Citations

¹ Child Maltreatment 2006. Washington DC: US Department of Health and Human Services Administration for Children and Families, Administration on Children Youth and Families Children’s Bureau; 2008. 1-194

²http://emedicine.medscape.com/article/916007-overview

³http://www.americanhumane.org/

⁴ http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-abuse-and-neglect-statistics.html

⁵ http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-abuse-and-neglect-statistics.html

⁶ http://books.google.com/books?hl=en&lr=&id=nXrCyT4J6o4C&oi=fnd&pg=PR13&dq=Childhood+victimization:+violence,+crime,+and+abuse+in+the+lives+of+young+people+By+David+Finkelhor&ots=cBmLbRNXBF&sig=1kSclkOp-PtXV9Pta9MqPYlRXHA#v=onepage&q&f=false

⁶ United States Department of Health and Human Services

⁷ “Child Abuse and Neglect, Posttraumatic Stress Disorder” by Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children’s Health Plan, Inc on http://emedicine.medscape.com/article/916007-overview

⁸ http://www.aacap.org/

The sad truth is, being tormented and teased — and even physically attacked — by other children has been a fact of life for many young people for as long as there have been schools.  According to bullyingstatistics.org, 77% of students experience bullying in some form: mental, verbal, or physical. Every seven minutes, a child gets bullied. ¹ But this does not make it any less traumatizing or troublesome.

What makes child bullying unique from other types of traumatic experiences is that the perpetrators are often also children. Kids bully other kids for a variety of reasons, some more obvious than others. Bullyingstatistics.org lists the primary motivations that compel bullies: ²

• A family environment of either neglect or physical abuse
• A school or institution’s lack of standards around interpersonal treatment
• Positive reinforcement around “acting out” in the form of added attention
• Our culture’s glorification with winning, power, and violence
• A history of the perpetrator him or herself having experienced rejection, failure, or bullying

Usually, bullying comes about as a result of a number of the above factors existing at once.

In clinical terms, to officially be considered “bullying,” the behavior needs to take place repeatedly. Interestingly, Post Traumatic Stress Disorder was traditionally considered to be a disorder that arose from a single traumatic incident. However, in recent years, experts have begun to identity a second definition for PTSD that allows for the victims of repeated traumatizing incidents. Bullying falls into this category.

Bullyonline.org points out that the most recent version of the DSM (Diagnostic and Statistic Manual, which all doctors use to diagnose mental illness) recently updated it’s definition of PTSD to note that, although PTSD has traditionally been thought to be caused by a single, life-threatening event (or, at least, an event that seemed to be life threatening), in the case of trauma such as bullying, PTSD can also come about by way of an “accumulation of many small, individually non-life-threatening incidents.” ³ (Note that this is often referred to as “Complex PTSD.”)

So by it’s most simplest definition, PTSD is brought on by one or a series of terrifying events and results in delayed and prolonged symptoms such as anxiety, depression, withdrawal, suicidal behavior, alcohol and drug abuse, and emotional issues.

Some examples of types of bullying:

1.     Physical violence toward a child

2.     Verbal teasing

3.     Spreading rumors about a child

4.     Excluding a child from a group

5.     “Gang up” behavior

6.     Cyberbullying — using the Internet, Facebook, Twitter, text messaging, or other technology to demean a child

In worst-case scenarios, the abuse of bullying can lead its young victims to suicide, sometimes called “bullycide.” But even though most children grow out of the stage of bullying and being bullied, victims of this hateful crime are still at risk for the long-term effects of PTSD.

With Complex PTSD, victims are “held captive” by their situations. Children who are subject to regular bullying may not have any way out of what they perceive as a trapped situation. Reporting incidents to teachers or other authority figures can be a daunting prospect, as this sort of “tattletale” behavior is so apt to exacerbate the bullying instead of halting it. A pattern of bullying can also be exacerbated by parents — especially, and traditionally, fathers — who may believe that being pushed around or beat up by your peers “toughens you up” and is just a “natural part of childhood.”

Of course, the best way to avoid PTSD from school bullying later in life is to prevent or stop the problem early on. This takes a vigilant approach on the part of parents and especially on the part of school administrators, as school is the most common place that children experience the harassment of bullying.

