"PTSD is caused by a person’s experience of an extremely stressful situation, such as threatened or actual violence toward the person or toward someone close to that person. Symptoms of PTSD include persistent recollections (e.g., dreams) of the trauma, avoidance of any stimuli (e.g., places or people) associated with the trauma, and persistent symptoms of increased arousal (e.g., hyper vigilance). PTSD is a relatively common consequence of physical or sexual child abuse" (Miller et al. 1997; Widom 1999)
Traumatic stress is an experience of overwhelming fear that may lead to PTSD if it is not acknowledged and worked through. Traumatic stress from a single event, such as a train crash can disintegrate personality causing dissociation in people whose brains are fully and securely developed. When children grow up in a violent and abusive environment their entire experience of childhood can be traumatic. The greater the trauma the more the child relies on the dissociative defence to cope so dissociative people have been highly traumatised in childhood, multiples have experienced the most severe traumatic stress which in the large systems was likely to be in the most horrific circumstances such as paedophile and satanic abuse rings.
There are two components to trauma:- the external event, a confrontation with a real or perceived threat to life of personal integrity to self or others and the internal experience of fear, hopelessness and terror. Secondary traumatisation is also common amongst children who witness abuse and can also lead to PTSD.
How the body and mind responds (Flight Fight Response)
When danger is perceived the mind and body switches from normal functioning (parasympathetic nervous system or PNS) which manages bodily functions out of our awareness to the Flight Fight Response (sympathetic nervous system or SNS). Fear inducing stimulus (trauma) is split off from the thalamus (the conscious, thinking bit in the limbic system) and transmitted in 12 milliseconds for emergency processing in the primitive amygdala in the mammalian brain which responds with ‘fight or flight’ causing dissociation. Oxygen supply is reduced to non-essential areas like digestion, the extremities and sexual arousal and increased to the heart and other muscles. Blood supply is also reduced to the cortex and mid brain- specifically the hippocampus which acts as the communication route between the limbic system and cortex (a kind of cognitive map for feelings) and the Broca’s area in the left frontal cortex which creates narrative memory and allows us to express internal experience in words.
When the individual returns to their normal associated state the dissociated memory has not been processed into normal memory storage so it is not accessible in normal recall.
In other words the trauma causes dissociation which is the brain's response to protect us from the traumatic event. A Survivor may have no recognition of it in conscious awareness but the memory will be waiting to resurface as post traumatic stress (PTS) the next time the individual is dissociated or asleep.
Normal Trauma Recovery.
Most people are able to recover spontaneously, firstly they get safe and recognise that they are safe but probably will not yet be able to recall events. As stress levels start to fall the energy in unprocessed memory start to discharge causing flashbacks, nightmares etc. Others tell them what has happened "you're arm hurts because you broke it in a car accident “so the traumatised person starts to make sense of flashes of memory which slowly becomes a narrative. Then they start ‘telling the story’ over and over again and when there are plenty of friends and family around paying attention they often join in providing a reality check… your arm is broken because you crashed the car. Eventually the story becomes ‘real’ and needs to be told less until it becomes ‘something that happened to me’ not an overwhelming experience. Traumatic stress is very much a social phenomenon as it damages the ability to relate to others and make sense of the world…the very processes needed to recover from it.
Post Traumatic Stress Disorder (PTSD)
Delayed PTSD is typical in adults who were abused as children when there is no acknowledgement of the trauma- without an extrenal reality check the recovery process couldn't begin so the memories remained hidden. Production of the hormone, cortisol, which normally inhibits the alarm response, is not activated so the body continues to produce flight or fight hormones which increase stress- this is why Survivors feel anxious, sometimes develop OCD and talk about ‘getting safe’. PTSD is very common amongst Survivors as memories in the form of flashbacks start resurfacing in adulthood when they have no memory of the abuse so struggle to make sense of it. The symptoms- flashbacks, nightmares, ruminating and obsessive thoughts occur when something that is associated with the event triggers the split off recording in the amydala which starts to come into conscious awareness. 'Someone I love/who looks after me hurt me.' Unable to accept the unacceptable the fight or flight response is reactivated, stress levels increase and the memory is pushed back into unconsciousness. Flashbacks are terrifying- the memory has not been processed so fear is re-experienced while the knowledge of the event is suppressed. Triggers may also become associated with things, feelings and people around during a flashback but not at the traumatic event- which may develop into phobias. Since it is almost impossible to identify all the triggers multiples they think they’re going mad so we explain what’s going on and help you get control over your recovery.
Dissociative Identity Disorder (DID) also known as Multiple Personality Disorder (MPD).
DID is an attachment disorder and occurs when the normal healthy dissociative defence becomes fixed due to recurrent trauma, (see Trauma Bonds) usually sexual and ritualistic where the child has no chance of escape, there was nowhere safe for this child. Faced with the choice of splitting off the experience or dying children are unable to process the traumatic material which remains suspended in unconsciousness- sanity is preserved but memory and consequently their identity is sacrificed. When persistent trauma is inflicted before the age of around three there is no split as the origonal psychic energy in the personality remains fragmented. Persistent trauma leads to a build-up of unprocessed toxic memory which becomes energised and evolves into alters to undertake specific roles to manage future abuse. When this goes beyond one alter (split personality) a system of alters develop to manage their abuse and prevent memories of abuse coming into conscious awareness (Dissociative amnesia).
The 'front person,' who we call the Chief Executive Alter or CEA at I et al (the alter with the primary life) doesn't develop symptoms of Complex PTSD or DID until the child gets ‘safe’- either by physically maturing and being able to defend their self or by physically getting away.
Why didn't I know I was a multiple?
CEA's (and some alters) knowledge of alters taking the executive power (coming ‘out’/going ‘up front’) when triggers energise unconscious material usually comes from other people as their only awareness is of lost time, but as the CEA has always had alters there would always have been lost time (zoning out/disappearing, etc.) which would have been normalised. DID is Complex PTSD so has all the symptoms of PTSD but as it is the supreme survival defence against the memories of abuse which are held by the alters who must maintain their existence outside out of the CEA's awareness to preserve the defence. DID is a self-sustaining system so any awareness or suspicion for a CEA of multiplicity is a symptom of improving psychological health.
It is only recently that DID has been officially recognised as a mental health issue and many multiples have a number of diagnosis which mask the underlying disorder. There is still a huge stigma about DID and child sexual abuse, especially satanic ritualistic abuse, ritualistic abuse and paedophile rings. DID is a defence mechanism, Survivors are extremely good at hiding it from everyone including themselves.
There are numerous excellent descriptions about PTSD you can explore on the web but none about how PTSD develops for an abused child. It was helpful for us and many clients to understand our 'madness' so we attempt to explain it on these pages.
To understand how PTSD develops for Survivors it is useful to have an understanding of how a normally healthy mind copes with Trauma click here.
Next we look at how PTSD develops for Dissociative Survivors who are not Multiple (known as singletons) here
Lastly we look at how DID/MPD or Multiplicity develops here
At I et al we are experienced working with all Survivors of child sexual abuse and PTSD. Click here to see how we can help.