Trauma, sexual abuse and emotions

Note: As this text references mostly English language sources and quotes extensively from English language sources, it has been first written in English and then translated into other languages, such as Spanish and – maybe – German.

During this last month I have been reading FORGE’s Self Help Guide for Trans Survivors of Sexual Violence, which has not been easy reading, believe me. I don’t know how often I had to put it down because I just had to cry. I have been reading quite a bit about trauma in the last two years especially, but not with a focus on sexual violence, and that makes quite a difference.

The guide has a theoretical part which explains how the brain works under condition of trauma, and talks about PTSD, as defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-V). However, many survivors of childhood sexual abuse (and other abuse, such as emotional abandonment), suffer from complex PTSD, which did not make it into the DSM-V, but is included in the WHO’s International Statistical Classification of Diseases and Related Health Problems (ICD), release 11 from 2018 and in effect since this January as code 6B41 “Complex post traumatic stress disorder”.

Even before getting back to the theme of sexual abuse, the definition of complex PTSD or complex trauma, which I first discovered on the blog of Meg-John Barker, does resonate with my own experience. The most important symptoms, as summarised by Meg-John Barker, are:

• Emotional flashbacks
• Being highly critical of ourselves and/or others
• Toxic shame
• Abandoning ourselves
• Anxiety and/or struggles around social situations or relationships
• Loneliness and/or feeling abandoned
• Dissociation (feeling checked out and/or distracting yourself/numbing with food, drink, worrying, working, social media, TV, etc.)
• Feeling bad about ourselves from low self-esteem to self-loathing
• Big mood changes and struggles with feelings
• Difficulties with relationships 
• Being easily triggered into the 4Fs

Back in May 2020 I wrote:

"I also feel I need to learn more about complex trauma and complex PTSD to understand better what’s happening to me. I have been working on my trauma on and off for almost four years now, been in therapy, and certainly made huge progress, but at the same time I now feel I have only been scratching at the surface so far. Just writing this one sentence brings a lot of pain in my chest again…"

I am still on that long journey, and since November the issue of childhood sexual abuse has been added (again) strongly to these different causes of my complex PTSD.

Emotions

“One possible aspect of emotional regulation problems may be an inability to even identify what emotions one is having. The person who has this problem, also called alexithymia, usually answers “I don’t know” or has only a very limited number of answers (“upset,” “ok”) when asked how they are feeling. Not only may they not know the words to put to what they are feeling, but they may even be unable to distinguish one type of feeling from another. Obviously, if you cannot even identify what you are feeling, it becomes much harder to learn strategies for constructively dealing with that feeling.” - page 19/20

I remember discovering alexithymia about 3½ years ago. What struck me back then was, for example (from Wikipedia): “Typical deficiencies may include problems identifying, processing, describing, and working with one's own feelings, often marked by a lack of understanding of the feelings of others; difficulty distinguishing between feelings and the bodily sensations of emotional arousal; confusion of physical sensations often associated with emotions; few dreams or fantasies due to restricted imagination; and concrete, realistic, logical thinking, often to the exclusion of emotional responses to problems.” I could (and can) connect to that, and beyond the emotional the constricted imaginal processes – a difficulty of thinking in symbols or images, for example – rings a bell with me. I always struggled with expressing myself via symbols – a colour, an image, an object. It just doesn’t work for me. And yes, my dreams are very realistic when I remember then. Maybe not always in the storyline – which can be strange – but the images are always very realistic, and not at all strange or abstract.

Back then I did one of the online tests available (English: https://www.alexithymia.us/alexithymia-questionnaire-online-test, Spanish: http://espectroautista.info/OAQ-es.html, German: https://www.alexithymie.com/alexithymie-fragebogen-test), and I scored always just above the threshold for alexithyima. Redoing the test now, I still score within "high alexithyima traits", even though since then I have connected much more with my feelings and have learned much more to express them. I especially show "high alexithymia traits" in the categories "Difficulty Identifying Feelings", "Difficulty Describing Feelings", "Restricted Imaginative Processes", and "Problematic Interpersonal Relationships". I don't count the category "Sexual Difficulties and Disinterest", where I also score high, as I doubt it takes into account asexuality as a valid sexual orientation.

This is not a problem of operating in a foreign language (be it English or Spanish). I think I would even have more problems describing my feelings in German, my mother tongue.

