This month we have been discussing complex post-traumatic stress disorder (CPTSD/ c-PTSD/ Complex PTSD) and adverse childhood experiences (ACEs). So far, we have explored the definitions of both, and some of the long-term consequences to the lives of children who survive their devastating effects into adulthood.
Today, we are going to examine the many mental health disorders which are directly related to both ACEs and CPTSD.
Some of the research we will be discussing is cutting edge and still debated in offices, laboratories and campuses all around the globe.
The Central Nervous System Changes Caused by ACEs: A Recap
In previous articles we looked into the brain changes which occur due to the levels of stress hormones which flood young children’s bodies when they experience ACEs. Let us recap last week’s information so we can better understand the mental health disorders caused by early childhood trauma.
To prepare our body for the fight/flight/or freeze response, hormones are released when the threat becomes noticed. These substances, neurotransmitters, alert our body to breathe faster and to increase our heartbeat, among other reactions necessary to help us get ready to fight or flee.
Typically, after the danger has passed, our body will return to baseline where the hormones stop flowing, and we return to a resting state. However, the bodies of children who are in constant danger of being attacked, are never given the chance to return to baseline.
The problem with this picture is that these substances cause harm to the child’s developing brain. This damage results in smaller than normal amygdalae and hippocampi as well as other changes which set up the child for a myriad of problems as they reach adulthood.
There are many responses we may be leaving out here, but we’ll tackle the other brain changes later when we discuss the different mental health issues caused by ACEs.
ACEs and Their Direct Link to Mental Health Issues
It is common knowledge now that adverse childhood experiences, including all forms of child abuse and neglect, are deeply connected to mental health problems in adults. Yet, there are still some scholars and pharmaceutical companies who would discredit these findings.
Nevertheless, the evidence is growing.
A good example is a paper published in the American Journal of Psychiatry in 2004.
The researchers discovered that 89.5% of the sample had one of the following diagnoses: undifferentiated somatoform disorder, generalized anxiety disorder, dysthymic disorder, simple phobia, obsessive-compulsive disorder, major depression, dissociative disorder not otherwise specified, and borderline personality disorder.
That isn’t all.
Researchers also found that dissociative disorders were present in 47.4% of those researched. Unfortunately, those with dissociative disorders also had experienced childhood emotional and sexual abuse, physical neglect, self-harming behaviors, and suicide attempts.
There have been hundreds of scientific inquiries resulting in published research papers linking ACEs and mental health disorders. Many are available free online to the public.
Anxiety Disorders and ACEs
Globally, one person in 13 lives with an anxiety disorder, with 10% of those in North America, Western Europe, and Australia/New Zealand, and 8% in the middle east with Asia reporting an affected population of 6%.
People with anxiety disorders are up to five times more likely to see their doctor and six more times likely to enter the hospital for psychiatric reasons than those who are healthy. These life-altering issues develop from a rather complex set of factors including genetics, brain chemistry, and personality.
An important and possibly the most significant cause of anxiety disorders are ACEs.
I’ll explain further.
Anxiety disorders are mental health issues where a person experiences a significant feeling of anxiety and fear. These feelings usually accompany physical symptoms such as a fast heart rate and shakiness. People living with an anxiety disorder live consumed with worry about the present, and future events and their reactions to this concern can be drastic.
There are several anxiety disorders, and many people have more than one. These disorders differ by the symptoms which result from them. The different types of anxiety disorders include generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism.
Anxiety disorders are rarely diagnosed alone and accompany other mental health diagnoses such as major depression, personality disorders, and substance abuse. For a medical professional to diagnose an anxiety disorder, the problem needs to have been present for at least six months and decreased the ability for the person to function.
The reason for the delay in diagnosis is that many other problems can cause anxiety such as hyperthyroidism, heart disease, caffeine, alcohol, and marijuana use.
How Do ACEs Tie into Anxiety Disorders?
In five studies conducted between 2001 and 2007, the researchers found there is much evidence to support the fact that early childhood trauma is responsible for 80% of adults experiencing depression, anxiety disorders, and addiction. (Heim and Nemeroff, 2001; Edwards et al., 2003; Gutman and Nemeroff, 2003; McFarland et al., 2003; Espejo et al., 2007).
Let us sit with this number for a moment.
In contrast, those disorders rarely appear in individuals who are traumatized as adults. This last observation points to the idea that there is a critical window of time of development when children are sensitive to stress-induced problems which affect them later in life (Brown and Moran, 1994; McCauley et al., 1997).
Brain Changes Associated with Anxiety Disorders
As we have discussed before, the amygdala is vital for us to respond to danger. However, usually, the thinking structure of our brain located in the front will dampen the fear response by telling the amygdala, “No, this is not dangerous. Calm down.”
