Catching Up

9 September 2005

It’s been a while since I’ve posted anything in here, and I apologize to any reader who looks for information here.

It’s rough, dealing with depression, acute chronic pain, multiple personalities, and abuse issues that still are active in my life.

You see, I’m not doing well. Many of my “family members” or some would call them personalities, personas, or manifestations, are in a dangerous downward slide. I have 2 or 3 family members who are self destructive, and or suicidal.

It does not help that one of the main abusers in my life… is still in my life, and trying her damnedest to ruin me. Not a meeting goes by where she does not put me down for one reason or another. “Can’t you clean up this mess?” “Why do you dress that way?” (I’m in my pajamas when she says this) It doesn’t matter what I do, I cannot please the thing called mother.

Meanwhile, Father-dearest stands by and does nothing. He says nothing, he doesn’t intervene. He thinks they have a right to talk to me in this manner.

I am disabled. It is part psyche, part physical. I broke my back twice. I cannot bend well, lift anything, twist my torso from left to right nor right to left. I needed spinal injections just last month. I have to rely on the parental things when I cannot drive or do anything, because they stuck me out in the middle of no-where so that if my car breaks down, I have absolutely no alternative transportation.

When I got the injections, I was not able to drive afterwards. This meant my father (or mother-dearest) had to come pick me up (an hour drive away), drive me to my appointment (back towards where they live – an hour away) wait for me to get the injections and then drive me back..

My fat headed father was pissed off at me – the second set of shots because my most wonderful  (in their eyes) Brother had to be at the airport to go to Ireland. So.. I got a hard time from my father about the appointment, and how he was not sure he’d be able to take me.. come to find out, my brother was not leaving the area until 7pm at night, and my appointment was for 10am.  HOW on earth did my appointment mess up HIS most glorious schedule???

My brothers can do no wrong, yet I am not able to do anything right. I am pissed at this. They drag me back to NY so I can be closer to “Family.” Well.. I have no ties to my “Family” here.  No-one cares that I am alive and breathing.. unless they have something to scream at me about.

There are things that need fixing around my house. I’ve tried time and again to get help doing them. They are supposed to be my landlords. I am supposed to be a tenant. Yet it goes 2 months before my lawn is mowed, I’ve asked 15 times to get stone put down between the end of my deck step and the gate leading out to the driveway (a total of 3-1/2 to 4 feet), and yet.. I still keep asking. However, if Mr.Wonderful brother asks for ANYTHING.. it’s there in a heartbeat.

Do I sound jealous? I’m not. I don’t want anything from my parents other than for them to get off my back. I’m done with them. I can’t afford to be here. I’m sick over what the new heating costs are going to be this winter, and I KNOW I’m going to hear about that. I might as well turn my bills over to them, and my paycheck.. and say “HERE You do the math!”

My younger brother is a loser. He works full time as a respiratory therapist. He owns several houses that he rents out apartments in. Yet he still lives with mommy and daddy. He’s 41 years old, and has not lived on his own for more than a few months at a time before he comes crawling back home.

He’s getting married to a woman he met through our sister-in-law. They’ve only talked on the computer and on the phone until just recently when my brother worked up the courage to go to Ireland to meet her. Now he plays the lovesick teenager, all drool and sap. It’s sickening to watch, because it is fake. He is too tightly wrapped in the umbilical cord that has never been severed to ever leave mommy. Oh, he’ll get married alright.. but the marriage won’t last. She will never measure up or replace his mommy.

I have two older brothers as well. One has fallen out of the graces of the mother’s eyes. He told her off, she told him off, he’s living with a woman my mother can’t stand (nor can I), he is an abuser, so I do not miss him. I wonder how many broken ribs his new woman will end up with. I know his ex- was not treated well. He threw her around as well as their son. I do not miss him, nor consider having lost him. Good Riddance.

My Oldest brother is only five miles from me. I hear nothing from him, nor his wife. I never know when they are home. I hear things second hand from my parental things.. like a couple weeks ago my sister-in-law wrapped her car around a telephone pole. Why didn’t THEY inform me, instead of my parents?
It’s simple, I’m second class in this family. I’m a burden, and not something they want around.

It’s no wonder that I have “Family” who are self destructive and suicidal. With all that “well deserved” treatment I get from my parental beings, and lack of support I get from the rest of the family… why would someone care to continue on in this existence?

