Monday, January 25, 2010
When PTSD goes AWOL (PTSD, part 2)
I think the most common and troubling PTSD I tend to see is in teens and/or adults who have experienced trauma (often multiple traumas) and has gone untreated for many years. Over the years they have developed a set of behaviors aimed at relieving their anxiety, which often includes various addictions. I also see that what began as PTSD symptoms (see previous post for a listing) has morphed into a post-traumatic stress personality. There may be minimal PTSD symptoms remaining years after the trauma(s) have occurred and in their place is an anxiety-ridden, angry monster in denial!
This is not to say that everyone who has ever experienced PTSD has his or her personality altered. And I also want to clarify that technically speaking, there is no such thing as post traumatic stress personality. This is just the name I have come up with to describe this type of personality. Typically this is a person who experienced multiple traumas, interwoven/complex traumas, or trauma that occurred repeatedly over a significant period of time. These traumas typically occurred at a young age, probably before age 8, and no one (including the child or adult in question ) has linked these past traumas to present day feelings. Usually these clients will say, "Oh, that happened a long time ago. I'm over it." This client has received no direct support, validation, or treatment related to the traumas they have experienced. The client has likely presented for treatment around age 17 due to frequent assaults on peers and teachers, chronic tension with a caregiver, inability to form attachments, and drug use. Usually these kids have been diagnosed with Attention Deficit Hyperactivity Disorder or possibly even Conduct Disorder (a disturbing diagnosis equivalent to Antisocial Personality Disorder for kids).
It is very common that these children or adults continue to have much chaos and drama in their lives, often at their own doing. Although they may no longer experience some of the acute symptoms of PTSD, the child or adult may engage in daily fights or sexual behavior that staves off the symptoms. The fighting or sexual behavior (or various other "delinquent" behaviors) have become reinforcing in themselves. They work! They keep people at a distance or get the desired attention. They provide immediate relief and maintain a certain level of required chaos. In some cases I see children or adults who seem to repeatedly re-create the original traumas. It is believed that many people do this in the desperate attempt to make right the past trauma. For example, a child who witnessed years of domestic violence may choose a violent partner as an adolescent, believing "my love will change him, this time it will be different, and I will feel BETTER." I also see adults who were victims of physical abuse grow up and have children who are abusive toward them. They have again become the victim within their own home. Another example is the child who was sexually abused who is highly sexualized as an adolescent and highly promiscuous. Particularly with sexual abuse, a child can have their internal sexual thermostat set to "high," and thus be easily aroused or sexually activated. We call this "sexually reactive."
If the adolescent or adult has developed an addiction in an effort to relieve PTSD, then treatment first has to deal with the addiction. This is very common. It is only natural that if you are experiencing intense anxiety, difficulty with relationships, sleep problems, or persistent hostility, you would want relief! Certainly you will get some quick relief from a drink or a hit of mary jane. Perhaps the addiction is one more subtle such as food, video games, relationships, or work. The addiction and the consequences of the addiction become troublesome themselves, wreaking havoc in the life of the addict. It becomes very difficult to address PTSD with someone who is afraid you're trying to take away their drug. Often clients are not open to the possibility of PTSD when the "drug" is keeping them from experiencing any anxiety. It is more likely that behavior and problems related to the increasingly dangerous addiction is what will lead this client into treatment.
Detox can be a piece of cake compared to the hard work of unraveling a PTSD personality. It is essential, however, that the client is willing to do the work of unraveling the knots of their personality if they want to prevent relapse in their addiction. I believe so many people go through drug treatment again and again, returning each time because they have never resolved the core issues of why they NEED to use to begin with. It is also very common that as clients go through drug treatment and "get clean," that they begin to experience years of repressed anxiety, grief, or anger. I'm sure this is probably not very encouraging to anyone who may be considering drug treatment, but wait! If you are at a place where you want to find true sobriety and serenity, the work of cleaning the old toxins from your soul is what will do the trick. We do not have to have our lives forever ruled by past events. We do not have to continue to suffer or engage in behaviors that stave off the pain. We may only be human, but we are strong enough to endure the work. Humans were created to both be hurt and to heal.
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