G3.8: Severe child trauma may lead to Dissociative Identity Disorder (DID) or PTSD.

Dissociative Identity Disorder (DID) is a mental health disorder that can result when there was severe child abuse and/or neglect. Colin A. Ross, M.D. is a specialist in the treatment of DID, see his book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality for more information. (G3.32)

The author provides an example script he developed for patients to describe what cognitive therapy is and how it might help them. The script begins with lines that suggest that our feelings are sometimes affected by what we think and that if that is true then changing how we think may be the best way to change how we feel. He describes cognitive therapy as a method for helping the patient to learn what not to do rather than focusing on teaching them what to do.(p 339, G3.32)

Incorrect beliefs can develop during childhood that may have been helpful to the child at the time but may cause problems later in life. The author discusses false assumptions commonly believed by DID patients and he describes a few cognitive therapy techniques which he found helpful for challenging the old beliefs and guiding the patients to new beliefs. Counseling strategies and false assumptions are discussed within the section titled Cognitive Restructuring Techniques. (pp 338-345, G3.32)

G3.9: Cognitive Restructuring Techniques for “false assumptions.”

The false assumptions are discussed in the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality within the section titled Cognitive Restructuring Techniques  (pp 338-345, G3.32) I found the ideas helpful and combined the false beliefs into a list, with notes summarized from my understanding of the text, words in italics are quotes from the text:

  1. “Different parts of the self are separate selves.” – Which can lead to the false belief that different parts of the self (alters) actually have different bodies and cognitive therapy may address the risk of one alter causing physical harm to the host (primary personality) by tackling the alters’ false belief that there are two or more separate bodies.
  2. “The victim is responsible for the abuse.”  This false belief may occur during developmental stages in early childhood when the child believes that what happens in the world is caused by the child’s actions. Cognitive therapy  can challenge the underlying belief that “I must be bad.”
  3. The abuse happened because I am bad.” Children can’t just leave their caregivers and the need to love and feel love is also strong so it can be a common false assumption that whatever is happening is right and the child is wrong or deserving of the mistreatment. Cognitive therapy can discuss the differences between a child’s and an adult’s responsibilities in life and whether traumatic events are something other children could cause to occur or that they deserve instead of normal love and affection.
  4. It is wrong to show anger.” Cognitive therapy can help teach what healthy anger is and how to control it. Underlying false beliefs can be challenged by asking: “Who says anger is bad? How do you know that?”
  5. The primary personality can’t handle the memories.” Cognitive therapy can help the DID patient to recognize that as an adult the primary personality is older and may have more ability to cope with painful memories. (paraphrased from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality: Cognitive Restructuring Techniques, (pp 338-345, G3.32))
  • The first and last of the assumptions listed above are more specific to DID in that amnesia is involved; the memory of the trauma is blocked from the primary personality. However a child in a trauma situation might also develop the last assumption about other people in their lives. They might feel a need to protect family or others from information that the child might fear is too disturbing in some way or had been told by someone else to keep secret.
  • Less severe cases of childhood trauma may result in the child growing up believing false assumptions similar to those listed in number 2, 3, and 4 without the child also developing amnesiac memory blocks or feeling like there are parts of the self that are separate from each other.

Dissociation can be a normal coping strategy but in DID it can become disruptive for the adult even though it may have helped the child survive traumatic events. Cognitive therapy strategies can help the patient recognize that the beliefs they had developed as a child are not necessarily true at all or they are not true now that the child is really an adult. Initial recognition of false assumptions can help change old beliefs and related behaviors quickly, but it can also take months or years repeating the new beliefs to replace the old childhood beliefs.

G3.10: Therapy for Dissociative Disorders can be Effective & Cost Effective.

