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#42
Canada / Canadian Study
May 10, 2023, 06:10:52 PM
Kim Harper, Carol A. Stalker, Sally Palmer & Sue Gadbois (2008) Adults traumatized by child abuse: What survivors need from community-based mental health professionals, Journal of Mental Health, 17:4, 361-374, https://www.tandfonline.com/doi/abs/10.1080/09638230701498366
Results: Participants reported difficulties managing intense feelings that surfaced after inpatient treatment, which became more problematic when they could not talk about them honestly with their community-based therapists. Therapists who were patient, understanding, and respectful of survivors' needs for a sense of control in working toward their own solutions were most helpful. Participants emphasized the need for accessible trauma-based treatment from clinicians.
Conclusions: Many communities in Canada, due to lack of resources, are not providing trauma-specific services. This study indicates that community-based therapists need to become more knowledgeable about trauma issues, to increase their ability to work collaboratively with adults abused as children in assessing their therapeutic needs, and to ensure that survivors have some control in the treatment process.
Results: Participants reported difficulties managing intense feelings that surfaced after inpatient treatment, which became more problematic when they could not talk about them honestly with their community-based therapists. Therapists who were patient, understanding, and respectful of survivors' needs for a sense of control in working toward their own solutions were most helpful. Participants emphasized the need for accessible trauma-based treatment from clinicians.
Conclusions: Many communities in Canada, due to lack of resources, are not providing trauma-specific services. This study indicates that community-based therapists need to become more knowledgeable about trauma issues, to increase their ability to work collaboratively with adults abused as children in assessing their therapeutic needs, and to ensure that survivors have some control in the treatment process.
#43
Personality Disorder (Perpetrator) / Meme about NPD
May 04, 2023, 02:59:10 PM
My T sent me a meme about NPD - spot on I'd say.
#44
Advocacy / Info about Accountability/Reparation for Relational Abuse/Neglect
May 03, 2023, 03:35:09 PM
The articles and books listed below are just a sampling of the info available about accountability and/or reparation for relational abuse/neglect. They are meant to give members a sense of the issues involved, the work being done at various levels and some of the successes and failures.
Restorative justice and child sexual abuse, by Karen J. Terry in the book International Handbook of Restorative Justice 1st Edition (2018) Routledge
ABSTRACT
Child sexual abuse is a serious and pervasive problem, which may lead to extensive, irreparable harm. Studies show those who were sexually assaulted as youths may exhibit increased levels of depression, anxiety, suicidal ideation, substance abuse, eating disorders, anger, resentment, low self-esteem, shame and self-blame. Additionally, child sexual abuse victims-survivors often have difficulty trusting others and forming intimate, interpersonal relationships. These psychological, emotional, physical and behavioural effects can be debilitating to some and permeate all aspects of their lives in both the short and long term. Theoretically, a restorative justice approach could help restore harm to victim-survivors of child sexual abuse through voluntary and honest dialogue between affected parties. Yet while there are many restorative justice options available to assist crime victims generally, there are few options for helping the victims-survivors of child sexual abuse. The restorative justice programmes that do exist lack consistency in definition, approach and application, and there is little research on the efficacy of these programmes. This chapter examines the research that does exist on restorative justice approaches for victim-survivors of child sexual abuse and discusses policy implications based on what is known.
Restorative justice and child sexual abuse, by Karen J. Terry in the book International Handbook of Restorative Justice 1st Edition (2018) Routledge
ABSTRACT
Child sexual abuse is a serious and pervasive problem, which may lead to extensive, irreparable harm. Studies show those who were sexually assaulted as youths may exhibit increased levels of depression, anxiety, suicidal ideation, substance abuse, eating disorders, anger, resentment, low self-esteem, shame and self-blame. Additionally, child sexual abuse victims-survivors often have difficulty trusting others and forming intimate, interpersonal relationships. These psychological, emotional, physical and behavioural effects can be debilitating to some and permeate all aspects of their lives in both the short and long term. Theoretically, a restorative justice approach could help restore harm to victim-survivors of child sexual abuse through voluntary and honest dialogue between affected parties. Yet while there are many restorative justice options available to assist crime victims generally, there are few options for helping the victims-survivors of child sexual abuse. The restorative justice programmes that do exist lack consistency in definition, approach and application, and there is little research on the efficacy of these programmes. This chapter examines the research that does exist on restorative justice approaches for victim-survivors of child sexual abuse and discusses policy implications based on what is known.
#45
About Complex PTSD / The Nuance of Familial Trauma
April 28, 2023, 04:23:08 PM
I just came across this article - good one if you want to drill down into the nuance of familial trauma.
Isobel, S., Goodyear, M., & Foster, K. (2019). Psychological Trauma in the Context of Familial Relationships: A Concept Analysis. Trauma, Violence, & Abuse, 20(4), 549–559. https://sci-hub.se/10.1177/1524838017726424
Abstract
Many forms of psychological trauma are known to develop interpersonally within important relationships, particularly familial. Within the varying theoretical constructs of psychological traumas, and distinct from the processes of diagnosis, there is a need to refine the scope and definitions of psychological traumas that occur within important familial relationships to ensure a cohesive evidence base and fidelity of the concept in application to practice. This review used a philosophical inquiry methodology of concept analysis to identify the definitions, antecedents, characteristics, and consequences of the varying conceptualizations of psychological trauma occurring within important relationships. Interactions between concepts of interpersonal trauma, relational trauma, betrayal trauma, attachment trauma, developmental trauma, complex trauma, cumulative trauma, and intergenerational trauma are presented. Understanding of the discrete forms and pathways of transmission of psychological trauma between individuals, including transgenerationally within families, creates opportunities for prevention and early intervention within trauma-focused practice. This review found that concepts of psychological trauma occurring within familial relationships are not exclusive of each other but overlap in their encompassment of events and circumstances as well as the effect on individuals of events in the short term and long term. These traumas develop and are transmitted in the space between people, both purposefully and incidentally, and have particularly profound effects when they involve a dependent infant or child. Linguistic and conceptual clarity is paramount for trauma research and practice.
Synthesized Definitions From the Literature
Interpersonal trauma - Encompassing both the act and the effect of trauma; identified as traumatic injuries experienced due to threatening, uncontrollable and unexpected events caused by other people (Horowitz, 1986), usually a known and trusted individual such as a relative (Cohen, Hien, & Batchelder, 2008). "Events" encompass a range of acts of maltreatment, interpersonal violence, abuse, assault, and neglect experiences (D'Andrea, Ford, Stolbach, Spinazzola, & Van der Kolk, 2012)
Relational trauma - A subtle cumulative form of interpersonal trauma that particularly occurs within important attachment relationships and induces chronic unpredictable stress (Schore, 2001); not restricted to certain events but rather the effects of dynamics and circumstances upon individuals (Chong, 2015)
Attachment trauma - Based on attachment theory and the lifelong impacts of early attachment relationships (within the first two years) on the development of self and safety (Allen, 2013; Tassie, 2015); must occur within relationships where there is a close emotional bond and a significant degree of dependency, usually between an infant and primary caregiver, where the infant or child experiences the primary caregiver as abusive, neglectful or emotionally unavailable (Tassie, 2015). May also occur due to adoption, parental death or other disruptions within early childhood (Becker-Weidman, 2006)
Betrayal trauma - An effect of an event; based upon a theory developed by Freyd, who defined it as "trauma involving a sense of having been fundamentally cheated by another person" (Freyd, 1994, p. 308). More recently clarified as being perpetrated by someone close (Gobin & Freyd, 2014), as well as trusted or dependent (Platt & Freyd, 2015) and subsequently the distress level of the trauma is amplified by the impact on the developmental tasks of attachment and individuation (Martin, Cromer, DePrince, & Freyd, 2013). Often refers to intrafamilial sexual abuse (Gobin & Freyd, 2014)
Cumulative trauma - Several episodes of trauma exposure; sustained, repeated or multiple and commencing in the childhood years (Cloitre et al., 2009). Often involved a sequence of similar or dissimilar traumas that happen across the lifespan (Kira, Lewandowski, Somers, Yoon, & Chiod, 2012), with severity increasing with the number of different trauma types experienced, not the total number of traumatic incidents (Martin et al., 2013) and resulting in a complexity of presentation.
