Trauma

Trauma can come in many forms.  It can be small, insidious and repeats over and over again for years (the little "t" traumas), or it can be large and can take over you and your life (the Big "T" truamas).  Small traumas are ones that we no longer count as trauma, such as small but repetitive comments from a parent regarding their looks while growing up, or having to deal with silent violence of neglect.  The big traumas are the ones that are easily identified and often treated appropriately, such as sexual assault, natural disaster, witnessing or being a victim of violence, and war.  Most poignant example of the big "T" trauma is like 9/11/01 attack.  Whatever the trauma is if left unprocessed and undigested, it can rear it's ugly head when least expected, leaving the individual feeling off balance, out of control and isolated. 

I find that there are many folks walking around day to day with so many traumas that they are not themselves.  The worse part is that they don't even know those experiences have changed them to the core.  These folks lose connections with loved ones and cannot seem to make new ones to replace them, they also find themselves reacting to small, sometimes benigh situations with such anger and frustrations that the response does not seem to fit the stimulus; for example, an adult blowing up screaming at a 3 year old for simplying spilling milk on the kitchen floor. 

 Now, most people say to me, "it happened XYZ years ago!  It doesn't bother me anymore."   Yet, they are engaging in abusive behaviors, perhaps alcohol or drugs, saying to yourself, "Pot is not a drug, besides, its the only thing that helps me sleep."  Or may be it's shopping for some of you, maybe its sex, or may be it binging and purging what you've eaten, or even cutting or burning yourself.  Whateven it is, we can't seem to stop and we feel the need to keep all of it a secret from the ones we love and trust (which adds to the isolation).  Repressing and suppressing memories without dealing with them and processing them only makes things worse (almost like a pressure cooker), and these destructive behaviors are the little valve that lets off steam from time to time to keep the whole thing from blowing up. 

 If you are reading this and finding that it sounds familiar, you probably are dealing with some kind of history of trauma.  You would get significant relief from feeling like you are constantly under pressure and need to act, sometime destructively, and impulsively, with appropriate treatment.  If you would like to further discuss your history and treatment options, please call us at 609-429-0094 or 908-419-8931and make an appointment for initial consultation/evaluation.

Attention-Deficit/Hyperactivity Disorder (ADHD)

ADHD is one of the disorders under the Pervasive Developmental Disorders category. This is a disorder of childhood, which means that the development of symptoms is usually in one's childhood and not in adulthood. Symptoms of Bipolar Disorder or Personality disorders are often misdiagnosed as ADHD, which can have detrimental results for the misdiagnosed individual.


Symptoms of ADHD do not suddenly appear in adulthood. They are something that dates back to ones young years and these symptoms must have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level of the individual.

There are two categories of symptoms that one with ADHD can exhibit. They are categorized as either inattention symptoms or hyperactivity-impulsivity symptoms.

Individuals with inattention symptoms are:

1. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
2. often has difficulty sustaining attention in tasks or play activities
3. often does not seem to listen when spoken to directly
4. often does not follow through on instructions and fails to finish projects or assignments unintentionally
5. often has difficulty with organizing
6. often avoids, dislikes, or is reluctant to engage in activities that require sustained mental effort
7. often loses things (i.e., keys, tools, assignments)
8. is often easily distracted
9. is often forgetful.

Individuals with hyperactivity-impulsivity symptoms are:

1. often fidget or has difficult time sitting still
2. often has difficult time remaining seated
3. often runs or climbs excessively in situations in which such behavior is inappropriate
4. often talks excessively and interrupts others when they are talking
5. often blurts out answers even before the questions have been completed
6. often has difficult time awaiting ones turn
7. often intrudes on others’ conversations or activities without invitations to do so.

One can have ADHD that have combined symptoms of inattention and hyperactivity-impulsivity or just have one or the other.

Please note that an individual suffering from other psychiatric disorders can experience similar symptoms in absence of actual ADHD. If you feel that you have some of most of these symptoms and have had to deal with them for more than 6 months at a time, you should contact a mental health professional for more thorough evaluation.

Dissociation Disorders Series, Part V

Depersonalization Disorder

Depersonalization disorder is characterized by persistent or recurring experiences of feeling detached from and/or as if the individual is an outside observer of, his/her mental processes or body. It is often referred to as dissociative episode and individuals that do experience this describe it as leaving one's body and watching events happen from above or feeling like they are having "an outer body experience" and viewing the events that they themselves are in from "the back seat" or on "a movie screen."

