Exploring Complex PTSD and Psychosis

Scientific research on cptsd

Interesting stuff coming out of the UK about Complex PTSD.

The North West United Kingdom mental health services conducted a unique study looking into the relationship of trauma, particularly complex trauma, with psychosis.

In short, they had 144 people who suffer from psychosis answer questions. The questions were designed to help assess the trauma the person suffered, the prevalence of PTSD and Complex-PTSD symptoms, as well as their symptoms of psychosis.

What the researchers found was –
10% of the study participants suffered from PTSD, but 40% of the sample suffered from cPTSD.

That in itself is a remarkable finding, but wait, there’s more.

The following sentence from the summary carries more meaning than you might initialy attatch to it.

PTSD and DSOs mediated the relationship between trauma and positive symptoms, controlling for dataset membership.

Let’s start with the definition of ‘positive symptoms’ –
In psychology ‘positive symptoms’ are defined as : highly exaggerated ideas, perceptions, or actions that show the person can’t tell what’s real from what isn’t. Here the word “positive” means the presence of symptoms. Which, in itself is not a positive thing. (Sorry, couldn’t resist the word play.)

The second term to parse out is DSOs. This is short hand for ‘disturbances in self-organization’ (DSOs) – which is a recognized attribute of Complex-PTSD in the International Classification of Diseases-11th Edition. Thank you Europe. You are so far ahead of the DSM.

Putting those terms together the sentence is telling us that PTSD and DSOs (aka cPTSD) were present in people who had suffered trauma and were now suffering psychosis. In addition there was also a relationship to exist between cPTSD and affective disorders (illnesses that affect the way a person thinks and feels).  

However, the relationship did not carry over to explain significant differences in the presence of negative sypmtoms. Remember, a ‘negative symptom’ doesn’t mean that there isn’t a problem. In psychology, a negative symptom denotes a loss of something. Negative symptoms include the inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships.

The summary of the article includes two important sentences:
1. Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, increasing symptom burden, decreasing quality of life and moderating treatment response.
2. The prevalence and impact of cPTSD and DSOs in psychosis remains to be explored.

So, what I’m reading here is that trauma that results in cPTSD does have some linkage to some symptoms of psychosis. BUT, we don’t know what that particular mechanism is yet.

They end the study summary with this line: “These findings indicate the possible value of adjunct therapies to manage cPTSD symptoms in people with psychosis, pending replication in larger epidemiological samples and longitudinal studies.”

In other words – people who suffer from psychosis might also benefit from therapies for cPTSD — as long as a future study doesn’t toss all this in the proverbial bin.

The Role and Clinical Correlates of Complex Post-traumatic Stress Disorder in People With Psychosis [https://www.frontiersin.org/articles/10.3389/fpsyg.2022.791996/full]

Tragedy

My Brother

My brother
A name
I simply moved
From
One column
To another.

An Analogy: the Wetsuit

When you grow up in a minefield, it seems normal.

People often find it difficult to explain, or to understand Complex PTSD. I often find myself falling into metaphor or analogy to explain the experience. The reason for using an abstraction is because in Complex PTSD the particulars from one person to another vary – greatly. I have found that trying to paint a detailed picture often results in becoming lost in the need for exactitude. It is impossible to be be ‘exact’ for everyone. Enter the analogy.

One question I have seen repeatedly about Complex PTSD is “Why am I having to deal with all this NOW? Why not when it was happening? Why 10/20/30/40 years after the fact?”

In the past I have often explained that when disfunction is your norm – you don’t see it as dysfunction.

Recently I thought this idea needed to grow. While comparing the environment to a minefield works it doesn’t go far enough. The minefield only addresses the environment, while Complex PTSD is the product of how we adapted to that environment.

