Me Too

I have been doing a lot of thinking about the #metoo movement. It has inspired many women to share their stories of sexual assault and violence. Strong women. I am amazed by all the strength I see in the women who have gone public to tell their stories of sexual assault and violence. It has inspired me to do the same. It is time. The stigma attached to sexual assault has to end. It is time that people placed the blame where it belongs. This is hard for me to write, and harder to share, but it is time.

My story starts before conscious memory. I was two when he started grooming me. Two. I would sit on the couch, and he would have me spread my legs so he could see my panties. He would bounce me on his knees, and stick his fingers between my legs. Sometimes, my mom was right there.

He was never that gentle, kind man that lured me into trusting him. He was my father, and he was all I knew. He was mean. He was a drunk. He was a drug addict. He was many things, but nice? No. Manipulative? Yes. He beat me, and he beat my mom in front of us. He was relentlessly cruel.

When I was five, he laid me down on his bed, put a knife to my throat, and told me he would kill me if I told. Then I watched the light beams overhead fracture into a million pieces as my world fell away into a flurry of pain. My psyche disappeared that day. Thank god I do not remember details.

When I was seven, I had this amazing friend who was deaf and wheelchair bound. I don’t really know how we became friends; communication had to of been hard, but we were little and we made it work. I would go to her house for lunch almost every day. We would have grilled cheese sandwiches while sitting in her yard. One night, my mom babysat my friend, and my mom had to run to the store. While she was gone, my father tried to do horrible things to my friend.

The next day, I went to her house for lunch, as normal, except her mom wanted us to come inside for grilled cheese that day. Right after she gave me my sandwich, she asked me a question about my father, and I couldn’t speak. I dropped my sandwich into my lap, and clammed up and started crying. My friend’s mom called the police, and they took us to the hospital after I told them what my father had been doing to me, my whole life. That day, we all went to foster care.

My father went to jail for his crimes. He was sentenced to sixteen years, but only served twelve. He was released the same summer my oldest daughter was born, 1999.

When I was nine, my mom rented this house from this man who lived in a shack in the back of the house, I can’t explain it better, but the shack wasn’t exactly in our yard, but it was on the same property. The landlord was nice. He was gentle and kind. He always had sweets and fun things to do. His shack was a place the kids liked to hang out.

It was Easter when I went to his place to give him some eggs.  I was alone, and uncomfortable, but he said he had something for me, so I went into his shack. I don’t remember if he had anything for me besides his fingers between my legs, but I ran out of there and told my mom immediately. She called Social Services instead of the police. Nothing happened, except we moved to a new place.

When I was ten, my mom was addicted to drugs, and she was often not attentive to her children. There were many nights we would spend the night alone while my mom was across the street at her friend’s house getting high. She had this friend, a man, who she got high with, and who hung around all the time. I didn’t really have an opinion of him.

One night, him and my mom were hanging out in our living room, while us kids all slept. I woke up to someone taking my panties off. He had told my mom that he was going to the bathroom, and came into my room instead. I slept on the bottom bunk, and shared my room with my little sister. He pulled her blankets down so I couldn’t see him, and when I kicked him, he ran out of my room and ran into the living room. I suppose he must have thought I would go right back to sleep, but I got up. I went into the living room and saw him sitting there, and I knew it was him who had taken my panties off and was touching me in my sleep. I told my mom I wanted to take a shower. She said it’s three in the morning to back to bed. I told her I needed to talk to her, and took her into my room, and told her what had just happened. She found my panties behind the toilet, where this man had thrown them when he ran out of my room. After kicking him out, my mom called the cops. They picked him up a couple of blocks away. Come to find out, he had been molesting many children I knew, both boys and girls. He was sentenced to six years in prison. Six years. At least four kids testified against him, and he got six years in prison. Doesn’t seem long enough.

For six years after that, the only abuse I had to deal with was the physical, mental, and emotional abuse my mom put me through. It’s sad but once you are a victim of sexual assault, you are more likely to be victimized again, and again. And those statistics have certainly proved true for me.

