Latest / System Speak: Complex Trauma and Dissociation / Recap: Brains & Dissociation

Transcript

Recap: Brains & Dissociation · System Speak: Complex Trauma and Dissociation

• 0:08
  Speaker 1: Over: Welcome to the System Speak Podcast, a podcast about Dissociative Identity Disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to long time listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what
• 0:40
  Speaker 2: we are currently learning and experiencing. As always, please care
• 0:44
  Speaker 1: for yourself during and after listening to the podcast. Thank you. One of the other sessions I attended at the ISSTD Virtual Congress was parsing the contributions of attachment and trauma in pathways to dissociation, suicidality, and borderline personality disorder. This was presented by Carnan Lyons Ruth, who is a professor at Harvard Medical School. I was interested in this class because while I've never been diagnosed with borderline personality disorder, I know that suicidality is something that is big with survivors and something we don't talk about much on the podcast simply because it is a triggering topic.
• 1:48
  But it is one I myself have been hospitalized for previously or even recently. And and the more that we have learned in podcast interviews about attachment, the more we are interested in that and how it relates to dissociation. So I was very excited for this course and her sharing about not just trauma that happens to you as far as abuse, like physical or sexual abuse, but the actual interactional patterns between parents and their children and the trajectories that forms toward dissociation or other psychopathology like borderline personality. There were several studies that she shared that she has worked on recently, like the most recent research on this. And the first one was about infancy predictors for borderline features in suicidality.
• 2:52
  They measured parent infant relationship at 18 of age by noting the infancy security of attachment and looking at disrupted maternal communication with the infant. The assessment was done through the separation reunion procedure, looking at how the infant approaches the parent for comfort after a brief separation and how effectively the parent provides that comfort. These have been studied for years and years, all the way back to Ainsworth and Bowlby and things Peter Barrish has shared with us on the podcast before. So we understood what she was doing and know that these measures were good ones for her to be using. Right?
• 3:40
  And another thing that they looked at was cortisol dysregulation in mothers and babies at four months of age. So just very simply, cortisol is a stress hormone and so they could measure how stressed the mother was and how stressed the baby was. So babies that did not have any kind of disrupted attachment issues at four months of age, the infant and maternal cortisol levels were very, very close. Moderate disruption, you could see that the infant cortisol started going up even when the mother's cortisol went down. But with severely disrupted, interaction, the mother's cortisol was very low, which is consistent with the a flat face or the still face experiment with the mother not responding.
• 4:44
  So there's no demand placed on the mother because she's not responding. She's dissociated from that, so to speak. And so there's no neurological demand placed on her. So her cortisol is very low, but the baby is left in distress because of it and so the cortisol level is very high. There are also common behaviors noted with the infant And this just fascinated me that they had a coding system, the ambiance coding system, to be able to measure this because there were five different communication patterns that they were able to measure and look at.
• 5:25
  Number one was negative intrusive behavior. For example, if they were mocking or teasing the baby. Number two, role confusion, and they were drawing attention to themselves when the baby was in need. Number three, contradictory affective communication, which was like talking in an inviting voice but physically blocking the infant's access. Number four, disorientation, showing confused, frightened, or odd affect with the infant.
• 5:58
  And number five, withdraw, interacting from a distance, interacting silently, walking around the infant. This part was actually fairly triggering for us and, in a way of just having very quick flashes of things from very long ago and recognizing some things that that I feel like we experienced in a really very valid way that we have for years and years and years not had context to explain in words. It's almost like one of those pre verbal things that you can feel sometimes, but you don't have words because you didn't have words then, and so it's very hard to express. I feel like this is one of those rare moments where we got words to explain some of the things that we've experienced very early, and that was fascinating to me. It also made me very consciously aware of our own parenting and if we are engaged and doing as well as we can as well as what things we want to do better.
