Krispy Lee

When I first picked up this book, I wasn’t quite sure that it had to do with me. It is a book about trauma – what it is, where it comes from, and how to treat it. But I had never experienced abuse, or been caught in a natural disaster, or been attacked. I didn’t have any trauma… Did I? As I turned the pages, slowly and then quickly, I was introduced to a completely new conception of trauma unlike anything I had ever encountered before. I’d spent years immersed in the “personal development” world, obsessed with uncovering hidden truths and rewriting limiting beliefs. I had read countless books on positive psychology, spiritual growth, and overcoming cognitive biases. But somehow, I had never taken the time to really understand what lies at the root of a disturbed psychology. On the pages before me I saw many of the challenges, I had encountered in myself, my students, and my clients for years, except this time framed as common side effects of trauma. For example: Difficulties with focusing and memory Sensory overload and filtering what matters from what doesn’t Difficulty sleeping and relaxing Learning new information and changing behavior Cultivating a sense of confidence and personal agency Fear and anxiety around taking risks Fully accessing imagination and creativity Self-doubt and perfectionism Chronic fatigue and exhaustion Maintaining motivation and a sense of purpose I was shocked to learn that not only is attention deficit a common symptom of trauma, but so is hyper-focus. They can both be forms of dissociation – an attempt to escape from the present moment. Even those of us who find it easy to “be productive” are not immune to the impact of trauma. I thought, could this be the key to so much that plagues us? Could it be the root cause of so many problems that keep us from achieving our most cherished goals and dreams? I’ve summarized the book The Body Keeps the Score (affiliate link) below because I want the information it contains to spread far and wide. These findings are critically important to everything from education, to social policy, to healthcare, to law enforcement, to personal development, and far beyond. In fact, I have difficulty thinking of any domain that they won’t have an impact on. The book is written by Dr. Bessel van der Kolk, summarizing his four decades of experience studying the impact of trauma on childhood brain development and emotion regulation. As a clinician and researcher at Harvard University and Boston University, he has published more than 150 academic papers and led studies on the effectiveness of yoga, Eye Movement Desensitization and Reprocessing, neurofeedback, MDMA, theater, and other methods for treating trauma. In other words, there is no one more qualified to speak on both the scientific and personal impact of trauma in a wide variety of contexts. I’ll focus on what I think are the most important, unusual, and powerful points from Dr. Van der Kolk’s message. All research and conclusions come from the book. Any errors or omissions are mine. Trauma is universal Trauma is an almost universal part of the human experience, the book establishes early on. We usually think of trauma as a thing that happens in very extreme circumstances – rape, molestation, physical abuse, extreme neglect, assault, domestic violence, or natural disasters. But this is acute trauma, which is not the only kind. Even acute trauma is common. Research from the Centers for Disease Control (CDC) found that one in five Americans has been sexually molested as a child; one in four has been beaten by a parent; one in four of us grew up with alcoholic relatives; and one out of eight has witnessed their mother being beaten or hit. These are appalling numbers, far beyond what even most practitioners expect. Childhood trauma is a silent epidemic, with only one-third of respondents in the landmark ACE study (from which these findings are drawn) reporting no such experiences. The CDC estimates that overall costs for childhood and adolescent trauma exceed those of cancer or heart disease, and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters. But even for those of us who experienced no such incidents, there remains a subtler and less graphic source of trauma: chronic emotional abuse and neglect. Incredibly, Van der Kolk’s research has shown that such abuse and neglect can be just as devastating as physical abuse and sexual molestation. Just as devastating as physical abuse and sexual molestation.just as devastating as physical abuse and sexual molestation. He cites the research on childhood attachment by his Harvard colleague Karlen Lyons-Ruth, who in the 1980s conducted an influential study that followed children from birth to 20 years old. Their hypothesis was that hostile or intrusive behavior on the part of mothers would be the strongest indicator of mental instability in their adult children. Instead, they found that a mother’s emotional withdrawal had the most profound and long-lasting impact. If your caregivers regularly ignore your needs, you learn to anticipate rejection and withdrawal. You cope by blocking out their hostility or neglect and acting as if it doesn’t matter. But the body keeps the score: it remains in a state of high alert, prepared to ward off blows, deprivation, or abandonment. One of the most devastating effects of this, Van der Kolk found, is “not feeling real inside.” When you don’t feel real, nothing matters. It’s impossible to protect yourself from danger or attend to your own needs. You may resort to extremes in an effort to feel something – even cutting yourself with razor blades or getting into fights with strangers. And all of this carries into adulthood. It doesn’t just go away on its own. A child who has been ignored or chronically humiliated is likely to lack self-respect. Children who have not been allowed to assert themselves will have trouble standing up for themselves. And many adults who were brutalized as children carry a smoldering rage they can barely contain. As psychologists have observed all the way back to Freud and Breuer, “the psychical trauma—or more precisely the memory of the trauma—acts like a foreign body which long after its entry must continue to be regarded as an agent that still is at work.” In other words, the memory of the trauma acts like a splinter in the mind – it is the body’s response to the foreign object that becomes the problem rather than the object itself. From a neuroscience lens, brain-imaging studies of trauma patients usually find abnormal activation of the insula. The insula integrates and interprets information from sensory organs, and transmits fight-or-flight signals to the amygdala when necessary. In people with trauma, these signals are firing all the time. It doesn’t require any conscious influence – you just constantly feel on edge, for no apparent reason. You may have a sense that something has gone wrong, or of imminent doom. These powerful feelings are generated deep inside the brain and cannot be eliminated by reason or understanding. All the time. It doesn’t require any conscious influence – you just constantly feel on edge, for no apparent reason. You may have a sense that something has gone wrong, or of imminent doom. These powerful feelings are generated deep inside the brain and cannot be eliminated by reason or understanding. All the time. It doesn’t require any conscious influence – you just constantly feel on edge, for no apparent reason. You may have a sense that something has gone wrong, or of imminent doom. These powerful feelings are generated deep inside the brain and cannot be eliminated by reason or understanding.all the time. It doesn’t require any conscious influence – you just constantly feel on edge, for no apparent reason. You may have a sense that something has gone wrong, or of imminent doom. These powerful feelings are generated deep inside the brain and cannot be eliminated by reason or understanding. Van der Kolk tells the story of a high-powered trial lawyer he had once worked with. He was driven, successful, and well-respected for his achievements. But he found that he was unable to enjoy them. He would pretend to feel gratified when he won a case, and when he lost it was as though he had seen it coming and was resigned to defeat before it even happened. The lawyer would get totally absorbed in devising a strategy for winning a case, and would stay up all night enmeshed in the details. “It was like being in combat,” he said. He felt fully alive, and like nothing else mattered. But when the case finished, win or lose, he would lose his energy and sense of purpose. This story describes a common experience among survivors of trauma: they only feel fully alive when they are totally absorbed, allowing them to escape their current reality, but at the cost of aliveness, motivation, excitement, and purpose in the rest of their lives. Trauma becomes physical symptoms When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other kinds of pain. Other common conditions which often have no clear physical cause include chronic neck pain, digestive problems, spastic colon/irritable bowel syndrome, chronic fatigue, and some forms of asthma. Traumatized children have fifty times the rate of asthma as their non-traumatized peers. These individuals may visit multiple specialists, undergo extensive diagnostic tests, and be prescribed medications. These measures may provide temporary relief, but none of them address the underlying cause. Another common symptom is alexithymia, in which a person reports feeling physically uncomfortable without being able to describe exactly what the problem is. This comes from self-numbing, which keeps them from responding to the ordinary needs of their bodies in quiet, mindful ways – shifting in their chair, stretching, drinking water, or going for a walk, for example. If you’re not aware of what your body needs, you’re unable to take care of it. If you don’t feel hunger, you can’t nourish yourself. If you mistake anxiety for hunger, you may eat too much. And if you can’t feel satiated, you’ll keep eating. The impact of trauma The overall effect of trauma can be described as a “loss in the feeling of aliveness, motivation, excitement, and purpose.” In brain scans of 18 chronic PTSD (Post-Traumatic Stress Disorder) patients, researchers discovered something startling: there was almost no activation of the “self-sensing” areas of the brain when compared to non-traumatized subjects: the medial prefrontal cortex, the anterior cingulate, the parietal cortex, and the insula were dark. Their conclusion was that “in response to their trauma, and in coping with the dread that persisted long afterward, these patients had learned to shut down the brain areas that transmit the visceral feelings and emotions that accompany and define terror.” Here’s the problem: those very same areas are also responsible for registering the entire range of emotions and sensations that form the foundation of our self-awareness. What the researchers were witnessing was a terrible tradeoff: in an effort to shut off terrifying sensations, they had also deadened their capacity to feel fully alive. Traumatized people often lose their sense of purpose and direction, because they cannot check in with themselves about what they truly want, as defined by the most basic sensations in their bodies, which are the basis of emotions like desire and passion. In some cases, the loss of self-awareness is so profound that subjects cannot even recognize themselves in the mirror. Suppressing one’s core feelings takes a tremendous amount of energy. This leaves less energy for pursuing meaningful goals, making you feel bored and shut down. But at the same time, stress hormones are flooding your body, leading to headaches, muscle aches, bowel problems, sexual dysfunction, or aggressive behavior toward people around you. This quote powerfully sums up what is missing: “All of us, but especially children, need such confidence—confidence that others will know, affirm, and cherish us. Without that we can’t develop a sense of agency that will enable us to assert: “This is what I believe in; this is what I stand for; this is what I will devote myself to.” As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts and stay up all night to finish projects. Children and adults will do anything for people they trust and whose opinion they value.” With a map of the world based on trauma, abuse, and neglect, traumatized people often seek shortcuts to oblivion. Anticipating rejection, ridicule, and deprivation, they are reluctant to try new options, certain that they will lead to failure. This lack of experimentation traps them in a