The emotional and psychological strain experienced by these caregivers can be overwhelming. They navigate through a labyrinth of uncertainty, dealing with the struggle of witnessing their child’s pain, managing disruptive behaviours, and coping with the impact on wider family dynamics. The persistent stress, vigilance, and feeling of helplessness can leave caregivers feeling emotionally drained, isolated, and overwhelmed with guilt.

Recognising and validating the trauma experienced by these caregivers is the first step towards providing the necessary support. By acknowledging their struggles, we can begin to develop comprehensive tools and resources specifically tailored to their needs. These might include accessible therapy options, support groups, respite care programs, and educational materials to enhance their understanding of mental illness and coping mechanisms.

Understanding Trauma

Trauma is the experience of a situation that is too overwhelming or terrifying for a person to deal with. This can range from surviving a car accident to developing a life-changing illness. An experience that is traumatic for one person may not be traumatic for another, as the way that we respond to situations and stimuli is influenced by a wide range of factors. Although trauma is most often understood as being caused by one single terrifying event, it can also be a result of long-standing, combined stress or overwhelm, such as living with an abusive parent or partner. This is often referred to as complex trauma and can be particularly difficult to address, although healing is always possible.

How to Spot PTSD

Post-traumatic stress disorder (PTSD) can significantly impact day-to-day life with a range of disruptive and unpleasant symptoms. These symptoms often develop during the first month after a traumatic event, yet in some cases, it can take months or even years. 

PTSD symptoms can vary widely between people, but generally fall into the categories; re-experiencing, avoidance and emotional numbing and hypoarousal.

Re-experiencing

The most typical symptom of PTSD is re-experiencing, which is when a person vividly relives the traumatic event in the form of:

• Flashbacks
• Nightmares
• Repetitive and distressing images or sensations
• Physical sensations, such as pain, sweating, feeling sick or trembling

Avoidance and Emotional Numbing

Many people with PTSD attempt to avoid things that may remind them of the traumatic experience.

Avoidance behaviours, often include staying away from people and places that trigger traumatic memories, as well as refraining from discussing their experiences. Many resorts to suppressing traumatic memories by immersing themselves in work or hobbies as distractions. Some cope by attempting to numb their emotions entirely, which can result in isolation, withdrawal, and a loss of interest in previously enjoyed activities.

Hyperarousal (Feeling “on edge”)

Hyperarousal is a common state experienced by individuals with PTSD, characterised by heightened anxiety and difficulty in achieving a state of relaxation. They remain consistently vigilant of potential threats and are easily startled by their surroundings.

Hyperarousal often leads to:

• Irritability
• Angry outbursts
• Sleeping problems (insomnia)
• Difficulty concentrating

Vicarious Trauma

 Vicarious trauma can include feelings of emotional exhaustion, intrusive thoughts, heightened anxiety, difficulty sleeping, and a shift in worldview. It is important for individuals experiencing vicarious trauma to seek support, self-care, and professional help to address and manage its effects.

Secondary Trauma

Secondary trauma, sometimes referred to as compassion fatigue or empathetic strain, is similar to vicarious trauma but is specifically associated with people who are directly involved in supporting or caring for trauma survivors. This means that caregivers of children with mental health issues, particularly PTSD, are at risk of secondary trauma.

Secondary trauma occurs when exposure to other people’s psychological struggles leads to the development of symptoms similar to post-traumatic stress disorder (PTSD). These symptoms can include intrusive thoughts, nightmares, emotional numbing, avoidance behaviours, anxiety, and a decreased ability to cope with stress.

How to Heal Amid Ongoing Stress

Caregivers can take several steps to heal from secondary trauma and promote well-being while still maintaining their role and supporting loved ones. 

• Seeking support from dedicated support groups, counseling services, or online communities provides validation and empathy. 
• Educating oneself about a young person’s mental illness can alleviate anxiety and uncertainty. 
• Prioritising self-care through hobbies, exercise, and setting boundaries is essential for physical, emotional, and mental well-being. 
• Establishing a support network of trusted individuals who offer emotional support and assistance is crucial. 
• Setting realistic expectations for oneself and the child, celebrating small victories, and practising self-compassion are important. 
• Managing stress through relaxation techniques, physical activity, counselling, or therapy can help to prevent burnout. 
• Taking regular breaks and arranging respite care allows caregivers to recharge. 
• Maintaining personal interests and nurturing individuality outside of the parenting role counterbalances caregiving stress and promote a sense of personal development and care.

Caring for a child with a mental illness can be confusing, overwhelming, and exhausting, but you don’t need to o it alone. Know that your experiences and struggles are valid and that making mistakes is normal.

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It is far more common for individuals who have experienced the physical side effects of trauma to struggle with medical trauma. They are, therefore, likely to feel triggered by environments that appear overtly clinical 1.

What Is Medical Trauma?

As a child, it can be difficult to understand the invasive procedures, unfamiliar spaces and strange sensations that come with professional healthcare. Medical trauma can result from uncomfortable treatment experiences or anxiety-inducing experiences in a medical setting.

Unlike adults, children and adolescents are less able to understand the necessity for certain treatments. Furthermore, children can sometimes feel a lack of autonomy and power. Not only is this cause for great distress, but it can also have a lasting impact on how they view the safety of their body 2.

Caregivers

Caregivers, who bear the weight of their child’s physical and mental health struggles, can find that this significantly affects their well-being. As a result, they may also develop an aversion to medical settings due to the stress and anxiety they trigger 3. Children and adolescents are highly perceptive and can sense this apprehension, exacerbating their existing worries.

It is therefore imperative that caregivers have trust in the support services being provided to their children. Otherwise, they will give off unconscious signs that this environment is not to be trusted. By working closely with caregivers and parents, it is possible to promote safe and nurturing environments that reduce the impact of medical trauma.