When I was sixteen, I went to a party, and got drunk. My friend put me in his roommates bed, because his roommate was gone for the weekend. I had never met his roommate. Sometime in the middle of the night, I came to and was being raped, but I was too drunk to do anything about it. When I woke up the next day, I couldn’t find my clothes, there was blood everywhere, and I was so sore. I have no memory of that night to this day. I finally found my clothes and got out of there. I reported the roommate to the police, so did two other girls. This guy was a serial rapist. For raping three girls in three nights, he got six months in county jail. Six months.

Not every woman you meet will have a story like or similar to this, but three out of four of them will. That’s three out of four women who have had a sexual crime committed against them. And, that’s only the statistics on crimes that are reported. Imagine all the little girls out there who can’t report it, who do not understand that this is a crime. Who do not understand that the most common perpetrator of such crimes are people you love and care for. People you would never imagine doing such a thing to you. The long term effects of such crimes, I will cover at a later date, because that’s enough sharing for one day.

If you know a woman who has been sexually assaulted, please be gentle and kind, be understanding and patient. Most survivors I know do not want pity. They want to place the blame where it belongs.

You are not alone.  I am here for you. #metoo

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Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a neuropsychological disorder that gained attention over the years due to soldiers returning from war with what use to be called “shell shock.” Post-traumatic stress disorder, however, is not solely associated with soldiers returning from war. In fact, the vast majority of people who suffer from PTSD is found in another population; adult women who suffered from childhood sexual abuse. The research for how childhood trauma, especially abuse by one’s caregiver, affects the brain is still a relatively new field, but evidence has revealed that it can change one’s brain, and thereby, change how a person responses to trauma in the future. Researchers also know that early victims are more likely to be re-victimized in the future; increasing one’s chances of developing PTSD. In this paper, I will discuss the effects of PTSD on the adult brain of a childhood sexual abuse survivor.

Post-Traumatic Stress Disorder

Post Traumatic Stress Disorder (PTSD) is a neuropsychological disorder that is caused by exposure to extreme trauma and stress. These incidences; sexual assault; unexpected death of a loved one; threatened death to one’s self or a loved one; obtaining or being threatened with serious bodily harm; or witnessing traumatic events such as a serious car accident (such as in the case of first responders); living through a natural disaster; and experiencing war; can cause a person to have vivid, intrusive, reoccurring flashbacks, nightmares, thoughts, or emotional or physical reactions to either internal or external cues that remind one of the incident  (DSM 5, 2013). In response to these intrusive memories, individuals will often employ some type of avoidance behavior; they will avoid talking about or being reminded of the event(s) in any way.

In addition, patients will experience a wide range of emotions that are negative in nature, and they must experience at least two of the following symptoms, in addition to the above symptoms, to be diagnosed with PTSD (DSM 5, 2013). Shortly following the event the patient may be unable to recall details of the incident; they may have overtly negative thoughts about themselves and/or the world; they may have an exaggerated sense of blame for either themselves or someone else for causing the incident; they may experience negative affect (an overwhelmingly negative view of the world); they may experience a decreased interest in participating in life or activities that once interested them;  they may have extreme feelings of isolation; and they may have difficulty experiencing positive affect (DSM 5, 2013).

After a traumatic event, individuals with PTSD will experience at least two of the following reactivity symptoms; they may become extremely irritable or aggressive; they may partake in risky or dangerous behavior; they may become hypervigilant (meaning that they may be always “on their guard” or “ready to run” at any time); they may have a heightened startle response; and they may experience difficulty with sleeping and/or concentrating (DSM 5, 2013). The symptoms must also have a duration of at least one month, they must cause significant distress or functional impairment in the patient’s life, and they must not be due to substance use or another psychological disorder (DSM 5, 2013).

Epidemiology

The National Comorbidity Survey Replication, conducted between February 2001, and April 2003, found that a diagnoses of PTSD, within the adult American population, was a remarkable 6.7 percent. Among men that percentage was 3.6 percent, and among women that percentage was at an astounding 9.7 percent of the population (Gradus, 2017). Women are almost twice as likely as men to experience PTSD in their lifetime, and this is mostly due to either childhood sexual abuse and/or, sexual assault as an adult.

