Histrionic Personality Disorder

by Aunt Becky | May 7, 2019

What Is Personality?

Personality is a particular set of behaviors, traits, emotions, and patterns that make up a person, his character, and their individuality. Personality includes how we see the world, our thoughts, attitudes, and feelings. Personality is strongly influenced by our values, attitudes, perception of ourselves, and predicts our reactions to people, the world, stress, and problems.

While there are many different definitions of personality, most focus on the pattern of behaviors and characteristics that can help predict and explain a person’s behaviors.

What Is A Personality Disorder?

A person’s personality may be influenced by experiences, environment (surroundings, life situations) and inherited – genetic – characteristics. A person’s personality typically stays the same over time.

While personality disorders differ from mental disorders, like schizophrenia and bipolar disorder, they do, by definition, lead to significant impairment. Personality disorders are estimated to affect about 10 percent of people, although this figure ultimately depends on where clinicians draw the line between a “normal” personality and one that leads to significant impairment.

A personality disorder is a way of thinking, feeling, and behaving that is different from the expectations of the culture, causes distress, problems functioning, and lasts over time. Personality disorders are almost always associated with marked social and personal disruption and are both pervasive and inflexible. While these behaviors can produce poor coping skills, leading to personal issues including anger, anxiety, depression, and distress, they are considered appropriate by the person with the disorder.

There are 10 specific types of personality disorders. Personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected. The pattern of experience and behavior begins by late adolescence or early adulthood and causes distress or problems in functioning.

Without treatment, personality disorders can be long-lasting. Personality disorders must affect at least two of the following areas:

• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior

What is Histrionic Personality Disorder?

Histrionic Personality Disorder (HPD) is a personality disorder characterized by a pattern of extreme, intense emotions as well as attention-seeking behavior. A person who has histrionic personality disorder needs to be the center of attention in a group – any group – and when they are not, they become upset and uncomfortable. Histrionic personality disorder (HPD) also majorly interferes with emotional stability, and are prone to emotional overreaction in a wide variety of situations, and from the viewpoint of others, they may seem constantly on edge. When they do react, it is usually from a self-centered perspective, and the needs of others are seldom their priority.

In addition to the extremes of their emotional sensitivity and reactivity, people with histrionic personality disorder have a strong need to be the center of attention and frequently exhibit a range of attention-seeking behavior. They also want instant satisfaction and are easily frustrated or overwhelmed by obstacles or criticism. People with HPD usually have good communication skills and are often quite charismatic, projecting a “life of the party” or “larger than life” image. But beyond good initial first impressions they have a difficult time establishing and maintaining close and satisfying relationships.

Despite their self-absorption, people with HPD are subsumed by insecurity, which usually leaves them frustrated and miserable and seeking answers for their feelings of inadequacy.

HPD is classified as a Cluster B personality disorder, along with borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder. People with Cluster B conditions are known to be highly emotional, erratic in their feelings and behavior, and self-centered in their approach to socializing and building relationships.

Nearly 15 percent of the American population meet the diagnostic criteria for one or more of 10 recognized personality disorders. Histrionic personality disorder is one of the least common of these personality disorders, affecting about 1.8 percent of the population – which still represents about four million people. Histrionic personality disorder is diagnosed more frequently among women, who comprise about two-thirds of the known cases. This may not reflect the true incidence of the disorder, but could relate to the willingness of women (or unwillingness of men) to seek assistance for the symptom of HPD when they manifest.

The seeds of histrionic personality disorder are likely sown in childhood, but its symptoms don’t normally become apparent until late adolescence. The severity of the condition may then escalate during early adulthood and become a dominant factor from that point on.

Those with histrionic personality disorder need novelty and thrills, which may lead them to become bored with the usual routines. This may lead to frustration when gratification is delayed, as they want immediate satisfaction. Interest in jobs, friendships, and relationships may quickly dwindle in favor of the shiny newness of other relationships.

Someone with histrionic personality disorder often appears as effervescent, lively, and interesting (sometimes shallow), and cannot handle it when the attention is not focused entirely upon them. In order to direct attention back to themselves, they may begin sexually suggestive or seductive behavior. Despite being highly sexual, people with histrionic personality disorder often have problems with emotional intimacy in sexual or romantic relationships.

Whether or not they are aware, they often choose a role (victim, princess) within their relationships. People with histrionic personality disorder may try to control their partner through seductiveness or emotional manipulation while displaying a strong dependency on their partners on another level. Because people with histrionic personality disorder crave excitement and newness, longer-term relationships are difficult for them to maintain.

It’s hard for those with histrionic personality disorder to maintain same-sex friendships because their sexually-charged style may come across as a threat to their friends’ romantic relationships. In addition, people with histrionic personality disorder can alienate friends through their demands for constant attention, and their depression when that attention is not provided.

What Are The Core Features of Personality Disorders?

The general requirements for the diagnosis of a personality disorder are:

• a pervasive pattern of maladaptive traits and behavior
• beginning in early adult life
• it usually has its first manifestations in childhood and is clearly evident in adolescence
• it is not diagnosed before early adult life because these maladaptive traits are very common in childhood and adolescence, but most individuals age-out of these traits before early adulthood
• leading to substantial personal distress and/or social dysfunction, and disruption to others
• is of long duration, typically lasting at least several years
• Severity Rating Scale For Personality Disorders:

Severity rating scale for personality disorders in the International Classification of Diseases (ICD)-11:

Mild Personality Disorder: notable problems in many interpersonal relationships and the performance of expected work and social etiquette, but some relationships are maintained and/or some roles carried out. Mild personality disorder is typically not associated with substantial harm to self or others.

Moderate Personality Disorder: marked problems in most interpersonal relationships and in the performance of expected occupational and social roles across a wide range of situations that are sufficiently extensive that most are compromised to some degree. Moderate personality disorder often is associated with a past history and future expectation of harm to self or others, but not to a degree that causes long-term damage or has endangered life.

Severe Personality Disorder: There are severe problems in interpersonal functioning affecting all areas of life. The person’s general social dysfunction is profound and the ability and/or willingness to perform expected occupational and social roles is absent or severely compromised. Severe personality disorder usually is associated with a past history and future expectation of severe harm to self or others that has caused long-term damage or has endangered life.

HPD is a serious condition that isolates those who surround the people who have the disorder.

A mnemonic that has sometimes been used to describe the criteria for histrionic personality disorder is “PRAISE ME”:

 

 

 

 

 

 

 

 

P – provocative (or seductive) behavior
R – relationships, considered more intimate than they are
A – attention, must be at center of
I – influenced easily
S – speech (style) – wants to impress, lacks detail
E – emotional liability, shallowness

M – make-up – physical appearance used to draw attention to self
E – exaggerated emotions – theatrical

However, people who suffer from HPD are often just as interested in attracting negative attention, including shock, anger, outrage, shame, guilt and remorse.

What Causes Histrionic Personality Disorder?

What Are Symptoms of Histrionic Personality Disorder? 

While people with Histrionic Personality Disorder are able to function at a high-level and be socially successful, they often use these skills to manipulate others and become the center of attention.

Personality disorders generally are marked by an obsessive concern for the self, rigid and uncompromising attitudes, and an inability or unwillingness to adapt to the needs and desires of others. These disorders function as a cover for deep-seated self-esteem issues, representing a form of overcompensation for feelings of insecurity and inferiority.

An accurate histrionic definition focuses on the distinctive symptoms HPD produces, which include:

• Strong and volatile emotions, both negative and positive
• Rapid shifts in mood, often triggered by seemingly benign events
• Self-centeredness, in conversation and behavior
• Exaggerated gestures or words designed to draw attention
• Expressions of sentiments toward others that seem shallow or insincere, as if meant to manipulate or create a certain impression
• Grossly exaggerated emotional displays
• Believe that their relationships are fa more intimate than they are
• A lack of patience, often accompanied by childish reactions
• Tendency to become flustered or frustrated when things go wrong
• Extreme sensitivity to criticism or perceived rejection
• Constant approval-seeking behavior
• Constant reassurance-seeking behaviors
• Flirtatious or sexually suggestive behavior that may violate interpersonal boundaries
• Exhibition-type behaviors
• Unwillingness to change; suggestions of change are viewed as threats
• Obsessive concern with physical appearance
• A tendency to become bored or distracted, making it difficult to finish tasks or projects
• Lack of empathy, no capacity to read the emotions of others or correctly interpret their words and actions
• Inability to maintain satisfying relationships due to self-centered tendencies and emotional outbursts

Many of these symptoms are common to other personality disorders, which inevitably interfere with personal, social, and professional functioning.

What Are Some Of The Traits Of Those Who Have HPD?

The following list is a collection of some of the more commonly observed behaviors and traits of those who suffer from HPD. Note that these traits are given as a guideline only and are not intended for diagnosis. People who suffer from HPD are all unique and so each person will display a different subset of traits. Also, note that everyone displays “borderline” behaviors from time to time. Therefore, if a person exhibits one or some of these traits, that does not necessarily qualify them for a diagnosis of HPD. See the DSM Criteria on this page for diagnostic criteria.

Catastrophizing – The habit of automatically assuming a “worst case scenario” and inappropriately characterizing minor or moderate problems or issues as catastrophic events.

Chaos Manufacture – Unnecessarily creating or maintaining an environment of risk, destruction, confusion or mess.

Baiting – A provocative act used to solicit an angry, aggressive or emotional response from another individual.

Acting Out – Acting Out behavior refers to a subset of personality disorder traits that are more outwardly-destructive than self-destructive.

“Always” and “Never” Statements – “Always” and “Never” Statements are declarations containing the words “always” or “never.” They are commonly used by most people but arerarely true.

Anger – People who suffer from personality disorders often feel a sense of unresolved anger and a heightened or exaggerated perception that they have been wronged, invalidated, neglected or abused.

Belittling, Condescending, and Patronizing – This kind of speech is a passive-aggressive approach to giving someone a verbal put-down while maintaining a facade of reasonableness or friendliness.

Blaming – The practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.

Cheating – Sharing a romantic or intimate relationship with somebody when you are already committed to a monogamous relationship with someone else.

Circular Conversations – Arguments which go on almost endlessly, repeating the same patterns with no resolution.

Confirmation Bias – The tendency to pay more attention to things which reinforce your beliefs than to things which contradict them.

Denial – Believing or imagining that some painful or traumatic circumstance, event or memory does not exist or did not happen.

Dependency – An inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.

Depression – People who suffer from personality disorders are often also diagnosed with symptoms of depression.

Dissociation– A psychological term used to describe a mental departure from reality.

Emotional Abuse – Any pattern of behavior directed at one individual by another which promotes in them a destructive sense of Fear, Obligation or Guilt (FOG).

Emotional Blackmail – A system of threats and punishments used in an attempt to control someone’s behaviors.

Engulfment – An unhealthy and overwhelming level of attention and dependency on another person, which comes from imagining or believing one exists only within the context of that relationship.

Escape To Fantasy – Taking an imaginary excursion to a happier, more hopeful place.

False Accusations – Patterns of unwarranted or exaggerated criticism directed towards someone else.

Favoritism and Scapegoating – Systematically giving a dysfunctional amount of preferential positive or negative treatment to one individual among a family group of peers.

Fear of Abandonment – An irrational belief that one is imminent danger of being personally rejected, discarded or replaced.

Feelings of Emptiness – An acute, chronic sense that daily life has little worth or significance, leading to an impulsive appetite for strong physical sensations and dramatic relationship experiences.

Frivolous Litigation – The use of unmerited legal proceedings to hurt, harass or gain an economic advantage over an individual or organization.

Harassment – Any sustained or chronic pattern of unwelcome behavior by one individual towards another.

Holiday Triggers – Mood Swings in Personality-Disordered individuals are often triggered or amplified by emotional events such as family holidays, significant anniversaries and events which trigger emotional memories.

Hoovers & Hoovering – A Hoover is a metaphor taken from the popular brand of vacuum cleaners, to describe how an abuse victim trying to assert their own rights by leaving or limiting contact in a dysfunctional relationship, gets “sucked back in” when the perpetrator temporarily exhibits improved or desirable behavior.

Hysteria – An inappropriate over-reaction to bad news or disappointments, which diverts attention away from the real problem and towards the person who is having the reaction.

Identity Disturbance – A psychological term used to describe a distorted or inconsistent self-view

Impulsiveness – The tendency to act or speak based on current feelings rather than logical reasoning.

Invalidation – The creation or promotion of an environment which encourages an individual to believe that their thoughts, beliefs, values or physical presence are inferior, flawed, problematic or worthless.

Lack of Conscience – Individuals who suffer from Personality Disorders are often preoccupied with their own agendas, sometimes to the exclusion of the needs and concerns of others. This is sometimes interpreted by others as a lack of moral conscience.

Lack of Object Constancy – An inability to remember that people or objects are consistent, trustworthy and reliable, especially when they are out of your immediate field of vision.

Low Self-Esteem – A common name for a negatively-distorted self-view which is inconsistent with reality.

Manipulation – The practice of steering an individual into a desired behavior for the purpose of achieving a hidden personal goal.

Masking – Covering up one’s own natural outward appearance, mannerisms and speech in dramatic and inconsistent ways depending on the situation.

Mood Swings – Unpredictable, rapid, dramatic emotional cycles which cannot be readily explained by changes in external circumstances.

“Not My Fault” Syndrome – The practice of avoiding personal responsibility for one’s own words and actions.

No-Win Scenarios – When you are manipulated into choosing between two bad options

Panic Attacks – Short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as hyperventilating, shaking, sweating and chills.

Push-Pull – A chronic pattern of sabotaging and re-establishing closeness in a relationship without appropriate cause or reason.

Raging, Violence and Impulsive Aggression – Explosive verbal, physical or emotional elevations of a dispute. Rages threaten the security or safety of another individual and violate their personal boundaries.

Relationship Hyper Vigilance – Maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.

Riding the Emotional Elevator – Taking a fast track to different levels of emotional maturity.

Sabotage – The spontaneous disruption of calm or status quo in order to serve a personal interest, provoke a conflict or draw attention.

Selective Memory and Selective Amnesia – The use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.

Selective Competence – Demonstrating different levels of intelligence, memory, resourcefulness, strength or competence depending on the situation or environment.

Self-Aggrandizement – A pattern of pompous behavior, boasting, narcissism or competitiveness designed to create an appearance of superiority.

Self-Harm – Any form of deliberate, premeditated injury, such as cutting, poisoning or overdosing, inflicted on oneself.

Self-Loathing – An extreme hatred of one’s own self, actions or one’s ethnic or demographic background.

Self-Victimization – Casting oneself in the role of a victim.

Sense of Entitlement – An unrealistic, unmerited or inappropriate expectation of favorable living conditions and favorable treatment at the hands of others.

Silent Treatment – A passive-aggressive form of emotional abuse in which displeasure, disapproval and contempt is exhibited through nonverbal gestures while maintaining verbal silence.

Situational Ethics – A philosophy which promotes the idea that, when dealing with a crisis, the end justifies the means and that a rigid interpretation of rules and laws can be set aside if a greater good or lesser evil is served by doing so.

Splitting – The practice of regarding people and situations as either completely “good” or completely “bad.”

Stunted Emotional Growth – A difficulty, reluctance or inability to learn from mistakes, work on self-improvement or develop more effective coping strategies.

Testing – Repeatedly forcing another individual to demonstrate or prove their love or commitment to a relationship.

Thought Policing – Any process of trying to question, control, or unduly influence another person’s thoughts or feelings.

Threats – Inappropriate, intentional warnings of destructive actions or consequences.

Triggering -Small, insignificant or minor actions, statements or events that produce a dramatic or inappropriate response.

Tunnel Vision – The habit or tendency to only see or focus on a single priority while neglecting or ignoring other important priorities.

What Other Mental Health Disorders Occur In People Who Have HPD?

It is possible for a person to have the symptoms of more than one personality disorder as these disorders often blend into one another.

Among people diagnosed with HPD, borderline personality disorder, dependent personality disorder, and narcissistic personality disorder are also frequently diagnosed. Borderline personality disorder is the most commonly detected of these conditions, and some mental health professionals actually classify HPD as a borderline personality disorder subtype.

Some of the other mental and behavioral health disorders routinely diagnosed in people with histrionic personality disorder include:

• Depression. HPD creates strong emotional responses, and when rejection or disappointment is experienced people with histrionic personalities can easily slip into clinical depression.
• Anxiety disorders, including panic disorder. In one study, between 35 and 52 percent of those with various anxiety disorders also met the diagnostic criteria for a personality disorder, usually of a type that affects emotion and stress responses (such as HPD)
• Somatoform Disorders
• Attachment Disorders, such as reactive attachment disorder
• Eating disorders. About one-third of eating disorder sufferers also have one or more co-occurring personality disorders, often including HPD.
• Substance use disorders. While different studies have produced varying results, most research has shown as least some relationship between histrionic personality disorder and addiction. However, the association is not as strong as with several other types of personality disorder.

When an additional mental or behavioral health condition is diagnosed in people with HPD, treatment plans must be developed that focus equally on each disorder.

How is Histrionic Personality Disorder Diagnosed?

HPD is not a devastating psychological disorder, which means that people with this disorder rarely seek treatment as most people with HPD function successfully in society and at work. In fact, people with HPD usually have great people skills. unfortunately, however, they often use these skills to manipulate others.

According to the Diagnostic and Statistical Manual of Mental Disorders (5^th edition), people with histrionic personality disorder must have at least five (or more) of the following symptoms:

• Is uncomfortable in situations in which they are not the center of attention
• Has interactions with others characterized by inappropriate sexually seductive or provocative behavior
• Displays rapidly shifting and shallow expression of emotions
• Consistently uses their physical attention to draw attention to self
• Has a style of speech that is excessively impressionistic and lacking in detail
• Shows self-dramatization, theatricality, and exaggerated expression of emotion
• Is suggestible (that is, they are easily influenced by others or circumstances)
• Considers relationships to be more intimate than they actually are

If you have HPD, you might also be easily frustrated or bored with routines, make rash decisions before thinking, or threaten to commit suicide in order to get attention.

