Joy of Meds: Effexor withdrawal (and oh yeah, Blogspot sucks)

Grrrr...I spent a whole morning on this post and blogspot went down for maintenance and ate the whole thing when I tried to post. When they came back up, I could only recover about half of it. Bastards.

First the good news: I have been doing pretty well lately, well enough to slowly come off some of the meds I take. All has gone fairly smoothly. I went from 140 mg/day of Geodon to 40mg. When I went lower symptoms came back, but getting rid of that and the Seroquel was like coming out of a daze. Friends noted a definite change in personality for the better, I seemed more alive and engaged, both subjectively and in the eyes of others. I reduced the trazodone (for sleep) to where I usually take half of a 25 mg tablet, occassionally taking the other half if my head won't shut down for the day and keeps spinning, a trauma response in some ways but also I think a symptom of a busy life. Wellbutrin went from 450 mg to 300, where I am leaving it for now because it seems to help more than some of the others, and Naltrexone, which I use to fight some of the addictive thinking and compulsivity involved with self-harm stuff, is next on the block but currently at 100mg and holding.

Everything has been more or less fine until the Effexor. If I had known what the withdrawal was, I don't think I would have gone on it even though I was pretty desparate for some relief at that time. I was on 450 mg/day, pretty much at the top end of what can safely be prescribed. My psychiatrist, who I work with on the meds, said withdrawal can be tough, but at first it was fine. I got down to 75 mg/day over the course of the better part of a year, knocking it down by 37.5 mg every few weeks. In going from 75 mg to 37.5 mg, I felt a little achey in the joints and feverish, but it passed after a few days.

Then when I made the last step down to zero, it made me really sick. I had brain shivers, or brain zaps -- sort of like an electric short circuit going bzzzzt in your head with the attendant feeling, or like the sound some modems make when they are connecting (more on other people's experiences of Effexor withdrawal are here and here). For about a week I slept for 16-20 hours a day, and I was very low energy when awake. Fortunately, I don't have fixed hours at work in the summer so I could do this. I ran a low grade fever, felt constant nausea, felt dizzy, like if I closed my eyes I would fall down a dark hole. This was different from the top-o-the-elevator, car-with-no-brakes feeling and or the world-dropping out from underfoot feeling: It was a visceral, bodily sensation of falling rather than a PTSD-induced feeling of unsafety, sort of vertigo without the heights. Also experienced headaches along with the feeling of having a wet blanket over my brain, sort of like in the cartoons where they show the little fizzy bubbles above people's heads. Consensus seems to be that the severity of the withdrawal symptoms is due in part to the short half life of Effexor (several hours as opposed to weeks for Prozac). To quote Iggy Pop, "no fun."

I did some research and found out what I experienced, along with a couple more, are pretty common withdrawal symptoms from Effexor. There are some suggestions for alleviating them, including tapering off the Effexor in smaller increments than 37.5 mg. This was my psychiatrist's suggestion, but I had already gone through the worst of it by then, and was not experiencing a re-onset of the symptoms the Effexor was supposed to treat (PTSD-related anxiety and depression) so I decided not to go this route as it seemed like it would only prolong the misery. Another option was to take a dose of Prozac, which has a longer half-life and masks the withdrawal. I didn't like Prozac at all when I took it, so I nixed this. A third was to take the anti-flu concoction Benadryl. I was a little skittish about this as a recovering addict, as twenty some-odd years ago when I was in rehab, they said to stay away from anything with antihistimines because of speed-like qualities. I tried it anyway and so far have not broken out on a crystal meth rampage :) -- and it seemed to help a little.

I seem to have made it through the worst of it, though still a bit dizzy and have the wet-blanket-over-the brain sensation a little. I think that about covers most of the stuff blogspot deleted.

safety and the familiar

My partner is out of town and I've been staying up late catching up on work. I got caught up so I decided to do something different and go out. I realized walking down the street that I have become a creature of habit because of the PTSD. I have a safe set of things that I do and seldom step out of them, which is strange because I used to be quite adventurous.

I realized that as soon as I got out in an unfamiliar time with unfamiliar people (I went out by myself) in a setting I no longer frequent, I got anxious and unsettled. The old feeling of being worried that the next step will be right off the world into some crazy traumatic space came back, like I had a feeling that I wouldn't be welcome -- these spaces are for other people, not for me. I wasn't doing anything dangerous, just going to a club to listen to some music and take in the scene. I don't drink or anything, so no worries about things getting out of control either.

Even so, my breath grew short and I had the top of the elevator, hit the brakes when your not driving feeling pretty bad. I practiced a mini version of my grounding excercise and tried to get back into my body and settle down. I just focused on breathing. Once when I was in the same room as someoone awful from my past, a friend just whispered to me to breathe. I think I had a mini-epiphany. When I dissociate, the first thing to go is I stop taking in the normal amount of air. It is like going underwater.

Focusing on breathing helped a little and I began to feel a better. Being outside helped, and I walked in the wrong direction, thinking the club I wanted to go to was somewhere else (I guess I don't get out much) and I think just walking helped. I hadn't been out all day, and a lot of the time, I think if I didn't force myself, or my partner didn't, I'd just hide out at home and never go anywhere because it is safe.