world of fear, isolation, and scarcity where it is impossible to welcome the very experiences that might change their basic perspective. A distinct lack of imagination has been noted among traumatized subjects. When they are compulsively and constantly being pulled into the past, they cannot envision a different future. But imagination is essential to the quality of our lives. It fires our creativity, relieves our boredom, alleviates our pain, enhances our pleasure, and enriches our most intimate relationships. Without it, there is no hope, no chance to envision a better future, no place to go, no goal to reach. Other common symptoms or effects of trauma include: Flashbacks and projection The traumatic event had a beginning, middle, and end. But flashbacks can be even worse: you never know when they will strike, or how long they will last. Traumatized people often “project” their trauma onto people and everyday situations, seeing risks and dangers where there are none. Othering of self and others After trauma the world becomes sharply divided – between those who know and those who don’t. People who have not shared the traumatic experience cannot be trusted, because they can’t understand it. Sadly, this often includes their spouse, children, and close friends. Feeling numb during children’s birthday parties or at weddings makes people feel like monsters, like they are not a part of the human race. As a result, shame becomes the dominant emotion and hiding the truth the central preoccupation. Disembodiment Van der Kolk and his colleagues often noted a distinct lack of physical coordination among their subjects: they had trouble playing sports, pitching tents, righting a boat, and even seemed stilted in casual conversation. He eventually came to understand these as symptoms of a profound disembodiment. Their bodies constantly bombarded by visceral warning signs, they become experts at ignoring their gut feelings and numbing awareness of what’s going on inside. Panic attacks People who cannot comfortably notice what is going on within them become vulnerable to any sensory shift, and respond either by shutting down or going into a panic. It is now understood that what drives panic attacks is not the initial trigger, but an escalating fear of the bodily sensations that accompany the panic attack itself. Chronically elevated stress hormones Embedded trauma can easily be reactivated at the slightest trigger. Massive amounts of stress hormones flood the system, and take much longer to return to baseline than normal. The insidious effects include memory and attention problems, irritability, and sleep disorders. Overcontrol and hyper-vigilance Being traumatized means continuing to organize your life as if the trauma is still going on. Every new encounter and event is continuously contaminated by the past in an endless loop. A survivor of trauma will devote their entire energy to suppressing inner chaos, leading to a withdrawal from life and a range of conditions such as fibromyalgia, chronic fatigue, and other autoimmune diseases. In a study on people with PTSD, researchers found that there was no activation in the frontal lobe when they encountered strangers. Instead of experiencing curiosity, there was intense activation in a primitive area known as the Periaqueductal Gray, which generates startle, hyper-vigilance, cowering, and other self-protective behaviors. In response to being looked at they simply went into survival mode. Dissociation and avoidance Dissociation is the essence of trauma. The traumatic experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations intrude into the present and are relived. These people respond to even the smallest of irritations as if they are going to be annihilated and can’t understand why. A common response is to reorganize their lives around trying to avoid these memories. But constantly fighting unseen dangers is exhausting and leaves them fatigued, depressed, and weary. While reliving trauma can be terrifying and even self-destructive, over time a lack of presence can be even more damaging. The kids who act out are at least given time and attention. But the ones who are simply blanked out don’t bother anybody and are left alone to lose their future bit by bit. Difficulty integrating traumatic memories Under ordinary conditions, our emotional and rational memory systems work together to integrate new experiences into a continuous flow. But in traumatic events, many regions shut down: linguistic areas, areas responsible for creating our sense of time and space, and the thalamus, which integrates raw sensory data. This results in a memory that is not cohesive and organized in a logical narrative, but stored as disorganized “fragments” of images, sounds, and chaotic physical sensations. In effect, a wall is erected between the two parts of a dual memory system. The traumatic memory isn’t integrated into the combined, ever-shifting sense of who we know ourselves to be. Ordinary memory is social and adaptive – it can be reorganized, condensed down for quicker retelling, or expanded into its full detail depending on the needs of the moment. But the fragmentation and chaos of traumatic memory makes it inflexible – the reenactment is frozen in time, unchanging and always lonely, humiliating, and alienating. Sensory overload In normal circumstances, the thalamus serves as a filter or “gatekeeper” for incoming information. This makes it a central component of attention, concentration, and learning, all of which are known to be compromised by trauma. People with PTSD have the sensory floodgates wide open. Lacking a filter, they are on constant sensory overload. In order to cope, they try to shut themselves down and develop tunnel vision and hyper focus. If they can’t do this naturally, they may turn to drugs or alcohol to block out the world. The tragedy is that by closing down they are also filtering out pleasure and joy as well. Addiction to trauma Van der Kolk noted a common phenomenon among his patients, which he calls “addiction to trauma.” Many traumatized people seem to seek experiences that would repel most of us, and even sometimes the very experience that traumatized them in the first place. They report a vague sense of emptiness and boredom when they are not angry, under duress, or involved in some dangerous activity. In an experiment with eight veterans, they were asked to keep their hand in painfully cold water for as long as possible. One group watched the graphic war movie Platoon – and were able to keep their hand in the water 30% longer than a control group. Re-exposure to memories of war-time stress functioned as a relief from pain and anxiety. The researchers calculated that the pain relief they experienced was equivalent to eight milligrams of morphine, about the same dose a person would receive in an emergency room for crushing chest pain. relief from pain and anxiety. The researchers calculated that the pain relief they experienced was equivalent to eight milligrams of morphine, about the same dose a person would receive in an emergency room for crushing chest pain. This could explain why people with trauma paradoxically seek injury or are only attracted to people who hurt them. If you have no internal sense of security, it is difficult to distinguish between safety and danger. If you feel chronically numbed out, potentially dangerous situations may make you feel alive. Pathways for treatment The Body Keeps the Score summarizes several decades of research into the nature of trauma. Drawing on Van der Kolk’s work and those of many others, it reveals the discoveries of a new generation of disciplines, including: Neuroscience, the study of how the brain supports mental processes. Developmental psychopathology, the study of the impact of adverse experiences on the development of mind and brain. Interpersonal neurobiology, the study of how our behavior influences the emotions, biology, and mind-sets of those around us. What these disciplines have revealed is that trauma causes actual physiological changes in the brain. This includes a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant. Trauma results in a fundamental reorganization of the way the mind and body manage perceptions, plunging people into a perceived world full of risks and threats. The book presents three pathways by which we can use the brain’s natural neuroplasticity to undo the effects of trauma: Top down, by talking, (re-)connecting with others, and allowing ourselves to know and understand what is going on within us, while processing the memories of the trauma. By taking medicines that shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information. Bottom up, by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma. Top down, by talking Although psychoanalysis has fallen out of favor in recent years, the “talking cure” remains one of the most established and popular ways of addressing trauma. Top-down regulation involves strengthening the capacity of the mind’s “inner manager” to monitor your body’s sensations. Its basic premise is that recounting the traumatic incident in great detail and processing it through language will help the mind to leave it behind. Here’s the limitation with the talking cure: trauma is preverbal. Neuroscience research shows that very few psychological problems are the result of defects in understanding. Therefore improving one’s understanding doesn’t help. Most psychological problems originate in deeper regions of the brain that drive our perception and action. A surprising finding of Van der Kolk’s research was that a region in the left frontal lobe called Broca’s area went offline when traumatized subjects experienced flashbacks. Broca’s area is a speech center, and is similarly affected during a stroke. Reliving trauma shuts down people’s ability to express what they are experiencing in words, just as in a stroke. At the same time, another region of the brain called Brodman’s area lit up. This is a region in our visual cortex that registers images when they first enter the brain. Flashbacks of trauma deactivate the left hemisphere – responsible for words, logic, and facts – and activates the right hemisphere, which is responsible for memories of sound, touch, smell, and the emotions they evoke. These memories bypass the executive functions of the brain, making them feel like intuitive truth – the way things are. Trauma by its nature drives people to the edge of comprehension. It cuts us off from language based on common experience or an imaginable past. Van der Kolk summarizes, “Our research did not support the idea that language can substitute for action.” Most subjects could tell a coherent story and experience the pain associated with what happened to them. Yet they continued to be haunted by unbearable images and physical sensations. No matter how much insight or understanding people develop, the rational brain is basically impotent to talk the emotional brain out of its own reality. When our emotional and rational brains are in conflict (as when we’re enraged by someone we love, frightened by someone we depend on, or lust after someone who is off limits) a tug-of-war ensues. But this battle is largely played out in the theater of visceral experience – in our gut, our heart, our lungs – and not in the world of ideas. Cognitive behavioral therapy (CBT), a more modern incarnation of the talking cure, nevertheless suffers from many of the same drawbacks. CBT has been used very successfully for irrational fears such as spiders, but has been much less successful for treating trauma, particularly those with histories of childhood abuse. Only about one in three participants with PTSD (post-traumatic stress disorder) who finish research studies in CBT show some improvement. Those who complete CBT treatment usually have fewer PTSD symptoms, but they rarely recover completely. Most continue to have substantial problems with their health, work, or mental well-being. Finding words to describe what has happened to you can be transformative, but it does not always abolish flashbacks or improve concentration, stimulate vital involvement in your life, or reduce hypersensitivity to disappointments and perceived injuries. Taking medicines Anti-psychotic medicines have transformed the psychiatric profession in recent decades. They were largely responsible for reducing the number of people living in mental hospitals in the United States, from over 500,000 in 1955 to fewer than 100,000 in 1996. Van der Kolk describes the pharmacological revolution as “unimaginable” and “miraculous.” Nearly overnight, he witnessed patients who had spent much of their lives locked in their own separate, terrifying