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| Postpartum Mood Concerns
Listen online Dr. Pauline Discusses Caring for the Postpartum Family on the Whole Mother show on kpft.org out of Houston.
Listen online as Dr. Pauline Dillard discusses PTSD after cesareans on the Whole Mother show on kpft.org out of Houston.
Listen online as Dr. Pauline Dillard discusses "Postpartum Depression Part I" on the Whole Mother show on kpft.org out of Houston.
Postpartum mood disorders, and post birth trauma are on the increase. An awareness of these disorders is being brought to the attention of moms and even the public. In order to better understand the impact of trauma on new moms, babies, and families I have posted the signs of trauma here. If you recognize yourself, or someone you know please contact a counselor who is familiar with not only post traumatic stress disorder (PTSD), but one who is also familiar with a women’s experience of giving birth as a traumatizing point.
If you would like to talk with Dr. Dillard about your symptoms please call our center at 719-231-7183 and Sharon will make a phone appointment for you to talk to her.
Symptom Categories for PTSD Compiled and written by Pauline Dillard, Ph.D. ©2009
The DSM IV-TR Definition of Posttraumatic Stress disorder. Within this definition PTSD is formed not only in the person the even happens to directly, but secondary trauma can occur in others as well.
The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. The person’s response to the event must involve intense fear, helplessness, or horror. (American Psychiatric Association, 2000, p. 463) Avoidance Symptoms Avoiding anything that may remind a person of a previous trauma is another symptom of PTSD. Also called constriction because it causes the person to draw into him- or herself .
A. Psychogenic or stress-induced amnesia: failure to remember important aspects of a trauma, or the entire trauma. This is an attempt by a PTSD survivor to avoid all reminders of the traumatic event. Amnesia is usually the result of dissociating during a traumatic event (see below). B. Avoiding emotional arousal, experiencing a progressive decline and withdrawal. C. Further stimulation actually provokes increased detachment. That’s because feeling nothing seems like a better alternative than feeling irritable and upset. D. Many survivors will create emotional distancing and withdrawal from all that was personal and had past meaning in a misguided attempt to appear normal. E. There is a sense in the survivor of constant pain and a knowing that this constant pain is foreign to those around them. Therefore sufferers learn to manage their lives so that they can bypass any activity or situation that may cause the old feelings of the trauma . If a person is consciously or subconsciously deciding every event or activity in light of what trauma reaction it may invoke avoidance then becomes the heart of many problematic behaviors as they may also stop participating in activities they had once found pleasurable.
Increased Arousal Symptoms “Hyperarousal is the nervous system’s response to threat, whether that threat is internal, external, real, or imagined.” (Levine, 1997, p. 134). These increased arousal symptoms are also referred to as hypervigilance. This hypervigilance is a state of constant awareness and continual anticipation of overwhelming threat. It causes difficulty with attention and concentration. It also contributes to a deep distrust, usually for good reason. A. Hypervigilance is a way of managing the excess energy resulting from an unsuccessful defense against an original threat. B. Even normal physical sensations can take on a new and threatening significance. C. Hypervigilance can interfere with normal activity because the person is constantly looking over their shoulder, or afraid to do enjoyable activities for fear of something catastrophic happening. D. They are easily startled and there is a growing tendency to see danger where there is none. E. A decreased capacity to experience curiosity, pleasure and the joy of life. F. At the core of our being we do not feel safe.
Other Symptoms In addition to the previous three main categories some sufferers of PTSD may display other symptoms as well.