Long term trauma, trauma in which the victim is under complete control of the perpetrator and cannot escape, such as childhood physical or sexual abuse, causes additional symptoms in the victims that may not manifest until later in life, and/or, they can or have, become chronic; causing severe dysfunction in the victim’s life and in their interpersonal relationships. Although it is not listed in the DSM 5, Complex PTSD, is a subtype of PTSD that only effects victims of long term trauma.  Survivors of long term trauma will often display issues with emotional regulation, consciousness, and self-perception; they may have a distorted perception of the perpetrator, often attributing total power to the perpetrator, or becoming preoccupied with revenge; survivors may experience a plethora of problems in their interpersonal relationships, including being unable to trust anyone, repeatedly looking for a “rescuer,” promiscuity may be a problem, or they may take the opposite route and never date anyone; and often survivors are plagued with a feeling of unworthiness, hopelessness, and despair (National Center for PTSD, 2016). Often survivors of childhood sexual abuse have relationships with people who continue to abuse them, or their children. Breaking the cycle of abuse, becomes a major aspect in treatment for these patients.

I started this paper with the belief that not too much research had been done regarding PTSD on victims of childhood sexual abuse, but I found plenty of research. I chose this topic because I am one of the many survivors of childhood sexual abuse, and I plan on targeting trauma, stress, and anxiety related disorders after I complete my doctorate in psychology; I want to know how to help survivors cope with the abuse they suffered through, how to heal from the past, and how to have a quality relationship with a partner in the present.

Natural History of PTSD

Almost everyone experiences some sort of traumatic event at least once in their life, but not everyone develops PTSD. Not everyone with PTSD has been through a dangerous situation either. Symptoms usually start occurring within three months of the incident, but they may not develop until years later. The course of PTSD varies, some patients recover within six months of treatment, but for some patients the condition may last much longer, or it may become chronic. It is important that people who do suffer from PTSD seek professional assistance as soon as possible. Treatment usually consist of psychotherapy and medication, and with treatment, a patient has an increased likelihood of recovering from PTSD. Without treatment a patient may go on to experience additional life problems to include; drug or alcohol abuse, depression or anxiety, physical symptoms of chronic pain, employment problems, and/or, relationships problems (National Center for PTSD, 2016).

Methods used to Diagnose PTSD

Psychologists have a variety of assessments available to them to diagnose PTSD. Some, such as the Beck Anxiety Inventory – Primary Care (BAI-PC), are self-reports, that the patients fill out on their own and then gives to a physician. The BAI-PC is a seven item self-report assessment that screens for anxiety, depression and PTSD, as well as other disorders that are highly co-morbid with PTSD, such as drug or alcohol abuse (Mori, 2003).  A positive score of five indicates the patient may suffer from PTSD, but will need to be screened again by a professional.

Other assessments are designed for use in a primary care setting. The Primary Care PTSD Screen for DSM – 5 (PC-PTSD-5) is a five item screen that was designed for use in a primary care setting and is used to determine those patients with probable PTSD (National Center for PTSD, 2017). However, a positive indicator on this assessment means that the patient should undergo a structured interview by a psychologist who specializes in trauma and stress related disorders. If a psychologist determines that a patient has PTSD, the use of medication may be required, but cognitive behavioral therapy and exposure therapy are two recommended treatments for PTSD (National Institute of Mental Health, 2016).

Risk Factors

While anyone can experience a traumatic event that results in a diagnosis of PTSD at any time, and at any age, there are certain risk factors involved in developing PTSD. People who have experienced long term trauma, or have a genetic predisposition to the disorder are more prone than others to developing PTSD after a traumatic experience. However, most people will not develop PTSD due to high resilience factors.

Some things that may increase one’s chances of developing PTSD include, living through dangerous events and traumas to include natural disasters; getting hurt; seeing another person hurt, or seeing a dead body; childhood trauma; feeling extreme fear; having little or no social support after the event; dealing with additional stress, such as the loss of a loved one, loss of a job or home, and being injured due to, or after the event (National Institute of Mental Health, 2016).

