Symptoms

By Mayo Clinic staff

Signs and symptoms of post-traumatic stress disorder typically begin within three months of a traumatic event. In a small number of cases, though, PTSD symptoms may not occur until years after the event.

Post-traumatic stress disorder symptoms are commonly grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal).

Symptoms of intrusive memories may include:

• Flashbacks, or reliving the traumatic event for minutes or even days at a time
• Upsetting dreams about the traumatic event

Symptoms of avoidance and emotional numbing may include:

• Trying to avoid thinking or talking about the traumatic event
• Feeling emotionally numb
• Avoiding activities you once enjoyed
• Hopelessness about the future
• Memory problems
• Trouble concentrating
• Difficulty maintaining close relationships

Symptoms of anxiety and increased emotional arousal may include:

• Irritability or anger
• Overwhelming guilt or shame
• Self-destructive behavior, such as drinking too much
• Trouble sleeping
• Being easily startled or frightened
• Hearing or seeing things that aren’t there

Post-traumatic stress disorder symptoms can come and go. You may have more post-traumatic stress disorder symptoms during times of higher stress or when you experience reminders of what you went through. You may hear a car backfire and relive combat experiences, for instance. Or you may see a report on the news about a rape, and feel again the horror and fear of your own assault.

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The Effects of Domestic Violence
on Children

In homes where domestic violence occurs, children are at high risk for suffering physical abuse themselves. Regardless of whether children are physically abused, the emotional effects of witnessing domestic violence are very similar to the psychological trauma of being a victim of child abuse.

• Children in homes where domestic violence occurs may “indirectly” receive injuries. They may be hurt when household items are thrown or weapons are used. Infants may be injured if being held by the mother when the batterer strikes out.
• Older children may be hurt while trying to protect their mother.
• Children in homes where domestic violence occurs may experience cognitive or language problems, developmental delay, stress-related physical ailments (such as headaches, ulcers, and rashes), and hearing and speech problems.
• Many children in homes where domestic violence occurs have difficulties in school, including problems with concentration, poor academic performance, difficulty with peer interactions, and more absences from school.
• Boys who witness domestic violence are more likely to batter their female partners as adults than boys raised in nonviolent homes. There is no evidence, however, that girls who witness their mothers’ abuse have a higher risk of being battered as adults.
• Taking responsibility for the abuse.
• Constant anxiety (that another beating will occur) and stress-related disorders.
• Guilt for not being able to stop the abuse or for loving the abuser.
• Fear of abandonment.
• Social isolation and difficulty interacting with peers and adults.
• Low self-esteem.
• Younger children do not understand the meaning of the abuse they observe and tend to believe that they “must have done something wrong.” Self-blame can precipitate feelings of guilt, worry, and anxiety.
• Children may become withdrawn, non-verbal, and exhibit regressed behaviors such as clinging and whining. Eating and sleeping difficulty, concentration problems, generalized anxiety, and physical complaints (such as headaches) are all common.
• Unlike younger children, the pre-adolescent child typically has greater ability to externalize negative emotions. In addition to symptoms commonly seen with childhood anxiety (such as sleep problems, eating disturbance, nightmares), victims in this age group may show a loss of interest in social activities, low self-concept, withdrawal or avoidance of peer relations, rebelliousness and oppositional-defiant behavior in the school setting. It is also common to observe temper tantrums, irritability, frequent fighting at school or between siblings, lashing out at objects, treating pets cruelly or abusively, threatening of peers or siblings with violence, and attempts to gain attention through hitting, kicking, or choking peers and/or family members. Girls are more likely to exhibit withdrawal and run the risk of being “missed” as a child in need of support.
• Adolescents are at risk of academic failure, school drop-out, delinquency, substance abuse, and difficulties in their own relationships.

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Why Women Stay
The Barriers to Leaving

One of the most frustrating things for people outside a battering relationship is trying to understand why a woman doesn’t just leave. A letter to Dear Abby on the subject was signed “Tired of Voluntary Victims.”