Sleep

“Many survivors have sleep problems. Nightmares, both specifically related to the abuse, as well as other non-abuse-related nightmares, are common. Many people also find it difficult to fall asleep or stay asleep through the night, frequently waking up. If the survivor was traumatized at night, perhaps particularly in their own bed, they may not feel safe enough to relax into sleep. Laura Davis notes that if a survivor is actively recovering previously unknown memories of their abuse, sleeplessness may precede and/or follow the emergence of new memories.” - page 27

I have sleep problems even when I'm well. Right now, when I'm really down and struggling with both, depression and complex PTSD, the sleep problems are worse than ever. I usually don't recall my dreams, nor do I recall nightmares, but recently I remember more often than ever parts of my dreams. As I have no memories of my abuse, I also have no abuse relased nightmares, but I did have other nightmares recently, and more generally strange dreams with the common theme of not being important to anyone, not being seen or being humilliated.

I decided to not use any chemical medications to cope with my sleep problems, certainly none that might be addictive, and the natural ones I tried have had no effect whatsoever. What I am now trying is some simple meditation to relax before going to bed (that's a new one for me - I have never meditated in my life). I tried for the first time last night, struggling to stay focused on my breathing, but I think it did help.

Relations

I’m aware of my problems with trusting people, and I think since I crashed really badly 5½ years ago I have slowly learned to trust and show myself vulnerable. But the following I read in the self-help guide made me cry:

“A related problem many have noticed is that survivors may have a hard time playing: Ogden and her colleagues noted, ‘Almost invariably, clients are unable to play, finding that their capacity to experience pleasure, exuberance, and joy in playful interactions or activities has either diminished, disappeared altogether in the wake of trauma, or is experienced as paradoxically dangerous and threatening.’” - page 29

How I can relate to this! And how difficult this can be in many situations.

The other problem I have is dealing with strong emotions, even if they are positive – such as love or appreciation. And quickly the trust issue comes back to haunt me in the form of an insecure attachment style, of strong anxiety related to if I can really trust in the relationship – be it a close friendship of something else.

I could write much more here, but leave it for now. Besides the above, nothing has been a really new revelation to me.

Healing

After reading the guide, I now have to start actually practicing some of the self-help tools (besides having therapy sessions). For now I have decided to discard any type of medication, as I simply do not trust psychopharmaceutical drugs. After all, these are drugs, even of they are called medication, and they make you dependent. Never in my life have I taken drugs that are addictive, and I am not going to make a difference for drugs that call themselves medication, besides not really trusting in their effectiveness.

One of the difficulties I have is identifying what actually triggers me, that is, what causes a flashback. And, contrary to the definition of PTSD (but in line with complex PTSD), my flashbacks are usually purely emotional, even though more recently I often have the image of a child looking at the erected penis of a man on my mind (an image or thought which also clearly triggers me, as does thinking of other traumatic aspects of my childhood).

Yesterday I was reading about emotions and healing in the guide, which made me cry a lot:

“Emotions and their regulation are typically major concerns for survivors of trauma. As noted in “The Brain and Trauma” section in this Guide, trauma actually changes the brain in lasting ways. In addition, experiencing emotions releases different chemicals in our brains, changing the way our brains operate in the moment.

If you were abused as a child, you are particularly likely to have problems with emotional regulation.

Therapists Sandra C. Palvio and Antonio Pascual-Leone in their book Emotion-Focused Therapy for Complex Trauma: An Integrative Approach, say, ‘Children learn to rely on avoidance to cope with the painful, powerful, and confusing feelings generated by these [abuse] experiences. When experiential avoidance is chronic, it is associated with a number of disturbances, including substance abuse, self-injurious behavior, interpersonal problems, and impoverished social support…

Moreover, chronic avoidance is thought to perpetuate trauma symptoms, interfere with recovery, and contribute to immune system breakdown…’” - page 91

What follows in the self-help guide is an adaptation of the five stages of emotions, as described by Staci Haines in her book Healing Sex: A Mind-Body Approach To Healing Sexual Trauma. I hope that FORGE doesn’t mind quoting excessively here:

“The five stages of emotions

Emotions and emotional expression follow a predictable cycle. The cycle of emotions can be like a wave building to fullness and crashing on the beach, then reintegrating into the ocean only to come to shore once more.

1. First, the emotion shows up as a sensation or feeling. The emotion may be a response to either a current or past experience. Of course, emotions from the past will emerge as you heal.

