Trafficking, trauma & PTSD: Margaret Howard answers your questions

By Holly Austin Smith — From her column Speaking Out in the Washington Times Communities


ST. LOUIS, Missouri, May 20, 2013 ─ Many believe that post-traumatic stress disorder (PTSD) exclusively affects war veterans. However, Licensed Master Social Worker Margaret Howard dispels this myth. In an interview earlier this month, Margaret explained how PTSD can affect survivors of human trafficking and sexual crimes. Since many are not familiar with the signs and symptoms of this disorder, Howard has agreed to continue the conversation with questions from survivors.

Can I have PTSD and not know it?  In other words, must a person be debilitated with terrifying flashbacks in order to be diagnosed with PTSD?

Yes, it is very possible to have PTSD and not know it. Flashbacks are only one possible feature of PTSD, and many people with PTSD do not have them. Usually when we think of flashbacks we think of something visual or auditory, like someone seeing or hearing sights and sounds that are of the original traumatizing event or events. However, traumatic re-experiencing probably more often looks or feels like one of these two things: hyperarousal or hypoarousal. Hyperarousal is an out-of-proportion emotional response to either something that is currently happening or an environmental cue associated with something that happened in the past. Hypoarousal is an emotional response that looks more like a person getting really quiet, spacing out, getting really tired or sleepy, or “going away,” which is dissociation.

How long can PTSD last, especially if you never receive treatment for it?

PTSD isn’t the kind of injury that heals itself. Like a broken bone, it needs to be “set,” treated, worked with by the injured person and a mental health professional who has specific training and expertise in working with trauma and the body. Traditional “talk therapy” can help, but the body also has to be engaged in the healing process, since, again, the injury is to the nervous system and the trauma is embedded in the body.

Sensorimotor psychotherapy as designed by Pat Ogden is one very good method. Trauma-informed yoga is also a very good healing modality, and has been shown in studies at Bessel Van der Kolk’s Justice Resource Institute to be even more effective than talk therapy. Psychotherapy that incorporates a mindfulness component, like Dialectical Behavioral Therapy, or even therapy that teaches mindfulness of body and mind can be good, too.

But if PTSD is not treated, it will persist. And every time a person has a re-experiencing episode — what we call “triggering” — the injury is driven deeper into the system, because it is happening again, as far as the body knows. It’s like hitting a bruise over and over. In order to stop the cycle of re-experiencing trauma, PTSD must be treated.

The good news comes with the word “neuroplasticity.” We now know for sure that the nervous system, including the brain and involuntary components, are “plastic,” or moldable.  In other words, they are changeable with inputs and experiences. Knowledge of specific changes in response to specific inputs and experiences is growing all the time because of our ability to image the brain with fMRI and other imaging technologies.

As a survivor of early childhood sexual abuse, I am sometimes overcome with a very “bad” feeling which I associate with this early abuse.  It was very strong in my teenage years and early 20s and comes much less frequently in my 30s.  Is this PTSD?

It’s hard to say. I would have to explore what “bad” means in this case. But it is interesting that you are identifying this as a feeling, not a thought, and that indicates that you are tuning into your body states, and that you are aware of those changes.  This awareness of body states is an important part of healing from trauma, as well as of recognizing when a new action is needed.  I think it’s important here to note that, in the dissociation/collapse end of the spectrum, there also can exist the feeling of shame. Trauma survivors do identify shame as a component, even when the accident or crime that caused the trauma is not sexual in nature. There is evidence that the sensation of shame is associated with hypoactivation states and, therefore, dorsal vagal nerve function.

As such, thinking “positive” thoughts and developing “positive” self image, though helpful, may not be all that is required to help heal.

One primary feature of traumatic injury is that the injured person’s involuntary nervous system, which can also be thought of as part of the unconscious mind, is very sensitive to environmental cues that in some way or another are related — directly or indirectly — to the traumatic event, or some part of the traumatic event.  These may be tiny things, like a smell, a song playing, a color or a feeling or a word, or telling the story again. The person may not even be consciously aware of the trigger or cue.

When a trigger or cue is picked up on, though, the body thinks it’s being attacked or held or hurt again, and it reacts as if the event is happening again, right now. Because this reaction is in the involuntary nervous system, and not in the person’s conscious thoughts, the body mobilizes against the “threat” in the same way it would if the trauma were really, truly happening again right now.

And here’s the most important part to understand- these aren’t just thoughts about the traumatic event, they are, in fact, a re-experiencing of the event. The person may “know” in their rational mind that it’s not happening, but the re-experiencing makes it feel real as if it is happening again. This can be very confusing to the injured person, especially because the injured person may not be consciously aware of the environmental cue or cues or triggers that caused the re-experiencing to kick in.

When would you recommend a survivor seek help for symptoms of PTSD?

According to current evidence, in order to avoid lasting traumatic injury, or PTSD, getting treatment as soon as possible is important. However, at any point good trauma treatment is going to help. For me, it was around 35 years before I got actual trauma treatment (though I’d had lots of therapy by then), and it still really helped.

May is Mental Health Awareness Month.  Everyone deserves to feel positive and healthy.  It’s important to spread awareness to others, especially children.

Be sure to follow Margaret Howard’s blog with the Huffington Post, or contact her via Twitter @MargaretAHoward.

If you are in need of immediate assistance, please contact a mental health specialist, your local crisis line, or your general practitioner.

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