If you are living with unresolved trauma memory, whether or not it’s posttraumatic stress disorder (PTSD) or dissociative identity disorder (DID), you will almost surely bewilder people some of the time. We both know you want this not to happen, but, as is surely obvious to us, you have little or no choice in the matter, other than to avoid triggers to the extent that you know them and can anticipate them. The real problem here is that you can’t avoid all triggers. So, you will bewilder and maybe even frighten people a certain amount of the time.
Your Trauma Story, Triggered in Public
Triggered breakdowns in social situations can have serious consequences. One person I knew and worked with almost went to prison, because of violent defensive behaviors that were triggered by a sense of extreme threat, when she felt abandoned by an intimate. Another person I like and respect recently encountered a massive trigger, entirely unexpectedly, while out for a social evening with family. He became almost unable to function, and felt absolutely terrible because there were people present who surely had no idea what was happening.
There are many things that are truly awful about such situations, but one of the worst is the feelings of shame that seem always to follow such episodes. People tend to feel defective, and at fault. Now, we know this is entirely irrational, but the feelings are very real, and they are hard to avoid.
This is especially a problem with DID (think of it as a kind of super-PTSD), where shame issues and dynamics tend to be a Really Big Deal. I want to propose that working on resolving this secondary reaction to the primary problem of triggered functional breakdowns in the midst of life is an essential part of your healing. To make this happen you will need to correct how you think about yourself, and from that will come corrections in how you feel. A key part of this is becoming a better storyteller, as you will see.
Your Trauma Story Needs an Update
Two things have to happen, if you are to bring about this engagement and then successfully resolve your highly distressing secondary shame reaction. You must learn what actually happened to you. This basically involves your constructing a story. You should start with a very simple one – something like this:
“Some years ago, a bad thing happened to me, and I was terribly frightened and hurt by it. I have not yet recovered from this, but I’m working on it. Until I finish this work, I will have periods of time where I become gravely frightened all over again and am unable to live my life in the way I’d like to. I can usually recover from this fairly quickly, but not immediately. I need to take care of myself until I have regained my ability to function. Then I need to return to my usual life and my ongoing healing work.”
You may not realize it, but you already have a story about what happened to you. I’ve heard these stories. Here are some:
- I’m crazy. I got crazy after my kids and husband were killed in an auto accident. There’s no hope for me. I’ll always be this way.
- My parents hated me. I’m an awful person. If I had been a better person they would not have hurt me. But I wasn’t, and I’m not. I’m defective. I deserve my misery. It’s my fault.
- I’m one of only two guys who survived when they blew up our truck in Iraq. I’m not any better then those guys who got killed. I should have been killed along with them. I have no reason to have been spared. I’ll never be the same. My life is just gone.
I have a couple of immediate reactions to these stories, every time I hear them:
- You’re not crazy, but your story sure is!
- You really don’t get it. You don’t understand what happened to you. That’s outrageously unfair. Someone should have helped you understand what happened in your brain, and that the change in your life – how you are now – is a perfectly normal reaction some people have to a very NON-normal event or events. We have to talk.
The correct story about what happened to you never includes the “it’s my fault” statement that so often people tell themselves initially. It DOES include a decent description of how stress-overloads can affect some people badly, and for a long time. Why not ALL people? We are still figuring this out, and don’t yet have a good answer. Lots of people fall off ladders, too, with only some of them breaking bones as a consequence. It just happens. It happened to you, and that’s what matters.
So, by whatever means it takes (usually the assistance of an experienced trauma therapist or PTSD professional) you simply MUST get the story you tell yourself straightened out. With that in hand, you’re ready for the next and final step.
Updating Your Trauma Story Prepares You To Tell Other People the Truth
This is probably the most important thing you will do with your story. You are simply not the only one with the wrong story. MOST people have the wrong story. That’s not acceptable. As part of your journey away from completely inappropriate and irrational shame about what happened to you, it is critical that you learn to simply tell the truth to other people, after you’ve learned to tell yourself the truth.
First of all, consider what that means. Think of what you do when you tell a kid about sex. Probably the most critical part of your story about sex is what you do NOT say. All you need to do is tell them what they want to know, and at least some of what they need to know – and all of it in simple, direct terms.
