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

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

Sexual abuse is a particularly sinister type of trauma because of the shame it instills in the victim. With childhood sexual abuse, victims are often too young to know how to express what is happening and seek out help. When not properly treated, this can result in a lifetime of PTSD, depression and anxiety.

The trauma that results from sexual abuse is a syndrome that affects not just the victim and their family, but all of our society. Because sexual abuse, molestation and rape are such shame-filled concepts, our culture tends to suppress information about them.

In the U.S (according to childtrauma.org), one out of three females and one out of five males have been victims of sexual abuse before the age of 18 years. And according to the American Academy of Experts in Traumatic Stress (AAETS), 30% of all male children are molested in some way, compared to 40% of females.

One of the most startling statistics unearthed during research into sexual abuse are that children are three times as likely to be victims of rape than adults. Stranger abuse constitutes by far the minority of cases. It is more likely for a child to experience sexual abuse at the hands of a family member or another supposedly trustworthy adult.

Sexual abuse is a truly democratic issue. It affects children and adults across ethnic, socioeconomic, educational, religious, and regional lines.

Exactly what constitutes “sexual abuse” when it comes to children?

The Incest Survivors Resource Network states that “the erotic use of a child, whether physically or emotionally, is sexual exploitation in the fullest meaning of the term, even if no bodily contact is ever made.” It’s important to notice this clause about “no sexual contact.” Often, victims of sexual abuse will try to downplay their experience by saying that it “wasn’t that bad.” It’s vital to recognize that abuse comes in many shapes, colors and sizes, and that all abuse is bad.

Outcomes of sexual abuse

The most common effect of sexual abuse is Post Traumatic Stress Disorder. Symptoms can extend far into adulthood and can include withdrawn behavior, reenactment of the traumatic event, avoidance of circumstances that remind one of the event, and physiological hyper-reactivity.

Another legacy of sexual abuse is that children abused at any early age often become hyper-sexualized or sexually reactive. Issues with promiscuity and poor self-esteem are unfortunately common reactions to early sexual abuse.

Substance abuse is a common outcome of sexual abuse. In fact, according to the AAETS, “specialists in the addiction field (alcohol, drugs, and eating disorders) estimate that up to 90 percent of their patients have a known history of some form of abuse.”

Specific symptoms of sexual abuse:
(citation, the American Academy of Experts in Traumatic Stress)

• Withdrawal and mistrust of adults
• Suicidality
• Difficulty relating to others except in sexual or seductive ways
• Unusual interest in or avoidance of all things sexual or physical
• Sleep problems, nightmares, fears of going to bed
• Frequent accidents or self-injurious behaviors
• Refusal to go to school, or to the doctor, or home
• Secretiveness or unusual aggressiveness
• Sexual components to drawings and games
• Neurotic reactions (obsessions, compulsiveness, phobias)
• Habit disorders (biting, rocking)
• Unusual sexual knowledge or behavior
• Prostitution
• Forcing sexual acts on other children
• Extreme fear of being touched
• Unwillingness to submit to physical examination

Studies have shown that children who experience sexual abuse tend to recover quicker and with better results if they have a supportive, caring adult (ideally a parent) consistently in their life.

Because most child sexual abusers were once abused themselves, it’s crucial for victims of sexual abuse to seek counseling and care so that they don’t end up repeating the pattern themselves.

http://ptsd.about.com/od/glossary/g/hypervigilance.htm

Trauma has occurred when symptoms have developed and have become visible. One type of trauma results from natural disasters such as earthquakes, tornados or hurricanes, forest fires, floods, volcanic eruptions, landslides, or tsunamis. These types of experiences are particularly insidious because they tend to traumatize large populations of people at once, and can result in epidemics of Survivor Guilt along with other PTSD symptoms.

Like many causes of trauma, natural disasters can be sudden and overwhelming. The most immediate and typical reaction to a calamity is shock, which at first manifests as numbness or denial. Quickly—or eventually—shock can give way to an overemotional state that often includes high levels of anxiety, guilt or depression.

If victims have lost their loved ones or their homes, they may feel helpless. This can be exacerbated if they have to live in shelters without support from relatives or friends for extended time periods. However, living with other survivors can be a time to reconnect, talk about the event with others, and help to reframe the event. Being able to help another survivor can reduce helplessness, and may start the healing process.

Natural disasters in particular can bring victims a feeling of being betrayed by “their god,” which can result in a loss of faith.  Making peace with “the divine” might be one step toward healing and gaining faith back.

It’s hard to predict when PTSD will set in with a survivor of a traumatic natural disaster. Some victims seem at first perfectly (or even abnormally) fine, only to be beset with symptoms later on.  Survivors are recommended to seek professional guidance if they find themselves unable to regain control of their lives or if they continue to suffer from PTSD symptoms for more than a month.

Victims do not need to have experienced a disaster firsthand in order to suffer from PTSD. As an example, an emigrant from Haiti living abroad at the time of the recent earthquake could be profoundly affected by the countless hours of television coverage of the disaster, especially if they still had family living in Haiti at the time of the event who they were unable to contact or gain information about.

It’s very important with natural disaster trauma that the victim give himself time to heal and pass through an appropriate mourning process. Only by processing the experience over a realistic period of time is healing possible.

Over the next few months, I’ll touch upon the most common types of trauma and the ones I see most frequently in my practice. You can also read a longer version of this article on Examiner, Psychology Today, and Womens Radio (published 3/3/10).

