This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Tuesday, September 23, 2014

Secondary Traumatization, Secondary PTSD, Caregiver Fatigue

Secondary Traumatization

Mental health care professionals specializing in the treatment of trauma hear tales of extreme human suffering and observe the emotions of fear, helplessness and horror registered by survivors on a consistent basis. Recent research demonstrates that these occupational duties may cause psychological symptoms in the practitioner who bears witness to the survivors' account of trauma.

Primary posttraumatic stress disorder may be diagnosed in an individual who experienced, witnessed or was confronted with a traumatic event and responded with intense fear, helplessness or horror. Intentional traumas (e.g., combat, sexual assault, terrorism and mass violence), as well as unintentional traumas (e.g., natural disasters, accidents), may cause this pervasive psychiatric condition.

Secondary trauma is defined as indirect exposure to trauma through a firsthand account or narrative of a traumatic event. The vivid recounting of trauma by the survivor and the clinician's subsequent cognitive or emotional representation of that event may result in a set of symptoms and reactions that parallel PTSD (e.g., re-experiencing, avoidance and hyperarousal). Secondary traumatization is also referred to as compassion fatigue (Figley, 1995) and vicarious traumatization (Pearlman and Saakvitne, 1995).

Secondary trauma is an understudied and controversial clinical phenomenon.

- See more at: http://www.psychiatrictimes.com/ptsd/secondary-traumatization-mental-health-care-providers#sthash.8DzM8Jjh.dpuf

Secondary traumatic stress (STS)

For therapists, child welfare workers, case managers, and other helping professionals involved in the care of traumatized children and their families, the essential act of listening to trauma stories may take an emotional toll that compromises professional functioning and diminishes quality of life. Individual and supervisory awareness of the impact of this indirect trauma exposure—referred to as secondary traumatic stress (STS)—is a basic part of protecting the health of the worker and ensuring that children consistently receive the best possible care from those who are committed to helping them.

SECONDARY PTSD

This information was adapted from this site.

Secondary PTSD is not a disorder which is recognized by the Diagnostic and Statistical Manual of Mental Disorders (as of the fourth edition).  However, if you lived with someone who suffers from PTSD, you may notice yourself beginning to "mirror" some of their behaviors.  This transformation is called Secondary Post Traumatic Stress Disorder.

The Many Faces of Secondary PTSD

The signs, symptoms, and effects of Secondary PTSD are just as varied as the ones exhibited by those with "primary" PTSD.  Basically, when you're living with someone who has Post Traumatic Stress Disorder, you
become his (or her) caretaker.  You slip into a role, without even noticing it, that has you constantly watching for people or circumstances that might "set him off."  You're trying to make sure everything stays in line - that nothing aggravates or upsets him or her - that everything is "perfect."  On a much too frequent basis, and despite your best efforts, you find you're still getting screamed at and berated by the person you're trying to help.

The person with PTSD is not emotionally "there" for you.  When you're upset or happy, angry or sad, you have to deal with your emotions on your own.  You begin to feel ignored and unloved and start "protecting" yourself by treating others - especially the person with PTSD - the same way.

You're also probably handling all household chores, childcare, financial management, etc.  You probably get no help (or very little) from your spouse or children.  You're the cook, chauffeur, secretary, accountant, yard guy, child care provider, laundry service, etc., etc., etc.  Everything in your family feels like it's up to you.  It is a 24x7 job at which you constantly fail.  It's not humanly possible to do everything - or to prevent PTSD from creeping in.

This cycle takes its toll on many spouses.  You lose yourself.  It's impossible to tiptoe around the person with PTSD, day in and day out, while taking care of all of life's other duties, without feeling the strain.   And that strain soon transforms into... ta da... Secondary PTSD.

Secondary PTSD may make you feel overly angry, depressed, exhausted (but, alas, unable to sleep), overwhelmed, and just plain unhappy with the world around  you.  I can honestly say there have been times when I found the idea of folding a load of laundry absolutely impossible.  I felt like I could not do anything right.  I cried a lot and was really, REALLY pissed at the world.
- See more at: http://www.familyofavet.com/secondary_ptsd.html#sthash.9xhee81O.dpuf

CAREGIVER FATIGUE

The demands of caregiving can be overwhelming, especially if you feel you have little control over the situation or you’re in over your head. If the stress of caregiving is left unchecked, it can take a toll on your health, relationships, and state of mind—eventually leading to burnout.

When you’re burned out, it’s tough to do anything, let alone look after someone else. That’s why taking care of yourself isn’t a luxury—it’s a necessity.

Caregiver stress and burnout: What you need to know

Caring for a loved one can be very rewarding, but it also involves many stressors. Caregiver stress can be particularly damaging, since it is typically a chronic, long-term challenge. You may face years or even decades of caregiving responsibilities. It can be particularly disheartening when there’s no hope that your family member will get better.