So my adventure was fine. The music wasn't so great, but I did something out of my usual routine and not only got through it, but even enjoyed it a little and learned a bit about how sheltered I have made my life. That has been crucial to my getting better, the feeling of having a safe place, a home. When I was in treatment for the PTSD, we decided that safety was the first thing I needed, before I could work on anything else. It makes perfect sense. I think a lot of Americans feel entitled to it and take it for granted for the most part, but the world I lived in wasn't safe and I no longer trusted any situation when the PTSD got bad. Everything was dangerous. Going out a little while tonight made me realize how much I depend on the safety I have established in my life, the familiar, home. Maybe I can extend that space outward little by little and slowly move back into the rest of the world without such a sense of foreboding anymore if I am careful and go little by little.

Writing when things are ok for once

Hi,
I'm still really busy with work and it is still crazy, but I've kind of made my peace with it for now and have gotten back to my regular work, which I like, and am just trying to stay out of the s***storm (see "Still here, still have ptsd"). The Grateful Dead had a song with an appropriate line about getting through such things: "aint no luck/I learned to duck." And no, I don't think I could be considered a deadhead. At least not lately. But sometimes when I am in the right mood I can listen to some of their stuff and enjoy. I used to like them a lot more.

So my ptsd on a good day is pretty mild. I feel a little off from the meds I take (still slowly lowering the doses on them) but that is normal. My hands are not very steady. That is from both the ptsd and the meds I think. But I am in the present. I am not obsessed with the traumatic past. I'm in my body and able to function. That is pretty amazing considering how awful the symptoms used to be.

I guess I should be grateful for all this, and to some extent I am. But I am not grateful for the traumatic events that led to the destruction of a good chunk of my life. I don't get all yippy-skippy with joy when things are going well. I've seen the bottom of that drop out in an instant and always remain a little detached and skeptical. I guess that will never go away. Maybe its normal, a reality check. When the ptsd was bad, I'd get terrible lows. But I am not after equally ecstatic highs. I'd rather go along kinda steady and ok. That is good enough for me and more than I would have expected if you had asked me a couple of years ago.

Still here, still have ptsd

Hi, it has been a while since I last posted, but I am still here. Lately I have been very busy with work. I pointed out a BIG problem there recently, and instead of dealing with it, the folks responsible decided to blame the messenger, scapegoating me as a distraction from the real problem. Getting blamed for stuff that I didn't do is a real trigger for me, and I woke up today crawling out of my skin, which I haven't felt in a while. For a little bit, I even thought I might go into a flashback or have a little non-epileptic siezure again. I was as close to that as I have been in quite a while. I was dissociating and feeling very much out of my body because of the skin-crawling feeling and another feeling that I have described as being in an elevator that is hitting the top floor all day. Another way I have come to describe it will make sense to drivers maybe. The feeling is like when you are a passenger in the front seat and somebody doesn't hit the brakes at a time when you would. That moment of feeling out of control, of not being in charge of yourself as you hurtle through space and time, of hitting the imaginary brakes and finding them not there, but all day, not just for the moment: that is my most common everyday experience of ptsd at present, some days worse than others and today, with the skin crawling and dissociation, pretty bad at the start.

What to do? I have a nice view out the window of my home that I find centering and comforting, so I sat and looked at that while I had my morning cup of coffee before going to work (cutting back on caffeine helps a lot! I used to drink a lot more coffee and it is no help for ptsd at all). At work I did my grounding exercise a couple of times through then got started with my job. After a while of engaging with that (I quite like my work, even when things are rough like at present) I slowly settled back into my body and the jitters and skin-crawlies subsided. Now my main goal is to stay out of the path of the mudslingers at work to keep the triggering to a minimum.

I still have plans for more posts, just no time to write them. I want to put a sticky post at the top of the blog with a sort of guide to all the previous posts so people can find resources quickly. I also want to talk a little about a couple of therapeutic techniques I have been working with, EMDR and a related practice called DNMS. I have had mixed, but overall useful results with both, though I remain a tad skeptical, which is an old defense that results from previous betrayals by therapists. I have since learned how to protect myself better when choosing therapists.

Fell off the blogosphere....

Hi, If you have been looking for a post here this past week or so, it hasn't been happening. My partner is out of town on family stuff and I got really busy at work and the two combined have thrown me a little out of whack. Plus writing all that stuff about trauma, betrayal bonds and ptsd was sort of emotionally draining. I just kinda wanted to get that out and then didn't have anything to say for a while. So my clock is all messed up from the ptsd. Having a hard time sleeping...I get terrible nightmares as I am dropping off that then wake me up, then I start to fall back asleep and the same thing happens again. Oh well...this is probably my karmic payback for once telling someone with insomnia that nobody ever died from lack of sleep. Days have been ok though. I'm seldom alone so being by myself is a different way of occupying my world. I miss my partner bunches but I'm ok alone. With the nightmares its probably good she's not here as I often accidentally maul her (not hurtfully fortunately, just wakes her) in my sleep or wake her from yelling out in my dreams. This has been going on for several years now, but this past week has been the worst its been in a while. So I don't have any new info...there is more I want to write about...I got a couple of books that Holly posted on a while ago. I read one and will give a mini review, then look around the other blogs on ptsd and related stuff and see if I have anything to say! And Grrrr...I just found out one of my posts that has the links to all the other ones disappeared. OK, fixed it...If you have been looking for the first page of the betrayal bonds post its back up. So that's my little 4 AM stream-of-consciousness report from the front.

If I don't get to posting tomorrow, I hope you have a warm and safe holiday with people you love and that love you. G'night.

grounding exercises for ptsd symptoms

Today I'll go over a grounding exercise I learned that was very helpful in managing ptsd symptoms. Its not a cure. At best, it makes the unbearable manageable. Sometimes when things were really bad it did not work well at all, but I did it anyway. The goal is to bring the ptsd sufferer back to the present by way of the senses, out of a flashback or intrusive memory. Anytime the symptoms of ptsd come on, whatever they are for you, is a good time to practice this exercise.

