Unleashing Your Body’s Healing Power

In the intriguing world of healing and therapy, a method is quietly revolutionizing how we approach and address trauma: Somatic Experiencing (SE). SE, a form of therapy developed by Dr. Peter Levine, operates on a notion that seems almost too simple to be true: the body knows how to heal itself. But before you dismiss this as another health fad, let’s journey into the fascinating world of somatic therapy. 

 Imagine for a moment an antelope in the wild, grazing peacefully. Suddenly, a predator appears, and the calm evaporates. In the face of imminent danger, the antelope’s body responds automatically with adrenaline-fueled fight or flight responses. And then, a remarkable thing.  If the antelope is lucky enough to escape the predator, it will literally ‘shake off’ the event and resume everyday life, seemingly unfazed by the traumatic experience.  

 Humans, on the other hand, aren’t so lucky. In our complex, civilized societies, we often override these natural responses, trapping our trauma within the body. This unresolved tension can emerge as stress, anxiety, or other mental and physical health problems. SE is a unique healing tool that works with this trapped energy, allowing it to complete and find our way back to flow and health.  This is true whether the trauma is stress at work, a car accident, an assault, or painful events during childhood. 

Resolving Trauma and Stress 

 The core benefit of SE is its potential to resolve trauma and mitigate stress. During a traumatic event, the body’s defense system often becomes dysregulated. If the body doesn’t return to its pre-trauma state, the individual may experience a host of stress-related symptoms such as anxiety, irritability, chronic fatigue, and insomnia. SE helps reestablish the body’s equilibrium by guiding individuals to move through their body’s instinctual fight, flight, or freeze responses. This can lead to a significant reduction in the symptoms of post-traumatic stress disorder (PTSD) and other stress-related conditions.   

 In practice, an SE therapist will help you locate your uncomfortable feelings in your body, and then in small incremental ways will ‘pendulate’ between the area of greater discomfort and a place of lesser discomfort.  This titrated approach allows the mind to gradually access, open up, and reconsolidate the painful memories. 

Enhancing Emotional Regulation 

 Somatic Experiencing aids individuals in developing a deeper understanding of their emotions. By using techniques that focus on the body’s reactions, people can identify and respond to their physical cues related to emotions. This increased self-awareness enables them to manage their emotions better and respond appropriately to stressful situations, which ultimately leads to healthier relationships with others. 

The Body Talks – It’s Time to Listen 

 Somatic Experiencing encourages a deep connection with one’s body. Through SE, individuals learn to tune into their bodily sensations and listen to the signals that their body sends. This enhanced body awareness can lead to healthier habits, as individuals become more attuned to their body’s needs for rest, nourishment, movement, and connection. 

Bouncing Back from Life’s Curveballs 

One of the primary aims of SE is to increase resilience – the ability to bounce back from adversity. Through guided therapeutic sessions, individuals develop a deeper understanding of their stress responses and learn techniques to navigate through life’s challenges more effectively. 

Unleashing Your Inner Superhero 

 The empowerment that comes from understanding and controlling one’s physical and emotional responses can significantly boost self-confidence and self-efficacy. Individuals who practice SE often report feeling more in control of their lives and are better equipped to handle future stressors. 

The Physical and the Phantom 

Ever experienced pain that just doesn’t have a logical explanation? Chronic physical conditions, like unexplained aches or digestive issues, can sometimes be the manifestations of unresolved trauma. By tackling trauma at its roots, SE offers a new pathway to relief. 

 Somatic Experiencing isn’t a magical panacea that can erase trauma overnight. But it offers something arguably better – a safe, progressive method to reset your body’s natural rhythm. It’s a gentle yet potent approach that nudges you towards a state of balance, resilience, and vitality. 

 In a world where the norm is to ‘think’ our way out of problems, SE is a refreshing deviation, beckoning us to ‘feel’ our way towards healing. By leveraging the wisdom of our bodies and releasing trapped trauma, we can unlock a more balanced, healthier, and peaceful version of ourselves.   

 Remember, though, that SE is not a one-size-fits-all solution. As with any therapy, it’s crucial to consult with a mental health professional who can guide you to the best-suited treatment based on your unique circumstances. So, are you ready to tap into the wisdom of your body? 

The GoodTherapy Registry might be helpful to anyone experiencing trauma. We have thousands of Therapists listed with us who would love to walk with you on your journey. Find the support you need today.

by Bren Michelle Chasse, Licensed Marriage and Family Therapist

Healing from Trauma Does Not Hinge on a Survivor’s Ability to Forgive

Forgiveness is an evolutionary phenomenon that, historically, has been a necessary part to building and sustaining community (Tooby & Cosmides, 2005)). In early times, it allowed groups to minimize conflict and helped support, foster, and preserve cooperation so that groups could function effectively, thrive, and achieve the goals necessary for their survival. In short, group members needed each other, a fact which didn’t change when a wrong had been done. They had to learn to deal with wrongs and stay alive. Over time, the concept of forgiveness has transformed into a modern-day virtue. Many consider forgiveness to be the moral high ground. There are even mental health providers who believe forgiveness to be the holy grail of healing, identifying it as a necessary therapeutic objective or clinical goal (Luskin, 2003). I am not one of them. 

A Deeper Look at Forgiveness and Trauma

Research has shown that, in general, people practice forgiveness more readily within their tribe or primary support group, while more likely to withhold forgiveness from those outside their group (McAuliffe & Dunham, 2016). However, this research depends on an assumption of high-functioning group dynamics. Not every relationship we experience in our lives (or even within our own family systems) falls into this category. It is simply inappropriate to generalize and apply a forgiveness model evenly across the board to all relationships. Relationships, by definition, are nuanced and very complex—and so is the experience of trauma.  

Additionally, not all transgressions are created equal. For example, I may be able to forgive a close friend who lied to me but find myself unwilling or unable to forgive the same friend if they were to assault me. A one-size-fits-all approach to healing simply doesn’t work! More specifically, the forgiveness model, when applied equally across domains, is fundamentally flawed. It fails to account for context, attachment style, cultural implications, personal moral values, organic individual differences, past experiences (including prior trauma exposure), and the depth and breadth of the transgression.  

Force-Fed Forgiveness?

Unfortunately, I’ve found in my practice that many clients have a history of being force-fed (through various sources) the value and importance of always forgiving. Consider the Lord’s Prayer, which requires we stand humbly before God and ask, “Forgive our trespasses…” and challenges us to “…forgive those that trespass against us.” The pressure to forgive is often applied by those we hold in high regard. When family members, advisors, mentors, close friends, or spiritual leaders insist on this, many clients feeling gaslit, shamed, and forced to betray themselves by placing the needs of their perpetrator above their own. 

Healing from trauma requires a focus on the self — not on the needs of another. When we claim that forgiveness is a necessary component of healing, we tell survivors that they cannot be whole again unless they extend forgiveness even to those who have committed the most physically and psychologically violent acts imaginable. 

