Approximate reading time 15 min
Happy Easter:-)
Today was my last day with Poppy and Ginger. What can I say, as always they were adorable. They pretty much followed me everywhere in that house for ten days solid. Poppy was happy to sleep in the room that I was occupying. But Ginger wouldn’t sleep unless I was sitting down. She is an anxious jumpy little thing….and not a huge fan of public displays of affection….
(Unless of course, I am kissing Poppy then she is all too happy to jump in between us and lap up some love)
I attempted to have a bath yesterday and Ginger popped her head over the bath at least 5 times to check that I was still in there.
The absolute worst part of this job…..is saying goodbye.
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I am kind of on a roll now getting my poems up at the moment. I also have my next assignment due at the end of the month so the poems are going to be my stop-gap fillers until then.
(Unless something magnificent happens of course;-)
I have attached a section from my last assignment on developmental trauma because it kind of goes with this poem and I didn’t feel like re-inventing the wheel.
So apologies that it’s a little formal.
(But at least there won’t be any swearing:-)
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Bessel van de Kolk an American psychiatrist began his research into PTSD in 1978 when he started working at the Boston Veterans Administration’s clinic (van der Kolk, 2015). Through his work in this area van der Kolk began to expand his understanding and knowledge to how trauma experienced in a child’s early developmental years can affect a child’s development into adulthood. These could be any type of trauma such as maltreatment, family violence, or a disruption in attachment to their primary caregivers. Complications during birth, or early medical interventions can also give rise to traumatic experiences (van der Kolk, 2015). While van de Kolk believes PTSD to be a good definition for acute trauma in adults he advocates that childhood traumas, that occurs while a child’s brain is still developing, ultimately have a much more pervasive and long-range influence on the child’s self-concept, on their sense of the world and on their ability to regulate themselves. (van der Kolk, 2015)
Van de Kolk felt frustrated by the DMS-V which seems to label so many children with psychiatric diagnoses, while others, who clearly struggle across numerous domains of functioning do not appear to meet the criteria for any particular diagnosis. His belief is that the origin of so many of these children’s problems stems from a combination of trauma and compromised attachment. He advocates that children who develop in the context of ongoing danger, maltreatment and disrupted caregiving systems are being ill-served by the current diagnostic systems that lead to an emphasis on symptoms and behavioural control with no recognition of interpersonal trauma (van der Kolk, 2015). Consequently, van der Kolk and his colleagues within the National Child Traumatic Stress Network drafted an appropriate diagnosis that they called Developmental Trauma Disorder (DTD). They sent their proposal to the DSM V editors advocating that DTD be included in the next addition. (Bremness & Polzin,2014) After organising all their findings they discovered a consistent profile for these children that included a pervading pattern of dysregulation; difficulties with attention/ concentration and struggles to get along with themselves and others.
As described by van de Kolk (2009)
“These children’s moods and feelings rapidly shifted from one extreme to another—from temper tantrums and panic to detachment, flatness, and dissociation. When they got upset (which was much of the time), they could neither calm themselves down nor describe what they were feeling. Having a biological system that keeps pumping out stress hormones to deal with real or imagined threats leads to physical problems: sleep disturbances, headaches, unexplained pain, and oversensitivity to touch or sound. Being so agitated or shut down keeps them from being able to focus their attention and concentration.”
Children who experience a disrupted or insecure attachment are unable to develop the capacity to self-regulate and modulate their intense feelings. ‘Chronically traumatised children struggle to identify and communicate their feelings and lack a sense of agency regarding their own internal experience and their ability to influence the world around (Cook et al. 2005, cited in Gregorowski & Seedat, 2013). This feeling of helplessness leads to excessive clinginess, excessive anxiety, internally or externally directed aggression and dissociation’ (Cook et al. 2005, cited in Gregorowski & Seedat, 2013). Research has shown that compared to children with PTSD, children who meet the criteria for DTD are more likely to experience panic disorder, separation anxiety disorder, ADHD, and disruptive behaviour disorders (Ford et al., 2021).
The APA essentially rejected the proposal to include DTD in the DMS-5 citing that there was no known evidence that trauma causes developmental disruptions. Since then, a growing body of research has been amassed with many psychologists calling for complex childhood trauma (DTD) to be clinically recognised.
In conclusion, it is clear that the effects of cumulative childhood trauma predict increasing complex symptoms, with the resulting developmental trauma having devasting and far-reaching effects. I hope that I have shown how these early and repeated failures of attunement in attachment relationships are ultimately one of the main determinates of Reactive Attachment Disorder, Developmental Trauma Disorder, disorganized attachment and even Post Traumatic Stress Disorder. While there are no doubt other environmental and social influences that contribute to these, this pervasive disconnect that so many children experience on a day-to-day basis and their lack of physical and emotional safety not only affects how they see themselves, but how they view the world and others. The field of trauma is currently fragmented with many brands of therapy focusing on a multiplicity of psychiatric disorders. This fragmentation calls out for a fresh clinical approach (Allen, 2019) at the way we should be treating this underlying attachment trauma hidden in all these labels. What is needed is a ubiquitous way of dealing with this disconnect rather than trying to continually manage the subsequent symptoms. It is imperative that we find a way of fostering empathetic attunement in the context of secure attachment relationships that will provide opportunities for healthy mentalising in children.
Written 5 April 2021
My dream was of a house
with a life of its own
Being drowned by leaves
that are chronically overgrown
Like a hawk I’m staring
at the windows and doors
Fearful panic they’ll close-up
even more
While I run around screaming
“Get out!
