Say Something, I’m Giving Up On You

Alexis hugs a pillow to her chest as she swallows hard. “Doc, I know you want me to tell him how I feel, but…It’s like there’s a block in my throat.” She seems to choke on her words when she senses conflict. She describes a fight she had with her boyfriend over dinner last night, and how it ended with her crying while he asked, “What did I do? Just tell me!” as he watched her withdraw into herself. Alexis knows that her voice hasn’t been the same since high school when a supposed friend violated her space and left scars deep within her psyche. Even though many years have passed, she still freezes when she feels threatened in her relationships, hiding behind a curtain of long brown hair and silence.

If you’ve ever loved someone who has been through the burning flames of physical or emotional abuse, there is a possibility that he or she has developed a complex posttraumatic stress disorder. In short, once an individual has been forced to endure the prolonged and repeated infliction of pain at the hands of someone they trust, they may have a hard time trusting anyone again. They may experience symptoms of complex trauma such as problems with emotion regulation, impulse control, focus, dissociation, and interpersonal relationships (van der Kolk, 2014). And the very nature of those symptoms means that it is often impossible for the sufferer to speak about what they are experiencing. Instead, they may shut down or react in defensive anger.

What they may actually be trying to communicate is:

1. When I feel threatened, it is hard for me to speak. The key word in that sentence is “feel.” You may not have actually lifted your hand or said something hurtful, and yet you may have triggered a fear that is mired in his or her past. Survivors of trauma often have overactive adrenal responses to threat, which means that when they register a threat to their emotional or physical safety, the blood rushes from their brains down to their extremities, readying their bodies to fight or flee. These involuntary protective mechanisms place a very real limitation on the biological functions necessary to communicate (Perry, 2009).

2. When I do speak up and tell you how I feel, know that this was a Herculean effort. Steven Porges (2011) identified as a dorsal vagal complex to severe threat, during which the brain shuts down non-essential functions like speech, and lowers metabolism throughout the body, leading to an internal collapse in a state known as “freeze.” This often appears as complete shut down: silence, lack of facial expression or interaction. Therefore, when your beloved survivor does try and speak in moments of conflict, be sure to listen, validate, and honor those words. As Alexis said to me during one tearful session, “just…just treat my words like little butterflies. If you crush them, they’ll die forever.”

3. I might have sudden extreme reactions that only make perfect sense if you understand how they happen. Imagine being plunged into a boiling hot bathtub; you would most likely scream, “Ouch!” Now imagine that the pain receptors in your body have been damaged, and you are in the tub, watching time pass by for a while before you notice third-degree burns on your body. Your scream may be sudden, and loud, and disproportionate to your seeming relaxation just moments before. This actually makes perfect sense if you factor in those damaged nerves.

MRI studies show that adult women who have been abused as children have hippocampal regions that are 18 percent smaller than those of a control group (Vythilingam et al., 2002). This means that the part of the brain responsible for regulating emotions is compromised. The survivor may not know how to read her own internal signals that tell her she is starting to feel hurt or upset. This makes sense because she has learned to ignore her own gut instincts. Therefore, when she finally realizes, with a jolt, that she feels afraid or hurt, she may react impulsively in a manner that seems extreme for a given situation.

4. I might blame myself for things that I have not caused. There are times when I will deny my own needs to reduce or avoid conflict. Object relations theory is an organized way of understanding relationship dynamics (Klein, M. as cited by Kernberg, 1988). The theory posits that infants use projective identification to cope with neglect or abuse. If babies could string sentences together, it might sound like this, “Well my mother is ignoring my cries. It is too dangerous and painful for me, being so tiny and helpless, to believe she doesn’t care about me. So instead I’m going to decide that I’m a bad baby and she is a wonderful, loving mother.” The self-blame is a way for the infant to maintain the necessary illusion of a safe and loving caregiver.

Object relations theory begins in early childhood, but without intervention, those patterns of belief can last way into adulthood. In real time, this means that you may see your loved one blame himself for any conflict in your relationship, even when you are the one at fault. As the concerned wife of one trauma survivor described, “When I get home from work in a bad mood, and he feels the stress radiating off my body, he darts around the house cleaning everything in sight. I don’t get it.” Well, that’s because on a completely unconscious level he might blame himself for your mood.

5. Please do not diagnose or label me. You may think you know what your partner has been through as a child, or you may recognize that s/he has some of these symptoms. Remember that trauma can only be diagnosed by a qualified mental health professional that has performed a comprehensive clinical evaluation. It is possible for children and adults to survive unthinkable conditions without developing trauma diagnoses. It is also possible for people to develop trauma symptomology from incidents you may not think are “that bad.”

6. If you are not up to the task, gently let me go. It is not uncommon for trauma survivors to unconsciously replay the past by choosing partners who have their own relational challenges. This creates the potential for cycles of abuse to continue on and on, hurting both partners in the process. You might feel yourself beginning to fray at the seams and act in ways that do not make you feel proud. You may realize that you are increasingly sacrificing your priorities and needs and feeling resentful as a result. These are signs that it may be time to let go or take a break so that each of you may pursue individual paths to healing.

All those among us who try to open their hearts following abuse: they are true heroes. We can honor the bravery of complex trauma survivors by tuning into their needs and creating a space for connection and trust. Within that secure space, we may get to see incredible strength, the kind that can inspire us to be better versions of ourselves. And when we embrace those who have survived the worst sorts of mistreatment, we can ensure that hate will not win in the world around us.

References

Kernberg, O. F. (1988). Object relations theory in clinical practice. The Psychoanalytic Quarterly.

Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics. Journal of Loss and Trauma, 14(4), 240-255.

Porges, S. W. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. Norton Series on Interpersonal Neurobiology (New York: WW Norton & Company, 2011).

van der Kolk, B. A. (2015). The body keeps the score: brain, mind, and body in the healing of trauma. NY, NY: Penguin Books.

Vythilingam, M., Heim, C., Newport, J., Miller, A. H., Anderson, E., Bronen, R., … Bremner, J. D. (2002). Childhood Trauma Associated With Smaller Hippocampal Volume in Women With Major Depression. The American Journal of Psychiatry, 159(12), 2072–2080.