A Love Letter to Neurodivergence

Dear Reader,

This is for all the people who identify as neurodivergent; I hope you feel seen and validated reading this. This is for anyone questioning whether neurodivergence might be a part of their experience, I hope this answers some of your questions, or at least leads you in a direction that will. This is also for anyone who loves, is friends with, or works with someone who is neurodivergent. In a sense, this post is really for everyone. If you’re reading this and think you don’t know anyone who is neurodivergent, guess again. Neurodivergence is mostly an invisible experience. There’s a fair chance you’re in community with neurodivergent people and don’t know due to stigma, masking, and the simple fact that it’s often just not that obvious. 

Each person has the fundamental right to be loved and accepted for who they are without needing to change or conform to societal expectations. This is essential for neurodivergent individuals who often face significant mental health challenges largely due to societal pressures and stigma. When people are accepted as their true selves, it fosters a sense of belonging and reduces the isolation that exacerbates these mental health challenges. Supporting neurodivergent people means recognizing their unique strengths and needs and allowing them to navigate the world on their own terms. This contributes to an inclusive society where all people are valued and understood. 

What is Neurodivergence?

Neurodivergence is a term that is increasingly being recognized in mainstream culture. You may have seen this term circulating on TikTok or depicted more frequently in television and film. That’s because more people have identified with this experience in recent years. According to the Centers for Disease Control and Prevention (CDC), roughly 15-20% of the population identifies as neurodivergent, and that percentage is expected to keep increasing as awareness and research continue to expand. But, what does it mean to be neurodivergent?

The word neuro refers to the brain. Its Latin roots mean nerves or nervous system. Neurotypes simply refer to different types of brains. Neurodiversity broadly describes differences in cognitive processes and sensory experiences. Neurotypical is the way that most brains function. Our brains are all wired somewhat differently, so neurodiversity exists regardless of whether you have a neurotypical or neurodivergent brain. Again, you will likely encounter many neurodivergent people in life and never know. All of that is to say that neurodivergence is a term used to describe brains that diverge from the norm. It’s important to understand that there’s no “right” way for your brain to work. Diversity is always worth celebrating.

Neurodivergence is an umbrella term for many different kinds of neurotypes, such as Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), learning disabilities, and more. Synesthesia, Tourette's Syndrome, Dyslexia, Dyscalculia, Dyspraxia, and Obsessive-Compulsive Disorder (OCD), all fall under this umbrella. Anxiety and panic disorders are more frequently considered a form of neurodivergence as well. The neurodivergent umbrella is constantly evolving as it is still a relatively new way of conceptualizing brain differences. 

ADHD and ASD are most typically associated with the term neurodivergent. ADHD is a neurodivergence (disorder) that affects someone's ability to focus and pay attention, sit still, and/or control their impulses. There are 3 types of ADHD, predominantly hyperactive, predominantly inattentive, or both. ADD is an outdated term because the predominantly inattentive type captures it. People with ADHD tend to need a lot of stimulation in their environment.

Autism Spectrum Disorder is a neurodivergence that affects a person’s ability to interact socially and increases sensitivity to senses. Autistic brains take in way more information because they have more neural connections. All brains go through a pruning system in early development where unnecessary connections between neurons are removed. Autistic brains do go through pruning, but not as much as a neurotypical brain. This is why folks with autism often need less stimulation in their environment. This contributes to what is called “autistic burnout.”  Stimming refers to repetitive or self-stimulating behaviors, such as making movements, and sounds, or saying words that people repeat. Stimming might occur at any time but is often used to calm or self-regulate when someone is overwhelmed. Among other behaviors, stimming might look like someone clapping their hands, tapping their feet, or rubbing or picking their skin. Echolalia is common in autism and involves an involuntary repeating of words or phrases.

AuDHD is a combination of both Autism and ADHD. This probably isn’t a term you have heard of unless you participate in neurodivergent communities. This can be confusing because Autism and ADHD may seem like totally different experiences. There is some overlap though. Both ADHD and Autism are interest-driven. Hyperfocus, the tendency to become completely absorbed in a task, is common in both ADHD and ASD. People with ADHD and ASD tend to experience rejection sensitivity (experiencing rejection more intensely than others) and time blindness (difficulty managing and perceiving time). Before the release of the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it was thought that the two conditions could not co-exist. This highlights how this area of understanding is continuously expanding with new research.

Masking is a term used to describe a process by which people may hide their neurodivergent traits and tendencies in attempts to appear normal. Masking can be intentional or an unconscious process learned and adapted over time. This is a term that has been historically used in the Autism community but has been increasingly used for other neurodivergent or mental health experiences. Masking is a strategy that helps people manage social situations, school, and work. It’s a tool people rely on to manage and achieve in those settings, however, it can result in psychological costs. For example, masking can be exhausting and often leads to burnout. It can also be invalidating and cause tension about one’s identity. Some people are high masking, meaning they can conceal their symptoms more, while others are low masking. High support needs and low support needs are also functional labels that are sometimes used within Autism communities. High functioning and low functioning are outdated terms because they are offensive and problematic, and don’t fully capture the complexity of experiences on the spectrum.  

