October 04, 2017

Resentment

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I've really struggled with resentment since James and I added Wally to the family, so I picked up this book (9 Steps to Heal Your Resentment and Reboot Your Marriage), ignoring how cheesy and self-helpy it sounded. It's helped me to look at and realize a few practical things.

First, the book had me list the things I'm resentful about. I won't recap them all, but so much of my resentment has revolved around an imbalance of work load (house chores, parenting), a lack of understanding (who I am as a mom, what I needed during that first year), how parenthood has affected us differently, wanting to matter, needing personal space (taking time for myself, having more boundaries, not feeling controlled), and fear (not feeling secure in his love for me).

But when we numb the painful, we numb the positive too. So we have to feel it all.

The book highlights the fact that we can only control ourselves, so why not take control. I'm responsible for my own happiness. I'm not a victim of my marriage or of motherhood or of my own life. So instead of straining to change James, I was to practice lowering my expectations and list three things I could get rid of:
  1. Working - I plan to quit! DONE!
  2. Always being the default parent - Practice taking time for myself
  3. Buying groceries, which is something James is supposed to do - simply stop and write what we need on a list for him

A basic exercise of simply saying no. Then I was to list things just for me, like little rewards, and experiment with using them. I was supposed to come up with 25 things, and I could only list 7 at first! I think that says something right there: Do I even know what I like?
  1. Getting a massage
  2. Reading a book
  3. Meeting someone for a beer
  4. Getting a coffee alone in the morning
  5. Taking a nap
  6. Going for a solo walk and taking in the falls, the leaves, the air
  7. Cookies - eating them and baking them
  8. Snowboarding
  9. Going for a run
  10. Getting outside
  11. Writing in my journal
  12. Writing on my blog

My Non-Negotiables:
  1. Running / exercising
  2. Writing or reading
  3. Morning time

The next part was difficult. The book had me list everything I've lost / everything I miss as well as everything I've gained as a result of marriage and having kids. The goal was to acknowledge and grieve and see that getting married and becoming a mom breaks you down and rebuilds you.

What I've Lost and Miss:
  1. Complete independence - not having to check in
  2. Freedom and control - even around simple things like money
  3. Praying in bed in the morning
  4. Traveling alone
  5. Having more time with friends
  6. A strong sense of self
  7. The chase
  8. Bulk of alone time
  9. A sense of being understood - less complicated life
  10. Minimal stress and anxiety environment

What I've Gained:
  1. A constant friend - someone is always around
  2. Not being alone at night
  3. The stimulation of growth
  4. Joy - watching Wally grow and the little moments
  5. Confidence of commitment
  6. James' cooking
  7. Hugs and kisses
  8. Someone to share walks, running, movies with
  9. Joy - witnessing James be a dad
  10. Date nights
  11. Beautiful home
  12. Family trips
  13. Laughing at silly things together
  14. Having lots to write about

The next part was to list everything I could about my own family dynamics in order to recognize the patterns that have been ingrained. I realized that I'm triggered by a failure to listen, controlling behavior, unhealthy boundaries, not being treated like I matter, the not helping...partly because my dad didn't do well with those things growing up. When feeling resentful and triggered, I'm to ask what's really asking for my attention right now?

Tips I Found Most Insightful:
  1. Ask for help and for what you want.
  2. Practice saying no because every time I say yes to something I don't want to do, I'll end up feeling resentful. And every time I say yes to something, I say no to something else.
  3. Focus on three positive interactions for every negative.
  4. Write one good thing about James per day.

To sum up the message, overcoming resentment lies mostly within gratitude, what I choose to focus on, taking responsibility vs. blaming, and taking time and doing things for myself.
September 25, 2017

Thoughts & Anxiety

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Maybe this seems a bit intense for a beach vacation, but it was actually nice to remove myself from every day life to think about something more serious, thoughts I've struggled with.

When I shared with my therapist the anxious thoughts that I've been having and how disturbing I find them, she said, "You know, medication can really help with that." But I refused to believe that a simple pill can clear all my anxious problems up. Mask them? Sure. But truly address them? So I picked up this book (Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts) out of my unwillingness to just surrender to them.

What I've learned is that just about everyone has intrusive thoughts. And when they are disturbing in their content, it's easy to hold onto them and start making judgments about yourself, your mind, your intentions. But here's the thing: "What you resist tends to persist."

A Few Voices Inside Our Heads

The book speaks of the voices in your head, Worried Voice and False Comfort:
Worried Voice articulates the fears and doubts and misguided conclusions that predict tragedies and awful outcomes...False Comfort is actually so disturbed and frightened by Worried Voice that it continuously tries to argue, control, avoid, suppress, reassure, reason with, neutralize, or work around whatever Worried Voice comes up with.
Worried Voice goes nuts when the content of the thoughts is essentially the exact opposite of who you are and what you truly want to believe. The ultimate goal is to experience the thoughts without judgment or evaluation.

Suffering about unwanted intrusive thoughts is a disorder of overcontrol, not undercontrol. Doubt and uncertainty. Trying to control those things that you can't control (the thoughts) and wanting to be absolutely sure that nothing bad will happen. And that's how the thoughts take hold. It makes perfect sense why I'd struggle, someone who wants to feel in control and wants to be reassured all the time.

But simply being alive involves risk. Loving involves the risk that you could lose the ones you so deeply care about.