Information from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality regarding the cost effectiveness of therapy for DID found it to be very cost effective and could save years of ineffective therapy. Clinicians have reported stable integration in children with DID in as few as 5 to 10 office visits. The shortest reported integration for a child patient occurred in just one session and the longest treatment reportedly took 30 sessions over five months. The point is made however, that it wouldn’t be ethical to treat a child with DID while they are still experiencing abuse because the therapy would be taking away the child’s coping strategies. (p256, G3.32)

Adults with DID have been reported to have spent as long as twenty years in ineffective therapy before the diagnosis of DID was made. Twenty years of therapy can cost $500,000. Research that examined the treatment of fifteen women found that it took an average of 8.1 years in therapy before a diagnosis of DID was even made, at an average cost of $166,786.97 each. In comparison the average length of treatment once a diagnosis of DID was given was 2.6 years. (p257, G3.32) Two to five years of therapy before reaching integration is typical for patients with DID. (p257, G3.32)

The diagnosis of DID became controversial in the past as some practitioners over diagnosed and may have led some patients to false memories during sessions. However it is a real condition that is not very common.

  • A narrative “dramatized” description of a patient with DID and her therapy is available in the book Jennifer and Her Selves. written by the patient’s psychotherapist: (G3.33)
  • A patient with the condition shared her own story and “survival tips” for others with Dissociative Identity Disorder. At the time she wrote her book the condition was still called Multiple Personality Disorder. The next section includes more of Sandra J. Hocking and Company’s story in their book, Living With Your Selves: A Survival Manual for People With Multiple Personalities, (G3.34) . Sandra wrote the book along with some of her “alters“, the other sides of her personality that were formed at different stages of her childhood or adult life.  More about her story and the difference between DID and schizophrenia will be included in the next post.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

References:

 

G3.4: Social contact would help protect against oxidative stress.

People and other species are social creatures whose survival may have been dependent on being part of a group rather than being isolated. Loneliness has been associated with increased inflammation and a reduced resistance to infection by viral diseases. Genetic changes have been found to occur in isolated individuals that lead to the increased inflammatory response in comparison to individuals who have more social support. Genes can be temporarily turned on or off depending on the environment.

Our instincts have developed to trust that being part of a group increases our chance of survival. Having a role that fulfills a valued purpose for the group is associated with an increased sense of happiness. Read more: A Better Kind of Happiness, by Will Storr, (G3.9).

Fitting into groups well can require social skills that need to be nurtured from birth. Infants learn body language at an early age by interacting with a parent who responds to the baby’s cues. If the baby smiles the mother smiles back and the baby learns to smile more readily. If the baby has a mother that doesn’t notice body language though, then the infant may stop smiling as often.

Infants and children depend on their caregivers for everything and try to please with their smiles, eye contact, or baby coos. If the infant isn’t receiving eye contact in return however they may stop trying or are scolded they may learn to look away and to avoid eye contact.

Children ideally need emotional support in order to develop trust in themselves and in others. Parents who have limited skills in understanding and accepting their own emotions may not be able to teach their children what they don’t understand themselves. Children who have some role model in their lives who understands emotional skills may cope better than children who don’t.

The topic is discussed in more detail in the book Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, by Lindsay C. Gibson, PsyD, (New Harbinger Pub., Inc., 2015, Oakland, CA) (G3.10) (This book is not a twelve step book and is not affiliated with the Adult Children of Alcoholic or Dysfunctional Parents twelve step group.) On page eight the author discusses the importance of emotional connection for humans and other mammals for responding less negatively to stress. Stephen Porges published work in 2011 suggesting that mammals evolved a way in which we can get additional soothing during fear situations when we are in touch physically or possibly even mentally – thinking about them during times of need. It involves vagus nerve pathways that can be inhibited to reduce the fight, flight, or freeze stress reaction. (G3.10)

So a sense of connection to others can help reduce the negative inflammatory effects of the stress response. Some stress can be healthy to help get us moving to meet whatever challenge has occurred. Stress may become more overwhelming however if the person is isolated or never learned social skills or developed enough trust in others to ask for help or seek out help.

Children in situations with emotionally immature caregivers may learn that people around them can’t be trusted or that trying doesn’t lead to success so why bother trying – they can learn a sense of helplessness and hopelessness and not even try to seek help because they are unfamiliar with finding strength or support from others.