Think of all those adaptations we learned or created to keep us safe as a wetsuit. See it in your mind and make it as thick or detailed as you like. Maybe you have one of those ‘survival suits’ for the North Sea, light blinking on the top and bright orange. Perhaps your wet suit is more like the body glove of neoprene we often visualize on Navy Seals and Frogmen.*

No matter how you envision your suit to look it all served one purpose – to preserve your life in a hostile environment. By ‘hostile environment’ any diver will tell you – you don’t need sharks to make the water dangerous. The water itself – everything surrounding you – is quite capable of ending you.

That is the mental state in which many of us grew up. Life itself, our most immediate environment posed an imminent threat to our survival. Perhaps there was a shark – a person(s) with the ability to harm you. Perhaps there was not – but your surroundings were as cold as Arctic waters. And some of us endured both.**

To survive we adapted. Those adaptations became the ‘wetsuit’ we wore to help us survive.

Our ‘wetsuit’ served us while we were in those dangerous places. But as we grow, age, we leave the environment(s) that caused us to make those adaptations.

When we no longer need that wetsuit because we have left the freezing water we don’t abandon it. Primarily because we are unaware of it. Those adaptations are integrated. Our ‘wetsuit’ is an intrinsic part of who we are.

Over time, out of that hostile environment, that wetsuit – our adaptations – no longer serve us. The neoprene becomes hot, binding, restrictive, and could even become more than an impairment, but a danger. ***

It is not a sudden appearance of Complex PTSD. We have carried it with us since we entered that hostile place. The reason for the sudden appearance is not because the wetsuit has changed, but because they have changed their environment and no longer need it.

Now – comes the work of peeling that sucker off. And that’s part of the reason you always have a dive buddy. It is easier to get out of the wetsuit when you have help.

At least, that’s one way to think about it.


*Note: I met one of the original ‘frogmen’, once, years ago. His stories were beyond impressive.
**Note: Just imagine a shark wearing a wooly knit jumper.
***Note: Good friend went to a Halloween party dressed as a ‘diver’ – full suit 5mm – almost cooked himself into heat stroke.

New class of antidepressants?

Scientific research on cptsd

Source C&E News February 7, 2022

How do you know if a mouse is hallucinating?

Apparently mice on LSD and psilocybin twich their heads. Fascinating. But then, if I was a mouse and my world had gone all psychotropic I suspect there would be some head twitching, too.

So what do tripping mice have to do with Complex PTSD?

As many readers may already know LSD and psilocybin are two controlled substances that have been demonstraated to help alleviate mood disorders. In light of CPTSD these mood disorders may include depression, major depression, persistent depression and psychotic depression. (yes, we are such a fun bunch. </sarcasm>)

Why do these drugs help with Complex PTSD?

The simple answer is ‘brain chemistry’.

The longer answer goes like this:
There is a receptor in the central nervous system called 5-HT2A. This receptor is where serotonin binds to the cell. Serotonin in the brain is linked with mood, anxiety regulation, sexuality, memory, and some social fascets. In essence, your brain is bathing in serotonin. This is why SSRI – Selective Serotonin Reuptake Inhibitors – class drugs are often prescribed to people with symptoms of depression.
Simple logic – raise the level of serotonin in the brain –> lower the presence of depression symptoms.

Guess what else binds to 5-HT2A. If you said magic mushrooms (psilocybin) and LSD you are correct.

However, these drugs also induce hallucinations. Psilocybin is “a Schedule I controlled substance because it has no approved medical purpose and the potential for abuse.”** LSD is also a Schedule I controlled substance. ***

What scientists are trying to discover is – what is the difference between a compound that binds to 5-HT2A that causes hallucinations vs. one that does not. That discovery will open an area of research into new antidepressive medication. It could also prove valuable for people who need antipsychotic medication.

So far scientists have produced two compounds based on this research that demonstrate antidepressant activity without hallucinations in mice.

There is a long step between the lab and a safe effective human medication. The process can take years. But, there is hope, and growing proof, of a new way to help people who suffer from a chronic imbalance of brain chemistry.