Common thoughts are of harming, either yourself or someone else. Thoughts about death and dying. Worry is even a form of intrusive thoughts. Especially when you worry about the fact that you're worrying all the time. Toxic worry tries to solve problems that cannot be solved or addressed (i.e. I'm worried that the plane could crash). Anxiety is reacting to something safe as if it's dangerous.

While thoughts have no power to change probabilities in the real world, experiencing disturbing thoughts somehow makes terrible things seem more likely, and so you work hard to "make sure" they never happen.
They fluctuate in intensity and frequency based on the fuel they receive—triggering events in the real world or the stickiness of your mind due to fatigue, mood, or anxiety—and, ironically, by the amount of effort you expend to try to counteract, avoid, or suppress them.
The basic premise of the book is that people who struggle have taken their thoughts too seriously, as if they actually say something about the people they are and the things that might happen. And so the key is to think of the thoughts in a different, non fearful light.

What the Book Teaches

The initial fear experienced as a result of the thought is unstoppable, but the ongoing fear is what we have the power to change. And that first bit of fear goes away quickly when you realize you are not in any danger.

Passivity is actually far more efficient than effort. Sometimes you just have to figure out how to let time pass. Without rationalizing or analyzing.

Most preached techniques involve trying to control. Trying to control the thoughts is entirely the wrong attitude. It ignores the fact that the thoughts are meaningless and harmless, and don’t require controlling. Because when you don't recoil from your thoughts, they lose their power.

The book also hit on a very important point for me involving faith and prayer, but simply by asking God to remove it, I give the thought power and am taking it seriously. And so the prayer feels ineffective, leading to doubt and questioning God. Giving the thought importance leads to it sticking all the more.

And so we are to recognize that they are just thoughts. Accept and allow them to be. Not to distract, not to engage, and not to reason them away. Float and feel them. Let time pass. And proceed. Continue on with normal activities.

Acceptance is the opposite of fighting with the feeling or fleeing from the thought.

Trying to figure out what the thoughts mean or whether or not they are true only keeps them coming back. The problem is thinking that Worried Voice is actually re-assurable. Worried Voice has to learn to tolerate that it can’t have a 100% guarantee about anything in life. And not everything has to mean something.

Anxiety tries to convince you that intrusive thoughts have a special meaning. Part of beating anxious thinking is refusing to be taken in by this misleading message.

Imagining a horrible future does not allow the present reality. 

And so it's best to return the mind to the present, noticing the floor under your feet or the sound of the wind. Focus on what you can sense right now. Sensations change from moment to moment, so do thoughts.

Intentional Exposure

This therapy takes recovery one step further by intentionally exposing yourself to triggers, like carrying the written thought around in your pocket. Saying, "I'm seeing the image of..." over and over to yourself.

The most important aspect of exposure is to stay in contact with what frightens you until the feelings seem more manageable. The goal is to allow all thoughts and feelings into awareness. Avoiding them reinforces and empowers the thoughts. But if intrusive thoughts just don’t matter because you have less fear of them and you are able to tolerate them much better, they then fade out on their own.

The books says that instead of responding to a what-if question, pivot your attention gently over to your senses: what can you hear, see, smell right now here in the moment? What does your body feel like? Notice without judgment or struggle.

Any thought can be tolerated...because there is no real danger. It is only a thought.
August 26, 2017

The Current War Within

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I have to believe that there's something more to this. I can't wrap my mind around the idea that there is this condition, like a disease, that must be addressed with something that's so passive, so simple, so...effortless.

I really thought that I was on to something this last week. I'd arrived at a desperate place once again, so easily serenaded by the sweet sounding words, "A pill is all you need to take." Because the deepest part of me wants to believe it's true.

"YES!" my inside screams. For a few hours, days, weeks even, I'm soaring above it all, wrapped up in the romance of such a simple fix.

Here I am, doing this, and yet I'm finding that I can't. I just can't do it. I can't take the risk. After how sweet it sounded. Knowing how easy it could be. The risk is driving me more mad than the anxiety itself.

Perhaps a drug can make it somewhat better, but a drug is still a drug. And a drug doesn't address how it got there, why it stayed, why it won't go away.

I have to remember that my anxiety is so much deeper, so much more complex than what genetics, science, and psychiatry all want me to believe. I'm lonely, isolated, imprisoned by my work, trapped in my guilt, longing for and needing so much more. And beneath it all are the lies I believe. About God. About life. About myself.

The story I'm hearing over and over. I'm not loved. I'm not known. God isn't there for me. God won't protect me or my family. And at the end of it all, maybe...maybe...He won't be there...The doubt.

Who wouldn't be anxious?

And on top of the issues themselves is a layer of thinking, of believing, of allowing my work to imprison me, of resentment and bitterness, of refusing to believe just how much God loves me, of letting my mothering say absolutely everything about me and not trusting where God has me in this moment.

Byproducts, really, of being isolated. The lies.

But this means that there is a solution. A hard one, but maybe a better, more permanent one. I will always be anxious if I'm doubting God. If I fear death and the safety of my family, the thoughts will overtake me. If I don't trust where God has me in this moment, the guilt will overwhelm me.

God, please have mercy on me.

I must do the simple work of caring for myself with food and water and activity. And I must do the difficult work of removing the bitterness, confessing, letting go, engaging harder in a community and putting energy towards finding the one for me.

I like to think that maybe I had to go through this struggle to actually step up and start fighting. That this blip mattered.

