How Attachment Trauma Leads to CoDependency & Personality Disorders

Foreign. Presentation on trauma, attachment, codependency and abandonment issues. I'm your host, Dr. Donnelly Snipes. In today's presentation, we're actually going to be talking about trauma and how that can potentially impact or the connection between trauma and personality disorders or personality disordered behavior, or said another way, symptoms of personality disorders. So let's just kind of get into this and you'll see what I'm talking about. So in this presentation, we'll explore the connection between disrupted attachment and adverse childhood experiences. And we will talk about how adverse childhood experiences constitute for many people, trauma and ongoing trauma, which can therefore result in what the ICD11 causes. Call CPTSD. We'll discuss how the symptoms of codependency make sense from a trauma informed perspective. And we'll talk about the connection between attachment disruption in relationships, especially primary attachment disruption and development of codependency symptoms. And then we'll discuss trauma informed strategies for addressing codependency and abandonment issues or symptoms that generally arise from the attachment trauma and the aces. So we're going to try to keep connecting this all back to and help you understand why behaviors develop for a lot of people, especially in response to trauma. Secure attachments help us feel safe, loved and provide support and assistance. When we have secure attachments in our life, we have that secure, that safe home base. When we talk about the development of attachment, we're talking about developing a relationship with somebody who is consistent, responsive, attentive, validating, encouraging and safe. And we're going to talk about the craves mnemonic in a minute. But we need that in our life, not only as children, not only as infants and young children, but as adults. We need people in our life that we can count on. That's just the way we're wired. We have an entire hormone dedicated to bonding. Um, it's also important to recognize that children who do not consistently have a consent consistent, responsive, attentive, validating, encouraging, supportive, safe caregiver may develop insecure attachment. Now let's think about that. When a child has a caregiver who is inconsistent, they don't know how to. They go to the their caregiver and they say, I don't feel well. One day the caregiver says, oh, honey, I'm so sorry. Come here. You know, let me help you. Let me. What do you need to feel better? And they go to the caregiver another day. And the caregiver is like, I don't care how you feel. Get over it. Go back to your room, go to bed. Whatever you need to do, but don't bother me, that's inconsistent. The response. They don't know if they're going to get Jekyll or Hyde. So it can be very scary to go to that caregiver and elicit help even when they need it. And remember that primary attachment starts forming from the moment the child is born, when they're in pre verbal stages. So a baby, for example, that cries because it's hungry and the caregiver puts it down, or usually the other way around, it's tired or it's cold or it's in pain, and the caregiver responds to those cries inconsistently. Sometimes they just let them cry it out and other times they're responsive. The child has no idea if somebody's going to come help them with whatever's causing them distress at the moment. The responsiveness, pardon me, is another part that we want to look at. Because even if the caregiver is consistent, when you cry, I come get you. But if they're not sensitive to the child's needs and they respond to every cry with a bottle, then they're not meeting the child's needs. If they're wet and you're giving the child a bottle, that's not going to solve the problem. If they're sleepy and you give the child the bottle or, well, maybe they'll fall asleep. But that wasn't actually the problem. Helping people be more consistent is really important. And a lot of caregivers, especially if they're struggling with mental health issues, extreme stress, poverty or substance abuse issues, they have difficulty being consistent and responsive. Think about when you're super stressed, super duper stressed, not just your run of the mill, it's a Monday. Are you as consistent in your responses to other people and yourself as you would be when you weren't stressed? Thinking about myself, when I get super stressed, I don't take as good a care of myself and as I do when I'm not stressed, so I'm inconsistent. When you are super stressed, are you responsive to your needs? If you're feeling anxious, do you get support or do you drink a six pack or eat a whole pizza or whatever it is you do to soothe yourself? Are you responsive in a healthy way, in a helpful way to eliminate the distress or, or to cope with the distress while it lasts? Or do you just try to avoid it, numb it, something else? And how are you with other people when you're super duper stressed, are you consistent and responsive? How are you with your clients? And this is One of the reasons that burnout is actually an ethical issue because when we get burned out, we have difficulty being consistent and responsive and validating and encouraging to people. So just looking at our own behaviors, we recognize that when we are super stressed, when we are distressed. And I feel pretty safe saying that when children experience aces, it's largely because there is some form of distress in the home. So when their caregivers are distressed, they are less able even if they wanted to be. They're less able to be consistent, responsive, attentive, validating, encouraging, and supportive. Not going to say that a bunch more times, but I kind of want to get that craves mnemonic stuck in your head because it is so important. Insecure attachment is the behavioral response that a person develops. And it can develop in adult relationships as well as primary caregiver relationships is the behavior that develops and the relationship strategies that develop when a child doesn't get or when a person doesn't get those needs met. And they develop as a way of protecting themselves. Early attachments create a prototype for future relationships, the love map that they talk about, for example. But it's important to recognize that people who had wonderful lives and wonderful secure attachments in childhood can have a really devastating relationship in adulthood. Maybe they get in a relationship with somebody who is domestically violent, who is struggling with significant substance use issues. You know, we can just give them a whole list of diagnoses and what they knew to be. Their relationship all of a sudden just disappears seemingly overnight. And that can be traumatic for people because they're the people that they count on in adulthood to be there for them, all of a sudden abandon them later experiences of rejection abandonment can also inhibit secure adult attachment. If you're in a couple of really bad relationships, or even one, it may be harder to develop secure attachment to someone else, to trust that they're going to be meeting those needs. Consistency, responsiveness, attentiveness, validating, encouraging and safe. Insecure attachments lead to a pervasive sense of unsafeness and sometimes disempowerment. When, especially as a child, when you rely on this person to meet your needs for survival and you can't count on them, you know, that's going to add some stress to your life as an adult. If you're in a relationship with somebody and you can't count on them to be safe, to be validating, to be appropriately responsive. And, and I don't mean they're your, your entire world revolves around them. In adult relationships or in adulthood, we tend to have multiple People that fill these roles. But thinking about your significant other, a lot of times we rely on that person a lot. And inconsistency can be really stressful. If you don't know whether you're going to wake up next to Jekyll or Hyde, it can be extremely stressful. And that causes the stress response to kick off, which is the HPA axis. We've talked about that in other videos. And when that stress response