Too much thinking…

been thinking too much… and when I think too much I come to sme fairly depressing conclusions… and far too many unanswerable questions…

had a chaotic few days… sort of felt like was back to square one… all that time convincing myself that it was not my fault sort of died and seemed wasted… started going over and over the events in my head again looking for any and all mistakes I made…
added to that a “new” alter has made an appearance. I have no “contact” with her, but Jack (my partner) “met” her at the weekend. Apprently she had no name then, and refused to come up with on as names “have to be given”… so she is now called Luna, due to her love of night time.
But I’ve also been thinking… I’ve seriously “not been there” for most of my life, I’ve actually missed most of my life… that’s… I don’t know… strange to think I guess… and a who we are is made up, in part, from our pasts and experiances, well… doesn’t that make me sort of “incomplete”? I know I’m not really incomplete as such, just sort of fragmented, but… well if I am “incomplete” then who am I? And if I don’t fully know who I am then how can I be a part of the world? How can I know what wants and needs are mine and which are not? How can I know what is me and what is just what my parents and other bad people sort of “programmed” into me?

Other thing I’ve been thinking is… is it all worth it? When you think about it the world is a violent, nasty place, full of evil and hurt… is all the fighting to survive really worth it in the end?

I also miss Isabelle… really miss her… I’m not sure if Ive spoken abut her on here before… but Isabelle is my daughter, she was born prematurely very ill, and she didn’t survive. People say I shouldn’t still be upset, esspecially as she was conseived via a rape. But the rape wasn’t her fault, who her father was wasn’t her fault. and I do miss her… it feels like something is missing… deep inside… I wanted to give her all the thngs I never had, I wanted to be a good parent, to show her love and kindness.To make it worse I think it was my fault that Isabelle died… when I got to the hospital after going into premature laoure they gave me some drugs to try to stop the labur but it didn’t work because it was too late… I culd have been there earlier… I could… and she’d have lived…

I miss Sam too… I really did fail him, misscariaed at 19weeks after a suicide attempt…

I wish they were here… Then I would actually have a family… I want to have been able to have given them a great life, the life I never got to have with my parents, I want to have given them the chance of life. But I failed them, failed both of them.

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what is DDNOS?

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disorders in which the predominant feature is a dissociative symptom (i.e., a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment) that does not meet the criteria for any specific Dissociative Disorder. Examples include

1. Clinical presentations similar to Dissociative Identity Disorder that fail to meet full criteria for this disorder. Examples include presentations in which a) there are not two or more distinct personality states, or b) amnesia for important personal information does not occur.

2. Derealization unaccompanied by depersonalization in adults.

3. States of dissociation that occur in individuals who have been subjected to periods of prolonged and intense coercive persuasion (e.g., brainwashing, thought reform, or indoctrination while captive).

4. Dissociative trance disorder: single or episodic disturbances in the state of consciousness, identity, or memory that are indigenous to particular locations and cultures. Dissociative trance involves narrowing of awareness of immediate surroundings or stereotyped behaviors or movements that are experienced as being beyond one’s control. Possession trance involves replacement of the customary sense of personal identity by a new identity, attributed to the influence of a spirit, power, deity, or other person, and associated with stereotyped “involuntary” movements or amnesia and is perhaps the most common Dissociative Disorder in Asia. Examples include amok (Indonesia), bebainan (Indonesia), latah (Malaysia), pibloktoq (Arctic), ataque de nervios (Latin America), and possession (India). The dissociative or trance disorder is not a normal part of a broadly accepted collective cultural or religious practice. (See Appendix B in DSM-IV-TR for suggested research criteria.)

5. Loss of consciousness, stupor, or coma not attributable to a general medical condition.

6. Ganser syndrome: the giving of approximate answers to questions(e.g., “2 plus 2 equals 5”) when not associated with Dissociative Amnesia or Dissociative Fugue

From the DSM-IV

Dissociative Disorder Not Otherwise Specified (DDNOS) is an inclusive category for classifying dissociative syndromes that do not meet the full criteria of any of the other dissociative disorders. A person diagnosed with Dissociative Disorder Not Otherwise Specified (DDNOS) typically displays characteristics very similar to some of the other discussed dissociative disorders, but not severe enough to receive their diagnoses. DDNOS includes variants of Dissociative Identity Disorder in which personality “states” may take over consciousness and behavior but are not sufficiently distinct, varients where alters are present but either do not take over consciousness or only ever do so in a co-consiouss mannor with the host, or variants of Dissociative identity disorder in which there is no amnesia for personal information. Other forms of DDNOS include possession and trance states, Ganser’s syndrome, derealization unaccompanied by depersonalization, dissociated states in people who have undergone intense coercive persuasion (e.g., brainwashing, kidnapping), and loss of consciousness not attributed to a medical condition.