Here are some potential signs that a child is experiencing repeated bullying:⁴

1.     Isolated or disconnected behavior that is not normally a part of the child’s personality

2.     Sudden physical complaints — especially ones that prevent the child from attending school or other events

3.     Degraded performance with schoolwork or difficulty concentrating

4.     Sleep issues or nightmares

5.     General malaise, withdrawal, or depression

6.     A sense of hypervigilance, anxiety, or a high temper

The good news is that the recent media interest in school bullying has resulted in wider awareness of this epidemic, and there are now many resources available throughout the U.S. that children, parents, peers, and teachers can turn to if they know or suspect that bullying is happening.

For more statistics, information, and stories, visit Bullyingstatistics.org. (http://www.bullyingstatistics.org)

CITATIONS:

1 http://www.bullyingstatistics.org>

2 http://www.bullyingstatistics.org/content/why-do-people-bully.html

3 http://www.bullyonline.org/stress/ptsd.htm

4 http://drtedzeff.com/news/warningsigns.php

• Children in the U.S. were abused or neglected at the rate of 1.23%
• Out of that number, 64.2% experienced neglect
• 1,530 children died of abuse or neglect that year
• Roughly half the victims were of each sex, with only a slightly higher incidence of neglect victims being female¹

The National Child Abuse and Neglect Data System defines neglect as “a type of maltreatment that refers to the failure by the caregiver to provide needed, age-appropriate care although financially able to do so or offered financial or other means to do so.” (USDHHS, 2007)² Neglect is a unique type of trauma in that only children (and, in some cases, dependant adults) are susceptible to it. In order to experience neglect, a person must be reliant on others for their physical and emotional wellbeing. This vulnerability means that the child victims of neglect are disposed to experiencing related trauma (including PTSD) later in life.

Types of Child Neglect: ²

Physical Neglect — Children need the same basic necessities as everyone: food, clothing, shelter. However, they are reliant on others to provide these necessities. If a provider is not ensuring that their trustee is given these essentials, it is considered neglect. Physical neglect might mean that a parent is neglecting to provide adequately nutritious meals consistently, or it might mean that a parent has literally abandoned their child.

Educational neglect — Failure to provide a child with adequate education in the form of enrolling them in school or providing adequate home-schooling.

Emotional neglect — Consistently ignoring, rejecting, verbally abusing, teasing, withholding love, isolating, or terrorizing a child. Emotional neglect can also include subjecting a child to corruptive or exploitative situations (such as illegal drug use).

Medical neglect —American Humane.org cites Medical Neglect as “the failure to provide appropriate health care for a child (although financially able to do so), thus placing the child at risk of being seriously disabled or disfigured or dying.” Of all the types of neglect, this is the trickiest to diagnose because arguable religious or financial factors can play an adverse role in a child receiving appropriate medical care.

According to Child Welfare.gov, child neglect can lead to problems as an adult which include: ³

Physical consequences — such as failure of the brain to develop properly due to malnutrition and other medical issues; also, poor physical health in general which can lead to an array of problems later on

Psychological consequences — low self-esteem, problems maintaining healthy relationships, depression, PTSD, eating disorders, suicide attempts, cognitive/learning disabilities, social disabilities, and other issues

Behavioral consequences — juvenile delinquency, alcohol and drug abuse, criminal or abusive behavior

The dangers of neglect can be dire for a child’s healthy development. Without proper care, children are in danger of not developing properly due to malnutrition, physical injury, or illness. But the hidden danger of child neglect — the one that may not be apparent for many years but which can stick with a person for their lifetime – is the risk of Post Traumatic Stress Disorder that can affect them psychologically and emotionally in the long-term.

The psychological principle of attachment theory proposes that children become psychologically attached to their caregivers (and particularly their mothers) as infants in order to establish a vital sense of security. ⁴ In nature’s terms, keeping a child attached to the mother increases its chances of survival. So it stands to reason that being neglected is an affront to the “healthy, normal” sense of attachment that nature desires for children to have with their caregiver(s).

According to extensive research done by psychologist Mary Ainsworth in the 1970’s (published in her groundbreaking study Strange Situation), “What happens to children who do not form secure attachments? Research suggests that failure to form secure attachments early in life can have a negative impact on behavior in later childhood and throughout the[ir] life. Children diagnosed with oppositional-defiant disorder (ODD), conduct disorder (CD), or post-traumatic stress disorder (PTSD) frequently display attachment problems, possibly due to early abuse, neglect, or trauma.”⁴ In other words, children who experience neglect early in life may be at risk for a lifetime of trouble attaching properly in relationships.

Another reason that child neglect can lead to such a wide array of development and psychological problems is that children (particularly, infants) need a certain amount and type of input for their brain development to proceed normally through it’s various growth states. When deprived of appropriate input and stimulation, the brain may not develop normally, and this can affect brain functioning later on, which can affect an individual in many ways.