What I hate most about medication is feeling like there's something wrong with me. There is something wrong, but there's a difference to me between a pill-sized missing link in my brain and the sin and lies I've been steeped in. There's no pill big enough to overcome the bitterness that's taken hold, the lies that have become rooted, and the hopelessness that's ensued.

And I can't just sit here and take a stupid pill because the work of marriage and motherhood and believing is "too hard." Especially when it's not just about me, but this baby too.
June 20, 2017

I Want Out

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Being different is hard. Sometimes, that's just the way it is. But other times, being different is a choice. I've felt so disconnected lately, from God, from people, from life. And I'm wondering, is it because I haven't been brave enough over the last few months to choose to be different from the rest of the world around me?

I've been missing writing in its purest form. Quite honestly, when I write for other people, the shift in focus steals something from the writing for me. The wanting to appeal, impress, please. The wondering what others will think as I construct my art. It changes everything.

The only reason I've hopped back on the social media train (quite fully) is because of writing, and that makes me so sad. Do I really have to play some soul-sucking game in order to write?

It seems that approval and acceptance have been even more important to me than I've thought. Because when I really stop and think about what it is that I'm after, it's validation, for an agent and a publishing house to take notice of me. And so I've been striving for some sort of platform. But that's not what I want my writing to be about.

Will someone take notice of me without one? Can I leave the party once again and still "make it" as a writer?

But maybe a more important question is what does it matter if I don't choose the traditional route once more? Are "traditional" and "mainstream" really the definition of success? And what does it matter if I don't "make it?"

So I've been thinking a lot lately about what other ideas I've been subscribing to, mostly because the culture is telling me to. It bothers me how obsessed I've been over the last few days about whether or not to cut my hair, as if cutting it might actually be the biggest mistake I could ever make with my life. When did I become so accepting of the idea that long hair equals beauty? Has it always been that way?

I hate that I've felt like I need to stay, that I have to keep thinking this way if I want to feel accepted and be connected to people.

I want out. I'm so sick of being what "they" want me to be. And I'm sick of nourishing the connections that only keep me tethered to the lies more tightly.

Who are "they" anyway? Have I forgotten that no one will ever think of me as much as I think of myself? An illusion and lies. Of what I need to do and who I need to be to win at this thing called life.
June 01, 2017

Postpartum Anxiety

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I've struggled with some intense postpartum anxiety, most severely during the first year after having my baby. In the beginning, I didn't know what was happening to me. I just knew that I was a professional test taker. I rated my emotions and doodled on little ovals during a three-minute, doctor's office quiz and successfully passed Depression.

I also knew that whatever was happening felt an awful lot like I'd gained this incredible super power that enabled me to do everything (anything!) all the time. But unfortunately, a side effect of this neat new power was a serious condition that would inevitably result in a grusome death.

I was lucky that the world was so gracious. It spit some of the most attractive of solutions at me. But sadly, my anxiety was not like all the other illnesses. It wasn't exactly a coat I could just take on and off at will, no matter how much I wanted to, no matter how hot or cold I got.


Clearly addressing the issue was going to require a lot more from me, a long list of changes I wasn't exactly excited about.

Doing all the things at the same time only meant more lists and tracking and obsessing. But I could try to do the one thing. Heels dug in, I made myself walk down the aisle and stare my Tiny Pill prescription in the face. Oh Tiny Pill was incredible at first! My anxiety was at an all-time low, so low that I was able to completely unlearn the feeling of guilt. But honeymoons are deception festivals. Tiny Pill had not yet revealed it's deepest, darkest secrets, its quirks and heaps of baggage.

Tiny Pill did something else to me besides hush the anxiety. Tiny Pill stripped me of most of my emotions, making it difficult for me to cry even when I desperately wanted to. Even when I had something legitimate to cry about! I'd lost my ability to be fully woman.

So I decided to get innovative. I would try and trick the anxiety into thinking that I sincerely wanted to be its friend.


I figured if I could just sort of accept what anxiety feels like, maybe it would leave me alone and move on to someone else. But when I began engaging with rage-filled outbursts and dabbling in manic mode, it was clear that my bright idea was backfiring. I had hacked Life. And Life did not want to be hacked.

Life can get quite hard. Usually there's a really easy way to fix the difficulty that is absolutely impossible to execute. And so, for a time, one may find herself befriending Tiny Pill. But she has not given up or given in. I guess she's just doing what she has to do, which is letting go of her pride, resting in her limitations, being well because she has to be. For her baby.

And maybe, for herself.
May 18, 2017

Hijacked :: CSA & the Developing Brain

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Martin Teicher and his colleagues of Harvard University are leaders in the area of sexual abuse research. The Child Welfare Information Gateway summarizes the specific long-term effects of abuse and neglect on the brain identified by Teicher and his team: (1) Diminished growth in the left hemisphere, which may increase the risk for depression; (2) irritability in the limbic system, setting the stage for the emergence of panic disorder PTSD and prolonged unhappiness; (3) smaller growth in the hippocampus and limbic abnormalities, which can increase the risk for dissociative disorders and memory impairments; and (4) impairment in the connection between the two brain hemispheres, which has been linked to symptoms of attention-deficit/hyperactivity disorder.[1]

Teicher’s research also indicates that a history of abuse is linked to (1) increased electrophysiological abnormalities[2]; (2) epileptic-like symptoms[3]; (3) EEG  abnormalities, which is the recording of electrical activity along the scalp[4]; (4) volume reduction in two areas of the hippocampus[5]; (5) volume reduction in the corpus callosum[6]; (6) impairment of the cerebellum vermis 6; (7) oddities in cortical size, symmetry, and neuronal density[7]; and (8) lateralized hemispheric responses to memory recall.[8] The remainder of this chapter will describe what these changes are along with their implications and the role of timing.