Developmental trauma - Makes an important distinction between the cause and the effect; identifying that the trauma is the lasting vulnerability as a result of adverse relational experiences that occur within the first four years of life (Friend, 2012) or ongoing traumas occurring over several developmental periods (Bremness & Polzin, 2014) which impact on development. A theoretically driven construct, which refers to a potentially traumatic relationship between the child and caregivers that impacts development often through a disavowal of the child's affective needs (Schimmenti, 2012)
Complex trauma - Refers to the effect that results from cumulative co-occurrence of different types of trauma typically beginning in childhood (Cohen et al., 2008); usually repeated or chronic (Aideuis, 2007) interpersonal events (Naff, 2014), most often perpetrated within the caregiving system or by other adults who typically are expected to be the source of security, protection, and stability (Courtois, 2004)
Intergenerational trauma - The process by which elements of parental traumatic experiences are passed on to the children of the next generation (Bradfield, 2011). It is debated whether the trauma that is transmitted is a replication of a parent's trauma, a response to familial trauma or a predisposition or susceptibility to further trauma but may manifest as a unique entity in the offspring (Baranowsky, Young, Johnson-Dougles, Williams-Keeler, & McCarrey, 1998). Initially, was identified as a traumatic event that had ended but continued to affect later generations, however, now includes both historical, and at times continuing, traumatic experiences that affected more than one generation with understanding of the complexity in the causation, mechanism and effects of trauma impacting family members across generations (Schwerdtfeger & Goff, 2007)[/i]
Isobel, S., Goodyear, M., & Foster, K. (2019). Psychological Trauma in the Context of Familial Relationships: A Concept Analysis. Trauma, Violence, & Abuse, 20(4), 549–559. https://sci-hub.se/10.1177/1524838017726424
Abstract
Many forms of psychological trauma are known to develop interpersonally within important relationships, particularly familial. Within the varying theoretical constructs of psychological traumas, and distinct from the processes of diagnosis, there is a need to refine the scope and definitions of psychological traumas that occur within important familial relationships to ensure a cohesive evidence base and fidelity of the concept in application to practice. This review used a philosophical inquiry methodology of concept analysis to identify the definitions, antecedents, characteristics, and consequences of the varying conceptualizations of psychological trauma occurring within important relationships. Interactions between concepts of interpersonal trauma, relational trauma, betrayal trauma, attachment trauma, developmental trauma, complex trauma, cumulative trauma, and intergenerational trauma are presented. Understanding of the discrete forms and pathways of transmission of psychological trauma between individuals, including transgenerationally within families, creates opportunities for prevention and early intervention within trauma-focused practice. This review found that concepts of psychological trauma occurring within familial relationships are not exclusive of each other but overlap in their encompassment of events and circumstances as well as the effect on individuals of events in the short term and long term. These traumas develop and are transmitted in the space between people, both purposefully and incidentally, and have particularly profound effects when they involve a dependent infant or child. Linguistic and conceptual clarity is paramount for trauma research and practice.
Synthesized Definitions From the Literature
Interpersonal trauma - Encompassing both the act and the effect of trauma; identified as traumatic injuries experienced due to threatening, uncontrollable and unexpected events caused by other people (Horowitz, 1986), usually a known and trusted individual such as a relative (Cohen, Hien, & Batchelder, 2008). "Events" encompass a range of acts of maltreatment, interpersonal violence, abuse, assault, and neglect experiences (D'Andrea, Ford, Stolbach, Spinazzola, & Van der Kolk, 2012)
Relational trauma - A subtle cumulative form of interpersonal trauma that particularly occurs within important attachment relationships and induces chronic unpredictable stress (Schore, 2001); not restricted to certain events but rather the effects of dynamics and circumstances upon individuals (Chong, 2015)
Attachment trauma - Based on attachment theory and the lifelong impacts of early attachment relationships (within the first two years) on the development of self and safety (Allen, 2013; Tassie, 2015); must occur within relationships where there is a close emotional bond and a significant degree of dependency, usually between an infant and primary caregiver, where the infant or child experiences the primary caregiver as abusive, neglectful or emotionally unavailable (Tassie, 2015). May also occur due to adoption, parental death or other disruptions within early childhood (Becker-Weidman, 2006)
Betrayal trauma - An effect of an event; based upon a theory developed by Freyd, who defined it as "trauma involving a sense of having been fundamentally cheated by another person" (Freyd, 1994, p. 308). More recently clarified as being perpetrated by someone close (Gobin & Freyd, 2014), as well as trusted or dependent (Platt & Freyd, 2015) and subsequently the distress level of the trauma is amplified by the impact on the developmental tasks of attachment and individuation (Martin, Cromer, DePrince, & Freyd, 2013). Often refers to intrafamilial sexual abuse (Gobin & Freyd, 2014)
Cumulative trauma - Several episodes of trauma exposure; sustained, repeated or multiple and commencing in the childhood years (Cloitre et al., 2009). Often involved a sequence of similar or dissimilar traumas that happen across the lifespan (Kira, Lewandowski, Somers, Yoon, & Chiod, 2012), with severity increasing with the number of different trauma types experienced, not the total number of traumatic incidents (Martin et al., 2013) and resulting in a complexity of presentation.
Developmental trauma - Makes an important distinction between the cause and the effect; identifying that the trauma is the lasting vulnerability as a result of adverse relational experiences that occur within the first four years of life (Friend, 2012) or ongoing traumas occurring over several developmental periods (Bremness & Polzin, 2014) which impact on development. A theoretically driven construct, which refers to a potentially traumatic relationship between the child and caregivers that impacts development often through a disavowal of the child's affective needs (Schimmenti, 2012)
Complex trauma - Refers to the effect that results from cumulative co-occurrence of different types of trauma typically beginning in childhood (Cohen et al., 2008); usually repeated or chronic (Aideuis, 2007) interpersonal events (Naff, 2014), most often perpetrated within the caregiving system or by other adults who typically are expected to be the source of security, protection, and stability (Courtois, 2004)
Intergenerational trauma - The process by which elements of parental traumatic experiences are passed on to the children of the next generation (Bradfield, 2011). It is debated whether the trauma that is transmitted is a replication of a parent's trauma, a response to familial trauma or a predisposition or susceptibility to further trauma but may manifest as a unique entity in the offspring (Baranowsky, Young, Johnson-Dougles, Williams-Keeler, & McCarrey, 1998). Initially, was identified as a traumatic event that had ended but continued to affect later generations, however, now includes both historical, and at times continuing, traumatic experiences that affected more than one generation with understanding of the complexity in the causation, mechanism and effects of trauma impacting family members across generations (Schwerdtfeger & Goff, 2007)[/i]
#46
Books & Articles / The Mother of Trauma Research and Acceptance
April 26, 2023, 02:43:24 PM
I am definitely a groupie of Judith Herman who was the first clinician to propose Complex PTSD in her book "Trauma and Recovery" back in 1992. I have always wondered why it took 30 years to be accepted as an official diagnosis (WHO ICD-11 2018) and this article sheds a lot of light on why that was - She Redefined Trauma then Trauma Redefined Her.
