The Role of Helplessness in PTSD Symptoms and Other Disorders

As you may know, many people who experience traumatic events do not subsequently develop post-traumatic stress disorder (PTSD).  One of the determining factors seems to be the feeling of extreme helplessness at the time the trauma occurred:  people who don’t feel helpless are able to process the experience in their usual way.  In language I’ve used elsewhere on this site, they are better able to “contain” their experience.  When someone is overtaken unaware by a traumatic event, however, they can’t rely on their usual resources to process or contain the flood of fear, anxiety, pain, etc. aroused by the event.  To protect itself from this overwhelming experience, the mind erects a barrier against the memory, segregating it from other memories and emotions in a process of defense against it.  The defense fails as the memory can’t be entirely excluded but continues to exert an extremely powerful effect.  The paradoxical result of this effort to ward off an overwhelming experience is to give it a lasting power to cause pain.

It was Sigmund Freud and Josef Breuer, of course, who first theorized about the power of unintegrated traumatic memories.  In their Studies on Hysteria (1895), the authors presented a theory that women who exhibited conversion (hysterical) symptoms suffered from “reminiscences” or memories — and in particular, memories of childhood sexual abuse.  They believed that these memories retained a lasting effect because, at the time the trauma occurred, these children were helpless and unable to protect themselves from the assault or react to it in a normal fashion.  As a result, the memory of that traumatic experience becomes walled off, segregated from other experiences and memories; it “acts like a foreign body” in the mind because it hasn’t been subjected to normal mental processing like other experiences (p. 6).

In the normal course of experience, a memory would be “abreacted” — brought into the “great complex of associations … alongside other experiences” where it “is subjected to rectification by other ideas” (p.9)  A “normal person” would be able to dissipate any disturbing feelings through this “process of association” with other thoughts, ideas and memories.  The treatment for hysteria which the authors recommended was to help their patients abreact the traumatic memories by doing just that — encouraging them gradually to revisit the painful emotions stirred up by the trauma and to reintegrate their memories of their experience into normal consciousness.  To my mind, this seems very much in keeping with the goal of  modern-day treatments for ptsd symptoms, whether it be through psychodynamic psychotherapy or graded explosure techniques used in cognitive-behavioral therapy.

Freud began his career as a neurologist and Studies in Hysteria explains these foreign-body-like memories on the level of neurons:  normal mental processing involves many interconnections between the neurons in the brain, while traumatic memories are deprived of such interconnections.  This was the beginning of his theory of psychological defenses; he believed that the overwhelming power of emotional trauma, coupled with the physical and psychological condition of helplessness, led the mind to protect itself from a sudden influx of extreme stimulus by diverting the neurological current of such stimulus and sidelining it, away from from the normal flow of thought and feeling.  My background in physiology is
limited, but this theory still makes a great deal of sense to me.  In an earlier post, I described how our psychological defenses are like well-worn ruts in the neurological road; traumatic memories are like little cul-de-sacs or dead-end roads that don’t connect to major thoroughfares or highways.

If this process of psychological self-defense occurs dramatically and suddenly in post traumatic stress disorder, leading to the eventual onset of ptsd symptoms, an analogous process occurs slowly over time and through repetition in the development of other types of defense.  In both cases, helplessness is the crux of the matter.  Let me explain by giving an example.  We need to envision the state of dependency and helplessness that characterizes infancy; try to imagine what it feels like to be a baby who understands virtually nothing about its experience.  Because everything is new, nothing is expected, at least at first.  All sorts of scary feelings and sensations come up with no advance idea that they will occur and and no understanding of what they mean.  Under “good enough” conditions, the parents protect their baby from too much stimulus and respond promptly to its needs; thus, those “impingements” don’t overwhelm the baby.

What happens when the parents are not “good enough”?  Say they lack the skills and empathy necessary to respond in the way their baby needs and therefore repeatedly expose it to excessive pain or frustration — more than it can bear but without any single moment rising to the level of ptsd-type trauma.  In this case, the infant finds its own neediness unbearable and develops defenses against the awareness of it.  Instead of isolating one traumatic experience from normal mental processes as in post traumatic stress disorder, it segregates an entire aspect of its emotional experience — that of being needy and depending upon other people.  Instead of displaying ptsd symptoms, it may develop a particular set of defenses that evolve into a character type. He or she may grow up to be an extremely self-reliant person who has a hard time sustaining intimate relationships.