The World Health Organization’s ICD-10 lists histrionic personality disorder as:

A personality disorder characterized by:

• shallow and labile affectivity,
• self-dramatization,
• theatricality,
• exaggerated expression of emotions,
• suggestibility,
• egocentricity,
• self-indulgence,
• lack of consideration for others,
• easily hurt feelings, and
• continuous seeking for appreciation, excitement and attention.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

A diagnosis of histrionic personality disorder occurs through a thorough examination by a psychiatrist or psychologist by reviewing symptoms and taking a detailed health history. If the symptoms meet the diagnostic criteria, a diagnosis of histrionic personality disorder is made.

What Are The Subtypes for Histrionic Personality Disorder?

Histrionic Personality Disorder Subtypes (As Suggested by Million)

Subtypes of HPD	Description	Personality Qualities
Infantile HPD	includes borderline PD symptoms	Labile, high-strung, volatile emotions; childlike hysteria and nascent pouting; demanding, overwrought; fastens and clutches to another; is excessively attached, hangs on, stays fused to and clinging.
Vivacious Histrionic	The seductiveness of the histrionic mixed with the energy typical of hypomania. Some narcissistic features may also be present	Vigorous, charming, bubbly, brisk, spirited, flippant, impulsive; seeks momentary cheerfulness and playful adventures; animated, energetic, ebullient.
Tempestuous histrionic	Includes passive aggressive PD	Impulsive, out of control; moody complaints, sulking; precipitous emotion, stormy, impassioned, easily wrought-up, periodically inflamed, turbulent.
Appeasing histrionic	Includes compulsive and depended PD	Seeks to placate, mend, patch up, smooth over troubles; knack for settling differences, moderating tempers by yielding, compromising, conceding; sacrifices self for commendation; fruitlessly placates the unplacatable.
Disingenuous histrionic	HPD and antisocial PD	Underhanded, double-dealing, scheming, contriving, plotting, crafty, false-hearted; egocentric, insincere, deceitful, calculating, guileful.
Theatrical histrionic	Variant of “pure” pattern	Affected, mannered, put-on; postures are striking, eyecatching, graphic; markets self-appearance; is synthesized, stagy; simulates desirable/dramatic poses.

How Is Histrionic Personality Disorder Treated?

Those who suffer Histrionic Personality Disorder are generally hard to treat for many reasons. People with HPD often only seek treatment when their symptoms have become too much for them to handle. Once in treatment, however, these people often exaggerate their symptoms and lack of ability to function. They also have a hard time, as they are emotionally needy, terminating therapy may become a problem.

If people who have HPD are truly determined to change their emotional and psychological reactions, HPD can be amenable to treatment.

Inpatient or intensive outpatient treatment programs in mental health treatment facilities are ideal for people diagnosed with HPD, who require peace, quiet, and ample social and psychological support in the early stages of recovery.

Psychotherapy is the preferred method of intervention for histrionic personality disorder. Some of the therapies that have proven effective for this condition include:

• Cognitive behavioral therapy (CBT). Through CBT people with histrionic personalities can begin to think and act more calmly and with more deliberation and contemplation. CBT is also effective against depression and anxiety disorders, which can co-occur with HPD.
• Interviews and self-report methods generally, in clinical practice with assessment of personality disorders, one form of interview is the most popular; an unstructured interview. The actual preferred method is a semi-structured interview. The reason that a semi-structured interview is preferred over an unstructured one is that semi-structured interviews tend to be more objective, systematic, replicable, and comprehensive. Unstructured interviews, despite popularity, tend to have problems with unreliability and are susceptible to errors leading to false assumptions of the client. One of the single most successful methods for assessing personality disorders by researchers of normal personality functioning is the self-report inventory following up with a semi-structured interview. There are some disadvantages with the self-report inventory method that with histrionic personality disorder there is a distortion in character, self-presentation, and self-image. This cannot be assessed simply by asking most clients if they have the criteria for the disorder.
• Psychodynamic therapy. The goal in psychodynamic therapy is to decrease emotional reactivity by identifying and demystifying the underlying reasons for the development of HPD.
• Family and couples therapy. Family therapy should be explored only after the person with HPD has done some hard work on him or herself; otherwise, the person with HPD is apt to dominate all conversations
• Holistic mind-body practices. Mindfulness techniques acquired through meditation, yoga, Tai Chi, biofeedback, and other holistic therapies have much to offer people with HPD, who need to reprogram their minds to more effectively control their hair-trigger emotional reflexes.
• Medications are not indicated for treatment of histrionic personality disorder, though they may be used to treat some of the symptoms and/or other, co-morbid, disorders.
• Self-help groups and/or group therapy is not effective for those who have HPD as they are prone to hysterics and outbursts

With careful and compassionate intervention that extends from initial treatment through aftercare, people with histrionic personality disorder can learn to minimize the condition’s influence on their lives. HPD cannot be cured, but over time its capacity to control emotional reactions can be reduced to a manageable level.

Coping With Histrionic Personality Disorder:

Lots of people with HPD lead normal lives and are able to work and be a part of society. In fact, many people with HPD do very well in casual settings. Many of them only encounter problems in more intimate relationships. Depending on your case, your HPD may affect your ability to hold a job, maintain a relationship, or stay focused on life goals. It may also cause you to constantly seek adventure, putting you into risky situations.

You are also at a higher risk for depression if you have HPD. The disorder can affect how you handle failure and loss. It can also leave you feeling more frustrated when you don’t get what you want. You should talk to your primary care provider if you have symptoms of HPD, especially if they are interfering with your everyday life and work or your ability to lead a happy, fulfilling life.

Loving Someone With Histrionic Personality Disorder:

It is exhausting to deal with a person who has this personality disorder as they are particularly demanding – which is part of the disorder. Sometimes, it may be possible to stop being around such a person and extricate oneself from the situation, in other cases, especially where family members are concerned, that is never a choice. Then what is one to do and how is one to keep the relation going?

Sometimes, people with HPD may be abusive. You are not obligated to spend time with an abusive person, and you have the right to distance yourself or cut contact altogether. Do what’s right for you.

Here are some ideas for dealing with a person who has histrionic personality disorder:

Establish And Maintain Boundaries:

Create realistic goals. Histrionic personality disorder is a complicated disorder, and there may be limited things that you can do to help your loved one. Therefore, realistic goals are incredibly important when you decide to help them.You must understand that you may never be able to help them with their condition.  Create some safe space between you for your own self care. You must take care of your self.

• Help your loved one set their own goals. For example, you may want to help them set goals related to the way they dress, the types of sexual relationships they have, or the amount of times they act out in a dramatic or theatrical way.

Set limits and stick to them. When your loved one has Histrionic Personality Disorder, you need to establish strict boundaries for your relationship. Your loved one may engage in attention-seeking, manipulative, or embarrassing behavior at any time, which does directly affect you. Try to have an open, honest discussion with them about your personal limits.

• For example, tell your loved one, “If you start manipulating me, I will leave” or “If you start acting out or embarrassing yourself to get attention, I will leave” and stick with this plan.

Make sure they know that you still love them. A relationship with a loved one with HPD can be complicated and tense as this personality disorder can cause major problems that cause hurt feelings and complicated, strained relationships. You should try to your loved one know that you still love them, even though you have limits and may sometimes leave, you still love and care for them.

• You can tell them, “I love you and want you in my life. However, there are times I cannot be around you because of your behavior.”

Know how and when to distance yourself. You may find yourself in a situation where your loved one is being manipulative, cruel, hurtful, embarrassing, or harmful which can be overwhelming to you. People with HPD often do anything to be the center of attention; including manipulation, acting dramatically, and love to play the victim. They may act in an overly provocative way, or act out in a hateful or angry way to gain attention. As you know, all of this can negatively affect you. Be aware that you may have to distance yourself from your loved one to protect yourself and your own well-being.

• Some people just aren’t equipped to help a person with HPD. Be aware that as a last resort, you may have to completely remove yourself from the situation and sever all ties.

Taking Care of Yourself:

Consider seeing a therapist. Talking with a therapist about your challenges and feelings regarding your loved one’s histrionic personality disorder is a good way to care for yourself. A therapist can help you to develop healthy coping mechanisms, learn how to communicate with your loved one more effectively, and work through your emotions. Consider talking to a therapist as part of your self-care strategy.

Seek help from your friends and family. Dealing with a loved one with HPD can be an emotionally exhausting rollercoaster and you may feel helpless, trapped, and/or confused. Find support from your loved ones when you need it, and ensure that you make time to be away from your loved one, and instead, visit and interact with others. This can help you feel supported.

• Talk to your friends and family about your difficulties. You can even ask them for advice if things get too much to bear.

Don’t let your loved one to dictate your other relationships. Because people with HPD often feel inadequate or inferior, they may throw fits or act in an over-dramatic way when you form relationships and spend time with other people. You cannot let the person with HPD dictate your other relationships.

• Your loved one may see another friend, partner, or even child as a threat. Discourage this behavior. Don’t give into any behavior in which your loved one tries to discourage the relationship.
• For instance, you can say, “I have friends and invite them over once in a while. This does not affect my love for you.”
• Your loved one may get jealous or threatened by you participating in activities that don’t include them. Refrain from giving up activities because of your loved one’s HPD.

Come to terms with the idea that your loved one may never understand your needs. People with HPD appear to be self-centered, which means that they may not understand or respect your needs, even if you have clearly outlined them. People who hav do not realize their actions are wrong, or how their actions affect other people.

• You may need to accept that your loved one will never treat you how you deserve to be treated. This is why setting boundaries and limits in the relationship is so important.

How To Cope With HPD:

Don’t make excuses. If your loved one has HPD, you may find yourself wanting to make excuses for their behavior, cover up their behavior, or clean up any messes they have made. This is not your job, and can take a toll on you. Try not to make excuses or mediate any messes your loved one has made. This may just enable your loved one’s behavior.

• Your loved one’s behavior may be humiliating for you. However, learning to walk away or detach yourself may be the best way to take care of yourself.

Avoid trying to teach your loved one a lesson. Sometimes, loved ones of those with HPD abandon the person to teach them some sort of lesson. This can arise when the person with HPD manipulates you too much or you feel nothing that you do is working. This kind of punitive behavior does not work with people with HPD, so you should avoid the temptation.

• • If you do this, your loved one may feel abandoned and throw a dramatic fit since you abandoned them.
  • You may end up feeling helpless and manipulated if you try to use this kind of manipulation on your loved one. Avoid using games with your loved one. Stay direct and open with them instead.

Don’t reward attention-seeking behavior. Your loved one may engage in dramatic, attention-seeking behavior regularly, and one of the best ways to deal with this is to ignore it. Don’t engage with them when they are acting like this, it will further reinforce the negative behavior with attention.

• Your loved one likely has a chemical imbalance, which means they may not be able to help their behavior. Instead of getting into an argument or encouraging behavior, just ignore it and let it pass.

Remain calm. One of the best things you can do to help your loved one is to stay calm. A person with Histrionic Personality Disorder thrives on chaos and drama, if/when they get dramatic or have a fit, reacting to them in a negative way will play into what they want and encourage the behavior. Instead, remain calm during these fits.

• You may need to engage in deep breathing exercises or step away from your loved one for a few moments to collect yourself.

Put physical distance between you and your loved one. People with HPD form intimate attachments very easily, which means they may cross physical boundaries. They may not be able to understand or respect the boundaries you have set for yourself. You may find your loved one hugs you, touches you, or invades your space more than you wish. Your loved one may interpret your actions as threatening or inappropriate. To help with this, keep physical distance between you and them.

• For example, you may want to sit in a chair if your loved one is on the couch, or sit on the other end of the couch. When standing, keep a few feet between you and your loved ones.
• Be mindful not to do anything that might be suggestive or interpreted as inappropriate. You don’t want your loved one to misinterpret what you are doing. Always be mindful of your boundaries.

Encourage your loved one to evaluate and think about what other people say. Some people who have HPD are highly suggestible and will go along with what other people say without enforcing their own boundaries and desires. If you notice that your loved one is blindly agreeing with people or doing what other people tell them to do, try to encourage your loved one to think for him or herself.

• If you notice that your loved one is agreeing with someone without evaluating the statement, you could try asking some questions to help you loved one evaluate what the person said.
  • For example, your loved one might repeat a political opinion as a fact because they heard someone else say it. You could then ask your loved one questions like, what is the evidence for that? How did they come to that conclusion? Why do you agree with them?
• If your loved one is doing something because someone has suggested it, then you can also use questioning to help.
  • For example, your loved one might start dressing differently because someone suggested it. You might ask your loved one questions like, do you really want to do that? Would you be doing that if he or she had not suggested it? What might you be doing if he or she had not suggested that?

Suggest different clothing for your loved one. One of the main symptoms of HPD is wearing provocative clothing to garner attention. This type of attire is not suitable for all situations, such as work. You can help your loved one by suggesting they dress differently for certain situations.

• Make sure to start any suggestion with a compliment. Those with HPD respond extremely negatively to any criticism. By complimenting them, you can help yourself get a positive response.
• For example, you may say, “I really love that outfit. You should wear that tomorrow night when you go out with your friends! Why don’t you wear this to work instead today? It looks great on you, and everyone will think you look classy.”

Ask for support when your loved one states their opinion. Often, people with HPD will just talk or argue because they like the attention and drama. They may offer strong opinions while offering no support. When this happens, ask your loved one to back up their opinion.

• For example, you may say, “What are you basing that opinion on?” or “Do you have any examples to support your opinion?” You may also say, “That doesn’t sound like a correct statement. Can you give me some evidence to support your position?”
• If your loved one cannot support their opinion, explain that they need to only provide opinions based on facts or details. Encourage research issues so they can make informed opinion

Help your loved one come up with solutions. Often, people with HPD ignore solutions in favor of focusing on the drama of the problem. One way you can try to help your loved one is by encouraging them to come up with solutions and focus on problem-solving techniques instead of the problem.

• For example, when your loved one gets dramatic about a problem, listen to what they say about the problem. Then say, “I understand you have a problem, but dwelling on it will not help you or anyone else. Let’s work together to find a solution.”

Explore other things. To help keep your loved one’s attention-seeking or manipulative behavior to a minimum, you should talk about or do other things with them. Don’t let your loved one dwell on problems or dominate the spotlight. Talk about yourself or suggest that the two of you do an activity together.

• • For example, you may want to say, “We have been talking about you for a long time now. I would like to share with you things about my life.”
  • You can try to distract your loved one if they are in a middle of an attention-seeking or manipulative episode. You can change the subject, start watching television, or suggest that you go for a walk or to a movie.

Communication With Your Loved One:

Try empathizing with them, then set a limit. People with HPD may feel sensitive to rejection, because they’re deeply insecure. Helping them label their feelings allows them to better understand how they’re feeling, and know that you aren’t rejecting them (just asking them to stop doing something).

• • • “I get that you’re feeling lonely. But faking an injury isn’t a healthy way to get attention. If you want, we could do something simple together, like taking a walk or playing a board game.”
    • “I know you’re excited to be with friends. Please remember to let Jamal talk, too.”
    • “I can tell that you’re upset. I’m exhausted, though, and I don’t have the energy to talk about it. Could you call your sister, or talk to me in the morning?”

Try labeling their behaviors. People with HPD report being somewhat oblivious to their destructive habits, meaning that they may not realize when they are out of line. Make an observation or question about what they’re doing. This encourages them to step back and re-evaluate what they’re doing.

• • • “You’re spiraling.”
    • “Are you trying to manipulate me?”
    • “It looks like you’re starting something self destructive.”
    • “Honey, you’re making it about you again.”

Remind them of the consequences of what they’re doing. People with HPD may not think things through, or realize that their actions could have destructive consequences. Calmly remind them of what could happen if they act, or keep acting, a certain way.

• • • “You’re making me uncomfortable. If you keep doing this, I will leave.”
    • “This is John’s special day. If you do that at his party, he’ll feel really hurt and upset.”
    • “You could get seriously hurt if you do that.”
    • “When you do this, it makes me not want to spend time with you.”

Express feelings and boundaries clearly and calmly. People with HPD can benefit from explicit boundaries and reminders. Try using “I” language to explain how their behavior makes you feel. This can serve as a warning so that they can slow down and think.

• • • “When you ______, I feel ______. Because of this, _________.”
    • “Please, stop interrupting me. I’m getting frustrated.”
    • “That really hurt my feelings.”
    • “You’re embarrassing me. It makes me want to leave.”

Follow through with consequences if your loved one doesn’t heed your warning. They need to know that when you set boundaries, you mean what you say.

• • • For example, if you say that you’re going to leave if they keep doing something, and they keep doing it, then leave.

Talk about inappropriate behavior, without criticizing them personally. People with HPD act out because they feel insecure, and you don’t want to be cruel or make things even worse. Talk about their behavior, and the consequences of their behavior, without labeling them as selfish or bad. This helps them re-examine their actions and learn from them.

• • • Unhelpful: “You’re such a drama queen! I can’t deal with you anymore! I’m never taking you anywhere again.”
    • Helpful: “I’m disappointed and embarrassed that you flirted with my boss, even after I asked you to stop. It makes me not want to take you to work parties anymore, because I don’t know how to deal with this.”
    • Unhelpful: “You’re so embarrassing! If you don’t stop being like this, you’ll end up sad and alone.”
    • Helpful: “You really embarrassed me in the grocery store today. Now I feel bad, and I don’t know what I’ll do next time I see Mrs. Martinez in public.”

Helping Your Loved One Get Treatment for HPD:

Encourage treatment. The best way a person with HPD can get better is through treatment. However, most people with HPD either don’t seek treatment or they only stay in treatment for a short period of time. You should encourage your loved one to get treatment. If they are already seeking treatment, help encourage them to continue treatment, even when they get bored or want to quit.