If you don’t get the physical and emotional support your need, the stress of caregiving leaves you vulnerable to a wide range of problems, including depression, anxiety, and burnout. And when you get to that point, both you and the person you’re caring for suffer. That’s why managing the stress levels in your life is just as important as making sure your family member gets to his doctor’s appointment or takes her medication on time.

Common signs and symptoms of caregiver stress

  • Anxiety, depression, irritability
  • Feeling tired and run down
  • Difficulty sleeping
  • Overreacting to minor nuisances
  • New or worsening health problems
  • Trouble concentrating
  • Feeling increasingly resentful
  • Drinking, smoking, or eating more
  • Neglecting responsibilities
  • Cutting back on leisure activities

Common signs and symptoms of caregiver burnout

  • You have much less energy than you once had
  • It seems like you catch every cold or flu that’s going around
  • You’re constantly exhausted, even after sleeping or taking a break
  • You neglect your own needs, either because you’re too busy or you don’t care anymore
  • Your life revolves around caregiving, but it gives you little satisfaction
  • You have trouble relaxing, even when help is available
  • You’re increasingly impatient and irritable with the person you’re caring for
  • You feel helpless and hopeless

Sound familiar?

SO WHAT DO YOU DO ABOUT IT?

Obviously it's different for everyone. 
Medication,  therapy - EMDR ( Eye Movement Desensitization and Reprocessing), respite, finding my love language, and support groups helped me a lot.

I also have a couple of posts that might help: 
Finding the Joy which is about finding ways to recover your positive attitude, and 
Caring for the Caregiver which is essential to filling your bucket, because you can't pour from an empty cup.

Wednesday, September 3, 2014

Dear Biofamily,

Kitty announced tonight that after an argument with Hubby on Sunday, she has decided to move back to Nebraska.  Her grandparents are supposed to be picking her up on Saturday.

Kitty went to live with biomom and biosisters in Nebraska on July 1.  She came back to Texas on August 1.  She freely admits that her memory of whichever place she's not currently living, becomes more of a fantasy than a reality.  For her, the grass is always greener on the other side of the fence - whatever side of the fence she's on.  She's already left once with no idea how she was going to handle things (no meds, no money, no practical skills...).  She literally could die if she goes off her medications cold turkey, but that was the situation she'd put herself in, and we couldn't help.

So this time I'm sending out an appeal to biofamily to please, please think of Kitty's future (which she's incapable of doing for herself right now) and encourage her to stay in Texas. Just for one year to finish beauty school, which will give her a skill she can take anywhere.  For her sake.

I'm sincerely hoping you will help me.  I need to talk to you about how Kitty's decision to move to Nebraska right now will really damage her future (not to mention her physical and mental health).  
I'll understand if she still wants to go after she has a chance to calm down, but right now she needs to stay in Texas to get on SSI and Medicaid (her medications cost almost $2000 a month if she doesn't have insurance, plus she needs to see a psychiatrist every 6-8 weeks - more if she's unstable).  Our insurance will no longer cover her if she moves out, and even with our insurance the copays are almost $200 a month.  
There's an agency here that will help her find a job that will work around her intellectual disabilities and her mental health issues as well.  They will also pay for community college and the beauty school she wants to go to.  If she moves, then she will have to pay out of state tuition and will likely not get the accommodations she needs.
I'm asking you to please do what's best for Kitty and not come get her until she's had a chance to at least try school.  I want her to have the best possible start in life and she can't get that if she keeps running away and has other people supporting her for the rest of her life.  I know you want what's best for her too.  Please, please encourage her to make the tough choice to stay and work through this.
Thank you,
Mary 

UPDATE:  I was able to get hold of Biograndma - who was the one who planned to drive cross company to get Kitty.  Unlike Biomom, Biograndma doesn't read this blog.  She had no knowledge of Kitty's issues, and how much Kitty would be losing if she leaves right now.  It took a lot of long conversations (and FB messaging), but Biograndma finally agreed that it wasn't in Kitty's best interest to leave right now.  After all of that, she admitted that she didn't have the money to make the drive anyway! I can't believe how close we came to Kitty blowing the meeting she had on Friday, for something that wasn't going to happen.

I did tell Kitty that I was going to do everything I could to keep her from leaving right now.  I feel like she felt abandoned when we didn't stop her last time.  This time I told her that I thought it was a really bad choice because of the timing (which I told her last time too), and that I was saying, "NO."  Since I'm not a cute boy, she refused.

When Biograndma told Kitty she wasn't coming, Kitty of course blamed me.  She's always mad at me though, except when she's not.  *sigh*

She's actually had a decent few days -- once we got past me enforcing her not sleeping all day so she'll be ready for school when it starts. For the last week, she's been sleeping 24 hours and staying awake 24 hours. She's gotten herself totally dysregulated by not taking her meds regularly, drinking, and totally mucking up her sleep schedule.  She's depressed, moody, and anxious.  We're trying to get her next psychiatric appointment moved up so we can get started on changing her meds if that's what's needed.