In psychotherapy, the goal would be to make that person aware — again and again — of how he or she avoids the experience of neediness through the use of characteristic defenses.  I  might show him how he typically elicits desire in other people and then rejects them; or how she keeps herself so busy with her high-profile profession (and all those people depending upon her!) that she never has time to date.   Within the context of the psychotherapy relationship, I would expect such a client to have a hard time letting me help.  He or she might continually bring up reasons to quit, or try to develop a collegial relationship with me instead of turning to me for help.

Just as the traumatic memory in post-traumatic stress disorder must gradually be revisited and re-integrated, so must the disavowed needy self be brought back into the light and absorbed.  Think of it as forging new neurological links, re-connecting the isolated aspects to the rest of the brain.  That’s how Freud thought about it, well over a hundred years ago as he began to develop his psychoanalytic model of the mind.  It still seems valid today … at least to me.

Finding Your Own Way:

The other night, I was lying in bed, trying (not for the first time) to imagine myself into the experience of an infant.  I think this is almost impossible, but give it a try.  Most important would be to deprive yourself of words:  don’t describe the experience to yourself but instead try to feel your way into it.  Try the moment of birth if you want a challenge.  Imagine you’re in this very warm, relatively stable environment where nourishment is delivered to your body before you ever become aware that you need it.  Almost nothing “happens”; the realm of your experience feels bounded and safe.

Then the birth process begins and you’re squeezed through a space far to0 small for you (this has to be painful and scary).   You finally emerge and feel cold for the very first time.  In the bad old days, somebody would then have slapped your behind and you would have experienced intense pain, most likely for the very first time.  Nowadays, they shove something up your nose and suck out the mucous so you’ll begin to breathe.  Soon enough, they wrap you in something soft (but nowhere as comforting as warm water), arms enfold you and maybe you feel safe again.  Then your body exhausts its pre-birth fuel and you feel hunger pangs for the very first time.

If you want to get closer to that particular experience, try fasting for half a day or so.  See how long you can bear those hunger pangs before you simply have to eat.  Now imagine if you were a hungry baby, unable to feed itself, feeling such pangs … and nobody came to feed you.  What could you do but try to get rid of your awareness of the experience.   That’s the beginning of projection and if it becomes habitual due to repeated and excessive frustration, it lays the groundwork for various types of mental illness.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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30 comments

    My mom just asked me today after Easter dinner, “Why do you have a book called ‘Understanding the Borderline Mother’? Is that about me?” and she acted sad. I had to quickly deflect her and say “no, mom, actually it’s about me, because I have Borderline Personality Disorder. It’s a pretty serious mental illness.”

    I found it ironic that you wrote this morning about reliving the birth experience and how traumatic that would be. When my mom asked what Borderline Personality Disorder entailed, I told her how my thoughts are chronically and severely distorted so that I always think the world is out to get me. She said “I wonder if it was from your long child birth. You’ve always been that way.”

    Huh. From a long and difficult childbirth, my mom supposes. Being that it was Easter and the spirit was jovial, I didn’t mention that it was the years of intense emotional, mental, physical, and sometimes sexual abuse that I suffered at the hands of my dad – her husband.

    But being that you said that about child birth, I do wonder if it can and does have an affect on people who may be predilected toward frontal lobe abnormalities such as ADD like myself. I’m a highly sensitive person, not just feelings – but perceiving senses of smell, touch, heat/cold, taste, hearing, etc…extremely sensitive. If you combine someone with that predisposition for highly sensitive personality coupled with a long difficult childbirth and coupled with PTSD-like situations (such as childhood abuse)….I think anyone is RIPE with PTSD or Borderline Personality Disorder.

    One of the things I haven’t yet covered is this issue of sensitivity. There’s plenty of empirical evidence that babies enter the world with different degrees of sensitivity; what would be manageable pain or frustration for one might be entirely unbearable for another. Parents who are “good enough” for a very calm, adaptable baby might not be so good for one with high sensitivity and greater emotional needs.

    I had a friend once who was very troubled, whose mother had developed the family myth that she’d been dropped on her head as an infant and all her psychological and emotional difficulties (she was a borderline) stemmed from that accident. No sense of personal involvement, that maybe mom and dad had something to do with it. Sound familiar?