It's a really interesting read and quite disturbing to me at least that she was put through the wringer for so long. Thankfully for her and for us she has come out the other end.
She has written a new book which follows on to "Trauma and Recovery" called "Trauma and Repair." I know I will be purchasing it.
It's a really interesting read and quite disturbing to me at least that she was put through the wringer for so long. Thankfully for her and for us she has come out the other end.
She has written a new book which follows on to "Trauma and Recovery" called "Trauma and Repair." I know I will be purchasing it. #47
Podcasts, Videos & Documentaries / Healing Trauma & How the Body Keeps the Score
April 23, 2023, 02:38:09 PM
Healing Trauma & How the Body Keeps the Score with Dr Bessel van der Kolk.
There are LOTS of videos with Bessel so just Google, but here's a good one to get going with.
There are LOTS of videos with Bessel so just Google, but here's a good one to get going with.
#48
Announcements / Swearing
April 17, 2023, 04:41:33 PM
Hi Everyone:
We have a guideline about swearing because we've found over the years once members start to swear it takes off and then there's a ton of it. I know it can feel good to let one go every once in a while but at the same time we have many members who were exposed to very abusive language and it can be very triggering for them. We want to keep this a safe , respectful space for everyone so please do your best to abide by our guideline.
Thanks!
Kizzie
We have a guideline about swearing because we've found over the years once members start to swear it takes off and then there's a ton of it. I know it can feel good to let one go every once in a while but at the same time we have many members who were exposed to very abusive language and it can be very triggering for them. We want to keep this a safe , respectful space for everyone so please do your best to abide by our guideline.
Thanks!
Kizzie
#49
Advocacy / Info about Intervention/Prevention of Relational Abuse/Neglect
April 04, 2023, 03:55:53 PM
Now that CPTSD has finally become an official diagnosis in one of two major diagnostic manuals, the WHO ICD-11 (despite the fact that many clinicians accepted it as credible), articles about prevention are beginning to pop up. As that happens they will be added here as this is an crucial piece to efforts to deal with the overall problem of Complex Trauma.
The articles and books listed below are just a sampling of the info available about accountability and/or reparation for relational abuse/neglect. They are meant to give members a sense of the issues involved, the work being done at various levels and some of the successes and failures.
I like this one because it discusses how imperative it is to reduce the shame and humiliation surrounding Complex Trauma in many sectors by promoting dignity. However, it also suggests that it takes too much time and $$ to work on treating Complex Trauma and that does a whole load of people a huge disservice. It's like saying it's too late for us and that I cannot abide. If we let this attitude stand (and it's out there - it's one reason insurers throw CBT at us, limited sessions = reduced cost but it doesn't do nearly enough), we will never get the relational treatment we need and deserve. So I am totally down with reducing shame and promoting dignity but not just in terms of primary prevention, it needs to be at all stages from prevention to treatment.
Reducing Shame, Promoting Dignity: A Model for the Primary Prevention of Complex Post-Traumatic Stress Disorder by Michael Salter and Heather Hall (2020) - https://sci-hub.se/10.1177/1524838020979667.
The articles and books listed below are just a sampling of the info available about accountability and/or reparation for relational abuse/neglect. They are meant to give members a sense of the issues involved, the work being done at various levels and some of the successes and failures.
*********************************************************************************
I like this one because it discusses how imperative it is to reduce the shame and humiliation surrounding Complex Trauma in many sectors by promoting dignity. However, it also suggests that it takes too much time and $$ to work on treating Complex Trauma and that does a whole load of people a huge disservice. It's like saying it's too late for us and that I cannot abide. If we let this attitude stand (and it's out there - it's one reason insurers throw CBT at us, limited sessions = reduced cost but it doesn't do nearly enough), we will never get the relational treatment we need and deserve. So I am totally down with reducing shame and promoting dignity but not just in terms of primary prevention, it needs to be at all stages from prevention to treatment.
Reducing Shame, Promoting Dignity: A Model for the Primary Prevention of Complex Post-Traumatic Stress Disorder by Michael Salter and Heather Hall (2020) - https://sci-hub.se/10.1177/1524838020979667.
#50
Announcements / New Blog Article by Narckiddo
April 04, 2023, 02:29:48 PM
Please see the article here - https://www.outofthestorm.website/guest-bloggers/2023/4/3/mens-sana-in-corpore-sano-meaning-a-healthy-mind-in-a-healthy-body-by-narckiddo-oots-member-3-april-2023. Thank you Narckiddo for writing this. 
Note that you need to scroll down past the index to see the article.
Note that you need to scroll down past the index to see the article.
#51
Religious/Cult Abuse / MOVED: Information about Religious/Cult Abuse
March 21, 2023, 04:30:28 PM #52
Questions/Suggestions/Comments / Zoom Trial Group?
March 17, 2023, 03:39:15 PM
I am in two groups at the moment, one F2F and the other in person. Now these are both therapy groups run by professionals so it's not the same as meeting in a group of just survivors but I see some promise despite or maybe because of my experience in these.
I never wanted to be in a group except like OOTS where it was completely anonymous and you could login whenever and read and post. And don't get me wrong I still see such value in this style of support group, but as I move along in recovery I found myself wanting a bit more personal connection although I am a wee bit nervous about this understandably as groups have not gone well for me because of my lack of trust and fear of getting hurt/rejected.
However, the two groups I'm in have been surprisingly comfortable and I don't think it's because they are facilitated by therapists so much as it just feels so good to be with others who are like me, who know what I'm talking about, who want the same thing as me (connection, support, warmth). I usually feel like an outsider in groups and I don't feel that way in either one. It makes a difference being with peers.
Anyhow, I have been considering trying out a Zoom group here, one in which no-one is "in charge" but more of a collective in which members decide what they'd like to talk about from week to week. I have an app I used with another group (work related) I belonged to in which members were in different time zones and it helps to pinpoint a time to meet that works for the majority of members (if there are some members who are interested).
Would that be of interest to anyone here? If so, please post here or PM me. I am thinking of a group of 5 or 6 so it's manageable and then go from there.
I never wanted to be in a group except like OOTS where it was completely anonymous and you could login whenever and read and post. And don't get me wrong I still see such value in this style of support group, but as I move along in recovery I found myself wanting a bit more personal connection although I am a wee bit nervous about this understandably as groups have not gone well for me because of my lack of trust and fear of getting hurt/rejected.
However, the two groups I'm in have been surprisingly comfortable and I don't think it's because they are facilitated by therapists so much as it just feels so good to be with others who are like me, who know what I'm talking about, who want the same thing as me (connection, support, warmth). I usually feel like an outsider in groups and I don't feel that way in either one. It makes a difference being with peers.
Anyhow, I have been considering trying out a Zoom group here, one in which no-one is "in charge" but more of a collective in which members decide what they'd like to talk about from week to week. I have an app I used with another group (work related) I belonged to in which members were in different time zones and it helps to pinpoint a time to meet that works for the majority of members (if there are some members who are interested).
Would that be of interest to anyone here? If so, please post here or PM me. I am thinking of a group of 5 or 6 so it's manageable and then go from there.