You need to do exactly the same thing with your family, your spouse, your relatives, your boss – or whoever, concerning your PTSD or your DID. Only two things will stop you: ignorance (which is taken care of by getting the story you tell yourself straight), and shame. And the good news about all this is that you really can do it little by little, just like kids and sex!
Start Small, and Go From There
To successfully tell other people about your situation, think hard about what they need to know, and about what they can realistically understand (Can People Without a Mental Illness Understand Us?). Think again about telling a 10 year old about sex: you’re dealing with limited interest and limited ability to understand. Your story should be simple and accessible to them. Now, transfer that idea to the people in your life who you want to understand you better.
PTSD isn’t too tough to talk about, thanks to all the media exposure it’s gotten in recent years. However, a fair amount of that exposure contains some real misinformation. So, expect to correct two common thinking myths: (a) people with PTSD are far, far more likely to be frightened and withdrawn than angry and assaultive, and (b) PTSD is highly treatable, but too often it is not treated, so people end up living with it unnecessarily.
With DID, the challenge is significantly tougher. I strongly recommend that you not attempt to actually describe DID, at least not at first. It’s tough to give a simple account of alters and switching. Few therapists can do it, so your chances aren’t good. Instead, just describe it as “complicated PTSD” (not complex PTSD [C-PTSD] – that’s different). I’ve seen (and heard) that this usually works rather well.
Remember, you’re talking to a 10 year old. They don’t need to know much! There are large payoffs for getting your story straight and then telling it to others. It will clarify and strengthen your own mind, and it will truly help those around you. When we understand what’s actually happening – even a little, we tend not to get frightened by it, and this benefits everyone.
By being an ambassador for yourself, for people like you, and for the disorder you’re working to overcome, you became a major asset to all of us. I personally think this is an opportunity you really shouldn’t pass up! But do it for yourself, first of all, for you are without doubt the most important person the story, at all points in this process. You first, then come talk to us!
“As far as your brain is concerned, a broken heart is not so different from a broken arm.” —Naomi Eisenberger, PhD
Social rejection is painful.
When we feel rejected, our self-worth is dealt a heavy blow. We lose a sense of security, a sense of belonging, and perhaps a sense that we matter.
At its most extreme, the pain from social rejection can lead to suicide, according to the interpersonal theory of suicide.
Although we know social rejection is painful, neuropsychological research has revealed how social rejection affects the same regions of the brain as physical pain, and therefore respond similarly to the affect of painkillers.
In the study, participants were given acetaminophen (commonly known as Tylenol), or a placebo pill. After three weeks of regular doses, those who received the drug reported lower levels of social pain, in addition to showing lower levels of pain in fMRI brain scans:
…acetaminophen reduced neural responses to social rejection in brain regions previously associated with distress caused by social pain and the affective component of physical pain…
These findings are particularly relevant given the recent opioid epidemic. Beyond over-prescription and their highly addictive properties, this drug of choice might also tell us something about the health of our social context.
Beyond coping with physical pain, individuals who feel rejected may be self-medicating with opioids to cope with social pain.
We can see this phenomenon in studies on populations with a heightened risk of opiate use: groups with low income, low education, those lacking permanent housing, those who are unmarried, recently released prison inmates, veterans, and LGBT groups.
Once someone begins experiencing an opiate addiction, they may then find themselves feeling even further rejected, especially if it results in heightened poverty. In turn, this perpetuates the downward spiral of self-medicating to further reduce the social pain, in addition to the physical pain of withdrawal.
Promoting social health means combating barriers to social integration. These barriers include stigma, prejudice, economic inequality, and lack of social programs/support for individuals undergoing major life transitions, as seen among veterans in transition to civilian life.
When treating and preventing opiate addiction, we need to be mindful of the social dimension of the issue, in addition to the biological and psychological.
Mission: TAPS is a national nonprofit organization offering comfort and care to anyone affected by the death of someone who served in the Armed Forced. We offer peer-based emotional support, crisis response and intervention, grief and trauma, casework assistance, long-term survivor wellness, and community and military education and outreach.
Results: Each year, TAPS hosts and participates in events across the country to provide support to all who are grieving the loss of a loved one who has died while in military service. Through our national and regional seminars and good grief camps, retreats, special presentations and fundraising events, TAPS is able to provide hope and healing. Our special presentations offer survivors, caregivers, military personnel, supporters and friends the opportunity to learn more about military grief and learn about the mission of TAPS.