Some things that may make a person more resilient against PTSD include, seeking out assistance and social support, friends, family, and a local support group are all good ideas; learning to feel good about one’s own actions during and following the traumatic experience; and having a positive coping strategy after the event (National Institute of Mental Health, 2016). Research is ongoing about the effects of PTSD on the central and peripheral nervous systems, however, some remarkable discoveries have already been discovered, and may assist in the diagnosis and treatment of PTSD in the future.

Neurological and Biological Systems Involved in PTSD

Women who have suffered and lived through prolonged childhood sexual abuse make up anywhere from eight to thirty-three percent of the American population, depending on how pervasive the abuse was (Steine et al., 2017). They are more likely to develop intimate relationships with abusers, and the abuse continues into adulthood. The patients who develop PTSD report multiple types of abuse, physical, mental, emotional, sexual, and neglect (Steine et al., 2017).  PTSD effects these patients differently than it does patients who have PTSD but did not suffer childhood sexual abuse (Binder, 2013). Post-traumatic stress disorder effects many parts of the brain, and those are some of the very parts of the brain affected by childhood sexual abuse (Blanco et al., 2015).

PTSD is an extremely complicated disorder, and its effect on the brain and hormones in the body are many and varied. The locus coeruleus, a nucleus located at the base of the brain stem, which is responsible for the bodies response to stress, among other things such as cognition and memory, releases increased amounts of norepinephrine (a hormone) into the body in response to stress. This makes the person more aware of their surroundings, and activates the sympathetic nervous system (flight, fight or freeze system). In patients with PTSD, norepinephrine is released in increased amounts; a patient may have a minor event that reminds them of a past traumatic experience, such as a combination of words, or the way a person touches them, that makes them over-react to the stimulus (Wilson, 2013).

Repeat exposure to trauma, such as in the case of childhood sexual abuse survivors, changes the hypothalamic-pituitary-adrenal (HPA) and endocrine response to stress, as well as its function in metabolic and immune systems of the body (McGowan, 2013). The HPA plays an important role in maintaining allostasis, or the body’s ability to maintain stability amongst challenging environmental circumstances.

The decreased size of the hippocampus shown in most patients with PTSD is related to an increase in the activity of the hormone called cortisol. Cortisol is released in relation to stress and the prolonged exposure to the hippocampus of this hormone has been shown to cause atrophy in the hippocampus, the area of the brain responsible for episodic memory creation. Decreased amounts of cortisol release during the initial event may lead to a chronic over-reaction to stress in patients who later develop PTSD (Sherin, & Nemeroff, 2011).  In addition, functional imaging studies have shown a decrease in response of the prefrontal cortex, and an increase in response from the amygdala in patients with PTSD, leading some scientists to believe that stimulators of the limbic stress system prevail over inhibitors (Malejko, et al., 2017). Since, in PTSD, individuals associate neutral cues with the traumatic event(s), it has been suggested that the interaction between the hippocampus and amygdala, as two regions of the brain that play a role in consolidating memories, may contribute to the intense recollection of trauma experienced by patients with PTSD (Malejko, et al., 2017).

The biological and neurological systems that are involved in, and affected by, PTSD are numerous and varied. Interactions between the stress response system and the threat response systems of patients with PTSD may explain the avoidance and emotional reactivity aspects of PTSD. Reduced connections between the amygdala and cingulate cortex imply a decreased ability to cope with fear vigilance and reactions to threats (Wilson, 2013). Research is underway in regards to genetic factors that may make a person more predisposed to develop PTSD. Recent research has revealed a relationship between the SLC6A4 serotonin transporter genotype and elevated PTSD symptoms (Wilson, 2013). Future studies hope to reveal the interconnectedness between all the neural pathways involved in PTSD.

Treatment Options

Diverse pharmacological and psychological treatments have been used for the treatment of PTSD. Pharmacological treatment doesn’t erase the traumatic memory of the incident(s), instead it aims to control such symptoms as anxiety, depression, and/or alcohol and drug related disorders, all common co-morbid diagnosis with PTSD. Medication to help with sleep disorders and/or nightmares may be prescribed as well (National Institute of Mental Health, 2016). Antidepressants, anti-anxiety, and sleep medications are common symptoms control treatments for PTSD. However, the best therapy for PTSD is psychotherapy.