What’s it like being neurodivergent?

There’s nothing wrong with being neurodivergent. Remember, different isn’t bad. It’s okay to have needs that are different from other people’s. Many qualities that neurodivergent people possess turn out to be gifts that can help them excel in their careers and lives, such as heightened empathy and compassion, unique perspectives, advanced problem-solving skills, attention to detail, the ability to hyper-focus, creativity and imagination, and a passion for social justice and fairness. One thing I want to be careful of though, is sounding too much like a cheerleader. For neurodivergent people, the struggles are so real.

Most challenges arise for neurodivergent individuals because the world is structured for neurotypical brains. It’s not just having this neurotype alone that causes dysregulation, but rather, certain environments that send the neurodivergent individual into sensory overload or burnout over time. Being neurodivergent is often traumatic for people. Quite literally, a neurodivergent experience involves some degree of nervous system dysregulation, especially in cases of ADHD, ASD, and sensory processing disorders. 

Nervous system dysregulation is a key component of trauma. Psychologist and founder of Somatic Experiencing, Peter Levine’s definition of trauma is anything “too much, too soon, or too little (i.e. in cases of neglect)” for our nervous system to handle. I appreciate this broad definition of trauma. This helps us understand that trauma is not only about the event itself but how our bodies interpret the experience. Peter Levine also defines trauma as experiencing fear in the face of helplessness. There’s a lot of overlap with how trauma and neurodivergence presents. 

Everybody has a nervous system. The nervous system runs throughout our entire body and has different states. The sympathetic nervous system state is known as the “Fight or Flight” response to a threat. This state also includes other responses such as Freeze, Fawn (to please someone to avoid conflict), and Flop (to become unresponsive and faint). These are all survival responses. They are all primal and adaptive because they can help you survive. The parasympathetic nervous system state, known as the “Rest and Digest” state, is reached when the body is relaxed and can focus on internal processes like digestion. 

Dysregulated is another term you’re probably hearing more of. This happens when the parasympathetic and sympathetic nervous system are out of balance. Psychiatrist Dan Siegel, M.D., introduced the concept of the “Window of Tolerance”. The window of tolerance describes the nervous system at its optimal level of arousal, where people can access their executive functioning skills (thanks to the brain's prefrontal cortex that allows for planning, organizing, and regulating emotions), be present, and respond effectively. It’s characterized by a sense of groundedness, openness, and ability to connect with other people. When you’re out of your window of tolerance, you’re either in a state of hyperarousal or hypoarousal. Hyperarousal looks like hypervigilance, heightened anxiety, and irritability. Hypoarousal is also a stress response but looks like shutdown, numbness, disconnection from reality, and dissociation. In the long run, hypoarousal looks like burnout or depression.

Everyone gets dysregulated. Everyone’s window of tolerance is also a little different, meaning every person has a personal capacity to handle distress and tolerate big emotions and challenging experiences. There is nothing to be cured. Your body is designed to be in these different states, but it is important to be able to move in and out of them. The goal is to be able to stay regulated for longer periods and to be able to move from one dysregulated state back into your window of tolerance without getting stuck. It’s common for people to get stuck in a trauma state, and not even realize it. Trauma can shrink your window of tolerance and make you more reactive to stress. Neurodivergent folks tend to be chronically dysregulated. You can work towards widening your window of tolerance though. When you learn how the nervous system works and about various ways to get your body back into its window of tolerance, you learn how to become less reactive to stress and increase your capacity to experience the full range of your emotions.

Growing up neurodivergent is also a traumatic experience in and of itself. Neurodivergent kids attempt to fit in socially and meet developmental milestones based on standardized criteria. This is where masking comes into play. Many people experience deep shame about their differences and confusion about why they are the way they are. When neurodivergence is overlooked and not diagnosed, kids are often considered shy, weird, unique, and/or misunderstood. Growing up neurodivergent is especially traumatic if you are undiagnosed. Especially because there is not an obvious physical difference, neurodivergent kids tend to internalize beliefs that they are somehow like everyone else, but worse or defective. They will likely feel stupid or not good enough as they struggle to understand and accept themselves. 

What’s next?   

For the most part, people are the experts in their own lives. I hold this sentiment very close to me and it has been a guiding principle in my work as a therapist. Receiving a mental health diagnosis is generally fraught with both pros and cons. It can be especially empowering, however, for neurodivergent people to receive a diagnosis. These labels can help people understand that their brains are not broken, but rather they just work differently. Finding a label can be very comforting.