Dissociation. A. Can be as mild as “zoning out” for a moment, or as severe as believing you are in a different place and time. B. Involves a sense of unreality, a feeling of distance from what is happening, a numbing of physical pain and other somatic sensations, emotional detachment, and distortion of time and place, including post-traumatic amnesia. C. Dissociation during a traumatic event can occur when the life-threatening event continues beyond the ability of the person to tolerate it. D. It is an automatic survival technique that seems to be a favored way of enabling a person to endure experiences that are at the moment beyond endurance E. Also referred to as emotional numbing. F. The way dissociation occurs at the time of the trauma will have an influence on how the more complex symptoms of PTSD develop. “…people who dissociate at the time of a trauma are at greatest risk for developing PTSD, and if they develop it, they continue to dissociate more and more as their condition evolves.” (Naparstek, 2004, p. 89). G. When they do dissociate these trancelike states do not allow them to remember details. However, the memories are still there even if they are hazy. Often we commend those who remained unusually calm during a crisis, however, even though they may seem to not be affected at all, it is usually because they have dissociated. H. Dissociation can also occur during flashbacks. I. Flashbacks themselves are dissociated events that are recreations of the original dissociated event. This can occur even if the person did not disassociate during the actual event as they are aroused, or when they begin to access uncomfortable traumatic memories, both images and sensations. J. Dissociation becomes a problem when it is chronic and evolves into more complex symptoms, as well as when it is neither conscious nor part of a deliberately chosen activity, but is rather a habituated response that occurs without awareness. K. Dissociation occurs more often in those who froze during the trauma. (see below)
Freezing. We often hear about the two main reactions of human beings being fight or flight, however there is a third that is just as common and just as normal—freezing. Whether a person responds with fight, flight, or freezing is not under their control. It is how they are wired. Or perhaps the person is so overwhelmed by the situation the fight or flight responses are not available to them. A. It is an automatic way of coping with traumatic stress, one that may keep us alive or relatively safe during the trauma. B. This response is least acceptable by our culture and is most closely related to the sense of helplessness that often accompanies trauma. C. If the victim freezes and is unable to do anything they are often blamed for the trauma The reality is that the victim may have had no choice, their biological system literally went into shut-down. D. We don’t know why some people freeze under trauma conditions and some don’t, what we do know is those who freeze are more prone to dissociation and dissociation is more highly associated with having PTSD.
Flashbacks A. Flashbacks may cause the person to experience the events over and over again in their minds, as they obsess over what might have happened if they had done something different. B. The awful experience of being frozen within the horrific trauma exists outside that which we intellectually call the ego. The experience is quite simply, too awful to invite in and make it a part of who we are. Our best judgment continually pushes us to reject it…Those thoughts conflict with our self-perception…This is the status of the embattled ego, the besieged self.
Associated Features These are difficulties that aren’t necessarily a part of the trauma itself, but can occur after an emotional shock. In addition they may cause victims to suffer to an even greater degree than they would from PTSD alone. Along with these associated features people will suffer from a variety of specific feelings such as shame, guilt and anger.
Reenactment. A. A puzzling tendency in a number of trauma survivors. B. In essence they replay the trauma in subsequent life scenarios. C. It appears that these people have a compulsive need to repeat trauma patterns. D. Not a deliberate act in the usual sense of the word. “…lack of conscious awareness plays a key role in perpetuating these often-bizarre reruns.” (Levine, 1997, p. 186). E. One of the main reasons why people find themselves in a similar situation over and over is an attempt to alter the outcome. Reenactment rarely accomplishes this end. F. Biophysical evidence suggests that this self-destructive, danger courting reenactment behavior is an unconscious neurophysiological condition. People are somehow unknowingly addicted to there own biochemicals and are thus provoking doses of their own stress neurohormone, which actually lead to the person developing a biased perception toward trauma-related triggers. G. This means that a traumatized person easily associates the traumatic even with another situation and repeats that situation instead of the original one. H. Often any seemingly coincidental reminder of the incident frequently occurs prior to a reenactment. I. This tendency toward reenactment usually has negative outcomes for the person trapped in this cycle such as: harm to others, self-destructiveness, and revictimization.
