What is Complex PTSD?

Although complex post traumatic stress syndrome (C-PTSD) is not yet formally recognized as a diagnostic designation, a case is being made in the psychiatric community for the recognition of this disorder as distinct from the currently defined form of PTSD. PTSD, as it is currently defined and diagnosed in Mansfield and elsewhere, is a result of exposure to acute trauma. It often occurs in individuals who have either witnessed or experienced tragedies, such as combat, a violent death, assault, or a natural disaster. C-PTSD is distinct from PTSD in that complex PTSD results from repeated trauma. It often develops as a result of prolonged sexual, physical, verbal, or emotional abuse. It can also occur in people who have survived a long-term hostage situation.

Causes of Complex PTSD

Whereas traditional PTSD is associated with acute psychological trauma, complex PTSD results from prolonged and systematic trauma exposure. Complex PTSD is often associated with relational abuse, such as spousal or child abuse. One of the distinguishing characteristics of C-PTSD, as opposed to “simple” PTSD, is the presence of disorders and problems with interpersonal attachment. Attachment in individuals who suffer from complex PTSD tends to take a pervasive insecure or disorganized form.

Diagnostic Criteria for Complex PTSD

The Centre for Addiction and Mental Health (CAMH) has put forth a potential set of diagnostic guidelines for complex PTSD:

I.                    Alteration in Regulation of Affect and Impulses

a.       Affect regulation

b.      Modulation of anger

c.       Self-destructive behavior

d.      Suicidal preoccupation

e.      Difficulty modulating sexual involvement

f.        Excessive risk-taking

II.                  Alterations in Attention or Consciousness

a.       Amnesia

b.      Transient dissociative episodes and depersonalization

III.                Alterations in Self-Perception

a.       Ineffectiveness

b.      Permanent damage

c.       Guilt and responsibility

d.      Shame

e.      Nobody can understand

f.        Minimizing

IV.                Alterations in Relationships with Others

a.       Inability to trust

b.      Revictimization

c.       Victimizing others

V.                  Somatization

a.       Problems with the digestive system

b.      Chronic pain

c.       Cardiopulmonary symptoms

d.      Conversion symptoms

e.      Sexual symptoms

VI.                Alterations in Systems of Meaning

a.       Despair or hopelessness

b.      Loss of previously sustaining beliefs

Many researchers advocate differences in diagnostic criteria for children versus adults. In this conceptualization of complex PTSD, the disorder is further divided into an adult symptom cluster and a childhood symptoms cluster.

A child and adolescent symptom cluster for complex PTSD would encompass the following domains:

·         Attachment

·         Biology

·         Affect or emotional dysregulation

·         Dissociation

·         Behavioral control

·         Cognition

·         Self-concept

An adult symptom cluster for complex PTSD symptoms would include:

·         Difficulty regulating emotions

·         Variations in consciousness, including psychogenic amnesia, dissociation, or intrusive flashbacks of traumatic episodes

·         Changes in self-perception, often involving a chronic sense of helplessness, along with irrational self-blame and feelings of shame and guilt

·         Varying changes in perception of the person perpetrating the abuse; this may involve attributing too much power to that person, being preoccupied with revenge, or even idealizing that person

·         Alterations in relationships with others; this may take the form of isolation and withdrawal, inability to trust, or reliance on the idea of a “rescuer”

·         Loss of faith or overwhelming sense of despair

Treating Complex PTSD

As with diagnostic criteria for complex PTSD, researchers advocate differences in treatment approaches in children versus in adults, in order to account for differences between childhood and adult reactions to and results of trauma. Some of the principles and guidelines that have been proposed for treating complex PTSD in children include:

·         Identifying and assessing current threats to the child’s safety and well-being

·         Relational and strength based diagnosis and treatment

·         Treatment aimed toward enhancing the child’s self-regulatory abilities to improve their coping abilities

·          Determine when and how it is appropriate to fully address traumatic memories

·         Preventing and managing psychosocial crises and ongoing relational issues

In adults, complex PTSD researchers have proposed six core components for treatment:

·         Safety

·         Self-regulation

·         Self-reflective information processing

·         Integration of traumatic experiences

·         Relational engagement

·         Positive affect engagement

5 Health Risks of Chronic Stress

Many, if not most, people in Mansfield struggle with stress on a daily basis. Whether it’s a deadline at work, a car breaking down, bills, or relationship problems, the number of factors that cause stress in modern life are too numerous to list or count. A 2012 study by the American Psychological Association (APA) reported that 20%, or one fifth, of Americans self-rated their day-to-day stress levels as an 8, 9, or 10 on a scale of 1-10. Some researchers go so far as to classify stress as a nationwide public health epidemic.