Making Change Happen

As a society and as therapists, we must begin to change the language and conversation around forgiveness. If we don’t, we maintain the status quo and risk becoming part of the problem. The language we use, especially when we are in a position of power, really matters. 

We have to change the way we think about this topic as well. An unwillingness to forgive does not directly translate to anger, aggression, seeking revenge, or a refusal to move on, nor does it necessarily equate to a dysfunctional response to trauma. In many cases, survivors simply don’t relate to the concept of forgiveness. The healing journey focuses on creating and enforcing healthy boundaries, refusing to hold toxic secrets, learning to prioritize their own physical and emotional needs, and healing the younger parts of themselves that still feel stuck in the trauma of their past. If forgiveness isn’t part of a survivor’s healing journey, it doesn’t mean there’s something wrong. 

Be True to Yourself as You Heal

Let me be clear — for those that find forgiveness to be a healing part of your journey, I encourage you to embrace it. If you don’t relate to that, or if you feel forgiveness is a barrier to your healing, I encourage you to honor that. What I am arguing is that not everyone who experiences trauma will benefit from sharing physical, emotional, or psychological space with the person who has harmed them. Forgiveness is not necessarily a required stop along the path toward healing. Simply put, how you heal is up to you!

References

Luskin, F. (2003).  Forgive for good: A proven prescription for health and happiness. Harper One.

McAuliffe, K. & Dunham, Y. (2016). Group bias in cooperative norm enforcement. Philosophical Transactions of The Royal Society B Biological Sciences, 371(1686). doi https://doi.org/10.1111/j.1467-9221.2008.00688.x

Tooby, J. & Cosmides, L. (2005). Conceptual foundations of evolutionary psychology, in Handbook of Evolutionary Psychology, ed. Buss, D. M. Wiley, 5-67.

by Mary Alexander, JD

What Makes Clergy Abuse So Different? 

Acts of sexual abuse are inexcusable. Acts of sexual abuse at the hands of priests, clergy, and other religious leaders are particularly inexcusable, not only given the many facets of their unique positions but also because of the complexity of the religious institutions that employ them. Clergy abuse causes harm in many ways, but new laws are increasing accountability for clergy members and legal options for abuse survivors. 

The abusive acts are never the fault of survivors. It takes courage for a survivor to acknowledge that abuse occurred. For some, reading this article may be a step in your process of acknowledging what has happened to you. You are not alone. 

This Moment in History

Clergy abuse is not a new phenomenon. Survivors, many of whom were children at the time of the sexual abuse, are now coming forward in greater numbers. This is, at least in part, due to recent changes in law allowing survivors to seek civil justice for the pain, emotional distress, and trauma suffered as a result of the abuse. 

Clergy Abuse Is Different

Clergy members are unique in their positions. Due to the inherent nature of their esteemed positions and the belief that they are closer to God, religious leaders occupy positions of authority. They are respected and deemed trustworthy. They are also the very people who are expected to set an example of moral and ethical behavior in our communities. People often look to clergy when in need of help, guidance, or to confess their sins.  

Betrayal of Trust

However, when members of clergy prey on their students and congregants, they are exploiting not only their trust but the trust of their families. These are the people they are supposed to be serving. Many survivors have suffered in silence, fearful that they would not be believed if they reported the abuse. Indeed, the dark irony is that the abuser may be the same person the survivor would have otherwise turned to for counseling in such a time of need. Furthermore, when the perpetrator of sexual abuse is a clergy member, the religious institution may also be responsible and liable for the abuse. 

Criminal acts of sexual abuse have been committed by local religious leaders and their employees for decades. The most common example is the longtime and ongoing abuse, mostly of minors, by Catholic clergy members. The 2015 film “Spotlight” told the true story of the Boston Globe journalists who uncovered decades-long cover-ups at the highest levels of Boston’s religious, legal, and government establishments, touching off a wave of revelations around the world. Because the cycle of abuse had occurred for so long in secret, with little to no consequences for the abusers, several of the accused or convicted in this investigation and others like it stated that the abuse had become normalized to them.  

The Impact of Clergy Abuse

Emotional Distress

Most, if not all, survivors will agree that the impact of sexual abuse does not stop once the physical contact has ended. Physical contact is often associated with levels of emotion, and it is well documented by organizations such as the Department of Health and Human Services that survivors feel shame, guilt, and embarrassment surrounding the abuse they suffered. These very same feelings are what predators count on to keep their abused silent. 

If you are wrestling with the emotional distress of abuse, help is available. Click through to find a therapist near you who can help. 

Power and Manipulation

When the abuser is a religious leader or member of the clergy, complications can arise because they often know how to elicit certain responses from people. Many priests are expected to be able to soothe and counsel people in times of emotional distress. It is reasonable to believe that if that same priest had engaged in physical or sexual abuse, he could use that specialized ability in more sinister ways, namely, to deter a survivor or their family from reporting the abuse to other leaders within the religious organization or to law enforcement. 

An abuser will often feel he is in control of the situation and will go on with life and business unscathed, believing he will presumably be backed by his religious institution if accused. That influence can begin with something as simple as a whispered rumor among the congregation to preemptively tarnish the survivor’s reputation. From there, the abuser succeeds if the matter snowballs in his favor or if the survivor never comes forward with a claim. 

Psychological Trauma

Psychological trauma often goes hand-in-hand with emotional abuse. But the critical difference between the two is that psychological abuse has stronger effects on a survivor’s mental capacity. While emotional abuse affects what people feel, psychological abuse affects what and how they think. 

It’s not uncommon for psychological abuse to take place during and even after the physical act(s) of abuse. This often looks like manipulation, gaslighting, or making harmful threats. In an instant, an innocent survivor will feel that what is happening is acceptable or that no one will believe them. Although many individuals do face hurdles when coming to terms with and reporting physical and sexual abuse no matter the context, reporting the abuse can often be a way to take back their own power. 

Mental Health Concerns

It is important for survivors of sexual abuse to seek professional help and to find healthy ways to cope with the emotional and psychological impact of their abuse. People who have experienced psychological abuse often report feelings of depression, suicidal ideation, low self-esteem, difficulty trusting others, and post-traumatic stress disorder (PTSD). PTSD has effects that can last for years. It can paralyze people’s mental states to prevent them from working, concentrating, or caring for themselves and others. 

Trying to Cope Through Substance Abuse

The psychological impact can also lead to drug and alcohol abuse as a coping mechanism. The National Institute on Alcohol Abuse and Alcoholism has published several studies and reports detailing how alcoholism can be a consequence of child abuse. While alcohol and controlled substances may do long-term damage, they can be perceived as providing temporary solace from the torment. However, research shows that alcohol can actually complicate symptoms of anxiety, depression, and PTSD. 

Sexual and Physical Pain

Physical abuse such as beatings, lashings, and burnings may have been supplemented by sexual acts performed or demanded by clergymen. The physical pain endured by survivors is often accompanied by and causes emotional distress and psychological trauma as well.