While aligning with a diagnosis can be very affirming, the process of getting assessed can be challenging as it can be expensive and time-consuming. The mental health world is catching up in the realm of neurodivergence. It may or may not be worth it to pursue an official diagnosis. Even in the mental health field, there’s a lot of stigma and misunderstanding. It’s difficult to identify and diagnose neurodivergence and there’s a long history of misdiagnosis. Historically, girls and people of color were not diagnosed with ADHD or ASD. Things are changing in recent years, but historically all disorders in the DSM were normalized based on middle-class white men. These experiences are deeply personal. No two people with Autism or ADHD are alike. There is a vast range of traits and tendencies that a person may or may not experience. Two people may have the same diagnosis yet experience a different set of symptoms. There are plenty of neurodivergent-friendly providers out there. It’s all about researching and using discernment when pursuing mental health care. There is also validity to self-diagnosis if one has done a lot of research, self-exploration, and sought out the help of a professional like a therapist or other neurodivergent folks with lived experience. If you need accommodations, you have the right to ask for those, whether you have a formal diagnosis or not.

You might be reading this and wondering how you can help the neurodivergent people in your life. Even though our brains are all wired slightly differently, all human brains are wired for connection. This is a basic need that we all have. For connection to occur, we must experience a felt sense of safety. In the 1940s, psychologist Abraham Maslow published the Hierarchy of Needs, a pyramid depicting the order of human needs from the bottom up. Physiological needs are at the lowest level, which includes the most basic things we need to survive, like food, water, clothes, and housing. Next on this hierarchy is safety. Once safety is achieved, love and belonging can occur. Feeling safe entails a sense of security and protection both physically and emotionally. Emotional safety involves knowing you can be yourself and express your thoughts and feelings without fear of judgment, harm, or rejection. Safety allows for relaxation, authenticity, and trust that your vulnerabilities will be respected and supported. Feeling safe in relationships fosters the ability to grow, thrive, and be confident.

As mentioned before, it can feel embarrassing and shameful to be neurodivergent and to talk about it with others. It’s very vulnerable to share about neurodivergent experiences, but it’s also necessary. You can create safety for your loved ones by building a warm, loving, and compassionate environment based on nonjudgment and curiosity. Consistency is important too. Check in regularly, plan around people’s particular needs, establish routines, and talk openly about differences. It signals safety to let your loved ones know that struggling is normal. Sharing and talking about it helps when we feel validated and cared for.

There’s also sometimes space to work through things collaboratively. If it involves your relationship, communicate how you can figure out what works best for each of you and be willing to make accommodations. If it is something they are sharing with you but does not involve you, check in about what the person’s needs are in sharing. A simple rule of thumb in any relationship (neurodivergent or not) is to say something like, “Thank you for sharing. I am here for you and want to support you. I am listening. Would you like me to simply validate and empathize with your experience or are you hoping for problem solving and solutions?” Oftentimes, what we need most of all is to feel heard.

People deserve to be believed about who they are and what they say their experiences are. Even if someone else’s experiences seem confusing to you or you do not think they are neurodivergent, that does not mean that you have a better understanding of who someone is. As I’ve laid out here, these experiences are layered and complex. There is a ton of misunderstanding and misinformation about neurodivergence in the general public. Many people do not have an accurate understanding of neurodiversity, although this is starting to shift with increased awareness and dialogue. Take it upon yourself to do further reading, listen to podcasts, join a support group, or simply ask and allow people to tell you about their experiences. 

So, it’s important to stay open-minded. Above all else, people deserve to be loved and accepted as they are, without pressure to change or fit into a box that was not made for them. This is especially important considering neurodivergent people are at much more risk for depression, anxiety, thinking about and dying by suicide, and substance abuse. This goes back to that deep-seated belief that “something is wrong with me.” But, nothing is wrong and nothing needs to be fixed. You can remind yourself and your loved ones that your brain works beautifully and is needed. Whether you’re on your journey of self-discovery as a neurodivergent person or you want to learn more about the neurodivergent people in your life, go slow and be gentle with yourself. It takes a lot of time and effort to change your patterns of thinking, learn how to regulate yourself, and have vulnerable conversations.

With warmth and gratitude, 

Kaitlyn Folkes, M.A.

References: 

CDC Data and Statistics (2024) 

https://www.cdc.gov/adhd/data/index.html

https://www.cdc.gov/autism/data-research/index.html

The Developing Mind Daniel J. Siegel (1999) 

The Myth of Normal by Gabor Matė (2023) 

Unmasking Autism: Discovering the New Faces of Neurodiversity by Devon Price, PhD (2022) 

Waking the Tiger: Healing Trauma by Peter A. Levine, PhD (1997) 

Your Brain’s Not Broken by Tamara Rosier, PhD (2021) 

What Are Your Internal Dialogues Trying to Protect You From?