realities suddenly able to return to their families and communities. Patients mired in darkness and despair started to respond to the beauty of human contact and the pleasures of work and play. Yet as transformative as these substances have been, we are starting to run up against their limits. Studies of Prozac found that it had no effect on combat veterans with PTSD. These results have held true for most subsequent pharmacological studies on veterans: while a few have shown modest improvements, most have not benefited at all. Van der Kolk has come to the conclusion that psychiatric medications have a downside: they may deflect attention from dealing with underlying issues. The diagnoses that people receive can take control of their fate out of their own hands, and put doctors and insurance companies in charge of fixing their problems. Consider the case of antidepressants. If they were indeed a permanent, long-term solution, depression should by now have become a minor issue in society. Yet it has not made a dent in hospital admissions. The number of people treated for depression has tripled over the past two decades, and one in ten Americans now take antidepressants. There is also a dramatically uneven socioeconomic impact. Children from low-income families are four times more likely than privately insured children to receive anti-psychotic medicines. These medications are often used to make abused and neglected children easier to deal with. But they also interfere with motivation, play, and curiosity, which are indispensable for maturing into well-functioning and contributing members of society. Children who take them are also at risk of becoming morbidly obese and developing diabetes. Based on these and other findings, Van der Kolk concludes that “…drugs cannot ‘cure’ trauma; they can only dampen the expressions of a disturbed psychology.” They do not teach the lasting lessons of self-regulation. They can help to control feelings and behavior, but at the price of blocking the chemical systems that regulate engagement, motivation, pain, and pleasure. The most controversial medications, the so-called “second-generation anti-psychotic agents” such as Risperdal and Seroquel, are the best-selling psychiatric drugs in the United States. More than half a million children and adolescents are now taking them. These anti-psychotic drugs are widely used to treat abused children who are inappropriately diagnosed with bipolar disorder or mood dysregulation disorder. And yet for the most severe symptoms – dissociation, self-mutilation, fragmented memories, and amnesia – they generally have no effect. Meanwhile, there have been no studies on the effects of psychotropic medications on the developing brain. These medications dampen the emotional brain and thus make children less skittish or enraged, but may also interfere with being able to appreciate subtle signals of pleasure, danger, or satisfaction. They can also make them physically inert, further increasing their sense of alienation. They may work in calming them down, but by blocking the dopamine reward centers, may interfere in learning age-appropriate skills and developing friendships with other children. Bottom up, through experiences Bottom-up regulation involves recalibrating the autonomic nervous system (ANS), which originates in the brain stem. We can access the ANS through breath, movement, or touch. In psycho-motor and somatic therapy, one of the treatment methods that fall into this category, the goal is to form new memories that live side by side with the painful realities of the past. These new memories provide sensory experiences of feeling seen, cradled, and supported in ways that can serve as antidotes to memories of hurt and betrayal. In order to change, people need to become viscerally familiar with realities that directly contradict the feelings of being frozen or panicked. They need to replace them with sensations rooted in safety, mastery, delight, and connection. A bottom-up approach trains people in reactivating the brain structures that were knocked out during the original experience of trauma. Before we examine the bottom-up pathway in more detail, we’ll need to take a detour into biology – specifically, the crucial role played by the vagus nerve. The vagus nerve Our social engagement system depends on nerves that have their origin in the brain stem regulatory centers, primarily the vagus nerve. Together with adjoining nerves it activates the muscles of the face, throat, middle ear, and voice box or larynx. When this nerve complex is working properly, we are able to empathize and synchronize with others. These nerves send signals down to our heart and lungs, slowing down our heart rate and increasing the depth of our breathing. As a result, we feel calm and relaxed, centered, or pleasurably aroused. Any threat to our safety or social connections triggers changes in the vagus nerve. The throat gets dry, the voice becomes tense, the heart speeds up, and respiration becomes rapid and shallow. These changes are partially meant to signal others to come to our aide. But if no one comes, the older limbic brain takes over. The sympathetic nervous system mobilizes muscles, heart, and lungs for fight or flight. Our voice becomes faster and more strident and our heart starts beating faster. Finally, if the threat continues and there is still no way out, the ultimate emergency system is activated: the dorsal vagal complex (DVC). This system reaches down deep below the diaphragm to the stomach, kidneys, and intestines. Our heart rate plunges (our heart “drops”), we can’t breathe, and our guts stop working or empty. Metabolism is drastically reduced throughout the body. This is the point at which we disengage, collapse, or freeze. Once this system takes over, both ourselves and other people cease to matter. We may not even register physical pain. This level of immobilization is at the root of most traumas. Bottom-up treatment of trauma Of the three pathways for trauma treatment, bottom-up approaches like somatic and psychomotor therapies are the least used and appreciated. Their aim is three-fold: To draw out the sensory information that is blocked and frozen by trauma To help patients befriend (rather than suppress) the energies released by that inner experience To complete the self-preserving physical actions that were thwarted when they were trapped, restrained, or immobilized by terror Talking and understanding help, and drugs can dampen hyperactive alarm systems. But research and practice have shown that imprints from the past can also be transformed by having physical experiences that directly contradict the helplessness, rage, and collapse that are part of trauma. And by doing so, regaining self-mastery. In the mid-1980s, Steven Maier and Martin Seligman performed experiments in “learned helplessness” with dogs. They repeatedly administered painful shocks to dogs who were trapped in locked cages, triggering a condition called “inescapable shock.” After the cages were opened, dogs who had been previously shocked didn’t run away. They simply laid there, whimpering and defecating. This famous experiment sheds light on what happens with trauma in humans: opening the pathway to freedom doesn’t necessarily mean they take it. Rather, they often just give up rather than experimenting with unknowns. The scientists found that the only way to teach the traumatized dogs to get off the electric grids when the doors were open was to repeatedly drag them out of their cages so they could physically experience how they could get away. Thus began Van der Kolk’s exploration into how these findings could be applied to humans. So they could physically experience how they could get away. Thus began Van der Kolk’s exploration into how these findings could be applied to humans. What he found was that the opposite of immobilization is effective action. Immobilization keeps the body in a state of inescapable shock and learned helplessness. If a person is held down, trapped, or otherwise prevented from taking effective action – such as in a war zone, car accident, domestic violence, or rape – the brain keeps secreting stress chemicals, and the brain’s electrical circuits continue to fire in vain. But if they can effectively fight or flee, the threat ends, and the body returns to normalcy. effective action. Immobilization keeps the body in a state of inescapable shock and learned helplessness. If a person is held down, trapped, or otherwise prevented from taking effective action – such as in a war zone, car accident, domestic violence, or rape – the brain keeps secreting stress chemicals, and the brain’s electrical circuits continue to fire in vain. But if they can effectively fight or flee, the threat ends, and the body returns to normalcy. Being able to move and do something to protect yourself is a critical factor in whether an experience ends up being traumatic in the first place. Survivors of Hurricane Katrina who were strapped down and airlifted out of dangerous areas suffered worse trauma than those who stayed, for example. The best way to overcome ingrained patterns of submission is to restore a physical capacity to engage and defend. Before beginning somatic and psychomotor therapies, patients are supported in building up a feeling of internal safety. Body-based therapist Peter Levine calls this “pendulation” – gently moving in and out of accessing internal sensations and traumatic memories. Once they can tolerate being aware of their trauma-based physical experiences, they are likely to discover powerful physical impulses – like hitting, pushing, or running – that were originally suppressed in order to survive. Somatic therapies create a safe space for these acts to be expressed, amplifying the movements and experimenting with ways to modify them to bring the incomplete actions of the past to completion. These therapies can help patients relocate themselves in the present by experiencing that it is safe to move. Feeling the pleasure of taking effective action restores a sense of agency and a sense of being able to actively defend and protect oneself. This can eventually lead to the resolution of the trauma. Essential steps for recovery All these findings and therapies point to a series of essential steps that help people heal their trauma. Reembodiment You can only be fully in charge of your body if you can acknowledge the reality of your body, in all its visceral dimensions. At some point, we need to feel at home and safe with the full range of sensations available to us. This can happen through rhythmic interactions with other people – such as in sports, music, dancing, or play. All these activities rely on interpersonal rhythms, visceral awareness, and vocal and facial communication. These help lift people out of fight/flight states, reorganize their perception of danger, and increase their capacity for relationship. This can happen through developing somatic awareness – by naming what one is feeling. Not the surface emotions like anger, fear, or anxiety, but underlying sensations such as pressure, heat, tension, tingling, caving in, feeling hollow, etc. These physical sensations are transient and respond to slight shifts in body position, changes in breathing, and shifts in thinking. Becoming aware of how your body organizes these feelings opens up the possibility of safely revisiting the past, where you can release impulses that were once blocked in order to survive. Van der Kolk describes their work helping patients create “islands of safety” within the body. These are parts of the body, postures, or movements they can use to “ground” themselves whenever they feel stuck, terrified, or enraged. These body parts usually lie outside the reach of the vagus nerve, which carries messages of panic to the chest, abdomen, and throat. They can serve as allies in reintegrating the trauma. Communicating and experiencing fully At some point in their treatment, victims of trauma must learn to communicate the full extent of their experience. Often their story has become a rote narrative over time, edited into the form least likely to provoke rejection. But through talking, writing, art, music, dance, and other forms of self-expression, they can begin to tell the real story. That may be one reason these art forms have been practiced in cultures around the world for millennia, helping individuals and communities come to terms with what has happened to them. In journaling, for example, things will come out that you didn’t even know were there. The inner critic quiets down as words spill out onto the page, as the pen or keyboard seems to channel whatever bubbles up from