#54
Emotional Abuse / Info About Emotional Abuse incl Narcissistic Abuse & Coercive Control
March 15, 2023, 04:49:33 PM
This section includes various types of emotional abuse including narcissistic abuse, coercive control and bullying. It's an important section because it can sometimes be difficult for survivors and others including the courts and even professionals in the mental health field to grasp what is emotional abuse and how it can be so damaging and lead to the development of Complex PTSD when it is ongoing. As such, I've included info about each here and the thread is yours to share about your experience of emotional abuse, and ask questions you may have.
Emotional Abuse in General
Hyland, P., Karatzias, T., Shevlin, M., McElroy, E., Ben-Ezra, M., Cloitre, M., & Brewin, C. R. (2021). Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM–5 . Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 133–141. https://doi.org/10.1037/tra0000908
The newly released 11th version of the International Classification of Diseases (ICD-11: World Health Organization, 2018) provides clinicians with guidance, rather than a formal definition, for what constitutes a traumatic event. In this study, we show that psychologically threatening events such as emotional abuse, neglect, bullying, and stalking that would not normally be considered traumatic were uniquely associated with meeting the diagnostic requirements for PTSD and Complex PTSD.
Mouradian, V. E. (2000). Abuse in intimate relationships: Defining the multiple dimensions and terms. Wellesley, MA: National Violence Against Women Prevention Research Center.
Psychological/emotional abuse has been variously characterized as "the use of verbal and nonverbal acts which symbolically hurt the other or the use of threats to hurt the other" (Straus, 1979, p. 77); "behaviors that can be used to terrorize the victim. . .that do not involve the use of physical force" (Shepard & Campbell, 1992, p. 291); the "direct infliction of mental harm" and "threats or limits to the victim's well-being" (Gondolf, 1987), and ". . . an ongoing process in which one individual systematically diminishes and destroys the inner self of another. The essential ideas, feelings, perceptions, and personality characteristics of the victim are constantly belittled." (Loring, 1994, p. 1). Psychological/ emotional abuse is considered an important form of abuse because many women report that it is as harmful or worse than physical abuse they suffer and because of its role in setting up and maintaining the overall abusive dynamic of the relationship.
Coercive Control
The term "coercive control" is relatively new but such am important shift in our justice/police understanding of more nuanced forms of relational trauma and emotional abuse. This is a huge step forward in identifying abusers and holding them accountable. Coercive control is a form of emotional abuse that seeks to take away a person's freedom and to strip away their sense of self. The person employing this type of emotional abuse creates a world in which the person experiencing coercive control is constantly monitored and criticized; their every move is checked against an unpredictable, ever-changing, unknowable rule book.
The following types of behaviour are common examples of coercive control:
• Isolating the individual from their friends or family
• Depriving of them of their basic needs
• Monitoring a person via online communication tools or using spyware
• Controlling how much money they have and how they spend it
• Monitoring their everyday activities and movements
• Repeatedly putting them down, humiliating them, calling them names, or telling them that they are worthless
• Threatening to harm or kill them or their children or their pets
• Threatening to publish information about them or to report them to the police or the authorities
• Damaging their property or household goods
• Forcing them to take part in criminal activity or child abuse
This above list is not exhaustive. Physical violence may be used alongside these other tactics of isolation, mind-games and the micro-regulation of everyday life or it may never be present other than as a threat or perceived.
Narcissistic Abuse
Journal Articles
Howard, V. (2022). (Gas)lighting Their Way to Coercion and Violation in Narcissistic Abuse. Journal of Autoethnography, 3 (1): 84–102. https://doi.org/10.1525/joae.2022.3.1.84
Narcissistic abuse is a hidden form of abuse and remains under-recognized in society and within the helping professions, partly due to victim difficulties in articulating the manipulative behaviors they have experienced.... gaslighting behavior, pathological dishonesty, and intimate abuse.
Levin, L. (2021). Understanding narcissistic abuse. Mental Health Matters 8(3).
The one theme underlying all the different nuances of any narcissist beyond being selfish, is that they're inherently focused purely on themselves at the expense of others. They have the sole-focus of meeting their own needs with little to no regard for the feelings and needs of others. Additionally, they lack any sort of real emotional connection to others and feel little to no remorse or guilt for the pain they inflict on others. This means that in relationships with others, they follow very specific patterns of relatively predictable and systematic abuse.
Emotional Abuse in General
Hyland, P., Karatzias, T., Shevlin, M., McElroy, E., Ben-Ezra, M., Cloitre, M., & Brewin, C. R. (2021). Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM–5 . Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 133–141. https://doi.org/10.1037/tra0000908
The newly released 11th version of the International Classification of Diseases (ICD-11: World Health Organization, 2018) provides clinicians with guidance, rather than a formal definition, for what constitutes a traumatic event. In this study, we show that psychologically threatening events such as emotional abuse, neglect, bullying, and stalking that would not normally be considered traumatic were uniquely associated with meeting the diagnostic requirements for PTSD and Complex PTSD.
Mouradian, V. E. (2000). Abuse in intimate relationships: Defining the multiple dimensions and terms. Wellesley, MA: National Violence Against Women Prevention Research Center.
Psychological/emotional abuse has been variously characterized as "the use of verbal and nonverbal acts which symbolically hurt the other or the use of threats to hurt the other" (Straus, 1979, p. 77); "behaviors that can be used to terrorize the victim. . .that do not involve the use of physical force" (Shepard & Campbell, 1992, p. 291); the "direct infliction of mental harm" and "threats or limits to the victim's well-being" (Gondolf, 1987), and ". . . an ongoing process in which one individual systematically diminishes and destroys the inner self of another. The essential ideas, feelings, perceptions, and personality characteristics of the victim are constantly belittled." (Loring, 1994, p. 1). Psychological/ emotional abuse is considered an important form of abuse because many women report that it is as harmful or worse than physical abuse they suffer and because of its role in setting up and maintaining the overall abusive dynamic of the relationship.
Coercive Control
The term "coercive control" is relatively new but such am important shift in our justice/police understanding of more nuanced forms of relational trauma and emotional abuse. This is a huge step forward in identifying abusers and holding them accountable. Coercive control is a form of emotional abuse that seeks to take away a person's freedom and to strip away their sense of self. The person employing this type of emotional abuse creates a world in which the person experiencing coercive control is constantly monitored and criticized; their every move is checked against an unpredictable, ever-changing, unknowable rule book.
The following types of behaviour are common examples of coercive control:
• Isolating the individual from their friends or family
• Depriving of them of their basic needs
• Monitoring a person via online communication tools or using spyware
• Controlling how much money they have and how they spend it
• Monitoring their everyday activities and movements
• Repeatedly putting them down, humiliating them, calling them names, or telling them that they are worthless
• Threatening to harm or kill them or their children or their pets
• Threatening to publish information about them or to report them to the police or the authorities
• Damaging their property or household goods
• Forcing them to take part in criminal activity or child abuse
This above list is not exhaustive. Physical violence may be used alongside these other tactics of isolation, mind-games and the micro-regulation of everyday life or it may never be present other than as a threat or perceived.
- Coercive Control UK
- So What Exactly is Coercive Control? by Laura Richards
- Coercive Control, Office for the Prevention of Domestic Violence, New York State, USA
- Coercive Control Checklist: 14 Signs Your Partner is Trying to Control You, by Rhalou Allerhand
Narcissistic Abuse
Journal Articles
Howard, V. (2022). (Gas)lighting Their Way to Coercion and Violation in Narcissistic Abuse. Journal of Autoethnography, 3 (1): 84–102. https://doi.org/10.1525/joae.2022.3.1.84
Narcissistic abuse is a hidden form of abuse and remains under-recognized in society and within the helping professions, partly due to victim difficulties in articulating the manipulative behaviors they have experienced.... gaslighting behavior, pathological dishonesty, and intimate abuse.