stays on for too long as a result of ongoing stress, ongoing threat, it starts to become dysregulated. When that happens, we start seeing a whole spectrum of symptoms. Because the HPA axis, your stress response system, also interacts with your gut microbiome and your hpg, your hypothalamic pituitary, gonadal axis, so your sex hormones and your HPT axis, your hypothalamic pituitary, thyroid hormones. And when that system starts to become dysfunctional, we see people having issues, symptoms that develop physically, emotionally, cognitively. And then those problems bleed into interpersonal and environmental. Remember, with the fight, with the stress response, we have multiple ways that it can come out. We have fight. That's when I feel angry, and I'm gonna, you know, try to fight to keep this relationship, or I'm gonna fight with you about how you're reacting to me or, you know, you're. It's an aggressive response. You have the flight response. I'm getting the heck out of here. Now, it could be physically removing yourself, or it could be checking out. And for children, you know, a toddler can't pack their stuff and say, later, mom can't take it anymore. You're just. You're too all over the place. So we often see the child flee cognitively from what's going on. They flee into a fantasy world. They may flee into themselves and become very shut down. We see freezing when something happens. Now, this is a little bit different than fleeing. We see freezing when people experience a trauma and they literally freeze like a deer in headlights. And it's like, crap, what do I do? Do I run? Do I stay? I don't know. I'm just. I'm stuck. But they are not. They're not checking out. They're still fully present. They just feel sort of paralyzed. And we've had people. I've had people in therapy tell me in this situation, it's super stressful right now, but I feel paralyzed. I feel like I don't know how I can move next. Then we have what some people call fawn or frantic, where they're just I will do anything, whatever it is you need me to do. And we see this in insecure attachment. We see this in codependency when people I will cover up for your behaviors. I will do whatever you need me to do. Just don't abandon me. And then Adriana proposed another alternative for F and that's flop. After that HPA axis has been on for so long and you fought the good fight or you've, you know, run from it as long as you can, eventually you get exhausted and and the person gets to the point where they're clinically depressed, they're burned out, they are just. They flop. They have no energy for anything. And we need to recognize when we're looking at overt behaviors, we need to evaluate how are those overt behaviors potentially connected to the stress response. Does it represent the person's way of fighting, fleeing, freezing, fawning, or flopping? So your insecure attachment styles if just a primer on this in case it's been a while, you have your avoidant attachment style. And a lot of times avoidant attachment is behaviors are overlapping with those types of behaviors you may see in antisocial personality. In avoidant personality disorder, as well as in post traumatic stress disorder or even autism spectrum disorders, the avoidant personality learns early on that others are not trustworthy and become distant or withdrawn. They often lack empathy, partly because they've never been shown empathy. They fear commitment and avoid conflict by either shutting down, leaving the situation, or even ending the relationship completely. Now, a person in a relationship that produces avoidant behaviors, whenever they do something incorrectly, whenever they show weakness, whenever they have a need, they are harshly criticized. It's like, suck it up, buttercup. We don't show weakness. And so the child or the person learns that, hey, these people in my life are not responsive when I have a need. It's not safe to go to them because they're going instead of helping, they're actually going to criticize me, make fun of me. So they learn to avoid. It's like it's just easier to not deal with people. It's just me and my dog anxious. This is the person that often has been had experiences of that Jekyll Hyde situation. We often see anxious attachment behaviors in what we label as codependency. And that's not actually a DSM 5tr diagnosis. Borderline personality, histrionic personality and PTSD. In the anxious insecure attachment, the caregivers were often inconsistent. Some days they would be all loving, and other days not so much. And the Person or the child had no idea what was going to show up or why the the caregiver or the other person was responding in that way. The person with anxious attachment tends to latch on to others that are needy and have difficulty separating themselves from their partner in healthy ways. They are so terrified of abandonment. They're so terrified that if you go away, I can't survive, that they will do whatever. They will fight, they will fawn, they will do whatever it is. They often interpret conflict or arguments as a signal that their partner will leave them and begin to frantically avoid abandonment. Disorganized attachment contains characteristics of both anxious and avoidant. So you can start to see how the attachment styles in and of themselves can create a situation that might promote personality disordered sort of behavior. Adverse child experience Adverse childhood experiences as defined by the ACES Too High survey as well as just trauma that somebody experiences in childhood can cause attachment disruption. If you have death or relationship loss, and this can be through divorce. In One of the ACEs that's assessed in the ACEs Too High is divorce. Now, not all kids who go through divorce experience traumatic injury. Sometimes it's a relief that mom and dad aren't fighting anymore. So it's important to recognize that. But note, you know, the more adverse childhood experiences that someone has, the more likely they are to have mental and physical health issues later in life. Obviously, death is an attachment disruption. Relationship loss can also be, especially for younger children. If they have a caregiver who is away for long periods of time, whether they're deployed, they're in jail, something else, and they have no contact with that person. They can't count on that person to show up for their birthdays to make sure they've got food to to their school plays. If there's abuse or victimization either of the child or of the primary caregiver of the child, then you know, if there's domestic violence in the house, that's traumatic, the child is not going to feel safe. The child is going to wonder, you know, who's going to protect me? And if the violence is directed at their primary caregiver, at their primary relationship, then the child's going to start freaking out and saying, well, if you hurt my caregiver, I am not going to be able to live, who's going to feed me, who's going to take me to school, who's going to do this? So the child, even if they're not thinking that, you know, a two year old does, can't put that into words. But we know a two year Old reacts when their primary caregiver is in danger and then neglect. This is the basic needs are not met. And in the Aces Too High study, they talked about mental health or substance abuse issues in the household. And I want you to think about that for a minute. If it's either in the caregiver themselves or in the household, how does that impact the, the environment for the child as they're growing up? When you have someone, and I should say uncontrolled mental health or substance abuse issues, if it's controlled, the person is virtually asymptomatic and so it shouldn't have an, a super negative impact. But when the mental health or substance abuse issues in the household are uncontrolled, if, if little Johnny's 4 years old and he has an older brother who's 16 who is hooked on drugs and skipping school and you know, truing whatever else, how does that impact the family unit, the nuclear family? It causes chaos. It causes chaos and it causes the caregiver's attention a lot of times to be focused on the 16 year old, you know, what do we need to do to keep him out of