Effects

The specific impacts of medical trauma are unique for each child. However, certain variables are likely to influence the nature of medical trauma:

Age – Infants may experience medical trauma through separation from their caregiver. Meanwhile, toddlers may lose autonomy in dressing, feeding and caring for themselves; this can greatly impact confidence. For preschoolers with more developed brains, their imagination can lead to traumatising interpretations of medical events 4.

Caregiver Response – As discussed, a caregiver’s reaction can hugely impact a child’s distress levels. This is not to place blame on parents or caregivers; having a child with mental or physical challenges is highly upsetting. However, some parents are more informed on treatment processes than others. For example, if a parent is a doctor, they will show fewer signs of upset during a blood test.

Expertise of Clinicians – When a clinician is trauma-informed, they will understand how best to treat children and adolescents. However, this framework is relatively recent. Although health policies endorse trauma-informed care in the UK, there is no specific legislation or funding. Consequently, well-intentioned clinicians and healthcare professionals can sometimes be unaware of how their actions impact young and highly vulnerable patients 5.

These are just a few examples of the intersecting factors that shape the nature of medical trauma. They highlight the fact that no form of medical trauma will be the same, its impact varies from person to person.

Trauma-Informed Approaches

Trauma-informed approaches to mental health support are vital for children and adolescents who have experienced trauma. In the context of medical trauma, this means empowering individuals to express pain, discomfort and anxiety.

When children and adolescents show visible signs of distress, clinicians and caregivers naturally want to reassure them. However, phrases such as “Don’t worry” or “You’re completely fine” can exacerbate pain and upset. This is because the child is expected to ignore their discomfort and simply trust in the people who appear to be hurting them. Instead, it is far more beneficial to distract children by engaging in play. This approach metabolises pain management in the body, reducing stress and anxiety levels 6.

Despite the rise of trauma-informed approaches in hospitals and other medical settings, there are many children and adolescents who continue to struggle with medical trauma. So what can clinicians and caregivers do to support these individuals?

How to Support Children and Adolescents

Children and adolescents who are wary of mental and physical health treatments require specialised experts trained in the latest therapeutic interventions. Khiron Kids is an environment where children and adolescents can feel supported and nurtured in a familiar setting. Our clinic is trauma-focused and nervous system-informed. We also offer a variety of innovative therapeutic modalities, including play therapy, EMDR, art therapy and more.

We foster dignified and empowering healing by collaborating closely with parents, caregivers and family members and allowing them to become actively informed on the treatment process. Family involvement plays a significant role in our approach as it is a crucial way to promote positive outcomes. As such, we offer parent and carer support, parent and family groups and consultations with schools and community organisations. Our ultimate goal is to create safe and healing environments that facilitate comfort for all children and adolescents.

Endnotes

1. Laricchiuta D, Panuccio A, Picerni E, Biondo D, Genovesi B, Petrosini L. The body keeps the score: the neurobiological profile of traumatized adolescents. Neuroscience & Biobehavioral Reviews. 2023 Jan 4:105033.
2. Peterson, Sarah. “Medical Trauma.” The National Child Traumatic Stress Network, May 25, 2018. https://www.nctsn.org/what-is-child-trauma/trauma-types/medical-trauma.
3. Peterson, Sarah. “Effects.” The National Child Traumatic Stress Network, March 19, 2018. https://www.nctsn.org/what-is-child-trauma/trauma-types/medical-trauma/effects.
4. Alexandra C De Young, PhD and others, Topical Review: Medical Trauma During Early Childhood, Journal of Pediatric Psychology, Volume 46, Issue 7, August 2021, Pages 739–746,
5. Emsley E, Smith J, Martin D, Lewis NV. Trauma-informed care in the UK: where are we? A qualitative study of health policies and professional perspectives. BMC Health Services Research. 2022 Dec;22(1):1-2.
6. Kassam-Adams, Nancy, and Lucas Butler. “What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches?” Journal of Ethics | American Medical Association, August 1, 2017. https://journalofethics.ama-assn.org/article/what-do-clinicians-caring-children-need-know-about-pediatric-medical-traumatic-stress-and-ethics/2017-08.

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In non-traumatised individuals, this happens throughout their lives and causes no ill effects. Their nervous systems respond appropriately to all levels of danger – they see it when it’s there and when it’s not, and they don’t feel the need to scan for it consciously.

However, the nervous systems of traumatised individuals are very different – they’re much more likely to be constantly on guard, scanning for the next threat. This state is called hypervigilance.

In this blog, we’ll explain what hypervigilance is and some healthy coping strategies you can employ to manage it.

What Is Hypervigilance?

Stephen Porges uses the metaphor of a ladder for our threat response. Before the most well-known responses, such as fight, flight, or freeze, comes hypervigilance – an extremely alert state where we’re actively looking out for danger. Our heart rate rises, adrenaline is released, our breathing becomes more shallow, and our muscles tense up.

Hypervigilance is one of the most common symptoms of post-traumatic stress disorder (PTSD). Constantly checking for danger is exhausting. On a physical level, our bodies weren’t designed to be under stress for long periods, and mentally it can be highly confusing and can distract us from our day-to-day activities. Completing work assignments or being emotionally present for our loved ones is difficult when our body is telling us to watch out for an attack!

As such, hypervigilance has a hugely detrimental effect on our personal lives. It can hold us back in our careers, prevent us from developing meaningful relationships, and stop us from sleeping properly.^[1] Symptoms present slightly differently in everyone, however some of the most common signs include:

• Anxiety
• Fear
• Sweating
• Feelings of paranoia
• Dilated pupils
• Agoraphobia
• Increased startle reflex

What To Do About Hypervigilance?

If you’re suffering from PTSD or suspect you are, a professional diagnosis and treatment is always advised. While it would be fantastic to be able to heal our trauma by simply following certain steps and practices, it’s often far more complex than that.

However, there are certain activities you can do to bring yourself back into a resting state if you’re noticing symptoms of hypervigilance. Please note that the list below is not exhaustive – it’s important to find what works for you.