Child Abuse Can Cause Permanent Damage to the Brain, Body, and Emotional Well-Being

In the first years of life, a child is especially vulnerable to abuse, not only because of their physical fragility, but also because the early years can be an especially challenging time for even the most well-meaning parents.

Many cases of child abuse aren’t intentional acts of violence committed by violent, uncaring parents--rather, child abuse often occurs in an instant of unthinking frustration and anger. An instant of uncontrolled anger is all it takes to shake a baby and inflict permanent brain damage, to yank a small arm out of its socket, or to inflict alarming physical pain and longlasting emotional injury.

Abuse During Childhood Can Permanently Rewire and Restructure the Brain

Researchers at McLean Hospital, the largest psychiatric affiliate of Harvard Medical School, have found that child abuse and neglect can "rewire" the developing brain. When brain circuitry is altered during the formative years it may eventually cause such disorders as anxiety and depression to more readily surface in adulthood.

According to Martin Teicher, MD, PhD, director of the Developmental Biopsychiatry Research Program, "science shows that childhood maltreatment may produce changes in both brain function and structure. These changes are permanent. This is not something people can just get over and get on with their lives."

During the course of their studies, the researchers found that four abnormalities are more likely to be present in victims of child abuse and neglect:

Changes to the Limbic System, the area of the brain that, together with the hypothalamus, controls hunger, thirst, emotional reactions and biological rhythms. In addition, it coordinates complex activities requiring a sequence of performance steps. Changes to the limbic system can result in epileptic seizures and abnormal electroencephalograms (EEG), usually affecting the left hemisphere of the brain, which is associated with more self-destructive behavior and more aggression.

Deficient Development of the Left Side of the Brain, which can contribute to depression and impaired memory.

Impaired Corpus Callosum, the pathway integrating the two hemispheres of the brain, which can result in dramatic shifts in mood and personality.

Increased Blood Flow in the Cerebellar Vermis, the part of the brain involved in emotion, attention, and regulation of the limbic system, which can disrupt emotional balance.

Animal studies have shown that neglect and emotional trauma triggers changes in hormones and neurotransmitters within parts of the brain that are responsible for regulating fear and anxiety. The researchers suggest that this may also occur in children. As Teicher emphasizes, "We know that an animal exposed to stress and neglect early in life develops a brain that is wired to experience fear, anxiety and stress. We think the same is true of people."

In July 2000, the Journal of the American Academy of Child and Adolescent Psychiatry reported that early emotional abuse can distort the processes of attachment and affective development. Child abuse and neglect could also impair the individual’s capacity to develop appropriate emotional responses, leading to lifelong emotional and social difficulties.

From: http://www.mental-health-matters.com/abuse/index.php

Children and Trauma

What are traumatic life experiences?
Traumatic life experiences challenge a person's normal coping efforts. For children and adolescents, traumatic experiences include such things as sexual and other physical abuse and neglect, peer or family suicide, dog bites, severe burns, natural disasters (e.g. floods, tornadoes, hurricanes, etc.), fires, and medical procedures.

It can be traumatic for children to witness or experience violent crimes (e.g., kidnapping, sniper fire, and school shootings) or vehicle accidents such as automobile and plane crashes. Witnessing assault, rape, or murder of a parent can also be traumatic for children. Traumatic life events are fairly common in childhood. Research suggests that 14 to 43% of children have experienced at least one traumatic event in their lifetime.

What is the range of responses?
There is a wide range of responses to catastrophic events. Some children and teenagers experience temporary worries and fears that get better quickly.

Others experience long-term problems such as fear, depression, withdrawal, anger, haunting memories, avoiding reminders of the event, regressive behavior (acting younger than their actual age), worrying about themselves and others dying or being hurt, and irritability.

Reactions can occur immediately after the event or weeks later.

Children who have had traumatic experiences may have difficulty sleeping or have nightmares. They may avoid activities, situations, thoughts, or conversations that may be related to the traumatic events, even if other people don't perceive them as related (e.g., a child who was eating corn flakes on the morning of a terrible event may not want to eat corn flakes).

They may play in ways that repeat something from their traumatic experiences (e.g., twirling or hiding under things after exposure to a tornado). They may recreate aspects of the traumatic experience in their behavior (e.g., a child who was exposed to a fire may set fires).

They may not want to be with people as much as before. They may avoid school, have trouble with schoolwork, or feel unable to pay attention. They may not want to play as much, avoid certain kinds of play, or lose interest in things they once enjoyed.

They may be sad or seem to have less emotion or feel guilty about things they did or did not do related to the traumatic experience.