• 7:10
  Obviously there were multiple risks associated with early disorganised attachment including family disturbances like maltreatment psychiatric problems for the mother, cumulative psychosocial risk, prolonged cortisol that means the baby is staying in a stressful state or remains in a stressful environment. And again, one of the biggest things that came out of the virtual congress this year is that it is actually more damaging to an infant to have relational trauma even than physical or sexual trauma. And those things are bad enough and they are obvious when they are talked about or noticed or there's evidence of it, but relational trauma historically has been so difficult to identify and to explore because it's invisible, because it happens in the relationship between people. And so finding ways to measure these are really important both for detection and for intervention. They showed examples of different disorganized attachment strategies when the infant was in the presence of the parent.
• 8:27
  So one was a dysphoric affect, a depressed affect, fearful or apprehensive behaviours. Another one was conflict behaviours, either inhibition of action already started or freezing and stilling, almost like slow underwater movements. And number three was disoriented behaviours, like disoriented wandering or confused or dazed expressions. And then number four was unexpected combinations of distress, avoidance, and approach toward the caregiver. And this was fascinating to watch videos of because I feel like I see, again, I see us do these things now whether with our friend or with a therapist or I don't know it was a very uncomfortable looking in the mirror of how we as adults, those of us who are trauma survivors or have disorganized attachment, to see what that looks like in an infant in a neutral way to see what that's like and what's happening away from my own context but absolutely feeling it apply to my own context and watching that happen and understanding why it happens for the whole I'm trying, I'm trying, I'm trying.
• 9:55
  So there's approach, approach, approach. And then either I messed it up or I'm not getting it right or it's not meeting my needs and so I avoid it because it hurts. And then I'm distressed because my needs are not being met and the whole thing that we learned about how our increased need for attachment, when we do get it, when we do get a good positive connection, it brings dissociation down so then we get more distressed because we can feel things when we're aware of things. And so that brings a higher need of connection for even more connection. And is that need going to be met or not?
• 10:37
  Like to see it play out with infants and how difficult and distressing it is for them, it was fascinating and it made me understand differently how it really is about the brain and it really is about what is happening relationally and not just that I am failing this or that I'm not good enough or I can't do it right. Like, it's really about a dynamic that we have learned by experience as opposed to something I'm just not smart enough to figure out. So it was a simultaneous experience of sort of the insight and understanding cognitively of those pieces clicking into place and understanding why those patterns happen, but also the grace or compassion for myself and for other survivors to understand why this can be so difficult. Minshee spoke a lot about borderline personality disorder and attachment patterns and she talked about part of what's so hard to understand that diagnosis is that the developmental pathways are completely undocumented. When someone is physically or sexually abused and has interventions from DHS or from a doctor or from an ER or a hospital or a SANE exam or something.
• 12:06
  All of these at least document what's happening along the way. And so like, for example, our foster care history or our adoption history or therapy records or school records from growing up. Right? These things get documented in different ways so that there's at least this paper trail talking about ACES scores or talking about the ways that the child is struggling or how they know it's happening. But with attachment issues, the developmental pathways don't show up because it's relational trauma.
• 12:43
  And so she talked about how hard it has been to study effectively, which has caused the increased stigma with it because there's no way to document what's happening while it's happening. So Harvard did the Family Pathways Study, which studied 120 young adults from low income families and followed 56 of them from infancy all the way into adulthood. And of those fifty percent were referred to home visiting services because of concerns with quality of care. Eighteen percent of them had documented maltreatment before the age of seven and twenty nine percent were rated at age 19 as having sexual or physical abuse. So again, one of the biggest things that came out of this has been how they are able to identify the epigenetic modification of DNA.
• 13:47
  That how the relational trauma actually impacts DNA. And I am not enough of a scientist to be able to explain this to you, and I would love to have some of these people come and speak and share in a way that's understandable. But basically, literally the tactile stimulation and the eye contact and things very similar to polyvagal theory interact with what is called active DNA and what is called silenced DNA and actually changes what parts in your DNA are activated or not and how that is damaged or not and how it's healed or not. So those times when you literally feel helpless or overwhelmed because you can't get it right like normal people, like when we compare ourselves to other people who had good families and good parents and fairly safe upbringings, and it's like, why can't I just do that? Why can't I just do what they're saying?
