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!

Monday, August 22, 2016

Psychosomatic - It's All in Their Head

Psychosomatic disorders are physical symptoms that mask emotional distress. The very nature of the physical presentation of the symptoms hides the distress at its root, so it is natural that those affected will automatically seek a medical disease to explain their suffering. They turn to medical doctors, not to psychiatrists, to provide a diagnosis. - Psychosomatic disorders: When illness really is all in the mind

Somatic/ Physical Issues 
If Bear's heart hurts (because he's upset or sad), then his heart literally hurts. Doctors have been telling us for years that my children some of the highest scores they have ever seen for psychosomatic illness. My kids were constantly complaining about boo-boos and, as far as I could tell, non-existent aches and pains. I'm totally fine with putting a band-aid on an unblemished piece of skin, but unfortunately for me, my kids' pains tended toward the, "I need an appointment to see a doctor the pain is so bad" variety. ALL THE FREAKIN' TIME!!! Both would pop Tylenol for minor aches and pains all day if I let them.

Kitty gets sick a lot.  Alleged vomiting (always at night without witnesses), nausea, headaches, sleepiness, twisted ankles, dizziness.  It's pretty much impossible to know when it's real and when it's psychosomatic.  I try to be sympathetic, but it's hard when she has so many psychosomatic/ stress-related issues or those caused by her unwillingness to treat her constipation issues. Between her very real physical diagnoses and mental illnesses she misses school a lot. When she's tired of being poked and prodded for some pretty serious health issues, she will begin refusing treatment and denying she even needs them, while at the same time demanding appointments for minor or psychosomatic issues. 

Concrete Pain means Concrete Cause
Imagine you have a stomach ache. You start looking around for causes. Did I eat something that could have been bad? When was the last time I went to the bathroom? Do I know anyone with stomach flu? Could I have stomach cancer? Is an alien creature going to come bursting out of my belly? 

My kids don't tend to think, "I'm worried about this test so my stomach hurts."

When my kids have feelings or symptoms they don't understand, they tend to blame something that makes sense to them. If the child is depressed or full of energy (which typically feels like anger to them), then instead of realizing it is a chemical imbalance, a sign that his or her bipolar disorder is turning toward depression or mania, he or she looks around to see what is causing it. Because of their attachment issues, that's usually me. 

If they are feeling anxious, then instead of thinking, hmm... there's a lot of drama with my friends right now, or I have a big test or event coming up that I'm worried about, they tend to think my stomach hurts because I'm sick. 

Understanding Abstract Emotions
Kids with trauma issues often missed important things like cause and effect and object permanence. This is something you learn as an infant. I'm hungry. I cry. Mama feeds me. I need a diaper change. I cry. Someone changes me. I smile at Mama. Mama smiles back. If something happens and their needs are not met, then the child is going to have trouble, because we build on this foundation and the trust and attachment that comes from it. If you're hungry and you cry, but no one comes, then eventually you stop crying and learn to ignore the feelings of hunger.

As kids get older, they start to recognize more complicated emotions and feelings, pride, frustration, fear, love, trust, anxiety, hunger. They use those early interactions as a base and watch us and learn from us. How does mom handle being mad? If mom yells and throws things, then her kids probably will too. 

Kids with trauma issues, usually can't learn from observing a role model. They have to be taught in a concrete way. We need to identify the feelings for them and often teach them the correct response. "You're feeling nervous. I can tell because your hands are clenched and your foot is tapping. You're feeling anxious because you're not sure what's going to happen. Let's breath some deep slow breaths together and talk about what's going to happen."

Shut Down Physical and Emotional Feelings. 
Our kids often have limited access and understanding of their emotions and physical feelings. When Kitty first came to us, she had completely shut down her emotional feelings. A "side effect" of this was that she shut down her physical feelings as well. She had very little awareness of her physical body (hunger/ satiation, constipation, tiredness, tension…). She wasn't ticklish. She literally couldn't feel pain or almost any touch on her arms and legs. She would invite other kids to pinch or kick her to prove it. 

Her attachment therapist and her EMDR therapist worked on both her emotional issues and her somatic issues. It was amazing to me how connected they were. As Kitty began to attach, she had a lot more awareness of her body as well. Before, she could have food literally dripping off her face and be completely oblivious to it. She often didn't realize she needed to use the restroom until it was almost too late (and many times she didn't have enough time to get to the restroom, so it was too late). 

Kitty still has high psychosomatic issues, but she now has awareness of things like food on her face and can feel touches on her extremities, including physical pain when her extremities are injured. 

It's About Trust
Kids with trauma issues can't trust others to take care of them when they're really sick. That's not "safe" (this is a perceived feeling of safety). They will complain about little stuff constantly, but generally keep the big stuff to themselves. 

I think the hardest part for me is finding the line. You can't run to the doctor every time a child with high psychosomatic issues cries, "Doctor!," but at the same time, if we get into the habit of ignoring it, then you could miss the real stuff.

The Boy Who Cried Wolf
In and among all the constant complaints of various aches, pains, and boo boos, my kids occasionally threw in something very real. Sometimes it seemed they took great joy in pointing out that they'd "told" me so. *ugh*

Since the day they'd come to us, the kids had been complaining of joint pain. They'd complained about a ton of other stuff too, so quite frankly, I ignored it. Until the day, Kitty couldn't close her mouth. On that day, we took her to the doctor and discovered that a side effect of one of the meds they were both on (Geodon) was joint pain. Kitty's extreme jaw pain was caused by this. They gave us another med to counteract this side effect (which really bothered me, and I worked to get them off this med and onto one that didn't require a second med just to handle a side effect of the first). The kids of course used this as yet another example of our untrustworthiness. 

Peeing blood
One evening, just before bed, Bear casually mentioned that he'd been peeing blood for 3 weeks. WHAT?!!