• • • “I love you, and your behavior is hurting yourself and me. Would you be willing to get treatment?”
    • “I know you feel that treatment is no longer exciting or that you are better, but this is a major condition that cannot be fixed quickly. Will you please reconsider going back to treatment?”

Help them get psychotherapy. Psychotherapy is the most effective treatment for HPD. This includes talking with a therapist who can use different therapeutic approaches to help your loved one, such as cognitive behavioral therapy. Most people with HPD don’t continue with their therapy after beginning because they lose interest, think they are better, or are too impulsive to follow through with their treatment.

• Cognitive behavioral therapy can address problematic behaviors, such as impulsive actions, manipulative behaviors, and theatrics.

Seek treatment for underlying conditions. Often, people with HPD also have other, co-occurring disorders, such as depression. Because of their feelings of insecurity, inadequacy, and abandonment, they may feel depressed and need to be treated for this.

• If this is the case, your loved one can take selective serotonin reuptake inhibitors (SSRIs) to treat the depression, which may help their overall mood. SSRIs are common in the treatment of depression, and include medications such as Zoloft, Celexa, and Prozac.

Keep watch for destructive behavior. Histrionic personality disorder may lead to self-destructive behavior. People with HPD often exhibit suicidal behavior or behavior leading to self-harm. The person may just be threatening these behaviors to gain attention, so you need to make a decision about the seriousness of the threat.

• Some people with HPD will harm themselves or try to commit suicide to gain attention. Try to notice when your loved one is getting to this destructive stage.
• People with HPD may also exhibit dangerous behavior towards others. Watch your loved one to see if they exhibit any tendencies to hurt those around them

Personality Disorder Resources

by Aunt Becky | May 6, 2019

What Is Personality?

Personality is a particular set of behaviors, traits, emotions, and patterns that make up a person, his character, and their individuality. Personality includes how we see the world, our thoughts, attitudes, and feelings. Personality is strongly influenced by our values, attitudes, perception of ourselves, and predicts our reactions to people, the world, stress, and problems.

While there are many different definitions of personality, most focus on the pattern of behaviors and characteristics that can help predict and explain a person’s behavior.

Explanations for personality can focus on a variety of influences, ranging from genetic explanations for personality traits to the role of the environment and experience in shaping an individual’s personality.

Environmental factors that can play a role in the development and expression of personality include such things as parenting and culture. How children are raised can depend on the individual personalities and parenting styles of caregivers as well as the norms and expectations of different cultures.

So what actually makes up a personality? Traits and patterns of thought and emotions play important roles, and some of the other fundamental characteristics of personality include:

• Consistency: There is generally a recognizable order and regularity to behaviors. Essentially, people act in the same ways or similar ways in a variety of situations.
• Psychological and physiological: Personality is a psychological construct, but research suggests that it is also influenced by biological processes and needs.
• It impacts behaviors and actions: Personality does not just influence how we move and respond in our environment; it also causes us to act in certain ways.
• Multiple expressions: Personality is displayed in more than just behavior. It can also be seen in our thoughts, feelings, close relationships, and other social interactions.

Personality is not just who we are, it is also how we are.

What Is A Personality Disorder?

A person’s personality may be influenced by experiences, environment (surroundings, life situations) and inherited – genetic – characteristics. A person’s personality typically stays the same over time.

While personality disorders differ from mental disorders, like schizophrenia and bipolar disorder, they do, by definition, lead to significant impairment. Personality disorders are estimated to affect about 10 percent of people, although this figure ultimately depends on where clinicians draw the line between a “normal” personality and one that leads to significant impairment.

A personality disorder is a way of thinking, feeling, and behaving that is different from the expectations of the culture, causes distress, problems functioning, and lasts over time. Personality disorders are almost always associated with marked social and personal disruption and are both pervasive and inflexible. While these behaviors can produce poor coping skills, leading to personal issues including anger, anxiety, depression, and distress, they are considered appropriate by the person with the disorder.

Some types of personality disorder were in previous versions of the diagnostic manuals but have been removed. Examples include sadistic personality disorder (pervasive pattern of cruel, demeaning, and aggressive behavior) and self-defeating personality disorder or masochistic personality disorder (characterized by behaviors consequently undermining the person’s pleasure and goals). They were listed in the DSM-III-R appendix as “Proposed diagnostic categories needing further study” without specific criteria. The psychologist Theodore Millon and others consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.

Now, there are 10 specific types of personality disorders. Personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected. The pattern of experience and behavior begins by late adolescence or early adulthood and causes distress or problems in functioning.

Without treatment, personality disorders can be long-lasting. Personality disorders must affect at least two of the following areas:

• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior

What Causes Personality Disorders?

The development of personality disorders in certain people – and not others from a similar background – remains the subject of much debate among researchers and scientists, however, research suggests that genetics, abuse, and other factors may contribute to the development personality disorders.

In the past, many people believed that people who have personality disorders were lazy, the devil, or evil. Thankfully, new research has begun to explore such potential causes as genetics, parenting, and peer influences in the development of personality disorders:

Genetic Factors: Researchers are beginning to identify some possible genetic factors behind personality disorders. New developments into the role of genetics in mental health and personality disorders occur every single day.

• (for example) One research team has identified a malfunctioning gene that may be a factor in obsessive-compulsive disorder.
• Other researchers are exploring genetic links to aggression, anxiety and fear — traits that may play a role in the lives of those who have personality disorders.

Childhood trauma. Findings from one of the largest studies of personality disorders, offer clues about the role of childhood experiences in the development of personality disorders.

• One study found a link between the number and type of childhood traumas and the development of personality disorders. People with borderline personality disorder, for example, had especially high rates of childhood sexual trauma.

Verbal abuse. Even verbal abuse can have an impact. In a study of 793 mothers and children, researchers asked mothers if they had screamed at their children, told them they didn’t love them or threatened to send them away.

• Children who had experienced such verbal abuse were three times as likely as other children to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood.

High reactivity: Sensitivity to light, noise, texture and other stimuli may also play a role in developing personality disorders

• Overly sensitive children, who have what researchers call “high reactivity,” are more likely to develop shy, timid or anxious personalities.
• However, high reactivity’s role is still far from clear-cut. Twenty percent of infants are highly reactive, but less than 10 percent go on to develop social phobias.

Peers. Certain factors can help prevent children from developing personality disorders.

• Even a single strong relationship with a relative, teacher or friend can offset negative influences from peers, say psychologists.

As researchers continue to make new discoveries about the roles of genetic, environmental factors, and abuse in personality disorders, we will be able to understand, identify, and treat people who have personality disorders more effectively.

What Are TheTypes of Personality Disorders?

Before jumping into characterization of these 10 personality disorders, it should be emphasized that they are more the product of historical observation than of scientific study, so that they are rather vague and imprecise constructs. As a result, these personality disorders rarely present in their classic textbook form, but instead tend to blur into one another. Their division into three clusters in DSM-5 is intended to reflect this tendency – any given personality disorder most likely to blur with other personality disorders within its cluster.

The majority of people with a personality disorder never come into contact with mental health services, and those who do usually do so in the context of another mental disorder, or at a time of crisis; commonly after self-harming or breaking the law. Nevertheless, personality disorders are important to health professionals, because they predispose people to other mental health disorders and affect the presentation and management of existing mental disorders. Personality disorders also result in considerable distress and impairment, and so may need to be treated on their own.

These personality disorders have been divided into three clusters, Cluster A, Cluster B, and Cluster C. Each cluster has personality disorders (not all listed here) that fall within them.

Cluster A: Paranoid, Odd, or Eccentric Behavior

Cluster A is comprised of paranoid, schizoid, and schizotypal personality disorders.

Paranoid Personality Disorder:

Those who suffer with paranoid personality disorder interpret the actions of others as deliberately threatening or demeaning. People who have paranoid personality disorder are often unforgiving, distrusting, and prone to aggressive outbursts (without justification) as they see others as disloyal, condescending, unfaithful, or lying. People with paranoid personality disorder may be jealous, secretive, guarding, and scheming, and may seem emotionally cold or extremely serious.

Paranoid personality disorder is characterized by a pervasive distrust of others, including even friends, family, and partners. As a result, a person with paranoid personality disorder seems guarded, suspicious, and constantly on the lookout for clues or suggestions to validate their fears. They will also has a strong sense of personal rights: they are overly sensitive to setbacks and rebuffs, are easily shamed and humiliated, and persistently bears grudges. Unsurprisingly, they tends to withdraw from others and to struggle with building close relationships.

The principal ego defense in paranoid PD is projection, which involves attributing one’s unacceptable thoughts and feelings to other people. A large, long-term twin study found that paranoid PD is modestly heritable, and that it shares a portion of its genetic and environmental risk factors with schizoid PD and schizotypal PD.

Schizoid Personality Disorder:

People who suffer from Schizoid Personality Disorder are solitary introverts that seem cold, distant, and withdrawn. People who have schizoid personality disorder spend much time lost in their own thoughts and feelings and feel fearful of intimacy with others.

The term “schizoid” means that a person a natural tendency to direct attention toward one’s inner life and away from the external world. A person with schizoid PD acts detached and are aloof and prone to introspection and fantasy. They have no desire for social or sexual relationships, they are indifferent to others and to social norms and conventions, and lacks a visible emotional response.

A competing theory about people who have schizoid PD is that they are actually highly sensitive with a rich inner life: they experience a deep longing for intimacy, but find initiating and maintaining close relationships too difficult or distressing, and so they go back into their inner world. People with schizoid PD rarely present for medical treatment, because despite their reluctance to form close relationships, they are mostly well-functioning and untroubled by their apparent oddness.

Schizotypal Personality Disorder:

Those who suffer Schizotypal Personality Disorder exhibit a pattern of peculiarities, with odd mannerisms while speaking or dressing. Schizotypal PD is characterized by oddities of appearance, behavior, and speech, unusual perceptual experiences, and anomalies of thinking similar to those seen in schizophrenia People who have schizotypal personality disorder often have wildly paranoid beliefs and, as such, have difficulties with relationships and feel marked anxiety while in social situations. They may not react at all (or react inappropriately) during a conversation, or instead, they may talk to themselves. People with schizotypal personality disorder may also believe that they can see the future or read minds, have odd beliefs, magical thinking (for instance, thinking that speaking of the devil can make him appear), suspiciousness, and obsessive ruminations.

People with schizotypal PD often fear social interaction and think of others as harmful. This may lead them to develop so-called ideas of reference — that is, beliefs or intuitions that events and happenings are somehow related to them. So whereas people with schizotypal PD and people with schizoid PD both avoid social interaction, with the former it is because they fear others, whereas with the latter it is because they have no desire to interact with others or find interacting with others too difficult.

People with schizotypal PD have a higher than average probability of developing schizophrenia, and the condition used to be called “latent schizophrenia.”

Cluster B: Dramatic, Erratic, or Emotional Behavior

Borderline Personality Disorder:

In borderline PD (or emotionally unstable PD), the person essentially lacks a sense of self and, as a result, experiences feelings of emptiness and fears of abandonment. There is a pattern of intense but unstable relationships, moods, self-image, interpersonal behaviors,  emotional instability, outbursts of anger and violence (especially in response to criticism), and impulsive behavior. Suicidal threats and acts of self-harm are common, for which reason many people with borderline PD frequently come to medical attention. Borderline PD was named as people who suffered from it were believed to be walking the border between neurotic (anxiety) disorders and psychotic disorders, like schizophrenia and bipolar disorder. I

Research seems to show that people who have borderline personality disorder as a result of childhood sexual abuse, which makes it much more common in women, in part because women are more likely to suffer sexual abuse. However, feminists have argued that borderline PD is more common in women, because women presenting with angry and promiscuous behavior tend to be labeled with it, whereas men presenting with similar behavior tend instead to be labeled with antisocial PD.

Abrupt, extreme mood swings, an unstable, fluctuating self-image, and stormy relationships are common for a person with borderline personality disorder. People with borderline personality disorder often view the world in black and white – all good or all bad. Someone with borderline personality disorder may have an intense relationship, only to have it devolve over a simple perceived slight. Extreme fear of abandonment may lead to extreme dependency upon others and self-injurious behaviors may be used as manipulation or as a means to get attention.

Antisocial Personality Disorder:

Until Kurt Schneider broadened the concept of personality disorders to include those who “suffer from their abnormality,” being diagnosed with a “personality disorder” was more or less synonymous with antisocial personality disorder. Those with Antisocial Personality Disorder ignore social rules of behavior and act out their problems as they desire. People with Antisocial Personality Disorder are callous, irresponsible, and impulsive. Generally speaking, someone with antisocial personality disorder may have a history of legal problems, aggressive or violent relationships, and a belligerent attitude. Those with antisocial personality disorder often have no regard for others, no respect for others, and feel no remorse about their actions.

Antisocial PD is found to occur much more often in men than in women and is characterized by a callous unconcern for the feelings of others. The person disregards social rules and obligations, is irritable and aggressive, acts impulsively, lacks guilt, and fails to learn from experience. In many cases, they have had no difficulty finding relationships – and can even appear superficially charming (as a “charming psychopath”) – but these relationships are usually fiery, turbulent, and short-lived.

As antisocial PD is the mental disorder most closely correlated with crime, they are likely to have a criminal record or have a history of being in and out of prison.

Narcissistic Personality Disorder:

For people who have narcissistic PD, the affected individual has an overblown feeling of self-importance, a tremendous sense of entitlement, absorbed by fantasies of grandeur, and an excessive need to be admired, and seek constant attention. This person is jealous of others and expects them be jealous in return. This person also lacks empathy and readily lies and exploits others to achieve their aims. To others, they may seem self-absorbed, controlling, intolerant, selfish, or insensitive. If this person feels obstructed or ridiculed, they can fly into a fit of destructive anger and revenge. This is called “narcissistic rage” and can have disastrous consequences for all involved.

People with Narcissistic Personality Disorder are overly sensitive to failure and often complain of mild somatic (non-specific, medical-type) symptoms, such as headaches or stomach aches.

Histrionic Personality Disorder:

People with histrionic PD lack a sense of self-worth and depend on attracting the attention and approval of others for their well-being. They often seem to be overly-dramatizing or “playing a part” in a bid to be heard and seen. Indeed, “histrionic” derives from the Latin histrionicus, which means “about to the actor.” People with histrionic PD may take great care of their appearance and behave in a manner that is overly charming or inappropriately seductive. As they crave excitement and act on impulse or suggestion, they can place themselves at risk of accident or exploitation. Their dealings with others often seem insincere or superficial, which in the longer term can adversely impact their social and romantic relationships.

This is especially distressing, as they are sensitive to criticism and rejection and react badly to loss or failure. A vicious circle may take hold in which the more rejected they feel, the more histrionic they become — and the more histrionic they become, the more rejected they feel. These people want to be the center of attention in any group, and become very angry if they are not. People with histrionic PD have shallow relationships and may use their social skills to manipulate others around them.

It can be argued that a vicious circle of some kind is at the heart of every personality disorder and, indeed, every mental disorder.

Cluster C: Anxious or Fearful Disorders

Obsessive-Compulsive (Anankastic) Personality Disorder:

First and foremost, obsessive-compulsive personality disorder is not the same thing as obsessive-compulsive disorder.

Anankastic  PD is characterized by an excessive preoccupation with details, rules, lists, order, organization, or schedules; perfectionism so extreme that it prevents a task from being completed. Their unending and devotion to work and productivity costs many their interpersonal relationships. A person with anankastic PD is typically doubting and cautious, rigid and controlling, humorless, and miserly. Their underlying anxiety arises from a perceived lack of control over a world that they don’t understand, and the more they try to exert control, the more out of control they feels. As a consequence, they have little tolerance for complexity or nuance, and tends to simplify the world by seeing things as either all good or all bad (often referred to as black and white thinking).

Their relationships with colleagues, friends, and family are often strained by the unreasonable and inflexible demands that they makes upon loved ones.

Dependent Personality Disorder:

Dependent PD is characterized by a major lack of self-confidence, often show patterns of dependent and submissive behavior, and have an excessive need to be cared for by another person or persons. People with dependent personality disorder need a lot of help to make everyday decisions and often surrenders important life decisions to others. They greatly fear abandonment and may go through considerable lengths to secure and maintain relationships. A person with dependent PD sees themselves as inadequate and helpless, and gives up any personal responsibility and submits themselves to one or more protective others. They imagine that they are at one with these protective other(s), whom they idealize as competent and powerful, and towards whom they behave in a manner that is ingratiating and self-effacing. Those who have Dependent Personality Disorder will rarely initiate projects or work independently.

People with dependent PD often end up with people with a cluster B personality disorder, who feed on the unconditional high regard in which they are held. Overall, people with dependent PD maintain a naïve and child-like perspective and have limited insight into themselves and others. This entrenches their dependency, leaving them vulnerable to abuse and exploitation. These people require extreme advice and reassurance and are easily hurt by disapproval or criticism. People with Dependent Personality Disorder feel helpless when alone and may be devastated when a relationship ends, due in part to their strong fear of rejection.

Avoidant Personality Disorder:

People with avoidant PD believe that they are socially inept, unappealing, or inferior, and fear being embarrassed, criticized, or rejected. People with Avoidant Personality Disorder often avoid any activities that involve interpersonal contact as they’re afraid of saying something wrong, they worry they’ll cry in front of others, and are very hurt when they are disapproved of by others. These people are sensitive to rejection and avoid meeting others and engaging in activities unless they are certain that they’ll be liked or good enough; they’re restrained even in their intimate relationships. Avoidant PD is strongly associated with anxiety disorders, and may also be associated with actual – or imagined – rejection by parents or peers during their childhood.

Research is showing that people who have avoidant PD excessively monitor internal reactions – of their own and those of others – which prevents them from engaging naturally or fluently in social situations. A vicious circle takes hold in which the more they monitor their internal reactions, the more inept they feel; and the more inept they feel, the more they monitor their internal reactions.

They feel extremely uncomfortable in social situations, are timid, and are afraid of being criticized.

