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Gift From Within - Questions & Answers with Frank Ochberg on PTSD

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Questions & Answers
Joyce Boaz & Dr. Frank Ochberg

Read "Survivor Psalm" by Frank Ochberg

Childhood Trauma and Intrusive Images.

Q: Dear Frank, Here is a question from a support pal.

I knew from the time I was a child that I was somehow different and some children picked up on this as well as adults. I began seeking counseling at age 22 and it wasn't until I was around 40 that I finally found out, on my own, what my symptoms meant. I found a therapist a few years later who specialized in trauma and knew EMDR. I can say the therapy has helped me to accept myself and show compassion to myself. However many of my symptoms are worsening and imposing more and more upon my daily life. The intrusive images, and nightmares and inability to control my racing thoughts at times are becoming very upsetting. I'm not even sure when I say "racing thoughts" that I'm describing it that well. The thoughts are always fearful thoughts. When Joyce sent out the article about how trauma can affect the brain in children and cause life-long struggles it all made sense. I have been doing more research on this subject. One very helpful article is in Cerebrum, Fall of 2000 by Teicher, "Wounds That Time Won't Heal: The Neurobiology of Child Abuse". I realize that I am diagnosing myself but I am an intelligent person and I know myself better than anyone else does. I was right-on about the PTSD. My therapist validated that finding and told me it's a miracle I have survived as long as I have for what I have gone through. I have often commented to people that I feel my situation is rather hopeless and have pretty much closed up and stopped talking to anyone about it. If childhood trauma really damages healthy brain function, do you recommend any particular type of therapy for such life-long symptoms? I understand I have to pretty much live with PTSD and will never completely heal. But I think I am a good person and can have a decent life and be of service to others if I can get the proper help.

A: Dear Joyce, this long and thoughtful question mentions some specific items that stand out and that could help GFW readers with similar personal issues. First, the writer explains that since childhood, she knew she was different and this difference was evident to children and adults. The difference may have been caused by abuse, but it may have been inherited. Or it may have been a combination of "nature and nurture" as are most long standing emotional conditions. Second, the writer describes her current symptoms: Intrusive images, nightmares and inability to control racing thoughts. The first two problems, intrusive images and nightmares, sound like PTSD - but they are only PTSD when the intrusive images and nightmares reflect events that are known to have occurred. If they never occurred, they are symptoms of a different condition. Racing thoughts are seldom seen in PTSD, but often occur in bipolar disorder. Without more information, I'm not sure what is really going on here. But as a GFW Q & A, the chance to discuss general concerns is really more important than trying to make a diagnosis with limited evidence. If you know that things have not been right since childhood you may have a sensitive emotional system that is easily triggered, whether you were abused, neglected or simply born that way.

The brain is a self-correcting, resilient organ that has amazing recuperative powers. Of course parental mistreatment of children is tragic and sometimes criminal -- but being the recipient of such mistreatment does not mean that hope is lost. It may mean the road through life is rough and difficult, and you have to learn ways to manage a brain that tilts in various directions, from time to time.

One common "tilt" is in the direction of fear. An excellent book by Gavin De Becker is titled, "The Gift of Fear." We need fear to warn us away from danger that could be fatal. To have an autonomic nervous system that makes our heart race, our guts churn and our mind worry is a good and necessary thing. But to be a fearful person, shrinking from opportunity and intimacy, is obviously an impediment. Anxiety is, by definition, an excess of fear-- fear without reason for being afraid. PTSD causes anxiety. Anxiety may interfere with calm thinking. But having many fearful thoughts at once is NOT the same as racing thoughts. A good therapist listens very carefully to the way a person describes her pattern of thought. If the speed of thought is unusually fast, and comes fast without fear, the underlying problem usually has to do with mood regulation, not fear regulation. When mood regulation is impaired, there is usually a medical, biological cause. Drugs used for PTSD such as Paxil and Prozac may make the condition much worse if racing thoughts are involved. There are newer, effective "mood stabilizing" medications that help this medical condition.

PTSD is a complicated condition and complex PTSD, dating from childhood abuse is even more complicated. It is possible to have intrusive thoughts, nightmares and racing thoughts due to trauma and inherited emotional challenges. EMDR and other forms of post-traumatic therapy are helping with fear management and with a sense of personal worth. But further diagnosis is needed and modern medication should be considered to control the racing thoughts, which may very well be a symptom of bipolar mood disorder and not PTSD. If the "racing thoughts" are always fearful thoughts it is NOT bipolar disorder. The writer is probably correct: this is a result of trauma, not an inherited mood disorder.

I have a patient who was a truck driver. A drunk driver veered into his path at night and my patient was forced to hit another car. Six people died. My patient had PTSD with nightmares and flashbacks. But he also had episodes of racing thoughts and anger and depression. When I treated his mood disorder with Lamictal he improved. It took me a while to realize that he had bipolar disorder in addition to PTSD. I don't believe the accident caused his bipolar disorder and his racing thoughts, but his PTSD may have made his mood disorder worse. I think he managed his mood disorder with alcohol before he met me.

The worst forms of parental abuse to the brain are drinking alcohol and using drugs during pregnancy, then refusing to stimulate the child during infancy. Those forms of abuse and neglect do cause permanent damage to brain architecture. Being a cruel or selfish parent may result in psychological damage, but that is usually something that can be overcome with good personal experience later in life.

In summary, child abuse can be bad for your mental health, but it isn't the same as permanent brain damage. Hope for a good outcome is reasonable. Inherited conditions like bipolar are commonly seen along with PTSD and not caused by PTSD, but made worse by it. Racing thoughts make me think of bipolar, not PTSD. The implications for treatment are profound, since the usual PTSD meds make bipolar worse.

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Page created on 4 February 2010
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