Not all children who experience neglect will experience long-term reactions. Factors determining whether the effects of abuse will be long-term include: ³

1.     The child’s age when the neglect occurred

2.     The type of neglect

3.     The frequency and duration

^CITATAIONS

¹ “Child Maltreatment 2006” released by the U.S. Department of Health & Human Services  — a 17th annual report of data collected via the National Child Abuse and Neglect Data System (NCANDS) http://www.acf.hhs.gov/programs/cb/pubs/cm06/cm06.pdf

² American Humane.org http://www.americanhumane.org/about-us/newsroom/fact-sheets/child-neglect.html

³ The Child Welfare Information Gateway http://www.childwelfare.gov/pubs/factsheets/long_term_consequences.cfm

⁴ http://psychology.about.com/od/loveandattraction/a/attachment01.htm

Postpartum PTSD is very different from Postpartum Depression. The former occurs as a result of trauma (or perceived trauma) during delivery, while the latter happens because of hormonal changes in a woman’s body as a natural result of giving birth. Nevertheless, these two conditions are linked together in some cases, and can certainly exacerbate one another. It’s important to distinguish between the two so that you can seek the most effective means of treatment.

Postpartum PTSD happens most often when mothers give premature birth to infants who begin their lives in critical condition. According to a new study from the Stanford University School of Medicine **, “… over half the parents whose babies were in the NICU for an extended period of time either had Post Traumatic Stress Disorder (PTSD), or were at high risk for developing it.”

Along with parenting premature babies who must endure Neonatal Intensive Care, PSI* also lists the following types of childbirth trauma that could potentially lead to PTSD:

·     Prolapsed cord
·     Unplanned C-section
·     Use of vacuum extractor or forceps to deliver the baby

Feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery can also contribute to Postpartum PTSD.
In 1993 The Journal of Obstetric, Gynecologic, & Neonatal Nursing printed the results of a study conducted to conclude how mothers of premature infants were affected by PTSD.***  Out of thirty mothers who had given birth to premature at-risk infants, sixteen of them showed symptoms of PTSD and a whopping 24 reported “re-experiencing” and “avoidance” characteristics. These reactions were still happening six months after the expected birth date.

The trick is to distinguish PTSD symptoms from those of postpartum depression and regular healthy recovery from childbirth. PTSD symptoms are generally grouped into three categories: re-experiencing, avoidance, and increased arousal.

Here are some of the signals to look out for:
·     Intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself)
·     Flashbacks or nightmares about the childbirth experience
·     Avoidance of stimuli that remind the mother of the childbirth experience—including thoughts, feelings, people, places and details of the event
·     Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response)
·     Anxiety and panic attacks
·     Feeling a sense of unreality and detachment

The good news is that Postpartum PTSD is treatable and temporary. The key is to get competent professional help as early as you can.  It’s important to treat PTSD before it begins to manifest as something harder to treat—such as an eating disorder, addiction, compulsive behavior, chronic panic disorder, or suicidal tendencies. If in doubt, contact your health care provider for advice right away.

More information:
Solaceformothers.org does a nice job of differentiating between “normal” biological postpartum depression and birth-related PTSD, and provides more detailed information, a breakdown of PTSD symptoms, and a helpline for those in need: http://www.solaceformothers.org/PTSD_info.html

SOURCES:
* http://www.postpartum.net/Get-the-Facts/Postpartum-Post-Traumatic-Stress-Disorder.aspx
** http://ksmu.org/content/view/6578/66/
*** http://onlinelibrary.wiley.com/doi/10.1177/0884217503252035/abstract

Grief after miscarriage

When we think about Post Traumatic Stress Disorder, we often think about war veterans and those who have endured violent crimes. But there are many other ways in which PTSD can affect victims of other, perhaps less obvious trauma. One of the less recognized forms of PTSD results from the trauma of having a miscarriage. While a period of grieving and sadness is to be expected after losing an unborn child, it’s important to recognize when normal grieving ends and clinical PTSD begins.

If a miscarriage happens before week twenty, it’s officially called a “spontaneous abortion (SAB).” After the twentieth week of the pregnancy, the medical term is “stillbirth.” Numerous studies have shown that about a quarter of all pregnancies end in miscarriage in the early stages. That’s a pretty high number. However, Stillbirths are far less common and statistics show that they occur roughly in 1 in 200 pregnancies.
A miscarriage could occur for many reasons—age, hormonal changes, lifetsyle, improper implantation of the egg, or trauma. And while it’s not always possible to know why a late-stage stillbirth occurs, a few common explanations are issues with the placenta or umbilical cord, chromosomal abnormalities, and infections.

