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Loving Your Body

“All the problems survivors experience with their bodies—splitting, numbing, addictions, and self-mutilations, to name a few—began as attempts to survive. You cut off from your body for good reasons, but now you need to heal that separation. You need to move from estrangement from your body to integration, to move from self-hate and rejection of your body to self-love and acceptance.”

~ The Courage to Heal by Ellen Bass & Laura Davis

We have the right to walk down the street without being met with glares, stares, verbal harassment or physical assault.:

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‘Inside Out’ Movie ~ MUST WATCH!

The movie ‘Inside Out’ illustrates important issues regarding the relationship between childhood memories and programming, and ongoing mental health and wellbeing.

This movie will help you understand where chronic depression stems from (basically your dominant childhood emotion)..

It had me in tears and caught me off guard but not in a bad way, in an enlightened way.

A must watch ..

SG xInside Out (2015) Poster

Inside Out focuses on an 11-year-old girl named Riley.

Well, more specifically, it focuses on the little voices inside of Riley’s head. Those voices are her emotions — Joy, Sadness, Fear, Anger, and Disgust.

Like many kids, Riley’s dominant emotion is Joy.

She’s generally happy and, when she’s not, everything inside of her works to restore equilibrium and get back to that happy place.

When Riley’s family moves from Minnesota to San Francisco, her world is turned upside down and everything that makes her, well, her (her “Personality Islands” — being a goofball, being honest, loving hockey, caring about her friends and family) is challenged.

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The Number One Cause Of Depression — Everywhere

Mood disorders are among the most common mental health problems experienced by children and adolescents. They include all types of depression as well as Bipolar Disorders (formerly called Manic-Depression) and are sometimes referred to as “affective disorders.” Children with mood disorders often are either depressed, manic (unrealistically “up” or hyper), or alternating between the two.

According to a group of researchers from around the world (including those from London and various regions in Spain), people who have suffered from abuse during their childhood are more likely to be diagnosed with clinical depression — and even more so if they are genetically predisposed to the condition.

Over a three-year period, scientists analyzed patients from 41 different health clinics in seven Spanish provinces who ranged in age from 18 to 75. And here’s what they discovered through genetic testing: The participants who were shown to have limited gene function implied in both BDNF (brain-derived neurotrophic factor, a protein-coding gene) and serotonin transmission were extra-sensitive to the damaging effects of child abuse — whether the abuse was psychological, physical or sexual. In other words, this particular lack of gene activity mixed with an abusive history can result in an increased risk for suffering from depression.

Blanca Gutiérrez, a professor in the psychiatry department at the University of Granada and the lead coordinator of this study, says that these findings — which were recently published in the Journal of Psychiatry and Neuroscience — are significant in terms of treatment.

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Hey Beautiful, You Deserve Love

Self-compassion, self-love, self-acceptance

The majority of people who read my blog have been wounded in some form or another (neglect, trauma, sexual, emotional/ psychological or physical abuse). All abuse is equal and damaging no matter what its form.

Often the trauma or abuse originated in early childhood (even if you can’t remember any serious abuse from your immediate family  – remember you can’t consciously remember what happened to you or who hurt you when you were very little) … and often very traumatic events are stored differently (very deeply) as a survival mechanism.

I found out at 45 that there were huge secrets in my family. I got regressed after years of chronic ill health and depression and finally answers came up that made sense.

I had always wondered why I was ‘different’.. why I suffered from childhood depression, why I was a little ‘space cadet’ (dissociative) and why I was so creative and intuitive (hyervigilant) and not particularly logical. Life had been extremely hard.

Early childhood abuse sets us up… it sets us up for more abuse throughout our lives. It sets us up for choosing unhealthy partners and friends and it is the major cause of mental illness. It’s also causes unhealthy coping mechanisms and addictions.

Today I have a message for those of you healing from abuse, trauma, neglect and the extreme stress and mental illness associated..