jail, to keep him alive, blah blah. And the four year old is standing over here going, anybody, anybody gonna pay attention to me? The caregivers are probably stressed. The caregivers may be bickering among one another about, well, if you would have done this, then we wouldn't have this problem. And we know how this goes in families where there is a troubled youth generally that is a behavior that results in some way as sort of their way to try to regain their, their power, to get safe in their own way. But we see that it causes chaos in the whole household and disrupts the caregiver's abilities to be consistent, responsive, attentive, validating, encouraging and safe to everybody else, including themselves. So that can cause problems. And then if a child's being in what I call it indirectly or inadvertently neglected because they're not getting their basic needs met, because the caregivers just had no clue that this child had basic needs that weren't getting met, that is also traumatic. The infant who is neuro atypical can't tell the caregiver, hey, that water feels really hot to me even though to you it feels tepid to me it feels really hot. Or hey, this onesie you put me in every night, you know, is, is painful when it rubs against my skin, it hurts even though you think it's just fine. So the caregiver may be trying to do what is recommended to do with the child of that age. But if the child is neuro, atypical, then the child can perceive it as extremely painful and extremely frightening. Every time caregiver comes in, it's like, oh, what pain is in store for me now? And that can even be caregivers swaddling children. Some children who are neuroatypical prefer being swaddled and having those weighted blankets. Other children, that feels oppressive, but they, especially preverbal children, can't articulate that. And so we do have issues that may be happening in caregivers from and. And relationships from infancy that may cause the child to see the caregivers as threatening, as dangerous, as untrustworthy. All right, so now we're to the symptoms, and I want you to sort of think about these as we go through. If you have been in a relationship, whether it's the primary caregiver or a dysfunctional adult relationship, been in a relationship in which you weren't sure if this person was going to stick around, if you grew up believing that you needed somebody else to survive, that if somebody else left, it wasn't that, okay, you know, I'm gonna have to do some things on my own, but I can get through it. It may suck, but I can get through it. If you rely on other people to validate your very existence, therefore, if they leave, you cease to exist, that's. That's terrifying. So we need to recognize when we see these intense and unstable relationships, one of those key factors in borderline personality. For example, where might that come from? Why might a person get into a relationship and just kind of grab on and be like, oh, my gosh, you're the love of my life. You're my savior. You're going to protect me now, Either in, in adulthood or in childhood. Now, in childhood, we can see a little bit more where the child is desperately seeking safety, but in adulthood, why are people continuing that behavior? And I encourage you to think back to the inner child and the lessons that we learn as we grow up carry with us until we alter them. So our love map that we learned, that we developed when we were growing up stays written the way it is until we rewrite it. And if somebody grew up in a household where their needs weren't getting met, or worse yet, they were experiencing violence or abuse, then, yeah, wow, it's. It's going to be really hard to trust people because nobody in your life has ever been trustworthy. And they may be seeking that one person that they've never had, that one person that's going to be their savior, which can lead to a lot of instability. When you grow up in that environment in which your caregivers were untrustworthy, then, or you've been in a relationship in which the person, the other person in the relationship was untrustworthy and it was an insecure attachment, then you start becoming hyper vigilant to cues their behaviors, the things they say, the way they say things, all of those dog whistles, as they call them now, that indicate that this person might be getting ready to abandon you, that might be unhappy with you. And in their mind, in this person's mind, if they're unhappy with me, it means they will abandon me. So in therapy, we need to start examining what need are you filling by jumping from relationship to relationship and just, you know, meeting somebody and two weeks later moving in with them. What need are you fulfilling? And this intense emotional connection where you fall head over heels in love in a week and then the relationship ends and you're, you know, clinically depressed and, you know, devastated from it. And this happens repeatedly. Number one, how does that mimic the environment that you grew up in? How does that mimic your relationship with your primary caregivers, where one day they were there and they were on and attentive and you just so desperately wanted to keep that going. You did whatever you could to try to keep that going, but eventually you would get the other one. I can never remember which one was the good one, Jekyll or Hyde, but you would get the other one. And you were still doing all the right stuff. But all of a sudden, you know, Jekyll showed up. We'll. We'll assume Jekyll's the bad one, and you don't know why. So you start becoming hyperv vigilant to signs that Jekyll may be getting ready to emerge. And children are very sensitive to this. Children can pick this up. This is not something you have to be 20 to pick up on. Fear of emotional intimacy. Now, this one may be more characteristic of the more avoidant type attachment styles. They don't want to get involved in an emotionally connected relationship because it's too dangerous. They may have this pie in the sky dream of what the ideal person's going to be like. But they never get too attached. They're always ready to cut bait whenever, because that's the way it was in their life growing up. That's what they needed to do in order to feel safe in their. In their skin, in their environments in the past. They needed to be ready to look to somebody else at any given moment. And picking unavailable partners is another potential symptom of a fear of emotional intimacy. If you pick somebody you want to be in a relationship with, but you know that they are married, you know that they're in jail, you know, in what way does that allow you to feel like you've got a connection, but keep it on a very shallow emotional level, Needing constant reassurance now. And think if you're growing up in this environment. And I will remind you that for personality disorders, the behaviors have to start showing up at the latest in adolescence or earlier late adolescence. So these behaviors are showing up early on in this person's life, which means whatever caused those behaviors to develop had to generally had to happen before that. So we're looking at that childhood attachment, that childhood attachment, trauma and abandonment. A child needs reassurance. Children haven't developed all those skills. Children want to make sure that you're that safe home base, that they're loved, that they're lovable. And when they don't get that consistently, then they may need to be told again, if you're not sure if you're going to get Jekyll or Hyde, then you're wanting to make sure you're getting that reassurance. So you know that Hyde is there, you know that you know you're good. And I'm probably using that one backwards, but whatever. Hyper vigilance. We've already talked about that. If you've been in environments, whether you were criticized for showing weakness or emotion or imperfection, or whether you were inconsistently consoled when you showed weakness or, or needs, then you tend to be hyper vigilant to what you assume people's reactions are going to be. So we start seeing in children that grow up in households where there are adverse childhood experiences where there's mental health issue, uncontrolled mental