First look around and see five things present where you are, naming them -- out loud if possible (the naming out loud is supposed to help, but sometimes I would cheat and do it under my breath, too). Anyway, name specific things, in detail, as you see them. For example, I see a picture of my old dog with a wet nose; I see a black computer speaker; and so on. Then name five things you can hear, like the humming of a fan, cars passing by, the dishwasher running, and so forth. Then name five things you can feel. I had a hard time with this first, because I thought it refered to emotions, feelings, but that's not what I was supposed to be after. Its the sense of touch, so I feel jeans against the skin of my left thigh; I feel the soles of my feet on the floor, and so on. If you get stumped, its ok to repeat things, just concentrate on actually sensing them in the present. Then repeat the whole process for sight, hearing and touch four times, then three, then two, then one. You get extra bonus points if you become so wrapped up in your senses that you lose count. Generally, this would bring me back a little. I would still be miserable most of the time and in pain, but the memory part would subside and sometimes the worst symptoms of a flashback would recede.

[n.b.: updated 12/8/08 to replace broken links with new ones]
This isn't the only way to do it, just a very simple and easy to learn one that worked for me if you need it. About.com has some simple suggestions. The Mental Health Matters web site breaks it into three options: accept it and go through with it, learn to control it, or escape it. It is not always a matter of choice though. Their methods of coping are the same for whichever option you choose (or which chooese you!), including one that I tried during the worst of the flashbacks at the behest of counselors in the PTSD treatment center I was in. They had me hold two liter bottles of frozen water (ummm, I think they call it ice :), one in each hand to bring me back. I melted the ice in both and still didn't come back...they were about to send me off to the hospital, but I managed to get a handle on things after about a four hour flashback. Possibly the worst few hours of my life. Cold, the site explains, activates some reflexes that slow down the heart and exert a calming influence. Finally, you can read a more academic but still enlightening and useful treatment of coping techniques in the book Rebuilding Shattered Lives by James Chu.

What's this betrayal stuff got to do with ptsd anyway?

I already wrote a little about betrayal in the posts on betrayal bonds and the effects of trauma over time. Carnes has a whole chapter explaining the power of betrayal. He write that "Common to all is a promise. Those who betray read their victims well. They appeal to the emptiness, the unfinished, and the wounds of others." Otherwise intelligent people set aside their intuitions because the promise is so attractive. "The starting point for all trauma survivors" he says, is a complete acceptance of the betrayal." From a distance this seems obvious, but it is hard to put into effect, and I still struggle with it. Abusive parents in denial, manipulative, self-serving people fostering traumatic relationships who want to feel good about themselves -- these types of abusers have an insidious way of getting into and undermining a person's very sense of self, making me doubt my own reality.

Carnes maps out "five main ways promises are used to betray:"

• Betrayal by seduction: "High warmth with low intention. . . . Relationships are manipulative and exploitive. Agreements are ill-defined, unclear, or tentative. Feelings are anxious and intense. Trust depends on exaggerated or unreal promises. Rewards are in the future and are often conditional. Risk is often one-sided." Most importantly, the seducer is deceptive about all these things in order to lure the other person into the relationship. People with family histories of abuse or trauma are particularly susceptible because they have never learned to protect or take care of themselves in important ways. A traumatized person's "picker" is often broken. Trauma shame creates doubt of one's intuitions. And there is a neediness that allows the person to ignore warning signs
• Betrayal by terror: If seduction fails, terror might work. Fear "deepens attachment" in ways that can be addictively intense, especially when coupled with seduction. Cults work this dual betrayal very well. They promise vulnerable people what they want, whether that be wealth, friends, spiritual growth, or whatever, but then withdraw support or even rip a person's life apart if they question things. This is the "love bomb" followed by the terror of abandonment. Often the result of betrayal by terror is guilt and shame on the part of the victim. According to Carnes, only seven percent of women who have been sexually assaulted, often by someone they know, report the offense. That is why Holly's work is so important.
• Betrayal by exploitation of power: Sexual harrassment often falls under this category, where women (or occasionally men) are in a position at work where to challenge the abuse would threaten their job because the abuser has more power. Incest relations are another example. They are "exploitation by people in power of those most vulnerable to them. If you're not equal in power, then by definition you're vulnerable. And that vulnerability is critical to trauma bonding."
• Betrayal by intimacy: In its strongest form this is emotional blackmail by someone you trust. Somebody does something wrong and the other person won't turn him in because she would be affected too. The cult abuse/'support community' that ripped up my life did this by trying to stop me from pursuing legal actions because of the ramifications it would have throughout the community.
• Betrayal by spirit: The most publicized version of this form of betrayal has been the sexual abuse scandals within the Catholic church over the past few years. Not limited by denomination, numerous televangelists have been undone by their sexual betrayals in the past few years too. Carnes thinks the reported cases are only the tip of the iceberg. He doesn't talk about it, but somewhat amorphous New Agey cultish groups also commit these spiritual betrayals. That is part of the story of how my life got ripped apart. And outside institutional religion, "spiritual" abusers often frame what they are doing as "God's will" or some such happy horseshit ("I like to think it happened for a reason"). Whatever the source, spiritual betrayal is doubly damaging, because beyond the abuse, the betrayal cuts off a primary resource for recovery, at least in the twelve step model. Such spiritual betrayals are part of why I don't do step programs any more. Maybe my belief in spirituality was just an illusion anyway. I might be better off, less deluded and vulnerable, without it.