These people may have no close relationships beyond their family (although they’d like to) because they’re too afraid of their inability to relate well to others.

Other Ways Of Classifying Personality Disorders:

In addition to classifying by category and cluster, it is possible to classify personality disorders using additional factors such as attribution, its impact on social functioning, and severity of the disorder.

Impact on Social Functioning: Social function is affected by many other aspects of mental functioning than just that of personality. But, whenever there is persistently impaired social functioning in conditions in which it wouldn’t be expected, evidence suggests that this may be more likely to be created by personality abnormality than by other clinical variables.

Attribution: Many people who have a personality disorder don’t see any abnormality in their functioning and will continue to believe that there is no abnormality with how the person functions. This group of people have been called the “Type R,” or “treatment-resisting personality disorders,” as opposed to the Type S or treatment-seeking ones, who are very interested on altering their personality disorders and often clamor for treatment  The classification of 68 personality disordered patients on the caseload of an assertive community team using a simple scale showed a 3 to 1 ratio between Type R and Type S personality disorders with Cluster C personality disorders being significantly more likely to be Type S, and paranoid and schizoid (Cluster A) personality disorders significantly more likely to be Type R than others.

Severity of the Personality Disorder: The extent to which the dysfunctions in the below areas are associated with distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.

Aspects of personality functioning that contribute to severity determination in Personality Disorder (Adapted from the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Personality Disorder) include the following:

Degree and pervasiveness of disturbances in functioning of aspects of the self:

• Stability and coherence of one’s sense of identity (such as: the extent that the sense of self is always changing and inconsistent or overly rigid and fixed).
• Ability to maintain an overall positive and stable sense of self-worth.
• Accuracy of one’s view of one’s characteristics, strengths, and limitations.
• Capacity for self-direction, ability to plan, choose, and implement appropriate goals.
• Degree and pervasiveness of interpersonal dysfunction across various types of relationships such as, romantic relationships, school/work, parent-child, family, friendships, peer contexts
• Interest in engaging in relationships with others.
• Ability to understand and appreciate others’ perspectives.
• Ability to develop and maintain close and mutually satisfying relationships.
• Ability to manage conflict in relationships.
• Pervasiveness, severity, and chronicity of emotional, cognitive, and behavioral manifestations of the personality dysfunction

Emotional manifestations:

• Range and appropriateness of emotional experience and expression.
• Tendency to be emotionally over- or under-reactive to stimuli
• Ability to recognize and acknowledge unwanted emotions (such as anger, sadness).

Cognitive manifestations

• Accuracy of situational and interpersonal appraisals, especially under stress.
• Ability to make appropriate decisions in situations of uncertainty.
• Appropriate stability and flexibility of belief systems.

Behavioral manifestations

• Flexibility in controlling impulses and modulating behavior based on the situation and consideration of the consequences.
• Appropriateness of behavioral responses to intense emotions and stressful circumstances (such as a propensity to self-harm and/or violence).

Common Traits of A Person Who Has A Personality Disorder (per Out Of The Fog):

The list below contains descriptions of some of the more common traits of people who suffer from personality disorders, as observed by family members and partners. Examples are given of each trait, with descriptions of what it feels like to be caught in the crossfire.

Of note: these descriptions are not intended for diagnosis. Refer to the DSM-V or ICD-11 Criteria for Personality Disorders for clinical diagnostic criteria. No one person exhibits all of the traits and the presence of one or more of these traits is not evidence of a personality disorder.

One common criticism is that this list of traits seems so “normal” – more like traits of an unpleasant person than traits of a mentally ill person. This is no accident. Personality disordered people are normal people. Approximately 1 in 11 people meet the diagnostic criteria for having a personality disorder. Personality-disordered people don’t fit the stereotypical models for people with mental illnesses but their behaviors can be just as destructive. These descriptions are offered in the hope that non-personality-disordered family members, caregivers and loved-ones might recognize some similarities to their own situation and discover that they are not alone. Many thanks to Out of the Fog for their amazing list of personality traits. These traits may include:

How Are Personality Disorders Diagnosed?

Every person has a characteristic manner of thinking, feeling, and way relating to others. Some of these personality traits can be so dysfunctional as to warrant a diagnosis of personality disorder. The World Health Organization’s International Classification of Diseases (ICD- 10) includes ten personality disorder diagnoses. Three issues of particular importance for the diagnosis of personality disorders are their differentiation from other mental disorders, from general personality functioning, and from each other. Each of these issues is discussed in turn, and it is suggested that personality disorders are more accurately and effectively diagnosed as maladaptive variants of common personality traits.

Researchers have been unable to identify a qualitative distinction between normal personality functioning and personality disorder. DSM-IV and ICD-10 provide specific and explicit rules for distinguishing the presence versus absence of each of the personality disorders, but the basis for these thresholds are largely unexplained and are weakly justified. The DSM-III schizotypal and borderline personality disorders are the only two for which a published rationale has ever been provided.

Characterizing the 10 personality disorders is difficult, but diagnosing them reliably is even more so. For example, how far from the norm must personality traits deviate before they can be counted as disordered? How significant is “significant impairment”? And how is “impairment” to be defined?

Whatever the answers to these questions, they are bound to include a large part of subjectivity. Personal dislike, prejudice, or a clash of values can all play a part in arriving at a diagnosis of personality disorder, and it has been argued that the diagnosis amounts to little more than a convenient label for undesirables and social deviants.

It is important to understand the difference between personality styles and personality disorders. A person who is shy or likes to spend time alone does not necessarily have an avoidant or schizoid personality disorder. The difference between personality style and a personality disorder often can be determined by assessing the person’s personality function in certain areas, including

• Work
• Relationships
• Feelings/emotions
• Self-identity
• Awareness of reality
• Behavior and impulse control

If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests- such as X-rays and blood tests- to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder. The doctor or therapist bases his or her diagnosis on the person’s description of the symptoms and on his or her observation of the person’s attitude and behavior. The therapist then determines if the person’s symptoms point to a personality disorder as outlined in the DSM-5.

According to DSM-5, a personality disorder can be diagnosed if there are significant impairments in self and interpersonal functioning together with one or more pathological personality traits. In addition, these features must be (1) relatively stable across time and consistent across situations, (2) not better understood as normative for the individual’s developmental stage or socio-cultural environment, and (3) not solely due to the direct effects of a substance or general medical condition.

Treatment of Personality Disorders:

People with personality disorders might not seek treatment on their own; and as a result, many go untreated. One reason for the failure to seek treatment might be that many people with personality disorders can function normally in society, outside of the limitations of their disorder.

Most personality disorders are constant, unrelenting, and very hard to cure. However, treatment can help relieve some of the more disturbing symptoms of many types of personality disorders.

Treatment varies depending on the type of disorder, but psychotherapy (a type of counseling) is the main form of treatment. In some cases, medication might be used to treat extreme or disabling symptoms that might occur. Medications that might be used include antidepressants, anti-psychotics, anti-anxiety drugs, and impulse-stabilizing medications.

Psychotherapy focuses on evaluating faulty thinking patterns, and teaching new thinking and behavior patterns. Therapy also aims to improve coping and interpersonal skills.

There are many options for treatment for those who have a personality disorder. These treatments may include therapies (individual, group, or family), which focus upon helping to see how their thought processes may lead to or cause their symptoms. Therapies may also help people with personality disorders learn to become more flexible in their thoughts and behaviors.

Certain types of psychotherapy are effective for treating personality disorders. During psychotherapy, an individual can gain insight and knowledge about the disorder and what is contributing to symptoms, and can talk about thoughts, feelings and behaviors. Psychotherapy can help a person understand the effects of their behavior on others and learn to manage or cope with symptoms and to reduce behaviors causing problems with functioning and relationships. The type of treatment will depend on the specific personality disorder, how severe it is, and the individual’s circumstances.

Commonly used types of psychotherapy include:

• Psychoanalytic/psychodynamic therapy
• Dialectical behavior therapy
• Cognitive behavioral therapy
• Group therapy
• Psychoeducation (teaching the individual and family members about the illness, treatment and ways of coping)

There are no medications specifically to treat personality disorders. However, medication, such as antidepressants, anti-anxiety medication or mood stabilizing medication, may be helpful in treating some symptoms. More severe or long lasting symptoms may require a team approach involving a primary care doctor, a psychiatrist, a psychologist, social worker and family members.

Outlook for Those With Personality Disorders: 

It is generally assumed that all personality disorders are linked to impaired functioning and a reduced quality of life (QoL) because that is a basic diagnostic requirement. But research shows that this may be true only for some types of personality disorder.

In several studies, higher disability and lower QoL were predicted by avoidant, dependent, schizoid, paranoid, schizotypal and antisocial personality disorder. This link is particularly strong for avoidant, schizotypal and borderline PD. However, obsessive-compulsive PD was not related to a compromised QoL or dysfunction. A prospective study reported that all PD were associated with significant impairment 15 years later, except for obsessive compulsive and narcissistic personality disorder.

One study investigated some aspects of “life success” (status, wealth and successful intimate relationships) and showed somewhat poor functioning for schizotypal, antisocial, borderline and dependent PD, schizoid PD had the lowest scores regarding these variables. Paranoid, histrionic and avoidant PD were average. Narcissistic and obsessive-compulsive PD, however, had high functioning and appeared to contribute rather positively to these aspects of life success.

There is also a direct relationship between the number of diagnostic criteria and quality of life. For each additional personality disorder criterion that a person meets there is an even reduction in quality of life.

Issues For People Who Have Personality Disorders:

In Children:

Early stages and preliminary forms of personality disorders also require a multi-dimensional and early treatment approach if this disorder is to be successfully managed. Personality development disorder is considered to be a childhood risk factor or early stage of a later personality disorder in adulthood.

Research indicates that some children and adolescents do suffer from clinically significant syndromes that resemble adult personality disorders, and that these syndromes have meaningful correlates and are consequential. Much of this research has been framed by the adult personality disorder constructs from Axis II of the Diagnostic and Statistical Manual. Children today are less likely to encounter clinicians and researchers who are simply avoiding use of the PD construct in youth. However, these children and families may encounter under-appreciation of the developmental context in which these syndromes occur.

That is, although PD constructs show continuity over time, they are probabilistic predictors; not all youths who exhibit PD symptomatology become adult PD cases.

At Work:

Depending on the diagnosis, severity and individual, and the job itself, personality disorders can be associated with difficulty coping with work or the workplace—potentially leading to problems with others by interfering with interpersonal relationships. Indirect effects also play a role; for example, impaired educational progress or complications outside of work, such as substance abuse and co-morbid mental disorders, can plague sufferers.

However, personality disorders can also bring about above-average work abilities by increasing competitive drive or causing the sufferer to exploit his or her co-workers.

In 2005 and again in 2009, psychologists Belinda Board and Katarina Fritzon at the University of Surrey, UK, interviewed and gave personality tests to high-level British executives and compared their profiles with those of criminal psychiatric patients at Broadmoor Hospital in the UK. They found that three out of eleven personality disorders were actually more common in executives than in the disturbed criminals:

• Histrionic personality disorder: including superficial charm, insincerity, egocentricity and manipulation
• Narcissistic personality disorder: including grandiosity, self-focused lack of empathy for others, exploitativeness and independence.
• Obsessive-compulsive personality disorder: including perfectionism, excessive devotion to work, rigidity, stubbornness and dictatorial tendencies.

According to leadership academic Manfred F.R. Kets de Vries, it seems almost inevitable that some personality disorders will be present in a senior management team.

Versus Mental Disorders:

The disorders in each of the three clusters may share with each other underlying common vulnerability factors involving cognition, affect and impulse control, and behavioral maintenance or inhibition, respectively. But they may also occur on a spectrum of other mental illnesses.

• Paranoid, schizoid or schizotypal personality disorders have be observed to be premorbid antecedents of delusional disorders or schizophrenia.
• Borderline personality disorder is seen in association with mood and anxiety disorders, with impulse control disorders, eating disorders, ADHD, or a substance use disorder.
• Avoidant personality disorder is seen with social anxiety disorder.

Coping With Personality Disorders:

In addition to actively participating in a treatment plan, some self-care and coping strategies can be helpful for people with personality disorders.

• Learn about the condition. Knowledge and understanding can help empower and motivate.
• Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety.
• Avoid drugs and alcohol. Alcohol and illegal drugs can worsen symptoms or interact with medications.
• Get routine medical care. Don’t neglect checkups or regular care from your family doctor.
• Join a support group of others with personality disorders.
• Write in a journal to express your emotions.
• Try relaxation and stress management techniques such as yoga and meditation.
• Stay connected with family and friends; avoid becoming isolated.

Challenges For People Who Have Personality Disorders (Including Loved Ones And Therapists):

The management and treatment of personality disorders can be a challenging and controversial area, as the difficulties are enduring and affect multiple areas of functioning. Challenges often involve interpersonal issues, and there can be difficulties looking for and finding help from area organizations, especially when trying to engage in a therapeutic relationships with a treatment team. Alternately, a person may not consider that they have a mental health problem. On the other hand, community mental health services may view people who have personality disorders as too complex or difficult, and may directly or indirectly exclude people with such diagnoses or associated behaviors.

The disruptiveness that people with personality disorders can create in an organization makes these, arguably, the most challenging conditions to manage.

Many people who have personality disorders don’t believe that they have them. This perspective can be caused by the person’s ability to see him or herself clearly, and unfortunately, there is major social stigma and discrimination related to the diagnosis of a personality disorder.

The term “personality disorder” involves a wide range of issues, each with a different level of severity or disability; thus, personality disorders require fundamentally different approaches and understandings.

Consider that while some disorders or people are characterized by continual social withdrawal and the shunning of relationships, others may cause fluctuations in forwardness. The extremes are worse still: at one extreme lies self-harm and self-neglect, while at the other people with PDs may commit violence and crime. There can be other factors such as problematic substance use, dependency, or behavioral addictions. A person may meet the criteria for multiple personality disorder diagnoses and/or other mental disorders, either at certain times or continually, making coordinated input from multiple services a requirement.

Therapists in this area can become disheartened by lack of initial progress, or by apparent progress that then leads to setbacks. People may be perceived as negative, rejecting, demanding, aggressive or manipulative.

Social skills, coping efforts, defense mechanisms, or deliberate strategies; of moral judgments, or the consideration for motivations for specific behaviors or conflicts can be incredibly challenging in people who have personality disorders and those who treat them. The vulnerabilities of a client (and therapist) may get lost in actual or apparent strength and resilience.

There is always a need to maintain appropriate professional personal boundaries, while allowing for emotional expression, and therapeutic relationships. However, there may be difficulty acknowledging the different worlds and views that both the client and therapist may believe in. A therapist may assume that the kinds of relationships and ways of interacting that make them feel safe and comfortable have the same effect on clients. An example of one extreme is this: people who may have been exposed to hostility, deceptiveness, rejection, aggression, or abuse in their lives, may be made confused, intimidated, or suspicious by presentations of warmth, intimacy, or positivity. On the other hand, reassurance, openness, and clear communication are usually helpful and needed.

It can take several months of sessions, and perhaps several stops and starts, to begin to develop a trusting relationship that can meaningfully address a client’s issues.

Coping With A Loved Ones Personality Disorder:

Family members can be important in an individual’s recovery and can work with the individual’s health care provider on the most effective ways to help and support. But having a family member with a personality disorder can also be distressing and stressful. Family members may benefit from talking with a mental health provider who can provide help coping with difficulties.

It may help to tailor how you approach someone based on the stage of acceptance they appear to be in.

Unawareness: Most people living with a personality disorder don’t realize they have one, even if they realize they aren’t easy to live with. It’s best to share your concern by giving someone specific examples of problem behaviors and follow up by offering the resources needed to find a doctor, or make or attend an appointment.

Denial. Most people who are told they have a personality disorder don’t believe it. It isn’t uncommon for them to get angry or defensive. Keep trying to share your concerns if someone is refusing help.

Resistance. When people first begin to accept there’s a problem, they fight the belief that it’s a serious problem. People with personality disorders often resist getting medical treatment as they believe they can change their behaviors on their own. At this stage, encourage a family member or friend to make medical help a part of their personal treatment plan.

Flakiness. Once they start therapy or medication, people with personality disorders often skip or stop treatment without warning. Be there to remind them that no one is perfect, no one is always at the top of their game, and that tomorrow offers new chances to make healthier choices.

Acceptance. After receiving the support needed to overcome denial, resistance and struggles with staying in treatment, patients with these disorders may come to a place of acceptance. In these situations, treatments are seen as a top priority and appreciated as tools for healthy living.

Coping With A Teen Who Has A Personality Disorder:

It’s sometimes difficult to tell the difference between childhood behaviors, teen angst and true personality disorders. When in doubt, it’s best to get a professional opinion. Talking to a child or teen before or after that stage can be daunting. It’s recommended that loved ones are:

• Be mindful of labels. No one wants to be defined by an illness.
• Learn as much as you can so you can pass on information instead of assumptions.
• Focus on feelings and behaviors.
• Emphasize they have a treatable medical condition.
• Stay positive by choosing words like “challenges” instead of “problems.
• If your child is on medication, talk with them about side effects they might be having.
• Invite your child to talk to you whenever questions arise. The worst-case scenario is having to say, “I’m not sure, but we can find out the answer.

Postpartum Mood Disorders

by Aunt Becky | Apr 28, 2019

What Are Postpartum Mood Disorders?

Pregnancy is a whirlwind of tons of emotions and sensations – our body is ever changing as well as our wishes, dreams, plans, hopes, and expectations that come at us both from every direction. It’s completely normal to feel overwhelmed by the idea of bringing a new life and person into the world, while strangers and loved ones alike bombard you with their experiences and ideas.

Most pregnant women feel their appetite increase, an eager anticipation of the new life to come, and sleep should be good (excepting getting comfortable, which is always a challenge during pregnancy). Normal worries and concerns will be sprinkled throughout the pregnancy experience, but they shouldn’t dominate our days or nights.