• 14:53
  Or why can't I just act like they do and feel what they feel and be normal? It's because you can't. You literally cannot. DNA has actually been changed so that different parts of you have been expressed literally at a neurobiological level, so that who you are has been modified because of what you've been through. And that can heal and you can do the work to bring healing.
• 15:24
  So I don't mean that as in a you're messed up forever kind of way. I mean that as in opportunity to have compassion for yourself, then not only was this not your fault, but it really did impact you in such a way as to make you different so that you literally cannot just do those things. There's not something wrong with your will to be better. There's not something where you have failed miserably as a human. It's that your expression of being human has literally changed at a DNA level because of what you've been through.
• 16:04
  So, again, it's not that you're so bad and terrible because you can't just live like these other normal people. It's that you cannot experience those things and feel those things because at a DNA level, all the way into you, that damage has been caused and needs healing. So with a growth mindset for resiliency, we would change that into you can't feel it yet and you can bring healing to it and focus on those things. I don't mean we have to give up and I don't mean it's forever. But it really is that hard.
• 16:44
  Someone can't just tell you to snap out of it and you can snap out of it because it's not in you to do. You literally don't have the skills. And I'm not just talking about a coping skill, I mean your body physically is unable to do that. The way my sons with autism cannot process sensory information. The way my son with cerebral palsy cannot use his left side, the way my daughters and I can't use our ears because they don't work.
• 17:16
  But all of us, whether it's my sons with autism or my son with cerebral palsy or my daughters and I with our deafness and hearing loss, we all have tools to adapt and we can still bring healing even to our DNA which we'll talk about later. So because of these findings, they used rats to study behavior and stress responses and they divided rat mothers, little mice mothers, into low nurturing and high nurturing. And so regardless of genetic inheritance, when you had a low nurturing mother, a mother who was dismissive of you, a mother who did not engage with you, a mother who was flat like in the still face experiment, a mother who was down the ladder on the polyvagal stuff with less eye contact and less engagement, all of those kinds of things, here is what happened no matter what your genetics started out as when you had a low nurturing mother who was not engaging with you, who did not notice, reflect and meet your emotional needs, here is what they found consistently: increased stress response in infancy, earlier puberty, enhanced sexual activity, decreased investment in nurturing their own offspring, offspring with increased stress responses already built in, so born with higher cortisol levels to start with, and differences in the expression of over 300 genes that regulate early brain formation and the stress response system in the body.
• 19:01
  That's incredible, you guys. This is not about you being an adult who just can't function. This is about before you even were born, things had already changed for you, working against you, making life harder. Even before you had gotten to the physical and sexual abuse. Do you understand?
• 19:24
  Or even if you did not have the physical or sexual abuse but you had the emotional and relational traumas. This is huge. This is not your fault. Again, she talked a lot about borderline personality disorder and eating disorders and I'm going to skip some of that because it was so much information that would be a whole different podcast. And just for the sake of this I want to focus on the dissociative pieces of what she shared.
• 19:54
  So what she has done in recent years is take all of those studies and use that to connect disorganized attachment to the rates of suicidality and the mothering behaviors that indicated a high risk for suicide even when it was just an infant that they were working with. The withdrawing profile included lack of parental initiative around attachment, so the parent did not initiate a greeting, did not offer comfort. Delayed responding to them. Did cursory responding like a pick up and a put down like a hot potato moved away from the child quickly, directs infant away from themselves to toys, distance interaction interacting from across the room, and little or no intrusion into the infant's world or would not let the infant intrude into their world. And again, this is something that both brought a flood of memories to me, as well as a lot of insight into my own children.