The most important thing to keep in mind is that extreme emotional abuse is always present in domestic violence situations. On average, an abused woman will leave her partner 6-8 times. The reasons they return or stay in the relationship vary from case to case. Some of these include:

• Economic dependence. How can she support herself and the children?
• Fear of greater physical danger to herself and her children if they try to leave.
• Fear of being hunted down and suffering a worse beating than before.
• Survival. Fear that her partner will follow her and kill her if she leaves, often based on real threats by her partner.
• Fear of emotional damage to the children.
• Fear of losing custody of the children, often based on her partner’s remarks.
• Lack of alternative housing; she has nowhere else to go.
• Lack of job skills; she might not be able to get a job.
• Social isolation resulting in lack of support from family and friends.
• Social isolation resulting in lack of information about her alternatives.
• Lack of understanding from family, friends, police, ministers, etc.
• Negative responses from community, police, courts, social workers, etc.
• Fear of involvement in the court process; she may have had bad experiences before.
• Fear of the unknown. “Better the devil you know than the devil you don’t.”
• Fear and ambivalence over making formidable life changes.
• “Acceptable violence”. The violence escalates slowly over time. Living with constant abuse numbs the victim so that she is unable to recognize that she is involved in a set pattern of abuse.
• Ties to the community. The children would have to leave their school, she would have to leave all her friends and neighbors behind, etc. For some women it would be like being in the Witness Protection program–she could never have any contact with her old life.
• Ties to her home and belongings.
• Family pressure; because Mom always said, “I told you it wouldn’t work out.” or “You made your bed, now you sleep in it.”
• Fear of her abuser doing something to get her (report her to welfare, call her workplace, etc.)
• Unable to use resources because of how they are provided (language problems, disability, homophobia, etc.)
• Time needed to plan and prepare to leave.

• Insecurity about being alone, on her own; she’s afraid she can’t cope with home and children by herself.
• Loyalty. “He’s sick; if he had a broken leg or cancer–I would stay. This is no different.”
• Pity. He’s worse off than she is; she feels sorry for him.
• Wanting to help. “If I stay I can help him get better.”
• Fear that he will commit suicide if she leaves (often he’s told her this).
• Denial. “It’s really not that bad. Other people have it worse.”
• Love. Often, the abuser is quite loving and lovable when he is not being abusive.
• Love, especially during the “honeymoon” stage; she remembers what he used to be like.
• Guilt. She believes–and her partner and the other significant others are quick to agree–that their problems are her fault.
• Shame and humiliation in front of the community. “I don’t want anyone else to know.”
• Unfounded optimism that the abuser will change.
• Unfounded optimism that things will get better, despite all evidence to the contrary.
• Learned helplessness. Trying every possible method to change something in our environment, but with no success, so that we eventually expect to fail. Feeling helpless is a logical response to constant resistance to our efforts. This can be seen with prisoners of war, people taken hostage, people living in poverty who cannot get work, etc.
• False hope. “He’s starting to do things I’ve been asking for.” (counseling, anger management, things she sees as a chance of improvement.)
• Guilt. She believes that the violence is caused through some inadequacy of her own (she is often told this); feels as though she deserves it for failing.
• Responsibility. She feels as though she only needs to meet some set of vague expectations in order to earn the abuser’s approval.
• Insecurity over her potential independence and lack of emotional support.
• Guilt about the failure of the marriage/relationship.
• Demolished self-esteem. “I thought I was too (fat, stupid, ugly, whatever he’s been calling her) to leave.”
• Lack of emotional support–she feels like she’s doing this on her own, and it’s just too much.
• Simple exhaustion. She’s just too tired and worn out from the abuse to leave.

• Parenting, needing a partner for the kids. “A crazy father is better than none at all.”
• Religious and extended family pressure to keep the family together no matter what.
• Duty. “I swore to stay married till death do us part.”
• Responsibility. It is up to her to work things out and save the relationship.
• Belief in the American dream of growing up and living happily ever after.
• Identity. Woman are raised to feel they need a partner–even an abusive one–in order to to be complete or accepted by society.
• Belief that marriage is forever.
• Belief that violence is the way all partners relate (often this woman has come from a violent childhood).
• Religious and cultural beliefs.

Long-Term Effects of Domestic Violence

The long term effects of domestic violence have not begun to be fully documented. Battered women suffer physical and mental problems as a result of domestic violence. Battering is the single major cause of injury to women, more significant that auto accidents, rapes, or muggings. In fact, the emotional and psychological abuse inflicted by batterers may be more costly to treat in the short-run than physical injury. Many of the physical injuries sustained by women seem to cause medical difficulties as women grow older. Arthritis, hypertension and heart disease have been identified by battered women as directly caused or aggravated by domestic violence suffered early in their adult lives.Battered women lose their jobs because of absenteeism due to illness as a result of the violence. Absences occasioned by court appearances also jeopardize women’s livelihood. Battered women may have to move many times to avoid violence. Moving is costly and can interfere with continuity of employment. Battered women often lose family and friends as a result of the battering. First, the batterer isolates them from family and friends. Battered women then become embarrassed by the abuse inflicted upon them and withdraw from support persons to avoid embarrassment.

Some battered women are abandoned by their church when separating from abusers, since some religious doctrines prohibit separation or divorce regardless of the severity of abuse.