DDNOS occurs primarily in men (80%) and is currently regarded as a dissociative means of withdrawal from a traumatic or stressful circumstance. It is characterized by absurd or approximate responses to interview dialogue, a dazed or clouded level of consciousness, somatic conversion symptoms (eg, pseudoparalysis), hallucinations, and, frequently, anterograde amnesia regarding the episode.

Trauma, Memory and the Brain

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Trauma changes our brains on a fundamental level, the psychologically traumatised brain causes inscrutable eccentricities which can (and do) cause it to overreact – or misreact – to stimulus and the realities of life. These neurological “misreactions” become established in part due to the effect that trauma has on the release of certain stress-responsive hormones, such as norepinephrine, along with the effect upon various areas of the brain involved in memory – particularly the amygdale and the hippocampus.

The amygdale is the part of the brain responsible for communicating the emotional importance and evaluation, via the thalamus, of sensory information to the hippocampus. In accordance with the amygdales evaluation the hippocampus will activate to a greater or lesser degree, and functions to organise this information and integrate it with previous similar sensory events. Under a normal range of situations and conditions this system works well and effectively to consolidate memories according to their emotional priority and content. However, at the extreme upper end of this hormonal activation, as with traumatic situations, a breakdown occurs. Overwhelming emotional significance registered by the amygdale actually leads to a decrease in hippocampal activation, this results in some of the traumatic input not being organised properly, not being stored as a unified whole, and not being integrated with other memories. This results in isolated sensory images and bodily sensations that are not localised in time or even in situation, nor integrated with other events. In effect these fragments of memory float about in the mind, ready to reappear at any moment.

To make matters even more complex, trauma may temporarily such down Brocas area, the region of the brain which translates experience into language, the means that we more often use to relate our experience and feelings to others and even to ourselves.

Regular memories are formed and are subject to meaningful modification, they can be retrieved when needed and can be conveyed to others through language and expression. In contrast, traumatic memories include chaotic fragments, which are sealed off from modification or modulation. Such memory fragments are wordless, placeless, and eternal. Long after the trauma has receded into the past the brains record of them may remain a fractured mass of isolated and confused emotion, images and sensations which can ring through the person like an alarm at any moment.

These sensations and feelings may not be labelled as part as belonging to memories from long ago, in fact they may not be labelled at all, as they may have been formed without language. They merely are, they come forward to take over the body giving no explanation, no narrative, no place or time, they are free-form and ineffable.

The traumatised brain has, effectively, a broken warning device in its limbic system. A bit like an old fuse box where the fuses tend to melt for no reason, reacting to an emergency when there is none.

self injury, dissociation and amnesia

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Self-injury in all its forms, including accident-proneness or a tendency to be victimised again in abusive relationships, may actually constitute screen memories of abuse or symbolic memories that a person is using to keep explicit abuse memories out of consciousness. Repeatedly hurting oneself is a way of not having to remember the original hurt. Self-wounding may also be an unconscious repetition of past abuse in an attempt to make sense of a dim but haunting memory. The person is trying to knit the implicit remnant of the trauma memory into fabric of a continuous mental narrative.

The amnesia that many self-injurers have for their destructive behaviour may be related to the return of memories from which they have disconnected. Since the emotional pain of returning memories is overwhelming, the person enters a trancelike state in an effort to keep them blocked. Self-injurers with dissociative disorders often say that they “find themselves” with injuries on their bodies in the same way that they in strange places without knowing how they got there. Self-injuring can be a form of reality testing for abuse that the person, on some level, knows happened but has split off from consciousness. Injuring oneself can bring “forgotten” memories of abuse into the awareness in several ways. The wounds themselves can reinforce the reality of past abuse, long disavowed by dissociation and the persistent denials of family members who maintain that the abuse never happened or was an expression of love. The pain of self-injury can test reality by restoring the feeling of being alive. Self-injury can also re-enact past abusive events symbolically, recalling them behaviourally, and reinforce the persons conviction that he/she was abused as a child. The fear of remembering what one was forbidden to remember may make amnesia a survival tactic once again.

How trauma effects memory

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Traumatic memories are more likely to be “forgotten” than non-traumatic memories due to faulty encoding or retrieving. A major mental process contributing to amnesia in dissociative disorders is known as state-dependant learning. According to this theory, information encoded in one mental state is most easily retrieved at a later time when in that same state. If a person experiencing trauma dissociates into separate state of mind, different memories will become available to that person at different times. Data encoded in one state will not be available to a person who is in a different psychological state; it will only be available when the person returns to the same state he/she was in at the time when it was encoded. For example: Harris, a thirty-seven-year-old pharmacist who was sexually abused repeatedly throughout his childhood by an older cousin, developed a six-year-old alternative personality named Barney. Harris could not remember the abuse until an assault by an armed robber at the drugstore where he worked triggered Barneys return.

