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

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Emotional Abuse.

Q: Dear Frank, One of our support pals said that her PTSD is the result of emotional abuse from significant others. She has low self esteem. She says she feels "locked into behaviors, relationships and interactions that are dysfunctional and that she relates to others by being too helpful and too caring." Then she feels that this leads her to feeling used. Does this sound like PTSD or something else? Any suggestions on how she can change old patterns and learn new and better ways of coping? Would cognitive behavioral therapy be useful?

A: Dear Joyce, Emotional abuse takes many forms. Several of my patients describe a childhood in which parents or siblings, often an older sister, were critical, sarcastic, demeaning and patronizing. It sounds like the Cinderella story, with relentless rebuke and second-class status for a sensitive, vulnerable child. I've heard worse: a childhood in which a father or mother's boyfriend beat the mother, threatened the use of deadly force, and made my patient live not only in fear for her life, but in fear for her mother's life. In a way, that was a larger threat since it left a little person with a large legacy of guilt. The guilt is irrational. But that doesn't help it go away. Children can feel great responsibility for the safety of a parent, and can blame themselves for failure to measure up to an impossible standard of care. These children are robbed of a normal, nurturing childhood. They often learn to become invisible. They smile. They please -- as best they can. They deny their own fears and frustrations. Some actually identify with Cinderella and other fictional, fantasy characters. they find it better to live in a dream world with fairy godmothers and handsome princes than to be painfully aware of inescapable reality. Of course this dysfunctional family life leads to feeling used. The little person is being used. She is a scapegoat, a butt of sick jokes, and a servant. Boys are not immune. It happens to them, too.

The consequence becomes PTSD when physical or sexual violence is part of the scene, and terrifying images become etched into memory, exploding in the form of nightmares or flashbacks. It really isn't PTSD when there are no brutal memories and the damage takes the form of low esteem, depression, avoidance, or inappropriate interpersonal behavior that is meant to please or to entertain, but that doesn't ring true. This "being too helpful and caring" is not genuine. The target of the caring can tell. And that person usually turns away, sooner or later. In some circumstances, that person takes advantage of the grown up Cinderella. He rapes her or beats her or exploits her cruelly and mercilessly. Sadistic psychopaths have a sixth sense for this vulnerability. The diagnostic labels that best capture such a survivor's situation are "borderline"or "histrionic" personality. I wish the label had no stigma attached and could be used in a helpful way. Unfortunately, any label has problems. The utility of the diagnostic label is that there are web sites with information and support groups with confirmation and counsel. It is NOT YOUR FAULT if you have been raised in a toxic family, exposed to emotional abuse, and done what you had to do to survive. It is NOT YOUR FAULT if you fit the label of borderline or histrionic personality disorder.

Thinking about such a childhood as a pathway to PTSD is, actually, helpful. The pattern of survival resembles a person who was held hostage and finally escaped. Thank goodness you have escaped! But now you need to learn a whole new set of lessons about trusting others, about improving your self-esteem, about modulating your negative emotion and about making wise choices. Look at our Gift From Within resources on complex PTSD. The material there probably applies. You may have regular PTSD and complex PTSD. They often co-exist. Learn about managing depression. There are many types of depression, but the common elements are feeling hopeless, helpless and worthless. You are not worthless. If you feel that way, cognitive behavioral therapy will help. You will learn how to change your thoughts in order to improve your feelings. But there is a lot more to learn and to manage. Therapists who specialize in treating survivors of trauma have skills and techniques that should prove useful. An older, wiser therapist who has seen this pattern many times before, and who has had great success in working with survivors of emotional abuse is worth her (or his) weight in gold. How do you find that person? You have to look hard, to ask friends, to call women's advocates and university departments of psychiatry and psychology. There are many GFW friends who have had good experiences with good therapists.

In sum, emotional abuse takes a toll and the result is usually something resembling PTSD but, technically, not PTSD. The recovery from prolonged childhood emotional abuse is difficult. An experienced therapist with a track record of success can make a huge difference. I hope, if this is you on the trail of such a therapist, that you succeed, you prevail, and you help others find the real "fairy godmothers" who are out there.

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