Ask yourself, “Do I emotionally feel like ‘me’ most of the day?” “Can I to sleep at night?” “Am I mostly excited about the baby coming?,” and “Am I eating enough?”

All of the above should be answered with a resounding “YES.”

If you’re not, it’s time to seek out a specialized health care practitioner who can help understand what’s happening with you

Depression and anxiety affect just as many pregnant women as new mothers, and can happen to the strongest, most intelligent, and loving moms. If you experience depression during your pregnancy, speak to your obstetrician – this is called antepartum depression, and it affects a great many men and women during pregnancy. There are a number of ways you can get help, and not all of them involve medications.

Every trimester you should either be given a formal screening or simply asked a few key questions to determine how you’re doing emotionally.  Receiving the right help during pregnancy will not only be best for you and your entire family, it will help you minimize the risk of postpartum depression.

Several days to weeks after giving birth, some mothers and fathers notice that they’re experiencing some strange symptoms, (most commonly) sadness, and/or anxiety after the birth of their child.

An estimated 1 out of every 6 women and 1 out of every 10 men experiences troubling depression or anxiety after the birth or adoption of a child, and in most people, these feelings are generally transient in nature. Given the tremendously stressful period of learning to live life with a newborn or new child is tremendously stressful to all involved, which is why we now recognize then men can also have postpartum mood disorders.

During the postpartum period, about 85% of women experience some type of mood disturbance. Generally, these symptoms are mild and short-lived; however, 10 to 15% of women and men go on to develop more significant symptoms of depression or anxiety. Postpartum psychiatric illnesses are typically divided into categories:

• Antenatal/Antepartum Depression
• Postpartum Baby Blues
• Postpartum Depression
• Postpartum Anxiety Disorders
• Postpartum OCD
• Postpartum Psychosis

It may be useful to conceptualize these disorders as existing along a continuum, where postpartum blues is the mildest and postpartum psychosis the most severe form of postpartum mood disorders.

Postpartum mood disorders are often characterized by despondency, emotional instability, anger, guilt, tearfulness, worrying, anxious thoughts or images, feelings of inadequacy and the inability to cope. It may occur shortly after the arrival of a new baby or many months later. For some, symptoms may begin in pregnancy; which is called or Antenatal Depression. The types of postpartum mood disorders generally lay on a spectrum.

Risk Factors for Developing Postpartum Mood Disorders:

Some things can make you more likely than others to develop postpartum mood disorders, including PPD. These are called risk factor. and having a risk factor or a few doesn’t mean for sure that you’ll have any problems with your mental health during or after pregnancy, but these risk factors, may increase your chances. Talk to your health care provider to see if you’re at risk for a postpartum mood disorder.

Your health care provider should assess you for PPD at your postpartum care checkups, including questions about your risks, feelings, stress level, as well as your moods.

Risk factors for postpartum mood disorders include:

• Depression during pregnancy (Antenatal depression) or you’ve had major depression or another mental illness before
• Family history of depression or mental health disorders.
• You’ve been physically or sexually abused in your life
• Problems with your partner, including domestic violence (also called intimate partner violence or IPV).
• Extra stress in your life, such being separated from your partner, the death of a loved one, or an illness that affects you or a loved one.
• Unemployed or have low income, little education, or little support from family or friends.
• Pregnancy is unplanned or unwanted, or you’re younger than 19.
• You have diabetes. Diabetes can be pre-existing diabetes (also called pre-gestational diabetes) or it can be gestational diabetes.
• Pregnancy complications such as premature birth, birth before 37 weeks of pregnant
• Multiples (twins, triplets) pregnancy
• Pregnant with a child who has been diagnosed birth defects
• Experiencing pregnancy loss.
• You have trouble breastfeeding or caring for your baby.
• Infant is sick or has ongoing health conditions.
• Negative thoughts about being a mom and/or having trouble adjusting to being a parent.

Negative thoughts and feelings about being a mom may include:

• Doubts that you can be a good mom
• Pressure to be a perfect mom
• Feeling that you’re no longer the person you were before you had your baby
• Feeling that you’re less attractive after having your baby
• Having no free time for yourself
• Feeling tired and moody because you aren’t sleeping well or getting enough sleep

What is Antenatal Depression?

Depression during pregnancy, or antepartum depression, is a mood disorder just like clinical depression as far as symptoms are concerned. Mood disorders are biological illnesses that involve changes in brain chemistry and men and women who suffer from major depression are at a higher risk for developing antenatal depression.

During pregnancy, as I’m sure you’re aware, hormone changes affects the chemicals in your brain, including those that tell you to eat, sleep, and rest. Some of the other hormone changes are directly related to Antenatal Depression and Antenatal Anxiety. Unfortunately, these hormones can be exacerbated by difficult life situations, stress, and other factors which can result in depression during pregnancy.

Women with Antepartum Depression tend experience some of the following symptoms for at least two weeks:

• Persistent sadness
• Problems concentrating
• Sleeping too little or too much
• Loss of interest in activities that you usually enjoy
• Recurring thoughts of death, suicide, or hopelessness
• Anxiety without a trigger
• Feelings of guilt or worthlessness
• Change in eating habits

What Are The Postpartum Baby Blues?

Specialists believe that approximately 50 to 85% of women and men experience postpartum blues during the first few weeks after delivery; part of it is related to wildly changing hormone levels, the stress of having a new person to care for, and not feeling as though they’ll be able to manage. As this type of mood disorder is common – even expected, it can be more accurate to consider The Baby Blues as a normal experience following childbirth rather than a psychiatric illness.

Rather than feelings of sadness, men and women with The Baby Blues more commonly report mood lability, tearfulness, anxiety, and/or irritability. These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within two weeks of delivery.

While these symptoms are unpredictable and often unsettling, they do not interfere with a woman’s ability to function. No specific treatment is required; however, it should be noted that sometimes The Baby Blues heralds the development of a more significant mood disorder, particularly in women who have a history of depression.

If symptoms of depression persist for longer than two weeks, you should be evaluated to rule out a more serious postpartum mood disorder.

What Is Postpartum Depression (PPD)?

PPD tends to emerge over the first two to three months postpartum but can occur at any point after delivery. Some men and women actually note the onset of milder depressive symptoms during pregnancy. Postpartum depression is clinically indistinguishable from depression occurring at other times during a woman’s life.

In women and men who have milder cases of PPD, it can be quite difficult to detect postpartum depression because many of the symptoms used to diagnose depression (such as sleep and appetite disturbance, fatigue) also occur in postpartum women in the absence of depression.

The Edinburgh Postnatal Depression Scale is a 10-item questionnaire that may be used to identify women who have PPD.

On this scale, a score of 12 or greater or an affirmative answer on question 10 (presence of suicidal thoughts) raise concern and indicate a need for more thorough evaluation.

Some of the symptoms of postpartum depression include:

• Depressed or sad mood
• Persistent sadness not otherwise explained
• Tearfulness
• Loss of interest in usual activities
• Feelings of guilt
• Feelings of worthlessness or incompetence
• Fatigue
• Sleep disturbance
• Change in appetite
• Poor concentration
• Suicidal thoughts

What Causes Postpartum Depression?

The postpartum period is characterized by a rapid shift in the hormonal environment. Within the first 48 hours after delivery, estrogen and progesterone concentrations fall dramatically. As these gonadal steroids modulate neurotransmitter systems involved in the regulation of mood, many investigators have proposed a role for these hormonal shirts in the emergence of postpartum affective illness.

While seems as if there is no consistent correlation between serum levels of estrogen, progesterone, cortisol, or thyroid hormones and the occurrence of postpartum mood disturbance, some investigators hypothesize that there is a subgroup of women who are particularly sensitive to the hormonal changes that take place after delivery. This population of women may be more vulnerable to PPD and to other hormonally driven mood disturbances, such as those occurring during the premenstrual phase of the menstrual cycle or during the perimenopause.

Other factors may play a role in the development of PPD. One of the most consistent findings is that among women and men who report marital dissatisfaction and/or inadequate social supports, postpartum depressive mental illnesses is more common. Several investigators have also demonstrated that stressful life events occurring either during pregnancy or near the time of delivery appear to increase the likelihood of postpartum depression.

While all of these factors may act together to cause PPD, the emergence of this disorder probably reflects an underlying vulnerability to affective illness. Women with histories of major depression or bipolar disorder are more vulnerable to PPD, and women who develop PPD will often go on to have recurrent episodes of depression unrelated to pregnancy or childbirth.

Who is at Risk for Postpartum Depression?

All women are vulnerable to postpartum depression, regardless of age, marital status, education level, or socioeconomic status. While it is impossible to predict who will develop PPD, certain risk factors for PPD have been identified, including:

• Previous episode of PPD
• Depression during pregnancy (antenatal depression)
• History of depression or bipolar disorder
• Recent stressful life events
• Inadequate social supports
• Marital or family issues

What Is Postpartum Anxiety?

Recent research suggests that 6% of pregnant women and 10% of postpartum women develop significant anxiety disorders. Sometimes these men and women experience anxiety alone, and sometimes they experience it in addition to postpartum depression. You do not have to be diagnosed with OCD to experience these common symptoms of perinatal anxiety

Generalized anxiety is common in both the general population and the postpartum period, however some women may also develop more challenging types of anxiety, such as panic disorder, and/or hypochondriasis in the postpartum period. Postpartum obsessive-compulsive disorder has also been reported, in which women report disturbing and intrusive thoughts of harming their infant.

• Constant worry
• Feeling that something bad is going to happen
• Racing thoughts
• Disturbances of sleep and appetite
• Inability to sit still
• Physical symptoms like dizziness, hot flashes, and nausea

Risk factors for perinatal anxiety and/or panic disorder may include a personal or family history of anxiety, previous perinatal depression or anxiety, or thyroid imbalance; however, many men and women develop Postpartum Anxiety without any risk factors.

Postpartum Panic Disorder is a form of anxiety with which the sufferer feels very nervous and has recurring panic attacks after the birth or adoption of a baby or child. During a panic attack, he or she may experience any or all of the following:

• Shortness of breath
• Feeling of someone sitting on his or her chest
• Chest pain
• Claustrophobia
• Dizziness
• Heart palpitations
• Numbness and tingling in the extremities.

Panic attacks seem to go in waves, but it is important to know that they will pass and will not hurt you.

What Is Postpartum Obsessive-Compulsive Disorder?

Postpartum Obsessive-Compulsive Disorder (OCD) is probably most misunderstood and misdiagnosed of the perinatal mood disorders. It is estimated that as many as 3-5% of new mothers and some new fathers will experience some of these symptoms. The repetitive, intrusive images and thoughts are very frightening and can feel like they come “out of the blue.” Fortunately, postpartum OCD is temporary and treatable with professional help. If you feel you may be suffering from one of this illness, know that it is not your fault and you are not to blame.

Research has shown that these images are anxious in nature, not delusional, and have very low risk of being acted upon. It is far more likely that the parent with this symptom takes steps to avoid triggers and avoid what they fear is potential  harm to the baby.

Some women and men do not have OCD but are bothered by obsessive-compulsive symptoms.

Symptoms of Postpartum Obsessive-Compulsive symptoms can include:

• Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. These thoughts are very upsetting and not something the woman has ever experienced before.
• Compulsions, where the mom may do certain things over and over again to reduce her fears and obsessions. This may include things like needing to clean constantly, check things many times, count or reorder things.
• A sense of horror about the obsessions
• Overly occupied with keeping your baby safe
• Compelled to do certain things over and over again to help relieve her anxiety and fears–This can include counting things, ordering things, listing things, checking and rechecking actions already performed, and cleaning repeatedly. This may manifest itself in cleaning, feeding, or taking care of the baby.
• May recognize these obsessions but feels horror and shame associated with them
• Obsessions or thoughts that are persistent, are repetitive and can include mental images of the baby that are disturbing
• Fear of being alone with the baby
• Women who suffer from PPOCD often know that these thoughts, actions, and feelings are not normal and do not act on them. But the obsession can get in the way of a mom taking care of her baby properly or being able to enjoy her baby. With the right treatment, women with PPOCD can experience freedom from being controlled by these obsessions and compulsions
• Fear of being left alone with the infant
• Hypervigilance in protecting the infant

Moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.

Risk factors for postpartum OCD include a personal or family history of anxiety or OCD.

Given the potential adverse effects of untreated mood and anxiety symptoms in either the mother, father, careful screening and early recognition of anxiety symptoms during the postpartum period is recommended. Antepartum anxiety are temporary and treatable with professional help. If you feel you may be suffering from one of these illnesses, know that it is not your fault and you are not to blame.

What Is Postpartum Post-Traumatic Stress Disorder (PPTSD)?

Postpartum post-traumatic stress disorder (P-PTSD) often affects women who experienced a real or perceived trauma during childbirth or immediately after the baby was born.

P-PTSD is not a well-researched postpartum mood disorder, but for the estimated 3 to 16 percent of new moms and dads who suffer from it, this postpartum mood disorder is very real and incredibly frightening. P-PTSD can greatly impact the way they experience parenthood and care for their new baby.

For most women, the safe delivery of a healthy baby is moment remembered with great happiness. But not every new mom’s birth experience is a joyful one. In fact, more than a third of recently delivered moms describe their birth as traumatic, and the American College of Obstetricians and Gynecologists estimate that 3 to 16 percent display severe traumatic stress responses in the postpartum period. Like war veterans who suffer from PTSD – intrusive memories and flashbacks after suffering traumatic experiences on the battlefield – moms with P-PTSD look at their childbirth experience as a source of pain and anxiety and suffer from very similar post-traumatic symptoms.

P-PTSD is triggered by a traumatic event or events – real or perceived –– during pregnancy, labor, delivery, or during the postpartum period.

A mom-to-be may experience a traumatic event, such as severe morning sickness, fertility treatments, or serious pregnancy complications. Some women might experience trauma during childbirth if their labor was long and painful, if there was a cord prolapse, shoulder dystocia, a severe tear, previously undiscovered birth defects, hemorrhage, or an emergency C-section.

Trauma may result from a home birth that resulted in a transfer to a hospital due to complications; it could be from a planned hospital delivery that ended up unexpectedly at home. Trauma may develop if someone who’d wanted an intervention-free birth ends up requiring life-saving interventions.

Postpartum traumas may include having a premature baby, a baby who needs to be in the NICU, breastfeeding difficulties, or worse, a stillbirth or loss of a child early on.

Often the trauma is an emotional one: feelings of being powerless, of not being listened to, of not having adequate support during childbirth.

It’s important to remember that postpartum PTSD can develop after a real or perceived threat of death of the mother, father, or baby.

Traumas that may cause postpartum post-traumatic stress (P-PTSD) disorder include:

• Unplanned or emergency C-section
• Emergency complication such as prolapsed umbilical cord
• Birth that requires invasive interventions such as vacuum extractor or forceps
• Baby requiring a NICU stay
• Lack of support and assurance during the delivery
• Lack of communication from the birth and support team
• Feelings of powerlessness

Symptoms of P-PTSD may include:

• Nightmares and flashbacks to the birth or trauma
• Anxiety and panic attacks
• Feeling a detachment from reality and life
• Irritability, sleeplessness, hyper-vigilance, startles more easily
• Avoidance of anything that brings reminders of the event such as people, places, smells, noises, feelings
• May begin re-experiencing past traumatic events, including the event that triggered the disorder

Women who are experiencing PPTSD need to talk with a health care provider about what they are feeling. With the correct treatment, these symptoms will lessen and eventually go away.

What Is Postpartum Psychosis?

Postpartum Psychosis (PP) is a severe, but treatable, form of mental illness that occurs after having a baby. It can happen ‘out of the blue’ to women without previous experience of mental illness. There are some groups of women, women with a history of bipolar disorder for example, who are at much higher risk. PP normally begins in the first few days to weeks after childbirth. It can get worse very quickly and should always be treated as a medical emergency. Most women need to be treated with medication and admitted to hospital.

Postpartum psychosis is the most severe form of postpartum mood disorders and is extremely – extremely dangerous. Postpartum Psychosis is a medical emergency. If you believe a friend or loved one is suffering from Postpartum Psychosis, don’t wait: call 911. This is an emergency.

Fortunately, postpartum psychosis It is a rare postpartum mood disorder that occurs in approximately 1 to 2 per 1000 women after childbirth.

The presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks.

With the right treatment, women with PP do make a full recovery. Recovery takes time and the journey may be tough. The illness can be frightening and shocking for both the woman experiencing it and her family. Women do return to their normal selves, and are able to regain the mothering role they expected. There is no evidence that the baby’s long term development is affected by Postpartum Psychosis.

There are a large variety of symptoms that women with PP can experience. Women may be:

• Excited, elated, or ‘high’.
• Depressed, anxious, or confused.
• Excessively irritable or changeable in mood.

Postpartum Psychosis includes one or more of the following:

• Strange beliefs that could not be true (delusions).
• Hearing, seeing, feeling or smelling things that are not there (hallucinations).
• High mood with loss of touch with reality (mania).
• Paranoia
• Attempts to harm the child or herself
• Severe confusion.

These are also common symptoms:

• Being more talkative, sociable, on the phone an excessive amount.
• Having a very busy mind or racing thoughts.
• Feeling very energetic and like ‘super-mum’ or agitated and restless.
• Having trouble sleeping, or not feeling the need to sleep.
• Behaving in a way that is out of character or out of control.
• Feeling paranoid or suspicious of people’s motives.
• Feeling that things are connected in special ways or that stories on the TV or radio have special personal meaning.
• Feeling that the baby is connected to God or the Devil in some way.

It appears that in most cases, postpartum psychosis represents an episode of bipolar illness; the symptoms of puerperal psychosis most closely resemble those of a rapidly evolving manic (or mixed) episode. The earliest signs are restlessness, irritability, and insomnia. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant.

Auditory hallucinations that instruct the mother to harm herself or her infant may also occur.

Risk for infanticide, as well as suicide, is significant in this population.