Levin, L. (2021). Understanding narcissistic abuse. Mental Health Matters 8(3).
The one theme underlying all the different nuances of any narcissist beyond being selfish, is that they're inherently focused purely on themselves at the expense of others. They have the sole-focus of meeting their own needs with little to no regard for the feelings and needs of others. Additionally, they lack any sort of real emotional connection to others and feel little to no remorse or guilt for the pain they inflict on others. This means that in relationships with others, they follow very specific patterns of relatively predictable and systematic abuse.
#55
About Complex PTSD / Information about Trauma, Child Abuse and Neglect
March 12, 2023, 02:31:50 PM
Cutland, M. (2012). Child abuse and its legislation: the global picture. Archives of Disease in Childhood, 97(
, 679–684. doi:10.1136/archdischild-2012-301648
The author reviews the global pandemic of violence against children and provides an overview of the legislation that has evolved over the last century in response to it.
Grant S., & Lappin, J. (2017). Childhood trauma: Psychiatry's greatest public health challenge? The Lancet, 2(7). https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30104-4/fulltext
Childhood injury and abuse are major and potentially modifiable contributors to the global burden of disease. Recent evidence underlines their effect beyond specific post-traumatic syndromes. Childhood trauma disrupts crucial physiological, psychological, and social developmental processes. It increases the risk of the full range of mental disorders, from personality, mood, and substance use disorders to psychosis. It should be seen as a major challenge requiring not only a systematic public health framework, but also a wider societal response to the prevalence and sequelae of childhood trauma. The questions now must be how best to respond to the central role of trauma in mental illness by developing effective approaches to reduce exposure, to reduce negative outcomes in the young people exposed, and to ensure effective detection and treatment for the millions of people affected.
The Wisdom of Trauma - https://m.imdb.com/title/tt13863968/plotsummary/?ref_=tt_ov_pl
One in five Americans are diagnosed with mental illness in any given year. Suicide is the second most common cause of death in the US for youth aged 15-24. It kills over 800,000 people a year globally and 48,300 in the USA. Drug overdose kills 81,000 in the USA annually. The autoimmunity epidemic affects 24 million people in the USA. What is going on? The interconnected epidemics of anxiety, chronic illness and substance abuse are, according to Dr Gabor Maté, normal. But not in the way you might think.
In The Wisdom of Trauma, we travel alongside physician, bestselling author and Order of Canada recipient Dr. Gabor Maté to explore why Western society is facing such epidemics. This is a journey with a man who has dedicated his life to understanding the connection between illness, addiction, trauma and society. Trauma is the invisible force that shapes our lives. It shapes the way we live, the way we love and the way we make sense of the world. It is the root of our deepest wounds. Dr. Maté gives us a new vision: a trauma-informed society in which parents, teachers, physicians, policy-makers and legal personnel are not concerned with fixing behaviors, making diagnoses, suppressing symptoms and judging, but seek instead to understand the sources from which troubling behaviors and diseases spring in the wounded human soul. He points us to the path of individual and collective healing.
"Trauma is not what happens to you. Trauma is what happens inside you, as a result of what happens to you."
Dr. Gabor Maté
, 679–684. doi:10.1136/archdischild-2012-301648 The author reviews the global pandemic of violence against children and provides an overview of the legislation that has evolved over the last century in response to it.
Grant S., & Lappin, J. (2017). Childhood trauma: Psychiatry's greatest public health challenge? The Lancet, 2(7). https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30104-4/fulltext
Childhood injury and abuse are major and potentially modifiable contributors to the global burden of disease. Recent evidence underlines their effect beyond specific post-traumatic syndromes. Childhood trauma disrupts crucial physiological, psychological, and social developmental processes. It increases the risk of the full range of mental disorders, from personality, mood, and substance use disorders to psychosis. It should be seen as a major challenge requiring not only a systematic public health framework, but also a wider societal response to the prevalence and sequelae of childhood trauma. The questions now must be how best to respond to the central role of trauma in mental illness by developing effective approaches to reduce exposure, to reduce negative outcomes in the young people exposed, and to ensure effective detection and treatment for the millions of people affected.
The Wisdom of Trauma - https://m.imdb.com/title/tt13863968/plotsummary/?ref_=tt_ov_pl
One in five Americans are diagnosed with mental illness in any given year. Suicide is the second most common cause of death in the US for youth aged 15-24. It kills over 800,000 people a year globally and 48,300 in the USA. Drug overdose kills 81,000 in the USA annually. The autoimmunity epidemic affects 24 million people in the USA. What is going on? The interconnected epidemics of anxiety, chronic illness and substance abuse are, according to Dr Gabor Maté, normal. But not in the way you might think.
In The Wisdom of Trauma, we travel alongside physician, bestselling author and Order of Canada recipient Dr. Gabor Maté to explore why Western society is facing such epidemics. This is a journey with a man who has dedicated his life to understanding the connection between illness, addiction, trauma and society. Trauma is the invisible force that shapes our lives. It shapes the way we live, the way we love and the way we make sense of the world. It is the root of our deepest wounds. Dr. Maté gives us a new vision: a trauma-informed society in which parents, teachers, physicians, policy-makers and legal personnel are not concerned with fixing behaviors, making diagnoses, suppressing symptoms and judging, but seek instead to understand the sources from which troubling behaviors and diseases spring in the wounded human soul. He points us to the path of individual and collective healing.
"Trauma is not what happens to you. Trauma is what happens inside you, as a result of what happens to you."
Dr. Gabor Maté
#56
Advocacy / Treatment of Seniors in Care with CPTSD/CRTR
March 11, 2023, 04:42:51 PM
IT'S NEVER TOO LATE: TREATING SENIORS IN CARE WITH A HISTORY OF COMPLEX TRAUMA
By Kizzie, March 10, 2023
I am a senior survivor of relational or interpersonal trauma and recently spent two months in hospital and an inpatient treatment program for what was diagnosed as anxiety and depression. During my treatment none of the professionals evaluating/treating me (including three psychiatrists), ever brought up the topic of past trauma. I brought it up with them, but it did not seem to resonate that my childhood abuse still impacted me greatly as a senior; that it is an important factor with respect to my current health, well-being, and treatment. One reason for this is likely due to the lack of trauma training many mental health clinicians (and medical professionals) receive according to Kumar et al (2022). In their study "68% of participants reported feeling inadequately trained to assess trauma and 75% felt inadequately trained to treat trauma."
It was with great interest, therefore, that I read Monica Cations' (2023) article "Growing Old with Trauma: Elder Care Through a Trauma-Informed Lens" in the International Society for Traumatic Stress Studies newsletter Stress Points in which she discusses the importance of providing trauma informed care (TIC) to seniors in care. Finally, here was research about people my age with a history of complex trauma in hospitals and care homes and their unique needs.
I went on to read an earlier article by Cations and her colleagues (2021) in which they write, "To our knowledge, this is the first research study aiming to examine the impact of TIC in geriatric inpatient care settings." I was surprised by this because there is a proliferation of data about childhood abuse/neglect which clearly demonstrates both mental and physical health effects of trauma that commonly extend to late in life (Afifi et al., 2016; Buhrmann & Fuller-Thomson, 2022; Cation, 2023; Dye, 2018; Felitti et al, 1998; Pfluger et al).