The Road to Healing

It is common for anyone who has been through the trauma of sexual abuse to want to feel safe and to regain control of their life. The process of healing from abuse is different for everyone, and support groups for survivors have grown in recent decades. 

But there is a difference between healing and justice, and survivors should feel vindicated if they want one or both. 

You Have Rights

The abuse of a child almost always occurs in private and out of public view, so proving that the church or religious organization knew or should have known (of the abuse) can be particularly challenging. Thankfully, legal reforms in California and other states have been passed to help empower survivors and their families. 

California Law

In 2019, California Governor Gavin Newsom signed into law AB 218, which enhanced protections for survivors of crime and abuse. This law includes measures establishing an amnesty clause protecting survivors and witnesses of sexual assault. 

For survivors of childhood sexual abuse that occurred in California, this update to the law adds extra time to seek civil justice. AB 218 raised the age limit for abuse survivors to bring legal action against their abusive clergy member or other church-affiliated abusers. This law gives survivors of childhood sexual abuse until age 40 – or five years from the discovery of the abuse – to file civil lawsuits. Before AB 218, the age limit had been 26, or within three years from the discovery of the abuse. Furthermore, AB 218 provides a three-year lookback window for claims that would have previously expired under the old law.

The Legal Process for Survivors Wanting Justice

Survivors of sexual abuse now have stronger laws on their side. If survivors want to secure civil justice, they can do so in a court of law. It can be tough to investigate claims if the reported abusive conduct took place many years ago. Still, it is important to move forward with them regardless of how much time has passed. 

The first step in achieving justice for a survivor of sexual abuse is to speak with a plaintiffs’ lawyer who is familiar with these new laws and has had success litigating sexual abuse claims. 

Law firms like mine represent clients of almost every age, gender, sexual identity, and race. We have collaborated with experts for years on civil and criminal matters involving clergy sexual abuse. It’s important to know that if you have suffered abuse, you have rights that you are free to exercise.

Mary Alexander is a plaintiff attorney based in San Francisco who represents victims of abuse and accidents. Visit her firm’s website here.

If you’re struggling to deal with any type of abuse, please reach out for help. There are many trauma therapists who are trained to support people in your exact situation. You don’t have to go it alone. To find a trauma therapist who can help, click through to search for a therapist near you and filter by Common Specialties>All other issues>Abuse/Abuse Survivor Issues.

Traumatic stress involves a threat to a person’s life or physical integrity. It can have a profound impact on the brain, nervous system, and peripheral bodily systems. The impact of trauma on our emotional and mental health is discussed at length in the literature. However, trauma’s impact on the peripheral body (the peripheral nervous system, as well as the muscles and internal organs it connects to) is less understood. Said impact is often not considered in primary health care or even a therapist’s office.

Physicians and therapists need to understand that trauma impacts more than emotional and mental health. While the mechanism is not fully understood, we know from large, population-based studies that traumatic stress is a factor in chronic diseases such as cardiovascular disease (CVD). An investigation that was conducted across diverse populations showed that people experiencing depression, posttraumatic stress disorder (PTSD), and anxiety are at an elevated risk of dying from cardiovascular disease.

How trauma affects the heart

Trauma is associated with behavioral factors that affect heart health and lead to an increased risk for CVD. Individuals with a history of trauma are more likely to:

• Begin smoking.
• Have low levels of physical activity.
• Abuse illicit substances and/or alcohol.
• Refuse to take medicines prescribed by doctors or follow doctors’ orders after a cardiac event.

In addition, evidence suggests there are biological effects of traumatic stress that occur independently of behavior. For example, individuals with past trauma show elevated biological markers of inflammation. In other words, traumatic stress increases inflammation in the body. In turn, inflammation has been shown to increase the risk of CVD. The effects of traumatic stress on inflammation and the subsequent link to CVD is likely to play a key role in the causal connection between trauma and CVD.

The effects of trauma on inflammation seem to hold over time. A study designed to assess trauma and inflammation looked at a sample of 1,021 individuals aged 40-90 years. Higher lifetime trauma exposure was linked to increased levels of biological markers of inflammation at baseline and after five years.

Complex trauma

Complex trauma and its related condition, Complex Posttraumatic Stress Disorder (C-PTSD), is different than PTSD. The cause of PTSD can be a one-time incident or group of incidents such as combat, a natural disaster, or a car accident. Meanwhile, complex trauma results from exposure to ongoing trauma over an extended period of time. Child abuse or neglect and ongoing interpersonal (relationship) trauma tend to meet the criteria for complex trauma.

The data suggest that taking steps to take better care of our bodies is extra important if we have a history of trauma. Prolonged trauma over the course of childhood results in a different cluster of symptoms and outcomes. It is sometimes more difficult to diagnose and treat. Clients with a history of prolonged trauma are exposed to elevated risk for CVD on multiple levels. Studies have found that the cumulative effects of prolonged trauma are associated with elevated levels of inflammation and have the most potent effects on one’s physical health.

What can be done today?

Studies show patients with CVD demonstrate higher biological markers of inflammation following acute mental stress as well as higher levels of circulating stress hormones. In addition to the ongoing physiological effects, childhood trauma exposure is also associated with unhealthy behaviors that further increase the risk of developing CVD.

In some cases, gaining a better understanding of how state-of-mind and health habits affect our bodies in a concrete way (such as cardiovascular risk) motivates us to make changes. The data suggest that taking steps to take better care of our bodies is extra important if we have a history of trauma. Similarly, taking steps to care for our mental health can mitigate the damage that PTSD and C-PTSD can inflict.

Therapeutic interventions are effective for PTSD and related symptoms. A trained professional can teach you strategies to deal with difficult emotions such as fear, worry, anger, and sadness. They can also help you with emotion regulation by providing the support necessary for healing.

Dealing with trauma needs to be a holistic venture, where the body, emotions, and mind are all addressed and nurtured. In addition to taking steps to improve physical health, individuals are also encouraged to seek therapy to protect their heart on every level possible.