    Yep! Sounds familiar indeed. And the reason I’ve been ministering to my mom and dad since being a child, and am now considering going into clinical psychology or clinical social work.

    It’s somewhat entertaining and sad all in the same instance to sit back and listen to them come up with their theories about why the kids are messed up, as if there is no way they have anything to do with it. :)

    Jodi!
    So can relate to this. My parents saw my studies in psychology as a threat. Why are all their kids f***ed up? it can’t have anything to do with them? possibly not..I have learned to accept that they are who they are, I cannot change them and will not try to anymore. I think this is the primary reason I went into psychology. I have recognised that this is so I can gain control over my circumstances so that I don’t have to feel helpless again. Unfortunately this has landed me in a job where I am repeatedly exposed to trauma (how ironic is that?). I have at least recognised that this is unhealthy and I am re-training, though career change is not always easy. I say to my friend ‘I am good at the job, but it is not good for me’ unfortunately I am geared to be excellent at it, I keep getting promoted. Am I doomed to be stuck in this trauma re-enactment of my own devising? be very careful and look after yourself :)

    My son, Sgt. Nicholas Ray Gibbs, joined the Army as a Proud Infantryman. Unfortunately, he was killed in action on December 6, 2006. I am his mother and am being treated for PTSD and Survivors Guilt. Are there any suggestions or medications that you would recommend to help me through this? Am now having to have my precious cat ~ sorry, she is like one of my children; have had her since 2002 and she has been diagnosed with cancer ~ and I’m NOT ready to say good-bye to her, either. Everything the Doctors have put me on, even sleeping pills, just DO NOT seem to help. I have always been a very sensitive and emotional person and losing my son has TOTALLY changed who I was. There are simple words that I KNOW but can not remember them. I can describe them and once someone says the word I say “That’s it” but I can’t think of them to save my life!!! My memory ~ which was alot starting to falter a little anyway ~ has REALLY gotten bad and am tired of being made fun of or teased about it. I can NOT help what this has done to me but no one that I personally know has ever had to walk in my shoes and I’m tired of being judged. I have but one judge. I have NO energy, NO motivation, NO NOTHING!!!! I will not lie to you ~ I wouldn’t care if I didn’t wake up in the mornings. He & I shared a VERY special & unique bond like I never dreamed possible. When he was about 4 yrs. old he started calling me his #1 Mom and I always called him my #1 son ~ he was my ONLY son ~ and that continued until he was killed in this stupid thing we call “war”. There are times I TRULY feel like I need to be put into a mental health facility until I can get the proper treatment and get my world to a place I can stand to be in again.

    Any comments, suggestion, etc. would be GREATLY appreciated. I have seen counselors through the VA, a psychologist AND a psychiatrist, to no avail. I feel like I have nowhere else to turn and that’s why I said I wouldn’t care if I didn’t wake up the next morning. Since my son was KIA, four of his good friends (non-military) have passed and they were like my own, my uncle has passed, I was diagnosed with Hep C five months after my son was KIA (have NO clue how I got that) was on treatments for six month, had to have my left knee replaced, four days later was re-admitted to the hospital for a blood clot in my stomach, had my left foot broken, and now have twisted the knee that was replaced and have to have surgery to have scar tissue removed. THEN, I have to have the right knee replaced so you see, the last 4 yrs. have been VERY hard for me and am just at the point that I DO NOT CARE ANYMORE!!!!

    PLEASE, anything you can advise me to do would be such a help to me. Thank you for taking the time to read this novel I just wrote to you. Honestly, I didn’t mean to write you a letter this long. Just so much to explain that I’ve gone through in only 4 yrs.

    Thank you for your time & patience ~

    Debbie Halstead
    Proud Mother of a Fallen Hero

    Debbie, yours is the kind of post comment that’s an agony to receive. The degree of your pain and loss seems unbearable to me, so I can completely understand why you “don’t care” any more. I know I would never get over the death of one of my children. Never. I might go on, but I’d never truly recover.

    It sounds to me as if you feel terribly alone with your grief; have you found any support groups for parents who’ve also lost children in action? I would think such groups must exist and might offer some comfort to you. You speak with such feeling about how the people around you don’t understand but judge you — it would help to be around people who understand EXACTLY what you’re going through.

    Did you see the film “Rabbit Hole” with Nicole Kidman and Aaron Eckhart? It’s about a couple who loses their son. I’m not sure if movies like that help or only make the hurt worse. My heart goes out to you.