I immediately made an appointment for the next morning. The doctor started asking the usual questions. When she asked him how long he'd had symptoms and he replied, "3 weeks," I could see her reaching for her pen to note, "Call CPS for neglect!" I immediately turned to Bear and asked him, "And when did you tell me about it?" Luckily for me, he was honest and said, "last night." No CPS report was filed. (Bear was diagnosed with a probable UTI and had to pee in a jug for 24 hours to see if he had a kidney stone). The item he claimed to have passed turned out to be a bit of plastic, so who knows how much, if any, of his story was true.

Faking It - to get out of doing something she doesn't want to do
Sometimes it feels deliberate, because they're suddenly "ill" or injured when they're supposed to be doing something (like cleaning up or chores). I have to remind myself that what I think is a perfectly normal expectation, could be completely overwhelming to this child (even if it's something they've been able to handle in the past when they were more regulated - check out the Spoon Theory for a possible explanation for this). 

Cleaning the Playroom - Kitty was laying around watching her sister pretend to clean the playroom. Kitty claimed to be taking a break because she was tired and/or ill.

I tried just supervising, but that didn't help. I got frustrated and threatened to throw away all the stuff I had to clean up. A bit of an effect on Bob, Kitty started whining that she was sick.

So I started picking up trash and throwing it away. Then I began picking up toys and putting them in the trash pile near Kitty (so she could pull them out if she wanted to). Kitty got overwhelmed and had a meltdown. I explained that I deliberately put the toys near her so she didn't have to get up off her tuckus. She still got upset. 

Looking back now, I realize that the task was beyond Kitty's abilities and she was completely overwhelmed. She was dissociating from what was going on, by being "sick." She wasn't "faking it" - she was dealing with it the only way she knew how.
School Nurse
For awhile, we stopped picking up the kids from school unless they had a fever or actual proof that they'd vomited. They'd missed so much school. Then I realized that while she couldn't leave school every time she felt "sick," she still needed help. Just not from the nurse, and usually not from me. 

She was feeling overwhelmed, stressed and/ or anxious. What she needed was help getting regulated again. We asked the school to train someone (or a couple of someones) in calming and relaxation techniques, and to give her a place to take a break. With a break and someone to help her get regulated, she could usually go back to class and learn.

Psychosomatic/ Emotional Eating
Kitty was already dysregulated from the playroom cleaning incident, when I realized we were late to Kitty's therapy appointment. At therapy, she spent the whole time complaining she was hungry and had nothing to talk about. The therapist, probably in an effort to see if changing things up would help, offered to continue the session outside. Kitty kept complaining that she was starving and literally ate grass. After therapy and on the way home we talked about how her feelings are related to eating.

After an hour of complaining that she was starving during therapy, I mentioned to Kitty that she was probably dissociating/ distracting herself from her emotions (she denied this of course). We talked about how she used to take medications that kept her from being hungry, and we kept telling her to go ahead and eat. Now she is probably on a med that is doing the opposite. I asked her to try to be aware of how much she is eating (lately more than a starving teenage boy and craving more!). We talked about how she spent so many years denying her emotions.

Kitty had always blocked her feelings. She didn't listen to her body. She even encouraged people to pinch her arms and kick her shins to show them that she has no feelings there. She "plays" roughly and has no idea how to handle it when it increases beyond her comfort level. She was "play fighting" with a boy and accidentally hit him in the nose - giving him a nose bleed. Everyone agreed it was an accident, but she had no idea how to prevent it from happening again. She tends to interact with others (especially boys) through teasing, but can't handle teasing from others at all.

Sometimes the injuries are real, but the child doesn't want actual treatment. They're getting something they need from having the issue (empathy, attention?)

Heat Exhaustion
Bear tends to wear at least 3 layers of clothing at all times (boxer briefs and a tank top, knee length shorts and a t-shirt - usually a super tight "cool gear" shirt, jeans and a button up. At least 3 pairs of athletic socks and boots 3 sizes too big). Needless to say, during the summer, in Texas, he had many heat strokes. We finally realized there was nothing we could really do about it. So we took him in to the doctor if he was vomiting, but other than encouraging him to drink lots of water, we let it go.

Talk to The Hand
One Saturday evening about 7:30 pm, during Kitty's 17th birthday party, months after Bear had moved out of our home, we were out at my sister's house having pizza and cake and watching The Muppets.  Bear called to say he'd injured his hand again and wanted me to take him to the ER.  When I asked why he'd waited until so late to call me if he'd gotten the injury at 1am, he got defensive and just said at least it wasn't like last time when he'd waited almost a week to tell me.

This was the second time this week that Bear wanted to go to the hospital, and I have to admit, I questioned whether this injury was any more real.  He'd called me earlier in the week wanting me to take him to the doctor for his "injured" back, but after talking to him, it turned out to be that he'd just strained a muscle or something when he was doing handstands in someone's yard.  I'd told him to alternate cold and heat... knowing he'd never do it.  He tends toward psychosomatic injuries that give him sympathy from others, which means actually caring for the alleged injury himself would defeat the purpose.

We heard several versions of how Bear injured his hand, but the most common version seems to be that he was at a party (drinking) and was playing "bouncer" (allegedly physically restraining someone who'd been drinking and was going to drive).  Somehow he threw a punch and hit some concrete.  He fractured his right hand.

The first time Bear broke his hand, a few weeks before, the ER started to put a splint on it, but Bear was honest and admitted he wouldn't wear it, so they put it in a cast.  We later discovered that Bear cut off his cast so he could be on the wrestling team (which luckily didn't happen). Now, 3 weeks later, he'd broken his hand again. This time the doctor refused to cast it, because Bear admitted he wouldn't keep it on anyway. 

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