Again, any combination, or even all of the above may be present.

Let me know if you read this by leaving a comment, ok?

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 47-72.

The roots of ptsd: how trauma affects people over time

Patrick Carnes lists eight ways trauma affects people over time:

• trauma reaction
• trauma arousal
• trauma blocking
• trauma splitting
• trauma abstinence
• trauma shame
• trauma repetition
• trauma bonds

Most traumatized people will display some combination of these rather than just one.

The information above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997).

betrayal bonds: trauma repitition

trauma repitition: This aspect of betrayal bonds involves reenactment or re-creation of prior traumas. Carnes calls it "living in the unremembered past." This can take several forms. Some get in abusive relationships that re-enact the original trauma. Sometimes it manifests itself in a compulsive behavior. Compulsive masturbation, for example, is usually a reenactment of a childhood trauma. Combined with shame, the person often becomes suicidal.

The key to understanding trauma repetition is that "in part, trauma repetition is an effort by the victim [or insome cases, the victim/perpetrator] to bring resolution to a traumatic memory. " It is a way of coping with old traumas, but instead of resolving the past, it creates new wounds, compounding and multiplying the problem. This is where complex ptsd comes from -- the continued repetition and compounding of some earlier trauma. For me that was childhood emotional, physical, and sexual abuse in a a family run by a raging alcoholic father and a classically co-dependent mother. It was a large family, and traumas inflicted on older siblings would then be reenacted on the younger ones.

Unfortunately, one form of trauma reenactment is "to victimize people in the same way they victimized you." While not all trauma repetition is perpetration (unless you want to count self-perpetration, which is sort of a contradiction of terms), all -- or nearly all -- perpetration is a repetition of some kind of trauma that the perpetrator also lived through. One perpetrator often victimizes many people, so the effects get spread widely. I reenacted things by somehow managing to always find relationships with abusive people, allowing both them and me to re-create traumatic experiences in a sick relationship.

According to Carnes (and I'm mostly but not exactly quoting), trauma repetition is characterized by repeated self-destructive (or destructive) behavior, usually of a repetition of some childhood trauma; reliving a story from the past, engaging in abusive relationships repeatedly (this was my pattern -- I thought abuse was normal, and couldn't even recognize it as such until I got in a non-abusive relationship and got help); repeating painful experiences, including specific behaviors, scenes, persons, and feelings; doing something to others that you experienced as an early life trauma.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 24-26.

betrayal bonds: more on trauma shame

ReallyNotImportant has made another comment that made me make a reply that made me think things through a little more so that I am going to make it its own post instead of a comment. Got all that? Nevermind. Just think of this as part two of the trauma shame post in the series about betrayal bonds.

Really said:

I'm very conscious that you have been through a lot and I don't want to make matters worse.

I guess from reading this stuff, I have been through a lot, but don't worry, as long as people are respectful and talking about their own experience, its fine. I didn't put this stuff up for sympathy or advice so much as to wonder if other people have been through the same sorts of things with their ptsd.

I've worked through a good deal of the shame issues I talk about in the post, very much along the lines you map out. One other thing I learned was that taking on other people's shame is a way of trying to gain control of the traumatic events. If its me, I have an explanation, and maybe even a solution: If its my fault, it might be under my control to change it somehow.

Of course, this is an illusion, one that gets reinforced by 12-step work, which encourages people to always look within for the source of our troubles: The only way it makes sense is if I am just somehow utterly broken goods towards whom such behavior is natural. This was reinforced by my abusers big time (who were, not coincidentally, all associated in one way or another with 12-step forms of recovery), and opting out of that illusion has been key to getting better. It is very tempting to revert to it though, in order to have a reason for things other than that people who I trusted and believed in were malicious and untrustworthy. Its a perverse sort of way of maintaining my old view of the world and denying the betrayals that took place.

When this self-shaming takes place now, I am usually aware enough to take a step back, separate myself from my abusers, and recognize that I am trying to make sense of things in a self-destructive way. The betrayals and abuses were real, and they are not mine. As you say, that then leaves me more freedom to deal with the strong emotions connected with the events, which though they may not be pleasant, they are at least somewhat healing.

I guess sometimes I still shy away from dealing with these emotions because when they all came out at once, it was totally overwhelming and destabilizing, so I need to have support and stability to let go of the shame. While it may be a dysfunctional and ultimately self-destructive way of coping, I needed to recognize that coping is what it was about, not some defect on my part, which of course would only reinforce the shame.

betrayal bonds: trauma shame

trauma shame: This aspect of betrayal bonds was huge for me. "when the victim feels defective, or even worse, at fault, there is traumatic shame. . . . Trauma can also leave a feeling of being defective or flawed. . . . People who become shame-based have core beliefs that they are unlovable, that if people knew what they were really like they would leave." Reading this was like a light going off. I still struggle with feeling defective. The last worst abusers in my life basically convinced me I was "a damaged self" that deserved being just discarded. I responded to these feelings by folding in on myself, sort of imploding. I got lost in compulsive use of internet porn to kill the pain and suicidal thinking. The porn (and the compulsive masturbation that went with it) made the shame worse, as in principle I think it is violent toward its subjects.

In the non-traumatic reltionship I had managed to get in, I was sure that if my partner found out about the Internet porn she would leave. She did find out...I finally told her when I thought I was going crazy. It really hurt her, but she immediately saw the connection with trauma that I couldn't and basically stayed with me, even as my mental health went completely to hell. That was a real lesson...she could see things in me that I could not and thought I was worth sticking around for. I figured I had better start to see some of those things in myself too, and I am slowly learning. Releasing myself from the shame and secrecy also undid the hold the compulsive acting out had on me. I started to deal with what had actually happened instead of my shame-distorted views of a whole series of traumatic events that stretched back to childhood.