    I am PTSD & will be trying ‘EMDR’ therapy. I don’t know if that’s reasonable for you but may be something to look into. Google it

    Your pain breaks my heart. I sincerely wish you the best.

    This post really resonates with me. How could I bring my ‘ disavowed needy self’ into my other self? It sounds impossible. My intimacy issues are infamous for it’s severity and my refusal to acknowledge them.
    My birth experience must have been traumatic. 20 days after I was born I was hospitalized because I had a really high fever, no one knew what was wrong with me and the fever subsided a week later and they released me with no diagnosis. They thought I was dying of malaria! Clearly I was not. I was delivered via cesarean. I suppose that is less traumatic than traditional childbirth, no?

    I would think a Caesarian birth would be less physically traumatic, but just being outside, after the more-or-less static comfort of the womb, has to be a major shock. As for how you re-integrate your disavowed needy self, that’s a lengthy process, and usually would involve some psychotherapy.

    Interestingly I would suspect a C-section would be more traumatic. In fact a lot of research suggests this and if you think about it, the most natural of any experience would be ‘better’ than anything man has intervened in – if you see what I mean? Mother nature has a fantastic way of preparing the mother and infant for natural labour via hormones and other chemicals transferred through the umbilical cord. The unnatural method of a section would shock and traumatise both the mother and the baby. I actually believe I have read that the ‘pain’ experienced by the infant during natural childbirth is not felt in the way we would perceive it (as adults understand pain) and in fact it is a necessary and stimulating sensation, there to encourage the baby to begin breathing and knowing of its existence. The trauma is mainly to do with the hormones or lack of – in a medically intervened labour.

    I was delivered by a planned C-section. I did not meet my mother for the first 30 hours of my life after being plucked from my safe little world without warning, before I was ready (as labour hadn’t started yet) as she was very ill from the general anaesthetic she had. I was ‘fed’ water for those 30 hours until my mother was able to feed me. I believe my planned section may be one of the small contributing factors (among many other childhood traumas and the emotional abuse and neglect I suffered through my whole childhood) towards my ptsd. I am only beginning to look into my symptoms as being part of something bigger, possible supressed memories – this, at the moment terrifies me, I don’t think I am ready to know that there were worse things that happened other than what I am already aware of. I have only had 7 sessions with my therapist (cbt psychotherapy) and so far he has been fantastic but I feel like we are only just scratching the surface. I can’t imagine being ready to leave but couldn’t afford to stay forever. That in itself is terrifying. The dependency I feel already; it is a very unsettling feeling.

    My daughter was born by emergency section after a very long and difficult labour. I had no choice as she and I would not have survived the labour had the doctors not operated and so after the birth I made it my mission to try to counterbalance the unnatural and distressing way she entered the world. I spent the majority of the first weeks of her life practicing skin to skin and constant on demand feeding which studies have shown aids the production of ‘feel good’ hormones in both mother and baby. I can certainly say it helped me and judging by her content and alert disposition I would like to think it had a positive affect on her as well. I have also slept near her, plan to feed her until she self weans and ‘worn’ her in a sling (she is now 17 months). Anyway, my much longer than I had planned, response is really just trying to illustrate a different perspective on the very interesting topic of traumatic births.

    Anyway, your c-section comment here interested me so I decided to add my opinion. I have been reading your blog for a while now and have found it to be a great source of support and information. Thank you for taking the time to write such detailed and thought provoking pieces. It certainly has helped me on my healing journey. I have been tempted to add a comment on many discussions but never had the guts… I hope you don’t mind me adding my contribution here.

    Thanks,
    L

    I’m glad to have your contribution, and it strikes me as very interesting. I need to mull that one over, but I definitely agree about how labor and hormones prepare both mother and baby for natural childbirth.

    Hello Joseph,
    thank you very much for this post. I read it with great interest. I have a friend who has suffered a lot during his childhood. From constant bullying and neglect, to sexual abuse by a stranger, his bio reads in many ways like an encyclopedia entry for PTSD. He has undergone years of therapy in order to “find” the “missing pieces” of his memory puzzle and thereby achieved a great deal more sanity and peace. However, he is not really able to fully unfold his potential yet. (At least that’s how it feels for him.)