A study conducted by research scientists Akemi Tomoda, Carryl Navalta, Ann Polcari, Norihiro Sadato, and Martin Teicher of Harvard Medical School’s Department of Psychology examined the brains of 23 young women with histories of childhood sexual abuse (CSA). These 18 to 20-year-old women were selected based on age, outstanding hearing and visual perception, and the absence of any additional trauma(s). Furthermore, their selection was independent of psychological condition in order to avoid overestimating the effects. For example, if only those with PTSD were selected, the effects of abuse may have been confounded “disorder-related differences.” In other words, the researchers didn’t want the effects of the abuse itself to be hidden within the effects of possessing a certain disorder.

Detailed medical, psychiatric, developmental, family, and trauma histories were first collected for each of the subjects. Unaware of the emphasis on their histories with abuse, the subjects underwent Magnetic Resonance Imaging (MRI). A global Voxel-Based Morphometry (VBM) analytic approach (a technique used for assessing structural changes in the brain) was then used to assess the results.

Those with a history of CSA showed significant gray matter volume reduction in the brain, specifically in the left and right lingual and inferior occipital gyri. At the front end of the occipital lobe, the visual processing center, are the occipital gryi.[10] The lingual gyrus is associated with processing vision, especially vision related to letters. It’s believed that the lingual gyrus may also play a role in the examination of the order of events as well as encoding visual memories. Furthermore, De Bellis and his team have also shown that superior temporal gyrus gray matter volumes are larger in abused than non-abused girls.[11]

It’s possible that reduction in gray matter volume in certain areas of the brain may present a preference for alternative facial perceptions. This may explain “the tendency of some patients to interpret ambiguous facial expressions as angry.” Sleep disturbances such as nightmares are common in sexual assault survivors. Such disturbances may reduce blood flow to certain areas of the brain, thereby altering “its developmental trajectory.”

When the results are evaluated in conjunction with a previous study (conducted by Fennema-Notestine et al.), the findings suggest that “exposure to abuse affects visual cortex development but that vulnerability is limited to an early sensitive period. In other words, reduced gray matter in certain areas of the brain was significantly associated with abuse occurring before the age of 12 and not after.

The Developmental Traumatology Theory hold five main assumptions: (1) Stressors are infinite, whereas the brain and body’s reactions to stressors are finite; (2) maltreatment in childhood may cause developmental delays or deficits; (3) trauma in childhood may be more detrimental than trauma in adulthood; (4) interpersonal stress in childhood leaves one at a greater risk for developing PTSD; and (5) in the case where the CSA survivor knows the perpetrator, “the maltreatment is not only the act of maltreatment itself (e.g., sexual abuse) but also a dysfunctional and traumatized interpersonal relationship.” In other words, the compounded effects of also suffering from a traumatized interpersonal relationship leave the child at a much higher risk for developing PTSD.[12] According to De Bellis and his colleagues, “An important mission for the field of developmental traumatology is to unravel the complex interaction between an individual’s genetic constitution, unique psychosocial environment, and proposed critical periods of vulnerability for and resilience to maltreatment experiences.”

There are particular stages in development where experience has the potential to affect an individual more significantly, the maximal effect occurring during sensitive periods and the essential occurring during critical periods.[13] Sensitive periods are evolutionary by nature. According to Oxford Dictionaries, a sensitive period can be thought of as “a time or stage in a person’s development when they are more responsive to certain stimuli and quicker to learn particular skills.”[14] In other words, sensitive periods permit experience to affect the development of neural circuits. Such alterations lead to variations in the way that information is perceived and processed, making it possible for the child to adapt to her environment. When acknowledging these sensitive periods, the question must be asked, are alterations in the brain indicative of damage, adaptive activity, or a combination of the two? Are the changes adaptive or maladaptive? The answer is not yet clear.[15] The hypothesis that these brain alterations serve an adaptive purpose has yet to be explored further.[16]

In a separate study, Tomada, Polcari, Teicher, and a second set of cohorts collected volumetric MRI scans from 26 women who endured repeated episodes of CSA (and 17 healthy, non-abused female subjects for comparison). A rather rigorous exclusion criterion was utilized when selecting the subjects. Differences in brain morphology that could obviously be attributed to CSA were actually excluded. This means that young women with neurological and medical disorders, past or present issues with alcohol or substances abuse, exposure to physical (non-sexual) abuse, etc. were purposefully omitted from the study. Reason being, these researchers aimed to uncover differences in brain structures that could widely be attributed to the occurrence of CSA occurring at specific developmental ages.