Be kind to yourself, because you are amazing

Be gentle on yourself where others haven’t been – because you are an exquisite soul

Accept yourself.. whether you are creative, shy, anxious, lonely….  a cutter, an overeater, an alcoholic, an anorexic…

Acknowledge your pain and emotions. It is not a sign of strength to repress your feelings.

Love yourself first, every inch of you because you deserve love (your own first) and love that doesn’t hurt.

 Remember you have been through enough stress and pain in your life, don’t add to it – No more unloving thoughts directed at yourself.

Accept this present moment – you are doing the best you can healing in a process that takes time, baby steps and courage. You deserve kudos and respect – your own first.

Don’t push yourself, rest if you need to, cry if you need to, create an environment that works for you, write your heart out if you need to, soothe your soul if you need to..

Just remember the exquisite soul you are and treat yourself accordingly.

Just. Pure. Lovely.

SG x

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Dissociative Disorders

 Dissociative Disorders: (A Medical Perspective)

As society has become increasingly aware of the prevalence of child abuse, trauma or neglect and its serious consequences, there has been an explosion of information on posttraumatic and dissociative disorders resulting from abuse or trauma in childhood. Since most clinicians learned little about childhood trauma and its aftereffects in their training, many are struggling to build their knowledge base and clinical skills to effectively treat survivors and their families.

Understanding dissociation and its relationship to trauma is basic to understanding the posttraumatic and dissociative disorders. Dissociation is the disconnection from full awareness of self, time, and/or external circumstances. It is a complex neuropsychological process. Dissociation exists along a continuum from normal everyday experiences to disorders that interfere with everyday functioning. Common examples of normal dissociation are highway hypnosis (a trance-like feeling that develops as the miles go by), “getting lost” in a book or a movie so that one loses a sense of passing time and surroundings, and daydreaming.

Researchers and clinicians believe that dissociation is a common, naturally occurring defense against childhood trauma. Children tend to dissociate more readily than adults. Faced with overwhelming abuse, it is not surprising that children would psychologically flee (dissociate) from full awareness of their experience. Dissociation may become a defensive pattern that persists into adulthood and can result in a full-fledged dissociative disorder.

The essential feature of dissociative disorders is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness. If the disturbance occurs primarily in memory, Dissociative Amnesia or Fugue (APA, 1994) results; important personal events cannot be recalled. Dissociative Amnesia with acute loss of memory may result from wartime trauma, a severe accident, or rape. Dissociative Fugue is indicated by not only loss of memory, but also travel to a new location and the assumption of a new identity. Posttraumatic Stress Disorder (PTSD), although not officially a dissociative disorder (it is classified as an anxiety disorder), can be thought of as part of the dissociative spectrum. In PTSD, recall/re-experiencing of the trauma (flashbacks) alternates with numbing (detachment or dissociation), and avoidance. Atypical dissociative disorders are classified as Dissociative Disorders Not Otherwise Specified (DDNOS). If the disturbance occurs primarily in identity with parts of the self assuming separate identities, the resulting disorder is Dissociative Identity Disorder (DID), formerly called Multiple Personality Disorder.

The Dissociative Spectrum

The dissociative spectrum (Braun, 1988) extends from normal dissociation to poly-fragmented DID. All of the disorders are trauma-based, and symptoms result from the habitual dissociation of traumatic memories. For example, a rape victim with Dissociative Amnesia may have no conscious memory of the attack, yet experience depression, numbness, and distress resulting from environmental stimuli such as colors, odors, sounds, and images that recall the traumatic experience. The dissociated memory is alive and active–not forgotten, merely submerged (Tasman & Goldfinger, 1991). Major studies have confirmed the traumatic origin of DID (Putnam, 1989, and Ross, 1989), which arises before the age of 12 (and often before age 5) as a result of severe physical, sexual, and/or emotional abuse. Poly-fragmented DID (involving over 100 personality states) may be the result of sadistic abuse by multiple perpetrators over an extended period of time.