Psychotherapy, also known as “talk therapy,” is the best know treatment for PTSD, and there are various forms of psychotherapy. The two best known treatments for PTSD are cognitive behavioral therapy, and exposure therapy. Both types of therapy should only be attempted with a psychologist who specialized in trauma and stress related disorders.

Cognitive behavioral therapy helps patients to question and then alter their dysfunctional perceptions and reactions to trauma by confronting traumatic memories, and retraining the patient in responding to those memories (Malejko, et al., 2017). Sometimes patients remember the event differently than it happened and in that case psychologists will help the patient remember it the correct way, or help them to make sense of the bad memory. Sometimes the patient may feel blame or guilt for something that is not their fault, and the psychologist will assist the patient in placing blame where it belongs (National Institute of Mental Health, 2016).

Exposure therapy involves slowly introducing aspects, such as tactile, visual, auditory, and olfactory cues that remind the patient of the traumatic event(s) (Malejko, et al., 2017). Occasionally, if possible, the psychologist may take the patient to the place the traumatic incident(s) occurred. This helps patients with PTSD learn to face and control their fear. By slowing introducing the patient to the traumatic event in a safe environment, psychiatrists help the patient cope with his or her feelings (National Institute of Mental Health, 2016). The main theme of treatment appears to be the confronting and restructuring of memories related to the traumatic experience(s).

Psychotherapy helps patients by teaching them about trauma and its effects on the body and brain. It teaches patients how to manage and control their anger, as well as techniques to relax, and calm down. Patients should learn about how to sleep, exercise, and eat better; learning the effects of how these things can effect responses in the nervous system. In addition, psychotherapy is designed to teach patients how to identify and cope with feelings of shame, guilt, disgust, revenge, and how to have a healthy relationship with oneself and with others (National Institute of Mental Health, 2016). In regard to patients with PTSD who also experienced childhood sexual abuse, it is important the doctor imparts to the patient, over and over again, that the abuse is not his or her fault.

Patients are highly encouraged to help themselves as well. Some ways that patients can help themselves recover from PTSD include; taking the first step by talking to their doctor; engage in physical activity every day; break up large tasks into smaller steps, and set realistic goals for oneself. Patients are especially encouraged to engage socially, either with trusted family and friends, or with a support group (National Institute of Mental Health, 2016).  Talking about the event gives it less and less power, and patients are encouraged to talk about the event(s), and triggers to people they trust. Patients should be aware that symptoms will improve gradually over time, not immediately. Patients are highly encouraged to seek professional help in an outpatient facility, such as their local mental health center (National Institute of Mental Health, 2016).

Future Research

Research is still underway on PTSD, but recent research has encouraged scientists and helped them to narrow their focus on different areas and functions of the brain, as well as possible genetic predispositions to the disorder (Sherin, & Nemeroff, 2011).  Some research is looking at trauma victims in acute care settings to try to better understand how the symptoms improve in those patients who heal naturally. Some research currently underway include looking at how fear memories are effected by learning, changes in the body, and sleep. Preventative treatment measures are also underway; scientists are currently looking into how to prevent PTSD following a traumatic experience. Research into trying to predict how a patient will respond to one intervention or another better is also currently underway. With technology improving every year, one-day scientist may be able to pinpoint the exact gene and part of the brain in which PTSD starts to develop (National Institute of Mental Health, 2016).

Conclusion

PTSD is a debilitating disorder that activates the bodies sympathetic nervous system causing the patients to experience a heightened response to stress and trauma, and minor cues of both internal and external stimuli that results in an over exaggerated startle reflex, and intrusive memories of the incident(s). Neurological studies have shown an extensive connection between the stress and fear response in the body’s central and peripheral nervous systems. Long term exposure to trauma, such as in the case of survivors of childhood sexual abuse, shows an increased probability of developing PTSD if one is exposed to trauma as an adult. Unfortunately, survivors of childhood sexual abuse are more likely to engage in unsafe activities and relationships that often result in exposure to more trauma. Psychologists should focus treatment on confronting and reshaping behaviors toward bad memories and traumatic experiences. PTSD is a curable disorder under the direction of a specialists who exposes the patient to the traumatic experience in a safe environment over a long term period. Patient can sometimes expect to see improvement in as little as six months, but, depending on the type of trauma one is exposed to, and its duration, symptoms may become chronic, but manageable. Patients must be willing to take the first step in talking to their primary care provider. “Trauma creates change you don’t choose. Healing creates change you do choose” (Michelle Rosenthal). One must choose to heal by taking away the power of the traumatic experience by talking about it, and remembering that you are not alone.