The scans were analyzed specifically for sensitive period effects on hippocampal and amygdala volume, frontal cortex gray matter volume, and corpus callosum area. What the study found, in short, is that the age of the individuals when the abuse incidents(s) occurred mattered significantly. The hippocampus plays a key role in memory merging and retrieval, and it is one of few areas of the brain that continue to produce cells after birth. Severe stress in childhood appears to affect this area.[17] Hippocampal volume reduction was mostly linked to CSA occurring between the ages of 3 and 5 and secondly between the ages of 11 and 13. Another study shows that adults who have suffered from CSA show deficits in short-term verbal memory.[18] Furthermore, CSA leading to PTSD, dissociative identity disorder, borderline personality disorder, or major depressive disorder has been linked to a reduction in hippocampal volume in adulthood.[19],[20] (People with dissociative identity disorder have “at least two seemingly separate people occupy the same body at different times, each with no knowledge of the other.”[21])

This research suggests that early abuse may have an effect on the brain that doesn’t emerge until well into adulthood. It’s important to note that PSTD and/or substance abuse are other factors that may lead to the size reduction; however, the “ticking time bomb effect” is worth studying. In other words, it seems most plausible that delayed effects of early abuse are cause for concern. And sexual abuse may not be the only means to the end. According to an article in The Guardian, Teicher’s findings indicate that key areas of the hippocampus were reduced by up to 6.5% in individuals who reported childhood maltreatment such as physical and even verbal abuse.[22]

The corpus callosum, a flat bundle of neural fibers that connects the right and left hemispheres of the brain, is also smaller in abused children. “We believe that a smaller corpus callosum leads to less integration of the two halves of the brain, and that this can result in dramatic shifts in mood and personality,” says Teicher. While this volume reduction in an integral portion of the brain is key to understanding the effects of sexual abuse on the brain, it’s important to note that this size reduction is seen in girls who have been sexually abused. In boys, however, such a reduction is associated with neglect. An interesting observation: A boy who experiences neglect is essentially subjected to a most severe loss of respect and worth, whereas a girl who experiences sexual abuse is left to face an attack on her feeling loved. Note that various forms of abuse and neglect tend to coexist, so it’s often difficult to tease out the effects. However, many scientific studies considering the effects of abuse take inventory of the subjects’ histories. Those with histories of neglect and other trauma are often not included in such studies.[23]

Teicher’s EEG research indicates that left-sided EEG abnormalities were more prevalent in CSA survivors, suggesting that the left hemisphere of abused children may not develop properly. It’s well-known that the dominant hemisphere is more developed, yet when Teicher and his colleague investigated the abnormalities in the left hemisphere of abuse survivors, they found that the right cortex was significantly more developed despite being right-handing. This anomaly was present regardless of the patient’s reported condition (PTSD, depression, anxiety, etc.). When tested further, individuals with a history of abuse appeared to use the left hemisphere when recalling neutral memories and the right when retrieving memories of disturbance. Individuals within the control group “had a more integrated bilateral response.” This reduction of development in the left hemisphere may increase one’s risk of developing depression.[24]

In the MRI scan study, corpus callosum volume reduction was linked to reported CSA occurring between the ages of 9 and 10. Furthermore, a weakened frontal cortex was observed subjects who endured CSA between the ages of 14 and 16 years. These results are consistent with the fact that the hippocampus has reached approximately 85% of adult volume by the age of 4, and functionality of the prefrontal cortex, the area of the brain responsible for planning complex cognitive behavior, the expression of personality, decision making, and moderating social behavior, may not develop until the onset of puberty. Finally, damage to the orbital frontal cortex can lead to hypersexuality, poor social interactions, compulsivity, substance abuse, and poor empathetic ability.

When analyzing the questionnaires that each of the subjects completed, depression was associated only with CSA occurring between the ages of 3 and 5, whereas PTSD symptoms were only linked to CSA occurring between the ages of 9 and 10.[25]

These results suggest evidence that various brain regions have distinct periods during development when they are especially vulnerable to the effects of traumatic stress such as CSA. These results echo the findings of related studies. According to researchers Kristen Brunson and her colleagues of the Department of Anatomy Neurobiology and Pediatrics at the University of California, early exposure of an immature hippocampus to corticotropin-releasing factor (CRF), both a hormone that stimulates other hormone (ACTH) secretion and a neurotransmitter involved in stress response, may result in long-term memory deficits and selective loss of hippocampal neurons.[26]

The team of researchers led by Martin Teicher has also studied around 200 individuals ages 18-25. (The original article was published in the Proceedings of the National Academy of Sciences.) They were told that they were participating in a study on memories of childhood. Those who had been maltreated showed volume reductions of approximately 6% (on average) in two areas of the hippocampus and 4% in the subiculum (which “helps determine both behavioral and biochemical responses to stress”) and presubiculum when compared to those who hadn’t been abused. Since previous studies haven’t supported these findings, the research suggests that such changes may not arise until after puberty. According to neuroscience journalist Maia Szalavitz, “High levels of stress hormones can lead to cell death in the very regions that are supposed to tell the system to stop production.” This means that one who has been abused may wind up with a stress system that’s always on high alert.