Although DID is a common disorder (perhaps as common as one in 100) (Ross, 1989), the combination of PTSD-DDNOS is the most frequent diagnosis in survivors of childhood abuse. These survivors experience the flashbacks and intrusion of trauma memories, sometimes not until years after the childhood abuse, with dissociative experiences of distancing, “trancing out”, feeling unreal, the ability to ignore pain, and feeling as if they were looking at the world through a fog.

The symptom profile of adults who were abuse as children includes posttraumatic and dissociative disorders combined with depression, anxiety syndromes, and addictions. These symptoms include (1) recurrent depression; (2) anxiety, panic, and phobias; (3) anger and rage; (4) low self-esteem, and feeling damaged and/or worthless; (5) shame; (6) somatic pain syndromes (7) self-destructive thoughts and/or behavior; (8) substance abuse; (9) eating disorders: bulimia, anorexia, and compulsive overeating; (10) relationship and intimacy difficulties; (11) sexual dysfunction, including addictions and avoidance; (12) time loss, memory gaps, and a sense of unreality; (13) flashbacks, intrusive thoughts and images of trauma; (14) hypervigilance; (15) sleep disturbances: nightmares, insomnia, and sleepwalking; and (16) alternative states of consciousness or personalities.

Diagnosis

The diagnosis of dissociative disorders starts with an awareness of the prevalence of childhood abuse and its relation to these clinical disorders with their complex symptomatology. A clinical interview, whether the client is male or female, should always include questions about significant childhood and adult trauma. The interview should include questions related to the above list of symptoms with a particular focus on dissociative experiences. Pertinent questions include those related to blackouts/time loss, disremembered behaviors, fugues, unexplained possessions, inexplicable changes in relationships, fluctuations in skills and knowledge, fragmentary recall of life history, spontaneous trances, enthrallment, spontaneous age regression, out-of-body experiences, and awareness of other parts of self (Loewenstein, 1991).

Structured diagnostic interviews such as the Dissociative Experiences Scale (DES) (Putnam, 1989), the Dissociative Disorders Interview Schedule (DDIS) (Ross, 1989), and the Structured Clinical Interview for Dissociative Disorders (SCID-D) (Steinberg, 1990) are now available for the assessment of dissociative disorders. This can result in more rapid and appropriate help for survivors. Dissociative disorders can also be diagnosed by the Diagnostic Drawing Series (DDS) (Mills & Cohen, 1993).

The diagnostic criteria for the diagnosis of DID are (1) the existence within the person of two or more distinct personalities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self, (2) at least two of these personality states recurrently take full control of the person’s behavior, (3) the inability to recall important personal information that is to extensive to be explained by ordinary forgetfulness, and (4) the disturbance is not due to the direct physiological effects of a substance (blackouts due to alcohol intoxication) or a general medical condition (APA, 1994). The clinician must, therefore, “meet” and observe the “switch process” between at least two personalities. The dissociative personality system usually includes a number of personality states (alter personalities) of varying ages (many are child alters) and of both sexes.

In the past, individuals with dissociative disorders were often in the mental health system for years before receiving an accurate diagnosis and appropriate treatment. As clinicians become more skilled in the identification and treatment dissociative disorders, there should no longer be such delay.

Treatment

The heart of the treatment of dissociative disorders is long-term psychodynamic/cognitive psychotherapy facilitated by hypnotherapy. It is not uncommon for survivors to need three to five years of intensive therapy work. Setting the frame for the trauma work is the most important part of therapy. One cannot do trauma work without some destabilization, so the therapy starts with assessment and stabilization before any abreactive work (revisiting the trauma).

A careful assessment should cover the basic issues of history (what happened to you?), sense of self (how do you think/feel about yourself?), symptoms (e.g., depression, anxiety, hypervigilance, rage, flashbacks, intrusive memories, inner voices, amnesias, numbing, nightmares, recurrent dreams), safety (of self, to and from others), relationship difficulties, substance abuse, eating disorders, family history (family of origin and current), social support system, and medical status.