health, or substance abuse issues, they start turning on that hyper vigilance sonar in order to stay safe. They start learning these actions or the way people say things or, or whatever that may indicate that, hey, it's getting ready to get ugly so they can run to a storm shelter, whatever that looks like for them. Hypersensitive to criticism. Well, if the person has avoidant attachment, a lot of times they developed those behaviors as a way of blocking against criticism because they had been criticized and punished so harshly for showing any weakness. They had been told that unless you're perfect, unless you're strong, unless you're invincible, you're not lovable. So, and, and you know, none of us is invincible, none of us is perfect. And. And so they recognized that they weren't lovable or they were taught that they weren't lovable because they were human, because they had imperfections. And that in that family, that meant rejection, that meant punishment, that meant criticism. And that was painful. That was awful. If they were in an inconsistent environment, then the goods were good, but the bads were really bad. And when the bad would show up, the caregiver would say things like, I wish I had never had you. You're the worst child in the world. I hate you, blah, blah. And. And the child's like, oh my gosh, I'm unlovable. You're getting ready to abandon me. Thinking again as a child, someone who can't rent an apartment, drive a car, and get a job. Yeah, it's looking pretty bleak if your caregiver rejects you and kicks you to the curb over Analysis paralysis. Some people get so focused on all of the micro signs on all of the dog whistles that they can't figure out they can't see the forest for the trees. Is this safe or is this not safe? Using the forest metaphor, did those leaves rattle over there because the wind just blew, or is there an angry, hungry bear behind those in the bush somewhere? I don't know. Let me think. Is it safe to move forward? Is it not? Let me stay here. So they end up in that freeze position. Intrusive thoughts of abandonment and rejection. Well, we've kind of talked about that ad nauseam. Relationship sabotage. If the person is feeling unsafe, they're in a relationship. And let's think with borderline personality. First, if you're in a relationship and you've got borderline personality, you get in and it's intense. However, it's intense. You feel vulnerable. You finally feel loved. Now you start becoming fearful of being abandoned. It's like, okay, this is too good. When's the other shoe gonna drop? You start becoming hyper vigilant to any signs that that person is upset with you, because upsetness may indicate that criticism and punishment is going to show up or that you're fixing to be abandoned. So the person becomes hypervigilant to this, which creates the instability. They start getting angry when their caregiver or their. Their partner doesn't respond the way they want them to or hope them to. And when that happens, they're feeling like they need to get out of that situation. So they may, may either inadvertently or overtly sabotage the relationship. It's like everything you do, I'm going To get angry with you. I'm going to create a situation where you end up leaving. That way, you know, I'm creating that self fulfilling prophecy. I'm afraid you're going to leave. And so it triggers my stress response. I'm going to get angry and or maybe even more clingy, which is going to push you further away and eventually leave. They cling to unhealthy relationships. I think we've been in counseling with people who have stayed in a relationship far longer than was healthy for them and they even recognize that. But they either believe that the other person can't live without them. So where would they learn that? Where would they develop that belief that this person can't live without me? Well, let's go back to their primary relationships. Let's go back to that family of origin. In their family of origin did they have to be the parent? Were they parentified? That is, did they have to tuck their parents in? Did they have to get their siblings off to school because their parents were in no shape to do it? Well, if that was the case, then they may start developing what we refer to sometimes as codependency in adulthood where they find people who need them just like their parents needed them. Their parents couldn't reject them because their parents needed them to keep everything going. They find somebody who needs them, which means they're unlikely to reject them and they cling to that relationship and they try to fix that person. People pleasing well, that's one strategy for trying to avoid abandonment. Difficulty trusting others unfortunately for a lot of people with personality disorders and trauma, both either they've had so many experiences where people have failed to meet their needs that they have difficulty trusting others. Now I want to put a caveat on that. Sometimes especially, well, not even especially as adults, sometimes people fail to meet their needs because they don't communicate those needs. Now obviously the example I gave of the infant with who was neuro atypical earlier, the infant can't communicate that. But as we get older, especially in adult relationships or as adolescents, we're able to use our words. And if we assume that people know what we want, we're setting oursel up for disappointment. We're setting oursel up to feel rejected because people may not know what it is we wanted. And that's another skill we need to work on in with people to help them develop secure attachments. You can't expect your partner or even your parent to know what you need all the time or what you want at all the time. You have to be able to articulate that. I mean, I remember when my children were young, very young, and they would get sick and, oh, it just tore me up inside because I didn't know what was wrong. You know, with my son, it was usually pretty easy. He'd start pulling on his ear. I'm like, we got another ear infection. With my daughter, it was a little bit different. She was a lot more nondescript about what was bothering her. And so it was kind of a guessing game. And I think most parents go through that with their preverbal children, low self esteem and a sense of unworthiness. Well, think about what a child. Remember, children think in all or nothing terms. I'm good or I'm bad. Now let's think about borderline personality disordered. Thinking it's good or it's bad is still that dichotomous thinking that was developed in childhood. They categorized the world as safe or unsafe. Now why didn't they move forward to start being able to see the different permutations? There's some argument, there's a lot of argument, actually, that when children are experiencing ongoing stress and trauma, or when people who develop CPTSD stay in this fight or flight mode most of the time. And when you're in fight or flight, you're not in that place where you can use your wise mind. You're in your emotional mind trying to survive. And that's what they did their entire life till now maybe, is tried to survive. So they didn't have the luxury of making mistakes. They didn't have the luxury of evaluating situations. They didn't have the luxury of someone sitting down with them and going, all right, well, let's take a look at what's going on here and evaluate. You know, Sally was mean to you at school today. So is Sally just the worst person ever? Now, you know, let's evaluate why that might have happened. Why might Sally have been mean to you at school today? Let's look at some different options. Besides, Sally hates you now just because she was, you know, unpleasant today, maybe she was having a bad day. And that's what happens in secure attachment in children. Or people who don't have secure attachments, don't have people that are responsive to them when they're in distress. It's harder to really evaluate situations, clearly, because you stay stuck in that threat zone, that place where you feel vulnerable, where you're, you know, just trying to survive. So it would make sense that people who've experienced insecure attachment, attachment trauma, trauma, growing up, may have Low self