• 21:09
  And my children have not had any kind of suicidality at this time, but they're very young and I want them to be well and safe and I want to be a good mother. And so this was one of those times where I could stop and process the information I was given and even though I did not experience healthy parenting myself, I can look at these indicators and warning signs and say these are the things I do not want to do with my own children and these are the mistakes I need to correct immediately. So it's very simple because it's a moment of we see this damaging children and so cognitively I can take that and apply that to my own parenting as well besides processing whatever is my own internal stuff which needs to happen. But also I can look at my own children and say, okay, I need to make sure I'm greeting them. I need to make sure I'm comforting them.
• 22:08
  I need to respond to them right away, I need to spend time with them instead of avoiding them, I need to interact with them myself instead of only distracting them or assigning them to different stations or things to do away from me. I need to interact with them directly and where I can physically touch them and not just from across the room. I need to be warm and engaging and have eye contact. I can literally improve my parenting by learning what went wrong as well as bringing my own healing to myself. But it was a very painful and triggering thing to watch the videos and to see that parents doing that actually damages the child and that that counts as abuse.
• 22:59
  Because I get that a lot on the emails that people send in from the podcast. I get it a lot in therapy sessions with other people where they say, Oh, it doesn't count as trauma because it's not as bad as what you went through or it's not as bad as what you see on a Lifetime movie or it's not as bad as what you see on the news. So it doesn't count because it wasn't physical abuse or sexual abuse or this or that. But relational trauma is a serious, serious thing and it absolutely counts. And in fact, in this study and in another session of the Virtual Congress, again, both of them said that relational trauma is actually more damaging to the child even than physical or sexual abuse, which is also damaging.
• 23:48
  I'm not saying those are not bad, I'm saying this causes even more problems at a cellular level, at a DNA level. So then taking these studies to older children at the preschool level and school age level like preschool elementary school, those infants, the same infants, when caregivers were responsive, they saw the same positive parenting traits at the preschool and school age level where they were helping the child organize themselves, guiding the child, praising the child, entertaining the child, being present with the child. But there were other parents who were controlling punitive, who were commanding, punishing, and humiliating the child. And then the disorganized attachment infants became behaviorally disorganized so they did odd out of context behaviors and odd out of context things that didn't quite make sense why they were doing what they were doing, which increased the dissonance and incongruence between the parent and the child. I'm not saying the child caused more attachment problems, but because the parent was already struggling and already not attached well in healthy ways, it made it even more difficult for them to attach to their child as the child grew older and so that increased the distance between them.
• 25:21
  And as these children continued to get older, as they became school age children, those disorganized behaviours became more solid in a role confused behaviour kind of way. So the child was carrying the burden of creating the interaction with the parent because the parent was not interacting with them or initiating interaction with them. The child had to structure the interaction because the parent was not interacting or structuring it. The child had to diffuse the parent's hostility because the parent was not regulating themselves. The child had to follow the parent's focused attention because the parent was not paying attention to them.
• 26:05
  And this goes with the other study that showed attachment issues with children growing up parents on their phones who don't have eye contact with them. And then children may entertain the parent with an over bright or too big set of behaviours because the parent is not doing that for the child. And then the child may encourage and praise the parent because the parent's not doing it for the child. And so basically by this point the parent has already abdicated the parental role and the child has already been parentified not just in caring for other siblings or not just by being exposed to abuse or age inappropriate activities but by even the interaction styles themselves. As these children became adolescents, this looked like more self damaging behaviours, whether that was sexual risk taking or disordered eating or substance abuse.
• 27:06
  There was impulsivity, recurrent suicidality, victimisation, peer conflicts, lack of control of anger or inappropriate intense anger often because they had lots of legitimate issues to be angry about. But it's almost as if by this age they can no longer even parent their parent because even that had been rejected and so they had never been cared for themselves internally and now their efforts at caring for someone else had also been rejected. So this is what makes disorganized attachment difficult is because you have not been cared for yourself and your efforts at caring for your parent also failed and so caring either receiving it or giving it now feels dangerous and now feels frightening and now feels impossible because it was not successfully done either way even though none of that was your fault. And all of this is stored all the way into your DNA and changes how these genes are expressed so that this study in Harvard could tell who was going to struggle with suicidality and dissociation by grade three. So by third grade they could see these things.