Hormones such as norepinephrine, serotonin, and dopamine are released as part of the stress response. The hormone serotonin stimulates certain circuits that create and lessen anxiety. It plays an important role in controlling mood, aggression, and impulsivity.[27] Chronic stress is known to lead to decreased serotonin levels in the prefrontal cortex. These low serotonin levels are linked to suicidal behavior, depression, anxious depression, and aggression. Dopamine, on the other hand, is overproduced as a result of chronic stress. During stress, dopamine pokes the prefrontal cortex, which can increase one’s likelihood of becoming extra vigilant, even paranoid or psychotic. Furthermore, research confirms that reported CSA is associated with low serotonin transporter binding (5-HTT BPP) in major depressive disorder.[28] In other words, CSA is linked to an inability to “recycle” serotonin, leading to misregulation, even depletion. [29]

As children abuse survivors are more distractible and have more difficulty maintaining focus. They have a more difficult time restraining themselves from certain behaviors.[30] For teens who have been abused, impulsivity may be more apparent than your average teen. These teens may be much more drawn to taking risks, which may include something like experimenting with drugs.[31]

At the 2007 joint conference sponsored by both the Massachusetts Adolescent Sexual Offender Coalition and the Association for the Treatment of Sexual Abusers, Teicher presented on Childhood Abuse, Brain Development and Impulsivity. Practically speaking, poor impulse control can be displayed as addictive, self-destructive, and abusive behaviors due to a decrease in judgment, reason, fear, and inhibition. This increase in impulsivity appears to be the result of diminished hemisphere integration, meaning abused children may act out of emotion as opposed to reason and logic in response to stress. Early stress trains the body to have a more exaggerated and prolonged reaction to future stressors. As a result, accelerated aging often takes place as a result of chronic stress. In other words, early abuse trains the body and the brain to survive in “what it predicts will be a malevolent world.”[32]

The amygdala reacts to the release of norepinephrine, serotonin, and dopamine. In turn, the hypothalamus releases CRF, which leads to increased ACTH secretion, another hormone. The chain of events eventually leads to elevated cortisol levels. If this process occurs frequently, CRF and cortisol levels remain elevated and disrupt the feedback loop. In other words, the result is an imbalance of hormones and deregulation of them. Research on CSA survivors supports this: “Elevated resting levels of CRF have been found in the spinal fluid of abuse victims.”[33] Practically speaking, this individual may experience anxiety, fear, lack of pleasure, which may lead to negative habits such as alcoholism if not properly addressed.

The University of Southern California teamed with the Cincinnati Children’s Hospital Medical Center back in 1987 to begin a study on 80 diverse girls with histories of CSA, some who were abused as early as age 2. The girls were anywhere from 6 to 16 at the start of the study. On average, the girls were sexually abused for approximately 2 years before child protective services got involved. The researchers assessed them (along with a control group) 6 times over the next 23 years. Unfortunately, there’s some truth to much of the stigma that’s historically been associated with sexual assault victims. The researchers found higher rates of depression and obesity and issues with chemical regulations in the brain. These CSA survivors were “more likely to become sexually active at younger ages, have lower education status, and have more mental health problems.” As children they had higher levels of cortisol, a hormone released in response to stress, yet by age 15 cortisol levels were lower than the control group, meaning the bodies of the abused children may have become increasingly unable to deal with the stress. “That [low levels of cortisol] tell us their stress response system is burned out,” says Dr. Frank Putnam, study co-author. Low levels of cortisol have been linked to a number of problems including obesity, depression, and PTSD.

Researchers at the University of Minnesota and the University of Rochester also investigated cortisol. The impact of sexual abuse occurring with the first 5 years of a child’s life was investigated by obtaining saliva samples from the children twice a day over a period of several days. The samples analyzed indicated an atypical flattening of cortisol production throughout the day in CSA survivors experiencing high internalizing symptoms. Upon further investigation, the researchers found that early onset of physical or sexual abuse was predictive of this phenomenon. In fact, factors such as type of perpetrator and recency could not explain the observations. This suggests that these children may be more likely to experience a lack of cortisol regulation in adulthood. However, it’s important to note that more may be at play. Physical and sexual abuse often occurs in the presence of neglect and emotional abuse.[34]

Some studies suggest that survivors may more easily perceive genital pain, meaning any touch in that area results in pain instead of pleasure. Research seems to support this. Dr. Charles Nemeroff and his colleagues from the University of Miami in Florida have found that “early life trauma was related to a much thinner somatosensory cortex, smaller hippocampal volume, and neurocognitive deficits,” which all may relate to genital sensation.[35]

Abused children may live in a persistent fear state. This constant response to stress and fear can “create permanent memories that shape the child’s perception and response to the environment.” The response can linger, even if the environment improves. This is where the term trigger originates. These memories may trigger responses apart from conscious thought. These children may become consumed with the need to monitor their surroundings for fear of encountering another threat. This is also known as hypervigilance. And because of the trauma of such memories, children may dissociate from them. This explains post-abuse amnesia and long-term memory loss. Perhaps to preserve the attachment process, my brain smothered the memories of my abuse until the triggers were too overwhelming. My memories of early abuse were buried until another incident “reminded” me of all that had happened.[36]

J. Douglas Bremner and his colleagues at the Emory University School of Medicine in Atlanta, Georgia have gleaned the following from their research: Relative to a control group, female PTSD patients with reported CSA “had increased left amygdala activation with fear acquisition, and decreased anterior cingulate function during extinction.” The amygdala is a part of the brain associated with distressing emotions such as fear. The anterior cingulate is thought to operate as a regulator for a wide range of reflex-like functions like adjusting heart rate and blood pressure. It’s also involved in logic processes, such as empathy, impulse control, emotion, and decision-making. The amygdala lights up at the onset of fear, whereas the anterior cingulate loses function as fear is eliminated. This suggests that one’s response to fear is somewhat anticipated, yet the post-fear effects may linger. Other researchers support this as abuse has been linked to Attention Deficit Hyperactivity Disorder (ADHD) behavioral problems.[37] Women with abuse-related PTSD may have bodies that struggle with returning to normal, pre-fear conditions. And in fact, “an inability to extinguish the effects of fear is a characteristic of PTSD patients.[38] Other characteristics include nightmares, sleep disturbances, flashbacks, intrusive thoughts, hypervigilance, and changes in memory.