Many battered women have had to forgo financial security during divorce proceedings to avoid further abuse. As a result they are impoverished as they grow older. One-third of the children who witness the battering of their mothers demonstrate significant behavioral and/or emotional problems, including psychosomatic disorders, stuttering, anxiety and fears, sleep disruption, excessive crying and school problems.

Those boys who witness their fathers’ abuse of their mothers are more likely to inflict severe violence as adults. Data suggest that girls who witness maternal abuse may tolerate abuse as adults more than girls who do not. These negative effects maybe diminished if the child benefits from intervention by the law and domestic violence programs.

Browne, Angela. When Battered Women Kill. (The Free Press 1987). Ewing, Charles Patrick. Battered Women Who Kill. (Lexington Books 1987).

How does Domestic Violence Affect Children?

The tragic reality is that anytime a mother is abused by her partner, the children are also affected in both overt and subtle ways. What hurts the mother, hurts the children.

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The Top Ten Secrets For Great Sex!

By Dr. Philip E. Humbert

Clearly there are no rules, only what lovers have known since Antony and Cleopatra: “Pay attention, be kind, and be loving”. But the following Top Ten List might be a useful reminder! Enjoy!

1. Guys: Great sex starts in the kitchen! Wash the dishes, take out the trash, give her a break, let her know she’s appreciated. Romance and exhaustion do not mix — think about it! (Besides, standing there, side by side, washing and drying those dishes, hands could get to roamin’ and motors could get to tickin’ …the most amazing things do happen!)

2. Gals: Tell that old fool just exactly what you’ve been waiting for! Most males are notoriously poor mind readers, they just don’t “get it”. So tell him! “A little softer” or “let me show you” goes much further than, “How come you never know what I want?”

3. Guys: Take time! Sex is about fun, relaxation, laughter and love — this is not a competition or a 50-yard dash to the finish line! Start slow, let it build, then finish strong. A glass of wine, maybe some music, a backrub, even a few minutes of silence can shift the mood and make things verrrry interesting!!

4. Gals: Make Time! How often does sex happen last thing at night, with two exhausted people trying to find each other in the dark? Or, first thing in the morning, half asleep, with bad breath? If sex is important, why not treat it like getting your haircut or picking the kids up after school?

In other words, schedule time, put it on the calendar and treat it as a key part of keeping yourself and the family running smoothly.

5. Guys: Think about your 4th date with the woman you love, after you were well acquainted but everything still felt new and exciting. Remember thinking about it, scheduling it, making dinner reservations?

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By Peggy Ferguson

There may be more to marital happiness than the anticipated ingredients of love, respect, honesty, and faithfulness.

But what does that really mean? Even with the desired relationships and partner characteristics of love, respect, honest, commitment, and faithfulness, one or both partners are unhappy in the relationship. What does it take for a marriage to be a happy one?

A missing ingredient may be “meaningful interaction”. While couples may be spending time with each other routinely, most couples neglect to nurture their relationship regularly. When both parties are feeling important, loved, and secure in the relationship, active attention to the relationship may not feel important. It becomes more important as one or both partners do not “feel” loved or important to the other. The need for active engagement and nurturance of the relationship is apparent when a partner complains that they “do not communicate” and do not spend enough “quality” time together

They often already know the problem and presumably how to fix it, but cannot seem to get started with enacting their solution. One of the stumbling blocks to being able to effectively bridge the gap and nurture the relationship is that each individual has made some attempts in his or her own individual way, but felt discouraged when it did not receive the desired response or effect. Each has different communication goals and expectations. They have different ways that they want to be shown love. Their ideas about what they want communicated are different. And there is great diversity in what “quality time together” means.

Attempts to solve the problem fail as one or both partners set out to fix the situation by giving to the partner what s/he wants from communication or time together. Since the partners want something other than what is being given, they stay frustrated. They are frustrated not only about still not getting what they are wanting but also about trying and not having their efforts recognized by the partner.

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Enhancing Marital Communication

March 25th, 2008  |

by John Gerson, Ph.D.

Click here to contact John and/or see his GoodTherapy.org Profile

I’d like to begin with the following vignette. It’s fictional, but contains communication snafu’s that, although probably unintentional, can be wounding. How the wound is dealt with can determine if its effects are short-lived or if they become part of the catalog of complaints that one spouse holds and remembers about the other.