By Concentric Therapist Intern Mara Hundrieser-Acosta, B.A. (Clinical Mental Health Counselor M.A.)

I know I am not the only one that has internal conversations with different parts of myself. Just going back and forth with what I should have done, said, or even experienced. I recently lost my mother to cancer. When someone asks me “How are you doing? I answer with “ I am doing ok, just taking it one day at a time.” but on the inside, my brain is struggling. The actual answer in my mind is, “ I miss my mom, I wish I could see her.” and then another part of my mind answers “I have to cook dinner, wash clothes, put them away, and so much more to do, I feel so overwhelmed.” and another part says, “People will think you don’t have a handle on your life if you let them know how you truly feel.” So, I end up giving a generic answer and smile. 

The conversation inside my mind keeps going even though on the outside I am smiling and making small talk. Sometimes when we have been through hard times, we develop a strong voice that keeps us “in check.” When we view this through an Internal Family Systems (IFS) lens, it's called a Manager. We all have these internal conversations. No, there is nothing wrong with us; it’s just part of how we take care of ourselves internally. You might wonder what I mean about how we take care of ourselves internally. We all go back and forth with all of our parts to try to navigate our lives through stress, anxiety, depression, painful situations, and trauma. Through IFS we can learn what these parts need in order to feel at peace in our life. 

“IFS guides us to offer deep understanding and credible help to the critic and the innumerable other parts who populate our clients’ inner worlds, some of whom long to transform but are stuck in extreme, destructive roles.” -Schwartz & Sweezy (2020)

What is IFS?

Internal Family Systems (IFS), a model of therapy and an approach to better understand ourselves, was developed by Dr. Richard Schwartz. He has worked on the development of IFS for over 40 years.  Dr. Schwartz holds a Ph.D. in Marriage and Family Therapy and was trained to view and understand people through a systematic lens.  After years of working with families and individuals, Dr. Schwartz noticed how clients would speak about their different inner parts. Just like I shared my internal dialogue about being asked about me in relation to my mother. 

While in session with clients, Dr. Schwartz’s patients would share how they would go back and forth with different parts of themselves.  Dr. Schwartz noticed those parts also operate within a system similar to how a system of family operates. For example, a family system consists of different family members, roles or parts (e.g. parents, children) that interact with each other.  

If we look at humanity or systems with a very wide lens, we notice a system is always in place, starting with our solar system. Dr. Schwartz was able to recognize there is a system that consists of people’s inner parts.  These parts are called Managers, Firefighters, and Exiles. These parts have developed to protect us from harm, trauma, and difficult experiences that have left a wound inside our psyche. They all have a specific role that falls under a three-group system. All of our parts are good, even though they might seem mean or aggressive at times. 

The goal of IFS is to help people become Self-led, which means that their various parts feel loved by the Self and trust the Self’s leadership. IFS therapy has a gentle way to ease the pain of people’s experiences and parts and to help navigate the internal turmoil one often faces throughout life. 

The Roles of Parts: A Three-Group System

In order to understand further this three-group system we need to understand that each group or also called protective parts (Managers, Exiles, and Firefighters) doesn't have just one personality. There are different kinds of Managers; each one has its own role to play, as well as the Exiles and the Firefighters to protect us internally. These three-group systems work with each other and sometimes what feels like against each other in order to keep us safe internally. 

In other words…

One group tends to be highly protective, strategic, and interested in controlling the internal or external environment to keep things safe. In IFS, we call the members of this group Managers. 

A second group contains the most sensitive members of the system. When these parts feel injured or outraged, Managers will banish them for their own protection and the good of the whole system. We call them Exiles. 

A third group tries to stifle, anesthetize, or distract from the feelings of Exiles, reacting powerfully and automatically, without concern for consequences, to their distress as well as to the over-inhibition of Managers. We call these members Firefighters. 

Trauma & Internal Family Systems 

According to Schwartz & Sweezy (2020), internal systems (parts) that are responding to trauma not only divide into these roles, but the protective parts (Managers and Firefighters) also form alliances and get into conflicts with each other and can be very harsh or smothering with the Exile they are trying to protect or ward off. The sadder, more terrified, ashamed, rageful, or sexually charged an Exile is, the more protectors legitimately fear its release and the more extreme they become in their efforts to suppress and constrain them. In turn, the more an exile is suppressed, the more it tries to break out. In this way all three groups become victims of an escalating cycle of internecine* conflict. 

*internecine: destructive to both sides in a conflict.

Example: The more ashamed I feel about a traumatic event that happened to me the more scared the Managers and Firefighters are of me releasing or admitting this shame. So, the Managers and Firefighters will try really hard for me to suppress that shame. Which can mean one can begin to use drugs and alcohol to control that shame, or become very narcissistic in order to push it way down. The Managers and Firefighters believe that if one releases or admits this shame, it (the part) will ultimately fall apart. 