After gathering important information, the therapist and client should jointly develop a plan for stabilization (Turkus, 1991). Treatment modalities should be carefully considered. These include individual psychotherapy, group therapy, expressive therapies (art, poetry, movement, psychodrama, music), family therapy (current family), psychoeducation, and pharmacotherapy. Hospital treatment may be necessary in some cases for a comprehensive assessment and stabilization. The Empowerment Model (Turkus, Cohen, & Courtois, 1991) for the treatment of survivors of childhood abuse–which can be adapted to outpatient treatment–uses ego-enhancing, progressive treatment to encourage the highest level of function (“how to keep your life together while doing the work”). The use of sequenced treatment using the above modalities for safe expression and processing of painful material within the structure of a therapeutic community of connectedness with healthy boundaries is particularly effective. Group experiences are critical to all survivors if they are to overcome the secrecy, shame, and isolation of survivorship.

Stabilization may include contracts to ensure physical and emotional safety and discussion before any disclosure or confrontation related to the abuse, and to prevent any precipitous stop in therapy. Physician consultants should be selected for medical needs or psychopharmacologic treatment. Antidepressant and antianxiety medications can be helpful adjunctive treatment for survivors, but they should be viewed as adjunctive to the psychotherapy, not as an alternative to it.

Developing a cognitive framework is also an essential part of stabilization. This involves sorting out how an abused child thinks and feels, undoing damaging self-concepts, and learning about what is “normal”. Stabilization is a time to learn how to ask for help and build support networks. The stabilization stage may take a year or longer–as much time as is necessary for the patient to move safely into the next phase of treatment.

If the dissociative disorder is DID, stabilization involves the survivor’s acceptance of the diagnosis and commitment to treatment. Diagnosis is in itself a crisis, and much work must be done to reframe DID as a creative survival tool (which it is) rather than a disease or stigma. The treatment frame for DID includes developing acceptance and respect for each alter as a part of the internal system. Each alter must be treated equally, whether it presents as a delightful child or an angry persecutor. Mapping of the dissociative personality system is the next step, followed by the work of internal dialogue and cooperation between alters. This is the critical stage in DID therapy, one that must be in place before trauma work begins. Communication and cooperation among the alters facilitates the gathering of ego strength that stabilizes the internal system, hence the whole person.

Revisiting and reworking the trauma is the next stage. This may involve abreactions, which can release pain and allow dissociated trauma back into the normal memory track. An abreaction might be described as the vivid re-experiencing of a traumatic event accompanied by the release of related emotion and the recovery of repressed or dissociated aspects of that event (Steele & Colrain, 1990). The retrieval of traumatic memories should be staged with planned abreactions. Hypnosis, when facilitated by a trained professional, is extremely useful in abreactive work to safely contain the abreaction and release the painful emotions more quickly. Some survivors may only be able to do abreactive work on an inpatient basis in a safe and supportive environment. In any setting, the work must be paced and contained to prevent retraumatization and to give the client a feeling of mastery. This means that the speed of the work must be carefully monitored, and the release painful material must be thoughtfully managed and controlled, so as not to be overwhelming. An abreaction of a person diagnosed with DID may involve a number of different alters, who must all participate in the work. The reworking of the trauma involves sharing the abuse story, undoing unnecessary shame and guilt, doing some anger work, and grieving. Grief work pertains to both the abuse and abandonment and the damage to one’s life. Throughout this mid-level work, there is integration of memories and, in DID, alternate personalities; the substitution of adult methods of coping for dissociation; and the learning of new life skills.

This leads into the final phase of the therapy work. There is continued processing of traumatic memories and cognitive distortions, and further letting go of shame. At the end of the grieving process, creative energy is released. The survivor can reclaim self-worth and personal power and rebuild life after so much focus on healing. There are often important life choices to be made about vocation and relationships at this time, as well as solidifying gains from treatment.

This is challenging and satisfying work for both survivors and therapists. The journey is painful, but the rewards are great. Successfully working through the healing journey can significantly impact a survivor’s life and philosophy. Coming through this intense, self-reflective process might lead one to discover a desire to contribute to society in a variety of vital ways.

by Joan A. Turkus, M.D.