Article is at : Hallucinogen Chemistry Guies Antidepressant Drug Discovery by Bethany Halford
[ https://pubs.acs.org/doi/pdf/10.1021/cen-10005-leadcon ] (Sorry, you need ACS membership.)

**(source: USDA [ https://www.usada.org/spirit-of-sport/magic-mushrooms-prohibited-status/ ] as of Feb. 16, 2022)
***(source: DEA [https://www.dea.gov/drug-information/drug-scheduling] as of Feb 16, 2022)

Divided

Siblings and Complex PTSD

I cannot describe
how deep
the wound goes.

When I lost my
brother – he was
only seven and
I was only three.

After that
we shared
the same house.

We fought
and shunned
one another.

Neither one aware
of the poison
that forced us apart.

Fierce Independence

Complex PTSD Survivor Voices vacant black and gray chair in room

A part of the Complex PTSD Survivor Voices Series. This strives to be a safe place for Complex PTSD survivors to write about their experiences. Our stories are as different as our journeys.

What is Complex-PTSD

by Anonymous

Fierce independence and self-reliance are survival skills. We don’t see the rage or pain behind it, we don’t hear the primal screams of an abandoned child or see the unshed tears, the shattered pieces of her soul. We see someone strong, capable, courageous, a miracle…

The world is so busy praising her survival, the miracle she is alive that they are blind to the scars, the tattered brokenness of her. They all forget how fragile she really is, maybe it is her fault, after all, she never forced them to see her, she allowed them to live in the happy oblivion of her survival miracle.

They said she was strong she sighed, shook her, kept silent while the world prattled on the praise..”No, you are, you’re so strong!! I can’t imagine living through all that…blah blah blah” Do we really think she wanted to? That it was a choice? She tried a hundred times to die… by the way she didn’t hear anything said after all that, the noise in her head just got too loud.

Everyone is so sure that she is so strong and capable, brave and resilient, such a fucking miracle how dare she shed a tear…they see strong, capable, brave…they can’t see the girl, they don’t accept her truth, if perhaps by chance a silent tear falls from her eye, she wipes it away quickly, the world ignores it, and the bullshit continues…just once perhaps if we could shut the fuck up long enough and look at her, see her, accept her, we could actually be helpful beyond platitudes that perpetuate the facade of strength, survival, and miracles, maybe just maybe we could hold her hand, offer a shoulder, or just shut up and hold space, then maybe just maybe the tears of her wounded broken shattered soul could fall and she would begin to heal…until then she must for our sake, for our comfort, for our selfishness continue to be strong, capable, courageous, a fucking miracle.

Gabby Petito – Another Lost

Gabby Petito

The video of the stop in Moab Utah.
Fair warning – It is hard to watch.

I heard the news this morning about Gabby Petito as I checked my feeds. The confirmation of my worst fears was there, displayed on the screen.

I heard there was a video of the interaction with law enforcement in Utah. I had avoided it until now. But now I needed to see it. I thought it was necessary – though, at the time, I couldn’t put ‘why’ into words.

Watching it reminded me so much of my own past with domestic and relational violence. The images hit close to home – the reverberation shaking loose forgotten things. In those forgotten images I pieced together the ‘why’.

#metoo

I suddenly appreciated anew that I survived. That I escaped. I saw again how close I had skirted danger. I celebrated the ones I helped get out and I cried for the ones that died. And I was reminded of one gold brick put in a friend’s wall with his name on it. A figurative gold brick, but nonetheless one where we all paid a very high price.

I remembered something I had believed long ago, and I remembered how my experience changed me. So I’m going to say something no one is going to like to hear, and then I’ll tell my story.

I believe everyone needs to experience that powerlessness of being the victim of domestic violence.

I’ll soften that statement and say – ok, maybe not everyone. Maybe there are people out there who can understand that position without having lived it, but most people can’t.