Sleep Hygiene

Sleeping properly is essential to every aspect of our health. However, hypervigilance makes this difficult – it’s hard to drift off when your body is telling you to watch out for danger.

This sets off a horrible cycle of feeling worn out due to lack of rest, exacerbating our existing problems. While there isn’t a guaranteed way of falling asleep on command, there are certain practices you can follow to make getting some better quality rest more likely:

• Avoid screens for an hour before bed, especially video games.
• Have a set time you wake up and go to bed – your circadian biological clock likes routine.
• Exercise regularly, but not just before bed.
• Don’t nap after the early afternoon.
• Use your bed for sleeping – don’t bring your work laptop or phone with you!
• Avoid heavy meals, alcohol, and caffeine before bed.

Exercise

Exercise is one of the best things we can do for hypervigilance. It’s not just about keeping our body supple, stretching out the muscles that tense up during hypervigilance, and working off the adrenaline energy. Exercise also releases feel-good endorphins that can boost our mood and overall sense of well-being.

Certain exercises, such as yoga stimulate the parasympathetic nervous system.^[2] This part is responsible for our rest and digest state and helps calm us down.

Remember To Breathe

When our bodies are getting ready for threat, our breathing becomes sharp and shallow as we attempt to take in as much oxygen as possible in case we have to fight or run away. We might not be able to control our heart rate or perspiration consciously, but we can control our breathing.

Studies have shown that deep, paced breathing correlates with activation in our insula, the region of the brain linked to bodily awareness, interoception, and pain processing. By breathing deeply and calmly, we can send a message back to our brain that we’re in a safe place.^[3]

Conclusion

It’s very easy to think of our nervous system as a one-way road. It sends the message we’re in danger or that we’re safe, and we respond accordingly. However, our nerves are actually information superhighways, with signals travelling both ways. By sending signals back to our brain that we’re safe, we can stop it from firing so many signals.

Although none of these activities are suggested as helping to heal trauma and PTSD, they are brilliant coping strategies for the symptoms that can blight our lives. They complement each other, are very accessible, and cost nothing – you’ve got nothing to lose by trying.

If you have a client or know of someone struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

[1] Wyk, M. V.. “The relationship between PTSD, hypervigilance and disordered sleep.” (2013).

[2] Khattab, Kerstin et al. “Iyengar yoga increases cardiac parasympathetic nervous modulation among healthy yoga practitioners.” Evidence-based complementary and alternative medicine : eCAM vol. 4,4 (2007): 511-7. doi:10.1093/ecam/nem087

[3] Haase, Lori et al. “Mindfulness-based training attenuates insula response to an aversive interoceptive challenge.” Social cognitive and affective neuroscience vol. 11,1 (2016): 182-90. doi:10.1093/scan/nsu042

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Trauma is a situation where an individual fears for their life or experiences extreme physical or psychological danger. This could be a natural disaster, a catastrophic accident, physical abuse, sexual abuse, neglect, or witnessing violence. It is estimated that up to 40% of children and teenagers experience at least one traumatic experience.[1]

A child’s propensity to developing PTSD is related to how they experience the gravity of the trauma, their proximity to the trauma, whether the trauma is repeated, others’ reactions to the event, and their relationship to those involved.

The child or teenager may struggle with disturbing memories, flashbacks, nightmares, and physical distress symptoms following the event, making day-to-day life a struggle. This is especially true for young people who may not have the tools or skills to explain how they feel and what they are experiencing.

PTSD can happen to anyone regardless of gender, ethnicity, or age. The symptoms of PTSD often present differently in children and teenagers, so a diagnosis may, unfortunately, be missed.

Symptoms of PTSD in Children & Adolescents

The symptoms of PTSD frequently look different among children and adolescents compared to adults. Young children commonly display symptoms of PTSD through their play and interactions with others.[2] The phenomenon of Post-traumatic Play has been mainly studied among children who have experienced terror events; however, it is seen across all types of traumatic events. Play analysis has shown that children are likely to re-enact traumatic situations, follow morbid themes, display a reduced awareness of themselves as a player, and display a lower developmental level.

In contrast, teenagers with PTSD have been found to exhibit impulsive, aggressive, and even violent tendencies with their peers, family, and authority figures.[3]

PTSD symptoms shared by both children and adolescents may include:

• Memories, nightmares, and flashbacks. 
• Acting or feeling like the trauma is repeating.
• Physical trauma symptoms such as a racing heart, trembling and tension, headaches, digestive discomfort, clammy or sweaty skin, fatigue and pain.
• Losing interest in friends or hobbies.
• Insomnia.
• Displaying sudden or extreme emotions.
• Expressing acute anger, frustration, or irritability.
• Difficulty focusing or concentrating.
• Concerns about dying at a young age.
• Showing a lower developmental level than their peers.
• Feeling nervous, restless, or anxious.
• Experiencing emotional numbness or dissociation.
• Relationship problems with peers, family members, and teachers.
• Decreased school performance.

Both children and adults can have difficulty recollecting the trauma event narrative; however, children and teenagers often remember things in the wrong order. An adverse side-effect of this erroneous narrative is that children and adolescents frequently believe there was an advance warning sign they failed to be aware of. This creates more significant anxiety, lack of trust, and trepidation in their daily lives as they try to prevent any similar trauma from reoccurring.

PTSD & Co-Occurring Disorders

Along with the aforementioned associated symptoms, several psychiatric disorders can be found among young people with PTSD. The most common co-occurring conditions include major depression, panic disorder, separation anxiety, generalised anxiety disorder, ADHD, conduct disorder, and substance use disorder.[5]

Children who have experienced trauma often have additional problems with loneliness, low self-worth, fear, sadness, low self-esteem, a lack of trust in others, feeling inferior, patronised, and misunderstood. As such, there is a propensity among this demographic to display aggression, impulsive or risk-taking behaviours, self-injurious behaviour, abuse of drugs or alcohol, adverse sexual behaviour, and suicidal ideation.[6]

Trauma symptoms and associated disorders are wide-ranging, challenging, and can appear to hold the person hostage in a place of constant threat and danger.