    I can definitely see (and like him) for his good heart, but he is not really master of his time and although he has often claimed to be extremely loyal – I can see that he also makes sure that he stays busy so that he won’t be available emotionally and physically when in need. There is a certain awareness about some aspects of his intimacy issues with him but it seems beyond his power to actually do something differently in order to get out of his behaviour spiral. Time is ticking for him, he will turn 50 next year and a great part of him craves for the nurturing home he’s never had. However, as it is at the moment, there is always something more important to deal with, so his intimacy issues remain untouched.

    And with that infront of my eyes – I often wondered, if there is something I can do as a friend. I am not really sure what characterizes a good friend for someone with such a powerful destructive subconscious to begin with. I am reluctant to constantly push buttons and point out when witnessing defenses at play. (I dont know if that kind of feedback would change anything other than make him feel more incapable than he already does). I believe in the power of being understood, authenticity and encouragement though… so ideally I try to understand first rather than just get mad, when the actions caused by his defenses happen to affect me in person. It’s not always easy to not take things personally but at least I try and I think, that I have benefitted from that in my own character development a lot. Learning more about him and the roots of his strange behaviour was good for my own evolving as a person too. Today I am mostly relaxed and hard to aggrevate by it. Still: That’s great for me, that I am able to look past it, but not necessarily a help for him, as he has to deal with “normal people” too and they do get pissed when he’s pulling a strange defense mechanism!

    Speaking of PTSD – I feel very much that “the repressed neediness” you are speaking about goes hand in hand with the subject of “difficulties with boundaries”, another fascinating topic I would love to read more about in your blog!

    Thanks for your comments. You asked a couple of questions — first, I think that you should only point out someone’s defensive behavior if asked to do so; otherwise, your well-meaning comments might be met with hostility (even in therapy, when you’re being paid to say the hard things, a good interpretation often meets with resistance). And as for how to be a good friend, it sounds like you already are one. All you can do is understand and be emotionally present, offer support without colluding with denial and destructive behavior, and make sure to take care of your own needs at the same time.

    “Difficulties with boundaries” is a big subject. Did you have a specific behavior or relationship-type in mind?

    Hello there and thanks for your kind answer.

    My thoughts on a possible topic boundaries:

    I have met in my life a couple of people that apparently had difficult childhood experiences and the subject of maintaining healthy boundaries seems to be relevant for all of them in many different ways.

    One girl I know gets terribly angry and aggressively defensive for reasons that most people wouldn’t even be bothered with. Although I am not a professional I believe that she most likely suffers from a borderline personality disorder. One of the scariest things about her is that even when you are extremely cautious and attentive to not offend her sensitive nature, there will come a time when (and I don’t know how to describe this better) she simply “needs the tantrum to unfold”. What’s really fascinating then is, to witness how her boundaries begin to shift. What was alright and no problem at all 8 weeks ago, all of a sudden is a capital offense and leads to a severe crisis in the friendship. She is the type of person that draws people in and makes them feel like they are extremely special to her but then, miraculously (and it’s of course always the others, never herself) exactly these people betray her in the most awful way. Even when you try to point out where her assumptions have flaws, she simply doesn’t manage to shift her position and get ridd of the anger that has build up inside of her. You can literally feel it in the air when being around her in a moment like that and she has NO tools whatsoever to do something about that “discomfort” inside of her – other than drinking lots of alcohol and throwing her anger vivldy at people. I have often wondered what happens in her brain chemically in this very situation because these “tantrum” moments (and that moment of shifting boundaries) feel very hormonal to me and something that is entirely unconnected to any conscious thinking – it seems very much beyond her own power to even “notice when it’s coming”. Needless to say, that most people (me included) find maintaining a friendship with her extremely tiresome and the only thing that’s possible on a long run is something very loose and superficial. (Noone needs that sort of pressure and drama in a friendship!)