Trauma shame tends to make some people overcompensate with unrealistic goals followed by more shame at failure in a classic binge/purge cycle. For people with ptsd, all experiences are tend to be processed by the brain as extremes, all black or white, with no grey. The loss of "the ability to operate in a balanced way...further adds to shameful feelings." Shame based people also have a tendency to re-create childhood traumas in adulthood. This was certainly my pattern anyway.

Trauma shame can result in obsessive self-hatred, worse than feeling unlovable or depressed, which can lead to self-destructive, even suicidal thinking and behavior. I made an attempt, but failed, and ended up in a loony bin for three weeks. Never got near addressing any of the causal issues and left basically promising myself not to make another attempt -- I had had my chance -- but still feeling suicidal. I felt suicidal for the next nine years, obsessively self hating and managing to stuff all my feelings, and the memory of traumatic events until everything just fell apart.

In the paragraph that follows, my comments are in parentheses, the rest is quoted from Carnes. Some signs of shame, according to Carnes, are: "feeling ashamed because you believe trauma experiences were your fault; loneliness and estrangement from others because of trauma experiences; self mutilating behaviors such as cutting or burning (when things were at their worst for me, I would literally rip chunks of flesh out of my stomach, the backs of my hands, and other places, I still have problems with self harm sometimess but not as bad); self destructive behaviors, enduring physical or emotional pain that most people would not accept, avoiding mistakes at any cost; feeling that you should be punished for the trauma event and being unable to forgive yourself (I experienced this as the result of cult abuse, where they ripped apart my life and then blamed me for it); feeling bad when something good happens (good things happening still make me anxious); having suicidal thoughts, threats, and attempts; possessing no ability to experience normal emotions such as sadness, anger, love and happiness (one thing I learned was not to trust anything. I couldn't feel anything but a ripping feeling in my stomach and a lump in my throat for a long time, then rage as I realized what had really happened. Slowly I've gotten some of my emotions back, but I have difficulty trusting happiness or anything good, even today -- its just asnother setup, I think); having a deep fear of depending on people (my partner said I tested her all the time, trying to figure out if she was dependable); feeling unworthy, unlovable, immoral, or sinful because of trauma experiences; perceiving others always as better, happier, and more competent (I saw this as a problem with envy. My abusers got off scot free with ripping up my life, and even seemed to benefit from it and it drove me mad for a while); having a dim outlook on the future; avoiding experiences that feel good, have no risk and that are self-nurturing. "

I would have never made the connection between trauma and shame without help, including Carnes' book. I had basically repressed memories of the traumatic events and just thought I was a crazy, no good mixed up, broken person, even as my life on the outside appeared to be very successful. Learning the connection between trauma and shame was a real life-saver for me, making sense of something that seemed utterly senseless to me.

Another thing I learned along the way is that there is a healthy role for shame. When someone does something bad, shame is an appropriate response. What happens in trauma bond situations is -- and let me just shift to first person here -- I took on my abusers' shame. They are the ones that should have felt shame, but in a trauma bond situation, perpetrators shuck it off onto their victims, compunding the abuse. Learning that this shame was somebody's, but not mine, was healing.

• A little more on trauma shame is here.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 21-24.

betrayal bonds: trauma abstinence

Trauma abstinence: The underlying problem causing this aspect of betrayal bonds is a core belief in one's unworthiness. Self denial is followed by out-of-control sprees. There is an aversion to good, healthy, or nurturing things for the self. Bulimia and anorexia would fall into this category. Often the trauma at the heart of this behavior is family neglect. Children become comfortable with it and become self-neglectful as adults. Coupled with "high arousal events such as domestic violence and sexual abuse and you have a neurochemical cocktail that is hard to beat. . . . the only way to control survival becomes to freeze...Ask nothing. Do nothing. Attract no attention. Yet fear mobilizes the body...In a constant state it can become addictive." Trauma abstinence "occurs especially around memories of success, high stress, shame, or anxiety. . . deprivation is driven by terror and fear" which have powerful effects on the brain.

Carnes talks about trauma abstinence in conjunction with addiction, saying the two go hand in hand. I experienced this as getting one area of my life under control only to see another part go out of control. To me its like that game in the amusement park where you swat at gophers as they pop up out of holes. A soon as you get one, two more pop up and they are never under control...which of course is the "rush" of the game.

What are some of the behaviors associated with trauma abstinence? Carnes says (and I'm mostly quoting him with my own thoughts thrown in): Compulsive debtors, people who deny basic needs like groceries, avoid any sexual pleasure or feel extreme remorse over sexual activity, hoard money and avoid spending it on legitimate needs, work in under-achieving jobs and make unwarranted sacrifices at them, spoil success opportunities (this is the one I relate to most), have periods of no interest in eating (for a while when things were bad I didn't eat hardly at all. I'd eat a little because my partner would make me. Lost 40 pounds. Meds put it all back on...drat.) attempt diets repeatedly, see comfort, luxuries, and play activities as frivolous, skip vacations to work on unrewarding tasks, avoid normal activities because of fears (hmmm...I might still do this some...I tend to hide out when left to my own devices), have difficulty with play (I don't have a problem with this:), be underemployed, vomit food or use diuretics to avoid weight gain.