inside. Through writing, we can connect parts of the brain that don’t normally speak to each other, without worrying about what anyone will say. In a study by James Pennebaker and Anne Krantz, a San Francisco-based dance and movement instructor, non-verbal artistic expression was compared to writing in its ability to process trauma. One group was asked to disclose a personal traumatic experience through expressive body movements for at least ten minutes per day for three consecutive days and then to write about it for another ten minutes. A second group danced but did not write about their trauma, and a third group engaged in a routine exercise program. Over three months members of all three groups reported feeling happier and healthier. But only the expressive movement group who also wrote showed objective evidence: better physical health and improved grade point averages. In a subsequent study by Pennebaker, participants were asked to recount their traumatic experiences into a tape recorder. They found that those who allowed themselves to feel their emotions showed significant physiological changes, both immediate and long term. The drop in blood pressure could still be measured six weeks after the experiment ended. Learning to trust others again One of the most devastating effects of trauma is the loss of the ability to trust others. How can you surrender to an intimate relationship after you’ve been brutalized or violated? Everything about us – our brains, our minds, our bodies – is geared toward collaboration in social systems. It is our most powerful survival strategy. The key to our survival as a species. And it is precisely this that breaks down in most forms of mental suffering. If you look beyond the formal symptoms, almost all forms of mental suffering involve either trouble creating workable and satisfying relationships, or difficulties in regulating arousal (becoming habitually enraged, shut down, overexcited, or disorganized). All of these interfere with our basic social support machinery. Many traumatized people feel chronically out of sync with other people around them. They often seek out others with similar experiences, who “get it.” This alleviates their sense of isolation, but sometimes at the price of having to deny their individual differences. Isolating oneself into a narrowly defined victim group promotes a view of others as irrelevant at best and dangerous at worst, leading to further alienation. Gangs, extremist political parties, and religious cults may provide solace, but don’t usually offer the mental flexibility needed to be fully open to what life has to offer. Social support is not merely just being in the presence of other people. The key issue is reciprocity: being truly seen and heard by the people around us, and feeling that we are held in someone else’s mind and heart. For such reciprocity to be possible, our defensive system must temporarily shut down. Intimacy requires us to be able to experience vulnerability without fear. Being able to feel safe with other people is probably the single most important aspect of mental health. Trusted, intimate connections are fundamental to meaningful and satisfying lives. Because trauma almost always involves not being seen, not being mirrored, or not being taken into account, treatment needs to restore the capacity to mirror and be mirrored by others, without being hijacked by others’ negative emotions. Traumatized people recover in the context of relationships: with families, loved ones, AA meetings, veterans’ groups, religious communities, or professional therapists. Letting go of shame Deep down, many traumatized people are haunted by shame over what they did or didn’t do during their experience. They despise themselves for how terrified, dependent, excited, or enraged they felt. This is particularly true if the abuser was someone close to them as a child, or someone they depended on, as is so often the case. The result is confusion about whether one was a victim or a willing participant, which in turn leads to bewilderment about the difference between love and terror, pain and pleasure. Part of recovery is letting go of these feelings of guilt and shame. Forgiving oneself for what happened or didn’t happen. Or realizing that there is nothing to forgive. Reintegrating memories and changing their meaning As we saw before, traumatic memories often exist in a separate, walled off part of the mind. An essential part of trauma treatment is reintegrating those memories back into your sense of self, where they often take on new meanings. Van der Kolk describes his experience working with Albert Pesso, a former dancer who had developed a new kind of treatment for trauma called Pesso Boyden System Psychomotor (PBSP) therapy. It involved creating “structures” or scenarios where subjects recreated scenes from their past. Through an interview format, the main participant (called the “protagonist”) would direct people to sit or stand in positions around the room that represented their role or relationship toward them. The human brain processes spatial movements with the right hemisphere of the brain, which is the same area that is most affected by trauma. Through creating and then manipulating these structures, the protagonist is able to replay and change scenes from their past. For example, by having someone “play” their mother or father and expressing anger, disappointment, or unexpressed love toward them. Protagonists became like the directors of their own play, enlisting others to provide the love, support, and protection that had been lacking at those critical moments.changescenes from their past. For example, by having someone “play” their mother or father and expressing anger, disappointment, or unexpressed love toward them. Protagonists became like the directors of their own play, enlisting others to provide the love, support, and protection that had been lacking at those critical moments. These innovative treatment methods don’t erase bad memories, or even neutralize them. They provide fresh options – an alternative memory where your basic human needs were met and your longings for love were fulfilled. Structures promote one of the essential conditions for deep therapeutic change: a trance-like state in which multiple realities can live side by side. In that state you can simultaneously experience the complex emotions of loyalty and tenderness mixed with rage and longing. The possibility of self-leadership Trauma robs people of self-leadership – the feeling that you are in charge of yourself. A challenge of recovery is reestablishing ownership of your body and mind. For most people this involves: Finding a way to become calm and focused Learning to maintain that calm in response to images, thoughts, sounds, or physical experiences that remind you of the past Finding a way to be fully alive in the present and engaged with the people around you Not having to keep secrets from yourself, including secrets about the ways that you have managed to survive As long as people are either hyper aroused or shut down, they cannot learn from experience. Even if they manage to stay in control, they can remain inflexible, stubborn, and depressed. Recovery from trauma involves the restoration of executive functioning, and with it, self-confidence and the capacity for playfulness and creativity. As our visceral connection to our bodies is reestablished, there is a brand new capacity to warmly love the self. We begin to care for our health, our diet, our energy, and our time. This caring arises spontaneously and naturally, not in response to a “should.” This sets the stage for developing our internal leadership skills – how well we listen to our different parts, make sure they feel taken care of, and keep them from sabotaging one another. Instead of any one part of ourselves dominating the conversation, we can treat them all as important elements in a complex constellation of thoughts and emotions. Pioneering neuroscience research by scientists like Michael Gazzaniga, combined with work in IFS (Internal Family Systems), has given us a model of the human mind as consisting of multiple distinct subsystems. Each one operates semi-autonomously, with its own needs, skills, and history. They also have different levels of maturity, excitability, wisdom, and pain. In trauma, the relationship between these subsystems breaks down and they go to war with one another. Self-loathing fights with grandiosity, loving care with hatred, numbing and passivity with rage and aggression. Trauma hijacks these feelings out of their natural, valuable states. For example, we all have parts of ourselves that are childlike and fun. When we are abused, these are the parts that hurt the most, and they become frozen with the pain, terror, and betrayal of abuse. This burden makes them toxic, and the other parts rally to shield themselves from its pain. In so doing, these “internal managers” take on some aspects of the abuser. Hypercritical and perfectionistic internal voices make sure we never get close to anyone, or drive us to be relentlessly productive, or throw us into a rage at the slightest provocation. They are trying to protect us from the feeling of annihilation, but in the process are making us miserable. Every complex system requires competent leadership, and this internal system is no different. Treatment involves assuring all parts that they are welcome and valued, even those that are suicidal or destructive. It involves calling on one’s internal leader to wisely distribute the available resources and supply a vision for the whole that takes all parts into account. This “leader self” does not need to be cultivated or trained. It is always there beneath the surface, ready to take charge once the protective mechanisms that have arisen to protect it from destruction step back. In a nine-month study, a group of IFS subjects showed measurable improvements in self-assessed joint pain, physical function, self-compassion, and overall pain relative to a control group. They also showed significant improvements in depression and self-efficacy. The subjective improvements were maintained one year later, but not the objectively measured ones, indicating that what had improved was their ability to live with their pain. Traumatic adaptations continue until the entire human organism feels safe and integrates all the parts of itself that are stuck fighting or warding off trauma. If you were abused or neglected as a child, you likely still have a childlike part living inside you that is frozen in time, still holding fast to self-loathing and denial. Pushing these feelings away can be highly adaptive in the short run, helping you preserve your dignity, or focus on critical tasks like caring for your family or rebuilding a house. But it requires an enormous amount of energy to keep the system under control. A single comment may trigger several parts simultaneously: one that becomes intensely angry, another filled with self-loathing, and a third that tries to calm things down with coping habits. The internal manager we enlist to manage this situation can become a problem unto itself – creating obsessions, seeking distractions, imposing control, thirsting for power, suppressing emotions, or denying reality altogether. Eventually, the powerful managers that we created to protect against the feeling of helplessness need to be put to rest. The future of trauma Currently more than 50% of the children served by Head Start have had three or more “adverse childhood experiences” as defined by the ACE study, such as incarcerated family members, depression, violence, abuse, drug use in the home, or periods of homelessness. This is an absolutely staggering number. It defies our understanding of trauma as something uncommon, that only affects a small minority of people. Meanwhile, child abuse and neglect are the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide. We are slowly moving toward becoming a trauma-aware society, as the research and clinical practice outlined in this book spread into the medical establishment and therapeutic culture. But as Van der Kolk documents in detail, there have been backlashes against acknowledging the reality of trauma before. This book is a landmark achievement in the history of trauma awareness and treatment. It threads scientific research together with clinical practice and new treatment methods. It calls attention to the horrific impact of trauma and individuals and on society, while suggesting numerous practical ways it can be treated, including ones not included in this summary such as EMDR (Eye Movement Desensitization and Reprocessing), neurofeedback training, and theatre.