Childhood & Internal Family Systems

The Self can be forceful and protective. Children who have experienced developmental trauma or any abuse of their independence, spontaneity, leadership (or other traits that rely on courage themselves) begin to suppress their courageous side. It takes tremendous courage to go toward terrifying places in the psyche. Many protectors avoid stepping out of their roles because they believe the person would be weak and passive without them. Protectors always have intense fears about allowing clients to open the door to Exiles they locked away years ago in inner dark places. When a client says they are afraid to do something, we know a part in their inner world is speaking. But once the part understands the fearless nature of the Self, its fear (and emotional pain, shame, and rage) surrenders.

IFS Therapy has 4 Goals:

1. To liberate parts from the roles they have been forced into, freeing them to be who they were designed to be.

2. To restore faith in The Self and in Self-Leadership.

3. To re-harmonize the inner system.

4. To encourage the person or client to become increasingly Self-led in their interactions with the world.

So, What Does This All Mean? 

The intention of IFS is for the client to access, experience, and be Self-led, to feel safe, to learn their inner world, and understand how their parts work together or against each other in order to protect them. The more we learn and understand about our parts and what they are trying to tell us; it then becomes easier to identify when they get activated. Understanding who we are, where we have been, and what has hurt us, is what is going to give us the opportunities to heal ourselves. The end goal is to be able to be our own saviors, but to get there we must be willing to surrender and be open to learning. 

Once a person experiences faith in The Self and in Self-leadership, the IFS therapist seeks to help the client develop the Eight C’s. 

The Eight C’s

Curiosity: The client learns to be inquisitive, and have interest rather than be judgmental or fearful. This is where one comes with no agenda, one just wants to learn, know, and understand. There is a sense of feeling at ease and moving forward with wonder. There is a sense of safety that opens the door to vulnerability. 

Calm: After being in a high alert state, where one’s nervous system is often aroused, Self-leadership does the opposite by creating a sense of calm that is both physical and mental. The client is able to accept life on its own terms and there is a sense of resilience and assertiveness. 

Courage: When a client says they are afraid to do something in the inner world, we know a part is speaking. But once the part understands the fearless nature of The Self, its fear (and emotional pain, shame, and rage) surrenders. 

Confidence: The Self validates and comforts its Exiles bringing about an infectious air of confidence, conveying to protector parts that it is safe to relax instead of trying to “let it go and move on” (the typical protector advice that encourages people to abandon and isolate their burdened young parts), injuries can be healed. When Exiles are unburdened, the system becomes less delicate and less reactive, and protective parts are more inclined to trust Self-leadership. 

Connectedness: The Self, in its natural state, experiences the sense of connectedness. Instead of trying really hard to obtain a connection with someone, through trauma bonding.  The Self can now move through the world in harmony. Connectedness links with calm and confidence which altogether links up The Divine. 

The Divine: Through extensive research by Dr. Richard Schwartz this is what he describes as The Divine. “Though they used different words, all the esoteric traditions within the major religions – Buddhism, Hinduism, Christianity, Judaism, Islam – emphasized their same core belief: we are sparks of the eternal flame, manifestations of the absolute ground of being. It turns out that the Divine within – what the Christians call the soul or Christ Consciousness, Buddhists call Buddha Nature, the Hindus Atman, the Taoists Tao, the Sufis the Beloved, the Quakers the Inner Light.” 

Clarity: One can see things more clearly. The distortions are no longer in effect and the extreme beliefs ease as one can see authenticity. Our vision is clear when we see through the eyes of the Self versus when our vision is distorted through the eyes of extreme parts.

Creativity: It’s believed that once the inner turmoil and constant struggle start to quiet down and The Self becomes the leader (aka Self-led), creativity can emerge naturally. This means once the managers start to relax, we can problem-solve with greater ease which becomes second nature. 

Compassion:  Once a client finds some separation or healthy distance from their angry or scared part, they can now see these parts from a compassionate lens.  They can express how sad or sorry they are for those parts and are willing to help them heal. This inherent desire to help their suffering parts signifies and taps into compassion. 

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I hope that after reading all this information there is a part of you that feels compelled to explore IFS. I want to say to “the part” of you that has that interest, that feels like it has been lost, in pain, or any other unresolved feelings; you are important and you deserve to be seen and heard. If you are wondering which part that might be, I am talking to your Self-led part; the part that might be hiding in the shadows for a while. 

We live in a time where we are overworked, overwhelmed, on the go, not getting enough sleep, expecting to be everything and nothing at all, where we have to walk on eggshells, but make a difference. It’s no wonder that our Self-led part feels so overwhelmed and just lost. This is the time when we need to slow down and rebel; which translates to going inside, getting curious about your parts, and reconnecting to who we truly are meant to be.