“Kitty and Joe, both in the early 40’s, have been married for 15 years, and have 2 children, Cathy, age 12, and her younger brother, Bobby, age 8. B0th Kitty and Joe are attorneys; Kitty works part time for a local corporation, and Joe works full time in his family’s law practice. They are generally a thoughtful, cooperative couple, and after Cathy’s birth, found that the increased stress and demands placed on both of them made their cooperation with each other even more important. Their relationship is strong, and its durability has rested on their usually being mature and above all, conscious of their own behavior and how it affects their partner.

Recently, however, stress has mounted. Joe’s law practice has suffered an economic downturn; fewer and fewer litigation cases are coming into the firm, and although Joe’s compensation is not yet being affected, he’s worried. Cathy continues her part-time corporate job. She’s is as yet personally unaffected by the slowing economy, but she is aware that the company has been considering laying off less essential personnel. In short, both husband and wife are somewhat worried; their sleep is being affected, and Joe, the spouse more inclined to somaticize his stress, that is, to put it into his body, has had bouts of diarrhea and headache.

It’s a Tuesday, not one of Kitty’s work days. She has spent her morning doing bills; she has had a few phone conversations with neighbors about their kid’s health and the sports activities that their children have in common. Kitty has been frustrated that Cathy hasn’t been selected to play on the town basketball league, and has both been trying to understand the coach’s position and dealing with Cathy’s feelings of hurt and anger. She knows that her daughter can be moody, and for years has seen Cathy scream and have mild breakdowns when playing with other kids who she sees as ‘unfair.’ Nevertheless, she tells her friend on the phone, “this is a children’s league, after all, and sports are where they are supposed to learn sportsmanship, and Cathy is a good player. Maybe I’ll talk to the coach myself.” Kitty’s irritation is supported by her friend, and she finds the feeling useful as she tackles some housework, carrying the laundry downstairs and putting the first of at least 4 loads into the washing machine. The house is not completely picked up, and has that definitely lived in appearance. Kitty is hungry, decides to have lunch, and get to the house later, maybe after she’s dropped Bobby off for soccer practice, and before she has to pick him up again. Bobby’s bus drops him off, he has a snack, and Kitty loads him and his equipment into the car. Just as she says goodbye to her son, he begs her not to leave and to watch him play. She agrees, and stays at the field.

Meanwhile, Joe is driving home early from the office, having had his own frustrating day. There have been more and more of them, as local firms are becoming more competitive for clients, and clients are thinking twice about retainer fees in this environment, preferring to wait and tolerate whatever their injuries are, at least for now. When traffic on 684 suddenly slows to a crawl, the feeling that he just can’t get a break becomes compounded. He and Kitty have not been getting along as well as they used to; each of them has become more peevish and irritable, and the bad feelings have been circling with little interruption for weeks. Somewhere inside him he implicitly knows that his frustration has been leading him around, driving the car, rather than sitting in the back seat as one of his emotional passengers.

Kitty’s efforts to recognize what he’s been going through have not really hit the mark, and as a result of his relatively unabated irritability her needs for loving attention have gone unmet, and she has become more aggressive in return. Now there’s this miserable traffic! He picks up his cell phone, calls the house, only to get their answering machine. She won’t even be there when he gets home, he thinks to himself, with growing resentment. Joe’s need for soothing has been growing, and when he left the office early, he thought that maybe today he would get what he needed from her. Irritation blended into despondency and back again in a slow cycle that seemed to match the traffic’s crawl.

Joe finally pulls into his driveway; Kitty’s car is not there. Given the recent emotional stalemate between them, he’s not sure if this is the good news or the bad news, and resolves to take a bike ride, thinking the exercise would help to reduce his stress. His bicycle shorts are nowhere to be found, and there are no athletic socks in his drawer. Grumbling to himself, he heads down to the laundry room, to find 1 load of wet laundry sitting in the machine, and the rest of the wash in baskets on the floor. He heads back upstairs with mounting anger, developing a case of his own that he doesn’t count around here, that he can’t get his needs met, and lately that’s included in the bedroom. Kitty comes home with Bobby. The afternoon has been a good one for her, and she had found herself glad to have spent the time at the field with her son, enjoying the children’s activity and breathing in the cold wintry air. Her own irritation and despondency had been softened by the sensuousness of her experience, and when she saw Joe coming down the stairs she approached him with an affectionate hug. Joe’s mood remained dark, and unable to accept her gesture, he snapped. “What have you been doing all day? The house is a mess, and I can’t find my bicycle shorts, which I assume are still wet.”

Kitty attempts to explain her day, and Bobby wanting her to watch the game, when he cuts her off. “I can’t get anything around here. Bobby got what he needed, but not me! I’m working my ass off all day, and that’s not adding up to much. Do you have any idea the pressure I’m under to bring money into this house?”