A mental health condition, people with dissociative identity disorder (DID) have two or more separate personalities. These identities control a person’s behavior at different times. DID can cause gaps in memory and other problems. Various types of psychotherapy can help people manage the symptoms of DID. OVERVIEW What is dissociative identity disorder (DID)? Dissociative identity disorder (DID) is a mental health condition. People with DID have two or more separate identities. These personalities control their behavior at different times. Each identity has its own personal history, traits, likes and dislikes. DID can lead to gaps in memory and hallucinations (believing something is real when it isn’t). Dissociative identity disorder used to be called multiple personality disorder or split personality disorder. DID is one of several dissociative disorders. These disorders affect a person’s ability to connect with reality. Other dissociative disorders include: Depersonalized or derealization disorder, which causes a feeling of detachment from your actions. Dissociative amnesia, or problems remembering information about yourself. How common is DID? DID is very rare. The disorder affects between 0.01 and 1% of the population. It can occur at any age. Women are more likely than men to have DID. SYMPTOMS AND CAUSES What causes dissociative identity disorder (DID)? DID is usually the result of sexual or physical abuse during childhood. Sometimes it develops in response to a natural disaster or other traumatic events like combat. The disorder is a way for someone to distance or detach themselves from trauma. What are the signs and symptoms of DID? A person with DID has two or more distinct identities. The “core” identity is the person’s usual personality. “Alters” are the person’s alternate personalities. Some people with DID have up to 100 alters. Alters tend to be very different from one another. The identities might have different genders, ethnicities, interests and ways of interacting with their environments. Other common signs and symptoms of DID can include: Anxiety. Delusions. Depression. Disorientation. Drug or alcohol abuse. Memory loss. Suicidal thoughts or self-harm. DIAGNOSIS AND TESTS Is there a test for DID? There isn’t a single test that can diagnose DID. A healthcare provider will review your symptoms and your personal health history. They may perform tests to rule out underlying physical causes for your symptoms, such as head injuries or brain tumors. Symptoms of DID often show up in childhood, between the ages of 5 and 10. But parents, teachers or healthcare providers may miss the signs. DID might be confused with other behavioral or learning problems common in children, such as attention deficit hyperactivity disorder (ADHD). For this reason, DID usually isn’t diagnosed until adulthood. MANAGEMENT AND TREATMENT What is the treatment for dissociative identity disorder (DID)? Some medications may help with certain symptoms of DID, such as depression or anxiety. But the most effective treatment is psychotherapy. A healthcare provider with specialized training in mental health disorders, such as a psychologist or psychiatrist, can guide you toward the right treatment. You may benefit from individual, group or family therapy. Therapy focuses on: Identifying and working through past trauma or abuse. Managing sudden behavioral changes. Merging separate identities into a single identity. Can hypnosis help with DID? Some healthcare providers may recommend hypnotherapy in combination with psychotherapy. Hypnotherapy is a form of guided meditation. It may help people recover suppressed memories. PREVENTION Can dissociative identity disorder (DID) be prevented? There’s no way to prevent DID. But identifying the signs as early in life as possible and seeking treatment can help you manage symptoms. Parents, caregivers and teachers should watch for signs in young children. Treatment soon after episodes of abuse or trauma may prevent DID from progressing. Treatment can also help identify triggers that cause personality or identity changes. Common triggers include stress or substance abuse. Managing stress and avoiding drugs and alcohol may help reduce the frequency of different alters controlling your behavior. OUTLOOK / PROGNOSIS Will dissociative identity disorder (DID) go away? There is no cure for DID. Most people will manage the disorder for the rest of their lives. But a combination of treatments can help reduce symptoms. You can learn to have more control over your behavior. Over time, you can function better at work, at home or in your community. LIVING WITH Are there ways to make living with DID easier? A strong support system can make living with DID more manageable. Make sure you have healthcare providers, family members and friends who know about and understand your condition. Communicate openly and honestly with the people in your support system, and don’t be afraid to ask for help. If a friend or family member has DID, how can I help? Having a loved one with DID can be confusing and overwhelming. You may not know how to respond to their different alters or behaviors. You can help by: Learning about DID and its symptoms. Offering to attend family counseling or support groups with your loved one. Staying calm and supportive when sudden behavior changes occur. When should I call my doctor about DID? If you or someone you know has DID and exhibits any of the following symptoms, seek medical attention right away: Self-harm. Suicidal thoughts. Violent behavior. You can call the National Suicide Prevention Lifeline at 800.273.8255. This hotline connects you to a network of local crisis centers that provides free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. In an emergency, call 911. Dissociative identity disorder (DID) is a mental health condition. Someone with DID has multiple, distinct personalities. The various identities control a person’s behavior at different times. The condition can cause memory loss, delusions or depression. DID is usually caused by past trauma. Therapy can help people manage their behaviors and reduce the frequency of identity “switches.” It’s important for anyone with DID to have a strong support system. Healthcare providers, family members and friends can help people manage DID.