One unfortunate side effect of a calamity such as the recent earthquake in Haiti is a phenomenon known as Survivor Guilt. Obviously, Survivor Guilt affects those who are fortunate enough to survive a traumatic event such as a natural disaster.

The phenomenon of Survivor Guilt is especially insidious because those who are afflicted with it are under the impression that they have done something wrong, and that their own survival is somehow responsible for the death, injury or trauma of others.

Interestingly, The DSM-IV (The Diagnostic and Statistic Manual of Mental Disorders—the professionals’ guide to mental illness and diagnosis) lists Survivor Guilt as a symptom of Post Traumatic Stress Disorder, and not as a malady in its own right. Like other symptoms of PTSD, Survivor’s Guilt is a distorted reaction to a traumatizing experience.

What Survivor Guilt Looks Like

Survivor Guilt is defined by a pattern of symptoms such as anxiety, depression, social withdrawal, sleep disturbance, nightmares/flashbacks, and emotional lability (instability). As we know, PTSD can also manifest as physical symptoms, which is the body’s way of expressing pent up stress.

Proactive Reactions to Disaster

Those of us who live in earthquake-prone places such as the Bay Area find it easy to feel empathy for those who are suffering in Haiti. After all, it could easily be us. And we can derive lessons from this tragedy.

Dr. Peter Levine, a well-known trauma therapist, offers the following suggestions, which he calls “Emotional First Aid” for trauma. (You can read the expanded version of this list here. http://www.summerjoy.com/September112001/levinepeter.html)

Fortunately, many of these suggestions are inherently practical in the wake of a natural disaster—such as an earthquake—that affects an entire community and displaces people from their homes.

1. Get together with family and friends for support.

2. Organize and meet in community/neighborhood groups.

3. Don’t be isolated.

4. Try to get the information about your loved ones ASAP… without getting hooked on traumatic images on the TV.

5. Refocus on your resources and support systems, and keep your mind occupied.

6. Stay active, volunteer, and help.

7. Encourage people and yourself not to tell their stories in a repetitive way which ultimately deepens the trauma.

Therapy for Survivor Guilt

Once Survivor Guilt has been diagnosed, therapy is of course the most appropriate form of action.

A therapist working with a traumatized victim of a natural disaster will help the patient to formulate alternative and more positive views on the situation and will also help the patient consciously recognize how their own trauma is affecting their behavior. It’s important for the afflicted person to understand that their own actions did not cause or exacerbate the situation, and that they in fact were a victim.

The next and most important step for conquering Survivor Guilt is to pass through an appropriate mourning process. Only then can the patient continue on with their life.

trust

“We’re never so vulnerable than when we trust someone—but paradoxically, if we cannot trust, neither can we find love or joy.” — Walter Anderson

Merriam Webster dictionary defines trust as the “assured reliance on the character, ability, strength, or truth of someone or something” and “one in which confidence is placed.”

But unfortunately, trust can be broken in many ways. We may have been betrayed, mistreated, lied to or hurt by someone such as a partner, family, friend or colleague.

Instead of developing mistrust only for the person who hurt us, we often begin to be suspicious of every person from that point on. Out of protection to avoid getting hurt again, we carry our unpleasant memories of that original person with us and displace the distrust onto other relationships. Sometimes it only takes one person to determine that nobody is in fact trustworthy due to past trauma. In the process, we often lose trust in ourselves—simply because our judgment of the person or circumstance was incorrect—and we then wonder how we can believe our own judgment. As a result, we might close our hearts, repress our emotions, and walk around numb or suspicious in relationships.

The problem is, we need to be able to trust in order allow ourselves to fall in love and to feel loved. Yes, we can live our life by carrying our hurt everywhere we go… but not without consequences. The consequences of not trusting (and therefore not feeling) may hurt others who were not responsible for our pain and may deprive us of feeling loved, and emotional wellness. This eventually leads to loneliness, depression, and relationship difficulties.

The first step to recovering our sense of trust is to learn to trust our own judgment and feelings again. The following is a somatic exercise to learn increase trust in yourself:

• Sit or lie down so that you are comfortable and are in a safe place.
• Now, how can you make it even more comfortable? Get a blanket, a pillow, whatever will make you feel relaxed and content.
• Once you are settled, ask yourself: “How do I know this is comfortable?” This might appear to be a silly question, and perhaps even confusing. However, it is an important one in increasing your skills of building trust.
• Continue to explore what sensation you feel that you recognize as comfort. For example, you might think, “I do not feel any pain,” “I breath easily,” or “I feel relaxed.”

You might be anticipating that this feeling won’t last, which is true. We can’t control or grasp to this pleasurable feeling. It’s only important that you are in the present moment right now, not drifting into thoughts of the future or the past. Thinking of the future can create anxiety; thinking of the past can create depression.

This is an awareness exercise so that you learn to trust what you are feeling right now. Remain aware of any sounds, the temperature, the light, and your physical sensations. Can you let yourself simply enjoy the moment?

You can practice this exercise for as long as you prefer and as time allows you. Just keep checking in with your level of comfort. What feelings indicate that you are comfortable? With time, you may start to trust your feelings again.

When you start to say to yourself; “I trust myself,” you begin to restore faith in your judgment of others and situations, and as a result, you open your heart to love, joy and feeling safe again.