What is stress? Stress is an organism’s reaction to environmental conditions or stimuli that the body interprets as dangerous or threatening. The human body responds to such “stressors” by engaging the sympathetic nervous system in what is sometimes called a “fight-or-flight response.” The stress response is mediated in the brain; mostly in the midbrain areas associated with emotion. Stressors are associated with the release of certain hormones. One of the best-known of these is a hormone called cortisol, a glucocorticoid steroid. Stress is a natural reaction that evolved in order to prepare us for threats to our health and safety. Nowadays, this reaction is triggered by work, relationships, and other more modern concerns.

If you’re like most people in Mansfield, you experience some level of stress on a fairly regular basis. Maybe you deal with a lot of stress. Maybe it’s rare that you don’t feel stressed out. You’re probably well aware that being stressed out is highly unpleasant and psychologically damaging, but you may not be aware of the many physical health risks associated with stress.

Health Risk #1: Stress makes you more likely to get sick.

The steroid hormone cortisol is released as part of the body’s “stress response”. The main function of cortisol is to redistribute energy, in the form of the sugar glucose, to parts of the body where it is needed in order to fight or flee from a threat. Cortisol also inhibits the immune system by inhibiting the proliferation of T-cells, a type of white blood cell instrumental in fighting off disease. The effects of cortisol on the immune system mean that chronic stress makes you more likely to come down with something. It is also part of why shingles most often occurs as a result of stress.

Health Risk #2: Stress Increases Your Risk of Developing Anxiety or Depression

People who have depression or anxiety in Mansfield tend to produce less serotonin and more cortisol in their brains. Elevated cortisol levels from chronic stress can also impede the synthesis of serotonin, due to its effects on tryptophan, a precursor molecule for serotonin. People who are chronically stressed are more likely to develop a mental health issue, such as depression or anxiety.

Health Risk #3: Stress Increases Your Risk of Heart Disease

In excess, such as when it is secreted in a stress response, cortisol raises blood pressure, meaning chronic stress in Mansfield is a risk factor for hypertension. Over time, stress increases a person’s susceptibility to cardiovascular problems.

Health Risk #4: Stress Impairs Your Memory

Chronic stress has a detrimental effect on your ability to learn and remember information. This is even truer for individuals who have, or are at greater risk for, mild cognitive impairment. In senior citizens, cortisol associated with chronic stress is associated with the development of dementia.

Health Risk #5: Stress Makes You More Likely to Gain Weight

Excess cortisol due to chronic stress may make people more likely to gain weight. One reason for this is that stressed people are more likely to overeat for a number of reasons. Being stressed makes it harder to stick to disciplined eating habits, as well as causing people to be more likely to indulge in “comfort food” that may temporarily alleviate the stress. Not only is this associated with weight gain, but cortisol is also associated with weight gain specifically in the abdominal area. Excess abdominal fat is known to be more of a health risk than fat stored in other areas of the body.

CHRONIC STRESS MANAGEMENT IN BOSTON

Treating Obsessive Compulsive Disorder in Children

Treating Obsessive Compulsive Disorder in Children with Family-Based Exposure Therapy 

Obsessive-Compulsive Disorder is a relatively common anxiety disorder. OCD is characterized primarily by intrusive thoughts (“obsessions”) that cause significant and overwhelming anxiety, which often causes the person to engage in certain repetitious behaviors (“compulsions”) to try to temporarily relieve that anxiety. Although obsessive-compulsive disorder in Mansfield and the Boston area is more commonly diagnosed in adolescents and adults, this condition can also occur in children. OCD in children is arguably more difficult to deal with than obsessive-compulsive disorder in adults, and children often do not respond as well to psychiatric medications. However, a recent study has found compelling evidence that one form of behavioral therapy, called “Family-Based Exposure Therapy”, may be a particularly effective approach to pediatric obsessive compulsive disorder treatment. 

How is Obsessive Compulsive Disorder Diagnosed in Mansfield? 

Obsessive-Compulsive Disorder in Mansfield is diagnosed, usually by a psychologist or psychiatrist, based on an accepted set of diagnostic criteria. The ICD-10 lists the following criteria for a diagnosis of obsessive-compulsive disorder:

A. Obsessions and Compulsions.

·         OBSESSIONS are defined as:
 1.) Recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, are intrusive or inappropriate, and cause marked anxiety or distress.
2.) The obsessions are not exaggerated real-life worries
3.) The person attempts to ignore or suppress the obsessive thoughts, or to neutralize them with a different thought or action.
 4.) The person recognizes that obsessional thoughts arise within their own mind, rather than delusionally believing they have been “inserted” by an outside party

·         COMPULSIONS are defined as:
 1.) Repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession, often according to rules that must be rigidly adhered to
2.) These behaviors or mental acts are aimed at preventing or reducing distress preventing a dreaded turn of events, BUT these behaviors are excessive or irrational and not connected to the thoughts and anxieties in a realistic way.