I didn’t. I didn’t understand at all.

I grew up in a house that was poisoned. I won’t go into the particulars of that today, but I will describe what those years made me.

I was strong. I was stoic. I needed no one. I didn’t feel pain, not physical, not emotional, not mental. I never needed help. I was independent. I was hyperaware of everything. I knew my exits. And I knew to never admit fear or weakness because that was blood in the water.

This was me at 14, 16, 18 and on. So in those years when I heard of domestic abuse I was incredulous, even indignant. The lack of agency on the part of these women, the stuff they endured. How could they?

I didn’t understand. I couldn’t understand.

I thought ‘I would have left.’ I would have got up and walked out. I would have, I would have…

Later, as I emerged into the world from the claustrophobic circles of high school I was convinced that every person was like my family, or like the evil portrayed on television, or found in the newspapers that I made myself a promise. If anyone ever struck me out of anger I would leave. There would be no second chance. There would be no reconciliation. It would be over and I would be gone.

So, why didn’t these women leave? I would.
I still didn’t understand.
And when I made this declaration on the first date – as was my practice – I saw very few second dates. As a matter of fact – the only second dates I had were with the men who would turn into my abusers.

Funny that.

What I didn’t know at the time – although I lived it every minute of my life – was that I wanted a rescuer. I wanted someone to come in and sweep me up in a romantic embrace, promise to never abandon me, and save me from my past. I wanted to be rescued from my life so badly that to someone abusive I must have looked like a neon sign.

And when my rescuers came I couldn’t see anything other than the ‘good’ that they presented at first. I ignored warnings from friends. My father knew – but he didn’t say anything – that’s a different story. These men became my rescuers – my romantic partner, my tormentor, my abuser.

I couldn’t reconcile the two realities. I was primed to believe that something was wrong with me. I believed that somehow I earned the disdain, the silence, the taunts, the threats. After all explosive violence was the legacy of my family – so, at least there wasn’t that.

Somewhere along the way that protective cocoon that he formed around me started to smother. I was isolated. Our finances were combined, we lived together. How could I leave? I couldn’t hurt him. He didn’t mean to hurt me.

Somewhere in those years, I began to understand why women (or men) don’t ‘just leave’ an abusive relationship. There are lives – jobs, obligations, a thousand little ties that connect you to where you are physically, mentally, and emotionally.

If you sever one thread there are still the other thousand to draw you back again and again.

And make no mistake those who would abuse another become skilled in playing their victim like an instrument. They are able to draw out any emotion they wish. To them, you are part toy, part safety blanket, part mirror, part captive audience.

My abuser had a distinct pattern that he moved his victims through. I stuck around long enough that not only did I get to see all the roles he shoved his partners into, I played those roles myself. When I saw the entire tableau, I helped the women he was grooming to leave before they were caught in the pernicious cycle. And they, in turn, helped me to leave.

Let me emphasize I was never struck. I don’t know if that is because of my declaration at the beginning or if I just got out in time. I suspect the latter. But, even if I was never physically hurt, that doesn’t mean that I wasn’t wounded by the time I left.

Those years in the crazy-making, gaslighting, emotionally battering world stripped me of so much. When I finally fled I was a fraction of myself. And after you escape there is shame, and anger at yourself and them. There is the world not able to understand how you could leave someone ‘so nice’. There is a whole new landscape to navigate. And you start on your knees. Or, at least, I did.

But, I came away from those years with a new understanding, new compassion for those who live with violence. It is not something you can just drop and walk away from. You fight your way out of it. You fight to reclaim yourself. And I finally understood that leaving wasn’t the end. It was just the beginning.

Nailed in the past… a paradox

This is one of those things that when I think about my Complex-PTSD should have been obvious. How I missed it for so long really confounds me.

I often talk about the paradoxes that arise in C-PTSD. Here I have stumbled into another one. It goes something like this.