esteem and a sense of unworthiness. They are their primary caregiver wasn't there for them. You know, that's how we're wired. Is our primary caregiver supposed to be there for us? And, and we even see this some in or often frequently in people who are adopted. Even if they were put up for adoption basically at birth, there is a fundamental relationship between the birth parent and the child that often sort of haunts the child and may impact their self esteem. So we need to help people examine with wise eyes now that they're adults, help them examine and look back and say the things that happened to you. Was it because you were inept, Was it because you were a screw up or was it because you were a bad person? Or was it because your caregiver was struggling with addiction or mental health issues or didn't know what to do and helping them reevaluate that again with wise eyes from a different perspective now they may stick with their original assessments. It's not for me to tell them what happened. But we do want to at least help them evaluate things in their past that caused them to believe that they are unworthy or incapable and say all right, based on the facts in context, how accurate is that? Looking at it with adult eyes, we see emotional disregulation or emot. Emotional numbing. That's what happens when that stress response gets out of whack. People become flat. They get to that flop place where it's hard to care about anything. They've been trying to struggling to stay safe and to exist for so long. They just, they don't have it in them. But when something is sufficiently stressful to trigger that response, then all of a sudden we see a tsunami of stress hormones released in the body and the person goes from flat to frantic or flat to furious. And, and again, because a lot of times trauma results in borderline esque behaviors. I keep referring back to that one, but that's another symptom of borderline personality is that emotional disregulation. And we need to recognize that it's not totally a cognitive thing. There are some thoughts that go into it that may trigger the emotional response, but the emotional response is neurological. Their autonomic nervous system is just wow, out of whack. And so not only do they have a stronger response, but it takes them longer to get back to baseline. Think about if you have a flood in your house. All right, heaven forbid, but you have a flood in your house. If it is the kitchen sink ran over because you Left the water on while you took the dogs out, you know, yeah, that's going to be a mess. It's going to take a bunch of towels to clean up, but it'll dry in a couple of hours as opposed to if the water main breaks and floods your house a foot deep, then it's all in the drywall and it's, it's going to take weeks to dry out. Same sort of thing with the tsunami of stress chemicals. For a typical reaction, it would be, you know, like water overflowing the sink. It's going to take a minute after you get stressed to downregulate and feel rejuvenated again. It's going to, to not be exhausted. For someone with borderline personality or insecure attachment or complex post traumatic stress, they emotionally dysregulate. So then it takes longer to get back to baseline and when they get there, they're plum exhausted and it's going to take a while to get that energy back. Emotional numbing is another symptom that we see. And again, this is often, more oftenly, more often seen more often in people who have antisocial esque or avoidant esque personality disorders. But this is somebody who doesn't appear to feel. They just, they shut it off. It's too painful. I'm not going to feel. I will think, I will see, I will do, but I'm not going to feel. And, and again, behavior is communication. Behavior always serves a purpose. What is the function of this behavior? Protection, survival. I don't want to hurt anymore. Along with that, we see anxiety, which, you know, makes sense if you're worried about abandonment or you're worried about somebody getting too close. We see depression and that could be because of emotional dysregulation from the trauma or that could be a additional characteristic when somebody just, they've lost all hope. They feel totally hopeless and helpless and they're just like, screw it, I give up. Jealousy and envy. This is one we don't talk about a lot, but this is one you see in, dare I say it, narcissistic personality. People who've had unstable relationships, who've had unhealthy and unhappy lives, may be jealous or envious of people who appear to have happy lives. They may feel entitled to have what they were supposed to have, that, know, idyllic childhood or whatever. And that jealousy and envy can sometimes lead to manipulative behaviors. It can lead to violating other people's boundaries. It's like, you don't need all that stuff. I deserve it. I'm jealous of you because you have that. So I'm taking it from you because I want it. And, and yes, that's not a healthy behavior. But again, we want to think back if it developed as a young child. That's how children think. You're on the playground. Jimmy has a ball and you want the ball. A young child is probably going to try to take the ball from Jimmy because it's like, I want it, you don't need it. And, you know, in a healthy environment, the child has learned to empathize and recognize boundaries and all that stuff. But if not, then maybe they learned in childhood that if you want something, you got to take it. If somebody else has something that you're envious of, you got to take it. Or they may have learned that only people who are perfect, only people who are successful are lovable. So they're jealous or envious of anybody they perceive as smarter, prettier, richer, happier than they are. And that makes them feel insecure. So how do they compensate for that? Well, that's that narcissistic facade that we all too often hear about. And they may be highly critical of self and or others. They grew up in an environment where they didn't have secure attachment, where their caregivers were sometimes or all the time highly critical. Then, yeah, they learn to be highly critical of themselves and others. That's, you know, a learned behavior. They learn to focus on what was wrong, what was bad, what was inadequate. If they grew up in an environment where they didn't have secure attachment, they also may fear other people being more lovable than they are. So they may have developed being critical as a react reactive measure to try to bring this person down. Oh, you think that person's so great? Well, let me tell you all these things about them. So see, they're not so great after all. So I'm safe. If you're not wanting them, then maybe I'm still lovable. So the treatment, we want to explore prior relationships, patterns, projections, and lessons learned. And this is where, in my opinion, a good autobiography can be really helpful because it introduces the therapist to the entire cast of characters in 20 or 30 pages. And I know you're like 20. 