How Are Postpartum Mood Disorders Treated?

Postpartum depression presents along a continuum, and the type of treatment selected is based on the severity and type of symptoms present. However, before initiating psychiatric treatment, any medical causes for mood disturbances (including thyroid dysfunction and/or anemia) must be excluded. Initial evaluation of a man or woman for postpartum mood disorders should always include a thorough and complete history, a physical examination, as well as routine laboratory tests.

Non-pharmacological therapies are often useful in the treatment of postpartum depression. It has been wildly demonstrated that short-term cognitive-behavioral therapy (CBT) was as effective as treatment with fluoxetine in women who have postpartum depression. Interpersonal therapy (IPT) has also been shown to be effective for the treatment of women with mild-to-moderate postpartum depression. Not only is IPT effective for treating the symptoms of depression, women who receive IPT may also benefit from significant improvements in the quality of their interpersonal relationships.

These non-pharmacological interventions may be particularly attractive to those patients who are reluctant to use psychotropic medications (such as women who are breastfeeding) or for women who have milder forms of depressive illness. Women with more severe postpartum depression may choose to receive pharmacological treatment, either in addition to or instead of these non-pharmacological therapies.

Only a few studies have systematically assessed the pharmacological treatment of postpartum depression.

Conventional antidepressant medications (fluoxetine, sertraline, fluvoxamine, and venlafaxine) have shown efficacy in the treatment of postpartum depression, standard antidepressant doses were both effective and well tolerated. The choice of an antidepressant should be guided by the woman’s prior response to antidepressant medication and side effect profile. Specific serotonin reuptake inhibitors (SSRIs) are ideal first-line agents, as they are anxiolytic, non-sedating, and well-tolerated.

For women who cannot tolerate SSRIs, bupropion (Wellbutrin) may be an alternative; although one pilot study suggests bupropion may not be as effective as SSRIs

Tricyclic antidepressants (TCAs) are frequently used and, because they tend to be more sedating, may be more appropriate for women who present with prominent sleep disturbance. Given the prevalence of anxiety symptoms, adjunctive use of a benzodiazepine (including clonazepam, lorazepam) may be very helpful to help ease anxiety and allow for relaxation.

While it’s difficult to reliably predict which women in the general population will experience postpartum mood disorders, it is possible to identify certain subgroups of women (such as men and women with a history of mood disorders) who are more vulnerable to postpartum affective illness.

Current research indicates that prophylactic interventions may be instituted near or at the time of delivery to decrease the risk of postpartum illness. Several studies demonstrate that women with histories of bipolar disorder or puerperal psychosis benefit from prophylactic treatment with lithium instituted either prior to delivery (at 36 weeks gestation) or no later than the first 48 hours postpartum.

Women and men with postpartum psychiatric illness are offered a variety of services by clinicians with particular expertise in these areas:

• Clinical evaluation for postpartum mood and anxiety disorders
• Medication management
• Consultation regarding breastfeeding and psychotropic medications
• Recommendations regarding non-pharmacological treatments
• Referral to support services within the community

Puerperal psychosis is considered a psychiatric emergency that typically requires inpatient treatment.

Acute treatment with either typical or atypical anti-psychotic medications is indicated. Given the well-established relationship between puerperal psychosis and bipolar disorder, postpartum psychosis should be treated as an affective psychosis and a mood stabilizer is indicated.

Electroconvulsive therapy (ECT) is well-tolerated and rapidly effective for severe postpartum depression and psychosis.

Can I Take Medications While Breastfeeding?

The nutritional, immunologic and psychological benefits of breastfeeding have been well-documented. Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into the breast milk, though concentrations in the breast milk appear to vary widely throughout the day The amount of medication to which an infant is exposed depends on several factors including, dosage of medication, rate of maternal drug metabolism, and frequency and timing of feedings.

Over the past five years, we’ve learned more regarding the use of various antidepressants during breastfeeding. Available data on the tricyclic antidepressants, fluoxetine, paroxetine, and sertraline during breastfeeding have been encouraging and suggest that significant complications related to an infant’s exposure to these medications in breast milk appear to be rare. While less information is available on other antidepressants, there have been no reports of serious adverse events related to infant exposure to these medications.

Women who have bipolar disorder may discover breastfeeding may be much more problematic. The first concern is that on-demand, around-the-clock breastfeeding may significantly disrupt the mother’s sleep, which can increase her vulnerability to a relapse of bipolar disorder during the postpartum period. Second, there have been reports of toxicity in nursing infants who have been exposed to various mood stabilizers in the breast milk, including lithium and carbamazepine. Lithium, a gold standard in management of bipolar disorder, is excreted at high levels in the mother’s milk, so infant serum levels of Lithium are relatively high, which brings an increased risk of neonatal toxicity. Exposure to carbamazepine and valproic acid in the breast milk has also been associated with hepatotoxicity (liver toxicity) in a nursing infant.

If you’ve been diagnosed and treated for bipolar disorder, the very best thing that you can do for yourself and your infant is to develop a postpartum plan with your psychiatrist and your OB, based on the symptoms you experienced before you were pregnant. In this plan, you can address your postpartum concerns and ways to manage these concerns.

Additional Things You Can Do To Help Postpartum Mood Disorders:

Childhood Trauma Resources

by Aunt Becky | Apr 11, 2019

What Is Trauma?

Trauma is any injury, physically or emotionally inflicted upon a person. Trauma has both a medical and a psychiatric definition. For the purposes of this site, we will focus primarily upon psychological trauma and its effects.

Emotional, or Psychological, Trauma is an intense, emotional reaction to a traumatic or severe situation. Trauma may be caused by stressful events such as natural disasters, incidences of abuse, assault, or death. Trauma can also be caused by more minor events, like a car accident or sports injuries.

A traumatic event involves a single event, or a repeating pattern of events that completely overwhelm an individual’s ability to cope or integrate the emotions involved in that experience. That feeling of being overwhelmed can last days, weeks, even years as the person struggles to cope.

Trauma can be caused by a number of events, but there are a few common aspects. There’s often a violation of the person’s familiar ideas about the world and of their rights, which puts the person into a state of extreme confusion and insecurity.

Psychological trauma may be accompanied by physical trauma or exist independently.

Trauma, while often involving a threat to life or safety, can also involve any situation that leaves you feeling stressed or alone, even if it didn’t involve physical harm. It’s not the objective facts that determine if an event is traumatic, but the subjective emotional experience of the event. The more frightened and helpless you felt at the time, the more likely that you will feel traumatized afterwards.

A traumatic event or situation creates psychological trauma when it overwhelms the individual’s ability to cope, and leaves that person fearing death, annihilation, mutilation, or psychosis. The individual may feel emotionally, cognitively, and physically overwhelmed. The circumstances of the event commonly include abuse of power, betrayal of trust, entrapment, helplessness, pain, confusion, and/or loss.

This definition of trauma is fairly broad. It includes responses to powerful one-time incidents like accidents, natural disasters, crimes, surgeries, deaths, and other violent events. It also includes responses to chronic or repetitive experiences such as child abuse, neglect, combat, urban violence, concentration camps, battering relationships, and enduring deprivation. This definition intentionally does not allow us to determine whether a particular event is traumatic; that is up to each survivor. This definition provides a guideline for our understanding of a survivor’s experience of the events and conditions of their life.

There are two components to a traumatic experience: the objective and the subjective:

It’s is the subjective experience of the objective events that constitutes the trauma. The more you believe you are endangered, the more traumatized you will be. Psychologically, the bottom line of trauma is overwhelming emotion and a feeling of utter helplessness. There may or may not be bodily injury, but psychological trauma is coupled with physiological upheaval that plays a leading role in the long-range effects.

In other words, trauma is defined by the experience of the survivor.

Two people could undergo the same noxious event and one person might be traumatized while the other person remained relatively unscathed. It is not possible to make blanket generalizations such that “X is traumatic for all who go through it” or “event Y was not traumatic because no one was physically injured.” In addition, the specific aspects of an event that are traumatic will be different from one individual to the next. You cannot assume that the details or meaning of an event, such as a violent assault or rape, that are most distressing for one person will be same for another person.

Trauma comes in many forms, and there are vast differences among people who experience trauma. But the similarities and patterns of response cut across the variety of stressors and victims, so it is very useful to think broadly about trauma.

What Conditions Co-Occur in Children And Adults Who Have Experienced Childhood Trauma?

Adults who experienced childhood trauma are at a greater risk for a number of complications and co-occurring disorders that may require diagnosis and treatment:

• Chronic pain and physical illnesses like diabetes or heart disease
• Depression
• Anxiety disorders
• Obsessive-compulsive disorder
• Substance use disorders
• Post-traumatic stress disorder and other trauma-related mental illnesses
• Dissociative disorders
• Self-harm
• Suicide

What Are Some Statistics About Childhood Trauma?

60% of adults report experiencing abuse or other difficult family circumstances during childhood.

26% of children in the United States will witness or experience a traumatic event before they turn four.

Four of every 10 children in American say they experienced a physical assault during the past year, with one in 10 receiving an assault-related injury.

2% of all children experienced sexual assault or sexual abuse during the past year, with the rate at nearly 11% for girls aged 14 to 17.

Nearly 14% of children repeatedly experienced maltreatment by a caregiver, including nearly 4% who experienced physical abuse.

1 in 4 children was the victim of robbery, vandalism, or theft during the previous year.

More than 13% of children reported being physically bullied, while more than 1 in 3 said they had been emotionally bullied.

1 in 5 children witnessed violence in their family or the neighborhood during the previous year.

In one year, 39% of children between the ages of 12 and 17 reported witnessing violence, 17% reported being a victim of physical assault and 8% reported being the victim of sexual assault.

More than 60% of youth age 17 and younger have been exposed to crime, violence and abuse either directly or indirectly.

More than 10% of youth age 17 and younger reported five or more exposures to violence.

About 10% of children suffered from child maltreatment, were injured in an assault, or witnessed a family member assault another family member.

About 25% of youth age 17 and younger were victims of robbery or witnessed a violent act.

Nearly half of children and adolescents were assaulted at least once in the past year.

Among 536 elementary and middle school children surveyed in an inner city community, 30% had witnessed a stabbing and 26% had witnessed a shooting.

Young children exposed to five or more significant adverse experiences in the first three years of childhood face a 76% likelihood of having one or more delays in their language, emotional or brain development.

As the number of traumatic events experienced during childhood increases, the risk for the following health problems in adulthood increases: depression; alcoholism; drug abuse; suicide attempts; heart and liver diseases; pregnancy problems; high stress; uncontrollable anger; and family, financial, and job problems.

People who have experienced trauma are:

• 15 times more likely to attempt suicide
• 4 times more likely to become an alcoholic
• 4 times more likely to develop a sexually transmitted disease
• 4 times more likely to inject drugs
• 3 times more likely to use antidepressant medication
• 3 times more likely to be absent from work
• 3 times more likely to experience depression
• 3 times more likely to have serious job problems
• 2.5 times more likely to smoke
• 2 times more likely to develop chronic obstructive pulmonary disease
• 2 times more likely to have a serious financial problem

What Is a Traumatic Event?

A traumatic event is a frightening, dangerous, or violent event that poses a threat to a child’s life or bodily integrity. Witnessing a traumatic event that threatens life or security of a loved one can also be traumatic, particularly for young children as their sense of safety depends on the safety of their guardians.

Traumatic experiences can lead to strong emotions and physical reactions that may persist long after the event is over. Children may feel terror, helplessness, or fear, as well as physiological reactions such as heart pounding, vomiting, or loss of bowel or bladder control. Children who experience an inability to protect themselves or who lacked protection from others to avoid the consequences of the traumatic experience may also feel overwhelmed by the intensity of their physical and emotional responses.

Who Is At Greater Risk For Childhood Trauma?

Some groups of children and families are disproportionately represented among those experiencing trauma, which means that they may be exposed to trauma at particularly high rates or be at increased risk for repeated victimization and traumatic experiences. For some populations, co-occurring issues and unique adversities can complicate recovery from trauma.

Others may face major challenges related to access to services or require services that are specially adapted for their needs.

Trauma and Substance Abuse:

There is a strong connection between traumatic stress and substance abuse that has implications for children and families, whether the user is an adolescent or a parent or caregiver.

Research studies have shown that adolescents who engage in problematic substance use are more likely to experience traumatic events and develop PTSD, depression, violent behavior, suicide, and other mental health problems compared to those who do not use substances. Additionally, adolescents exposed to traumatic events are more vulnerable to problematic substance use. Psychoactive substances can both dull the effects of stress and place teens at increased risk for experiencing trauma.

Caregiver substance use carries many risks for child and adolescent development. Starting even before children are born, parental substance use increases children’s risk for later mental health problems and victimization. Children and adolescents with substance-using parents may be exposed to other high-risk situations, such as violence in the home and community.

Economic Stress:

Whether living in urban, suburban, or rural settings, people face the reality of economic downturns: being laid off, being unable to find a job, having difficulty supporting a family, or the closing of community organizations or local services upon which they depend. Economic challenges can affect feelings of safety, the ability to remain calm, relationships with others, and hope and belief that things will improve. When times are uncertain, people feel frustrated, angry, scared, or hopeless; they may have to plan new ways to overcome obstacles.

As children hear, see, and read about what is happening in their homes, communities, and the world, they experience economic stress alongside their parents; when their parents are worried, children begin to worry too.

Military and Veteran Families:

Children of military and veteran families experience unique challenges related to military life and culture. These include deployment-related stresses such as parental separation, family reunification, and reintegration; disruption of relationships with friends and neighbors due to frequent moves; and adaptation to new schools and new community resources.

Added to this, some children face the trauma of a parent returning home from combat with injuries or illness; others must face their parent’s death. Research indicates that although most military children are healthy and resilient and have positive outcomes, certain deployment stresses put some groups at risk: young children; children with preexisting health and mental health problems; children whose parents serve in the National Guard, are reserve personnel, or have had multiple deployments; children who do not live close to military communities; children who live in places with limited resources; children in single-parent families with that parent deployed; and children in dual-military parent families with one or both parents deployed.

Intellectual and Developmental Disabilities:

Research indicates that youth living with intellectual and developmental disability (IDD) experience exposure to trauma at a higher rate than their non-disabled peers. Children with IDD appear to be at an increased risk for physical abuse, physical restraint, seclusion, sexual abuse, and emotional neglect. Additionally, this psychological distress comes second to medical problems and procedures and is more common among children living with IDD than their typically developing peers, as they also may have chronic medical problems that necessitate surgeries and other invasive procedures.

When trauma occurs with children and families with IDD, it is challenging to effectively address the psychological impact of the event.

Homeless Youth:

As many as 2.5 million youth per year are homeless. Along with losing their homes, community, friends, and routines – and their sense of stability and safety – many homeless youth are also victims of violence or other traumatic events. While coming from a variety of backgrounds, research suggests that most of these youth have experienced early and multiple traumas. Their responses to these events have been shaped—at least in part—by age, gender, ethnicity, and sexual orientation.

This history of trauma in turn can cause significant mental health problems, including depression, anxiety disorders, PTSD, suicidal ideation, attachment issues, and substance abuse disorders. Once they arrive on the street, many youths are re-traumatized. Then they struggle to recover from earlier traumatic events at the same time that they are trying to survive in a hostile street environment replete with countless dangers, including an increased likelihood of substance abuse and a vulnerability to being trafficked.

LGBTQ Children and Teens:

Lesbian, gay, bisexual, transgender, and queer, or questioning (LGBTQ) youth experience trauma at higher rates than their straight peers. Common traumas experienced by these youth include bullying, harassment, traumatic loss, intimate partner violence, physical and sexual abuse, and traumatic forms of societal stigma, bias, and rejection. Historically, professionals have failed to recognize and meet the needs of traumatized LGBTQ youth, leading to poor engagement and ineffective treatments that, in some cases, perpetuate the youth’s traumatic experiences.

What Experiences Might Be Traumatic?

• Physical, sexual, or psychological abuse and neglect (including human trafficking)
• Bullying is a deliberate and unsolicited action that occurs with the intent of inflicting social, emotional, physical, and/or psychological harm to someone who often is perceived as being less powerful.
• Natural and technological disasters or terrorism
• Family or community violence
• Sudden or violent loss of a loved one
• Substance use disorder (personal or familial)
• Refugee and war experiences (including torture)
• Serious accidents or life-threatening illness
• Military family-related stressors (e.g., deployment, parental loss or injury)

When children have been in situations where they feared for their lives, believed that they would be injured, witnessed violence, or tragically lost a loved one, they may show signs of child traumatic stress.

How Does Trauma Affect Children?

While adults work hard to keep children safe, dangerous events still happen. This danger can come from outside of the family (such as a natural disaster, car accident, school shooting, or community violence) or from within the family, such as domestic violence, physical or sexual abuse, or the unexpected death of a loved one.

Traumatic experiences are often shattering and life-altering for children. These experiences may effect all levels of functioning and result in an array of distressing symptoms:

Physical Symptoms of Exposure to Trauma Can Include:

• nervousness,
• tiredness
• headaches
• stomach aches
• nausea
• palpitations
• pain
• difficulty sleeping
• nightmares
• worsening of existing medical problems

Emotional Symptoms of Exposure to Trauma Can Include:

• fear
• anxiety
• panic
• irritability
• anger
• withdrawal
• numbness
• depression
• confusion
• hopelessness
• helplessness

Academic Symptoms of Exposure to Trauma Can Include:

• inability to concentrate or remember
• missing school
• poor academic performance.

Relational Symptoms of Exposure to Trauma Can Include:

• emotional barriers between caregivers and children
• distrust and feelings of betrayal
• attachment problems

Nearly all trauma survivors have acute symptoms following a traumatic event, but these generally decrease over time.