Huh. I just realized how weird it is to live with one foot nailed in the past when you can’t remember any of it.

ThinkingTooLoud

Poetry Battle: Bliss

The prompt and the week that it is attached to sometimes are not in sync. This is the situation reflected in this entry to the poetry battle. The prompt was : Bliss.

The word repels me.
Turned its back on me.
So I turn away in turn.
Sore.
Ignored
And bruised.
It denies me its presence
So I deny its existence.
I will be
Barren stone
To being a fool
Waiting
Longer
Longing
For rain
To bloom.

Healing the Invisible

There is an event in the writing world called #PitMad. It is a Twitter event with a specialized hashtag, #PitMad in this case, where writers can pitch their novels to agents. It’s a bit like Carnivale crossed with Bedlam.

These events have really taken off in the past couple of years. From initially a few hundred pitches over the day agents and publishers can now be bombarded with thousands of pitches an hour. How they wade through all that, I have no idea.

How you stand out as a writer is even harder.

This is where my Complex PTSD enters the picture.

For someone who has grown up in an environment where they were in essence ‘invisible’ learning how to be seen, and heard, and noticed is an exercise in something not only new, but frightening in cases. If, like me, your home was dysfunctional with explosive anger you might also have learned that being unseen was safer. I learned early that it was better to be the child that didn’t need, or want, or ask.

I learned that lesson so well, so many times that I even made up a little chatechism that I recited every night.

Don’t Ask – You’ll be denied.
Don’t Rely – You’ll be disappointed.
Don’t Trust – You’ll be betrayed.

By the time I was 13 I had carved a reminder of this into my arm so I would never forget it again. I still have those scars fourty years later.

But, I’m trying not to live by those rules any more. Trying. The healing doesn’t always go smoothly, or in a straight line. Think of it more like a mental health cha-cha. Sometimes you go forward, sometimes you go back. You get the idea.

To tie these two things together – PitMad and CPTSD recovery – think of it as peeling off layers and layers of habitual camoflague. Rule one of PitMad is if you want to ‘win’ an agents attention via the event – you have to enter. You must put yourself out there. An agent is not going to come knocking on your door.

Image by 愚木混株 Cdd20 from Pixabay : Words by MStewart

Participation, putting myself ‘out there’, that means making an active attempt to be seen. That idea just registers in my core as pure insanity.

Be Seen. NO! That’s when ‘bad things’ happen. You get ignored or hurt when you are seen.

Don’t touch it! Just, put the idea down, and slowly step away.

One day you finally figure “Meh, I’ll try it.” So, you do. And you hear the worst thing you could. SILENCE.

Why is silence the worst? When in a situation like PitMad it could mean –

  • The agent just isn’t looking for a fantasy book about a mentally challenged heroine.
  • The agent blinked when your pitch scrolled by.
  • They stepped away for a minute (they’re human, too)
  • Their dog farted and they had to clear the room.
  • They already have a book that is a fantasy about a mentally challenged heroine.

Who knows? There are literally millions of reasons that no one put a little red heart next to your entry. And the competition is stiff. Thousands of entries for all kinds of books scroll by during the day. There is not enough time to respond to them all.

But, though my rational brain knows this, my emotions tie themselves into knots and I’m that small, inconsequential, invisible girl again. Being back in that place makes me wonder if I ever left it at all. Maybe that invisibility is permanent? Perhaps there is nothing I can do to be seen or heard. I will forever be shouting into the void. And, even there, drowned out by millions of others. Never to be more than a dull anonymous speck among stars.

Ouch.

After a few tries you wonder if the voices of the CPTSD are right. You fear you never will be ‘visible’.Part of you contracts with the pain of the idea. But, there is a tiny voice within undulled by all the abuses and fear that whispers – “Try.”

That seed, our original and true self is the one we must nourish.

So, rest when you must. When you can, move on; sure in the knowledge that the Universe sees you.