    Another girl I know has a very needy mother who (after the break up with her father when she was 3 years old ) made my friend pretty much the center of her life. This girl seems to have difficulties with boundaries too but in a completely different way. She is the type of person that simply can’t say “no” or feels extremely bad when she has to do so (even if everyone around her is totally understanding).
    I have often wondered how she endures her mother’s constant calls and the guilt trips she puts on her when she is not responding in an appropriate time frame (and my friend is in her mid 30s now!). A couple of weeks ago, she, her husband and her own daughter went on a short holiday (the first in years). Her mother – who was diagnosed with schizophrenia several years ago- was home alone and the neighbours were asked to have a look after her while my friend was away. Her mother was “alright” before my friend left but during that week of my friend’s absense she became extremely apathetic and inable to take care of herself (and the neighbours were clearly overstrained with her being like that). Surprisingly, the moment my friend returned, the mother was “good” again! It only then dawned upon me that its exactly this kind of emotional terror that probably led to my friends inability to be more forceful in defending her own boundaries. She was an only child and a daughter who had noone but her mother when she was little. If you’re emotionally blackmailed like that by the person you rely on the most for years – no wonder you become scared and reluctant to claim more privacy for yourself and defend your own personal freedom.

    And to get back to my PTSD friend mentioned in the comment above. His reactions when it comes to not getting close to having to deal with the subject boundaries are “legendary”. I guess the fact that every effort of defending them was punished with beatings simply made him extremely sore. I can tell that he engages into all kinds of weird behaviour just to avoid the subject (Be it his boundaries or even other people’s boundaries around him). The reactions range from forgetting stuff, making weird priority shifts, becoming extremely busy with something else to simply claiming to not care at all, etc. It’s always the others that set the conditions and he has become a master of simply dealing with the shit he’s presented with (but at the same time he oftenwise ends up frustrated with the others insensitivity and gets sulky with the world)…

    So many things to say about the subject- I definitely think the subject itself is worth an own post (or maybe a number of posts). I am looking forward to it/them already. It will be very interesting for e to read a specialists perspective on them!

    Have a lovely Sunday evening!

    Wonderful descriptions! You’re correct, the first person you’re describing sounds like a class borderline. I’ve been intending to write a post about BPD but it seems little overwhelming as there’s so much to say about it. If I have an area of expertise, it is working long-term with this type of client … and I’ve worked with a number of them. The issue of confused boundaries between self and others always comes up. The second person you described probably has a great deal of anger somewhere, completely split off and denied, because she felt she had to get rid of all of her own needs in order to take care of her mother’s. I’ll try to write something about that dynamic, too.

    I have been diagnosed with Bipolar1 and PTSD and BPD
    My first experience with a Therapist
    During 2010 and 2011 my therapist constantly provided support and encouragement only to withdraw it every few week or so… I was so confused by his treatment that I suffered panic attacks on the way to see him, but I kept on going back, I desperately needed his support, encouragement and yes his comfort. Sometimes I did have a good session, but more often than not, his cruelty during our meetings left me in such an emotional state that I would get home sobbing. He was aware that I was diagnosed as having Bipolar, under the care of a psychiatrist and on medication. I was having difficulty maintaining my sobriety and getting the bipolar under control. He did not at anytime consider the impact his brutal words had on my mental state. My spouse and my friend always knew when I came from seeing him, as I was usually very upset.
    I told him in March of 2010 that I depended too much on his support and was having attachment problems. I was emailing him regularly almost every day and on facebook. I told him that I was confused about my feelings for him. I had never seen a therapist before and told him on many occasions that he was the only one that I trusted completely. He encouraged this affection I felt for him and told me that he would always be there for me, support me and that I could trust him completely.
    In 2010 He invited me to his church where he was pastor; I went readily joined hoping that I could find spiritual help along with counseling.
    He would often tell me what he would write down in my file… which was completely different from what he had discussed during our session.
    In September of 2010, without prior noticed informed me that he could not help me with my bipolar and suggested that I find a therapist that could help me with the Bipolar. I did not agree him and became very upset, I told him that I did not want to talk to anyone else but him… again mentioned that I had attachment issues. He agreed to continue to see me on D&A issues only. Again his demeanor was as before… the support, encouragement followed by cruel indifference. I told him many times that his harsh and cruel treatment was hurting me deeply and that I didn’t understand why he treated me this way. In November 2011, I was on Facebook and he appeared to be trying to entice a young and obviously intoxicated young woman to a video conference. I sent him a message to be careful what he writes on FB because everyone can see what he was writing and they may come to the same conclusion as I did. He immediately sent me an email and told me that he was canceling our appointment and that he wasn’t going to see me anymore, he took me off his friends list on facebook, but he told me that I could continue to send him emails anytime. I have an anonymous account on facebook and in December 2011, I befriended him on Facebook through this account; I missed talking to him so very much and was having a very hard time dealing with the fact that even after I had told him that I had attachment issues and depended on him so much…he continued to encourage contact and was not addressing the issue!! From the Anonymous account , I asked him to be my friend and within 5 minutes he was already seducing me (Which was not my intentions)! He then initiated an online sexual relationship that lasted until Feb 2012. When the guilt finally became too much, I told him that the name was fictitious and he immediately admitted that he knew it was me, he also indicated that he wanted to have sexual contact during our sessions together. This created more confusion and caused a downhill spiral into depression. On one occasion I wrote him an email, he misunderstood the email and concluded that I was going to attempt suicide. He emailed me back and told me that if I was going to hurt myself, I needed to go talk to someone else.
    This therapist is Chairman of the licensing board…. You can probably imagine that I would never consider therapy as an option for help.