Trauma affects the way cells in the brain process, interpret and react to information. It not only impacts the physical process of thinking, but thought, which drives behavior. Understanding trauma’s effect on the brain will help you understand, and address, your child’s emotions and behaviors. Trauma primarily involves three parts of the brain: the amygdala, the hippocampus and the prefrontal cortex. Each of them has a role to play in what your child thinks and feels and influences his or her choices of behaviors. When you understand what part of the child’s brain is driving thoughts and behavior, you will be able to determine how to provide effective and compassionate guidance. Amygdala Responsible for using emotions such a fear or pleasure to ensure survival. It’s the “primitive” brain. How this Part Processes Trauma Sends messages to the hippocampus to prepare for danger. How this Part Interprets and Reacts to Trauma Chooses one of these responses: flight, fight or freeze. Hippocampus Responsible for creating memories from sensory information and attaching them to emotions. It’s the “emotional brain.” How this Part Processes Trauma Releases stress hormones (cortisol) in the presence of danger. How this Part Interprets and Reacts to Trauma The process of making and retrieving memories is impeded. Prefrontal Cortex Responsible for thought; has control over planning, reasoning and organizing. It’s the “thinking brain.” How this Part Processes Trauma Attaches strong emotions and behaviors to specific thought patterns. How this Part Interprets and Reacts to Trauma May create anxiety, phobias, panic disorders, obsessive-compulsive disorders, etc. Trauma Triggers Regress to an earlier developmental stage Throw tantrums Become clingy Masturbate or initiate sex acts with toys or other children Begin bed wetting Withdraw Damage property Become sexually promiscuous Run away Engage in self-injurious acts or delinquent behavior Triggers may also initiate a flashback, which is the feeling that the event is currently happening. During a flashback, the child’s primitive brain may automatically take control to deal with what is perceived to be reality. When this happens, the child will choose flight, fight or freeze. One good response is to help the child regain a connection with the environment. For example, you might say, “Look at the sky. See the birds? Can you hear them?” Don’t be surprised if it takes a while to reconnect. Keep trying. Do not address behavior and emotions until the child is reconnected. One good response is to help the child regain a connection with the environment. For example, you might say, “Look at the sky. See the birds? Can you hear them?” Don’t be surprised if it takes a while to reconnect. Keep trying. HELPING YOUR CHILD RECOVER FROM TRAUMA If a traumatic event happens once and is not likely to repeat, it is said the child has simple trauma. If the traumatic event happens repeatedly, over a period of time, and/or is likely to happen again, the child is said to have complex trauma. Depending on the severity and duration of the abuse, distressing emotional reactions to triggering events can last weeks to years after the traumatic events have stopped. It depends on how long the abuse went on, how many times it happened, who perpetrated the abuse and who was impacted by it (other than the child). RESILIENCE Resilience is the ability to cope with life’s challenges and hardships. Research has shown that up to half of the children who experience sexual trauma are resilient and will not show any long-term problems or symptoms. Although a child’s resilience is due in part to biological and genetic factors, it is also a quality that you can encourage. Resilient children often possess high self-esteem, the ability to recruit help and the belief that their actions can make a difference for the better. Below are ways in which you can foster resilience in your child after a sexual assault. Encourage your child to develop a personal narrative of the events that includes a positive interpretation. For example, you can emphasize your child’s strength in surviving the betrayal of their trust, of coming forward and disclosing and of working hard to heal. When your child speaks of the abusive event, look for his or her underlying strengths and bring them into the conversation. Over time, your child will develop an abuse narrative that includes their courage and smart handling of a traumatic experience. Demonstrate your support and love for your child at every possible moment. Studies have shown that a mother’s sensitivity to her abused child’s needs and support of her or his healing are key to increasing the child’s resilience. A supportive and caring father or other caregiver also has a profound effect on resilience and recovery. A sexually abused child builds strength from the love and support of family and community, including extended family members, the child’s friends, supportive teachers or other trustworthy adults. Create opportunities for positive social support. The support can be from family members, the child's friends, supportive teachers or other trustworthy adults. Opportunities include mealtimes, family outings, activities with friends, holidays and other celebrations, gathering at places of worship and even quiet times spent together. Encourage your child’s activities, especially in extracurricular activities at school such as sports or clubs. Allow opportunities for artistic expression and involvement with cultural events. Facilitate participation in spiritual and charitable outlets. Studies have also shown that involvement in these activities builds resilience. Maintain a home environment free from any form of violence and substance abuse. These activities have been shown to reduce a child’s resilience Encourage your child to talk about the abuse. Children who face a traumatic event and process its effect on them have the best chance of healing. Avoidance as a coping method is the least favorable means of handling an abusive experience. Studies have found that increasing a sexually abused child’s self-esteem, strengthening the parent-child bond, providing positive school experiences, and participating in school activities such as sports and ensuring access to strong social supports will build resilience to the negative effects of sexual assault such as depression and anger. SIBLING REACTIONS AND RECOVERY The sexual assault of one child typically affects the whole family, including siblings. Everything you do to help your children at this time is important. Even your smallest actions can create big opportunities for healing in your children. Below are some common reactions you can expect from the siblings of a sexually abused child. Stress is normal in situations such as this. Teach relaxation techniques and be sure everyone is eating healthily and being active. Siblings may resent the attention the abused child is getting from parents, other caregivers and extended family and friends. You can help to reduce resentment by making sure every child has special time and by including siblings in as many age-appropriate activities as possible. Older siblings may feel responsible for their sibling’s abuse and respond by trying to protect that child from all potential risks. Help your children understand that they are not responsible for anyone’s safety. It is your job, as the parent, to protect the children in the family. Common reactions from siblings: Resentment of the abused child Emotional distress Over-protection Stigmatization Blame An abused child can acquire a stigmatized role among siblings or be blamed for the distress the family is experiencing. Redirect negative sibling reactions to the abuse to the only person responsible for the abuse – the abuser. Remind them that their sibling did not want to be abused and needs to be treated with acceptance in order to find the way back to normal. Your children may be experiencing changes and challenges at this time. You can try to minimize the amount of change they have to face at once and constantly reassure them by providing them with love, understanding and support.

Dissociative identity disorder (DID), previously called multiple personality disorder or split personality disorder, is a complex, post-traumatic, developmental disorder that affects approximately 1% of the general population. A person with DID presents with different identities. The person often is unaware these other identities exist and is unable to remember what took place when another identity was in control. They may encounter people who know them but whom they don't recall meeting, find things they have purchased without remembering, be unaware of how they got to a location, or experience a sense of amnesia or missing time. DID is almost always the result of childhood trauma. While it always develops during childhood, it may begin to manifest in adulthood, usually as a result of stresses or triggers. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), DID is a mental health condition in which a person has two or more distinct identities that alternate appearing, or being "in control." They each have their own sense of self and sense of agency, affect (outward expression of emotions), behaviors, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These differences are sometimes, but not always, observable to others. A person with DID typically does not remember what occurred when another identity was presenting. The person will have gaps of missing time, being unable to remember events and other details that occurred during those times. While the person with DID may not remember after another identity has taken over, the other identities have their own agency (acting independently and making their own choices), will, and perspective. What Are the Symptoms of Dissociative Identity Disorder? People with DID may show symptoms associated with mood, anxiety, and personality. Some symptoms of DID May include Inability to remember large parts of childhood Episodes of memory loss or "lost time," for instance, finding themselves somewhere they don't remember getting to, or in possession of items they don't recall buying. Sudden return of memories (flashbacks) Periods of feeling disconnected or "detached" from their body and thoughts or having out-of-body experiences Hallucinations (sensory experiences that are not based in reality) Differences in handwriting from one time to another Changing levels of functioning Thoughts or actions of suicide or self-harm Help Is Available If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. If you or a loved one is struggling with dissociation or dissociative identity disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. Other symptoms and conditions associated with DID include: Depression Mood swings Anxiety and related symptoms and conditions Eating disorders Sleep difficulties Headaches and body pains Sexual dysfunction What Causes Dissociative Identity Disorder? DID is almost always associated with recurrent childhood trauma, such as abuse or neglect. One study showed 86% of the sample of people with DID report a history of sexual abuse. Some factors believed to be involved in the development of DID include: Severe, recurrent childhood trauma, including physical, emotional, or sexual abuse The lack of safe and nurturing resources to respond to and manage trauma The child's ability to dissociate easily Dissociation, or "splitting," as a defense mechanism against the trauma and a survival skill A child who experiences ongoing trauma may tell themselves, "That's not me; that's someone else" as a response to the overwhelming fear they are experiencing. This detaches these thoughts and feelings from themselves and places them onto "someone else", even though that other individual is still part of them. Dysfunctional attachment to caregivers may also contribute to the development of DID. Disorganized attachment (in which an infant or child is both frightened of and seeks comfort and security from a primary caregiver) or betrayal trauma (in which someone the child relies on causes them trauma), can prompt the child to dissociate as an adaptive response. This compartmentalization lets the child maintain attachment to an abusive or neglectful person who is also vital to their survival and development. Can DID Develop in Adulthood? DID almost always develops in childhood, but it may not become apparent or manifest as multiple identities until later in adolescence or adulthood. Mode Theory Dissociative identities can result from a breakdown between how experienced events are encoded (as part of memory) and a sense of ownership of those memories. Different identities take on ownership of these memories and how they respond to them. How and why these different ways of encoding occur may be due to the theory that personality is made up of "modes" containing cognitive, affective, behavioral, and physiological representations, or schemas. These modes influence how a person responds to internal and environmental demands. For example, a woman may have a "mother" mode who determines how she thinks, feels, and experiences when caring for her child. She may also have a "boss" mode, a "wife" mode, a "daughter" mode, and other modes that all influence how she feels and interacts in different situations. Usually, a person can incorporate all of these modes into one "conscious control system" that gives an overall sense of self. When switching between modes, most people are still aware of the other modes and are able to accept that each of these modes integrates into who they are as one person. DID can arise when these modes become disconnected from each other, creating smaller, isolated pockets. For example, modes associated with families, such as mother and partner, may become detached from those associated with work. This creates multiple conscious control systems, each with its own aspect of self that is based on the modes they are comprised of. This then gives rise to distinct, first-person perspectives. Can DID Be "Faked"? Theories exist that DID could be caused by suggestion, fantasy, or role-playing. These theories are not supported by evidence, and trauma researchers repeatedly challenge this myth. Brain Differences People with DID have been found to have some alterations in their brain morphology (structural measures of the brain such as volume and shape). The amygdala (part of the brain involved in the input and processing of emotions) and the hippocampus (part of the brain involved in learning and memory) have also been found to be affected in people with DID. Studies have also shown a reduction in functioning and blood flow in the orbitofrontal cortex (the front area of the brain) in people with DID. People with DID also show smaller volumes in the parietal structures (located in the upper back area of the skull) involved in perception and personal awareness, and frontal structures involved in movement execution and the learning of fear. Increased white matter tracts involved in information communication between certain areas of the brain (somatosensory association areas, basal ganglia, and the precuneus) have also been noted in people with DID. How Is Dissociative Identity Disorder Associated with Trauma? DID is heavily associated with childhood trauma. Among people with DID in the United States, Canada, and Europe, about 90% experienced childhood abuse and neglect. Summary DID is a mental health condition in which two or more identities exist within one person. DID is almost always a response to severe and ongoing childhood trauma, such as abuse or neglect. Structural brain differences have also been noted in people with DID. A Word from Very well healing from your past trauma If you are experiencing signs of DID, it's important to seek help from a healthcare provider or mental health professional. Getting an accurate diagnosis is the first step on the road to healing from your past trauma and managing your symptoms. And managing your symptoms. you are experiencing signs of DID, it's important to seek help from a healthcare provider or mental health professional. Getting an accurate diagnosis is the first step on the road to healing from your past trauma and managing your symptoms., and managing your symptoms., and managing your symptoms.healing from your past trauma, and managing your symptoms. FREQUENTLY ASKED QUESTIONS Is multiple personality disorder real? Dissociative identity disorder is a real mental health condition that is outlined in the DSM-5. On-going studies continue to confirm its validity. Is dissociative identity disorder genetic? Currently, there is no direct evidence to show that DID is genetic, but there may be a genetic link that has not yet been identified. Are there movies that feature someone with multiple personalities? Portrayals of DID are common in movies, books, and television shows, but they are rarely accurate. Unfortunately, this creates a lot of misconceptions about the condition and the experiences of people who live with it. How should you respond to someone with split personalities? "Switching" to one of the alter identities, sometimes abruptly, can make your friend or loved one sound and act differently. If they don't know who you are, introduce yourself and reassure them in they are frightened.