Target demographics: families of fallen military service members heal and rebuild their lives.
Geographic areas served: the United States and around the world
Programs: TAPS is a national non-profit organization made up of, and providing services at no cost to, all those who have suffered the loss of a loved one in the Armed Forces. The heart of TAPS is its national military survivor peer support network, which brings together the families, friends and coworkers of those who are suffering a loss. TAPS, an official Veteran Service Organization, also offers bereavement counseling referral, provides case worker assistance that carries the work of the casualty assistance officers into the future, hosts the nation’s only annual National Military Survivor Seminar and Kids Camp, publishes a quarterly journal mailed at no charge to survivors and care givers, maintains a comprehensive website, and offers a toll-free crisis and information line available 24 hours daily through 1-800-959-TAPS. TAPS offers total care and support for the military family experiencing a casualty. Please call on us to help!
Source: On Missing Combat
For patients with PTSD to derive the greatest benefit
from available evidence-based psychotherapies and
psychiatric medications they must be able to fully
engage in their treatment. However, a wealth of
published data demonstrates that a majority of service
members and Veterans with PTSD are not successful
in doing so (e.g., Hoge et al., 2014; Spoont, Murdoch,
Hodges, & Nugent, 2010). Patient engagement in
mental health services has received relatively little
attention as compared to the substantial consideration
given to patient engagement in the design and
delivery of patient-centered physical health care
(Carman et al., 2013). Below, we provide a selective
review of the available literature in an attempt to
describe factors that make patients more likely to
engage in PTSD treatment and identify interventions
that may improve patient engagement in PTSD
treatment, with a focus on evidence-based treatments.
Following Gruman et al.’s (2010) conceptualization,
we define patient engagement as the behaviors
required to achieve optimal benefit from health care.
The review focuses on the three aspects of
engagement most often examined in the PTSD
literature: treatment initiation (utilizing care; starting
treatment), retention (completing the intended
course of treatment), and adherence (performing
behaviors in the treatment plan). The scope of the
review is adult patients’ engagement in PTSD
treatment; however, due to limited data regarding
civilians’ engagement, a majority of the studies
reviewed focus on active duty and Veteran populations.
Following the review, we evaluate this literature
within a patient engagement conceptual framework
and suggest future research directions.
Factors Associated with Engagement
Demographic factors such as age, gender, race, and
ethnicity have been the most frequently studied and
are among the few variables that have consistently
demonstrated significant associations with treatment
initiation and retention across studies. Patient
age has r
epeatedly been found to predict initiation
and retention in general mental health treatment,
psychotherapy, and evidence-based psychotherapy
(EBP) in that younger patients are less likely to
initiate and be retained in treatment (Goetter et al.,
2015; Kehle-Forbes, Meis, Spoont, & Polusny, 2016;
Spoont et al., 2014). Patient race has also been
shown to be associated with treatment initiation and
retention, although not as consistently as age
(Goetter et al., 2015; Spoont, Hodges, Murdoch, &
Nugent, 2009; Spoont et al., 2015). For example,
African American and Latino Veterans were found
to be less likely than white Veterans to receive
a minimally adequate trial of treatment (both
psychotherapy and pharmacotherapy for African
American Veterans; pharmacotherapy only for Latino
Veterans) within six months of PTSD diagnosis
(Spoont et al., 2015). Negative attitudes towards
psychotherapy and pharmacotherapy (e.g., believing
that treatment wouldn’t be helpful) accounted for
the disparity in Latino Veterans’ retention, but the
disparities in African American Veterans’ retention
remained after accounting for treatment-related
beliefs (Spoont et al., 2015). Findings regarding
the associations between engagement and other
demographic variables such as Veterans’ service
connection status, marital status, and employment
have been equivocal (Goetter et al., 2015; Mott,
Mondragon, et al., 2014; Grubbs et al., 2015).
Potentially modifiable factors underlying differences
in engagement between demographic groups should
be the focus of future research.
Pretreatment symptomology and patients’ social
environments are two nondemographic factors that
have been subject to considerable study. Research
regarding the impact of PTSD severity on initiation
and retention has yielded inconsistent results, with
some studies showing that higher total levels of
If you want to read the entire article click on the fallowing link; Patient Engagement in PTSD Treatment