I personally can attest that trauma does not simply fade or go away with time and does indeed follow one over the course of one's lifespan if not recognized and treated effectively. I am not alone in this. I run a web site and forum (Out of the Storm) which I started with 3 members in 2014 and now has almost 11,000 survivors registered from 68 countries. Many are seniors who like me did not realize they suffer from Complex PTSD until later in life and have not received the treatment they need. Unfortunately, the lack of trained professionals, accessible care (cost-wise or geographic), and misdiagnoses are common complaints by these members.
It was in 2014 that I read about Complex PTSD and realized that my mental health issues went beyond chronic depression and anxiety, and that I had been underdiagnosed and undertreated for decades. As Brand (2016) suggests, it essential for those proving care to recognize the lasting impact of Complex Trauma and provide effective treatment:
....it is critical that clinicians are trained in the assessment and treatment of trauma-related reactions, and in particular, dissociative reactions. If dissociation and DD are not recognized, many of these patients will not be referred to psychotherapy, and even if they are referred, they are unlikely to optimally respond to treatment until the role of trauma in creating and maintaining their distress is addressed.
At least part of the lack of recognition/treatment of trauma in seniors may be because Complex PTSD was not recognized as an official diagnosis by the World Health Organization until 2018 and many, perhaps most, went untreated or were misdiagnosed and treated for other mental health issues such as dementia, borderline personality disorder, and/or anxiety and depression (Bailey & Brown, 2020; Powell, 2019). It is only recently that Complex PTSD has become more widely known allowing survivors to finally put a name to what has been plaguing them and to seek professional help and support from one another. Powell (2019) describes finally receiving a diagnosis of Complex PTSD from her new therapist after years of looking for answers: "She took her time getting to know me for weeks before she suggested any diagnosis, and when she finally did, it was complex PTSD. As she explained what it is to me, I sobbed. Finally, someone understood me and, even more, I finally understood myself."
According to Cations (2023), TIC is not about treatment of trauma, but providing an environment that is as safe and non-triggering as possible. I was fortunate that although the inpatient program I spent time in did not provide actual trauma treatment, they were all about TIC and this allowed me and my fellow patients to feel safe and valued. We all had relationships with the staff that were very caring and supportive and that in and of itself was healing to a degree. The atmosphere in the program I attended was much like de la Perrelle et al (2022) describe in their study:
Staff behaviours demonstrated respect, fostered trust, and anticipated needs without unnecessarily imposing care. Staff consistently offered choices, used residents' names, sought permission before providing care, and offered reassurance. Staff reported high morale with a commitment to delivering high quality care, and feedback to management. Effective communication promoted information sharing and trust among staff.
I am left to wonder, however, just how much more recovery and healing would have taken place if the focus of treatment were on trauma with the same TIC approach were in place. Most of the psychoeducation groups in the program were about positive skills/resiliency building (assertiveness, Cognitive Behavioural Therapy, and relationship building), all good but tough trauma related topics (hypervigilance, dissociation and avoidance, low self-esteem, abandonment and rejection, isolation and relationship/ intimacy difficulties) were not addressed. According to the Jewish Centre on Aging and Trauma (n.d.), even seniors who have experienced past Complex Trauma and are coping well may become increasingly distressed as aging brings about unsettling events.
Traumatic stress symptoms can persist and re-emerge in older adulthood as this is a phase of social, financial, and physical change. These changes can trigger a traumatic stress response even for those who had previously been coping well. As trauma survivors age, their trauma symptoms can resurface and evolve as a result of major life changes such as retirement, emergence of health problems, loss of independence, loss of loved ones.
I learned from several of my fellow patients that they had been in the program previously and wondered if the reason was the treatment provided only dealt with part of the problem. I personally felt lost and anxious after being released from the program as I went from a lovely, safe bubble of care to struggling with my trauma symptoms on my own again.
In that many (most?) patients in the program I attended had experienced Complex Trauma in childhood/youth, it seems a natural evolution of TIC to include the identification and treatment of trauma. This might initially drive the cost of the program up because professionals with more extensive trauma training would be required (i.e., psychologists versus occupational therapists), and treatment would take longer, but in the long run would likely cost less because the same survivors would not return to the program a second or even third time (which was the case).
As a senior of 66 years, I would welcome trauma focused in-patient treatment. Given I may (hopefully) live another 15 to 20 years I would like to do so with a greater degree of healing, peace and yes fun in my later years. Dealing with Complex Trauma symptoms is not only emotionally exhausting, but physically detrimental as so many data have demonstrated, beginning with the Kaiser Permanent Adverse Childhood Events (ACEs) study in the 1990s (Felitti et al, 1998). This well-known study demonstrated "a strong dose response relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults".
TIC if done properly in hospital and care settings is important in that it provides safety, a sense of being valued and having a say in one's care. Beyond care however, is trauma focused treatment which can help decrease symptoms associated with past abuse/neglect and let seniors live out their remaining years in less distress. It is never too late to do so.
References
Afifi, O. et al. (2016). Child abuse and physical health in adulthood. Statistics Canada Health reports, 27(3), pp. 10-18. https://www150.statcan.gc.ca/n1/pub/82-003-x/2016003/article/14339-eng.pdf
Bailey, T.D., Brown, L.S. (2020). Complex trauma: Missed and misdiagnosis in forensic evaluations. Psychological Injuries and Law 13, 109–123. https://doi.org/10.1007/s12207-020-09383-w
Brand, B. L. (2016). The necessity of clinical training in trauma and dissociation. Journal of Anxiety and Depression, 5(4). https://doi.org/10.4172/2167-1044.1000251.
Buhrmann, A. & Fuller-Thomson, E. (2022). Poorer physical and mental health among older adults decades after experiencing childhood physical abuse, Aging and Health Research, 2(3), https://doi.org/10.1016/j.ahr.2022.100088
Cations, M. (2023). Growing old with trauma: Elder care through a trauma-informed lens, Stress Points, 37(1). International Society for Traumatic Stress Studies.
Cations, M., Laver, K., Couzner, L., Flatman, S., Bierer, P., Ames, C., Huo, Y., & Whitehead, C. (2021). Trauma-informed care in geriatric inpatient units to improve staff skills and reduce patient distress: a co-designed study protocol. BMC Geriatrics, 21(1), 492. https://doi.org/10.1186/s12877-021-02441-1
de la Perrelle, L., Klinge, N., Windsor, T. D., Low, L. F., Laver, K., & Cations, M. (2022). Characterizing trauma-informed aged care: An appreciative inquiry approach. International Journal of Geriatric Psychiatry. https://doi.org/10.1002/gps.5802
Dye, H. (2018) The impact and long-term effects of childhood trauma. Journal of Human Behavior in the Social Environment, 28(3), 381-392, https://doi.org/10.1080/10911359.2018.1435328
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext
Jewish Center on Aging and Trauma (n.d.). Aging and trauma. https://cdn.fedweb.org/fed-42/2/AgingAndTrauma_FactSheet_CenterOnAgingAndTrauma_2fdbr.pdf
Kumar, S. A., Brand, B. L., & Courtois, C. A. (2022). The need for trauma training: Clinicians' reactions to training on complex trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 14, 1387–1394. https://doi.org/10.1037/tra0000515
Pfluger, V., Rohner, S.L., Eising, C.M. et al. (2022). Associations between complex trauma exposure in childhood/adolescence and psychopathology in older age: The role of stress coping and coping self-perception. Journal of Child & Adolescent Trauma 15, 539–551. https://doi.org/10.1007/s40653-021-00419-0
Powell, T. (2019). Complex PTSD and misdiagnosis: It happens more than you know. Healthy Place. https://www.healthyplace.com/blogs/traumaptsdblog/2019/5/complex-ptsd-and-misdiagnosis-it-happens-more-than-you-know
By Kizzie, March 10, 2023
I am a senior survivor of relational or interpersonal trauma and recently spent two months in hospital and an inpatient treatment program for what was diagnosed as anxiety and depression. During my treatment none of the professionals evaluating/treating me (including three psychiatrists), ever brought up the topic of past trauma. I brought it up with them, but it did not seem to resonate that my childhood abuse still impacted me greatly as a senior; that it is an important factor with respect to my current health, well-being, and treatment. One reason for this is likely due to the lack of trauma training many mental health clinicians (and medical professionals) receive according to Kumar et al (2022). In their study "68% of participants reported feeling inadequately trained to assess trauma and 75% felt inadequately trained to treat trauma."