References:

1. de Assis, M. A., de Mello, M. F., Scorza, F. A., Cadrobbi, M. P., Schooedl, A. F., de Silva, S. G., … & Arida, R. M. (2008). Evaluation of physical activity habits in patients with posttraumatic stress disorder. Clinics, 63(4), 473-478.
2. Feldner, M. T., Babson, K. A., & Zvolensky, M. J. (2007). Smoking, traumatic event exposure, and post-traumatic stress: A critical review of the empirical literature. Clinical Psychology Review, 27(1), 14-45.
3. Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018). Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?. World Journal of Psychiatry, 8(1), 12-19.
4. Hendrickson, C. M., Neylan, T. C., Na, B., Regan, M., Zhang, Q., & Cohen, B. E. (2013). Lifetime trauma exposure and prospective cardiovascular events and all-cause mortality: findings from the Heart and Soul Study. Psychosomatic Medicine, 75(9), 849-855.
5. Kop, W. J., Weissman, N. J., Zhu, J., Bonsall, R. W., Doyle, M., Stretch, M. R., … & Tracy, R. P. (2008). Effects of acute mental stress and exercise on inflammatory markers in patients with coronary artery disease and healthy controls. The American Journal of Cardiology, 101(6), 767-773.
6. Kuhl, E. A., Fauerbach, J. A., Bush, D. E., & Ziegelstein, R. C. (2009). Relation of anxiety and adherence to risk-reducing recommendations following myocardial infarction. The American Journal of Cardiology, 103(12), 1629-1634.
7. Martens, E. J., de Jonge, P., Na, B., Cohen, B. E., Lett, H., & Whooley, M. A. (2010). Scared to death? Generalized anxiety disorder and cardiovascular events in patients with stable coronary heart disease: The Heart and Soul Study. Archives of General Psychiatry, 67(7), 750-758.
8. von Känel, R., Hepp, U., Kraemer, B., Traber, R., Keel, M., Mica, L., & Schnyder, U. (2007). Evidence for low-grade systemic proinflammatory activity in patients with posttraumatic stress disorder. Journal of Psychiatric Research, 41(9), 744-752.

Nearly 7% of Americans will be diagnosed with posttraumatic stress (PTSD) at some point during their lives. In any given year, 3.5% of Americans have PTSD. Many struggle with sleep problems such as insomnia, sleeping too much, and nightmares. For people struggling with trauma during the day, nighttime can feel like a battleground that offers little respite from traumatic memories and intrusive thoughts.

Are Sleep Problems a Symptom of PTSD?

Trauma changes the brain, and these changes can also affect sleep. The Diagnostic and Statistical Manual (DSM) lists sleep disturbances—such as insomnia, frequent waking, or nightmares—as one of many potential symptoms of PTSD. Specifically, to be diagnosed with PTSD, a person must show at least two of six “alterations in arousal and activity.” Those changes include:

• A heightened startle response
• Trouble concentrating
• Sleep disturbances
• Hypervigilance
• Self-destructive or reckless behavior
• Irritability or aggression

For some people, other symptoms of arousal play a role in sleep problems. For instance, a person who is anxious and hypervigilant may be too afraid to fall asleep, while a person with a heightened startle response may startle awake at every sound as they drift off to sleep. This change in sleep can also exacerbate other PTSD symptoms. A chronically exhausted person may be more irritable or have greater difficulty concentrating.

Some research suggests that sleep problems are more than just a symptom of PTSD. Instead, they may be a core component of the diagnosis. Research published in 1989 suggests that disturbances in rapid eye movement (REM) sleep are a PTSD hallmark that play a key role in other PTSD symptoms. Subsequent research has yielded mixed results. While some studies, including of animals, find a pattern of REM disturbances associated with PTSD, others do not.

A 2013 review of the literature argues that disturbances in sleep, especially REM sleep, may increase the risk of PTSD. Sleep issues may also worsen outcomes in people with PTSD. The study further argues that sleep issues can decrease the effectiveness of many PTSD treatments and that targeted treatments for sleep issues may speed recovery.

How Does PTSD Affect Sleep?

People with PTSD often find that their traumatic memories intrude on their ability to sleep. Some common PTSD-related sleep symptoms include:

• Being unable to fall asleep because of anxiety or agitation.
• Difficulty staying asleep because of frequent nightmares.
• Poor quality sleep because of nightmares. Some people report waking up many times each night and struggling to fall back asleep each time. This is called maintenance insomnia.
• Sleep problems related to drugs or alcohol. Some people with PTSD use alcohol or drugs to cope, which can cause sleep problems. Some medications for PTSD and anxiety may also cause sleep problems. For example, benzodiazepines may make it difficult to wake up in the morning.

A study that compared people with insomnia who did not have PTSD to those with combat-related PTSD and insomnia found important differences in the two groups. Those included:

• More repetitive nightmares in people with PTSD. People with PTSD were more likely to say their nightmares made it difficult to go back to sleep.
• More anxiety during the day in people with PTSD.
• More fatigue during the day among people with PTSD.

This suggests a feedback loop between sleep issues and other PTSD symptoms. Sleep problems can intensify daytime PTSD symptoms, which may make it even more difficult to sleep at night. People who feel anxious or fatigued during the day may ruminate more on their traumatic memories, increasing the risk of nightmares and other issues when they try to sleep.

Sleep problems can intensify daytime PTSD symptoms, which may make it even more difficult to sleep at night. People who feel anxious or fatigued during the day may ruminate more on their traumatic memories, increasing the risk of nightmares and other issues when they try to sleep.

Other Sleep Problems and PTSD

Sleep issues are common, even in people without PTSD. A 2009 study found that about 30% of people experience insomnia in a given year. Some people also struggle with sleeping too much or with not feeling rested after sleeping. This may be due to:

• Shift work sleep disorder, a condition that alters the “internal clock” of people who work nights or unusual hours.
• Sleep apnea, a disorder that affects breathing during sleep, causing people to briefly wake many times during the night.
• Sleep behavior disorder, which causes people to do unusual things while sleeping, such as sleepwalking, driving, or eating.

People with PTSD who have a pre-existing sleep disorder may find their symptoms get worse following a traumatic experience. Conditions that affect sleep can also compound the effects of PTSD, leading to depression, anger, difficulty concentrating, and more trouble coping with PTSD symptoms.

Even when the symptoms of a sleep disorder are not directly related to PTSD, it’s important to get help. Getting quality sleep is an important component of PTSD self-care.

Strategies for Coping with PTSD-Related Sleep Problems

Lifestyle changes can help some people with PTSD sleep more soundly. The National Sleep Foundation emphasizes that sleep is a habit, so the right changes can help the body adopt healthy sleep habits that offer better sleep. Try the following:

• Design a comfortable sleeping area, with a firm and supportive mattress and comfortable pillow.
• Develop a relaxing bedtime ritual.
• Stick to the same sleep schedule every day, even on weekends or vacations.
• Avoid napping during the day if you have trouble sleeping at night.
• Exercise every day, but not right before bed.
• Keep your bedroom cool, between 60-67 degrees Fahrenheit.
• Keep your bedroom quiet. Some people find that a white noise machine helps.
• If you can’t fall asleep, get up and do something else.
• Use your bed only for sleeping—not to play, read, or do work.
• Eat a light snack 45 minutes before bed if you tend to wake up hungry.
• Avoid heavy meals, alcohol, caffeine, and cigarettes before bed. Some people find drinking caffeine in the afternoon makes it harder to sleep.

Stress and anxiety management strategies can be especially helpful for managing PTSD-related sleep problems. Some people find relief from meditation or yoga. Others find that guided imagery or positive mantras as they try to sleep can help.

Medications, including anti-anxiety and sleeping medications, may help some people. However, when the underlying PTSD symptoms remain, sleep problems will likely return when you stop using medication.