Young children (age 5 and younger) may experience new fears such as separation anxiety or fear of strangers or animals. They may act younger or lose a skill they have already mastered (such as toilet training).

Elementary school-aged children (6 to 11) may get parts of the traumatic experience confused or out of order when recalling the memory. They may complain of body symptoms that have no medical cause (e.g., stomach aches). They may stare into space or seem "spacey," or startle easily.

Adolescents (12 to 18) may experience visual, auditory, or bodily flashbacks of the events, have unwanted distressing thoughts or images of the events, demonstrate impulsive and aggressive behaviors, or use alcohol or drugs to try to feel better. They may feel depressed or have suicidal thoughts.

What are the risk factors for long-term problems?
Children are at greater risk for developing problems if the traumatic event was very severe (death, injury, bloody scenes), if the child's parents are extremely distressed in the aftermath of the traumatic event, or if the child was directly exposed to the event (versus hearing about it later).

In addition, risk increases if the event is an interpersonal trauma (caused by another person) such as rape and assault or if the child or adolescent has been exposed to numerous stressful life events previously or has a pre-existing mental health problem.

None of these risk factors means that the child will definitely have problems, but the risk factors increase the probability a child or teenager might develop problems after an extremely stressful event.

What can adults do to help?

• Let the child know it's normal to feel upset when something bad or scary happens
• Encourage the child to express feelings and thoughts, without making judgments
• Protect the child or adolescent from further exposure to traumatic events, as much as possible
• Return to normal routines as much as possible
• School can be a major healing environment as the child's most important routine.
• Educate school personnel about the child's needs. Reassure the child that it was not his or her fault, that adults will try to take care of him or her, etc.
• Allow the child to feel sad or cry
• Give the child a sense of control and choice by offering reasonable options about daily activities (choosing meals, clothes, etc.)
• If the child regresses (or starts to do things he or she did when younger), adults can help by being supportive, remembering that it is a common response to trauma, and not criticizing the behavior

Adults can be most helpful if they take care of themselves and get help for their own distress, since children and adolescents may respond to adults' feelings and reactions.

Most children and adolescents will recover within a few weeks with such support. However some children may require more help.

Responsible adults who are concerned about their child's reaction to a very stressful event may want to consider seeking the help of a mental health professional who is trained in helping children with traumatic responses or post-traumatic stress disorder.

Therapies can be individual, group or family sessions that include talking, drawing and writing about the event. In some cases medication can be helpful.

A family doctor, clergy person, local mental health association, state psychiatric, psychological, or social work association, or health insurer may be helpful in providing a referral to a counselor or therapist with experience in treating children affected by traumatic stress.

For more information about traumatic stress or the International Society of Traumatic Stress Studies, call 847-480-9028.

© 2005 International Society For Traumatic Stress Studies. All rights reserved.

Self Injury Fact Sheet

source: Deb Martinson

Self-injury basics:

• Most researchers agree that self injury (SI) is self-inflicted physical harm severe enough to cause tissue damage or marks that last for several hours, done without suicidal intent or intent to attain sexual pleasure. Body markings (piercing, tattooing, etc) that are done as part of a spiritual ritual or for ornamentation purposes generally aren't considered SI.
  SI generally is done as a way of coping with overwhelming psychophysiological arousal. This can be to express emotion, to deal with feelings of unreality or numbness, to make flashbacks stop, to punish the self and stop self-hating thoughts, or to deal with a feeling of impending explosion. SI is more about relieving tension or distress than is it about anything else.


• Although cutting is the most common form of SI, burning and head-banging are also very common. Other forms include biting, skin-picking, hair-pulling, hitting the body with objects or hitting objects with the body, etc.


• SI is a crude, ultimately destructive coping mechanism, but it works. That's why it sometimes seems to have addictive qualities. To help a client, you must offer more effective coping strategies as replacement. Learning these ways can take time; punishing a client or patient for coping in the only way s/he knows how can make therapy unworkable.


• Most people who self-injure hate the term "self-mutilation." That phrase speaks to intent and maiming the body is usually not the intent of SI anyway. Better phrases are self-inflicted violence, self-harm, and self-injury.

Who is likely to self-injure:

• Self-injurers come from all walks of life and all economic brackets. People who harm themselves can be male or female; gay, straight, or bi; Ph.D.s or high-school dropouts; rich or poor; from any country in the world. Some people who SI manage to function effectively in demanding jobs; they are teachers, therapists, medical professionals, lawyers, professors, engineers. Some are on disability. Some are highly-achieving high-school students.