20 or 30 pages. I typically, when I do an autobiography with somebody, I have them start from their first memory and I have a list of questions. I ask them who was in your household at that point? You know, list each person. What positive and what negative do you remember about that person? How did you feel? Did you feel safe? Did you Feel loved and what did you do? What did your day look like? If they remember kindergarten, you know, what did your day look like in kindergarten? What did you know, who was there? And then we move. And I usually use the anchor points of school because most everybody has gone through school at least up until, you know, mid adolescence. So I say, okay, the next year. And there's again that list of questions in first grade. Who was your teacher? Who did you hang around with? What did you do? And who was in your life? Blah, blah, blah. So you start getting all of the whole cast of characters, but you also start getting a. An overarching feeling of when Junior started feeling unsafe or if they ever felt safe. Those autobiographies are almost never complete. They're always able to be added to over time as the brain starts letting some memories out that it's had locked away. But I have each year. So kindergarten's on one piece of paper, first, grades on another piece of paper, second on another. So obviously you can see if you're working with somebody who's 25, you're going to have 20 pages. Now, there may be more or less writing on each page, but by doing it that way, you leave room to add and to modify for each year as new things come up as they remember. Oh, yeah, when I was in fourth grade, my dog died. Oh, okay. Well, let's add that in there. And through that you can go through. And I typically take the entire autobiography, I read through it, and if that's okay with the client. And we talk about people who were present in their life a lot at first. You know, let's talk about the main characters and what were your relationships like with them? What did you learn about yourself or what did they tell you about yourself? And do you believe that? What were the patterns in your relationships with these people and between those people, like between your caregivers and between your parent and your siblings? What were those relationships like? And are you recreating those now? What are you projecting onto people in your current life? What are you assuming they're going to do based on what somebody did 20 years ago? And what lessons did you learn growing up in that environment? Both the good and the bad? Yeah. Using a traumatic growth standpoint, we can talk about how strong a person had to be to even survive that environment, Talking about how they did what they needed to do to survive until now and how impressive that is. I mean, I see. I hear stories of people who have just gone through incredible traumas and trials, and I think to myself, I Don't know if I could have done that. Own and normalize your feelings. When people are going through treatment, it's important for them to be able to own how they feel. If they are angry or scared, they need to start being able to say, I'm angry and scared, and not be afraid that they're going to be ridiculed or punished or ignored or something else. They also need to learn how to start parenting themselves when they're scared. You know, owning that feeling, normalizing, hey, you know, I feel anxious right now, or I feel scared right now, because then I can look at the facts in context to see if there's an actual threat, and then learning how to process those feelings to understand why I feel scared. And still, instead of saying, well, you're stupid for being scared about this, saying, all right, I am. What. What's underlying that? What are the thoughts that I'm telling myself? Or if you go back to cognitive, behavioral, what are the underlying beliefs that are leading to the consequence of me being anxious in this situation? And once people start to understand their reactions, it feels a lot less overwhelming. Once people start to realize, John went through this situation and reacted totally differently than I did, I reacted. I. I was terrified. Well, let's look at it through your lens, through your phenomenological reality, or through your trauma glasses. That's how you see the world. Because every experience you've had has shaped how you perceive the world, so you perceive it differently than John does. Roller coasters. Some people love them. I'm terrified of them now, why I'm terrified of them. I never really did figure out where that factored into my trauma glasses, but I normalized it and I said, you know what makes sense from a survival perspective? That you probably shouldn't be going 80 miles downhill and turning upside down without being in an enclosed environment or maybe at all. Recognizing our feelings and then figuring out how to address them. Feelings aren't meant to be nurtured and held and just there carried around for days on end. Feelings are meant to tell us, hey, there may be a threat. Just like when the smoke alarm goes off, there may be a threat. Evaluate the situation, figure out if there is, and then figure out what you need to do. Identify triggers and mitigation strategies for unsafeness and disempowerment. And that means going back over the autobiography, but also just in the present tense. Looking back over today, looking back over yesterday, what things are going on in your life, in your relationships at work, financially, that are causing you to feel unsafe or powerless and what can you do about those? Sometimes you just have to sit with the distress. If you are waiting on results to come back from your blood work at the doctor, there is nothing that's going to make that come any faster. So how do you mitigate that distress in the meantime, what can you do in order to feel less disempowered? Mindful awareness. Focus on this context and this person at this time. You can beta test. You can breathe. That's the first thing. Just slow your breathing and you can do that. A lot of people don't like doing square breathing where they breathe in for four, hold for four, exercise, exhale for four, hold for four and do it again. That feels too clinical or weird for them. So you can also slow your breathing by singing really loudly. You breathe in and you project or chewing gum and blowing bubbles. You breathe in, you blow the bubble. Or for kids, you can get little bottles, like in the wedding aisle, they have those little tiny bottles of bubble stuff and you can let them blow bubbles because again, they take a big breath in and then they try to blow as many bubbles as they can. Or they try to blow really slowly and get that one big bubble. Seek support or urge surf. It's important to help people recognize that urges are only thoughts. I have to have a cigarette. I have to have a drink. I have to engage in unhealthy behavior in some way. That's an urge. Your body is or your brain is telling you, I have this urge to do something that has made the pain stop in the past. Okay, you don't have to act. And Hayes, in acceptance of commitment therapy, talks about unhooking instead of saying I have to, saying, I'm having the thought that I have to. I'm having the thought that I have to have a cigarette. Okay, well, I've got this thought. Doesn't mean I have to do it. Once I have this thought, I can disconnect it from me and go, I've got this. What do I do with it? I'm having this thought that I want, need to engage in some unhealthy behavior. Well, that's a thought. Let me evaluate it and see if it's accurate. We can do the same thing with feelings. You know, I feel anxious or I am anxious. Well, that means that's part of me. I can't get rid of part of me. I'm having the feeling of anxiety. All right, well, let me look at this feeling and see if I want to carry it around with me all day. Help people learn what A healthy relationship and secure attachment looks like when people have secure attachments, they're much less likely to engage in behaviors that are commonly associated with personality disorders. And it's important to remember. We're going to talk about this in the next video. But it's important to remember that personality disorders must represent an enduring behavioral pattern over time and across situations. It can't just be this person is an arrogant, self centered, you know, not nice person at work, but they're just a sweetie pie the rest of the time. You know, that doesn't qualify as a personality disorder. That qualifies as a bad boss loss, but not necessarily a personality disorder. So we do need to recognize the CAveats for diagnosing PDS. We do need to very closely, very carefully ferret out whether the behaviors developed after a trauma as and and are a result maybe may be representative of post traumatic stress reactions as opposed to inherent disordered personality. So anyway, helping people learn what a healthy relationship and secure attachment looks like is really important because then they'll, they can feel safer and they may be able to get into their wise mind and start learning alternate behaviors instead of the ones associated with disordered personalities. Help them learn about boundaries. Emotional boundaries, cognitive boundaries, physical boundaries, but also also environmental boundaries. My stuff, stay out of my stuff. And, and if you remember back