I think where it shows up in my life is in everyday neglect...not wanting to shower (but I do...so don't worry about the blog smelling bad:), not bothering to eat or eating badly when my partner isn't around, that type of thing. I may have it around some sexual stuff, but its hard to sort all that out. Sex is a real trigger for my ptsd. My partner is also a survivor, and since my ptsd messed up our sex life, we tend to avoid having sex on any regular basis. I don't know if its abstinence or just that freaking out isn't really fun or pleasurable for either of us. I'll talk more about that some other time.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 17-21.

betrayal bonds: trauma splitting

trauma splitting: Carnes defines trauma splitting as the aspect of betrayal bonds that ignores "traumatic realities by splitting off the experiences and not integrating them into personality or daily life." It is creating another reality and going to it during traumatic events. When this coping style becomes a pattern of dealing with everyday life it becomes a problem instead of a solution.

It can take the form of amnesia. I had no memory of what happened at the time when some of the trauma and betrayal stuff happened for years afterward. When it came back I was overwhelmed with flashbacks and stuff, so splitting was an attempt to protect myself from that I guess. I would not be able to remember what day it was or how long ago the flashbacks were either, so I guess that was dissociation too. It can also take the form of splitting from one's body, maybe flying around the room, or detaching and looking down on the scene from above. Sometimes different personalities form during splitting. This gets called multiple personality disorder or dissociative identity disorder (DID).

Addictions often have a component of splitting. Addictive behavior, whether in the consumption of a drug, obsessive or compulsive sex, gambling, or even religious or artistic preoccupation, can be a form of splitting, of creating a fantasy reality that ignores the real state of things. Lots of addicts talk about a "Jekyll and Hyde" experience of having one set of values and behaviors they believe in and another personality, the out of control addict, that seems intent on destroying these.

Some signs of dissociation are spacing out as a response to painful memories, confusion and forgetfulness because of preoccupation, resorting to a fantasy world when things get tough, feeling separate from the body as the result of a flashback, amnesia, preoccupation, having compartments to your life others don't know about, living a double life, obsessing around addictive behavior, losing yourself in romantic fantasies, or using marijuana or psychedelic drugs. All of us space out sometimes, the problem is when it becomes a way of life.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 14-17.

betrayal bonds: trauma blocking

trauma blocking: This aspect of betrayal bonds is about numbing out in all its various forms. Alcohol and drugs are often used. I used compulsive masturbation and internet porn to kill memories and pain. Others eat compulsively, excessive sleep, watch mind-numbing TV to waste time, become workaholics, maybe bingeing occasionally on any of these behaviors. Often times this is trouble for recovering alcoholics: When they stop the drug, the pain rushes in and they go back or switch to other addictions. The behaviors reduce anxiety, but have their own set of problems.

Often trauma blocking alternates with trauma arousal. A person will engage in high-risk, high shame behavior such as compulsive sexual activity followed by numbing out with food alcohol or something to numb out the shame. Another example would be an addict alternating between ice and alcohol, the former for arousal and the latter to numb out afterwards. When I was using, I used to do speed with alcohol and depressants in order to be "normal!" Not quite.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 12-14.

betrayal bonds: trauma arousal

trauma arousal: This aspect of betrayal bonds is about getting hooked on high risk, high stress behavors, whether sex, business, violence, dangerous activities, or gambling: seeking pleasure in the face of high risk, danger, violence, or shame. I used to have this a lot more when I drank and drugged, but it was not as much a part of my behavior once I got off the booze and drugs. A person gets hooked to the rush, even if it becomes addictive and interferes with life.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 9-11.

betrayal bonds: trauma reactions

trauma reaction: This aspect of a betrayal bond takes the form of PTSD. It includes things like intrusive thoughts or memories, sleeplesness, sudden vivid memories, extreme caution, an easily triggered startle response, nightmares, distress at anniversaries or other triggers, angry outbursts, irritability, distrust, physical reactions like cold sweats, shortness of breath, or flashbacks. Any number of things can trigger a ptsd response, which may be pretty severe in the case of a flashback, or somewhat milder but still yukky things like nightmares. I still struggle with sexual relations because they trigger really strong memories of abuse and I have a sort of automatic reaction and just kind of shut down. BTW, this really sucks. the sustained, overwhelming sense of fear that triggers bring on actually changes the neurology of the brain. The body is constantly on a state of high alert, which is wearing.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 6-9.

more on betrayal bonds, aka trauma bonds

OK, back to ptsd and betrayal bonds. I wrote a little about them a few days ago. I have also put up a whole section on other symptoms of ptsd. Here is some more on betrayal bonds.

At the treatment center I went to for ptsd I was introduced to the concept of a trauma bond. They shared portions of a book, Patrick Carnes' The Betrayal Bond: Breaking Free of Exploitive Relationships, with me. I immediately bought the whole thing, and it remains about the only self-help type book that I have managed to work all the way through. It transformed my understanding of what was going on in my life, why I kept repeatedly getting involved in traumatic relationships even after getting clean and sober, why I was unable to "just get over it," and finally, what made these relationships so powerful in my life.

The place to start is with betrayal. What is it? Carnes starts his book by saying it is "a breach of trust. Fear. What you thought was true -- counted on to be true -- was not." ReallyNotImportant, in his blog on Zen and PTSD, describes it nicely when he says that "the world is suddenly a very strange place. Nothing makes sense. Nothing is clear-cut, everything has nuances. All the certainty is gone." The world becomes unsafe. It may fall away from beneath your feet at any moment. But its not all a lie. According to Carnes, "there was just enough truth to make everything seem right. . . . a little truth with just the right spin." The rest was exploitation and a harsh form of abandonment, which he connects to the core of addictions and shame. It is worse than neglect, being purposeful, in my case even intentionally cruel. And "if severe enough, it is traumatic," he concludes, creating "a mind numbing, highly addictive attachment to the people who have hurt you," leading to self-distrust and self-abandonment.