It was with great interest, therefore, that I read Monica Cations' (2023) article "Growing Old with Trauma: Elder Care Through a Trauma-Informed Lens" in the International Society for Traumatic Stress Studies newsletter Stress Points in which she discusses the importance of providing trauma informed care (TIC) to seniors in care. Finally, here was research about people my age with a history of complex trauma in hospitals and care homes and their unique needs.
I went on to read an earlier article by Cations and her colleagues (2021) in which they write, "To our knowledge, this is the first research study aiming to examine the impact of TIC in geriatric inpatient care settings." I was surprised by this because there is a proliferation of data about childhood abuse/neglect which clearly demonstrates both mental and physical health effects of trauma that commonly extend to late in life (Afifi et al., 2016; Buhrmann & Fuller-Thomson, 2022; Cation, 2023; Dye, 2018; Felitti et al, 1998; Pfluger et al).
I personally can attest that trauma does not simply fade or go away with time and does indeed follow one over the course of one's lifespan if not recognized and treated effectively. I am not alone in this. I run a web site and forum (Out of the Storm) which I started with 3 members in 2014 and now has almost 11,000 survivors registered from 68 countries. Many are seniors who like me did not realize they suffer from Complex PTSD until later in life and have not received the treatment they need. Unfortunately, the lack of trained professionals, accessible care (cost-wise or geographic), and misdiagnoses are common complaints by these members.
It was in 2014 that I read about Complex PTSD and realized that my mental health issues went beyond chronic depression and anxiety, and that I had been underdiagnosed and undertreated for decades. As Brand (2016) suggests, it essential for those proving care to recognize the lasting impact of Complex Trauma and provide effective treatment:
....it is critical that clinicians are trained in the assessment and treatment of trauma-related reactions, and in particular, dissociative reactions. If dissociation and DD are not recognized, many of these patients will not be referred to psychotherapy, and even if they are referred, they are unlikely to optimally respond to treatment until the role of trauma in creating and maintaining their distress is addressed.
At least part of the lack of recognition/treatment of trauma in seniors may be because Complex PTSD was not recognized as an official diagnosis by the World Health Organization until 2018 and many, perhaps most, went untreated or were misdiagnosed and treated for other mental health issues such as dementia, borderline personality disorder, and/or anxiety and depression (Bailey & Brown, 2020; Powell, 2019). It is only recently that Complex PTSD has become more widely known allowing survivors to finally put a name to what has been plaguing them and to seek professional help and support from one another. Powell (2019) describes finally receiving a diagnosis of Complex PTSD from her new therapist after years of looking for answers: "She took her time getting to know me for weeks before she suggested any diagnosis, and when she finally did, it was complex PTSD. As she explained what it is to me, I sobbed. Finally, someone understood me and, even more, I finally understood myself."
According to Cations (2023), TIC is not about treatment of trauma, but providing an environment that is as safe and non-triggering as possible. I was fortunate that although the inpatient program I spent time in did not provide actual trauma treatment, they were all about TIC and this allowed me and my fellow patients to feel safe and valued. We all had relationships with the staff that were very caring and supportive and that in and of itself was healing to a degree. The atmosphere in the program I attended was much like de la Perrelle et al (2022) describe in their study:
Staff behaviours demonstrated respect, fostered trust, and anticipated needs without unnecessarily imposing care. Staff consistently offered choices, used residents' names, sought permission before providing care, and offered reassurance. Staff reported high morale with a commitment to delivering high quality care, and feedback to management. Effective communication promoted information sharing and trust among staff.
I am left to wonder, however, just how much more recovery and healing would have taken place if the focus of treatment were on trauma with the same TIC approach were in place. Most of the psychoeducation groups in the program were about positive skills/resiliency building (assertiveness, Cognitive Behavioural Therapy, and relationship building), all good but tough trauma related topics (hypervigilance, dissociation and avoidance, low self-esteem, abandonment and rejection, isolation and relationship/ intimacy difficulties) were not addressed. According to the Jewish Centre on Aging and Trauma (n.d.), even seniors who have experienced past Complex Trauma and are coping well may become increasingly distressed as aging brings about unsettling events.
Traumatic stress symptoms can persist and re-emerge in older adulthood as this is a phase of social, financial, and physical change. These changes can trigger a traumatic stress response even for those who had previously been coping well. As trauma survivors age, their trauma symptoms can resurface and evolve as a result of major life changes such as retirement, emergence of health problems, loss of independence, loss of loved ones.
I learned from several of my fellow patients that they had been in the program previously and wondered if the reason was the treatment provided only dealt with part of the problem. I personally felt lost and anxious after being released from the program as I went from a lovely, safe bubble of care to struggling with my trauma symptoms on my own again.
In that many (most?) patients in the program I attended had experienced Complex Trauma in childhood/youth, it seems a natural evolution of TIC to include the identification and treatment of trauma. This might initially drive the cost of the program up because professionals with more extensive trauma training would be required (i.e., psychologists versus occupational therapists), and treatment would take longer, but in the long run would likely cost less because the same survivors would not return to the program a second or even third time (which was the case).
As a senior of 66 years, I would welcome trauma focused in-patient treatment. Given I may (hopefully) live another 15 to 20 years I would like to do so with a greater degree of healing, peace and yes fun in my later years. Dealing with Complex Trauma symptoms is not only emotionally exhausting, but physically detrimental as so many data have demonstrated, beginning with the Kaiser Permanent Adverse Childhood Events (ACEs) study in the 1990s (Felitti et al, 1998). This well-known study demonstrated "a strong dose response relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults".
TIC if done properly in hospital and care settings is important in that it provides safety, a sense of being valued and having a say in one's care. Beyond care however, is trauma focused treatment which can help decrease symptoms associated with past abuse/neglect and let seniors live out their remaining years in less distress. It is never too late to do so.
References
Afifi, O. et al. (2016). Child abuse and physical health in adulthood. Statistics Canada Health reports, 27(3), pp. 10-18. https://www150.statcan.gc.ca/n1/pub/82-003-x/2016003/article/14339-eng.pdf
Bailey, T.D., Brown, L.S. (2020). Complex trauma: Missed and misdiagnosis in forensic evaluations. Psychological Injuries and Law 13, 109–123. https://doi.org/10.1007/s12207-020-09383-w
Brand, B. L. (2016). The necessity of clinical training in trauma and dissociation. Journal of Anxiety and Depression, 5(4). https://doi.org/10.4172/2167-1044.1000251.