In an anxiety disorder, something goes terribly wrong.
In the previous article from last week, we touched on the structures which are damaged by ACEs. Research published in 2017 by the Psychiatric Clinic of North America offers the following conclusions:
“The Neurobiology of Anxiety Disorders Commonalities in anxiety disorders include functional hyperactivity in limbic regions, particularly the amygdala, and the inability of higher cortical executive areas to normalize the limbic response to stimuli.”
Let us translate that into easier to understand language.
This research shows that the fear center of our brain and first to respond to danger, the amygdala, is in overdrive within people suffering from anxiety disorders. This small region of our limbic system, vital for recognizing danger and keeping us safe, instead of using our thinking brain to single out what is dangerous and what is not, responds to everything as if it were dangerous.
Thus, people living with an anxiety disorder are anxious and ready to flee or fight all the time.
To back up this assumption, let us look at this conclusion written in a paper published in the journal Biological Psychiatry in 2003. Hariri, Mattay et al. state:
“The current results further implicate the importance of neocortical regions, including the prefrontal and anterior cingulate cortices, in regulating emotional responses mediated by the amygdala through conscious evaluation and appraisal.”
To state it more plainly, our cortex (the thinking part of our brain) is not able to regulate the fear responses sent out by our amygdala by processing and evaluating whether the danger is present and real.
It should be clear by now that when our amygdalae are damaged in childhood by ACEs, when we become adults our brain is incapable of adequately recognizing what is dangerous—and what is not dangerous. This constant alertness and seeing danger everywhere and all the time means we are anxiously awaiting doom which is inescapable.
This constant fear response is the fuel which feeds adult anxiety disorders.
Dissociative Disorders and ACEs
To discuss the connection between dissociative disorders and ACEs, we must first get a good definition of what they are and how they affect those who live with them.
The International Society for the Study of Trauma and Dissociation (ISST-D) explains dissociative disorders as follows:
“the disconnection or lack of connection between things usually associated with each other. Dissociated experiences are not integrated into the usual sense of self, resulting in discontinuities in conscious awareness.
In severe forms of dissociation, disconnection occurs in the usually integrated functions of consciousness, memory, identity, or perception.”
The ISST-D website goes on to state that dissociation can occur when there is severe neglect or abuse, and children may also dissociate when they live in homes which are frightening, and unpredictable.
A paper published in the American Journal of Psychiatry in 1998 states that out of a randomly selected sample of 1,028 people from the United States, up to 6.3% experienced occasional dissociative symptoms. They also found the following:
“Among these individuals, the rate of childhood, sexual abuse was two and one-half times as high, the rate of physical abuse was five times as high, and the rate of current psychiatric disorder was four times as high as the respective rates for the other subjects.”
The Three Major Types of Dissociative Disorders
There are three central types of dissociative disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) which is published by the American Psychiatric Association. They are depersonalization-derealization disorder, dissociative amnesia, and dissociative identity disorder. There is also one other dissociative disorder I will mention as well, which is labeled dissociative disorder not otherwise specified (DDNOS).
Depersonalization-Derealization Disorder. Depersonalization involves episodes of a sense of detachment or being outside oneself and observing your actions from a distance or as though watching a movie. Derealization feels like other people and things around you feel detached and dreamlike. Time appears to slow down or speed up, and the world feels unreal.
Some people experience both depersonalization and derealization at the same time or just one. Whatever a person may experience with this disorder, the symptoms can be very distressing and frightening and can last for months and come and go for years.
Dissociative Amnesia. This disorder is something I often experience myself. It is very distressing and sometimes frustrating.
Dissociative amnesia’s main symptom, as the name suggests, is a loss of memory which is much more severe than average forgetfulness which is not explained by a medical condition. Events and people become lost, especially during a time of trauma. This form of amnesia may be specific to a particular time in one’s life or involve everyday events where there is no easily identifiable trigger. These amnesiac events may last for minutes, hours, months or even years and usually come on very suddenly.
In my life, dissociative amnesia is a nuisance with which I am forced to live. I often lose events for seemingly no reason, or conversations, and oh yes, I forget names. I have received accusations of signing up for events online without any knowledge of what transpired. Usually, I am completely oblivious to having “forgotten” something and only become aware that the information is missing when someone brings up an event or conversation for which I have no memory. It is highly frustrating not to remember your day or to have a conversation and not remember what was said, or sometimes, to whom you were speaking with.
Dissociative Identity Disorder. Unfortunately, I understand DID all too well as I received this diagnosis in 1990.
Formerly known as multiple personality disorder, DID is the most severe and long-lasting of the dissociative disorders. The main characteristic of DID is the presence of two or more distinct identities who will take control of an individual’s behavior. Following these “switches,” the core self-state usually has no memory of what was done or said as the “alter” who took over.