The Last Two Weeks

The last two weeks has been spent devoted almost exclusively to homework as I have a huge research paper due – tomorrow. UGH! Now that I have all the research done, and I am well versed in the subject – I have no idea what to write. My mind is a muddle of thoughts.

I have spent the last two weeks studying and reading about Multiple Personality Disorder (MPD), or, as it is now known as in Diagnostic Statistical Manual: Five (DSM-IV), Dissociative Identity Disorder (DID). As far as I can tell, it is one of the only Psychological Disorders that is caused entirely by human action – more specifically, childhood sexual abuse and extreme trauma.

The stories I have read over the last two weeks would make anyone’s mind or psyche, run, and I have had a hard time wrapping my head around it. People who suffer from DID recount stories of extreme trauma and abuse – some stories that tell of satanic ritual abuse. In a society that denies the existence of such an atrocious act, it’s hard to believe these stories, but at the same time, it’s hard not to. These poor people suffer their whole lives, not understanding what is wrong with them, why they lose time and behave in ways that no rational adult would behave.

Childhood abuse is a subject that is taboo in our society, sexual abuse is something no one wants to talk about. But the truth is one in four women will experience some form of sexual assault or harassment in their life. The department of Social Services, nationwide, receives over three million phones calls a year from people who are concerned about a child they know.  Three million. Some are calls about the same child, and some are calls about multiple children in the same home. But the truth is; child abuse is a subject that needs to be brought out into the light; it’s been hiding in the dark alley long enough.

Many children suffer from neglect, so many the number is unknown. Even more children suffer from emotional abuse. Children are the most vulnerable to abuse as they are completely dependent upon the people in charge of their care. Children are also the most forgiving. If a parent abuses a child, that child will continuously love the parent, and they will place the blame for the abuse on their selves. How sad that they think they are bad and deserve the abuse? No one, especially a child, deserve abuse, of any kind.

Being a parent can be hard, and frustrating, and sometimes it can be hard to remain calm. Especially when you are listening to your child scream for the fourth hour in a row, and no matter what you do, they will not quit crying, but there are ways to remain calm when dealing with a difficult child. The best thing to do when you feel yourself getting overwhelm is take a break. Walk away. Call a friend and have some adult time. Go in your backyard and scream. Punch a pillow if you need a physical release. Please do not take it out on your child.

If you feel like you may suffer from an anger issue, please seek assistance. There are many Mental Health offices in the United States. As well as crisis hotlines that are available twenty-four hours a day. If all you are feeling is overwhelmed, and just need someone to talk too, you can still call these hotlines. That’s what they are there for.

If you are a child in an abusive home, there are people available to help you. The fear of telling is a conditioned response. You have been told that more bad things will happen if you tell. Here’s the truth: the only way the abuse will stop is if you tell. Please tell. Tell a teacher. Tell a friend. Tell a friend’s parent. Tell. Tell. Tell. And remember: The abuse is NEVER your fault.

Hotline Numbers for in the United States:

National Domestic Violence Hotline
(800) 799-7233

National US Child Abuse Hotline
(800) 422-4453

Teen Help Adolescent Resources
(800) 840-5704

Rape, Abuse, and Incest National Network (RAINN)
(800) 656-HOPE

National Domestic Violence/Child Abuse/ Sexual Abuse
(800) 799-7233

Judge Baker Children’s Center – Child Abuse Hotline
(800) 792-5200

Child Help USA National Child Abuse Hotline
(800) 422-4453

Covenant House
(800) 999-9999