I know it might sound like a big ask, yet if you go back and read about The Eight C’s and imagine experiencing them, I think it’s all worth the journey of healing. The idea of feeling liberated is what motivates me through the IFS lens. I wish for you and my clients to feel liberated from whatever has been holding you back from being your most authentic self and be connected to your Divine. 

So, next time you have those internal conversations bring awareness to what each part is saying, and ask them what they truly need. They are trying to protect you even if they might sound very harsh or act maladaptively; they just haven’t learned a better way, yet, to communicate with you. Even if you don’t think you have the power within you to heal, to reframe those inner dialogues; you actually do, it’s inside you.

Resources for Consideration

Books: IFS online store | IFS Institute 

Videos: Dr. Richard Schwartz explains Internal Family Systems (IFS) Dr. Richard Schwartz Has A Radical Approach To Healing

Podcast: Multiplicity of the Mind: An Approach To Healing the Inner Self | Dr. Richard Schwartz X Rich Roll

Let's Talk About Complex Trauma

By Concentric Counselor Jordan Perlman, LPC, NCC

I imagine many people have heard of Post-Traumatic Stress Disorder (PTSD) but not nearly as many are familiar with Complex Post-Traumatic Stress Disorder (C-PTSD) which is lesser-known and unfortunately, not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). And while an individual with a PTSD diagnosis, which is often the result of an isolated incident, a person who experienced complex or repeated traumas requires different considerations.

But first, it’s important to understand the differences between each:

PTSD

According to the DSM-V, PTSD is diagnosed when an individual meets the following criteria that create distress or functional impairment last more than one month, which is not a result of medication, substance use, or other illness. The individual was exposed to one of the following: 

• Death or threatened death 

• Actual or threatened serious injury

• Actual or threatened sexual violence 

• Witnessing trauma

• Learning that a relative or close friend was exposed to trauma 

Indirect exposure to aversive details of the trauma (usually in the course of professional duties), the individual must have at least one intrusive symptom that causes the persistent re-experience of the trauma in the following ways:

• Nightmares

• Flashbacks

• Emotional distress after exposure to traumatic reminders

• Physical reactivity after exposure to traumatic reminders

The individual must also experience avoidance of trauma-related stimuli after trauma either by trauma-related thoughts or feelings, or trauma-related external reminders.

Two negative alterations in cognitions and mood must be present where the negative thoughts or feelings began or worsened after trauma in the following ways:

• Inability to recall key features of the trauma

• Overly negative thoughts and assumptions about oneself or the world

• Exaggerated blame of self or others for causing trauma

• Negative affect

• Decreased interest in activities

• Feeling isolated

• Difficulty experiencing positive affect

 Lastly, there must be alterations in trauma-related arousal and reactivity that began or worsened after trauma in the following ways: 

• Irritability or aggression

• Risky or destructive behavior

• Hypervigilance

• Heightened startle reaction

• Difficulty concentrating

• Difficulty sleeping

 C-PTSD

Trauma typically associated with C-PTSD tends to be long-term, where the individual is generally held in a state of captivity, physically or emotionally. In these situations, the victim under the control of the perpetrator has little or no chance to get away or escape from the danger. Some examples might include:

• Long-term domestic violence

• Long-term child physical and/or sexual abuse

• Neglect

• Organized exploitation rings

• Concentration/Prisoner-of-War Camps

• Prostitution brothels

• Recruitment into armed conflict as a child

• Sex trafficking or slave trade

• Experiencing torture

• Exposure to genocide campaigns

• Other forms of organized violence

Some might be wondering, why is this difference important then? This is because of exposure to long-term or prolonged or repeated trauma results in a broad range of symptoms that go beyond the diagnostic criteria of PTSD, a.k.a “simple” PTSD.  As such, the basic symptoms of C-PTSD are:

• Somatization (physical problems, associated pain, and functional limitations)

• Dissociation (a division of the personality into one component that attempts to function in the everyday world and another that regresses and is fixed in the trauma, spacing out, daydreaming, or feeling strong sensations of being disconnected from one self or the world)

• Affect Dysregulation (difficulty with emotions, such as experiencing and/or expressing them, alteration in impulse control, attention and consciousness

• Self-Perception (experience of their own perspective tends to be drastically different from how others perceive them)

• Interpersonal Relationships (tend to be a struggle, difficulty with engaging with others, feeling distrustful of others)

• Perception of Perpetrators (can be skewed, or longing to be loved by their abuser)

• Systems of Meaning (doubt there is any goodness in the world, outlook on life can be dark)

Further, a 2018 study by Karatzias et al. found the most important factor in the diagnosis of C-PTSD was negative cognitions about the self, characterized by a “generalized negative view about the self and one’s trauma symptoms; attachment anxiety which is defined as involving a fear of interpersonal rejection or abandonment and/or distress if one’s partner is unresponsive or unavailable; and expressive suppression, conveyed by efforts to hide, inhibit, or reduce emotional expression.”