State-dependent learning theory explains the severe amnesia that occurs in DID. Experiences encoded in a psychological state of abuse can chain together into a complex and consistent personality if the abuse is sufficiently traumatic and persistent. These particular alert personalities of overwhelming pain and fear are outside the persons conscious cognitive awareness, they live on in an alter personality and are still psychologically active and influential.

The “lost time” or “memory gaps” of someone with DID have preserved their sanity but have also swallowed up vast chunks of their past and identity. The future of a person with amnesia can be compromised too. The inability to integrate traumatic memories caused the person to fixate art the time of the trauma and impairs the integration of new experiences. When Barney resurfaces Harris was unable to concentrate on his job as a pharmacist and fill prescriptions that were beyond the comprehension of a six-year-old child. For many people, traces of the painful memory tend to linger and intrude as flashbacks, obsessions, or re-enactments of the trauma in self-mutilation or other self-destructive behaviours.

Methods to deal with stress and panic

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Practice relaxation techniques such as visualization, progressive muscle relaxation and deep breathing.
Exercise regularly, 20 minutes per day, three days per week. Exercise releases the “feel good” hormones into our blood stream,  lowers blood pressure, relaxes muscles and clears the mind.
Your attitude and the way you respond to stressful situations is important. You can choose to let something upset you or not.  You can use a positive attitude to get through a tough time.
Avoid consuming excessive amounts of alcohol, caffeine, fats and sugars.
Know your stress signals. When you’re feeling stressed, how does your body react? Does your pulse begin to race? Can you feel your heart pounding? Pay attention to your body language and take steps to calm it down with deep breathing or leaving
the situation.
Eat healthy. Maintaining your energy level and having the strength to keep your attitude positive and your stress under control relies greatly on putting good fuel into your body.
Sleep is important for keeping stress away. When you’re well-rested it’s easier to focus, and you have the energy to accomplish all that needs to be done.
Remember to mentally pat yourself on the back when you have accomplished something, no matter how small.
Don’t waste your time and raise your stress level by reliving mistakes. Every mistake is a learning experience. Learn from it; then move on.
Laughter is often the best remedy for stress. Find reasons to laugh. See a funny movie or visit a comedy club.
When you feel your temper rising, count to to 10. This will give you time to calm down and keep you from saying something you might regret later. If 10 is not enough time to calm down, keep counting.
Sit in a hot tub or sauna. (alternatively a hot bath)
Get a massage.
Enjoy the people in your life that make you happy. Make time to be with them.
Learn to recognise what you can control and what you can’t. Work to let go of what you can’t control.

3 breathing techneiques (provided by Rachel – hence the green text 😛 ):


Clensing Breathes
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Sit with your feet flat on the floor with your shoulders down or stand with your back straight and your shoulders relaxed. Take in as much air as you can through your nose. As soon as you have inhaled breathe all the air out through your nose. Don’t pause in-between breathes. Keep your breathing smooth, centered, and gentle. Let the air flow out of your body don’t force it. Continue this exercise for 20 breathes.


Deep Breathing
~~~~~~~~~~~~~~~
This breathing exercise is very helpful to calm and center you before making important decisions, facing emotional times, or entering meetings that make you feel uncomfortable. Sit with your back straight, shoulders down and relaxed, and your feet flat on the floor. Breathe in as much air as possible through your nose in a slow deep breath. Slowly exhale through your nose. Count slowly to three and repeat the exercise six more times.


Centered Breathing
~~~~~~~~~~~~~~~~~
Sit with your back straight and your shoulders relaxed. First take 5-6 deep breathes in through your nose and out through your mouth. These should be deep belly breathes using your diaphragm. Cover your right nostril with your finger and slowly breath in through your left nostril for a count of four. Hold for a count of 2 and switch your finger to the other nostril. Slowly exhaling through the right nostril. Repeat this 5 times then repeat the deep breaths and then this exercise once more.


What is PTSD ?

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PTSD has a unique position as the only psychiatric diagnosis (along with acute stress disorder ) that depends on a factor outside the individual, namely, a traumatic stressor. A patient cannot be given a diagnosis of PTSD unless he or she has been exposed to an event that is considered traumatic. These events include such obvious traumas as rape, military combat, torture, genocide, natural disasters, and transportation or workplace disasters. In addition, it is now recognized that repeated traumas or such traumas of long duration as child abuse , domestic violence, stalking, cult membership, and hostage situations may also produce the symptoms of PTSD in survivors.