How To Treat PTSD in Children and Teens?

At Khiron Clinics, our professional PTSD therapists offer a range of treatment modalities developed to aid children and adolescents in their recovery.

Somatic Experiencing

Somatic experiencing is a body-focused therapy that addresses the root causes of trauma symptoms. This therapy aims to release the stored energy from the body’s fight-flight-freeze response, which was activated at the time of the trauma. The approach guides clients to recognise and understand the physical sensations which arise in the body in response to trauma reminders or triggers. Through increased awareness of sensations, suppressed emotions, and defensive tension is released.

Sensorimotor Psychotherapy

Sensorimotor psychotherapy combines talk therapy with somatic therapy. This approach focuses on the physical experiences of the body to develop an awareness of mental states. As trauma profoundly affects the body, we believe it is essential to use the body as a gateway to understanding a person’s psychology and towards improved mental health. Sensorimotor psychotherapy directly treats the symptoms of trauma within the body, which facilitates emotional and cognitive healing.

Other Treatments

Khiron Clinics offer customised treatment plans tailored to an individual’s unique needs. Treatment may also include medication, EMDR, Internal Family Systems, Lifespan Integration and BSP (Brainspotting).

Conclusion

We understand that as a parent, you want the best for your child and that there is nothing worse than watching them suffer. Feeling powerless or confused when confronted with PTSD symptoms in your child is natural. However, PTSD is fully treatable, especially when caught early on. Together we can help your child regain control of their future and build a happy, healthy life free from the effects of trauma.

At Khiron Clinics C+A, attuned therapists can help you work through and process any unresolved trauma using specialist techniques and methods. Please contact us today.

At Khiron Clinics C+A, attuned therapists can help you work through and process any unresolved trauma using specialist techniques and methods. Please contact us today.

Sources

[1] “Posttraumatic Stress Disorder (PTSD)”. Aacap.Org, 2019, https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Posttraumatic-Stress-Disorder-PTSD-070.aspx.
[2] Cohen, Esther et al. “Posttraumatic Play In Young Children Exposed To Terrorism: An Empirical Study”. Infant Mental Health Journal, vol 31, no. 2, 2010, pp. 159-181. Wiley, doi:10.1002/imhj.20250. Accessed 17 Aug 2021.
[3] Fehon, Dwain C. et al. “A Comparison Of Adolescent Inpatients With And Without A History Of Violence Perpetration”. Journal Of Nervous & Mental Disease, vol 193, no. 6, 2005, pp. 405-411. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/01.nmd.0000165294.41091.fc. Accessed 17 Aug 2021.
[4] Foa, Edna B. et al. “Psychometrics Of The Child PTSD Symptom Scale For DSM-5 For Trauma-Exposed Children And Adolescents”. Journal Of Clinical Child & Adolescent Psychology, vol 47, no. 1, 2017, pp. 38-46. Informa UK Limited, doi:10.1080/15374416.2017.1350962. Accessed 17 Aug 2021.
[5] Cohen, Judith A. “Practice Parameter For The Assessment And Treatment Of Children And Adolescents With Posttraumatic Stress Disorder”. Journal Of The American Academy Of Child & Adolescent Psychiatry, vol 49, no. 4, 2010, pp. 414-430. Elsevier BV, doi:10.1016/j.jaac.2009.12.020. Accessed 17 Aug 2021.
[6] “VA.Gov | Veterans Affairs”. Ptsd.Va.Gov, 2018, https://www.ptsd.va.gov/understand/what/teens_ptsd.asp.

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Experiencing acute or sustained trauma can give rise to many emotions such as fear, rage, denial, sorrow, regret, and mental health challenges like anxiety and depression. Some of these will resolve more quickly than others, and some will need to be remediated, perhaps with the help of a professional and the adoption of appropriate coping strategies.

People often link PTSD to war veterans (though in this case, although shame is relevant, guilt and fear is more likely to be experienced), and while the numbers for this demographic are high (between 13.5 – 34% dependent on the parameters of the study^[1]), anyone can suffer the effects of PTSD, including children. It is especially prevalent in those who experience (especially) sexual and other forms of physical abuse, either in childhood or during their adult life.^[2] The degrading and crushing nature of these types of relational abuse and the resultant powerlessness and lack of control makes them excellent breeding grounds for relational trauma-based shame. This feeling of subordination foments equally unhelpful thoughts and behaviours that ensue as a result of the shame, which include:

• Perfectionism (if I’m perfect, it will never happen to me again)
• Culpability (it’s my fault, if I didn’t do XYZ, it would not have happened)
• Low self-worth (I’m no good and don’t deserve anything good or to look or feel good – which can lead to victim behaviour, perpetuating the cycle)
• Becoming an abuser

Shame is a form of self-judgment which emanates from what is believed to be a deviation away from accepted cultural or societal norms. One of the worst aspects of shame is that people often get locked into it, eschewing the people and activities that could help them break out of this gloomy cycle, devoid of hope or positivity and often, human contact, making the sufferer more vulnerable and treatment more problematic.^[3]

When removed from the world, it is easy to believe the negative self-talk that occupies the sufferer’s mind because there is nothing and no one to counter it, which can exacerbate the problem and make recovery seem impossible. Most people have some form of insecurity, but for people who have PTSD, these insecurities can be triggers for reliving painful memories and shame – ushering in intense self-criticism, a major component where shame is concerned. Where most people might feel bad about a particular incident where they think they could have done better, someone suffering the effects of shame judges themselves as a lost cause, completely worthless and, sadly, unlovable.

Guilt and shame hold a strong link, but whereas guilt is often connected to an isolated incident that a person will often seek redemption or make recompense for, shame is more deeply held and relates to the person’s sense of belonging, of self, and of self-worth. In short, it could be described as I’ve done vs I am.^[4] The person views themselves as an abject failure and blames themselves for their continuing trauma.