For those who may wonder why people affected by a long-term trauma “can’t just get over it,” the answer lies in the fact that even after a person is removed from the event, their brain may be permanently affected by that intense and prolonged trauma. And since a person’s nervous system is shaped by his or her experiences, stress and trauma over time, can lead to changes in the parts of the brain that control and manage feelings and the long-term effects are found on a physical and emotional level.  

Symptoms may manifest as:

• Eating disorders

• Substance abuse

• Alcoholism

• Promiscuity

• Chronic pain

• Cardiovascular and gastrointestinal problems

• Migraines

• Rage displayed through violence, destruction of property, or theft

• Depression, denial, fear of abandonment, thoughts of suicide, anger issues

• Flashbacks, memory repression, dissociation

• Shame, guilt, focusing on wanting revenge

• Low self-esteem, panic attacks, self-loathing

• Perfectionism, blaming others instead of dealing with the situation, selective memory

• Loss of faith in humanity, distrust, isolation, inability to form close personal relationships

Special Considerations for Survivors of C-PTSD from Childhood 

Many survivors of C-PTSD also experience Attachment Disorder which is a huge consequence of individuals who suffered complex trauma as children. Attachment Disorder is the result of a person growing up with primary caregivers who were regularly dangerous. Recurring abuse and neglect habituate children living in fear and sympathetic nervous system arousal, which over time creates them an easily triggerable abandonment mélange of overwhelming fear, shame, and depression. 

Because a child’s main attachment (to their primary caregiver) helps them learn to control their emotions and thoughts, when a caregiver’s responses are in tune with a child’s needs, the child feels secure. The child then uses this relationship pattern as a practice to build coping skills.

However, children who receive prolonged confusing or inconsistent responses from their primary caregiver are prone to be fussy, have a hard time calming down, may often withdraw from others and may have frequent tantrums. Unlike adults who have more tools to understand what is happening to them, children often do not possess these skills or have the ability to separate themselves from another’s unconscionable actions. Consequently, the resulting psychological and developmental implications become complexly woven and spun into who that child believes themselves to be, thereby creating a messy web of core beliefs that are harder to untangle than the flashbacks, nightmares and other posttraumatic symptoms that may surface later. Further, these disorganized attachments and mixed messages from those who are supposed to provide love, comfort, and safety - all in the periphery of extreme trauma - can create even more unique struggles that PTSD-sufferers alone don't always face.

Treatment Considerations 

While the symptoms can be daunting and the future seems bleak for someone who appears to be suffering from C-PTSD regardless of whether an individual has been diagnosed with a trauma-related disorder or not, there is help out there and there are ways to manage and help the individual cope. 

Treatment challenges include, Survivors:

• Avoiding thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming

• Relying on alcohol or other substances as a way to avoid and numb feelings and thoughts related to trauma

• Engaging in self-mutilation and other forms of self-harm

• Who have been abused repeatedly are sometimes mistaken as having a “weak character” or unjustly blamed for the symptoms they experience as a result of victimization and often have comorbid disorders such as dissociative identity disorder (DID), other specified dissociative disorder (OSDD), borderline personality disorder (BPD), depressive or bipolar disorders, anxiety disorders, obsessive-compulsive disorders, eating disorders, and substance abuse

Since many trauma specialists see Attachment Disorder as one of the key symptoms of C-PTSD, a relational, individual, approach will often be most beneficial for many of these clients. For many survivors, therapy is the first opportunity to have a safe and nurturing relationship.  Therefore, the therapist must be especially skilled to create the degree of safety that is needed to build trust or risk adding to the attachment trauma. Working with these clients is essential to the development of trust and relational healing and the four key qualities are empathy, authentic vulnerability, dialogically (when two people move fluidly and interchangeable between speaking and listening) and collaborative relationship repair. This makes therapy a teamwork approach where there is mutual brainstorming and problem-solving in a respectful way implying mutuality. All of these steps will provide the client with a “good enough secure attachment” to serve as a model for other relationships. 

However, and as expected, there is no “one size fits all” approach to working with individuals who have survived trauma, but one thing is for certain: recovery from Complex PTSD requires restoration of control and power for the traumatized person. Survivors can become empowered by healing relationships which create safety, allow for remembrance and mourning, and promote reconnection with everyday life. 