There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life. Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis). Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode. Cyclothymic disorder. You've had at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression). Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke. Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment. Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time. Mania and hypomania Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization. Both a manic and a hypomanic episode include three or more of these symptoms: Abnormally upbeat, jumpy or wired Increased activity, energy or agitation Exaggerated sense of well-being and self-confidence (euphoria) Decreased need for sleep Unusual talkativeness Racing thoughts Distractibility Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments Major depressive episode A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms: Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability) Marked loss of interest or feeling no pleasure in all — or almost all — activities Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression) Either insomnia or sleeping too much Either restlessness or slowed behavior Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Decreased ability to think or concentrate, or indecisiveness Thinking about, planning or attempting suicide Other features of bipolar disorder Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons. Symptoms in children and teens Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder. Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes. The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings. When to see a doctor Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need. And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble. If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control. When to get emergency help Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room. Causes The exact cause of bipolar disorder is unknown, but several factors may be involved, such as: Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes. Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder. Risk factors Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include: Having a first-degree relative, such as a parent or sibling, with bipolar disorder Periods of high stress, such as the death of a loved one or another traumatic event Drug or alcohol abuse Complications Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as: Problems related to drug and alcohol use Suicide or suicide attempts Legal or financial problems Damaged relationships Poor work or school performance Co-occurring conditions If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include: Anxiety disorders Eating disorders Attention-deficit/hyperactivity disorder (ADHD) Alcohol or drug problems Physical health problems, such as heart disease, thyroid problems, headaches or obesity Prevention There's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening. If you've been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression: Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you're falling into an episode of depression or mania. Involve family members or friends in watching for warning signs. Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back. Take your medications exactly as directed. You may be tempted to stop treatment — but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects or your symptoms may worsen or return.

Bipolar I disorder (BP-I) and bipolar II disorder (BP-II) are two of the three major forms of bipolar disorder. While both involve shifts in mood, energy, activity levels and concentration, BP-I and BP-II have two key differences. These differences include the intensity of manic episodes and the prevalence of major depressive episodes. Intensity of manic episodes One major difference between BP-I and BP-II is the intensity of manic episodes. BP-I involves periods of severe mania whereas BP-II involves periods of less severe hypomania. Mania and hypomania are both marked by persisting elevated, expansive or irritable mood that is uncharacteristic of the person at baseline. These periods may also involve abnormally elevated self-esteem, decreased need for sleep, increased talkativeness, flight of ideas or racing thoughts, abnormal distractibility, increased energy or goal-directed activity and abnormally risky behaviors. Mania lasts for at least one week and is considered a medical emergency, often requiring psychiatric hospitalization Its effects on one’s personal life and ability to work are debilitating. Hypomania lasts for at least four days. It does not cause impairment in functioning, require hospitalization, or have psychotic features. Prevalence of major depressive episodes Another notable difference between BP-I and BP-II is the prevalence of major depressive episodes. A BP-II diagnosis requires a patient to experience at least one major depressive episode. While those with BP-I may also experience major depressive episodes, a major depressive episode is not a diagnostic requirement. Major depressive episodes involve persisting depressed mood or anhedonia (the inability to feel pleasure) for at least two weeks. These periods may also involve an increase or decrease in appetite or body weight, persisting insomnia or hypersomnia, persisting fatigue or energy loss, psychomotor agitation (fidgeting or restlessness) or slowing, feelings of worthlessness or excessive guilt, problems concentrating or making decisions and recurring thoughts of death or suicide.

The Stages of Grief ABOUT TRANSCRIPT IN THIS ARTICLE What Are the Stages of Grief? How Long Is Too Long to Mourn? Do I Need Professional Help? Grief is a natural response to losing someone or something that’s important to you. You may feel a variety of emotions, like sadness or loneliness. And you might experience it for a number of different reasons. Maybe a loved one died, a relationship ended, or you lost your job. Other life changes, like chronic illness or a move to a new home, can also lead to grief. Everyone grieves differently. But if you understand your emotions, take care of yourself, and seek support, you can heal. What Are the Stages of Grief? Your feelings may happen in phases as you come to terms with your loss. You can’t control the process, but it’s helpful to know the reasons behind your feelings. All people experience grief differently. Though it no longer considered the ideal way to think about grief, you may have heard of the stages of grief: Denial: When you first learn of a loss, it’s normal to think, “This isn’t happening.” You may feel shocked or numb. This is a temporary way to deal with the rush of overwhelming emotion. It’s a defense mechanism. Anger: As reality sets in, you’re faced with the pain of your loss. You may feel frustrated and helpless. These feelings later turn into anger. You might direct it toward other people, a higher power, or life in general. To be angry with a loved one who died and left you alone is natural, too. Bargaining: During this stage, you dwell on what you could’ve done to prevent the loss. Common thoughts are “If only…” and “What if…” You may also try to strike a deal with a higher power. Depression: Sadness sets in as you begin to understand the loss and its effect on your life. Signs of depression include crying, sleep issues, and a decreased appetite. You may feel overwhelmed, regretful, and lonely. Acceptance: In this final stage of grief, you accept the reality of your loss. It can’t be changed. Although you still feel sad, you’re able to start moving forward with your life. Every person goes through these phases in their own way. You may go back and forth between them or skip one or more stages altogether. Reminders of your loss, like the anniversary of a death or a familiar song, can trigger the return of grief. How Long Is Too Long to Mourn? There’s no “normal” amount of time to grieve. Your grieving process depends on a number of things, like your personality, age, beliefs, and support network. The type of loss is also a factor. For example, chances are you’ll grieve longer and harder over the sudden death of a loved one than, say, the end of a romantic relationship. With time, the sadness eases. You’ll be able to feel happiness and joy along with grief. You’ll be able to return to your daily life. Do I Need Professional Help? In some cases, grief doesn’t get better. You may not be able to accept the loss. Doctors call this “complicated grief.” Talk to your doctor if you have any of the following: Trouble keeping up your normal routine, like going to work and cleaning the house Feelings of depression Thoughts that life isn’t worth living, or of harming yourself Any inability to stop blaming yourself A therapist can help you explore your emotions. They can also teach you coping skills and help you manage your grief. If you’re depressed, a doctor may be able to prescribe medicines to help you feel better. When you’re in deep, emotional pain, it can be tempting to try to numb your feelings with drugs, alcohol, food, or even work. But be careful. These are temporary escapes that won’t make you heal faster or feel better in the long run. In fact, they can lead to addiction, depression, anxiety, or even an emotional breakdown. Instead, try these things to help you come to terms with your loss and begin to heal: Give yourself time. Accept your feelings and know that grieving is a process. Talk to others. Spend time with friends and family. Don’t isolate yourself. Take care of yourself. Exercise regularly, eat well, and get enough sleep to stay healthy and energized. Return to your hobbies. Get back to the activities that bring you joy. Join a support group. Speak with others who are also grieving. It can help you feel more connected.