Therapy can help with both sleep issues and PTSD. A compassionate therapist will help you work through your trauma in a safe space, free of judgment. Your therapist can help you set goals, cultivate new tools for managing stress, help you understand how trauma changes the brain, and work with your doctor to decide which, if any, medications are appropriate.

PTSD can feel overwhelming. Some people become depressed because they think things will never change. Others are too exhausted to work or enjoy time with their family. It doesn’t have to be this way. Reach out to a therapist who is highly skilled at treating PTSD.

References:

1. Germain, A. (2013). Sleep disturbances as the hallmark of PTSD: Where are we now? American Journal of Psychiatry, 4(170), 372-382. doi: 10.1176/appi.ajp.2012.12040432
2. Gradus, J. L. (2007, January 31). Epidemiology of PTSD. Retrieved from https://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp
3. Healthy sleep tips. (n.d.). Retrieved from https://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips
4. Inman, D. J., Silver, S. M., & Doghramji, K. (1990). Sleep disturbance in post-traumatic stress disorder: A comparison with non-PTSD insomnia. Journal of Traumatic Stress, 3(3), 429-437. doi: 10.1007/BF00974782
5. Phillips, K. (2015, February 4). What are the types of sleep disorders? A full list of sleep disorders. Retrieved from http://www.alaskasleep.com/blog/types-of-sleep-disorders-list-of-sleep-disorders
6. Sleep and PTSD. (2015, August 13). Retrieved from https://www.ptsd.va.gov/public/problems/sleep-and-ptsd.asp
7. Yehuda, R., Hoge, C. W., Mcfarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., . . . Hyman, S. E. (2015). Post-traumatic stress disorder. Nature Reviews Disease Primers, 15057. Retrieved from https://www.nature.com/articles/nrdp201557#t1

Posttraumatic stress (PTSD) can develop following any exposure to trauma—including trauma another person experienced. A military spouse may get PTSD after learning about or otherwise being exposed to trauma their partner faced. This is sometimes called vicarious trauma or secondary trauma.

How Do Military Spouses Get Traumatized?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person doesn’t have to directly experience trauma to develop PTSD. Witnessing someone else’s trauma, learning a loved one was hurt, or repeatedly hearing details about a traumatic event can also cause PTSD.

A military spouse might develop PTSD stemming from their partner’s trauma by:

• Repeatedly listening to their partner’s traumatic stories.
• Witnessing gruesome military combat on television, either during or after a partner’s deployment.
• Feeling unable to escape the trauma their partner continually relives.

Some military spouses also develop PTSD due to their own military-related trauma. Depending on the mission, a spouse may not be able to locate or talk to their deployed partner. They may spend months or years terrified about their partner’s well-being. This fear can be compounded by graphic media coverage.

Military spouses who experience symptoms of PTSD should know that military combat is not the only reason people develop posttraumatic stress. PTSD symptoms may be related to another trauma, such as a car accident, sexual assault, or child abuse.

A 2011 study followed 170 female military spouses who reported symptoms of PTSD. Researchers asked about the women’s experiences of stress and trauma and found:

• 12.9% of wives attributed their symptoms solely to a spouse’s deployment-related trauma.
• Most wives (62.4%) said their distress was wholly unrelated to a partner’s military service.
• 24.7% said their distress was due to a combination of their partner’s military service and other factors.

For people who have already experienced trauma, exposure to a loved one’s trauma may re-trigger the previous trauma.

How Common Is PTSD Among Military Family Members?

PTSD is a common experience. According to the National Institutes of Health, about 7.7 million Americans have PTSD at any given time. The 2011 study above found 21.6% of military wives qualified for a PTSD diagnosis.

Whether or not a military spouse develops PTSD depends on multiple factors, including:

• Previous and ongoing trauma: For instance, a sexual assault survivor may be more likely to develop PTSD, or to re-experience trauma, in response to a spouse’s trauma.
• Support system: A person may become socially isolated as they await the return of their loved one. Someone with little social support and few coping skills may be more likely to struggle.
• Overall mental health: A person who is already struggling with mental health issues may be more likely to develop PTSD.

Children can also be affected by a parent’s military experiences. Children who develop secondary trauma may have nightmares, unusual fears, or increased irritability. Trauma can also shift the way children relate to one or both parents. The likelihood of a child developing PTSD depends on their age, gender, and general family functioning.

Military Spouses and Compassion Fatigue

Military spouses who act as caregivers for their loved ones can experience compassion fatigue. Over time, the demands of continually caring for someone can deplete empathy. A spouse might begin feeling resentful instead of compassionate. Compassion fatigue can harm the relationship, and it may lead to worsening symptoms of PTSD in one or both spouses.

Trauma is not a contest…Everyone affected by PTSD needs and deserves help.Support from expert caregivers, such as therapists and doctors, can be crucial. Regular breaks from the demands of caregiving can also be important. A person who intends to provide all the care their loved one needs, without any assistance, is much more vulnerable to compassion fatigue.

Romantic relationships are an important outlet for many people. Spouses often rely on one another for emotional support, freely venting and seeking empathy. When a partner is struggling with serious mental health symptoms, they may be less able to provide comfort. This change deprives the caregiving partner of an important source of emotional support during a time when they need it most.

Therapy can help partners manage the effects of PTSD on a relationship. With the right therapist, military spouses can stop feeling like caregivers and begin feeling like partners again. Therapy can also help the care recipient feel understood and supported. A couple may find the process of navigating trauma together deepens their relationship in the long run.

Self-Care for Military Spouses

As a military spouse, you may feel guilty for struggling with your own trauma. You may believe you cannot have PTSD if you didn’t experience combat. Or you may recognize your symptoms but hide your distress because your spouse “had it much worse.”

Trauma is not a contest. You might face unique stressors that your partner does not. It doesn’t matter who has it worse or who has suffered more. Everyone affected by PTSD needs and deserves help.

Some self-care strategies that can help military spouses cope include:

• Limiting exposure to triggering media, such as war movies or graphic news stories.
• Taking frequent breaks from caregiving. No one can provide 24/7 care with no support. Schedule time to do things that make you feel good several times a week.
• Talking to loved ones about your own struggles and trauma.
• Joining a support group for military spouses.
• Getting plenty of exercise. Exercise can help with depression, trauma, and anxiety.
• Getting adequate sleep.

Military spouses who struggle with secondary PTSD can find much relief in therapy. Therapy helps you understand how your partner’s trauma affects you. It may also help you identify traumatic experiences in your own life that play a role in your PTSD. Therapy can be a supportive place to discuss your feelings without judgment. The right therapist can help you make healthy lifestyle changes and boost your resilience.

PTSD isn’t just for soldiers. You don’t have to suffer alone. You can find a therapist who can help you manage secondary trauma here.