• 28:34
  And from third grade to adolescence, the child's burden in the role confused interactional relational pattern with the parent. The child was prematurely drawn into attempts to regulate the parent's emotions and behaviour and suppress his or her own experiences. There was suppression of self expression, the child was less able to develop initiative, autonomy, mastery behaviour or peer relations. There was already unintegrated experience. The child's own experience remained unintegrated with resulting propensity to conflict and disorganization at times of stress.
• 29:19
  So already some dissociation showing meaning not necessarily development of parts, although for some of us that has been an issue shall we say but dissociated from not being able to associate memories together meaning sensory input and memories and emotions and feelings and to have all of that into one memory or one experience it's already being separated out into different things. So they may feel angry but not know why they are angry because the memory of it is separate, or have a strong memory but not know how they feel about it, or be overwhelmed by sensory input almost in a way that autism could be given as a wrong diagnosis because the sensory input is so overwhelming but really just the experience of it is not being able to neurologically be integrated into one thing. They also had guilt, helplessness, and rage. The premature burden of responsibility for monitoring and engaging the parent is often associated with guilt, helplessness, anger. And then finally, no effective parental regulation.
• 30:29
  The parent has abdicated a regulatory role and failing to provide the comfort, responsiveness, and scaffolding that help the child to develop more mature forms of emotional regulation. So all the way back in 02/2004 researchers were able to connect the patterns that seemed so similar between infant disorganization and adult dissociation. Saying that trauma dissociation and disorganized attachment are three strands of the same braid. So the Minnesota longitudinal study took 126 young people and studied them from birth to age 19 and then even after that. And they found through this study significant predictors of dissociative symptoms from birth to age 18.
• 31:24
  There was a prediction for overall chronicity, severity and age of onset from abuse to clinical levels of dissociation. And they were able to do this from psychological unavailability and disorganized attachment by 24 of age. So that's part of why like Fran Waters' work is so important in working with children with dissociation. Because we can help people earlier and earlier. And again, we want to be careful not blaming the baby.
• 31:56
  It's not the baby's fault that this is happening. It's not the baby's fault that they are disorganized. The issue is the quality of the parent infant affective dialogue. Abuse and ongoing affective dialogue of care make separate and distinct contributions to dissociation. And so, they were able to measure and conclude that the effects of maltreatment on dissociation are partially due to the continued deviations in the dialogue between the parent and the child from young infancy to young adult as indicated by disorientation on the parts of both the parent and young adult in the conflict discussion.
• 32:38
  So yes, the severity childhood abuse has an impact on the level of dissociative symptoms, as does things like unresolved loss or unresolved trauma, but the hostile or helpless representation of a parent or the disengaged caregiving or the relational trauma of neglect and disengagement has more of an impact on dissociation than anything else. And again, this conference they set that in three, two different sessions for sure. Someone else, a friend who attended another session said they found it in that session as well. So as far as we know so far, I'm still watching the recordings of the other sessions, but as far as we know so far, three different times in this virtual congress, they said that relational trauma, there's evidence that it is worse than physical or sexual abuse as far as the impact on the body and the level of dissociation. Which is huge because we already know that physical and sexual abuse is bad.
• 33:54
  But this goes all the way back to Ainsworth and Balby and Peter Barrish connecting attachment issues to the trauma response and to DID itself. And now we can see it at a DNA level that he was right. So my friend Peter gets a thousand therapy points. This presenter also talked about the cascade of response. This is brand new to me.
• 34:20
  I don't know if it's been around forever and I've just read the wrong books, but I've never heard about this cascade of response. And so I'm going to skip this section and not talk about it now because Christine Forner is gonna talk about it for us. But talking about the brain and how the brain works and how one thing leads to another so it causes this cascade of trauma response. And again, this is not about you not being good enough or not about being able to do it well enough. It's about how you respond neurobiologically because you are human, because of how your brain works, because of how the body works.