Buhrmann, A. & Fuller-Thomson, E. (2022). Poorer physical and mental health among older adults decades after experiencing childhood physical abuse, Aging and Health Research, 2(3), https://doi.org/10.1016/j.ahr.2022.100088
Cations, M. (2023). Growing old with trauma: Elder care through a trauma-informed lens, Stress Points, 37(1). International Society for Traumatic Stress Studies.
Cations, M., Laver, K., Couzner, L., Flatman, S., Bierer, P., Ames, C., Huo, Y., & Whitehead, C. (2021). Trauma-informed care in geriatric inpatient units to improve staff skills and reduce patient distress: a co-designed study protocol. BMC Geriatrics, 21(1), 492. https://doi.org/10.1186/s12877-021-02441-1
de la Perrelle, L., Klinge, N., Windsor, T. D., Low, L. F., Laver, K., & Cations, M. (2022). Characterizing trauma-informed aged care: An appreciative inquiry approach. International Journal of Geriatric Psychiatry. https://doi.org/10.1002/gps.5802
Dye, H. (2018) The impact and long-term effects of childhood trauma. Journal of Human Behavior in the Social Environment, 28(3), 381-392, https://doi.org/10.1080/10911359.2018.1435328
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext
Jewish Center on Aging and Trauma (n.d.). Aging and trauma. https://cdn.fedweb.org/fed-42/2/AgingAndTrauma_FactSheet_CenterOnAgingAndTrauma_2fdbr.pdf
Kumar, S. A., Brand, B. L., & Courtois, C. A. (2022). The need for trauma training: Clinicians' reactions to training on complex trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 14, 1387–1394. https://doi.org/10.1037/tra0000515
Pfluger, V., Rohner, S.L., Eising, C.M. et al. (2022). Associations between complex trauma exposure in childhood/adolescence and psychopathology in older age: The role of stress coping and coping self-perception. Journal of Child & Adolescent Trauma 15, 539–551. https://doi.org/10.1007/s40653-021-00419-0
Powell, T. (2019). Complex PTSD and misdiagnosis: It happens more than you know. Healthy Place. https://www.healthyplace.com/blogs/traumaptsdblog/2019/5/complex-ptsd-and-misdiagnosis-it-happens-more-than-you-know
#57
Advocacy / CPTSD/CRTR as a Normal Response to Trauma
March 11, 2023, 04:37:37 PM
The effects of trauma are indeed just that—effects of an event [or events]—and as such are causally related to the trauma and not to the harmed individual. .... when psychology and mental health professionals draw that causal path incorrectly, when the field fails to place the dysfunction solidly on the shoulders of individual and societal wrongdoing, survivors of trauma .... end up shouldering the burden. This, in essence, is pathologizing—the assumption that because individuals exhibit certain sets of symptoms, they are themselves disordered. From Rosenthal et al, (2016). Deconstructing disorder: An ordered reaction to a disordered environment. Journal of Trauma & Dissociation 17(2).
As this article points out, we are not disordered; rather, we sustained lasting psychological and physical injuries due to the abuse/neglect of others. These symptoms we develop are normal responses to an abnormal situation; that is, the ongoing abuse/neglect we were subjected to. These responses allowed most, but not all, of us to survive. It is important to our mental health and to how we are treated by professionals, government, the public and family that we accept this perspective rather than accept blame for our symptoms.
As this article points out, we are not disordered; rather, we sustained lasting psychological and physical injuries due to the abuse/neglect of others. These symptoms we develop are normal responses to an abnormal situation; that is, the ongoing abuse/neglect we were subjected to. These responses allowed most, but not all, of us to survive. It is important to our mental health and to how we are treated by professionals, government, the public and family that we accept this perspective rather than accept blame for our symptoms.
#58
Announcements / New Personal Story - Narckiddo
March 10, 2023, 05:04:21 PM
Thanks to Narckiddo for kindly adding her personal story here - https://www.outofthestorm.website/narckiddos-story. I think it does a really good job of articulating what it's like to live with a parent who has NPD and the crazy making emotional abuse that brings.
#59
Announcements / New Blog Article
March 10, 2023, 03:16:22 PM
I wrote an article about my experience and thoughts re in-patient treatment of seniors with Complex PTSD - https://www.outofthestorm.website/guest-bloggers/2023/3/9/its-never-too-late-treating-seniors-in-care-with-a-history-of-complex-trauma-1. Note: You have to scroll down past the index.
#60
General Discussion / Child Abuse Across the Globe
March 01, 2023, 07:29:29 PM
I came across this study today which confirms what we all know as survivors - child abuse is basically a pandemic around the world.
Stoltenborgh, M., Bakermans-Kranenburg, M., Lenneke R. A., & van IJzendoorn, M. (2014). The Prevalence of Child Maltreatment across the Globe: Review of a Series of Meta-Analyses. Child Abuse Review, 24(1). doi/10.1002/car.2353
Abstract: In this review, we combine and compare the results of a series of meta-analyses on the prevalence of child sexual, physical and emotional abuse and physical and emotional neglect, including 244 publications and 551 prevalence rates for the various types of maltreatment. Child maltreatment research seems to be dominated by research on sexual abuse, studies in developed parts of the world and research using self-report measures. The overall estimated prevalence rates for self-report studies (mainly assessing maltreatment ever during childhood) were 127/1000 for sexual abuse (76/1000 among boys and 180/1000 among girls), 226/1000 for physical abuse, 363/1000 for emotional abuse, 163/1000 for physical neglect and 184/1000 for emotional neglect. The overall estimated prevalence rates for studies using informants (mainly assessing the 1-year prevalence of maltreatment) were four per 1000 for sexual abuse and three per 1000, respectively, for physical abuse and emotional abuse. We conclude that child maltreatment is a widespread, global phenomenon affecting the lives of millions of children all over the world, which is in sharp contrast with the United Nation's Convention on the Rights of the Child.
FYI - The United Nations Convention on the Rights of the Child ( UNCRC ) is an international human rights treaty that grants all children and young people (aged 17 and under) a comprehensive set of rights. Children's rights include: the right to health, education, family life, play and recreation, an adequate standard of living and to be protected from abuse and harm.
Stoltenborgh, M., Bakermans-Kranenburg, M., Lenneke R. A., & van IJzendoorn, M. (2014). The Prevalence of Child Maltreatment across the Globe: Review of a Series of Meta-Analyses. Child Abuse Review, 24(1). doi/10.1002/car.2353
Abstract: In this review, we combine and compare the results of a series of meta-analyses on the prevalence of child sexual, physical and emotional abuse and physical and emotional neglect, including 244 publications and 551 prevalence rates for the various types of maltreatment. Child maltreatment research seems to be dominated by research on sexual abuse, studies in developed parts of the world and research using self-report measures. The overall estimated prevalence rates for self-report studies (mainly assessing maltreatment ever during childhood) were 127/1000 for sexual abuse (76/1000 among boys and 180/1000 among girls), 226/1000 for physical abuse, 363/1000 for emotional abuse, 163/1000 for physical neglect and 184/1000 for emotional neglect. The overall estimated prevalence rates for studies using informants (mainly assessing the 1-year prevalence of maltreatment) were four per 1000 for sexual abuse and three per 1000, respectively, for physical abuse and emotional abuse. We conclude that child maltreatment is a widespread, global phenomenon affecting the lives of millions of children all over the world, which is in sharp contrast with the United Nation's Convention on the Rights of the Child.
FYI - The United Nations Convention on the Rights of the Child ( UNCRC ) is an international human rights treaty that grants all children and young people (aged 17 and under) a comprehensive set of rights. Children's rights include: the right to health, education, family life, play and recreation, an adequate standard of living and to be protected from abuse and harm.