In the book Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, by Lindsay C. Gibson (G3.10) four different types of emotionally immature caregivers are described and how growing up with them might affect children. Solutions are also provided in the form of techniques for how, as an adult, a person might overcome the lessons they learned as a child once they discover that emotions aren’t dangerous things to never be discussed or worse –  that one might be punished for exhibiting them.

Some emotionally immature people may feel threatened by strong emotions and may react negatively to children who are simply being children. The child in that situation learns to not trust themselves and may not learn that emotions are normal rather than upsetting or frightening.

Severe childhood trauma can lead to changes in the brain that cause ongoing symptoms of Post Traumatic Stress Disorder (PTSD). A new strategy for treating PTSD has been developed which involves electrical stimulation of the vagus nerve called Vagal Nerve Stimulation (VNS).  

The excerpt summary from the book Adult Children of Emotionally Immature Parents (G3.10) regarding the research by Stephen Porges suggests that the vagal nerve is the nerve pathway that naturally is stimulated when social contact is sought by mammals who are enduring a stressful situation. (G3.11) (G3.12)

Whether you are a parent or a teen or an adult learning more about emotional maturity and immaturity can help understand your own emotions and others. Whatever we grow up with will seem normal to us and as adults we tend to seek out similar relationships to those we were familiar with as children – but sometimes what seems normal to some people isn’t normal for everyone else and there is no need to continue living in abusive situations just because it seemed like a normal part of life as a child.

Lack of emotional skills may increase the risk of acting inappropriately when under severe stress. People need the support of people to help reduce negative effects of stress and increase a sense of connection and purpose. People need to learn emotional skills from people who have emotional skills  – or sometimes from a book, Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, by Lindsay C. Gibson: (G3.10)

  • Attachment Theory and parenting styles are discussed in section 8. Trust is learned early.

The descriptions in this section suggest the inconsistent parenting of the Disorganized style or a parent that switches between Avoidant and Anxious-Resistant styles. A more trusting  Secure style can be achieved with the help of Cognitive Therapy techniques and practice; but it is a lot of work to change core values, or more realistically – attempt to modify slightly, core values that remain from early childhood. Art Therapy or EMDR therapy can help access nonverbal feelings and events that may have occurred during the preverbal years of childhood. Dialectical Behavior Therapy can help when there are cognitive and physical issues underlying mood symptoms.

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.
  • The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)

References:

Mental health and nutrients; TEDx talk by Julia Rucklidge

A TEDx talk by Julia Rucklidge, PhD reviews the risks of long term psychiatric medications for the mental health of young people and the benefits found with supplementing with a wide variety of micronutrients.

Supplementation for a community that experienced trauma was found to reduce the frequency/severity of PTSD in the individuals of the community.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

People may need people and a sense of purpose for health and happiness

People and other species are social creatures whose survival may have been dependent on being part of a group rather than being isolated. Loneliness has been associated with increased inflammation and a reduced resistance to infection by viral diseases. Genetic changes have been found to occur in isolated individuals that lead to the increased inflammatory response in comparison to individuals who have more social support. Our instincts have developed to trust that being part of a group increases our chance of survival. Having a role that fulfills a valued purpose for the group is associated with an increased sense of happiness.

Fitting into groups well can take social skills that need to be nurtured from birth. Infants learn body language at an early age by interacting with a parent who responds to the baby’s cues. If the baby smiles the mother smiles back and the baby learns to smile more readily. If the baby has a mother that doesn’t notice body language though, then the infant may stop smiling as often. Infants and children depend on their caregivers for everything and try to please with their smiles, eye contact, or baby coos. If the infant isn’t receiving eye contact in return however they may stop trying or are scolded they may learn to look away and to avoid eye contact.

Children ideally need emotional support in order to develop trust in themselves and in others. Parents who have limited skills in understanding and accepting their own emotions may not be able to teach their children what they don’t understand themselves. Children who have some role model in their lives who understands emotional skills may cope better than children who don’t.