when you were a child, you may have had a diary and you didn't want your sister or your mother or somebody reading your diary. That that was your stuff. And if they did, that felt like an extreme betrayal. So that is a boundary. You have things you don't want your neighbor coming over to your house and going through your medicine cabinet and your lingerie drawer. You know, it's just, it's not appropriate. That's a boundary. It's not your physical boundary, it's your environmental boundary. They're in your stuff and that's where your private stuff is. We want to make sure they understand what consistency looks like, what responsiveness looks like, as opposed to enabling. And responsiveness is being there to support people, allowing them to do what they can, not doing things for them that they can do for themselves, but allowing them to do the things that they can, but supporting them along the way. Being responsive, being that listening ear attentive is spending quality time with somebody proactively. Not just I'm going to respond when you've got an emergency, but hey, I want to spend time with you. I enjoy spending time with you. Let's go out to lunch validation, encouraging them to validate themselves. I feel how I feel, I think, how I think I, I can evaluate whether I think that I'm accurate or not. But validating in the moment, this is how I feel. Encouragement. Encouraging somebody to take that next step, to go out of the safety zone can be huge in helping them feel, achieve their goals. Because anytime we achieve a goal, it's a little bit outside of our comfort zone. And that can help people move forward if they feel like, hey, there's a safe home base I can come back to if I fail. And if, if I fail at what I'm getting ready to do, that means I'm failing at a behavior or at a task, I'm not a failure as a human being. And then that safe home base. And finally, assertive communication. Helping people learn how to use I statements, how to avoid the blame game, how to communicate their needs so people aren't having to guess, well, what is it that you need? You know, stop expecting mind reading and stop doing it. We need to help them develop a sense of self esteem that hey, I'm okay, I'm acceptable, and self efficacy. I can do things that I need to do and a lot of things that I want to do. I'm not going to succeed at everything, but I can achieve goals. We want to help them develop a secure attachment with themselves. And this is really scary for a lot of people. So that's one of the reasons it's kind of down on the list because they've got to start paying attention to themselves, using mindfulness each day to figure out, how do I feel about this, how do I feel about me, what do I need right now? What are my thoughts, wants and needs? That's where that authenticity comes in. And then being responsive to their own needs, validating their feelings, thoughts and needs, encouraging themselves to move forward to achieve their goals, goals and their rich and meaningful life, and providing a safe home base, if you will. If they fail, all right, you know, I failed, I, I screwed that up or I'm not going to be able to do that. Doesn't mean I am less of a person. It doesn't mean I'm less lovable. When they can start developing that internal dialogue, then a lot of those behaviors that were required to feel safe and avoid abandonment will disappear. Because they don't need any one particular person to be their savior. And we need to help them use decisional balance exercises regarding relationships. So you have have them put the relationship up here and then you have them list the good, the benefits and the drawbacks to staying in the relationship and the Benefits and the drawbacks to leaving the relationship and help them make a very objective evaluation of what's going on, treatment targets and strategies. Again, we're going to go back to those symptoms we talked about earlier and I'm not going to go through each one of these in depth again. But that pattern of intense and unstable relationships have them really focus and be mindful of their current relationships so they can become aware of their projections, their assumptions, their mind reading, their how they may be using the relationship to fill a need instead of for what it is and evaluate what's going on in their relationships that that may be causing instability or causing them to perceive instability. I use the analogy with relationships that they're, they're like cookies. You have sugar cookies over here, perfectly good on their own. You have chocolate chips over here, really good on their own. When you put them together, they bring out the best in each other. You eat them. Can you have them each independently? Yes. They don't complete each other. They enhance each other. We have people evaluate their ability for emotional intimacy, to trust others, and for, for people who have more anxious attachment, a lot of times that's helping them learn how to reign it in a little bit and not just put everything out on the table right away. And for people who are more avoidant, helping them figure out how can I test those waters to figure out if it's safe to share. Keeping a journal even of their need for reassurance and their hyper vigilance to evaluate what triggers that and what they can do to address it. In therapy, having them identify three times over the last week they felt criticized and they may in their estimation have been hypersensitive to it. What was that about? What other messages were they telling themselves or what events did that remind them of in the past? If they get over analysis paralysis, they have been talking about doing something for the last six sessions, then we need to, you know, stop and go. Okay, we've been talking about this for six sessions. We've been going over the same thing. I'm wondering what the next step is to move forward in this and what do you need to do really? Helping people start making a decision and recognize that most of the time, even if you take a step forward and it doesn't work out, you can back up and regroup. It's generally not going to be totally catastrophic. Have them keep a log of their intrusive thoughts of abandonment and rejection and develop counter statements to tell themselves that they believe. You know, if they are telling themselves, you, you're worthless Nobody wants to stay with you. And you tell them we'll replace that with I am lovable and I deserve to have someone in my life. They don't believe that. So most likely. So telling themselves that's pro. That's not going to sink in. It's not like if they say it enough times, it's going to all of a sudden mean something. So we do want to have people develop something that works for them. If they have these intrusive thoughts that, you know, what if this person leaves me? Okay, you know, let's look at, what does that mean? Can you survive? Will it suck? Yes. But can you survive? So have them recognize that yes, that is not what I want, but I am strong enough to get through it. And this is how. Have them evaluate past relationships and ways that they may have sabotaged inadvertently those relationships and what they can do to prevent that in the future. Have them evaluate their behaviors based on people pleasing and point that out in, in session. When you're talking about things and you, you hear them saying, yeah, I agreed to go help so and so move and I agreed to do this and I agreed to do that, they can't say no. I will often point that out and go, hm, sounds like you're having difficulty saying no. And I'm wondering what function this people pleasing is, is serving for you. Difficulty trusting others. Look at the facts in context. Not every, well, most everybody, I won't say everybody, most everybody is going to disappoint you or, or let you down once in a while. That's just humanity. But recognizing each situation with the facts in context, did this person do it intentionally? Did they do it maliciously? Even if it was unintentional, if you pointed it out to them, did they stop or did they keep doing it? And then making decisions whether that person is safe based on their behaviors, identifying alternatives, alternative explanations