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

Lifestyle Tips for Dealing with Anxiety

Many people suffer from some form of anxiety disorder. Everyone feels anxiety from time to time, such as when final exams are approaching; a big job interview comes around; or when faced with financial problems. However, an anxiety disorder goes beyond normal anxiety, with feelings of worry and fear that are disproportionately overwhelming and may not even be attached to an identifiable trigger.

If you have an anxiety disorder, the best thing to do is to seek treatment. Some people are more predisposed toward anxiety than others, for reasons related to genetics and brain structure. Anxiety can be managed on a psychosocial level, with psychotherapy and cognitive-behavioral therapy; on a neurochemical level, with medications that correct chemical imbalances in the brain; and with neurofeedback therapy, which corrects underlying brainwave dysregulation associated with anxiety. A psychiatrist, counselor, or clinical psychologist can find a treatment plan that works best for you.

In the meantime, if you are dealing with anxiety on a daily basis, there are a few changes you can make to your diet and sleeping habits that may help you reduce and cope with your anxiety.

·         Eliminate foods and drinks that cause or contribute to anxiety. For many people, this means caffeine. Coffee, energy drinks, and other caffeinated beverages can cause or exacerbate anxiety due to the drug’s stimulant effects.

·         Avoid starches and sugars. When stressed out, many people reach for starchy or sugary foods as “comfort foods,” but these can actually worsen your anxiety later on by causing fluctuations in blood sugar.

·         Avoid excessive alcohol. Although some people feel a few drinks may help them unwind, others may actually feel more anxious or depressed if they become too inebriated. Alcohol also creates unpleasant hangover effects.

·         Exercise can help relieve anxiety. Exercise causes the release of mood-boosting, anxiety-reducing endorphins, an effect that persists for hours after you finish your workout. Cardiovascular exercises, such as running or cycling, are great for stress relief. You may also try yoga or tai chi, which incorporates meditation and breathing techniques that makes them highly relaxing.

·         Try deep breathing exercises. Remain mindful of your breathing, especially if you begin to feel worried or stressed. Slow, deep breathing has a direct effect on your heart rate and can reduce anxiety.

·         Avoid commitments and situations that will exacerbate your anxiety levels. You can’t always run away from what causes your anxiety, and social anxieties and phobias have to be overcome by exposure and desensitization. You may want to avoid taking on too many work tasks or interpersonal commitments if an overloaded schedule will cause your anxiety to flare up. Remember, it’s okay to say no.

·         Get enough sleep. Maintaining a regular sleep schedule can help reduce cortisol, a stress hormone. Herbal remedies or melatonin supplements can help with this, if needed.

If you have an anxiety disorder, you should seek mental health treatment to address the underlying issues that are causing your anxiety. There are several strategies that can help you deal with anxiety, and  plenty of rest and good nutrition are necessary for overall health and wellness, including mental health. 

Identifying and Treating Anxiety Disorders in Foxboro

If you’re feeling fearful in Foxboro, you may actually be suffering from an anxiety disorder. Anxiety is characterized by overwhelming feelings of extreme fearfulness and worry, beyond what would qualify as a rational response. Although a person with anxiety may recognize that their feelings don’t quite make sense, they still cannot control these emotions. 

The symptoms of anxiety include:

·         Excessive worry

·         Excessive fearfulness

·         Irritability

·         Panic attacks

·         Shaking and trembling

·         Headaches

·         Stomachaches

·         Sweating

·         Trembling

·         Accelerated heart rate

·         Difficulty concentrating

·         Impaired performance at school or work

·         Interference of anxiety with relationships

There are several anxiety disorders, including generalized anxiety disorder, social anxiety disorder, phobic disorder, and panic disorder.

Medications for Anxiety

Anxiety disorders are frequently treated with prescription medications, usually selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines. SSRIs are often used as a long-term anxiety treatment. These drugs can take several weeks to begin working effectively, but are often effective for reducing anxiety symptoms. Many anxiety patients have good results with SSRIs, but other people find that the side effects are highly problematic. 

Side effects of SSRIs often include: 

·         Lack of energy

·         Increased appetite

·         Weight gain

·         Impairment of sexual desire and performance

·         Stomach upset

·         Nausea

·         Headaches

·         Drowsiness or somnolence

While SSRIs are a long-term treatment modality, more immediate anxiety relief is often found in benzodiazepines like Xanax. Although Xanax can “mellow out” an anxious person, benzodiazepines are not without side effects, including:

·         Memory deficits

·         Impaired coordination

·         Lightheadedness

·         Changes in appetite

·         Fatigue

·         Drowsiness

·         Impaired concentration

·         Unsteadiness, trembling, or other problems with muscle control

·         Unusual weakness or tiredness

·         Abdominal pain

·         Blurred vision

·         Increased appetite

·         Changes in sexual desire

·         Weight gain

·         Interference with menstrual cycle

Like SSRIs, benzodiazepines treat the symptoms of anxiety by altering neurotransmitter levels, but at the cost of side effects that can sometimes be more problematic than the original anxiety was. Xanax and other benzodiazepines are known for their tendency to be habit-forming, which needs to be taken into consideration when these medications are prescribed. People occasionally become addicted to the pleasant emotional sensations associated with Xanax, and long-term misuse can have adverse health consequences.

Managing Anxiety with NeurofeedbackTherapy

Neurofeedback therapy is a promising alternative to drug-based therapies for anxiety disorders. In neurofeedback therapy for anxiety, EEG (electroencephalographic) neuroimaging technology is used to identify dysregulation in electrical frequencies in areas of the brain associated with mood regulation. People with anxiety disorder often emit abnormally high levels of beta brainwave frequencies, associated with concentration and mentally alert states in certain regions of the brain. Neurofeedback therapy can be used to train individuals to alter these brainwaves to more relaxed alpha and theta states, which can help reduce the symptoms of anxiety. Neurofeedback training occurs over numerous sessions by a trial-and-error learning process, but can cause lasting changes in the brain that allow its benefits to persist long after therapy is completed. Neurofeedback is a useful alternative or addition to pharmaceutical anxiety therapies, and is known for its complete lack of negative side effects. During 40 years of research on neurofeedback therapy, it has repeatedly been proven to be safe and side-effect-free. Neurofeedback participants also report undergoing therapy is a relaxing and enjoyable experience. Neurofeedback therapy is now available in Foxboro and may be a helpful addition for managing your anxiety.

Anxiety disorders are characterized by constant, overwhelming feelings of fear and worry, often to an irrational extent and without any identifiable cause. There are several types of anxiety disorders, all of which can be managed with cognitive-behavioral therapy, prescription medications, and neurofeedback therapy. Anxiety can be a debilitating condition causing significant impairment in academic and occupational performance, in the person’s overall sense of well-being, and in interpersonal relationships; however, it is treatable and many people have successfully overcome anxiety.

NEUROFEEDBACK IN FOXBORO

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

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