PTSD is, at its root, an anxiety disorder where the subject experiences strong negative emotions such as fear and threat, which are two of the primary emotions and early symptoms or experiences of the condition. The risk of developing more ubiquitous and insidious emotions becomes high, with a large percentage of people living with PTSD experiencing shame despite receiving high-quality treatment for the condition. Studies have shown that treating shame is a key aspect of treating PTSD as a whole, lest it stifle therapeutic gains and that when trauma-related shame increases, PTSD symptoms increase accordingly, along with suicidal ideation.^{[5] [6]} This is perhaps attributable to shame being such a strong response that it is marked by increasing sympathetic nervous system activity, meaning there is evidence that it is associated with visceral, biological stress.^[7]

This kind of autonomic arousal is common in trauma survivors and is what often forms a physiological feedback loop that keeps people trapped in a state of trauma, as noted by trauma authorities such as Professor Stephen Porges and Bessel van der Kolk.

Self-Compassion and Other Routes Out of the Shame and Blame Game

Although this is a challenging situation to address, there are routes out of shame. One of these is self-compassion which can help restore a sense of calm, increase trust, and help with forming new connections. Showing compassion for oneself along with kindness and understanding helps to release the love hormone, oxytocin, which is responsible for things like empathy, trust and relationship building which are all necessary to combat (the usually self-imposed) isolation that stems from shame.

Positive and intentional distractions can also help quash negative thoughts and influences and replace them with healthier, more positive ones. Positive distractions include:

• Popping on some uplifting music when you feel shame bubbling up
• Physical activity such as walking, cycling, or swimming
• Having a bath with some uplifting, relaxing aromatherapy oils such as bergamot, lavender, grapefruit, orange, lemon, lime, or white fir
• A guided meditation to try and clear the mind of unhelpful, unwanted thoughts
• Reaching out to a friend or attending a support group with like-minded souls

Learning to repeat these feel-good strategies to combat what was most probably the repeated nature of the abuse which led to the trauma in the first instance, makes for a much more positive spin on unhelpful rumination and self-sabotage. It also helps to quell reptilian fight or flight responses which pump excessive amounts of cortisol around the body. When these responses are inappropriately employed on a continual basis, it causes equally inappropriate physiological responses (including hypertension), saps strength, and depletes the feel-good hormones that help us experience pleasure.

Showing love for the self helps bring about behaviours that can align or connect sufferers to outside resources or forms of support, namely fellow humans. In doing so, one of the things which will become apparent is that everyone has flaws and insecurities and makes mistakes but that this does not render them unlovable – what it makes them is human.

These strategies should be undertaken in tandem with specialised care, which can help unpick the damage done by the trauma that led to the shame in the first place. This can include individual or group-based therapy, but it must be tailored to and mindful of the subject and their story on a personal level. With a caring and understanding approach in an environment of respect, empathy, and kindness, people can be shown the path to self-forgiveness (even if there was nothing to forgive themselves for) and a happier and fulfilling life.

If you have a client or know of someone struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

^[1] Kimbrel, Nathan A. et al. “An Examination Of The Broader Effects Of Warzone Experiences On Returning Iraq/Afghanistan Veterans׳ Psychiatric Health”. Psychiatry Research, vol 226, no. 1, 2015, pp. 78-83. Elsevier BV, doi:10.1016/j.psychres.2014.12.007. Accessed 27 July 2021.

^[2] Lee, Deborah A. et al. “The Role Of Shame And Guilt In Traumatic Events: A Clinical Model Of Shame-Based And Guilt-Based PTSD”. British Journal Of Medical Psychology, vol 74, no. 4, 2001, pp. 451-466. Wiley, doi:10.1348/000711201161109. Accessed 27 July 2021.

^[3] Øktedalen, Tuva et al. “Trauma-Related Shame And Guilt As Time-Varying Predictors Of Posttraumatic Stress Disorder Symptoms During Imagery Exposure And Imagery Rescripting—A Randomized Controlled Trial”. Psychotherapy Research, vol 25, no. 5, 2014, pp. 518-532. Informa UK Limited, doi:10.1080/10503307.2014.917217. Accessed 27 July 2021.

^[4] Lee, Deborah A. et al. “The Role Of Shame And Guilt In Traumatic Events: A Clinical Model Of Shame-Based And Guilt-Based PTSD”. British Journal Of Medical Psychology, vol 74, no. 4, 2001, pp. 451-466. Wiley, doi:10.1348/000711201161109. Accessed 27 July 2021.

^[5] Saraiya, Tanya, and Teresa Lopez-Castro. “Ashamed And Afraid: A Scoping Review Of The Role Of Shame In Post-Traumatic Stress Disorder (PTSD)”. Journal Of Clinical Medicine, vol 5, no. 11, 2016, p. 94. MDPI AG, doi:10.3390/jcm5110094. Accessed 27 July 2021.

^[6] Bryan, Craig J. et al. “GUILT, SHAME, AND SUICIDAL IDEATION IN A MILITARY OUTPATIENT CLINICAL SAMPLE”. Depression And Anxiety, vol 30, no. 1, 2012, pp. 55-60. Wiley, doi:10.1002/da.22002. Accessed 27 July 2021.

^[7] Freed, Steven, and Wendy D’Andrea. “Autonomic Arousal And Emotion In Victims Of Interpersonal Violence: Shame Proneness But Not Anxiety Predicts Vagal Tone”. Journal Of Trauma & Dissociation, vol 16, no. 4, 2015, pp. 367-383. Informa UK Limited, doi:10.1080/15299732.2015.1004771. Accessed 27 July 2021.

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People living with PTSD can be particularly prone to sensory overload, which can have a major impact on the normal functioning of brain processes if not identified and treated. The impact on a happy, healthy life is the same, regardless of the original trigger for the anxiety or sensory overload, and there are strategies to help restore equilibrium and quality of life.