Get out!”
But no one is listening
as I frantically shout!
For a moment I’m distracted
I look away
As the killer leaves overwhelm
I’m in complete disarray
I realise I’m too late
as my head starts to spin
I’m trying to escape
but they are choking me in
I claw and I pull
in an attempt to break free
it’s like they’re alive
I’m watching them breathe
They latch on tight
absorb every part
There really is no escape
as they suck up my heart
The strangest thing
my lack of panic at the end
It was as if I was able
to simply transcend…
Or was it rather resignation
things just hurt?
There is really no way
pain can be shirked
Is the house my safe place?
My cocoon?
Or simply my cage
with so little room
No doubt, this dream
represents my anxiety
That at times wants to choke
the life out of me
So,
I’m looking for an EMDR therapist
To do some work with
who specialises in anxiety
which has become my monolith
It’s this gigantic stone
I just cannot lift
I don’t care how much I spend
but this dam thing needs to shift
My exaggerated startle response
is such a fucking pain
I’m twitching like a maniac
it’s driving me insane
My flatmates, bless them
have to highlight
When they walk into the kitchen
Or I’ll hit the roof with fright
I was waiting for a friend
at the station a while ago
When she walked up to me
and simply said hello
I got such a huge fright
I actually screamed
You would have thought
someone was murdering me.
I mean I have always been jumpy,
(just a nervous disposition?)
Such a joke with many men,
who love putting you in that position
Cause it’s funny right?
Watching other people jump?
Um well I guess that depends
on what side you are on
Yes of course, we anxious types
will always just laugh
It’s our way of regulating anxiety
that’s shooting off the chart
My body feels so stuck
in fight or flight
I’ve got a therapist
I’m on meds
but anxiety clings tight
I am slowly learning more
as I go along.
How the effects of developmental trauma,
continually hit the same gong
Dr Peter Levine clarifies in his book
how the root causes of trauma
are so often mistook
The narrow view of trauma
is that it is connected to large events
While a series of minor mishaps
similar anxiety symptoms can present
Relational childhood trauma
growing up with disconnect and rage
can often leave people struggling
very much on the same page
You might feel overly emotional
or have other labels for yourself.
A worrier?
Neurotic?
Take your pick from the shelf.
The emotional part of your brain
Is called the amygdala,
(Your fight and flight responses
all live here)
Accumulated stresses
that continually play out
Activate the child’s amygdala
without a doubt
An overactive amygdala leads
to a heightened fear response
the upshot is reacting to stress
with very little bounce
This state of the brain is called ‘kindled’-
scientists used to believe
because the amygdala is so hard to deactivate
eradicating trauma couldn’t be achieved
But thank God we have moved on
in the last 30 years
Now there are so many experts
on the neuroscience frontier
It’s now known that certain types of stimulation
can turn the amygdala off
Making trauma not psychological
but biological of course.
And this has now led me to
discovering EMDR
I’m not sure if it works
But nothing else has so far
Eye Movement Desensitization
and Reprocessing therapy
I’ll try to explain
give a little more clarity
It is believed that over time,
this ground-breaking technique,
can lessen the impact
that trauma can wreak
During an EMDR session
traumatic experiences are relived
While the therapist uses his hand
to direct your eye movements
Not much is understood
about how this works so well
But stressful memories not integrated
Continue to ring like a cowbell
I still have a lot to learn
So that’s enough for now
But I live in a state of hopefulness
that I will figure it all out somehow…
References
Allen, J. (2019). Mentalizing in the development and treatment of attachment trauma. ROUTLEDGE as cited in Lahousen, T., Unterrainer, H. F., & Kapfhammer, H. P. (2019). Psychobiology of Attachment and Trauma-Some General Remarks From a Clinical Perspective. Frontiers in psychiatry, 10, 914. https://doi.org/10.3389/fpsyt.2019.00914
Bremness, A., & Polzin, W. (2014). Commentary: Developmental Trauma Disorder: A Missed Opportunity in DSM V. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 23(2), 142-145. Retrieved February 1, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032083/
Cook A, Spinazzola J, Ford J, Lanktree C, Blaustein M, Cloitre M, van der Kolk B. 2005. Complex trauma in children and adolescents. Psychiatric Annals 35: 390 cited in Gregorowski, C., & Seedat, S. (2013). Addressing childhood trauma in a developmental context. Journal of Child and Adolescent Mental Health, 25(2), 105-118. https://doi.org/10.2989/17280583.2013.795154
Ford, J. D., Spinazzola, J., & van der Kolk, B. (2021). Psychiatric comorbidity of developmental trauma disorder and posttraumatic stress disorder: Findings from the DTD field trial replication (DTDFT-R). European Journal of Psychotraumatology, 12(1). https://doi.org/10.1080/20008198.2021.1929028
van der Kolk. B. (2015). The body keeps the score: Mind, brain and body in the transformation of trauma. Penguin Books.
Kolk, B.V., Pynoos, R.S., Cicchetti, D., Cloitre, M., Ford, J.D., Lieberman, A.F., Putnam, F.W., Saxe, G.N., Spinazzola, J., Stolbach, B.C., & Teicher, M.H. (2009). PROPOSAL TO INCLUDE A DEVELOPMENTAL TRAUMA DISORDER DIAGNOSIS FOR CHILDREN AND ADOLESCENTS. Submitted February 2009.