    Thank you for your article on PTSD. I am diagnosed with this although there is talk of a new diagnosis C-PTSD which fits better. I was abused in every way by my father who was finally diagnosed and committed to a state mental institution as a psychopathic personality when I was 15 years old. He also was a pedophile who abused boys and girls alike and used me and my siblings as bait to gain access to more victims. He used fear/abuse to intimidate all of us into compliance. Needless to say I was diagnosed with MPD at age 37 and saw a Christian counselor treating other victims of SRA (which I was not a victim of). The therapy went well for about 3.5 years then he suddenly dumped me as a client. Devastated I turned to the church for help, and did receive support and help through a support group run by a NP who treated me well and was able to work with the alters that revealed themselves to her. I was pretty much integrated when I decided to go to a Christian college and get a degree in counseling. While there I was spiritually/emotionally abused by a psych prof who used Gestalt type therapy which caused me to dissociate again. I turned to a secular Psychologist now for the past 2 years who has been able to help me with understanding the religious abuse I’ve dealt with but my issue is that he keeps wanting to do EMDR with me and I’m feeling guilt because I get so terrified thinking of it and fear he won’t think I trust him enough to do what he feels is right. I know this goes back to my father who used to guilt us into doing what he wanted, but just can’t seem to make the leap. Maybe I need to talk to my T about this also? It gives me a headache right now thinking about it. Trust is an enormous issue for me, of course. (When I admitted to the psych prof my neediness he just said he felt the same way.) We did do the EMDR once and it of course brought up lots of issues I suffered with for days afterward. You brought up the point that it’s hard for those with this diagnoses to admit their neediness and let the T help them. Thanks for that, but do you see the dilemma I face about letting my T do EDR? He says that by recalling one image it will displace onto many others thereby lessen my symptoms. I would appreciate your thoughts on this. Thank you.

    Given your background, especially the psychological abuse by your former therapist, I think your fears are understandable. Rather than urging you to comply, your therapist needs to leave room for you to come to a decision yourself. Trying to impose his own therapeutic plan against your wishes is simply too loaded.

    “Now imagine if you were a hungry baby, unable to feed itself, feeling such pangs … and nobody came to feed you. What could you do but try to get rid of your awareness of the experience. ”

    Wow. I’m really, really glad you wrote this, because it gives me some insight into my husband. Shortly after he was born, he very nearly starved to death because, having been born prematurely, he didn’t know how to suckle and couldn’t breast feed. His mother feels horribly guilty about it now, but I still marvel at just how out of touch she was with his experience that she couldn’t figure out what was going on.

    To this day, my husband gets intensely irritable when he’s hungry. And sure, hunger does that to any of us, but it has always seemed to me that his discomfort has an extra edge of fear and anger to it. He also has a lot of difficulty preparing food for himself – getting hungry tends to take him utterly by surprise, like he’s unaware of it coming on until things reach a state of urgency. Once he gets to this point he tends to just grab the nearest bag of something he can eat right out of the package (cookies, chips, lunch meat) and empty it, often binging until he gets an upset stomach. He’s not good at balancing his meals or eating things that are going to stick with him – he might eat an entire pint of yogurt or bag of carrot sticks and nothing else, seemingly not realizing or caring that he’ll be hungry again very soon if he doesn’t have some fat and protein. It now occurs to me just how infantile (I use that word as a neutral descriptor) this behavior is.

    I’ve gotten frustrated with him a lot over the course of our marriage for the fact that I have to take a lot of responsibility for helping him eat well, and for the fact that his urgent binges mean that easy-to-eat food always disappears and there’s nothing for me to eat myself or prepare for our dinner that doesn’t require significant time and effort (often made more difficult by the fact that certain fresh ingredients I’ve been planning to use in a dish have disappeared in a binge). I’ll chew him out for this behavior, but I always feel guilty after because I guess I’ve sensed his helplessness and pain in connection to these habits.

