Post-Traumatic Stress Disorder
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Introduction to Trauma and Stressor-Related DisordersSigns and Symptoms of Trauma and Stressor-Related DisordersDiagnostic Descriptions of Trauma and Stressor-Related DisordersWhat Causes the Symptoms of Trauma-Related Disorders? Treatment of Trauma, PTSD, Abuse and Other Stressor-Related Disorders Conclusion, Resources and ReferencesDealing with the Effects of Trauma - A Self-Help Guide
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Anxiety Disorders
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Dissociative Disorders

Distressing Images, Thoughts, Memories

Jamie Marich, Ph.D., LPCC-S, LICDC-CS, RMT, edited by C. E. Zupanick, Psy.D.

A distressing memory, image or thought is something that you can't get out of your head related to trauma or stress. Distressing memories and images may occur spontaneously, or they may be cued/triggered. Let's consider several case examples to see how this phenomenon may manifest differently.

upset womanFirst there's Gwen. She is an adult survivor of childhood sexual abuse by one of her father's friends. Whenever she becomes physically intimate with her husband, disturbing images of her past sexual abuse intrude upon her mind, making it difficult to enjoy this time with her husband. During highly stressful periods of her life, these intrusive thoughts and images get worse. Nonetheless, physical intimacy is clearly the trigger.

Next there's Gale. Gale is an adult transsexual survivor of sexual assault. This assault occurred during his teenage years when he was brutally raped by several older men. Gale is plagued by these intrusive thoughts and images at random intervals throughout the day. No specific trigger is needed; they occur spontaneously. Gale can be in the middle of working, or studying, or trying to fall asleep, and suddenly he becomes flooded with horrible thoughts and images.

Then there's Dominique. Dominique is a seven-year-old girl. During periods of high stress, Dominique tears the stuffing out of plush toys, and dismantles dolls in a rather grotesque manner. Young children lack the developmental ability to understand and express their emotions. This is also true for older children who have been neglected. This is because the adults in their life did not validate their feelings and emotions, nor did they model healthy ways of coping with a full range of feelings. Thus, children's behavior can be baffling at times. Indeed, clinicians must work very carefully to understand the meaning of some behaviors. Dominique's trauma-competent therapist learned her treatment of dolls and toys was a reenactment of how she felt when her mother left her two years prior-like she was being torn apart, emptied out, and deflated.

Because children's behavior can have subtle and hidden meaning, we would all be wise to avoid making swift judgments about why a child does a particular thing. Too often children are labeled with Conduct Disorder or ADHD when they are really crying out for help; trying to communicate with us. Behaviors that are labeled "acting- out" may indeed be just that: Acting out (re-experiencing) the harm that was done to them. As the acting-out aggressor, they have a degree of control that they did not have as victim. This hardly means that every child who is acting out was some victim of abuse or neglect. Nevertheless, it is helpful to take a slow and thoughtful approach.


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