As with so many mental health conditions, sensory overload is related to the reptilian brain and the fight, flight or freeze (FFF) responses to calamity or what we perceive as a calamity. When we are overwhelmed, our five senses (sight, sound, smell, touch, and taste) tend to become over-sensitised, which causes our brain to become overwhelmed or overloaded by the amount of data being submitted. This is a bit like trying to stuff more clothes into a trunk than it can physically handle until something has to give, or to use a more 21^st Century analogy, running out of RAM, which makes everything just seize up. When this happens, it causes a sense of anxiety, panic, and a general feeling of being unsafe, and during sleep can give rise to nightmares which then exacerbates problems in waking hours.^[1]

Regardless of whether the anxiety or the sensory overload has come first, the outcome is the same; the sufferer will frequently find themselves in situations and settings that will trigger their symptoms or an episode. Several conditions are linked with sensory overload, but it is highly common for people with Post-traumatic Stress Disorder (PTSD); for instance, soldiers who are easily tripped into FFF responses by, for example, loud noises, strobe lighting, or fireworks, which can cause a meltdown. People who have suffered sexual or other forms of physical abuse and violence, accident survivors, or even people who have lived through natural disasters can all develop PTSD ^[2].

Brought about by a traumatic event that the person has associated with the possibility of death or grave injury at the very least, the condition can become highly debilitating, quickly sparking an episode and triggering the preferred coping mechanism of the sufferer. It’s worth noting that the event may not be traumatic for someone else, so it’s about perception and context. The problem with this is that it becomes exhausting as this hypervigilance is based on a faulty detection system which causes the sufferer to feel worried or frightened when there is no actual threat to life and limb. To use another analogy, it’s like that annoying alarm on your neighbour’s car that is frequently set off by another vehicle just driving by (usually at 2am!) or someone bumping the car as they walk past.

The Brain and Trauma

Trauma experts like Dr. Bessel van der Kolk and Professor Stephen Porges describe the brain actually being altered as a coping response to traumatic events, especially those that are sustained or repeated in nature, which is a neurobiological, chemical response and nothing to do with personal resilience or fortitude.^[3] Due to the trauma, future events are responded to in a similar way, in the form of a variation on a theme (different triggers but a standard response) because it is comfortable for the brain, which has, in effect, become stuck in a loop.

Signs and Triggers

Like most things, the signs of sensory overload can span the spectrum from the very obvious to the more subtle or less easy to correlate. For instance, someone placing their hands over their ears, attempting to flee or fainting at the sight of fireworks might be pretty obvious, whereas a general inability to relax or being highly restless might not. In children, this might spark a tantrum which may be misinterpreted as receiving a simple shock when it is, in fact, sensory overload. In general, witnessing a hyper response or high levels of anxiety or, at worst, panic, which is quite different to the normal reaction in others, is usually a pretty good indication. However, some symptoms such as a racing pulse and pounding heart or dizziness won’t be visible to others. In general, symptoms fall into four categories:

• intrusion
• arousal
• avoidance
• thoughts and feelings, which are usually negative

Triggers can vary depending on the way the PTSD presents and whether the sensory overload is also related to another condition such as autism or ADHD, but common triggers include:

• being caught in a crowd.
• loud and/or shocking noises such as fireworks or helicopters.
• strong scents which can remind the sufferer or people or situations they identify as stress-inducing.
• inappropriate or unwanted physical contact or proximity.
• restrictive or otherwise uncomfortable clothing.
• flashing lights such as strobe lights or fireworks.
• extreme temperatures, especially sudden in nature.
• certain individuals or groups.

How Do We Clear the Cache and Delete the Trauma Cookies?

Obviously, the easiest route to avoiding a stress-induced episode is to avoid it, but unless we resign ourselves to a solitary life, living indoors with limited stimuli, the chances are that we are going to encounter new and stressful situations – and your sensitivities could actually increase. While this is a challenge even for non-PTSD sufferers, for those with PTSD, it can be debilitating and can prevent them from living full lives and even precipitate comorbidities such as substance abuse. Mastering breathing techniques for relaxation and learning to meditate can be invaluable in situations where you feel your pulse rate start to increase.

Sleep also plays an integral part in the body’s capacity for resilience (the more tired you are, the more sensitive you will be), as does eating healthily, cutting down on salt, exercising, and drinking plenty of water.^[4] Avoiding stimulants like nicotine, coffee, alcohol, and illegal drugs is also recommended. In some cases, medication can be helpful though all the factors in your condition need to be considered and viewed holistically and empathetically by a healthcare specialist who can take all of the elements into account.

Other recommended strategies include:

• When out and about, choose more quiet periods and less buzzy environments such as restaurants if eating out.
• If holding a meeting, try to choose a quiet venue and ask people to speak slowly and in turn. If you don’t feel comfortable explaining the real reason, tell them that you have a hearing issue.
• If you feel one sense overloading, try some distraction tactics like relaxing music or eating something with a strong flavour like chilli or peppermint. Experimenting with smell in the form of aromatherapy (including candles) can also be helpful, and there are a multitude of essential oils to choose from.
• Deep pressure can remove the focus and place it somewhere else, for instance, on the steering wheel of your car by squeezing some wrist grips, or the most fun way, giving yourself a hug.
• Embrace your inner Marie Kondo by living minimally, which not only helps with mental clarity but also reduces the risk of injury if overstimulated.
• Invest in some earplugs and/or headphones, so you choose what and when you listen to something.
• Have some white noise like a fan or something on quietly in the background like a radio or TV.
• Sunglasses or tinted glasses depending on the stimulant can aid with visual over-stimulus.
• If you find travelling stressful and you are not the driver, take the opportunity to nap.