B. The person has recognized that the obsessions and compulsions are not reasonable or rational. (This does NOT apply to children.)

C. The obsessions and compulsions are distressing, time-consuming, and interfere with a person’s normal activities.

D. The obsessions and compulsions are not restricted to another comorbid disorder (such as generalized anxiety or major depression).

               

To diagnose a child in Mansfield with obsessive compulsive disorder, a psychiatrist or psychologist must rule out other possible diagnoses, including autism-spectrum disorders, attention deficit disorders, and other anxiety disorders. 

Family-Based Exposure Therapy: A Promising New OCD Treatment for Pediatric Patients 

Obsessive-compulsive disorder in children can be difficult to approach and treat. In Mansfield adults, SSRI medications are sometimes incorporated into treatment for obsessive-compulsive disorder. Although these medications can be effective for anxiety and depression in adults, however, they are not recommended for children. A better approach for treating obsessive compulsive disorder in children is to use behavioral therapies, such as cognitive-behavioral therapy or talk therapy.

Recently, a study conducted by the Bradley Hasbro Children’s Research Center has found that a technique called “family-based exposure therapy” was an especially effective approach for treating obsessive compulsive disorder in children between the ages of 5 and 8. Although CBT therapies have been well substantiated in adults and adolescents, there had previously been little research into their efficacy for young children.

Exposure therapy is often used to treat anxiety disorders in Mansfield, including obsessive-compulsive disorder. Exposure therapy is based on behavioral principles of “respondent conditioning”, famously discovered by Pavlov. This therapy approach aims to identify the thoughts and feelings leading to the anxiety response when a “trigger” is presented, and at reducing those responses though exposure to the stimulus. The “family-based” aspect refers to keeping the child’s family informed and involved in the treatment.

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The Three Types of PTSD Symptoms

Posttraumatic Stress Disorder, better known as PTSD, is a psychiatric condition that occurs in people who have been exposed to traumatic events. People who have experienced the horrors of war and combat can develop PTSD, but it can also occur in victims of sexual assault, victims of child or domestic abuse, and other traumatic events. There are three main categories of PTSD symptoms:

·         Re-experiencing symptoms

·         Avoidance and numbing symptoms

·         Hyperarousal symptoms

To qualify for a diagnosis of PTSD, a person must experience one or more re-experiencing symptoms, at least three avoidance and numbness symptoms, and at least two hyperarousal symptoms for at least one month.

“Re-Experiencing Symptoms” in PTSD

Re-experiencing symptoms in PTSD involve reliving the traumatic event. These symptoms may include:

·         Flashbacks or extremely vivid and intrusive memories

·         Recurring distressing dreams

·         Intense negative reactions to things that remind the person of the traumatic event

These symptoms can strike seemingly without warning in response to a trigger that reminds the person of the event. The memories may be so vivid that the person feels like they are literally experiencing the event again, along with all the feelings of fear and helplessness.

Avoidance and Numbing Symptoms in PTSD

The second set of PTSD symptoms involves avoidance of things that remind the person of the traumatic experience, and emotional numbing as a reaction to overpowering fear and helplessness.

·         Avoidance of stimuli that remind the person of the trauma, including certain conversation topics or things that remind the person of the event.

·         Avoidance of behaviors, places, or people that might cause an intrusive memory of the event

·         Inability to recall major parts of the trauma

·         Loss of capacity to feel certain emotions; feeling “emotionally numb”

Hyperarousal Symptoms in PTSD

An individual with PTSD may often be in a state of hyperarousal or hypervigilance. This set of PTSD symptoms includes:

·         Difficulty sleeping

·         Angry outbursts

·         Being tense or “on-edge” much of the time

·         Easily startled

Are PTSD Symptoms Different in Children than In Adults?

In children younger than age six, there are some behavioral markers that can result from PTSD that are not found in adults. This includes some regression:

·         Bedwetting or soiling themselves, when they had been previously potty-trained

·         Forgetting how to talk, or being unable to talk

·         Acting out the traumatic event in play

·         Unusally clingy with a trusted adult

The symptoms of PTSD cause marked psychological distress and interfere significantly with the person’s quality of life. There are treatments for PTSD, including talk therapy, medications, or a combination of the two. Talk therapies can help the person identify and deal with the guilt, shame, fear, and other feelings that are a result from the traumatic event. A qualified therapist can help them face the bad memories and make sense of what happened and how they feel about it. Along with psychotherapy, medications like Zoloft or Paxil are sometimes used to treat chemical imbalances in the brain that are associated with PTSD symptoms. 

NEUROFEEDBACK FOR PTSD

NEUROFEEDBACK IN BOSTON