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PTSD Questions & Answers
Joyce Boaz & Dr. Frank Ochberg, M.D.

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Recovery: Rebuilding Self Esteem.

Q: Dear Frank, many PTSD survivors talk about their lack of self esteem. What suggestions do you have on how to start rebuilding one's self esteem after a trauma?

A: Dear Joyce, negative thoughts are now included in the definition of post-traumatic stress injury. After a profound trauma the brain may be wounded and the result is a pattern of disturbed memory, thought and emotion. The negative thoughts are often about others (no one can be trusted), about the future (nothing good will come to me) and about oneself (I am worthless and deserve to suffer). Compounding the negative perspective on life is the numbing that so often is part of PTSI. Positive emotion (joy, love, pride) is blunted. Without the capacity for uplifting emotion, the heavy and dark sensations predominate.

So the first step in overcoming negative thoughts, including low self-esteem, is the realization that this is the result of an injury and not a true assessment of yourself and your worth. If you wear very dark glasses the world looks dark. Your perception of reality has been altered. As simple as that sounds, it is rather complex and difficult to absorb. Call it PTSD or PTSI - it is an injury to brain function and an outcome of that injury is temporary distortion of perception. Things look, in a way, darker than they actually are. Your self-view is darker than it deserves to be.

After a trauma and during recovery from post-traumatic stress injury, we are particularly vulnerable to voices from the past. If we were raised by harsh and demeaning parents, if we had older sisters and brothers who bullied and belittled us, if there were other sources of abuse and neglect when we were growing up, we may experience self-defeating thoughts in later life. It is very common to have a "Greek chorus" in our head, telling us we are worthless, hopeless and we deserve to suffer. The recent trauma makes us vulnerable and the traumas from childhood come back with a vengeance. That is why I use the image of a "board of directors" to help survivors replace destructive friends and relatives with worthwhile role-models in their minds: The second step in overcoming low self-esteem is to recognize your own "board of directors" and learn to replace those sick and sour people from the past. Some are still present - demanding that you visit during holidays, only to abuse you again.

So a third step in elevating self-esteem is NOT to go home again to a toxic family. Survivors of abusive families are often like ex-hostages, suffering a Stockholm syndrome and attached to the very person who threatens their existence: Learning how to insulate and separate from narcissistic and psychopathic relatives is, indeed, difficult. it may take lengthy therapy to overcome a pattern of trauma-bonding that causes you to have low self-esteem and repeated exposure to sources of psychological slavery.

The most important source of self-esteem is the ability to be of help to others. Some of us achieve that as parents, as partners, and as friends. Some achieve that in the workplace or in the community. When physically and emotionally wounded, we may have far less capacity to be helpful to others. But, eventually, we all need to have a realistic basis for considering ourselves worthy.

Gift From Within is a community that values service to others - learning to listen, caring for fellow travelers, encouraging the long walk from being a victim of trauma to being a survivor. Trauma often results in growth, not just in pain and loss. But the purpose of post-traumatic growth is not simply personal gain. It is the opportunity to contribute in some meaningful way to the well-being and fulfillment of others. Self-esteem can be the result and the cause of a life with meaning.

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Page created on 9 Febrruary 2010
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