In this blog we will be exploring how a diagnosis such as depression or anxiety can on further exploration in fact be Adverse Childhood Experiences (ACE) and Complex Posttraumatic Stress Disorder (CPTSD). This knowledge shows the importance of therapeutic practitioner’s looking at your life in whole not just one stage to understand how a person ticks.
Complex Posttraumatic Stress disorder arises when there is multiple incidents of trauma occurring during the developmental stage. The three clusters of symptomologies are; dysregulation in emotion; negative self-cognitions and interpersonal hardship (Giourou et al., 2018). Looking at things from a trauma informed lens, the focus is on the individuals developmental trauma which is known as ACE. This gains us insight and understanding as to what led the individual to where they are now. Felitti et al. (1998) supports this conception expressing that there is a clear correlation between trauma in childhood and future issues. It is important to note that ACE and CPTSD play a key role in an individual’s resilience. Resilience signifies a dynamic procedure incorporating positive adjustment even after significant adversity. Luthar and Cicchetti (2000) voice that although some at-risk children prosper within their lifetime, the majority falter and are incapable of adaptation. However, they go on to say that resilience is not a static state, individuals can exhibit resilience at different periods of their lives including those who were riddled with grave adversity in their early childhood (Coie et al.,1993; Luthar & Cicchetti, 2000). This ultimately gives hope to people experiencing CPTSD and ACE.
For some, culture plays a very important role in how people perceive mental health issues as well as seeking help when they struggle. In many European families, and I speak from experience regarding this, what happens in the home stays in the home. Basically meaning that our struggles are ours and ours only, if we speak about them it is going against everything we have been raised to learn and know. Cheung, Chan and Chung (2020) found that if mother’s exhibited emotional dysregulation during their child’s early years as well as adolescence, the likelihood of their son or daughter internalising their problems was exponentially likely. Meaning in their adulthood they will likely repeat history with their own children (Cheung, Chan and Chung, 2020). If we reflect on this with individuals of ACE and CPTSD, we realise that because their primary caregiver was likely the victim of domestic violence, their inability to regulate their emotions had a negative domino effect on their children on top witnessing and experiencing domestic violence. If we can learn anything from this, we need to learn to express how we are feeling as it not only affects you but your loved ones also.
We all go through adversity some more severe and detrimental than others. However, those who went through the unspeakable, primarily witnessing and experiencing domestic abuse, can leave a mark on ones self for life and gives us an insight into the bond between primary caregivers and child (Cederlund, 2013). According to The British Psychological Society and The Royal College of Psychiatrists (2013) as well as Lieb et al. (2000), incidents like this can cause a child to become fearful and avoidant, in turn impacts their coping mechanisms, which play a significant role in development. Felitti et al. (1998) contends that high volumes of ACE have a direct link to numerous leading causes of death in adults, including cancer, heart and lung diseases and skeletal fractures. It is also noteworthy that those with CPTSD and ACE are: twice as likely to be at risk of mental health issues in later life; 70% more likely to die by age 41 and 60% more likely to do poorly in school.
Unfortunately for these young people, most of the time the trauma did not end in their childhood, which caused them to do things out of the norm to escape it. Specifically forming coping mechanisms which were and are maladaptive, some of these strategies include gambling, smoking and drinking. Poole et al. (2018), explores how emotional dysregulation is a mechanism that can explain the connection among ACE and disordered gambling. Further, the conception that gambling will solve everything is a fallacy. Edwards et al. (2007) also found that substances such as smokes and alcohol only have provisional improvement on ones mood, however that brief reprieve causes them to continue to use it as a coping mechanism. We can see from these statistics that when we are in such vulnerable positions we yearn for anything to make it better, unknowingly falling into negative patterns and ultimately making predicaments worse.
If you were to go about a diagnosis like CPTSD and ACE from a trauma informed lens, with a recovery-oriented framework, it is unique and personalise. This holistic method focuses on individual growth, autonomy, options and empowerment, operating with the individual’s fortitude and augmenting hope (MHT, 2015). In line with a strength-based method, trauma-informed counsellors can assist clients to modify problematic conduct, cope with crises efficaciously, as well as teach them to be more nurturing and sympathetic parents (Levenson, 2014; SAMHSA, 2014a). This intervention also enables clients to discuss distressing recollections whilst reducing their anxiousness and increasing their tolerance levels plus teaching them how to regulate their emotions and behaviours. This process aims to not only assist them to overcome trauma but to build resilience. This is prime in preventing intergenerational cycle of victimisation (Harris & Fallot; Larkin et al., 2014). Rather than going from a medical based model, endorsing medications, this method helps individuals attain a meaningful and fulfilling semblance of life, with continuous affirmation, positiveness, encouragement and support.