Seeking support from your friends, family, and colleagues can also play a crucial part in helping you to circumnavigate triggers where possible. Choosing quiet activities in calmer settings instead of crowded restaurants, concerts, theatres (where you might also be trapped in a row of people) would be preferable alternatives, and they need to know this. Securing appropriate advice and treatment for accompanying conditions is also key to avoiding one condition feeding off another. Again, a trusted medical or mental health professional can be invaluable in helping you to manage this very fine balance to live a full and satisfying life.

If you have a client or know of someone struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

[1] Tanev, Kaloyan S. et al. “Positive Association Between Nightmares And Heart Rate Response To Loud Tones”. Journal Of Nervous & Mental Disease, vol 205, no. 4, 2017, pp. 308-312. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/nmd.0000000000000641. Accessed 18 July 2021.

[2] Clancy, Kevin et al. “Restless ‘Rest’: Intrinsic Sensory Hyperactivity And Disinhibition In Post-Traumatic Stress Disorder”. Brain, vol 140, no. 7, 2017, pp. 2041-2050. Oxford University Press (OUP), doi:10.1093/brain/awx116. Accessed 18 July 2021.

[3] van der Kolk, Bessel A. “The Body Keeps The Score: Memory And The Evolving Psychobiology Of Posttraumatic Stress”. Harvard Review Of Psychiatry, vol 1, no. 5, 1994, pp. 253-265. Ovid Technologies (Wolters Kluwer Health), doi:10.3109/10673229409017088. Accessed 18 July 2021.

[4] Baglioni, Chiara et al. “Sleep And Mental Disorders: A Meta-Analysis Of Polysomnographic Research.”. Psychological Bulletin, vol 142, no. 9, 2016, pp. 969-990. American Psychological Association (APA), doi:10.1037/bul0000053. Accessed 18 July 2021.

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If you’re reading this article, there is a chance you’re worried about how your past is impacting your parenting. You might have a formal diagnosis of PTSD, or you might have recognised some of its symptoms in yourself and are curious. Maybe you didn’t have a great childhood experience growing up, and you’re worried about becoming a parent. Whatever your situation, it’s never too late to seek help. There is no such thing as a perfect parent after all.

Understanding the Role That Attachment Style Has on Your Relationships

We aren’t responsible for how we were raised – as children, our upbringing was totally out of our control. However, our early life relationships can affect how we relate to others both as children and when we grow up. This is called our attachment style – of which there are four. They are not mutually exclusive, and it is common to have a mix of two or more.

The attachment styles are:

Secure

This style comes from having a consistent, predictable, and trustworthy caregiver. This translates into being an adult that successfully navigates conflicts and builds relationships easily.

Insecure-Ambivalent

This results from an inconsistent caregiver – they might have been caring at times, but also volatile and unpredictable. As an adult, this can lead to fear of abandonment and strong dependency on others.

Insecure-Avoidant

This attachment style arises from a disengaged and emotionally distant caregiver that ignores your needs to be loved, accepted, and seen. This leads to dismissing your own emotions as an adult and struggling with intimacy.

Disorganised

This style is the result of a chaotic and abusive caregiver that is a source of fear. As children, we still crave attachment, so we form a bond with the parent despite the relationship’s negative impact on us. It translates into feeling high levels of fear, irritability, anger, depression, despair, and defeat. Adults with disorganised attachment often subconsciously repeat the parental behaviours they witnessed as a child.

Attachment Styles and PTSD

Unsurprisingly, research has found that insecure-avoidant and disorganised attachment styles correlate higher with instances of PTSD in adults. ^[1]  Whatever your attachment style or styles are, it will affect how you parent – whether you’ve learned to suppress your emotions and not react to situations or overreact and lose your temper at insignificant things.

Post-traumatic stress disorder, or PTSD, can cast a shadow over our lives. Past energy from unresolved trauma can trigger us and cause us to act in certain ways, e.g. we might flare up in anger or fall into depression. These triggers can seemingly come from nowhere and make it feel like we are re-experiencing the original trauma, and they can be alarming, not only for us but for our loved ones around us.

Most research around parenting and PTSD centres on war veterans as often, people only associate trauma with the most extreme instances. However, traumatic events come in many guises, and PTSD can occur after any stressful, dangerous, or scary event. It could have happened over a long time period, such as physical abuse or be a one-off event. ^[2]

Often, parents with PTSD worry they aren’t parenting as well as they can or that their trauma will be passed on to their children. They hold themselves to an impossibly high standard to mitigate this risk, ending in a cycle of self-blame and disappointment. This doesn’t have to be your reality – studies have shown that a PTSD diagnosis does not necessarily correlate with parenting risk. ^[3]

Parenting is difficult, and you’re allowed to make mistakes. It’s important to remember that you can always review whether or not your reaction is appropriate for the situation. If you’ve overreacted to something minor, take a step back from the situation and give yourself time to relax. The same applies to underreacting – firm boundaries are essential for balanced emotional development, and children need guidance.

If you’ve made a mistake, you should be willing to apologise; however, genuine apologies require a committed effort to change. In the meantime, you could try explaining to your children what the reality of living with PTSD is like and how it affects the way you act. This will help them understand that the reaction is related to you and your past rather than them and will hopefully prevent them from internalising your actions and behaviour.

Of course, altering long-standing well-entrenched behaviours takes time and often requires professional intervention. There is nothing wrong with seeking help – overcoming past trauma isn’t easy alone. It doesn’t mean you’re a bad parent – it actually signifies wanting the best for your children.

Trauma-informed professionals can help you understand how your past affects your parenting and show you healthy coping strategies for managing your PTSD symptoms.

At Khiron Clinics C+A, attuned therapists can help you work through and process any unresolved trauma using specialist techniques and methods. Please contact us today.