when things don't work out, you know, why else might this have happened besides you're a loser, which is what they're saying. I would never say that to them. What, what other things contributed to this failure? Again, we talked about low self esteem, emotional dysregulation, healing, the HPA axis healing, that autonomic nervous system is essential for emotional regulation. It will be important for people to start getting adequate quality sleep, eating a relatively healthy diet, removing any physical stresses they can, as well as removing as many environmental psychological interpersonal stressors that they can. Now, they probably can't go sit on a beach in Tahiti for three months. So we know there's Going to be some stress, but helping them recognize the impact that stress has on preventing them from healing. It's like picking the scab off. Every time it starts to form a scab, you pick it off. Well, it's going to take longer for the cut to heal, so we need to not pick our scabs. Early attachments create a prototype for future relationships. Later experiences of rejection and abandonment can also inhibit secure adult attachment. Insecure attachments lead to a pervasive sense of unsafeness and sometimes disempowerment, which causes disruption of the HPA axis, the stress response, and leads to a spectrum of symptoms. Sleep disruption, increased inflammation, increased sickness, increased irritability, difficulty concentrating, brain fog, intrusive thoughts. The list goes on. When early attachments are insecure, the person in treatment or eventually will need to re examine their expectations or their assumptions about people and develop a new relationship model. So let me turn this back on. All right. You can obviously use the chat window or you can turn on your microphone if you want to ask questions. Allan asks, how do you treat a client whose lack of love as a child causes them the inability to feel love as an adult? Obviously, one size doesn't work for all. So I'm going to throw out a couple different suggestions. The first would be to examine not having love as a child and grieve that loss. They didn't have that and love hurts. Now, loving someone or feeling love from someone hurts because it may remind them of all of the years they so desperately wanted love and didn't have it. So grief work can be really, really helpful. If they have never experienced love, then they may not know what love feels like. You can have them go through the love languages. You know, whether it's touch acts of service gifts, quality time, and physical touch acts of service qualities. What's the fifth one? I can't remember right now. You can have them go through that and identify what their love language is and then start noticing when people communicate that way to them. So maybe they start identifying, oh, that's, that's, that's what love is. You know, that's, that's what it feels like to actually feel love. They may not know what they're expecting. They may be expecting fireworks and rainbows and they ain't getting it. And they're like, well, I, I don't, I don't know how. I don't feel any love. I don't feel anything. We also need to recognize that when the HPA axis is disregulated, people are often apathetic, flat Anhedonic, they can't feel the emotion center of the brain says we don't have energy for those feelings. Things right now, we're just flat, and if necessary, we'll get furious or frantic, but we don't have energy for those happy emotions at the moment. They have wired for a state of persistent fight or flee. It's either rest and recoup and prepare for the next sprint from the hungry lion or, well, sprint from the hungry lion. So those are a bunch of different reasons, I guess, underlying causes for why someone may not be able to feel love. I might also ask them, what is it that you're hoping this love to look like? Have you seen someone experience love? What did that look like? Have them start communicating that if they're in a relationship with somebody, going back to those love languages, maybe they're having difficulty feeling love because that person's not communicating to them in their love language. So that might be a couple's therapy session. What else do y' all have to put out there that. What. What else might you do if you are working with a client who is having difficulty feeling love? Words of affirmation. Thank you, Adriana. That was the one I was forgetting. If the child grew up or the person grew up in a very critical household, then they may have craved words of affirmation and never gotten it. They may fear words of affirmation. Now they want to love. They want to be loved. But again, just like the feeling of love, the actions, the love languages themselves may almost cut to the core. Help them explore how they love themselves. Or if they don't love themselves, is there anything that they do love? Maybe. And. And I don't say this in jest, maybe it's their dog. Some. Some people are very. I mean, they would walk over hot coals for their animal. They would skip a meal so their animal could eat. You know, they're. They show love to that animal that way, partly because animals give unconditional positive regard. But that's a whole different. Whole different video. Or to their child. If they are able to love their child, how do they do that? And how can they do that for themselves? How can they do those same behaviors like making sure to be responsive to their needs, that they're getting fed bed, that they're getting bathed, that they're feeling safe? Michelle says when dealing with attachment issues. Oh, and welcome, Michelle. Good morning. What does treatment look like for someone who has disorganized attachment? What type of self work can the client do between treatment sessions? With any type of attachment issues. I encourage journaling, and it doesn't have to be really long. It can be a little bullet points, whatever. But I encourage journaling so they can start identifying patterns in disorganized attachment. Sometimes they're going to feel avoidant and sometimes they're going to feel anxious. So what's the difference? Is it a difference in them? For example, if they're feeling exhausted and overwhelmed, they just can't deal with other people, they'd rather be alone. And then other times they really crave a relationship. Or is it with certain types of people they are avoidant of authority figures or avoidant of people who might want to show them love because they're afraid of abandonment, but they are anxiously attached at work and they will do whatever they need to do in order to keep their job. I don't know. But identifying, because that behavior is communication. When you start avoiding something, you're protecting yourself. What are you protecting yourself from? When you start clinging, you're still protecting yourself, but in a different way. So how is that thing that you're trying to cling to that you're becoming anxious that you're going to lose? What function is that person, event, whatever, serving in your life? Audio journaling. Great suggestion, Enola. Audio journal journaling can really help for people like me who hate to write. You can also in Microsoft Word, it actually has a pretty good dictation tool now if you want to dictate your journal onto that so you have something written down that you can give to your therapist. So that's a, that's a great idea. And I hadn't brought that up. They said, and I never did any research on the actual veracity of this claim, but they said that Sigmund Freud used to talk to himself all the time. He would basically psychoanalyze himself using that free association. He would just talk in order to uncover his unconscious motives. And for some people, that really works. They can sort of talk it out if they don't have somebody they can bounce it off of. Recording into your mobile device can also be helpful if you're having a thought record right now that you want to get back to, or if you're just, you're having a thought, you record it and then you play it back and you hear it. And when you hear it out loud, you're like, yeah, I'm not thinking that's accurate. So that's a really interesting way to use the recorder. So that, that's cool.