• Their ages range from early teens to early 60s, maybe older and younger. In fact, the incidence of self-injury is about the same as that of eating disorders, but because it's so highly stigmatized, most people hide their scars, burns, and bruises carefully. They also have excuses to pull out when someone asks about the scars (there are a lot of really vicious cats around).


• People who deliberately harm themselves are no more psychotic than people who drown their sorrows in a bottle of vodka are. It's a coping mechanism, just not one that's as understandable to most people and as accepted by society as alcoholism, drug abuse, overeating, anorexia, bulimia, workaholism, smoking cigarettes, and other forms of problem avoidance are.


• Self-injury is VERY RARELY a failed suicide attempt. People who inflict physical harm on themselves are often doing it in an attempt to maintain psychological integrity -- it's a way to keep from killing themselves. They release unbearable feelings and pressures through self-harm, and that eases their urge toward suicide. Some people who self-injure do later attempt suicide, but they almost always use a method different from their preferred method of self-harm. Self-injury is a maladaptive coping mechanism, a way to stay alive. Unfortunately, some people don't understand this and think that involuntary commitment is the only way to deal with a person who self-harms. Hospitalization, especially forced, can do more harm than good.

What helps people who self-injure:

Medications (mood stabilizers, anxiolytics, antidepressants, and some of the newer neuroleptics) have been tried with some success. There is no magic pill for stopping self-harm (naltrexone, though effective in people with developmental disabilities, doesn't seem to work nearly as well in other patients). Many therapeutic approaches have been and are being developed to help self-harmers learn new coping mechanisms and teach them how to start using those techniques instead of self-injury. They reflect a growing belief among mental-health workers that once a client's patterns of self-inflicted violence stabilize, real work can be done on the problems and issues underlying the self-injury.

This does not mean that patients should be coerced into stopping self-injury. Any attempts to reduce or control the amount of self-harm a person does should be based in the client's willingness to undertake the difficult work of controlling and/or stopping self-injury. Treatment should not be based on a practitioner's personal feelings about the practice of self-harm.

Self-injury brings out many uncomfortable feelings in people: revulsion, anger, fear, and distaste, to name a few. If a medical professional is unable to cope with her own feelings about self-harm, then she has an obligation to herself and to her client to find a practitioner willing to do this work. In addition, she has the responsibility to be certain the client understands that the referral is due to her own inability to deal with self-injury and not to any inadequacies in the client.

People who self-injure do generally do so because of an internal dynamic, and not in order to annoy, anger or irritate others. Their self-injury is a behavioral response to an emotional state, and is usually not done in order to frustrate caretakers. In emergency rooms, people with self-inflicted wounds are often told directly and indirectly that they are not as deserving of care as someone who has an accidental injury. They are treated badly by the same doctors who would not hesitate to do everything possible to preserve the life of an overweight, sedentary heart-attack patient.

Doctors in emergency rooms and urgent-care clinics should be sensitive to the needs of patients who come in to have self-inflicted wounds treated. If the patient is calm, denies suicidal intent, and has a history of SI, the doctor should treat the wounds as they would treat accidental injuries. Refusing anesthesia for stitches, making disparaging remarks, and treating the patient as an inconvenient nuisance simply further the feelings of invalidation and unworthiness the self-injurer has. It is useful to offer mental-health follow-up services; however, psychological evaluations with an eye toward hospitalization should be avoided in the ER unless the person is clearly a danger to him/herself or to others. In places where people know that seeking treatment for self-inflicted injuries are liable to lead to mistreatment and lengthy psychological evaluations, they are much less likely to seek medical attention for their wounds and thus are at a higher risk for wound infections and other complications.

©1999 by Deb Martinson. Reproduction and distribution of this material is enthusiastically encouraged, especially distribution to medical personnel.

References:

Alderman, T. (1997). The Scarred Soul: Understanding and Ending Self-Inflicted Violence. Oakland: New Harbinger.

Coccaro, E. F., Kavoussi, R. J. , Sheline, Y. I., Berman, M. E., & Csernansky, J. G. (1997). Impulsive aggression in personality disorder correlates with platelet 5-HT2A receptor binding. Neuropsychopharmacology, 16(3), 211-216.