Kitty backs up, feels like crying, but doesn’t. She’s no lightweight, and can defend herself. “Don’t speak to me that way, like I’m a piece of trash. I have a life of my own, and I’m your wife, remember? Screw you!”

With that she storms past him, and he heads for the door, needing to be away from her. Before slamming it behind him, he fires a last volley, escalating their conflict: “And what about last night?” referring their not having sex.

What’s happened here? What’s gone wrong? Is their marriage in trouble? What steps would you take to heal their hurt feelings?

Key Points to Remember:

1. Demonstrate that you have empathy for your partner’s experience. People who do not experience empathy in their relationships feel unimportant and disconnected.

2. Empathy occurs through Active Listening, with such language as, “I hear what you’re saying,” and even better, “I hear you,” spoken with real feeling.

3. Efforts to empathize with words alone are shallow and insufficient. Tone of voice must be consonant with the intended message.

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Pediatrician believes ADHD does not exist
By Jimmy Tomlin
Oct 26,2008

HIGH POINT – If there’s such a thing as an “ADHD Establishment,” Dr. Bose Ravenel stands firmly in the anti-establishment camp.

And that badge – he refers to himself as “a rebel with a cause” – is one the 70-year-old High Point pediatrician wears proudly.

“I don’t relish it,” he says, “but it doesn’t bother me because I’m convinced about what we’re doing.”

Ravenel, who has practiced in High Point since 1988, has co-authored a new book – with noted family psychologist John Rosemond – that likely will make him a lightning rod for criticism from the aforementioned ADHD Establishment.

In the book, “The Diseasing of America’s Children: Exposing the ADHD Fiasco and Empowering Parents To Take Back Control” (Thomas Nelson, $24.99), the authors not only hold the ADHD Establishment’s feet to the fire – they toss the establishment into the fire, using such pointed phrases as “a travesty of science,” “flimsy evidence,” “a scandal waiting to erupt,” and “an effort that has resulted in the manufacture of diseases that do not exist.”

Specifically, the authors contend that those “diseases that do not exist” – namely, ADD (attention-deficit disorder), ADHD (attention-deficit hyperactivity disorder) and ODD (oppositional defiant disorder) – are based on bad science, most likely do not derive from a genetic brain disorder, and therefore do not require potentially harmful medications for treatment.

They further contend that the classic ADHD symptoms such as inattention, forgetfulness, inability to focus, hyperactivity and impulsivity can be addressed through a behavioral treatment model rather than resorting to drugs.

“We believe the professional literature is skewed in the direction of overstating the effect of medications on these children and understating the potential harmful effects,” Ravenel explains.

Ironically, Ravenel admits he’s a former member of the ADHD Establishment.

“That’s why I don’t blame them, because I was there with them,” he says. “I never knew any different. As a busy doctor, you tend to read the journals that are published by authors who have heavy pharmaceutical company ties, so you’re not aware of this whole alternative perspective.”

About seven or eight years ago, though, Ravenel says he began to question the alarming rate at which children were being diagnosed with ADHD, particularly considering the absence of the disease in previous generations.

“That got me to begin looking seriously at those rare individuals who would write articles suggesting that ADHD is not real – I looked at why they said that,” Ravenel recalls.

His conclusion? ADHD is B-O-G-U-S.

Ravenel and Rosemond argue in their book that in the 30-plus years since ADHD was recognized as a behavior disorder, no objective diagnostic criteria have been developed; no ADHD gene has been discovered; and no ADHD biochemical imbalance has been quantified.

“We don’t believe there’s any evidence to support (ADHD’s existence), and there’s a compelling amount of evidence to support what we’re proposing,” Ravenel says. “We think everybody ought to be trying this alternative first.”

Ravenel’s primary concern, he says, is the longterm impact of ADHD medications such as Ritalin, Concerta and Adderall.

“Even establishment members would agree that no one knows what the effects of longterm exposure to these psychotropic drugs would be,” he says.

The authors recommend a four-prong behavioral approach in lieu of medication:

• Reframe the child’s self-image from that of a person with a disabled brain to one with great potential. That can be done, they say, through an old-fashioned parenting approach that combines “powerful love and powerful discipline.”

• Eliminate or restrict the child’s exposure to electronic media such as TV, video games and computers. “Children get addicted to these electronic stimuli,” Ravenel says.

• Change the child’s diet from the typical American diet of fast food, processed carbohydrates and sugars to more healthy foods. Also, fish oil supplements have been shown to benefit learning and behavior, Ravenel says.

• De-emphasize the current educational trend that requires kindergartners to learn what once wasn’t learned until first grade, because that trend causes more children to struggle and fail.

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