    It’s never occurred to me to look at his behavior as being related to a defense mechanism of blocking out his awareness of hunger, but it makes SO much sense! He’s been making a big effort to improve for my sake, and knowing this will help us quite a bit. Thank you!

    Sounds like you’re on the right track. Denial of hunger as a defense until the defense breaks down and he’s overwhelmed by the fear of starvation. This might sounds funny, but you could help him to pay more attention to the places in his body where he might notice the approach of hunger. He probably lives “in his head” and is out of touch with his body. Some kind of mindfulness meditation, with a focus on bodily sensations, might be useful.

    I’m not sure I completely understand this piece. I came to it hoping for some understanding of neediness in those with PTSD. I think I got confused by the switch half way through to discussing other disorders/defences. Are you saying that PTSD is one kind of defence, and neediness another? My own experience supporting my partner with PTSD (from childhood abuse) is that he can be very needy to the point where I have to say “no more!” fairly regularly as his demands can get too much. He becomes like a helpless child. He pushes my boundaries constantly and can be manipulative rather than expressing what he really wants or needs. I think though I am privileged in a way to be allowed to see him this vulnerable, but still…..it is very hard to be loving and keep some reasonable boundaries at the same time.

    Neediness is not a defense but rather a fact. Trying to control the object of need is a defense against feeling needy and dependent. Don’t confuse being demanding with being needy. Everyone has needs but the person who tries to manipulate the object of his needs has little tolerance for actual dependency and feelings of helplessness.

    I’m a survivor of childhood abuse & have been working on my PTSD symptoms. One I cannot get a handle on and was hoping your article could help me on, is the fact that I am always cold. Once I become cold, it takes a lot to warm me up again, usually a very hot electric blanket for an hour. When I’m waiting to warm up again, the experience is almost unbearable, as if I am locked in a freezer. However, it can simply be a few minutes outside that caused me to become cold in the first place. Everyone around me will be either fine or warm. It is not a normal reaction and I have not discovered any pattern to what triggers it.

    Back in April 2011, user ‘nins’ stated “Speaking of PTSD – I feel very much that “the repressed neediness” you are speaking about goes hand in hand with the subject of “difficulties with boundaries.” I also am interested to hear more discussion on this topic. I did a search for related words on this blog and didn’t see any discussion come up. Maybe I need to do a bit more digging around. But, if not – as far as type of relationship issues – I know that the therapeutic relationship dynamics gives much insight into other issues that the client may be struggling with (i.e. boundary issues). So my interest is to hear more on what the inability to keep appropriate boundaries between therapist and patient means in terms of the larger picture for either the patient or therapist. I am aware of the challenges of transference/countertransference issues, but beyond that. Maybe I need to begin with asking the question: How does boundary issues become an “issue”? Much of the time in life we are finding a balance to boundaries and there isn’t a one size fits all answer to this. One time my therapist told me I have issues with boundaries. ..for example, whether that be creating boundaries (where there wasn’t before with toxic relationships in my life, which makes sense and I believe is important) and keeping these boundaries in check (because boundaries seem to get bumped around easily by the inevitable changes we face in life). In other words it seems healthy to allow certain boundaries to have some flexibility in them. But I think alot of people when they hear the word “boundary,” think of a hard line in the sand and very rigid type of thinking. While I think that is beneficial in some cases to have a more rigid boundary, other cases seem to have some more room to move and be adjusted. Do boundary issues relate to an underlying more pathological issue as it relates to the guaging of one’s neediness? does it relate to the idea of protection?..say if we were unprotected from early childhood trauma (my case, I have PTSD from living with an emotionally, physically, psychologically abusive father). Does it relate to attachment or abandonment issues? (like protecting oneself from experiencing loss or rejection of a person). Somehow it seems it could be a little bit of all of these. And I ask this question in light of navigating relationships appropriately that are considered healthy relationships (whether this be with a previous therapist (both females with 2 yrsthat have passed); and also friends; family; spouse). Well, I think I’ve layed out enough here more or less to generate others thoughts and yours Dr. Burgo. Would love to hear more on this topic. thanks for reading!

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