Crawford, M. J., Turnbull, G., & Wessely, S. (1998). Deliberate self-harm assessment by accident and emergency staff -- an intervention study. Journal of Accident and Emergency Medicine, 15(1), 18-22.

Favazza, A. R. (1998). The coming of age of self-mutilation. Journal of Nervous and Mental Disease, 186(5), 259-68.

Favazza, A. R. (1996). Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry, 2nd ed. Baltimore: The Johns Hopkins University Press.

Haines, J., Williams, C. L., Brain, K. L., Wilson, G. V. (1995). The psychophysiology of self-mutilation. Journal of Abnormal Psychology, 104(3), 471-489.

Hawton, K., Arensman, E., Townsend, E., et al. (1998). Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ, 317(7156), 441-7.

Herpertz, S., Sass, H., & Favazza, A. R. (1997). Impulsivity in self-mutilative behavior: psychometric and biological findings. Journal ofPsychiatric Research, 31(4), 451-465.

Herpertz, S., Steinmeyer, S. M., Marx, D., et al. (1995). The significance of aggression and impulsivity for self-mutilative behavior. Pharmacopsychiatry, 28(Suppl 2), 64-72

Hogg, C. & Burke, M. (1998). Many people think self-injury is just a form of attention seeking. Nursing Times, 94(5), 53.

Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder and Skills Training Manual for Treating Borderline Personality Disorder. New York: The Guilford Press.

Miller, D. (1994). Women Who Hurt Themselves: A Book of Hope and Understanding. New York: BasicBooks.

New, A. S., Trestman, R. L., Mitropoulou, V., et al. (1997). Serotonergic function and self-injurious behavior in personality disorder patients. Psychiatry Research, 69(1), 17-26.

Simpson, E. B., Pistorello, J., Begin, A., et al. (1998). Use of dialectical behavior therapy in a partial hospital program for women with borderline personality disorder. Psychiatric Services, 49(5). 669-73.

Solomon, Y. & Farrand, J. (1996). "Why don't you do it properly?" Young women who self-injure. Journal of Adolescence, 19(2), 111-119.

Stein, D. J., Trestman, R. L., Mitropoulou, V., et al. (1996). Impulsivity and serotonergic function in compulsive personality disorder. Journal of Neuropsychiatry and Clinical Neurosciences, 8(4), 393-398.

Strong, Marilee. (1998). A Bright Red Scream. New York: Viking.

MPD/DID Key Findings Quick Facts

From the National Foundation for the Prevention and Treatment of Multiple Personality

• Victims of multiple personality disorder (MPD) are persons who perceive themselves, or who are perceived by others, as having two or more distinct and complex personalities. The person's behavior is determined by the personality that is dominant at a given time.

• Multiple personality disorder is not always incapacitating. Some MPD victims maintain responsible positions, complete graduate degrees, and are successful spouses and parents prior to diagnosis and while in treatment.

• A MPD victim (a multiple) suffers from "lost time," amnesia or "black-out spells," which lead the victim to deny his/her behavior and to "forget" events and experiences. This may result in accusations of lying and manipulation and may cause severe confusion for the undiagnosed multiple.

• More than 75% of MPD victims report having personalities in their system who are under 12 years of age. Personalities of the opposite sex or with differing styles are also common. Personalities within a multiple system often hold conflicting values and behave in ways that are incompatible with one another.

• 97% of MPD victims report a history of childhood trauma, most commonly a combination of emotional, physical and sexual abuse.

• Multiple personality disorder can be reduced or prevented by early diagnosis and treatment of traumatized children and by working to eliminate abusive environments.

• While usually not diagnosed until adulthood, 89% of MPD victims have been mis-diagnosed include: depression, borderline and sociopathic personality disorder, schizophrenia, epilepsy and manic depressive illness.

• When they first enter treatment, most MPD victims are not aware of the existence of other personalities.

• MPD victims require treatment techniques which specifically address the unique aspects of the disorder. Standard psychiatric interventions used in the treatment of schizophrenia, depression and other disorders are ineffectual or harmful in the treatment of MPD.

• Appropriate treatment results in a significant improvement in the quality of life for the MPD victim. Improvements commonly include reduction or elimination of: confusion, feelings of fear and panic, self- destructive thoughts and behavior, internal conflicts and stressful periods of indecision.

• Multiple personality disorder has been recognized by physicians since the 17th century. While often confused with the relatively new diagnosis of schizophrenia throughout most of the 20th century, MPD is again being understood as a legitimate and discrete disorder.
  

Multiple personality disorder IS treatable!