References:

1. Cook, C. R., Slater-Williams, A. A., & Harrison, L. R. (2012). Secondary PTSD in children of service members: Strategies for helping professionals [PDF]. In VISTAS (Article 6). Retrieved from https://www.counseling.org/resources/library/VISTAS/vistas12/Article_6.pdf
2. How to deal with stress as a caregiver. (2018, March 21.) Military OneSource. Retrieved from https://www.militaryonesource.mil/-/how-to-deal-with-stress-as-a-caregiver
3. Renshaw, K. D., Allen, E. S., Rhoades, G. K., Blais, R. K., Markman, H. J., & Stanley, S. M. (2011). Distress in spouses of service members with symptoms of combat-related PTSD: Secondary traumatic stress or general psychological distress? Journal of Family Psychology,25(4), 461-469. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156850
4. PTSD: A growing epidemic. (2009). NIH Medline Plus, 4(1), 10-14. Retrieved from https://medlineplus.gov/magazine/issues/winter09/articles/winter09pg10-14.html
5. Yehuda, R., Hoge, C. W., McFarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., . . . Hyman, S. E. (2015, October 8). Post-traumatic stress disorder. Nature Reviews Disease Primers, 1. Retrieved from https://www.nature.com/articles/nrdp201557/tables/1

The influence of trauma in mental and chemical health treatment is getting more and more attention.

When we hear the word “trauma,” we tend to think of events that lead to death or injury. These events might include sexual violence, accidents, war crimes, and/or natural disasters. This is an accurate description of trauma. It also fulfills the criteria for a diagnosis of posttraumatic stress (PTSD).

But the transmission of the effects of trauma may be far broader and more complicated. Thus, it is important that the intricacies of trauma-related symptoms within interpersonal or systemic contexts continue to gain recognition. When we, as therapists and other helping professionals, increase our awareness of trauma and its varied symptoms, we can better serve people seeking our help.

How Is Trauma Defined in the DSM?

The fifth and newest edition of the Diagnostic and Statistical Manual of Mental Disorders broadened the definition of trauma to include direct or indirect recurring exposure to traumatic events. The broadened definition refers to two types of trauma.

• Complex trauma, which is the result of repetitive, prolonged trauma that occurs in interpersonal relationships with an uneven power dynamic. This type of trauma might include neglect or abuse from a caregiver, for example.
• Vicarious or secondary trauma may be defined as indirect exposure to trauma firsthand or through narratives of the event. In other words, this type of trauma is often experienced by helping professionals such as therapists.

Symptom criteria in the DSM-5 for a PTSD diagnosis includes four categories beyond trauma exposure.

1. Intrusive symptoms, such as flashbacks or distressing memories
2. Avoidance symptoms, including avoidance of internal or external reminders
3. Negative alterations in mood or cognition. In other words, a person might have a persistent negative emotional state or negative beliefs about the self or the world.
4. Hyperarousal symptoms, such as anger, reckless behavior, or difficulty concentrating

If some symptoms are present and interfere with typical function, but not all symptom criteria is met, a diagnosis of Other or Unspecified Trauma- and Stressor-Related Disorder may be given.

How Can a Broader Diagnostic Definition Help?

Exploration of trauma helps broaden the diagnostic definition. Recent findings in neuroscience may also be relevant to the understanding of the contextual factors in interpersonal traumas. Research has found that social exclusion and rejection are mediated by the same aspects as our physical pain system.

Human physiology does not differentiate between social and physical pain. Trauma-related symptoms may result when someone feels threatened or experiences physical harm or injury, either directly or indirectly. But experiences of social exclusion or rejection are likely to result in the same symptoms.

Transgenerational or Intergenerational Trauma

First identified in the 1960s, this type of trauma describes the symptoms experienced by descendants of Holocaust survivors. It occurs when trauma symptoms are present within generations of the same family, beyond the generation of the person who experienced the trauma. This particular trauma may also be present in the context of immigration-related traumas.

Research suggests symptoms may be transmitted to later generations when a parent’s unresolved grief, depression, anxiety, and/or other symptoms interfere with the ability to establish healthy or secure attachment with their children and consistently meet the emotional needs of their children.

Historical Trauma

This type of trauma also involves a subjective reexperiencing and recollection of traumatic events by an individual or a community over multiple generations. The term has origins in the 1980s and is based on the studied traumas of the colonization, relocation, and assimilation of the Native Americans.

The experience of historical trauma is absorbed into the cultural memory of the group, flowing from generation to generation. This is similar to the way non-traumatic aspects of the culture regenerate. Traumatic stress may be altered in each generation as members continue to witness the effects of trauma on previous generations. As a result, each successive generation may begin to exhibit unique symptoms of trauma.

Racial Trauma

In 2001, the U.S. Surgeon General identified racial trauma as the attributing factor to ethnic and racial disparities. This type of trauma considers the symptoms that may result when a person experiences racism. Some forms of race-based trauma include:

Trauma-related symptoms may result when someone feels threatened or experiences physical harm or injury, either directly or indirectly. But experiences of social exclusion or rejection are likely to result in the same symptoms.

• Experiencing and/or witnessing racial harassment
• Ethnoviolence
• Microaggressions
• Institutional racism
• The constant threat of racial or ethnic discrimination

Research indicates that the more subtle forms of racism lead to constant vigilance, or a kind of “cultural paranoia,” which may serve as a defense mechanism. Experiences of racism may be subtle, but the culmination of these types of race-based trauma often result in traumatization.

Systemic Trauma

In spite of the above knowledge of the many contexts of traumatic experiences, many socially relevant forms of trauma are not always considered traumatic, even by mental health care providers. This shows the relevance of systemic, or institutional, trauma.

Also known as institutional trauma or betrayal, this type of trauma is defined as the institutional action and inaction that can worsen the impact of traumatic experience. Systemic trauma regards the contextual features that give rise to, maintain, and impact trauma-related responses. There are parallels between the interpersonal and institutional trauma. These include factors of trust and dependency, as well as a lack of sustained awareness across contexts.

How Can We Improve Trauma Treatment?

As trauma professionals, it is necessary to acknowledge the above and incorporate systemic approaches in order to better assess, diagnose, and treat trauma. For instance, I ask you to consider an African-American whose current lived experience includes transgenerational trauma, historical trauma, racial trauma, and systemic trauma. Their trauma-related symptoms, such as anger or distrust, may then be interpreted by others—including those in power—as character flaws. This only heightens the trauma response, on every level.

It can be challenging to expand our paradigms of trauma. A broadened conceptual framework is necessary, both scientifically and ethically. This perspective extends the conceptualizations of trauma to consider the influence of environments beyond the person themselves. These might include the following:

• Schools and universities
• Churches and other religious institutions
• The military
• Workplace settings
• Hospitals, jails, and prisons
• Agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media
• Conflicts involving war, torture, terrorism, and refugees
• Dynamics of racism, sexism, discrimination, bullying, and homophobia
• Issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention.