• 34:56
  This isn't that you weren't tough enough to deal with what happened to you. This isn't about you failing your own childhood. This is about what they did and what they didn't do. And so almost like, do you remember how the therapist said it's not your secret in talking about the physical and sexual abuse? Well, this is not your damage.
• 35:19
  They damaged this. They The impact of what they did and didn't do damaged at a cellular and DNA level, and that has impacted you. So yes, there are secrets and are damaged because we walk around with them every day, but there is healing for these things and we don't have to keep carrying them because they are not our fault and they are not our things. They talked about the rapid volume increase in the human amygdala during the first two years after birth and how it is particularly vulnerable to stress because it has such a high density of stress hormone receptors, but also that the enlarged volume of the amygdala is resistant to change in adulthood even after the removal of the stressors. So again, this is not your fault.
• 36:14
  Your body literally was changed. So when you see your normal friends out there doing normal things and you're like, why can't I feel like that? Why can't I do that? What's wrong with me that I can't get myself together? This is what's wrong.
• 36:32
  This isn't about you not trying hard enough. This is not about you not being able to do it right. This is about a changed capacity and a changed physiological response in your brain and in your DNA that has made your life difficult not because you're a terrible person but because terrible things happen to you, even if those things came relationally. They talked about MRI studies, they talked about the chronology of exposure scale, they talked about the maltreatment and abuse chronology of exposure scale, which assesses 10 types of maltreatment from childhood to age 18. And they found that the effect of maltreatment on regional brain volumes depends to a substantial degree on the type and timing of maltreatment during developmentally sensitive periods.
• 37:27
  So, who were exposed to more maltreatment and more relational trauma had enlarged amygdalas, which were also more resistant to change because it had happened for so long. So no wonder it's so difficult, you guys. This isn't just about trying hard enough. And in fact, that's part of what happens with healing and we'll get to that. But part of what is needed with healing is a very long time of consistency and availability and constancy and steady presence almost to make up for the time that was lost without it.
• 38:10
  And so it's not just that we need safety and we can do some quick therapy and feel better, it's that we need safety for a long time. So the clinical implications on different threats to development were that there are distinct and separable contributions of both abuse experiences and attachment relational processes to dissociation, to suicidality, and to amygdala, as well as hippocampal volumes. So there is hope in understanding cognitively what is going on because it gives room to understand what has happened in a framework that's not just about you failing childhood because this is what was done to you. And it really gives evidence of how hard you did try both to survive and to get care that your body knew it needed to develop properly. It also gives you understanding and ideas for how parent differently than what parenting you yourself received.
• 39:27
  And it teaches us that the relational trauma we have endured is significant more so than the physical and sexual abuse that many of us have endured. And it goes to show that we need to broaden our understanding of trauma and trauma survivors because people with relational trauma who did not have physical and sexual abuse are still trauma survivors. And they still need healing. And it gives hope that even though we see how deeply we have been affected by this in our physical bodies, that with time and with connection and with consistency, we can get better. But it takes work, and it takes practice, and it takes others.
• 40:20
  We can't do it by ourself, and that's maybe the most frightening and most terrifying piece of this is that it's going to take a connection with someone else. It's going to take an other in some way to bring healing to all of us. And so we've got to stay present, especially in the context of this pandemic, right? And in the context of disorganized attachment and in the context of how hard it is to connect when you need it most. That's absolutely when it's most important to reach out, to speak up, to ask for help, to listen to others, to check on your friends and your family, even when they're chosen family.
• 41:12
  So scientifically, now we know we really are better together. Thank you for listening. Your support of the podcast, the workbooks, and the community means so much to us as we try to create something together that's never been done before, not like this. Connection brings healing, and you can join us on the community at www.systemsspeak.com. We'll see you there.