(See Handout on PTSD and Opioid Effect)
Emotional detachment. A. During dissociation the person will most likely have gone to a numb emotional place, blocking out all feeling. B. For some victims they remain emotionally numb long after the danger has passed. C. Feelings about what happened may be deeply suppressed. This suppression is the conscious act of not thinking about something and allows them to continue to not have to feel anything about their experience. D. This tendency to shut down emotionally is also called psychic numbing. E. Although the person may not be consciously aware of it, the suppressed and repressed memories and emotions are still there, and when tapped into can be recovered fully. F. If a traumatized person actually talks about their experience they will often convey it in a detached monotone without much emotional expression. G. Many people with PTSD seem emotionally flat. They don’t show excitement, happiness, or joy because they have numbed themselves to sadness, horror, and fear. H. The bad news about this is that underresponsiveness may also lead to a series of changes in the central nervous system that are similar to the effects of prolonged sensory deprivation. I. Can lead to not feeling connected to spouse or children—difficulty attaching to baby.
Social detachment. A. Many victims feel they no longer fit in—anywhere. B. There is a sense of estrangement and fear, especially at thoughts of talking to anyone about the symptoms he or she is experience. C. Certain that no one else has possibly experienced the same thing. Therefore they are suspect that anyone will believe them and that others will perceive them as going crazy. D. Because of this sense of “differentness” they often live lives of quiet desperation in significant distance from others. E. They seem to drive others away in an attempt to protect themselves from seeming destruction and harm later. F. They hide, from themselves, others and God.
Physical Ailments. Due to the low levels of emotional expression discussed in the previous section PTSD sufferers also have an increase in physical illnesses. They experience any and all types of stress related illnesses, at levels beyond the average population. “…horrific traumatization in the lives of persons will compromise them at many and varied physical levels for greatly extended periods of time.” (Sinclair, 1993, p. 47). A. There appears to be an increase in issues such as migraine headaches, Epstein-barre, fibromyalgia, back pains, and other baffling chronic conditions and “functional” diseases that have no other obvious cause. B. Many of these sufferers are found to have previous histories of severe trauma, and because their alarm symptoms are constantly activated there is an accumulation of metabolic waste products in the muscle fibers. C. There is the release of kinins and other chemical pain-generators into the tissues leading to many of these chronic pain/fatigue symptoms. (See handout, PTSD and Opioid Effect).
Anxiety and Paranoia Paranoia is the state of being unjustly suspicious. A. The person is unable to overcome anxiety and remains overwhelmed, defeated and terrified. B. Anxiety crops up for a variety of reasons, and all of these factors combine to produce a phenomenon known as a traumatic anxiety
Helplessness All trauma sufferers experience helplessness to some degree or else they would not perceive themselves as being victims. This sense of powerlessness is the central insult of trauma. A. Leads to an inability to fully participate in new situations. B. Often they make the “decision” that they are helpless and this continues into other areas of their lives as they continue to prove their victimization to themselves and others. C. Can be seen even in situations where the person clearly has the resources to master a situation. D. Feel as if this is just the way their life is and they have no sense of working their way back to normal. E. Many aren’t even aware that this state of helplessness was created by trauma due to denial and amnesia. F. This sense of helplessness during a trauma can also be carried over so that some adult trauma survivors act and feel like a child. When this happens it is called regression. G. Guilt also accompanies helplessness and is almost universal among people with PTSD. H. Helplessness to its extreme can lead to despair. a. Despair is often the taproot of depression. b. When it reaches this level it can even lead to the lack of a will to live due to hopelessness about the future. c. This hopelessness is the bottom level of helplessness.
Other symptoms that may occur for PTSD sufferers A. Eating disorders B. Sleep disorders. C. May want to always control their environment. D. May be involved in some sort of self-destructive acting out. E. May have free-floating anger, but usually underneath all this rage is a deep, quiet sadness. F. Shame G. Denial of this shame can lead to further abuses. H. Poor impulse control. I. Unable to overcome anxiety about their experience. J. Remain overwhelmed by the event, defeated, and terrified. K. Many are so busy surviving the present that they don’t plan for the future and school, work, and home lives suffer. L. May feel as if some long held, feared, belief about themselves has been confirmed. M. Many show a decline in their normal ability to sort out relevant matters. This leads to a perceptual dissonance, which leads to many of the symptoms discussed in this chapter.
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