Women who have made the conscious choice to have a child begin bonding with that unborn baby very early on. Intense hormonal and physical reactions can be dramatic, as well as the unexpected loss of a baby that the mother has already started to bond with in-utero. The further along the pregnancy evolves, the more potentially traumatic a miscarriage can be. In addition, a miscarriage that occurs in the later stages of pregnancy can be very painful and require major surgery to recover from. Things like breast engorgement and hormonally-induce postpartum depression need to be added to the already debilitating emotional aftereffects.

By far the most common PTSD symptoms that result from miscarriage are depression and anxiety. Other symptoms may include fatigue, sleep difficulties, lack of concentration, loss of appetite, and frequent episodes of crying. The impact of the trauma depends on the inner and outer resources of the new mother, her stress level at the time of event, the strength of her relationship with a partner (if she has one), outside support, the important of her hopes of creating a family, and her level of ability to grieve.
Parents who have experienced miscarriages need not only to process their grief but also to resolve their trauma. It’s vital that the former mom-to-be recognize that the miscarriage was out of her control and not her fault.

For those trying to navigate how to approach a partner, family member, or friend who has recently experienced a traumatic miscarriage, sensitivity and patience are key.

Here are some appropriate steps to take if you or someone close to you has recently experienced a miscarriage and is struggling to come to terms with it:

1.    Seek counseling. Your doctor is a great place to start. He or she can provide answers to questions that may put your mind and heart at ease, and will also be able to recommend further counseling sources.

2.    Create a support system of friends and family. Being able to talk about it can help profoundly.

3.    Get an evaluation for Acute Stress Syndrome. If the symptoms last for more than a month, seek follow-up testing for PTSD. Research has found that up to 25% of miscarriage victims meet the criteria for PTSD a month later. *

Not every woman who suffers a miscarriage will suffer from PTSD. According the American Family Physician, “Anecdotal evidence suggests that up to 10 percent of women meet criteria for ASD (Acute Stress Disorder) within one month of having a spontaneous abortion and that up to 1 percent meet the criteria for PTSD four weeks after the event.” In order for a diagnosis of PTSD to be validated, a victim of miscarriage must experience symptoms for longer than four weeks. ASD, on the other hand, can set in after only a few days. **

Healing does not mean forgetting. Communicate with others, find support groups, educate yourself with books, allow yourself to grieve, and if you find yourself falling into depression, seek the help of a therapist.

* CITATION: Journal of Family Practice, November 2006 http://findarticles.com/p/articles/mi_m0689/is_11_55/ai_n27059397/

** CITATION: The American Family Physician web site http://www.aafp.org/afp/20000315/1689.html

Some helpful web sites that address miscarriage and pregnancy loss include:

• www.nationalshareoffice.com
• www.mend.org
• www.aplacetoremember.com
• http://www.miscarriagesupport.org.nz/sarah.html
• http://www.hopexchange.com/
• http://www.americanpregnancy.org/pregnancyloss/

Books:

• Miscarriage: Women sharing from the Heart — by Shelly Marks, Marie Allen.
• Miscarriage: A Shattered Dream — by Sherokee Isle, Linda Hammer Burns
• Surviving Pregnancy Loss: A complete sourcebook for women and their families — by Rochelle Friedman and Bonnie Gradstein

Post Abortion Stress Syndrome (PASS) is the name that has been given to the psychological aftereffects of abortion, based on Post Traumatic Stress Disorder (PTSD). It is important to note that this is not a term that has been accepted by the American Psychiatric Association or the American Psychological Association. In fact, pro-choice advocates accuse their counterparts of making up PASS in order to further their political agendas.

Nevertheless, any event that causes trauma can indeed result in PTSD, and abortion is no exception. A woman can be of sound and solid mind when she makes a choice to terminate a pregnancy, but it is never an easy decision. Even when it is the right decision, there is sometimes a level of conflict that needs to be addressed so that the woman can be at peace with her choice. Believing that PASS exists does not mean that one does not believe in a woman’s right to choose; it simply means that one believes in supportive and constructive counseling around the trauma symptoms that arise after an abortion.

Symptoms of PASS may include any of the following:

1.    Guilt: Experiencing guilt does not imply that you made a mistake or “violated your own moral code,” as some pro-lifers would imply. However, feelings around having an abortion may be complex and have to take into account fear of what others might think.

