Do you have a history of trauma (i.e., abuse, neglect, psychological or emotional chaos growing up, etc)? Trauma can include a host of experiences, too many to name here. But trauma is a powerful consequence of emotional and psychological chaos. What I mean by this is that despite whatever the traumatic situation entailed, the result is often chaos in the mind and emotions of the person who experienced the traumatic event. In fact, our perceptions of the event itself could lead to symptoms of trauma, which I have discussed in previous articles.
This article will highlight some of the ways trauma can complicate treatment and the importance of being open to the ways it can affect diagnosis and treatment recommendations.
Allow me to explain what I mean by trauma complicating treatment. About 7 years ago I was assigned an older aged client (about 66yrs old) while an intern in a community mental health center. This older male had a long history of chronic abuse and domestic violence from the age of 10yrs old to the age of 50yrs old. That chronic abuse included rape and molestation by men and females he knew and did not know. By the time he got to me, his trauma symptoms worsened and evolved into delusions. The delusions included delusions of grandeur (belief that he could defeat his enemies by just looking at them), delusions of persecution (belief he was being persecuted for being “so talented”), and somatic delusions (belief that he smelled like flowers and fear of what others would think).
What I failed to understand at the time was that his delusions were not so much of a psychotic nature as they were of a trauma-based nature. In other words, his delusions were developed, without his awareness, as a defense against years of trauma he had experienced. His trauma developed into strong beliefs held to be true despite strong evidence to the contrary. Nothing anyone else would tell him made a difference in how he viewed himself. In fact, when he would ask me if I noticed a feminine fragrance on him and I would say “no, not at all,” he would indicate I was lying, telling him what he wanted to hear, or “couldn’t detect it.” He would say “I’m so spiritual and ‘set apart’ that you can’t meet me where I’m at.” He was tormented by these delusions triggered by years of trauma.
Following this experience, I sadly encountered similar situations within the teen and adult population. I then pursued training in trauma-informed care (i.e., knowledge of trauma and how it affects the psyche).
Below you will find a few ways a history of trauma can not only destroy a therapeutic relationship, but halt it completely:
- Post Traumatic Stress Disorder (PTSD) can exaggerate symptoms of other mental health challenges: PTSD can trigger symptoms of a psychotic disorder (delusions or hallucinations), mood disorder (depression or bipolar disorder), or even a medical condition such as migraine headaches or somatic disorders like Fibromyalgia or Arthritis due to stress. Because PTSD often includes symptoms of hyper-vigilance and some degree of paranoia for some people, delusions and hallucinations can be triggered. An individual who is struggling with the feeling of needing to be hyper-vigilant and watchful of other’s may begin to believe that their spouse is cheating (delusions of jealousy), that they are holy and able to be omnipotent in some form (delusions of grandeur), and/or that they have a deep and loving relationship with a TV personality (delusions of erotomania). If delusions and PTSD symptoms remain untreated, the individual could begin to experience hallucinations (i.e., seeing, hearing, tasting, or feeling something that is not really there).
- Anxiety can trigger symptoms of trauma: According to Anxiety and Depression Association of America, about 40 million adults (18+) in the U.S. struggle with some form of anxiety. Generalized Anxiety Disorder affects about 6.8 million adults. Social anxiety is also challenging for adults in the U.S. as about 15 million suffer from it. It is not unlikely that an adult with a traumatic past becomes extremely anxious when memories of a traumatic event are triggered. For example, an individual who observed domestic violence for years as a child may become triggered by a crying child or yelling and screaming. This triggering event may stir up symptoms of anxiety such as: shaking or nervousness, increased heart-rate or palpitations, sweating, nausea, dizziness, or fear. In turn, when anxiety symptoms are triggered, the individual may begin to re-experience their own trauma and become helpless to fear.
- A patient can be vulnerable to misdiagnoses: Symptoms of trauma (i..e, fear, hyper-vigilance, nervousness, mistrust, inattention, lack of organization, confusion, etc) can look very similar to a severe form of anxiety or even ADHD, primarily for youngsters. For example, someone who should be diagnosed with PTSD may receive a diagnosis of Generalized Anxiety Disorder, Social Anxiety Disorder, or Attention-Deficit Hyperactivity Disorder. This is not to say that the mental health professional diagnosing the individual is incompetent or unprofessional. But what I am saying is that trauma symptoms often complicate the clinical picture and can result in misdiagnosis of the real problem. Children and teens who go see severe domestic violence every single week will struggle with attention and organization or intense fears. ADHD may not be the correct diagnosis for this case. A more fitting diagnosis may be PTSD.
- Some symptoms have nothing to do at all with a traumatic past: Some kids who come to see me for individual therapy for symptoms of inattention, poor organization, limited social skills, or oppositional and rebellious behaviors, qualify for a diagnosis of oppositional defiant disorder, ADHD, or some other diagnosis. I have had some families ask me why PTSD was not a diagnosis and I have had to explain that symptoms were not severe enough to qualify for this diagnosis. After the intake session (gathering information on the client), assessment scales (surveys or tests to help me understand symptoms), and my clinical observations, it became clear that PTSD was not to blame for symptoms.