When we consider all these factors, we can provide more specialized treatment to people seeking trauma treatment. Above all, we must remember that context matters.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2. Carter, R. T. (2006, December 1). Race-based traumatic stress. Psychiatric Times, 23(14). Retrieved from http://www.psychiatrictimes.com/cultural-psychiatry/race-based-traumatic-stress
3. Goldsmith, R. E., Martin, C. G., & Smith, C. P. (2014, March 11). Systemic trauma. Journal of Trauma & Dissociation, 15(2), 117-132.
4. MacDonald, G., & Leary, M. R. (2005). Why does social exclusion hurt? The relationship between social and physical pain. Psychological Bulletin, 131(2), 202-223.
5. Phipps, R. M., & Degges-White, S. (2014, July 1). A new look at transgenerational trauma transmission: Second-generation Latino immigrant youth. Journal of Multicultural Counseling & Development, 42(3), 174-187.
6. Smith, C. P., & Freyd, J. J. (2014). Institutional betrayal. American Psychologist, 69(6), 575-587.
7. Williams, M. T., & Leins, C. (2016). Race-based trauma: The challenge and promise of MDMA-Assisted psychotherapy. Multidisciplinary Association for Psychedelic Studies (MAPS) Bulletin, 26, 32-37.

“Mindfulness” is a popular buzzword in therapy and personal-growth circles. Mindful.org defines mindfulness as “the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us.” In the vernacular, it essentially means “being fully present in the moment.”

Sounds good, right? Well, it’s trickier than it seems. As Peter Levine points out, trauma robs us of our ability to be in the present moment. The threat response in our nervous system gets stuck on “on,” and so we find ourselves automatically preoccupied with the past, or else projecting the past into the future.

Some people do this to such a degree they are not even aware that they are doing it. They have lost track of what it’s like to slow down and pleasantly be in the present moment (or they never learned in the first place). It can be amazing to witness when they learn to just be, to feel the sensations of simply being alive in a living, human body instead of constantly worrying and anxiously scheming.

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The power of somatic therapy is particularly apparent in working with this issue. I define somatic mindfulness as the ability to step back from what your nervous system is telling you. You step back, observe it, feel every bit of it. Then you consciously decide what you want to do instead of automatically falling into long-standing patterns and the behavior they dictate.

Here’s an example, representative of many people I’ve worked with: Bernard grew up in a rough and unforgiving environment. There was no one around he could trust. Many people around him got what they could by whatever means were available to them. He realizes this way of life left its mark on him, so he started working with me and eventually we settled into a productive therapeutic relationship.

One day, not long after we started working together, I rearranged the chairs in my office. I was preparing to start a new group and I needed more comfy chairs. At the beginning of Bernard’s next session, I noticed this caught his attention, so I encouraged him to take in the environmental changes and notice the sensations in his body. His body started to brace and his face became hard. He asked me if I made these changes simply to “screw around with people, you know, to get a rise out of them so they can get their money’s worth out of the session.” He looked as if I’d tried to pull something over on him.

Bernard was projecting his past onto his present, and he was also quite likely using this to make predictions about his future—or at least the future of his therapy with me. Both my training and my humanity encouraged me to be transparent in these matters, so I disclosed the reason for the changes in my office decor. He immediately softened, relaxed, and started to backpedal.

Somatic mindfulness creates mind-body integration where it had been lacking. It allows us to use our somatic responses as one source of information without letting them run the show.

Now we had something to work with: His body had sent out an exaggerated “danger” signal when there was no actual threat, either in my office or in his relationship with me. Had I not been prepared to calmly hold this, it could have unnecessarily ruined the relationship, as well as any benefit he could have obtained.

When we discussed it, he said he felt disoriented as he came in. As I encouraged him to notice his physical sensations, he said he felt a jolt of energy in his body, movement impulses in his arms and fists, a burning in his chest, and anger. In the future, if he can “catch” this automatic body reaction, to sit with it and question it, he’ll have mastered somatic mindfulness. He’ll have developed active control over this threat response. Over time, as his nervous system gets better at distinguishing when the threat response is necessary, it will soften.

These automatic bodily and behavioral responses can occur in any situation, in countless different ways. Somatic mindfulness creates mind-body integration where it had been lacking. It allows us to use our somatic responses as one source of information without letting them run the show. This kind of therapeutic work softens and reduces the hypervigilant threat response and hyperarousal in the nervous system. These old traumatic residues can stress the body and cause burnout. They are also thought to contribute to many physical health problems.

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Full embodiment in the present moment can be a truly wonderful experience. There’s no way to explain it if you haven’t felt it. I’ve watched it occur many times in my office. Time spent in nature or with animals is often helpful in this quest. When developing this skill, it is essential to work with a therapist or other trusted mentor who has somatic mindfulness training and a stable nervous system.

References:

1. Levine, P. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.
2. Mate, G. (2003). When the body says no: Understanding the stress-disease connection. New Jersey: John Wiley & Sons.
3. What Is Mindfulness? (2014). Retrieved from https://www.mindful.org/what-is-mindfulness

The news is so full of dark and scary stories these days that it can be overwhelming. I, for one, find it troubling to hear about repeated shootings where innocent lives are taken, the growing number of teen suicides due in part to a spike in adolescent depression, the unprecedented opioid epidemic, and the sexual abuse and harassment that has come to light in recent months.

The fact these types of stories are constantly featured in news and social media cycles can bring us down in significant ways. This is particularly true when we see the dire effect on our youth, as well as the damage to families, friends, and communities. Just trying to absorb these stories can invoke a sense of hopelessness and helplessness.

It may seem unusual for a counselor to start an article with so much gloom and doom. How depressing! But I do so to point out that because we are bombarded by such volume and intensity of negative information 24/7, we need more effective means of coping and managing the fear and trauma that comes with it. We need to be able to find relief and a sense of balance and safety in our daily lives.

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I work with individuals and families who deal with these kinds of concerns in very personal ways. When they first come to therapy, their darkness is stark, real, and often overwhelming. It’s imperative for me to not only notice but to join them in that darkness, such that the power of the dark space is recognized and revered for what it is and the impact it has.

At this point in the therapeutic process, there is no light—just the small adjustments made by the human senses to initiate calmness. There is little to no means of navigation through this space.

As the therapist, I am initially charged with illuminating this space. I think of this as being in charge of a flashlight, which I must hold until the person I am with is able. I shine a dim beam of light in the space until the shapes and contours of the pain start to appear. The brightness of the beam depends on how much the person in therapy can tolerate seeing at once.

So, what does the flashlight represent and how can it be used to soothe and heal emotional pain? The flashlight is the means by which we can begin to reconcile and come to terms with what has happened.

As time goes on, my job becomes more about adjusting the flashlight beam so the space becomes incrementally brighter. The events of whatever tragedy took place become more understood and digestible, if only for brief, erratic segments of time. Emotions become more readily distinguishable and we begin the long journey of softly illuminating the space. The ultimate goal is for the person in therapy to take over holding the flashlight—perhaps temporarily at first, but with more confidence and self-direction as time passes.