2.    Anxiety: General anxiety is a common symptom of PTSD—in the case of PASS, there might be a particular anxiety over fertility issues and the ability to get pregnant again.

3.    Numbness, Depression: Again, common symptoms of PTSD.

4.    Flashbacks: Abortion is surgery, and in most cases, it’s surgery that happens while the patient is fully conscious.  This can be a distressing experience.

5. Suicidal thoughts: In extreme cases, the PTSD that results from a controversial abortion could lead to suicidal thoughts or tendencies and would require immediate treatment. It’s important to note that this is not a common or expected symptom of PASS, but as with any form of PTSD, it is possible.

While abortion can induce post-traumatic stress in some, others will suffer no repercussions at all. In fact, studies have shown that women may feel relieved after experiencing an abortion. However, women who are okay with having an abortion are more likely to talk about their experience then women who are ashamed and regretful and have a better chance of working through this process faster than other women. Nevertheless, even those who argue that PASS does not exist will acknowledge that having an abortion may induce normal feelings of sadness, grief, or regret. And women with religious backgrounds can have a hard time choosing to abort. But admitting that abortion is a difficult choice does not equate to admitting that it is “wrong.”

Feelings are complex, and sometimes a woman will need to seek out counseling to help her sort through her own emotions and reactions as well as any perceived or actual stigma she may be experiencing. Post-abortion syndrome exists and could be overcome, even if the women believe that they are not allowed to be happy again. A compassionate, unbiased, and appropriate counselor can help a woman who has undergone an abortion come to terms with her decision and find peace again—without a political agenda.

Sources:

Ms Magazine, “Abortion Under Attack,” by Cynthia L. Cooper http://www.msmagazine.com/aug01/pas.html

Afterabortion.com
http://www.afterabortion.com

Victims of a mugging incident may experience any of the classic symptoms of PTSD:

• Reoccurring, terrifying flashbacks or nightmares
• Avoidance of situations that remind one of the incident
• Irritability or anger
• Emotional numbness
• Trouble concentrating
• Withdrawal from friends and family
• Physical anxiety symptoms
• Problems eating or sleeping

Victims express their distress in varying ways, and it’s not always obvious that someone is struggling with the aftereffects of experiencing trauma.

According to the National Institutes of Health*:

PTSD symptoms seem to be worse if they were triggered deliberately by another person, as in a mugging or rape. Most PTSD sufferers repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings. They are often triggered by ordinary occurrences, such as a door slamming, a car backfiring, or being in a place that looks like where the trauma took place. A person having a flashback is likely to feel the emotions and physical feelings that occurred when the incident happened despite no longer being in danger.

There is a scientific, physical reason why trauma impacts us so strongly, and it can be traced to the amygdala—a very small nugget of our brain lodged deep inside the temporal lobe, it processes memory and emotion. Unlike conscious memories that we are aware of—for instance, a victim returning to the scene of a mugging would recognize the environment and perhaps remember details about what happened—the amygdala is in charge of deeper, unconscious emotion that can develop into PTSD. The amygdala is also responsible for the Fight/Flight/Freeze response. **

When we experience an “emotionally arousing event” such as a mugging, the amygdala is activated and it then produces a protein in the neurons of the hippocampus. This protein helps the nervous symptom to convert immediate memories into permanent ones.  ***

Because of the unique way the brain processes traumatic memories, they can actually become more vivid and intrusive over time, rather than fading away like most memories do naturally. Any memory associated with a life-threatening event has this capacity to grow and transform into PTSD.

According to NYU’s Le Doux Laboratory (Center for Neural Science):

Neuroanatomists have shown that the pathways that connect the emotional processing system of fear, the amygdala, with the thinking brain, the neocortex, are not symmetrical—the connections from the cortex to the amygdala are considerably weaker than those from the amygdala to the cortex. This may explain why, once an emotion is aroused, it is so hard for us to turn it off at will.

This is not to say that PTSD and anxiety disorders cannot be solved. Somatic Psychology has been particularly effective in treating the symptoms (and the root neurological cause) of PTSD. Recovering from the trauma of a sudden violent attack like a mugging requires a re-wiring of the brain’s fear response associated with memories of the event. With patience, we work with a victim to heal themselves.

* Citation: NIH Medline Plus Magazine http://www.nlm.nih.gov/medlineplus/magazine/issues/winter09/articles/winter09pg10-14.html

** Citation: NYU’s Le Doux Laboratory (Center for Neural Science)

** Citation: Medical News Today http://www.medicalnewstoday.com/articles/28124.php