2. Then you have a choice. You can turn away from the emotion or you can open toward it. There are times when putting an emotion on hold is a good way of taking care of yourself. (See “Container Exercise,” above, for an example of a tool to put emotions on hold.)

Holding emotions down doesn’t work as a way of life, however. The longer you brace against emotions, particularly those wrought by abuse, the longer those emotions will run your life.

Instead of turning away from emotions, you can choose to welcome them. In stage two of the cycle, you attend to the emotion, feeling your way into the sensation. When you do this, the emotion tends to intensify and reveal itself. This stage can often be the scariest. Just as in healing from dissociation, feeling your emotions means learning to tolerate these sensations in your body.

3. Stage three brings the emotion to fullness. The emotion grows in its charge and sensation. You may feel like you are about to cry. Your chest may overflow with joy and pleasure. You may want nothing more than to throw a major tantrum.

4. Stage four brings release. Depending upon the emotion, you may experience this release as gentle or very intense. You may sweat or blush, sob, shake, tremble, kick, laugh, yell, or become overheated or chilled. This expression is the release of the emotion. Surprisingly, the full expression of even the most intense and scary emotions usually lasts only twenty minutes at most.

5. After the full expression of the emotion, you may find relief, peace, renewed energy, and a sense of healing or transformation. This is the completion of the cycle, or what some people call integration. Take time to be with yourself. Breathe. Check in with your internal sense of safety and well-being. Notice that you are alright, that you are complete with this piece of your healing; it can be helpful to say this out loud. Bring intentionality to this part of the process.”

I noticed two things:

1. I think often, even though I already start to cry, I actually cut off the emotion, turning away from it. Yesterday, just reading this sentence made me cry heavily: “The longer you brace against emotions, particularly those wrought by abuse, the longer those emotions will run your life”. Yes, these emotions I have been cutting off have run my life to a large degree, and continue to do so.

2. But even if I allow the emotion, I think I often fail at the integration stage. As the guide goes on: “Pay attention to the completion stage. Sometimes you may find yourself pouring out emotion with no experience of change or integration. You could be recycling the trauma rather than healing it. This does not happen often—most people who are not ready for healing try to repress emotions related to the abuse. But if this is happening to you, ask yourself, ‘What would it take to complete this feeling?’ If you don’t know the answer, make one up. Imagine you know what completion would feel like. Try it on for size.”

Here now is my challenge, or are my challenges. Not cutting off the difficult and painful emotions from my trauma when they emerge, but rather either accept them and deal with them, or somehow “contain” them at the moment to be able to deal with them later, when it is safe and I might be able or have the support to do so. But “containing” the feeling is different from cutting it off. It includes acknowleding that it is there. The guide includes this practical container exercise:

“If you have overwhelming emotions or physical sensations that are too much to process all at once, try “containing” them.

This exercise is adapted from Robin Shapiro’s book The Trauma Treatment Handbook: Protocols Across the Spectrum.

1. Imagine a container that is big enough and strong enough to hold all your feelings and distressing sensations. It could be anything from boxes to bottles to small-town water tanks or huge oil tankers.

2. Pour your distressing emotions into that container. Make sure you get them all in.

3. When they are all in, find a way to lock that container up so that nothing leaks out.

4. Now install a tap or special airlock on your container so that when the time is right, preferably with a therapist or other support person, you can bring the sensations and emotions out a little at a time, for clearing.

5. If anything new triggers you into big, distressing feelings, or a flashback, you can send all those feelings into the container, as well.”

As Meg-John Barker writes in their blog post Staying with the Big Feels:

“1. The evidence is clear that people do best – in terms of mental and physical health – when they can tune into their bodies and feel their feelings, and live their lives on the basis of that self-awareness: expressing their needs, desires, boundaries, and so on.

2. Most of us struggle to do this because our culture discourages any experience or expression of emotions, particularly ‘negative feelings’, and because traumatic experiences growing up give us the message that such feelings are unsafe to express, or even to feel.

3. In order to address this, we can learn practices – like focusing and forms of meditation – which explicitly involve tuning into our feelings, welcoming them, and learning what they have to tell us.”

Their Staying with Feelings zine is also a good tool practice, as is the book Hell Yeah Self Care.

What I am now struggling with is the question ‘What would it take to complete this feeling?’. I haven’t yet been able to make up my answer. But I will.