Sources

[1] Woodhouse, Sarah et al. “The relationship between adult attachment style and post-traumatic stress symptoms: A meta-analysis.” Journal of anxiety disorders vol. 35 (2015): 103-17. doi:10.1016/j.janxdis.2015.07.002

[2] Costello, E Jane et al. “The prevalence of potentially traumatic events in childhood and adolescence.” Journal of traumatic stress vol. 15,2 (2002): 99-112. doi:10.1023/A:1014851823163

[3] Muzik, Maria et al. “Psychopathology and parenting: An examination of perceived and observed parenting in mothers with depression and PTSD.” Journal of affective disorders vol. 207 (2017): 242-250. doi:10.1016/j.jad.2016.08.035

The post The Bravest Challenge: Parenting, PTSD, and the Past appeared first on Khiron Clinics.

Absent or unavailable is an umbrella term (not a medical term) used to describe parents who are uncaring, emotionally unavailable, narcissistic or generally display self-centred and cruel behaviours which can – and often do – tip into verbal and physical abuse.

Start typing the word toxic into any one of the big search engines, and you will find no shortage of survival guides to help you navigate and recover from what can be some very damaging treatment in your formative years. In fact, as soon as you type the letters “tox”, there is an array of choices from popular searches with options like toxic childhood stress. Can it really be that bad? Actually, it can.

What Is the Role of A Parent?

In the main clauses of the parent/child service level agreement sit obligations like food, shelter, clothing, and other basic material needs. Often, even the children of emotionally unavailable parents will have their needs in these areas met but is that enough? If you want a happy, confident, successful, and balanced child, then no.

In the next tier are the logistical clauses such as consistency and routine, which help children feel safe and in control. Included in the next tier of the unwritten parent manual comes praise, encouragement, helping to understand the importance of rules, honesty, and the concepts of caring, socialisation, and sharing. These life skills won’t prevent a child from surviving, but a lack of mastery over them will make it harder for them to forge their own healthy relationships and succeed in life.

As we reach the pinnacle, really competent parents will understand and make allowances for the concepts of gender difference, where a child sits in the family pecking order, and crucially, personality – taking these factors into account when ensuring that their mutual expectations are compatible. All of the tiers of this hierarchy should be running concurrently to ensure that the child’s basic human needs (see non-negotiables of the parent/child SLA) are met.

Nobody’s Perfect but Trying At the Very Least is Quite Important

One could argue that modern parenting requires today’s parents (and often those under the heading of non-traditional, which includes single parents) to manage more moving pieces than their earlier counterparts, especially if they are working.

Every parent will tell you that they make mistakes, but in the main, they manage to not damage their children too badly in the process of parenting, and this is where things differ with EA parents. The effects of toxic stress on the children of EA parents is extremely damaging and very real and can give rise to neurobiological and psychological damage.

The healthy development of a child “depends on adult caregivers, who are mediators of child development because infants depend on parents or other primary caregivers for physical and emotional care.”  Their mandate is to provide the full spectrum of love and care and accept that their children are individuals with their own personalities and aspirations. They should ensure their children feel safe but not over-protected and guided but not controlled.

According to educator and author Michael Grose, “Families work well when they are guided democracies or benign dictatorships. Someone should be in charge of a family, and it’s a good idea if it’s parents!” Unfortunately for some children, the dictatorship is not so benign, with the concepts of firmness and nurturance, in reality, becoming a combination of cruel and neglectful. These actions aren’t one-offs but a pattern of behaviour that has a cumulative negative effect on the child, carrying into adulthood which can then create a generational pattern of behaviour.

All parents make mistakes, but the difference is that the average parent will acknowledge this, make amends and undertake to do better. This is not so with EA parents, who are often also narcissists who are only concerned with their own needs. Research found that adult children of narcissistic parents experience problems with substance abuse, mood disorder, PTSD, anxiety disorder, reported insecurity in relationships, and difficulty with intimacy.  It’s important for parents to at least try to get parenting right, acknowledge when they’re not, and seek help.

How to Recognise if Your Childhood Was Unhealthy

You may have been controlled or manipulated or not had your boundaries respected, especially as you got older and were consistently told that everything was always your fault.

Here are some of the other signs that you were brought up in a harmful environment:

• There was a role reversal in the child/parent relationship, which meant you had to parent your parent(s) or take on responsibility not appropriate for your age.
• You were told that you deserved the physical abuse doled out to you because that was the only way you would learn or something similar.
• You were forced to lie about your mistreatment under the threat of more punishment. This includes sexual and other physical abuse.
• One or both of your parents competed with you. This is particularly common in father/son and mother/daughter relationships.
• You were emotionally neglected or abused, perhaps being told things like you’re no good, ugly, or you need to try harder.
• You often felt fearful, afraid to express yourself and challenge opinions, or were just afraid of your parents in general.
• Love or any form of attention was conditional and therefore frequently withdrawn if you fell short of often unrealistic criteria.
• You experienced a lack of understanding when you needed support and comfort the

You might not have realised that life, especially a child’s life, is not supposed to be like this because it was the only benchmark you had. This can especially be the case for over-protected children who are not allowed to go anywhere independent of their parent(s).

In other words, this is the only version of normal, you know.

Because of this, your blueprint for acceptable behaviours and forming bonds with people may also be compromised.

The Ongoing Effects of Emotionally Absent Parenting and Moving Forward

Coming to the realisation that what you viewed as normal was actually very unhealthy is the first step to getting help and support and finding liberation toward a new and healthier way of being. It will probably be imperative to you that you don’t carry on the legacy of this behaviour passed to you like a badly smoking torch. As is often the case, the abused can themselves become abusers as it’s all they’ve ever known. It can also explain why children of abusive and unavailable parents cling to them despite their mistreatment. It is crucial for a child’s self-worth and self-esteem to have their deepest emotional needs met and to be able to relate to parents on an emotional level. When they are instead met with detachment and constant criticism, it creates an atmosphere of stress and anticipation of punishment, which can have long-term effects on both physical and mental health due to the relentless environment of stress it creates. The good news is that with the appropriate care and support, you can move past this. You can put down that baggage and change the course of history, or even her story.

If you have a client or know of someone struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

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