It was another layer of unrelated trauma that taught me an even more intense level of fear. And today? Behind the shower curtains and in the corners of a dark garage—that’s where the malicious individuals typically lurk, or so I think. No matter how irrational, implausible even, I anticipate these people, these things, harming me. My mind and my body convince me. I can explain this to myself a million times over, but only when I flip on the lights can I truly calm the stress response solidly seen in the wideness of my eyes, the rapidness in my heart beat, and the sweating that soaks my lower back.

Fear and anxiety tend to provoke people towards further harm. Individuals often turn to drugs, alcohol, sedatives, and sleep to relieve their anxieties, yet even sleep, which may seem harmless, can make matters worse. Sleep tends to establish and fuse traumatic memories together. For example, the Israeli army advises against sleep post-combat. Instead, soldiers are encouraged to stay awake and engage in sincere human interactions in order to mitigate the risk of PTSD. Studies show that the more “support, altruism and connection people share, the lower the risk for the disorder and the easier the recovery.” [39]

A study distinguishing the PTSD that abused children may experience from the PTSD that’s caused by other types of trauma (in adults) was published in the Proceedings of the National Academy of Sciences. This particular study is unique compared to many other CSA studies, the reason being that the team of researchers studied African American women in their late 30s to mid-40s who had been exposed to various types of trauma which may have included CSA and/or being held at gun-point. Of the 169 individuals evaluated, 108 were resilient, meaning they never developed PTSD. (PTSD symptoms are normal responses to stress, yet the symptoms typically fade in the first three months post-trauma.[40]) Out of the ones that did (61), 32 had been sexually abused as children. The researchers examined the blood cells of these women, specifically looking for genetic changes. Such genetic alterations are chemical changes that don’t actually affect the DNA itself but rather how the genes are made into proteins. “In PTSD with a history of child abuse, we found a 12-fold higher [level] of epigenetic changes,” says postdoctoral student Divya Mehta of the Max Planck Institute of Psychiatry in Munich Germany. Those who experienced trauma later in life exhibited genetic effects that tended to be short-lived and didn’t permanently affect the functioning of the genes. [41]

Luckily around 80 percent of people exposed to trauma will never develop PTSD, but those who do may have a long battle ahead. According to Bruce Perry, Senior Fellow of the ChildTrauma Academy, “When people are terrorized, the smartest parts of our brain tend to shut down.” Due to the need for rapid responses, our normal pathways get short-circuited when exposed to terror. According to Bremner, imaging studies have shown alterations in a circuit within the brain including the prefrontal cortex, hippocampus, and amygdala. Terror teaches us to see everything as a threat in order to protect us. “But once the immediate threat has passed, this style of thinking can become a hindrance, not a help.” Bremner says that early treatments don’t always help. In fact, immediate treatment such as Critical Incident Stress Debriefing (CISD), a specific, 7-phase, small group, supportive crisis intervention process, may actually lead to a worsening of the symptoms compared to no treatment at all. Instead, he advocates for the use of antidepressants for chronic PTSD: “Antidepressants have effects on the hippocampus that counteract the effects of stress.” What’s even more encouraging is remedies that are effective in treating PTSD appear to promote neurogenesis in animal studies. In other words, a mechanism that’s most active during pre-natal development—the populating of a growing brain with neurons—is stimulated as a result of treatment. Treatment also appears to result in increased memory and hippocampal volume.[42]

This doesn’t mean, however, that CSA survivors are doomed to a life of destitution. The differences between the sexually abused girls and the control group are significant, but that doesn’t mean that each survivor experienced these hardships. In fact, many are resilient and never develop conditions like PTSD. I’d argue the variation within the abused group may be an area for further study. Why is it that many of the CSA survivors experienced these difficulties while others did not? Moreover, can various treatments prevent these conditions from developing and/or reverse the effects? Researchers are currently unable to answer such questions with confidence. Lead author Penelope Trickett, psychologist and professor of Social Work, says, “What is clear here is that abuse is not something that’s a one-time fix.”[43]

The cerebellum vermis—a part of the brain that develops slowly and continues to grow new neurons after birth—is instrumental in the body’s sense of touch, spatial positions, and movements. The vermis also has an emotional stabilizing function, which may be impaired in sexually abused children due to limited blood flow to the area. According to Teicher, the vermis is more strongly influenced by environment versus genetic factors. Other researchers support this by explain that it has a high density of stress hormone receptors, “so exposure to such hormones can markedly affect its development.” [44] Though to date no statistical evidence to support this exists, Teicher and his colleagues believe that exercise may stimulate the vermis, thereby expanding attention span and combating hyperactivity. Even rocking and simple movements can have calming effects. The hypothesis is intuitive, for blowing off extra steam is known to help calm one down.[45]

Children’s brains that have suffered CSA and/or intense deprivation may actually permanently lose the ability to properly use serotonin, a neurotransmitter that assists in emotional stability.[46] Teicher has asked the question, “Does abuse modify a brain to cope with what it predicts will be a malevolent world?” Does one enter into a semi-permanent survival mode? Does what seems to be a hindrance instead aid the individual down the road? Teicher and his team are considering testing such questions with lab animals. They hope to determine if, for example, lab rats that are exposed to severe stress at an early age react better in particular situations compared to rats that enjoy an easy-going life early on.[47] If this hypothesis is true, perhaps experiencing hardship in childhood equips one to better deal with other hardships throughout her life.