A person suffering from PTSD experiences flashbacks, nightmares, or daydreams in which the traumatic event is experienced again. The person may also experience abnormally intense startle responses (hypervigilance) , insomnia , and may have difficulty concentrating. Trauma survivors with PTSD have been effectively treated with group therapy or individual psychological therapy, and other therapies have helped individuals, as well. Some affected individuals have found support groups or peer counseling groups helpful. Treatment may require several years, and in some cases, PTSD may affect a person for the rest of his or her life.

Causes

When PTSD was first suggested as a diagnostic category for DSM-III in 1980, it was controversial precisely because of the central role of outside stressors as causes of the disorder. Psychiatry has generally emphasised the internal weaknesses or deficiencies of individuals as the source of mental disorders; prior to the 1970s, war veterans, rape victims, and other trauma survivors were often blamed for their symptoms and regarded as cowards, moral weaklings, or masochists. The high rate of psychiatric casualties among Vietnam veterans, however, led to studies conducted by the Veterans Administration. These studies helped to establish PTSD as a legitimate diagnostic entity with a complex set of causes.

BIOCHEMICAL/PHYSIOLOGICAL CAUSES. Present neurobiological research indicates that traumatic events cause lasting changes in the human nervous system, including abnormal secretions of stress hormones. In addition, in PTSD patients, researchers have found changes in the amygdala and the hippocampus—the parts of the brain that form links between fear and memory. Experiments with ketamine, a drug that inactivates one of the neurotransmitter chemicals in the central nervous system, suggest that trauma works in a similar way to damage associative pathways in the brain. Positron emission tomography (PET) scans of PTSD patients suggest that trauma affects the parts of the brain that govern speech and language.

SOCIOCULTURAL CAUSES. Studies of specific populations of PTSD patients (combat veterans, survivors of rape or genocide, former political hostages or prisoners, etc.) have shed light on the social and cultural causes of PTSD. In general, societies that are highly authoritarian, glorify violence, or sexualize violence have high rates of PTSD even among civilians.

OCCUPATIONAL FACTORS. Persons whose work exposes them to traumatic events or who treat trauma survivors may develop secondary PTSD (also known as compassion fatigue or burnout). These occupations include specialists in emergency medicine, police officers, firefighters, search-and-rescue personnel, psychotherapists, disaster investigators, etc. The degree of risk for PTSD is related to three factors: the amount and intensity of exposure to the suffering of trauma victims; the worker’s degree of empathy and sensitivity; and unresolved issues from the worker’s personal history.

PERSONAL VARIABLES. Although the most important causal factor in PTSD is the traumatic event itself, individuals differ in the intensity of their cognitive and emotional responses to trauma; some persons appear to be more vulnerable than others. In some cases, this greater vulnerability is related to temperament or natural disposition, with shy or introverted people being at greater risk. In other cases, the person’s vulnerability results from chronic illness, a physical disability, or previous traumatization—particularly abuse in childhood. As of 2001, researchers have not found any correlation between race and biological vulnerability to PTSD.

Symptoms

  • Traumatic stressor: The patient has been exposed to a catastrophic event involving actual or threatened death or injury, or a threat to the physical integrity of the self or others. During exposure to the trauma, the person’s emotional response was marked by intense fear, feelings of helplessness, or horror. In general, stressors caused intentionally by human beings (genocide, rape, torture, abuse, etc.) are experienced as more traumatic than accidents, natural disasters, or “acts of God.”
  • Intrusive symptoms: The patient experiences flashbacks, traumatic daydreams, or nightmares, in which he or she relives the trauma as if it were recurring in the present. Intrusive symptoms result from an abnormal process of memory formation. Traumatic memories have two distinctive characteristics: 1) they can be triggered by stimuli that remind the patient of the traumatic event; 2) they have a “frozen” or wordless quality, consisting of images and sensations rather than verbal descriptions.
  • Avoidant symptoms: The patient attempts to reduce the possibility of exposure to anything that might trigger memories of the trauma, and to minimize his or her reactions to such memories. This cluster of symptoms includes feeling disconnected from other people, psychic numbing, and avoidance of places, persons, or things associated with the trauma. Patients with PTSD are at increased risk of substance abuse as a form of self-medication to numb painful memories.
  • Hyperarousal: Hyperarousal is a condition in which the patient’s nervous system is always on “red alert” for the return of danger. This symptom cluster includes hypervigilance, insomnia, difficulty concentrating, general irritability, and an extreme startle response. Some clinicians think that this abnormally intense startle response may be the most characteristic symptom of PTSD.
  • Duration of symptoms: The symptoms must persist for at least one month.
  • Significance: The patient suffers from significant social, interpersonal, or work-related problems as a result of the PTSD symptoms. A common social symptom of PTSD is a feeling of disconnection from other people (including loved ones), from the larger society, and from spiritual or other significant sources of meaning.
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