Factors That Impede Processing Childhood Trauma:

• Previous exposure to trauma: This may include neglect, physical abuse, sexual abuse, or abrupt separation from a caregiver.
• Duration of exposure to trauma: A one-time exposure, such as a car accident, results in very different responses than exposure over several years, such as domestic violence.
• The longer the exposure, the more difficult the healing process.
• Severity of exposure: An incident that happens directly to a child or in front of a child will have different impacts than an incident that happened to someone else or one a child was told about later. The more severe the exposure, the more difficult it will be to heal.
• Prior emotional and behavioral problems: Pre-existing problems with being able to pay attention, being hyperactive, fighting or not following rules, or a prior history of depression or anxiety may complicate a child’s response to a traumatic event.
• Caregiver’s response after the exposure: It matters whether a caregiver validates the child’s experience or blames the child, or if the caregiver is able to provide comfort and reassurance instead of having difficulty responding to the child. When a caregiver experiences a high level of distress, a child often responds similarly. Caregiver’s support is one of the most important factors in a child’s recovery from trauma.

What Is Childhood Traumatic Stress?

Children who suffer from childhood traumatic stress have been exposed to one or more traumas over their lifetime and develop a reaction that lasts longer than the traumatic event; this reaction affects their everyday life.

Traumatic reactions can include a variety of responses, such as intense and ongoing emotional upset, depressive symptoms or anxiety, behavioral changes, difficulties with self-regulation, problems relating to others or forming attachments, regression or loss of previously acquired skills, attention and academic difficulties, nightmares, difficulty sleeping and eating, and physical symptoms, such as aches and pains.

Older children may use drugs or alcohol, behave in risky ways, or engage in unhealthy sexual activity.

Children who suffer from traumatic stress often have these types of symptoms when reminded in some way of the traumatic event.

While many of us may experience reactions to stress some of the time, when a child is experiencing traumatic stress, these reactions interfere with the child’s daily life and ability to function and interact with others. At no age are children immune to the effects of traumatic experiences. Even infants and toddlers can experience traumatic stress. The way that traumatic stress manifests will vary from child to child and will depend on the child’s age and developmental level.

Without treatment, repeated childhood exposure to traumatic events can affect the brain and nervous system and increase health-risk behaviors (such as smoking, eating disorders, substance use, and high-risk activities).

Research shows that child trauma survivors can be more likely to have long-term health problems (such as diabetes and heart disease) or to die much younger than average people. Traumatic stress can also lead to increased use of health and mental health services and increased involvement with the child welfare and juvenile justice systems.

Adult survivors of traumatic events may also have difficulty in establishing fulfilling relationships and maintaining employment.

Factors That May Increase The Likelihood Of Children’s Recovery From Trauma (Resilience Factors)

Individual Traits:

• Easy temperament
• Feeling of control over one’s life
• High self-esteem/self-confidence
• Sense of humor
• Optimism
• Sociable
• Intelligent

Family Traits: 

• Safe, warm, caring, supportive environment
• High expectations for achievement
• Good communication
• Strong family cohesion
• Reasonable structure and limits
• Strong relationship with at least one caregiver

School-Based Traits

• Considers school a safe place to be
• Warm, caring, supportive environment
• High expectations for achievement
• Significant adult committed to child
• Academic achievement
• Models from peers of developmentally appropriate behavior
• Good relationships with peers
• Involvement and participation in school community/activities

Community Traits: 

• Safe community (or safe places to go)
• Access to resources and supports (e.g., church, mentor, clubs)
• Involved in community activities

 Factors That May Interfere With Children’s Recovery From Trauma (Risk Factors):

Individual Traits

• Difficult temperament (e.g., fussy, irritable, sensitive)
• Sense of a lack of control over life events
• Dependency beyond what is age-appropriate
• Low self-esteem/self-confidence
• Feeling of uncertain or poor future outcomes
• Shy/difficulty making friends

Family Traits:

• Physical or sexual abuse, neglect, domestic violence
• High levels of parental distress
• Lack of parental support
• Expectation that child will fail or act out
• Lack of structure, limit-setting
• Negative relationships with caregivers

School-Based Traits

• Exposure to school violence
• Lack of support from adults at school
• Poor academic performance
• Difficulty with peer relationships
• Lack of participation in school community/activities

Community Traits

• Violence in the community
• Unable to identify a safe place to go
• Unable to identify resources or supports in the community
• Disconnected from the community

Childhood Trauma: Reminders and Adversities

Traumatic experiences can set in motion a cascade of changes in children’s lives that can be challenging and difficult. These can include changes in where they live, where they attend school, who they’re living with, and their daily routines. They may now be living with injury or disability to themselves or others. There may be ongoing criminal or civil proceedings they must cope with.

Traumatic experiences leave a legacy of reminders that may persist for years. These reminders are linked to aspects of the traumatic experience, its circumstances, and its aftermath.

Children may be reminded and triggered by persons, places, things, situations, anniversaries, or by feelings such as renewed fear or sadness.

Physical reactions can also serve as reminders and triggers, for example, increased heart rate or bodily sensations.

Learning children’s responses to trauma and loss triggers is an important tool for understanding how and why children’s distress, behavior, and functioning often fluctuate over time. Trauma and loss reminders can reverberate within families, among friends, in schools, and across communities in ways that can powerfully influence the ability of children, families, and communities to recover.

Addressing trauma and loss triggers is critical to enhancing ongoing adjustment.

Childhood Trauma: Risk and Protective Factors

Fortunately, even when children experience a traumatic event, they don’t always develop traumatic stress. Many factors contribute to symptoms, including whether the child has experienced trauma in the past, and protective factors at the child, family, and community levels can reduce the adverse impact of trauma. These may include:

• Severity of the event. How serious was the event? How badly was the child or someone she loves physically hurt? Did they or someone they love need to go to the hospital? Were the police involved? Were children separated from their caregivers? Were they interviewed by a principal, police officer, or counselor? Did a friend or family member die?
• Proximity to the event. Was the child actually at the place where the event occurred? Did they see the event happen to someone else or were they a victim? Did the child watch the event on television? Did they hear a loved one talk about what happened?
• Caregivers’ reactions. Did the child’s family believe that he or she was telling the truth? Did caregivers take the child’s reactions seriously? How did caregivers respond to the child’s needs, and how did they cope with the event themselves?
• Prior history of trauma. Children continually exposed to traumatic events are more likely to develop traumatic stress reactions.
• Family and community factors. The culture, race, and ethnicity of children, their families, and their communities can be a protective factor, meaning that children and families have qualities and or resources that help buffer against the harmful effects of traumatic experiences and their aftermath. One of these protective factors can be the child’s cultural identity. Culture often has a positive impact on how children, their families, and their communities respond, recover, and heal from a traumatic experience. However, experiences of racism and discrimination can increase a child’s risk for traumatic stress symptoms.

What Are Some Effects Of Trauma Among Children?

Unexpectedly losing a loved one or being involved in a natural disaster, motor vehicle accident, plane crash, or violent attack can be overwhelmingly stressful for all of us – especially our children. A traumatic event can undermine their sense of security, leaving them feeling helpless and vulnerable, especially if the event stemmed from an act of violence, such as a physical assault, mass shooting, or terrorist attack. Even kids or teens not directly affected by a disaster can become traumatized when repeatedly exposed to horrific images of the event on the news or social media.

No matter the age of your child, it’s important to offer extra reassurance and support following a traumatic event. A child’s reaction to a disaster or trauma can be greatly influenced by their parents’ response, so it’s important to educate yourself about trauma and traumatic stress.

The more you know about the symptoms, effects, and treatment options, the better equipped you’ll be to help your child recover. With your love and support, the unsettling thoughts and feelings of traumatic stress can start to fade and your child’s life can return to normal in the days or weeks following the event.

What is Acute Traumatic Stress?

Acute trauma is generally a onetime event, such as a car accident or a natural disaster. Because children’s responses to acute trauma vary, awareness of the wide array of possible responses allows caregivers to provide a sense of safety and security, and support healing.

We each have an “alarm system” in our brain that signals us when we might be in danger. When our brain perceives danger, it prepares our body to respond. Our response often depends on the nature of the danger, but we are likely to react in one of three ways:

1. Fight
2. Flight
3. Freeze

Two parts of our brain respond to danger:

The “doing brain” signals the need for action, while the “thinking brain” tries to solve the problem and make a plan.

When the brain perceives danger, the “thinking brain” makes an assessment. If it’s a false alarm because there is no real danger, the “thinking brain” shuts the alarm off and we move on.

If there is actual danger, the “doing brain” signals the body to release chemicals, to provide energy for us to respond.

When this happens, the “thinking brain” shuts off to allow the “doing brain” to take over.

As a result of this alarm system, people often experience intense emotional responses after a traumatic event. These responses are generally short-lived and most people eventually return to their usual level of functioning after the event. To cope with traumatic exposure, people often need time and support to process the event. During this time, any reminder of the event may lead to a reactivation or increase in their responses.

Some people are unable to recover from acute trauma in a timely way. As a result, they are more likely to develop an Acute Stress Disorder or Post-Traumatic Stress Disorder. The type, severity, and duration of exposure to traumatic stress will influence the course of recovery. The situation is compounded for children by their developmental stages.

What Are Childhood Developmental Stages?

As children grow and mature, they are faced with age-specific challenges they must master before moving along to the next stage.

At each developmental stage, a child is faced with different tasks that build upon one another: a toddler learns to explore his world; school-aged children are interested in making friends; an adolescent tries to separate and become more independent.

When faced with traumatic stress, a child’s energy is diverted and she has less capacity to master developmental challenges.

Most children rebound from traumatic experiences and continue to achieve expected developmental milestones. One of the crucial ways children are able to heal is with support from caregivers to make them feel safe, secure, and protected. The level of support a child receives from a caregiver is the most significant factor in how well a child fares after a traumatic event.

Children’s Developmental Stages

Early Childhood (0 – 5 years) The tables below outline primary developmental tasks and how they may be impacted by exposure to an acute traumatic stressor. These tables include developmental tasks from birth to age twelve, and are not inclusive of every developmental task that may occur.

Histrionic Personality Disorder Subtypes (As Suggested by Million)

What Is Complex Trauma in Children?

Children experience complex traumatic stress when they have had prolonged exposure to trauma, (as would occur if the child suffers regular physical or sexual abuse), experience multiple traumatic events over time, or when different traumatic events occur at the same time (such as separation from a parent or caregiver that’s followed by physical abuse, neglect).

Complex trauma profoundly impacts children’s physical, emotional, behavioral, and cognitive development. It impairs their ability to feel safe in the world and to develop sustaining relationships.

Traumatic experiences change the way the brain functions. According to Judith Herman: “Traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory. Moreover, traumatic events may sever these normally integrated functions from one another.”

The brain’s alarm system prepares the body to respond to danger. The “thinking brain” assesses the situation to determine if there is danger or not.

For children who have experienced multiple traumatic events, such as physical abuse, sexual abuse, or witnessing domestic violence, this danger alarm goes off too often. When faced with repeated alarms, the “thinking brain” gets tired of checking things out, and assumes that the signal always means real danger, which causes the “thinking brain” to shut down and allows the “doing brain” take over.

False alarms or “triggers” can be set off when children hear, see, or feel something that reminds them of previous traumatic events. In the brains of children who have complex trauma, are trained to recognize these triggers, because in the past when they heard, saw, or felt that way, it meant they had to react quickly to a dangerous situation.Triggers can range from loud sounds such as sirens or yelling to smells, subtle facial expressions, or hand gestures. Triggers vary from child to child and are unique to each child’s experience

These triggers may not seem alarming to others, they don’t always seem to make sense to an outsider, including other children. Most of the time, children do not understand why they are acting this way.

Whatever the trigger, it sets off the alarm and the body “fuels” itself to prepare to deal with danger. When the danger is real, this response is helpful. When the body prepares, but there isn’t any danger, the child is left with pent up energy and no outlet. As a result, children may feel angry, want to fight, or hide in a corner to get far away from what their body perceives as danger.

How Does Complex Trauma Effect Children’s Developmental Milestones?

Attachment and Complex Trauma In Children

Attachment is the long-enduring, emotional bond between a child and a primary caregiver, as their caregiver serves as the child’s source of safety, provides for the child’s needs, and guides them in understanding themselves and others. In turn, the child meets the caregiver’s need to provide nourishment and guidance. This is a natural and automatic process that begins from the moment a child is born and a caregiver looks into the infant’s eyes.

Healthy attachments provide the building blocks for later relationships and a child’s ability to master developmental tasks by:

Regulating Emotions And Self-Soothing: A child learns how to calm down when a caregiver uses soothing techniques such as rocking, holding, and cooing. Over time, the child learns how to calm down by himself.

Developing Trust In Others: When the caregiver and child are attuned to each other, the caregiver knows how to respond to the child’s needs and the child learns that he can depend on others, which leaves the child with a sense the world is predictable and safe.

Encouraging Children To Freely Explore Their Environment: As the child has already learned that they can rely on others, they feels safe to explore the world knowing that someone will be there if they are in distress or needs help. This exploration is the way children learn.

Helping Children Understand Themselves And Others: The caregiver-child relationship provides the child with a model for understanding who she is, who the caregiver is, and how the world works. Because the caregiver responds, the world is seen as a safe place where people can be trusted and depended upon.

Teaching Children That They Can Have An Impact On Their World: Through interactions with the caregiver, the child learns that he has an impact on others. The child smiles and the caregiver smiles back; the child laughs and the caregiver plays with her; the child cries and the caregiver picks her up.

This natural process of attachment may be eroded by complex trauma in various ways:

• The caregiver may be the source of the trauma.
• The availability, reliability, or predictability of the caregiver may be limited.
• The child may not learn to regulate his emotions or calm himself down when experiencing intense emotions.
• The child’s ability to learn by exploring the world may take a back seat to the child’s need for protection and safety.
• The child begins to see the world as dangerous, leading to a sense of vulnerability and distrust of others.

As the child has little sense of her impact on others, their lack of control over her life leads to a sense of hopelessness and helplessness.

Coping With Acute And Complex Traumatic Stress in Children:

Suddenly losing a loved one or being involved in a natural disaster, motor vehicle accident, plane crash, or violent attack can be overwhelmingly stressful for children. A traumatic event can undermine their sense of security, leaving them feeling helpless and vulnerable, especially if the event stemmed from an act of violence, such as a physical assault, mass shooting, or terrorist attack. Even kids or teens not directly affected by a disaster can become traumatized when repeatedly exposed to horrific images of the event on the news or social media.Whatever the age of your child, it’s important to offer extra reassurance and support following a traumatic event.

A child’s reaction to a disaster or trauma can be greatly influenced by their parents’ response, so it’s important to educate yourself about trauma and traumatic stress. The more you know about the symptoms, effects, and treatment options, the better equipped you’ll be to help your child recover. With your love and support, the unsettling thoughts and feelings of traumatic stress can start to fade and your child’s life can return to normal in the days or weeks following the event.

When caring for a child who has recently experienced an acute traumatic event, it is helpful to think about meeting the child’s needs for safety, stabilization, and support.

Safety

Acute traumatic experiences challenge children’s idea that the world is a safe and predictable place. When scary things happen, children rely on caregivers to keep them safe. These are some of the ways you can help children feel safe:

Help the child find safe places to go when they’re feeling overwhelmed. At school, perhaps a safe place is in the reading corner, where the child can sit comfortably, look at books, or listen to music until they feel calm again. Perhaps it’s the guidance counselor’s office, the nurses office, or an area of the room separate from the main activities of the class. Ask the child what would make them feel safe when they’re feeling afraid, overwhelmed, or sad. Make sure if the child shows signs of acute traumatic stress (acting up, crying, withdrawing) that you ask the child if they would want to go to the safe place to calm down.

Find safe people for the child to talk with when they feel overwhelmed, asking the child who they feel comfortable being with when they’re upset. Reduce unnecessary secondary exposures and separations.

Routines can be a lifesaver. Tell children what to expect throughout the day, leading them to understand when the routine changes, always helps children feel comforted and secure.

It’s important to note that these children need to feel safe everywhere they go. Some children may feel safe in the classroom, but become overwhelmed in other environments. Helping children throughout the day and beyond the classroom may require communicating with other school personnel about how to accomplish this.

Be aware of Mandated Reporter laws. Many caregivers are required to report suspected abuse to child welfare authorities. Be aware of the laws in your state and work with your team to determine when you should file a report to protect a child.

Stabilization

Children who have been traumatized require stabilization to provide a sense of predictability, consistency, and safety – the very things that are lost when a traumatic event occurs. Stabilization allows children to process their experience and be able to move on.

Create a routine. Structure and predictability help children feel safe and secure.

• Start and end each day in the same way.
• Write down a schedule to be posted next to the child’s bed, on a classroom bulletin board, or at the child’s desk.
• Provide support so that the child and family feel safe and secure
• Help the child to return to typical routines (such as school) as soon as possible

Create a support system for the child; when children are supported by the people around them, their feelings of distress often decrease.

• Maintain a connection with children’s support network. Teachers and primary caregivers should communicate consistently with each other.
• A support system can include a child’s teachers, primary caregivers, as well as family members, guidance counselor, friends/peers, clergy, pediatrician, and neighbors.
• Advocate a supportive role by caregivers and others
• Maintain healthy relationships with the child’s primary caregivers and other close relatives/friends
• Create a supportive milieu for the spectrum of reactions and different courses of recovery
• Encourage and support help-seeking behaviors

Ensure the child’s physical needs are met. Traumatic experiences often affect physical health and emotional health.

• During acute stress following trauma, children may experience headaches, stomach aches, and muscle aches. Determine first if there is a medical cause for these symptoms. If none are found, provide comfort and reassure the child that these feelings happen to many children after a traumatic event. Be matter-of-fact with the child and beware that non-medical complaints too much attention may increase them.
• At home, be sure children sleep nine to ten hours a night, eat well, drink plenty of water, and get regular exercise.
• At school, be sure children drink plenty of water, have a well-balanced lunch, and get exercise during the school day.

 Recognize “triggers.”