So, what does the flashlight represent and how can it be used to soothe and heal emotional pain? The flashlight is the means by which we can begin to reconcile and come to terms with what has happened. It is a tool for assessing the damage done to our psyche in the midst of devastation so we can begin the process of sorting out and reorganizing our perceptions of our new realities post-calamity. In the end, it is about finding some solace and peace.

It’s important to point out that this process is not a quick, easy fix. Many have found eye movement desensitization and reprocessing (EMDR) to be helpful in giving the brain a jump-start to reprocessing chaotic aftermath. However, it takes time to fully comprehend and absorb what has happened and how that affects our new world of emotions.

For a more global or societal experience of trauma, the process is much the same, though perhaps at a less intense level. When we see or hear news about another terrorist attack, mass shooting, major earthquake, or bombing of innocent children, we may be shaken by fear, disillusionment, sadness, and a sense of hopelessness and helplessness.

But flashlights are available in this arena as well. Some recent examples include youth activism in response to school shootings and the #MeToo/#TimesUp movements bringing awareness and voice to the unacceptability of sexual abuse and harassment.

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These examples give us pause to reflect on the human capacity to find sources of light, be they others showing courage to respond proactively or our own internal strength and, perhaps, spirituality that help us reorient and heal. We can then hold that flashlight firmly until the darkness recedes.

If you need help, contact a licensed therapist.

Reference:

Slay-Westbrook, S. (2016). Respect-focused therapy: Honoring clients through the therapeutic relationship and process. United Kingdom: Taylor & Francis.

Food is an important element of every culture; the less of it available, the more important the meaning surrounding it. From holiday and traditional celebrations to the ritual of Sunday dinners, almost everyone has memories—happy, comforting memories—tied to food. So it is no surprise that people who are experiencing difficulties sometimes turn to food to try to evoke pleasant feelings.

Everyone is familiar with the idea of self-soothing through food. Eating a pint (or more!) of ice cream after a romantic breakup is a cliché. A cup of tea and a biscuit is an equally iconic response to an upset in English culture. However, this usually harmless form of self-soothing can become a problem for people with serious and persistent emotional challenges such as those occurring as the result of posttraumatic stress (PTSD). These problematic reactions may include:

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• Binge eating
• Anorexia
• Bulimia

What Is Posttraumatic Stress?

Briefly stated, PTSD is the result of experiencing a “shocking, scary, or dangerous event” (Post-Traumatic Stress Disorder, 2016). While not everyone will develop persistent symptoms as the result of such events, some people will go on to feel afraid or anxious even though they are no longer in danger. Symptoms may include flashbacks (intrusive memories), nightmares, avoiding places or things which trigger bad memories, being easily startled, or having difficulty sleeping. Sometimes symptoms don’t appear until months or even years after the experience.

Binge Eating

According to Dr. Cynthia Bulik, an expert on eating disorders at the University of North Carolina, “Binge eating is not just a lot of overeating … there’s this sense of loss of control. You start eating and you feel like you just can’t stop” (When Food Consumes You, 2017). This is the most common eating disorder in the United States. People with this condition eat past the point where they are full; they often feel compelled to go on eating. This may lead to obesity and the problems that come with it.

What is the link between the two? Most of the time, the trauma comes first and binge eating later (Brody, 2017). Research shows both PTSD and binge eating are related to production of stress hormones and mood-boosting brain chemicals. About one in four people who binge eat is believed to have PTSD; about 35% of women with a binge eating disorder have been sexually assaulted. PTSD and binge eating are linked in the body.

Bulimia

Sometimes, people who have indulged in binge eating will follow with an attempt to rid themselves of the excess calories. This may be done through self-induced vomiting; the use of laxatives to help food pass quickly through the body; prolonged exercise; or, paradoxically, periods of fasting. People with this condition (known medically as bulimia nervosa) may be able to maintain a normal weight because of their efforts to counteract the high caloric intake of an eating event. However, the cycle of overeating and purging may cause other health issues, including problems with the digestive system or heart irregularities, along with problems from a poorly balanced diet.

One study found about 25% of women with this condition have PTSD. (Blinder, et al., 2006), In a study of women in a residential treatment program for eating disorders, almost three-quarters had experienced significant trauma, and more than half reported symptoms typical of PTSD (Brewerton, 2008).

Anorexia

The least common eating disorder, but potentially the most deadly, is known as anorexia nervosa medically. People who have this condition typically think of themselves as overweight, leading to chronic under-nutrition. People literally starve themselves to death, thinking the whole time that they are obese. People with anorexia are six times more likely to die prematurely than members of the general population (DeNoon, 2011). People who are diagnosed with anorexia in their 20s are 18 times more likely to die prematurely.

Exactly what causes eating disorders may well be a mix of several factors: genes and family history are considered possible factors, along with environment and culture.

Causes and Treatment Options

Exactly what causes eating disorders may well be a mix of several factors: genes and family history are considered possible factors, along with environment and culture. Physical and emotional health, particularly PTSD, are additional factors which may offer opportunities to influence the course of this condition (When Food Consumes You, 2017). Early diagnosis and treatment are critical.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes five evidence-based treatments for PTSD: cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), prolonged exposure therapy (PET), eye movement desensitization and reprocessing (EMDR), and accelerated resolution therapy (ART). However, prolonged exposure therapy may increase the risk of binging at least temporarily (Brody, 2015).

Recent research has suggested that accelerated resolution therapy may be most effective. Walden Behavioral Care, which specializes in treating people with eating disorders, psychiatric conditions, and other comorbid issues, conducted an informal study for purposes of self-improvement. The study, which included 28 people, showed a significant reduction in self-reported levels of stress following treatment with ART. Before intervention, participants reported a mean level of distress of 7.62 (out of 10); after treatment, the level had dropped to 3.16, a reduction of more than half.

For help with problematic eating patterns, contact a therapist.

References:

1. Blinder B. J., Cumella E. J., & Sanathara V. A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine, 68, 454-462.
2. Brewerton, T. D. (2008, May 8). The Links Between PTSD and eating disorders. Psychiatric Times, 25(6). Retrieved from http://www.psychiatrictimes.com/articles/links-between-ptsd-and-eating-disorders
3. Brody, B. (2015, January 24). The link between trauma and binge eating. Retrieved from https://www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/features/ptsd-binge-eating#1
4. DeNoon, D. J. (2011, July 12). Deadliest psychiatric disorder: Anorexia. Retrieved from https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/news/20110711/deadliest-psychiatric-disorder-anorexia
5. Post-traumatic stress disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
6. Walden Behavioral Care reports aggregate quality assessment information on patients treated with ART. (n.d.). Retrieved from http://acceleratedresolutiontherapy.com/walden-behavioral-care-pilot-study-art/
7. When food consumes you. (2017). Retrieved from https://newsinhealth.nih.gov/2017/11/when-food-consumes-you