Because of my history of abuse and trauma, I managed to stack up a series of these betrayal bonds with god-awful results. Carnes notes that "adult survivors of abusive and dysfunctional families struggle with bonds that are rooted in their own betrayal experiences." He concludes that "Loyalty to that which does not work, or worse, to a person who is toxic, exploitive, or destructive to you, is a form of insanity." So I guess I was insane, at least for a while. That is how it felt, too.

He has a test on his website that you might take if you think you are in the grips of a betrayal bond. Some of the signs are "misplaced loyalty, inability to detach, and self-destructive denial." Then comes the punch line, the part that explained why everything could still go crazy even nine years after I had extricated myself from these relationships: " You will never mend the wound without dealing with the betrayal bond." Time won't heal it, compulsive or addictive behaviors won't numb it away, therapy won't cure it, spirituality won't work...none of it will unless you confront the trauma bond itself.

In what sort of contexts do they occur? Carnes gives a list of likely candidates:

• domestic violence
• dysfunctional marriages
• exploitation within the workplace
• religious abuse
• litigation
• kidnapping
• hostage situations
• cults
• addiction (alcohol, drugs, gambling, sex, high-risk behavior
• incest and child abuse

Half of those things happened to me in the span of a couple of years, and a couple more had happened earlier. Any of these are complex issues, and Carnes says "an unraveling must occur." There is no simple, quick fix.

He maps out abuse along two axes, from once or seldom to frequent or constant on the one hand, and from low trauma to high trauma on the other. That explains why someone who has a series of moderately traumatic events can have many of the same symptoms as someone who has a single highly traumatic event. While the symptoms are the similar, it seems to me that the unraveling is a little different for everyone.

He then lists eight ways trauma affects people over time, one of which is the betrayal bond. I'll go into those in the next few posts. Most often, a person who has been traumatized will be affected in more than one, perhaps even all of the ways listed.

As usual, if you got this far, let me know in a comment!

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997).

ptsd, flashbacks, and "pseudo-seizures"

Just a quick post today. I have lots to write about. Working hard on recovery and finding out some new things from this experience of blogging about my ptsd. I'll share in little bits over the next few days. Plus, I just spent my blogging time commenting on another thought-provoking article on Holly's Fight to Stop the Violence on Internet Porn and Sexual Addictions.

BTW, grounding exercises can help a little with flashbacks, so if what I describe below is familiar try them out. They don't make the flashbacks tolerable or make them go away, but they helped bring me back to the present a little sooner when I could do them.

I just want to talk about what are called "pseudo-seizures." They are a particularly nasty kind of ptsd flashback. When I first came upon the name in therapy, I was relieved that there was even a name for what I was undergoing, namely half-hour to hours long episodes in which I would become a tautly curled up shaking sobbing mass of pain, followed by major disorientation...I often would not know what day it was or if and how long ago the thing had happened. I had hundreds of these over the space of a few months, utterly terrifying and exhausting, doubly so when I didn't know what they were. I just thought I was going crazy. So unlke ReallyNotImportant, who dismisses the labels as not very helpful, I found having a name for what I was experiencing comforting to some degree. At least I was not alone. This was within the range of human experience, even sane experience.

If you are having these things, which doctors are now starting to call "non-epileptic siezures" because sufferers have understandably negative and invalidated responses to the "pseudo" part of the label, I truly feel for you and hope you will get help however you can to get through it. There is another side, as far away and impossible as that may seem. I didn't think so either but there is, so plz hang in and get help. There is nothing pseudo about the experience at all. It is horrible.

I tried to think what I might have called them if I didn't know what they were...When I was able to contain them to when no one was around, I invalidated them as just me being dramatic -- though never with an audience. I just tried to minimize, hide, and wish them away. Ultimately, they outed me and that is when I got help from my wonderful family of choice. I thought they would think I was crazy and just discard me like my abusers had when they were done with me.

I guess "crazy" or "insane" were my descriptors once the cat was out of the bag. And they would have been correct I suppose if I hadn't been so fortunate as to be able to get help and support. I looked and felt battered and emptied out of all humanity, only able to feel pain and not able to get rid of it for a moment. No relief.

I still get shadows of them today. Sometimes I shake badly. Sometimes like today I feel like I am hitting the top of an elevator all day, an unsteadiness in the pit of my stomach. It serves as a reminder of worse times, but it is nowhere near the intensity of before...I have been "pseudo-seizure" free for a couple of years now. They slowly worked their way out of me. So if you have 'em, please don't let them get that last little bit of you that you hang on by, even if you have to fight tooth and nail and act all unseemly and cry alot. I needed medication as part of my solution...Geodon was the key one for me, though I know others who hate it.

So if you are having these sorts of intense, seizure-like flashbacks, or have had them in the past, leave a comment and let me know I am not the only one in the blogosphere to have had them!

Trauma Bonds or betrayal bonds, Stockholm Syndrome

[n.b., I have a new post on betrayal bonds here that has more information]

reallynotimportant said:

I can understand your desire to want to try and understand everything and why people did what they did. It is natural. I have been there myself.
Ultimately, I think it is pointless and self-destructive.
For me, I decided in the end that some people did some bad stuff and deliberately tried to fuck up my (not personal though) life. Why they did it - well I really don't care. They did what they did. I have no desire left to 'understand' them.