Triggers are events/reminders/cues that cause children to become upset again (such as rain or thunder for children who experienced a hurricane). These reminders may seem harmless to other people, but they can be devastating to survivors. These triggers will vary from child to child.

• If a child becomes upset, it may be helpful to explain the difference between the event and reminders of the event.
• Protect children from reminders of the event as much as you can, particularly media coverage.
• Avoid secondary trauma by reducing the child’s exposure

Provide clear and honest answers.

• Be sure children understand the words you use. Find out what other explanations children have heard about the event and clarify inaccurate information. If the danger is far away, be sure to tell the child that it is not nearby. Avoid details that will scare the child.
• Use developmentally appropriately terms when talking about the event and the trauma

Practice relaxation techniques

Deep breathing, listening to soothing music, and muscle relaxation will help children relieve some of their stress.

Children may have trouble sleeping.

• Young children may be scared to be away from their caregivers, particularly at bed or nap times. Reassure the child that she is safe. Spend extra quiet time together at bed or nap time.
• Let the child sleep with a dim light on. Some young children may not understand the difference between dreams and real life, and will need reassurance and help in making this distinction.
• School age children may have sleeping problems due to nightmares. Ask the child to tell you about the bad dreams. Explain that many children have bad dreams after a traumatic event and the dreams will go away.

Self-Care is key

• It is important that caregivers take care of themselves.
• Dealing with traumatized children may trigger intense and difficult feelings in caregivers, leaving them feeling depleted and exhausted.

Minimize media impact:

Children who’ve experienced a traumatic event can often find relentless media coverage to be further traumatizing. Excessive exposure to images of a disturbing event—such as repeatedly viewing video clips on social media or news sites—can even create traumatic stress in children or teens who were not directly affected by the event.

• As much as you can, watch news reports of the traumatic event with your child. You can reassure your child as you’re watching and help place information in context.
• Limit your child’s media exposure to the traumatic event. Don’t let your child watch the news or check social media just before bed, and make use of parental controls on the TV, computer, and tablet to prevent your child from repeatedly viewing disturbing footage.
• Avoid exposing your child to graphic images and videos. It’s often less traumatizing for a child or teen to read the newspaper rather than watch television coverage or view video clips of the event.

Engagement:

You can’t force your child to recover from traumatic stress, but you can play a major role in the healing process by simply spending time together and talking face to face, free from TV, games, and other distractions. Do your best to create an environment where your kids feel safe to communicate what they’re feeling and to ask questions.

• Provide your child with ongoing opportunities to talk about what they went through or what they’re seeing in the media. Encourage them to ask questions and express their concerns but don’t force them to talk.
• Young children may have trouble expressing their feelings. Encourage them to put their feelings into words, such as anger, sadness, and worry about the safety of friends and family. Don’t force them to talk, but let them know that they can at any time.
• School age children may have concerns that they were to blame or should have been able to change what happened, and may hesitate to voice these concerns to others. Provide a safe place for them to express their fears, anger, sadness. Remind them that they can cry or be sad. Don’t expect them to be brave or tough. Offer reassurance and explain why it wasn’t their fault.
• Facilitate open but not forced communication with the child about his/her reactions to the traumatic event
• Focus on constructive responses
• Talk to child in developmentally appropriate terms
• Acknowledge and validate your child’s concerns. The traumatic event may bring up unrelated fears and issues in your child. Comfort for your child comes from feeling understood and accepted by you, so acknowledge their fears even if they don’t seem relevant to you.
• Young children may not have the words to express their fears, but may be able to process their emotions through play and drawing.
• School age children may retell or play out the traumatic event repeatedly. Allow the child to talk and act out these reactions. Let them know that many children respond to events like this in similar ways. Encourage positive problem-solving in play or drawings.
• Encourage children to write or draw. Suggest to children that they write about or make drawings of their experiences without forcing them to do so.
• Engage in positive distracting activities such as playing sports, games, reading, and hobbies
• Reassure your child. The event was not their fault, you love them, and it’s OK for them to feel upset, angry, or scared.
• Don’t pressure your child into talking. It can be very difficult for some kids to talk about a traumatic experience. A young child may find it easier to draw a picture illustrating their feelings rather than talk about them. You can then talk with your child about what they’ve drawn.
• Be honest. While you should tailor the information you share according to your child’s age, honesty is important. Don’t say nothing’s wrong if something is wrong.
• Do “normal” activities with your child that have nothing to do with the traumatic event. Encourage your child to seek out friends and pursue games, sports, and hobbies that they enjoyed before the incident. Go on family outings to the park or beach, enjoy a games night, or watch a funny or uplifting movie together.

Encourage physical activity:

Physical activity can burn off adrenaline, release mood-enhancing endorphins, and help your child sleep better at night.

• Find a sport that your child enjoys. Activities such as basketball, soccer, running, martial arts, or swimming that require moving both the arms and legs can help rouse your child’s nervous system from that “stuck” feeling that often follows a traumatic experience.
• Offer to participate in sports, games, or physical activities with your child. If they seem resistant to get off the couch, play some of their favorite music and dance together. Once a child gets moving, they’ll start to feel more energetic.
• Encourage your child to go outside to play with friends or a pet and blow off steam.
• Schedule a family outing to a hiking trail, swimming pool, or park.
• Take younger children to a playground, activity center, or arrange play dates.

Eat Well:

The food your child eats can have a profound impact on their mood and ability to cope with traumatic stress. Processed and convenience food, refined carbohydrates, and sugary drinks and snacks can create mood swings and worsen symptoms of traumatic stress. Conversely, eating plenty of fresh fruit and vegetables, high-quality protein, and healthy fats, especially omega-3 fatty acids, can help your child better cope with the ups and downs that follow a disturbing experience.

• Focus on overall diet rather than specific foods. Kids should be eating whole, minimally processed food—food that is as close to its natural form as possible.
• Limit fried food, sweet desserts, sugary snacks and cereals, and refined flour. These can all exacerbate symptoms of traumatic stress in kids.
• Be a role model. The childhood impulse to imitate is strong so don’t ask your child to eat vegetables while you gorge on soda and French fries.
• Cook more meals at home. Restaurant and takeout meals have more added sugar and unhealthy fat so cooking at home can have a huge impact on your kids’ health. If you make large batches, cooking just a few times can be enough to feed your family for the whole week.
• Make mealtimes about more than just food. Gathering the family around a table for a meal is an ideal opportunity to talk and listen to your child without the distraction of TV, phones, or computers.

Rebuilding trust and safety:

Trauma can alter the way a child sees the world, making it suddenly seem a much more dangerous and frightening place. Your child may find it more difficult to trust both their environment and other people. You can help by rebuilding your child’s sense of safety and security.

As children look to their caregivers to provide safety and security. Try not to voice your own fears in front of the child. Remind the child that people are working to keep them safe. Help the child regain confidence that you aren’t leaving him and that you can protect him.

The child may need on-going support long after the traumatic experience has occurred.

• Create routines. Establishing a predictable structure and schedule to your child’s or teen’s life can help to make the world seem more stable again. Try to maintain regular times for meals, homework, and family activities.
• Minimize stress at home. Try to make sure your child has space and time for rest, play, and fun.
• Manage your own stress. The more calm, relaxed, and focused you are, the better you’ll be able to help your child.
• Speak of the future and make plans. This can help counteract the common feeling among traumatized children that the future is scary, bleak, and unpredictable.
• Keep your promises. You can help to rebuild your child’s trust by being trustworthy. Be consistent and follow through on what you say you’re going to do.
• If you don’t know the answer to a question, don’t be afraid to admit it. Don’t jeopardize your child’s trust in you by making something up.
• Remember that children often personalize situations. They may worry about their own safety even if the traumatic event occurred far away. Reassure your child and help place the situation in context.

When Do I Seek Help For Childhood Traumatic Stress?

Usually, your child’s feelings of anxiety, numbness, confusion, guilt, and despair following a traumatic event will start to fade within a relatively short time. However, if the traumatic stress reaction is so intense and persistent that it’s interfering with your child’s ability to function at school or home, they may need help from a doctor, preferably a trauma specialist.

Warning signs include:

• Six weeks have passed, and your child is not feeling any better
• Your child is having trouble functioning at school
• Your child is experiencing terrifying memories, nightmares, or flashbacks
• The symptoms of traumatic stress manifest as physical complaints such as headaches, stomach pains, or sleep disturbances
• Your child is having an increasingly difficult time relating to friends and family
• Your child or teen is experiencing suicidal thoughts
• Your child is avoiding more and more things that remind them of the traumatic event

How Is Childhood Traumatic Stress Treated?

Immediate support for a child who has experienced trauma can help prevent many of the negative consequences. In some cases, the nurturing and support of parents and other family or caregivers is enough to avoid long-term harm. For those children who need professional care, mental health professionals may use cognitive behavioral therapy or trauma-focused therapies to help them learn to cope in healthy ways.

Cognitive-behavioral therapies are still the leading choice by most therapists, especially as the available research tends to be far stronger than research looking at psychoanalytic or purely medication-based treatment, which doesn’t address the underlying issues related to the trauma.

Although there are other CBT approaches that are used to treat trauma in children and adolescents including exposure therapy, art therapy and EMDR, a CBT-type approaches seem to work best for dealing with post-traumatic symptoms. All CBT methods that have been developed specifically for younger clients, there are some common features:

• Education to teach children about traumatic stress and the effects it can have on them
• Relaxation techniques
• A trauma narrative that encourages children to describe their experience in detail
• Cognitive restructuring to correct thoughts about the traumatic experience.

For all of the recognized CBT approaches for treating traumatized children, it is vital that children be encouraged to face their traumatic experience gradually and only in a way that they can handle emotionally. Since all children do not develop emotionally at the same pace, a therapist must tailor the treatment to the child’s level of emotional and cognitive development. If not, the therapist could end up doing more harm than good by re-traumatizing and re-exposing their child patients.

While CBT was first developed for trauma in adults and later adapted to adolescents, the special needs that adolescent trauma patients have has inspired the development of treatment methods focusing on children and adolescents alone. These treatment approaches include:

Multi-modality trauma treatment (MMTT) – was developed in 1998, MMTT is based on the idea that trauma at a young age can disrupt normal physical and emotional development and uses age-appropriate CBT strategies to help children or adolescents cope with trauma.  Usually seen in school settings, these programs have a format that can include education, narrative writing (writing about the traumatic experience), exposure, relaxation techniques, and cognitive restructuring. Empirical studies of MMTT have shown marked reduction in trauma symptoms with similar results for symptoms of depression, anger and anxiety. The advantage of using this type of therapy is that it was specifically developed for traumatized adolescents; however the nature of this therapy tends to focus on adolescents who have experienced only one traumatic event, but may be used in children who have experience many different traumas.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – developed in 2006, this type of treatment was developed specifically for children between the ages of three and eighteen who have experienced trauma. Treatment using TF-CBT can include a number of sessions involving the child alone or the child and a parent/caregiver. The goal of this type of therapy is to help children and adolescents learn coping skills that will help them deal with traumatic memories. In treatment, children receive education, are taught relaxation skills, as well as affective expression and modulation, and cognitive coping skills. Children are also encouraged to use trauma narration and to cognitively process the trauma, use exposure to master trauma reminders, have parent/child sessions, and increase their feelings of safety.

Stanford Cue-Centered Therapy (SCCT) – Developed Stanford School of Medicine’s Early Life Stress Research Program, this is a short-term treatment approach that uses one-on-one therapy for children and adolescents dealing with trauma. It was created to treat problems with a child’s cognitive, affective, behavioral, and physical functioning, and uses cognitive-behavioral techniques, relaxation training, narrative use, and parental coaching. The goal of this type of therapy is to reduce the child’s negative thoughts and beliefs as well as sensitivity to traumatic memory. This form of therapy encourages children to build coping skills including relaxation and self-empowerment, and helps children to learn how trauma affects them, while teaching them that they are able to control how they respond to traumatic triggers.

Seeking Safety was developed for use with substance abuse and trauma in adults and adolescents, Seeking Safety was specifically adapted for treating adolescents and, like the other treatment models, uses education, training in specific coping skills, and cognitive restructuring. Parental involvement is only needed in one Seeking Safety session.

Seeking Safety has five principles:

1. Personal safety is a priority
2. Integrated trauma and substance abuse therapy
3. Focusing upon the child’s needs
4. Attention to the therapeutic process
5. Focuses on thoughts, behaviors, interpersonal interactions, as well as case management.

Tips For Caregivers Of Children Who Have Acute And Complex Trauma:

Caring for children after a traumatic event is incredibly stressful. Caregivers or parents work to make sure their children’s needs are met, which can be draining and rewarding at the same time. Many caregivers report that they become extremely frustrated with the things they cannot control.

To understand self-care, you must understand what self-care is not:

• Self-care is not an “emergency response plan” to be activated when stress becomes overwhelming.
• Self-care is not about acting selfishly (“It’s all about me!”).
• Self-care is not about doing more or adding more tasks to an already overflowing “to-do” list. Healthy self-care can renew our spirits and help us to become more resilient.
• Self-care is most effective when approached proactively, not reactively.

Think of self-care as having three basic aspects: awareness, balance, and connection — the “ABC’s” of self-care.

Awareness:

Self-care begins while being quiet. By quieting our busy lives and entering into a space of solitude, we can become awareness of our own needs, then act accordingly. This is the contemplative way of the desert, rather than the constant activity of the city. Too often we act first, without real understanding, then wonder why we feel more burdened rather than relieved.

Balance:

Self-care is a balancing act between action and mindfulness. Balance guides decisions about embracing or relinquishing certain activities, behaviors, or attitudes. It also informs the degree to which we give attention to the physical, emotional, psychological, spiritual, and social aspects of our being. In other words, how much time we spend working, playing, and resting. Think of this healthy prescription for balanced daily living: eight hours of work, eight hours of play, and eight hours of rest!

Connection:

Healthy self-care cannot take place solely within oneself. It involves being connected in meaningful ways with others and to something larger. We are interdependent and social beings. We grow and thrive through connections that occur in friendships, family, social groups, nature, recreational activities, spiritual practices, therapy, and a myriad of other ways.

There is no formula for self-care. Each of our “self-care plans” will be unique and change over time. As we seek renewal in our lives and work, we must listen well to our own bodies, hearts, and minds as well as to trusted friends. Caregivers should rely on other adults and support systems (such as a support group or church) to help meet their own emotional needs so they will have enough energy to support a child who is stressed.

Hotlines For Childhood Trauma:

Childhelp National Child Abuse Hotline

800-4-A-CHILD (800-422-4453)
The mission of the Childhelp hotline is to provide help or answer questions about child abuse or neglect 24 hours a day.

FEMA Disaster Aid Hotline

800-621-FEMA
This hotline is available to provide direct and financial assistance to individuals, families, and businesses in an area whose property has been damaged or destroyed by disaster.

National Center for Missing and Exploited Children

800-THE-LOST (800-843-5678)
The mission of the National Center for Missing and Exploited Children is to help prevent child abduction and sexual exploitation; provide assistance with finding missing children; and assist victims of child abduction and sexual exploitation, their families, and the professionals who serve them 24 hours a day.

Center For Victims of Crimes

800-FYI-CALL (800-394-2255)
The National Center for Victims of Crime provides information, education, and referrals to local resources across the country. The hotline is available Monday through Friday from 8:30 am to 8:30 pm and is offered in numerous languages.

National Domestic Violence Hotline

800-799-SAFE (800-799-7233) and 800-787-3224 (TDD)
The mission of the National Domestic Violence Hotline is to provide crisis intervention, safety planning, information, and referrals for individuals experiencing domestic violence. The hotline is available 24 hours a day, and assistance is offered in numerous languages.

Mental Health America

800-969-6MHA (6642)
The mission of MHA is to promote mental wellness for the health and well-being of the nation. MHA offers information and resources on numerous mental health topics.

National Organization for Victim Assistance

800-TRY-NOVA (800-879-6682)
NOVA’s mission is to promote rights and services for victims of crime and crisis. The hotline provides information and referrals and is available 24 hours a day.

Homelessness Resource Center

617-467-6014
The Center is focused on the effective organization and delivery of services for people who are homeless and who have serious mental illnesses by providing technical assistance and training.

National Sexual Assault Hotline

800-656-HOPE (800-656-4673)
This hotline is operated by the Rape, Abuse & Incest National Network (RAINN), which also carries out programs to help prevent sexual assault, assist victims, and ensure that perpetrators are brought to justice.

National Suicide Prevention Lifeline

800-273-TALK (800-273-8255)

This suicide prevention service is available to anyone in suicidal crisis and is available 24/7.

National Teen Dating Abuse Helpline

866-331-9474 and 866-331-8453 (TTY)
This hotline was created to help teens ages 13-18 that experience dating abuse and it is available 24/7.

SAMHSA’s National Clearinghouse for Alcohol and Drug Information

800-729-6686
The Clearinghouse is a one-stop resource for information about substance abuse prevention and addiction treatment.

SAMHSA’s Substance Abuse Treatment Facility Locator

800-662-HELP (4357); 800-487-4889 (TDD); 877-767-8432 (Español)
A searchable directory of drug and alcohol treatment programs that shows the location of facilities around the country that treat alcoholism, alcohol abuse, and drug abuse problems.

Witness Justice

800-4WJ-HELP (800-495-4357)
Witness Justice is a national grassroots organization that provides assistance, support, and advocacy for survivors of violence and trauma.

Additional Childhood Traumatic Stress Resources:

Center For Trauma, Assessment, Intervention Services, and Treatment: The purpose of our Center is to provide national expertise on interventions for the developmental effects of trauma across child-serving settings, including child welfare, behavioral health, educational and juvenile justice settings.

Child Mind Institute offers Free Trauma Resources in a number of languages, all of which can be used to help the child recover from the trauma and heal the family as well.

Child Welfare.Org offers a number of free programs for children and their families who are coping with different types of trauma.

Substance Abuse and Mental Health Services Administration: This US government site helps to identify a number of different types of trauma, including reading on military families, substance abuse, for families, and for educators.