[1], [32], [37] Understanding the Effects of Maltreatment on Brain Development (2009): Child Welfare Information Gateway.
[2] Ito Y, Teicher MH, Glod CA, et al (1993): Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse. Journal of Neuropsychiatry and Clinical Neurosciences, 5:401-408.
[3] Teicher MH, Glod CA, Surrey J, et al (1993): Early childhood abuse and limbic system ratings in adult psychiatric outpatients. Journal of Neuropsychiatry and Clinical Neurosciences, 5:301-306.
[4] Ito Y, Teicher MH, Glod CA, et al (1998): Preliminary evidence for aberrant cortical development in abused children: a quantitative EEG study. Journal of Neuropsychiatry and Clinical Neurosciences, 10:298-307.
[5], [34] Szalavitz, Maia (2013): How Child Abuse Primes the Brain for Future Mental Illness. Time Health & Family. <www.healthandtime.com>.
[6], [26] Andersen SL, Tomada A, Vincow ES, Valente E, Polcari A, Teicher MH (2008): Preliminary Evidence for Sensitive Periods of Childhood Sexual Abuse on Regional Brain Development. Journal of Neuropsychiatry and Clinical Neurosciences, 20(3).
[7], [24], [45], [47] Cromie WJ (2003): Child abuse hurts the brain. Harvard University Gazette.
[8], [10], [19], [31] Navalta CP, Polcari A, Webster DM, Boghossian A, Teicher MH (2006): Effects of Childhood Sexual Abuse on Neuropsychological and Cognitive Function in College Women. Journal of Neuropsychiatry and Clinical Neurosciences, 18(1):45-53.
[11] Henry G, Williams PL, Gray H (1989): Gray's Anatomy. Edinburgh: C. Livingstone.
[12], [13], [16], [28], [30], [41] De Bellis MD, Spratt EG, Hooper SR (2011): Neurodevelopmental Biology Associated with Childhood Sexual Abuse. Journal of Child Sexual Abuse, 20(5):548-587.
[14], [21], [33] Teicher MH (2007): Child Abuse, Brain Development and Impulsivity. MASOC/MATSA Joint Conference. Marlboro, MA. 12 April 2007. Keynote Address.
[15] “Sensitive period” (2014): OxfordDictionaries.com, 24 March, 2014.
[17] Tomoda A, Navalta CP, Polcari A, Sadato N, Teicher MH (2009): Childhood Sexual Abuse Is Associated with Reduced Gray Matter Volume in Visual Cortex of Young Women. Biological Psychiatry, 66:642-648.
[18], [22], [25], [38], [44] Teicher MH (2000): Wounds That Time Won’t Heal: The Neurobiology of Child Abuse. Cerebrum: The Dana Forum on Brain Science, 2(4).
[20] Ball JS, Links PS (2009): Borderline personality disorder and childhood trauma: evidence for a causal relationship. Current Psychiatry Reports, 11(1):63-68.
[23] Jha, Alok (2012): Childhood abuse may stunt growth of part of brain involved in emotions. The Guardian.
[27] Brunson KL, Eghabal-Ahmadi M, Bender R, et al (2001): Long-term, progressive hippocampal cell loss and dysfunction induced by early-life administration of corticotropin-releasing hormone reproduce the effects of early-life stress. Proceedings of the National Academy of Sciences USA, 98:8856-8861.
[29] Miller JM, Kinnally EL, Ogden RT, et al (2009): Reported childhood abuse is associated with low serotonin transporter binding in vivo in major depressive disorder. Synapse 63(7):565-573.
[35] Cicchetti D, Rogosch FA, Gunnar MR, Togh SL (2010): The Differential Impacts of Early Physical and Sexual abuse and Internalizing Patterns on Daytime Cortisol Rhythm in School-Aged Children. Child Development, 81(1): 252-269.
[36] Johnson K (2012): Childhood Sexual Abuse Alters Female Brain Structure. Medscape.
[37] Bremner JD, Vermetten E, Schmahl C et al (2005): Positron emission tomographic imaging of neural correlates of a fear acquisition and extinction paradigm in women with childhood sexual-abuse-related post-traumatic stress disorder. Journal of Psychological Medicine, 35(6):791-806.
[40] Szalavitz, Maia (2013): How Terror Hijacks the Brain. Time Health & Family. <www.healthandtime.com>.
[41] Szalavitz, Maia (2013): Abused Children May Get Unique form of PTSD. Time Health & Family. <www.healthandtime.com>.
[42] Bremner JD (2006): Traumatic Stress: effects on the brain. Dialogues in Clinical Neuroscience, 8(4).
[43] Raymond, Joan (2011): Effects of sexual abuse last for decades, study finds; Levels of so-called stress hormone are altered for years, sometimes causing physical and mental problems, researchers find. NBC News. <msnbc.com>.
[46] Healy JM (2004): Your child’s growing mind: Brain development and learning from birth to adolescence. Broadway Books.