The topic is discussed in more detail in the book Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, by Lindsay C. Gibson, PsyD, (New Harbinger Pub., Inc., 2015, Oaklnad, CA) [1] (This book is not a twelve step book and is not affiliated with the Adult Children of Alcoholic or Dysfunctional Parents twelve step group.) An excerpt from page 108:

“Why is emotional connection so crucial?

According to neuroscientist Stephen Porges (2011), mammals have evolved a unique coping instinct in which they are calmed by proximity or engagement with others. Instead of just having the involuntary stress reactions of fight, flight, or freeze, like reptiles do, mammals can calm their heart rate and reduce the physical costs of stress by seeking reassuring contact with others of their kind. Certain vagus nerve pathways in mammals have evolved to allow stress hormones and heart rate to be reduced by confronting in such forms as physical closeness, touch, soothing sounds, and even eye contact. These calming effects conserve valuable energy and also create pleasurable social bonds that promote strong groups.

For all mammals, including humans, something magical happens when this desire to seek comfort switches on. The danger might not go away, but individuals can stay relatively calm as long as they feel tied into their herd, pack, or circle of loved ones. Most mammals have stressful lives, but thanks to their instinct for engaging with others, calming comfort and restored energy are just a friendly contact away. This gives mammals a tremendous advantage over other animals when it comes to dealing with stress in an energy-efficient way, since they don’t have to go into fight, flight, or freeze every time they sense a threat.” [1]

So a sense of connection to others can help reduce the negative inflammatory effects of the stress response. Some stress can be healthy to help get us moving to meet whatever challenge has occurred. Stress may become more overwhelming however if the person is isolated or never learned social skills or trust enough to ask for help or seek out help. Children in situations with emotionally immature caregivers may learn that people around them can’t be trusted or that trying doesn’t lead to success so why bother trying — they can learn  a sense of helplessness and hopelessness rather than finding strength from others.

The book Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, by Lindsay C. Gibson [1] describes  four different types of emotionally immature caregivers, how growing up with them might affect children and how the children might overcome the lessons they learned later in life as adults who only just discovered that emotions aren’t dangerous things to never be discussed or worse that one might be punished for exhibiting. Some emotionally immature people may feel threatened by strong emotions and may react negatively to children who are simply being children. The child in that situation learns to not trust themselves and may not learn that emotions are normal rather than upsetting or frightening.

Severe childhood trauma can lead to changes in the brain that cause ongoing symptoms of Post Traumatic Stress Disorder (PTSD). A new strategy for treating PTSD has been developed which involves electrical stimulation of the vagus nerve called Vagal nerve stimulation (VNS).  Which the excerpt from the book [1]  suggests is the nerve pathway that naturally is stimulated when social contact is sought during a stressful situation.

Stress and trauma have been too readily available lately. More police officers were shot today in the U.S. in Baton Rouge, Louisiana. Three are injured, one critically, and three officers were killed Sunday morning. The gunman was a former marine who drove there from his home in Missouri. The gunman was killed at the scene. Further information about his possible motives are not known at this time. Whether there were any accomplices is not known but it is believed he was a lone gunman and there has been no further shooting in the area.

My condolences and best wishes to the families, friends, and coworkers of the slain officers, may they rest in peace, and to the community of Baton Rouge

Emotionally immature parents may raise emotionally immature children who grow up to raise their own emotionally immature children. Help break the trauma cycle by reading the book Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, by Lindsay C. Gibson [1]. Whether you are a parent or a teen or an adult learning more about emotional maturity and immaturity can help understand your own emotions and others. Whatever we grow up with will seem normal to us and as adults we tend to seek out similar relationships to those we were familiar with as children — but sometimes what seems normal to some people isn’t normal for everyone else and there is no need to continue living in abusive situations just because it seemed like a normal part of life as a child.

Lack of emotional skills may increase the risk of acting inappropriately when under severe stress. People need the support of people to help reduce negative effects of stress and increase a sense of connection and purpose. People need to learn emotional skills from people who have emotional skills  — or sometimes from a book. [1]

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.