A person, like myself, living with dissociative identity disorder is not full of different people or personalities, but rather the aberrations in their personality are fragments of the original self who did not associate in childhood.
Each fragment has his or her own beliefs, ideas, and sometimes lead different lives which the core self and other fragments in the system are totally unaware.
On average, people living with DID present two to four alters when they are diagnosed, with an average of 13-15 emerging during treatment. However, some people, like myself, have up to and over 100 fragmented self-states.
The Diagnosis of Dissociative Disorder Not Otherwise Specified (DDNOS).
The symptoms of DDNOS do not meet the full criteria spelled out in the DSM-5 as dissociative identity disorder (DID). However, it can be just as prohibitive to one who desires to live a healthy and happy life.
The website Positive Outcomes for Dissociative Survivors (PODS) describes DDNOS as a partial dissociative identity disorder. They quote the ISST-D guidelines where they distinguish DDNOS as being either “not yet” or “not quite” DID.
A book published in 2007, by the premiere world leader in research about dissociative disorders, Dr. Colin Ross, states:
“The dividing line between dissociative identity disorder and most cases of Dissociative Disorder Not Otherwise Specified is arbitrary. Most cases of DDNOS are partial forms of DID which lack either clear switching of executive control, full amnesia barriers between identity states, or clear differentiation and structure of identity states. They are partial forms of DID with the same patterns of childhood trauma and co-morbidity.”
Indeed, those who receive the diagnosis of DDNOS usually are in one of two stages of diagnosis, those who have not yet received the diagnosis of DID, and those who do not meet all the DSM-5 criteria for dissociative identity disorder.
Right now, there is an ongoing debate about the criteria which depicts the symptomology of DID. Many believe it is not accurate in that it is too restrictive. They wish to include those who have up until now received the diagnosis of DDNOS into the category along with dissociative identity disorder.
Make no mistake, DDNOS and CPTSD are just as traumatic and life-altering as DID.
We will dive deep into a series on all dissociative disorders in the coming months, so keep your eyes open for new articles on the CPTSD Foundation website.
ACEs, DDNOS, CPTSD, and What CPTSD Foundation’s President, Athena Moberg, Is Doing About It
Today, we spent some time together connecting more dots between adverse childhood experiences, complex trauma, and dissociative disorders. Many scholars have studied the connections between DDNOS and CPTSD, and they are in agreement; these two constructs are similar in numerous ways. Our founder and president, Athena Moberg, started CPTSD Foundation out of both frustration and compassion. She was extremely frustrated by the dearth of scientifically based, trauma-informed, and accurate resources available to those who, like her, were desperately searching for answers while living with symptoms which were unmistakably “CPTSD or DDNOS” depending on which “expert” she was speaking with or which scholarly article she happened to be reading that day.
This lack of accessibility to helpful information was a breaking point for Athena. And yet her frustration didn’t end with her feeling defeated and helpless. No. Her frustration gave birth to deep compassion followed by inspired action. She was overwhelmed by the thought of countless others who would begin Googling their way through what could be years of fruitless research, only to end up feeling defeated, hopeless, and in most cases, suicidal.
The thought of millions of people impacted by ACEs living in despair and frustration, like she was, pushed Athena toward building a healing refuge where anyone, from anywhere, could find trauma-informed help at their fingertips. Here, at CPTSD Foundation, anyone who has endured ACEs can immediately find the answers they need without spending years or even decades wondering how to heal. In fact, in addition to the hundreds of free written, audio, and video resources Athena offers, the foundation facilitates live daily calls at 8:00 pm Eastern Time, 365 days a year, in a safe peer-to-peer environment, for anyone who has endured the pain of ACEs and complex trauma. If you have not yet found what you are looking for, reach out to Athena and the Daily Recovery Support team today.
Wrapping It All Up
If you remember from our very first articles about complex post-traumatic stress disorder, CPTSD is formed as a response to prolonged, repeated and interpersonal trauma where the person feels trapped and has no chance of escape.
Although this description can include experiences one might have as an adult, overwhelmingly those who live with it were traumatized in childhood. Yep. You guessed right, ACEs.
We’ve had only a brief glimpse at some of the mental disorders which are caused by ACEs. There are so many more that time and space do not allow me to cover them all today. These include, but are not limited to, such severe diagnoses as borderline personality disorder, in some cases, schizophrenia, and some forms of bipolar disorder.
While this piece and the others in this series may leave you shaken or feeling down, do not despair. Next week we will examine the treatments and hope-filled future that is coming into focus through the ardent research done by doctors around the world.
Until then, remember to keep moving forward.
I know I will.