There was something different about our experiences of trauma and ptsd here. You may be right about it being pointless and self-destructive to try and understand a perpetrator's motives. It is a long path to there for me. My last perpetrators were people I trusted and cared about a lot. What they did ultimately may have not been personal -- it is about their sick and twisted minds and the consequent actions--but they personalized it, putting a major head trip on me, which I bought into fully because I trusted and cared for them and was basically naive about how twisted people could be.

This sort of betrayal creates something called a trauma bond or betrayal bond. A trauma bond is where an intense, traumatic experience or betrayal of trust takes place, forming an equally intense relationship/bond with the perpetrator. It is related to Stockholm Syndrome, after the hostages of Stockholm bankrobbers who waited for them to get out of jail a decade later and defended them -- and one even got engaged to one of them. Its not a real simple thing to just detach from such a bond. I had no frame for understanding it. It cost me my whole community, and I ended up starting over in a new place, which in the long run was a blessing, but in the short run was overwhelming, just having gone through a series of really intense betrayals and having nowhere or no one to go with them and just vent, much less try to make sense of them.

Ultimately you are right, trying to understand stuff like this is like Nietzsche says, "if you stare long enough into the Abyss, the Abyss stares also into you." It literally made me insane. I had to learn that I was not how other people constructed me...I was and am in charge of my own identity, who I am, and why I do things. This is basic for most people I guess, but it has been a real task for me. I had to come to an understanding that what had been done was abusive, because in the manner of good psychopaths, they made everything look normal on the outside, that it was me with the problem. And so it was: their lives weren't being torn up, mine was.

I guess what makes things hard for me is that I really cared about and trusted these people, and it was so personalized, being meant to basically destroy me. I'll write more about this later maybe. I'll try and get some some sleep now.

• More on betrayal bonds.

my name, and more on 12 steps, aa people, and trauma

Another commetn that turned into a post today. Reallynotimportant raised the issue of ptsd and identity in a comment, saying my screen name over-identifies with ptsd, making the ptsd who I am rather than serving as a loose-fitting bundle of descriptions that more or less describe what is going on in my life. I chose the name ptsd guy without much thought. In fact, if I had waited five minutes or a half hour, I would have been traumarama, which I think is kind of funny, instead, but I didn't feel like going and creating a whole new account and so forth. If this blog were my whole identity, I'd be worried about my name...and a whole lot more, but its not. I have put together a pretty regular life, pretty much against all odds. A few people know about the ptsd because I shake badly from it sometimes and they wonder why, but I don't make it a big deal.

Hanging around with what you call normal people instead of people who define their whole lives around their addictions was a big and scary step for me, and the best one I ever took. I don't hang with people who define their lives by what is wrong with them any more and it has made a huge difference. For one thing I stopped being repeatedly re-traumatized, which was sort of a revelation.

One of the tools I picked up in the trauma treatment center I went to was to separate the trauma from me and distinguish between the two. This remains something I have to practice, some days maybe more than others, so I agree with your critique of my chosen name, but the blog is about that part of me and trauma and ptsd have shaped who I am to some extent, so as long as the blog is not all of who I am, its fine I think.

Maybe you are right about it being a 12-step hangover (nice concept) but to me its not all-defining. This blog is where I hope I can work out the parts of me that have been shaped by ptsd. I don't want to say a whole lot more. I don't put all of myself here. I like the anonymity. It allows me a freedom to speak and be spoken to experimentally, without the repercussions of if you knew more about me. Not trying to be mysterious here, but to explain what I put of myself into this blog.

Also, I pretty much hacked on 12 step programs in some of my posts (here, here, and here), but they really did save my life. I am quite ambivalent about them. I was incapable through willpower to quit drinking or using -- I tried that route for five of the most miserable years of my life -- and entering AA, working the steps with fellow addicts and alcoholics is what allowed me to get clean and sober, so I am not really an iconclast about it. It works for what it does, where other stuff fails. I just think that 12 step programs are ill equipped to deal with more than their single purpose. If someone came to me and said they couldn't stop drinking I'd take them to aa -- and probably leave them there:) But it does actually get millions of people sober who were intractably and incurably addicted to alcohol and other drugs. I think it is hard for someone whose willpower works for them to understand what it is like to not have it work. Addicts' willpower utterly fails them and they need something more to get clean. 12 step programs do provide that.

The problem is that when you dry them out, you have a room full of crazy addicts who are ten times as dangerous because they are no longer drugged and think they are the cat's pajamas when they are really incredibly twisted human beings who are fortunate to even be alive. That was not a good situation for me, because I seemed to be able to find the sickest most abusive, manipulative, and insidiously cruel people and choose them for friends.

I think that might be where our ptsd or trauma experiences might be a little different, something I just noticed you mention in another comment (Having a hard time keeping up!). What you have described seems to be a really major once-and-done thing (correct me if I'm wrong here). Mine is a long history of continued traumas, anyone of which might not have been debilitating in itself (but pretty much any of them could have killed me) which combined to make a pretty yukky soup out of my mind and experience. I have a lot less certainty about who I am maybe. I don't know, I am a little uncomfortable making this sort of comparison -- I posted on avoiding the oppression olympics so I don't want to imply that one is better or worse, just different in some ways in our experiences and responses. But at the same time, there is enough going on in common to make for a conversation in which I need to think about things from sometimes new, sometimes different perspectives, something I'm all for.

Anyway, I am being somewhat contradictory but that is how things are, and I guess I'll stick with my ill-chosen name for now. I'll keep what you said in mind though, and if I get around to it or think of a compelling one, maybe I'll change it. Maybe its reallynotimportant:)