Counselling would also be of great benefit for individuals experiencing this as they are given the opportunity to articulate how they are feeling rather than bottling it up. It also is a way to build their resilience and learn how to deal with issues that arise eventually on their own. Patience and unconditional positive regard are the foundations to assisting individuals to attain the hope they require to heal. Thus, the reason for positive psychology to be implemented, more specifically Learnt Optimism. Secondly, they need to create positive connections as they greatly effect good mental health. By forging friendships within the community, it can make a world of difference. For someone who is exhibiting skeletal pain and soft tissue injuries due to CPTSD, cold therapy interventions would be an additional benefit. Ultimately, cold therapy utilises ice packs as well as ice baths in the treating of acute soft tissue injuries (Dehghan and Farahbod, 2014). Cryotherapy (ice therapy) has been found to relieve pain for people whom suffer from chronic lower back pain (Dehghan and Farahbod, 2014). This has promising effects for individuals suffering from these problems, however it is not a sure thing and is all about trial and error.
Overall, it is important to have open-mindedness when approaching scenarios like the above, as well as willingness to tackle the situation from a trauma-informed model as opposed to a medical based one. If done successfully, it will give the individual a semblance of peace, a sense of hope and build their resilience.
References:
Cederlund, R. (2013). Social anxiety disorder in children and adolescents: assessment, maintaining factors, and treatment. Retrieved from http://www.diva-portal.org/smash/get/diva2:650125/FULLTEXT01.pdf
Cheung, R.Y.M., Chan, L,Y., & Chung, K.K.H. (2020). Emotion dysregulation between mothers,
fathers, and adolescents: Implications for adolescents’ internalising problems. Journal of
Adolescence, 83, 62-71. https://doi.org/10.1016/j.adolescence.2020.07.001
Coie, J. D., Watt, N. F., West, S. G., Hawkins, D., Asarnow, J. R., Markman, H. J., Ramey, S. L., Shure, M. B., & Long, B. (1993). The science of prevention. American Psychologist, 48, 1013–1022.
Dehghan, M., & Farahbod, F. (2014). The Efficacy of Thermotherapy and Cryotherapy on Pain Relief in Patients with Acute Low Back Pain, A Clinical Trial Study. Journal of Clinical & Diagnostic Research, 8(9), 1–4. https://doi-org.ezproxy.navitas.com/10.7860/JCDR/2014/7404.4818
Edwards, V. J., Anda, R. F., Gu, D., Dube, S. R., & Felitti, V. J. (2007). Adverse childhood
experiences and smoking persistence in adults with smoking-related symptoms and illness.
The Permanente journal, 11(2), 5–13. https://doi.org/10.7812/tpp/06-110
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J.
S. (1998). Relationship of childhood abuse and household dysfunction to many of the
leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study.
American Journal of Preventive Medicine, 14(4), 245–258. https://doi-
org.ezproxy.navitas.com/10.1016/S0749-3797(98)00017-8
Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018). Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?. World journal of psychiatry, 8(1), 12–19. doi:10.5498/wjp.v8.i1.12
Lieb, R., Wittchen, H.U., Hofler, M., Fuetsch, M., Stein, M.B. & Merikangas, K.R. (2000). Parental psychopathology, parenting styles, and the risk of social phobia in offspring: a prospective-longitudinal community study. Archives of General Psychiatry, 57(9), 859 –66. doi:10.1001/archpsyc.57.9.859
Luthar, S. S., & Cicchetti, D. (2000). The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work. Child Development, 71(3), 543. https://doi-org.ezproxy.navitas.com/10.1111/1467-8624.00164
Poole, J., Kim, H., Dobson, K., Hodgins, D., Poole, J. C., Kim, H. S., … Hodgins, D. C. (2017). Adverse Childhood Experiences and Disordered Gambling: Assessing the Mediating Role of Emotion Dysregulation. Journal of Gambling Studies, 33(4), 1187–1200. https://doi-org.ezproxy.navitas.com/10.1007/s10899-017-9680-8
The British Psychological Society & The Royal College of Psychiatrists. (2013). Social anxiety disorder: Recognition, assessment and treatment. National Clinical Guideline Number 159. Retrieved from https://www.nice.org.uk/guidance/cg159/evidence/full-guideline-189895069