Disruptive Mood Dysregulation Disorder (DMDD) is a pediatric mood disorder characterized by severe recurrent temper outbursts manifested verbally (verbal rages) and/or behaviorally (physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. These outbursts occur, on average, three or more times per week and the mood between temper outbursts is persistently irritable or angry most of the day, nearly every day. The symptoms must be present for 12 months before a diagnosis can be made, and diagnosis should not be made before age 6 or after age 18. ​​DIAGNOSTIC CRITERIA (From the DSM-5) A. Severe recurrent temper outbursts manifested verbally (verbal rages) and/or behaviorally (physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. B. The temper outbursts are inconsistent with developmental level. C. The temper outbursts occur, on average, three or more times per week. D. The mood between temper outbursts in persistently irritable or angry most of the day, nearly every day, and is observable by others (parents, teachers, peers). E. Criteria A–D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A–D. F. Criteria A and D are present in at least two of the three settings (at home, at school, with peers) and are severe in at least one of these. G. The diagnosis should not be made for the first time before age 6 years or after age 18 years. H. By history or observation, the age of onset of Criteria A-E is before 10 years. I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania. J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]). Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/ hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned. K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition. ​ A DMDD diagnosis is typically given by a licensed psychiatrist and should be confirmed only after the child has undergone a complete assessment to rule out other underlying conditions that could be causing similar symptoms - learning disabilities, neurological disorders, autism, etc. If you believe your child may have DMDD, please consult with a board-certified psychiatrist who specializes in pediatric mood disorders. Choosing a psychiatrist is one of the most important steps in the DMDD journey. Here are some tips to make the process easier. ​ 1. Get Referrals Start with a referral list of potential psychiatrists from your primary care doctor. You can add to this list by asking family, friends, and other healthcare providers for recommendations. Take the time to research the doctors’ credentials and experience. You'll discover that there are many different types of psychiatric practices and clinical subspecialties. As you narrow down your list, call each psychiatrist’s office to make a consult appointment to meet and interview the doctor. 2. Research the Psychiatrist’s Credentials Board certification is one of the most important factors to consider when you are choosing a psychiatrist. It tells you that the doctor has the necessary training, skills and experience to provide healthcare in psychiatry. Also confirm that the psychiatrist has no history of malpractice claims or disciplinary actions. You can find the psychiatrist’s medical school, training hospital, certifications, and malpractice and disciplinary history on Healthgrades.com and state websites. 3. Consider the Psychiatrist’s Experience When you’re facing mental health issues, experience matters. The more experience a psychiatrist has with pediatric mood disorders, the better your results are likely to be. Ask how many patients with pediatric mood disorders the psychiatrist has treated. If you are looking for a specific treatment plan, ask how many patients the doctor has treated with that plan and their outcomes. 4. Consider Gender If your child will also receive therapy from the psychiatrist, it’s important they feel comfortable openly discussing personal information. The gender of the psychiatrist may play a role in how comfortable they feel. 5. Research Hospital Quality Your doctor’s hospital is your hospital. Therefore, you also need to consider the quality of care at the hospital where the psychiatrist can provide care. Hospital quality matters to you because patients at top-rated hospitals have fewer complications and better care. Additionally, consider whether the hospital’s location is important to you. Should you need to go the hospital for tests or treatment, you want the location to encourage, rather than discourage timely care. 6. Evaluate Communication Style Choose a psychiatrist with whom you are comfortable talking and who supports your information needs. When you first meet the psychiatrist, ask a question and notice how he or she responds. Does he or she welcome your questions and answer them in ways that you can understand? Trust your instincts. Therapy can take months or years and you will need to build a relationship of mutual trust. Find a psychiatrist who shows an interest in getting to know you, who will consider your treatment preferences, and who will respect your decision-making process. 7. Review Patient Satisfaction Surveys Reading what other people have to say about a doctor can provide insight into how a doctor practices medicine, as well as how his or her medical practice is operated. Patient satisfaction surveys typically ask people about their experience with scheduling appointments, wait times, office environment, and office staff friendliness. You can learn about how well patients trust the doctor, how much time he or she spends with their patients, and how well he or she answers questions. ​ 8. Know What Your Insurance Covers Your insurance coverage is a practical matter. To receive the most insurance benefits and pay the least out-of-pocket for your care, you may need to choose a psychiatrist who participates in your plan. You should still consider credentials, experience, outcomes, and hospital quality as you select a psychiatrist from your plan. ​ Diagnostic Criteria Bipolar I disorder Bipolar II disorder Essential diagnostic features: a. At least one lifetime manic episode b. The manic episode was not due to the effects of medications, substances, or medical illness Diagnostic note: an episode of depression is not required to make a diagnosis Essential diagnostic features: a. At least one lifetime hypomanic episode b. At least one lifetime major depressive episode c. Neither the hypomanic nor the depressive episode(s) was due to effects of medications, substances, or medical illness

PTSD WHO IS AFFECTED Many of us in our lives at some points have dealt with many degrees of trauma and stress. Sometimes though these events are so horrific and terrible we are unable to function as a whole. When these events happen and we find ourselves frozen in those crippling moments of reliving the experience, this is labeled to be Post-Traumatic Stress disorder (PTSD). The Mayo Clinic describes PTSD to be as follows: PTSD is a mental health condition that is triggered by a terrifying event- either experiencing it or witnessing it. Symptoms include flash backs, nightmares, and sever anxiety as well as uncontrollable thoughts of what happen. The first mention of PTSD was over a century and a half ago. They tagged it with the name of hysteria. Hysteria was discovered by a French neurologist Jean-Martin Charcot in the mid 1800's. Male soldiers in World War 1 later displayed symptoms of mutism, amnesia, paralysis, tremor, blindness, and deafness. Charles Samuel Myers, a British military psychiatrist in the early 1900's, was the first to use the term “shell shock “to describe the condition supposedly brought on by exposure to exploding shells. Myers eventually came to believe that the cause of shell shock (later termed “war neurosis”) was emotional and thought it to be similar to hysteria. It wasn't until soldiers returning from Vietnam in the 1970's that the term PTSD evolved. Then the feminist movement recognized similar reactions in mainly female sexual assault and domestic violence survivors. There are similar reasons as to why one might develop PTSD. Anyone who goes through, sees, or is involved in death or threatened death, serious injury or sexual violation. Doctors are not sure as to why some people get PSTD, some think that it can come like most mental disorders and one, it can be inherited, two, from life experiences and three, by the way the brain regulates the chemicals it releases in response to stress. When doing my research, I have talked with a few people that have been diagnosed with PTSD. One man we will call Tracy, served our country this couple of years came back to the states from the Gulf states that the war didn't just change him, that he came back a totally different person that he has to learn to know all over again. “I once loved to be around a crowd and the center of attention when I would go out.” “Now I can barely leave my home let alone see or be around people.” A woman we will call Donna, talks of how after being sexually assaulted, “It was years later after I had children did it hit me like a nightmare one day that I couldn’t wake from. “ She says, “It started with a song I heard on my daughter's radio. I suddenly am taken back to that moment and the smells would soon follow.” Donna was assaulted 15 years ago with her very young children present. She later described thinking that her body just shut off and she did what had to be done to get out alive without her children coming into harm's way. “I guess because those things where so horrific to me that my mind just chose not to keep it in my head until that moment, I heard that song". During Hurricane Andrew Stevey was at school. When he got home, he found that the roofs of most of the houses on his street, including his own, had been blown off. He could not find his parents and his sister, who had been removed to a shelter. He searched the neighborhood and after several hours was found by the police, who reunited him with his family. The family stayed in the shelter for two weeks until they were relocated, and Stevie refused to eat or speak for several days. Two months later Stevie was still afraid to sleep alone at night, was not concentrating in school, and was irritable whenever there was a rainstorm. Not all people that experience trauma go through this of course. Thought the event may have been traumatizing, everyone deals with it differently. Some after a while find they can adjust or cope and eventually get over the events. Then while some after a few weeks or months will find that their condition gets worse over time rather than better. There is a good chance that is PTSD. In some cases, it was few years after the event did some people start having symptoms. Some symptoms that go along with this disorder is listed by the Mayo clinic: Avoidance a. Trying to avoid thinking or talking about the event. b. Avoiding places, activities or people reminding them of the event. Negative thinking and mood a. Negative feelings about self and others. b. Lack of positive emotions. c. Emotionally numb. d. No interest in activities they once enjoyed. e. Hopelessness of the future. f. Memory loss g. Difficulty keeping close relations. The National Institute of Mental Health (NIMH) also includes: Hyper arousal Symptoms a. Being easily startled b. On the edge. c. Lack of sleep and angry outburst. Children can also suffer from PSTD as well as adults, though symptoms may come out a little differently. · Fear separation from parents. · Looses previously learned skills (like using the toilet). · Problems sleeping and nightmares. · Acting out the event during play. · New phobias and anxieties that may be totally unrelated. · Aches and pains that may have no causes. · Irritability and aggression. After a traumatizing event, the mind and body go into a shock, but as you make since of what happened and process your emotions, you can find that in time you can come out of it. With PSTD, it is not the same nor as easy to process the events. You remain in psychological shock. Your memory of what happened and your feelings about it are disconnected. In order to move along we eventually have to face our fears head on and deal with them or we will just be emotionally stuck. Treatment usually involves Therapy and or Family therapy, and medications. Something else they have found to help is a Trauma-focused cognitive-behavioral therapy. Some may never fully be cured but can learn to in time manage the fear in order to function. When facing the event that has you frozen and confronting it in time can move passed it. It feels different for everyone. I suffer complex PTSD among other things because of my trauma. Someday I hope to share and maybe it will help me heal and my hopes to express you're not alone.