Such experience can be quite frightening to most people, but during such experiences, that individual's ability to know the difference between reality and non-reality (e.g., hallucinations, dreaming state) remains intact. For many, dissociative episodes cause clinically significant distress, impairment, or dysfunction in important areas of their life, such as work, family, and/or school life. It is important to distinguish that dissociative episodes are different from hallucinations or delusions (be it they are from thought disorders like schizophrenia or substance induced). It is not uncommon that individuals that suffer from other dissociative disorders have dissociative episodes. But diagnostic difference is that people with depersonalization disorder does not have diagnostic criteria of other dissociative disorders.

Persons with depersonalization disorder can benefit from psychotherapy (e.g., EMDR or DBT) that works on dealing with and processing traumatic events that often lead to disorders like depersonalization disorder. It is of utmost importance that those who suspect that they may have dissociative disorders of any kind to connect with a mental health professional that specializes in treating such issues.

Dissociative Disorders Series, Part IV

Dissociative Identity Disorder

Formerly known as multiple personality disorder, this particular dissociative disorder became infamous through Hollywood. Movies such as 3 faces of Eve and Sybil put DID on the map of public consciousness. DID's primary characteristic is that the individual presents with two or more distinct identities or personality states, most often each with its own way of perceiving, thinking and relating to the enviroment and others.

The second characteristic is that there are at least two of these identities or personalities that repeatedly take control over the person's behavior. Also, the individual has problem recalling important personal information that is too extensive to be explained by everyday forgetfulness.

Treatment for DID primarily is long-term psychotherapy to deal with possible history of trauma as well as medication that targets psychiatric symptoms that are present. There are no known pharmacological treatment for DID at this time.

The next installment of this series is the last in the dissociative disorder series, so stay tuned.

Dissociative Disorders Series, Part III

Dissociative Fugue

Formerly known as psychogenic fugue, individuals with this disorder primarily present with sudden and unexpected travel away from their home or work, with inability to recall his/her past. They show significant confusion about their personal identity (can't remember name, age, or what they did before the fugue episode), or assume a totally or partially new identity.

This condition usually occurs subsequent to a major stressor or trauma. Apart from inability to recall their past or personal information, patients with dissociative fugue do not behave strangely or appear disturbed to others. Cases of dissociative fugue are more common in wartime or in communities disrupted by a natural disaster.

Next installment of this series will deal with the most famous of dissociative disorders, dissociative identity disorder. So stay tuned.

Dissociative Disorders Series, Part II

Dissociative Amnesia

Formerly known as psychogenic amnesia, it is predominantly characterized by episodes of inability to recall personal information, most often related to events that are traumatic or stressful in nature. But such inability to recall is too significant to attribute to ordinary forgetfulness. Such amnesic episodes cause clinical significant distress or impairment in the affected individual's social, occupational and other parts of his/her life. Dissociative Amnesia is amnesia that cannot be accounted for by possible head injuries or other physical trauma (e.g., concussion), or other cerebral events (e.g., stroke).

On next blog, I'll discuss the dissociative fugue. So stay tuned.

Dissociative Disorders Series, Part I

Overview of Dissociative Disorders

Three faces of Eve, Sybil, and Raising Cain are movies that made dissociative disorders, specifically dissociative identity disorder, on the map of public mental illness consciousness.
Dissociative disorders are named as such because they are marked by a dissociation from or interruption of a person's rudimentary aspects of waking consciousness (i.e., one's personal identity, one's personal history, etc.). Dissociative disorders come in various forms and level of severity. The most famous of which is dissociative identity disorder (formerly known as multiple personality disorder).

All of the dissociative disorders are believe to share a root cause of past trauma experienced by the individual with this disorder. The dissociative aspect is thought to be a coping mechanism -- the person literally dissociates oneself from a situation or experience too traumatic to integrate with his conscious self. In other words, the horror of the trauma is too much for one's mind to process appropriately and the conscious mind turns itself off to avoid having to be aware of traumatic events.

Symptoms of these disorders, or even one or more of the disorders themselves, are also seen in a number of other mental illnesses, including post-traumatic stress disorder, panic disorder, and obsessive compulsive disorder. Treatment for dissociative disorders may include psychotherapy, hypnosis (although quite controversial regarding the efficacy of it), EMDR (to process the traumatic event), and medication. Although treating dissociative disorders can be difficult, many people with dissociative disorders are able to learn new ways of coping and lead healthy, productive lives.

There are four specific types of dissociative disorders:

1. Dissociative Amnesia (aka psychogenic amnesia)


2. Dissociative Fugue (aka psychogenic fugue)


3. Dissociative Identity Disorder (aka multiple personality disorder)


4. Depersonalization Disorder

For the next several posts, we will describe, explain and discuss each type of dissociative disorders. So, stay tuned.