If you feel as though you have experienced complex trauma, it is important to know what happened to you was not your fault. While it is undeniable trauma changes the way we experience the world, I strongly believe like a phoenix, a person who suffered from trauma can arise from the ashes, stronger than ever before. This “stronger than ever before” is also known as “Post-Traumatic Growth.” Post-Traumatic Growth identifies a shift in personal strength and worldview as a consequence of trauma. Although you can’t change it, you can change what your life looks like going forward. One step you can take towards recovery is calling to schedule an appointment with a therapist who can help guide and support you on your healing journey. 

Finding Balance Between Healthy and Unhealthy Anxiety

By Concentric Counselor Charles Weiss, LPC

There are 10 seconds left of the clock in the state championship game and your team is down by 2 points.  You have the ball and the fate of the team is in your hands on what will you do next, either pass or take the game winning shot.  Sweat is protruding down your face, your heart is beating a thousand miles a hour, your mind is racing with a million and one different case scenarios on what you should do and then your anxiety starts to take over.  However, you realized that your anxiety has allowed you to think quicker on your feet and make better decisions, because you don’t let it control and consume you.  3, 2, 1 and throw up a prayer of shot from about 35 feet away from the basket, knowing that being vulnerable to your anxiety, you can live with the consequences…  Swish!  Game over and you have just won the state championship for your team.

Anxiety… What is it and what does to mean to us when it begins to take control; do we let it control our consciousness or embrace it as an opportunity of growth and self-discovery?  According to dictionary.com, anxiety is defined as “a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.”

When outcomes are uncertain to us in which we want to control, but can’t, anxiety can consume our every decision, thought and feeling.  It leads to panic, fear and vulnerability to the unknown, having us over-analyze every decision we make, postulating those “what if” scenarios.  Anxiety can so debilitating to someone when it’s severe and impacts our day-to-day activities.  Plain and simple, anxiety can suck!  Nobody wants to constantly live a life of panic, fear, worry and dread, wondering all the time, “What if?” When you let anxiety take control and inhibit your ability to just be “you”, it becomes unhealthy.

Is there a way to gain back that control over anxiety before it begins to consume us, crippling our sense of self and being vulnerable to “What if…?”  Anxiety is your body’s indication that something isn’t right, like a built-in warning system indicating that your homeostasis might be out of balance.  When we listen to our body as it talks to us and yes, our body does speak to us, you can begin to prepare and embrace for its impact and figure out how to manage it. Certain symptoms to be mindful of that can alert us when something “isn’t right” and anxiety begins to manifest itself within us, are the following:

·        Racing thoughts

·        Irritability

·        Headaches

·        Nausea/upset stomach

·        Disturbed sleep

·        Muscle tension/tightness

·        Shortness of breath

·        Mind going blank

·        Difficulty concentrating/focusing

·        Fatigued

·        Palpitations

When we are able to listen to these symptoms we experience, then we can to things to keep these symptoms in check before they exacerbate. Taking the time to do a body scan, deep breathing exercises, mindfulness exercises, progressive muscle relaxation techniques can all help keep the heightened level of anxiety at bay.

Can anxiety be healthy?

Anxiety can also be a way to motivate yourself to reach your goals and achievements that you have established.  It can better help prepare yourself to face as well as overcome challenges. When we approach anxiety as a hindrance, it can become unhealthy. You can instead capitalize on it as more of a way to inspire your self-growth and to live a more authentic life.  According to Katharina Star, Ph.D., anxiety is another way people can be more empathetic towards other people’s issues and concerns, and help with how they interact with others. She also stated that individuals who struggle with anxiety are often more cautious thinkers, problem solvers and decision makers because they are often building-in “back-up plans” for when things go wrong. 

Bottom line, anxiety isn’t always bad and unhealthy when individuals experience it, it can be a way people thrive if they are able to recognize it, understand it, and know how to cope and properly channel the healthy aspects of it. People can still live fully authentic lives when experiencing anxiety, it’s when it takes control and we begin to panic, that derails aspects of our lives.

If you are experiencing at least 3 symptoms of anxiety, that have been affecting your ability to function on a day-to-day basis in a variety of settings (i.e.: school, work, home) and those symptoms have been occurring for at least 6 months in which you find it very difficult to control that worry and anxiety, please contact your local mental health provider and schedule an appointment with a professional who can help you learn how to regain control over your anxiety and transform it into a healthier form of anxiety for you. 

Asking for Help - Not Waving but Drowning

By Concentric Counselor Christian Younginer, LPC, NCC

Not Waving but Drowning

By STEVIE SMITH

Nobody heard him, the dead man,   

But still he lay moaning:

I was much further out than you thought   

And not waving but drowning.

Poor chap, he always loved larking

And now he’s dead

It must have been too cold for him his heart gave way,   

They said.

Oh, no no no, it was too cold always   

(Still the dead one lay moaning)   

I was much too far out all my life   

And not waving but drowning.

I believe this poem verbalizes well a common societal pressure. That is, the need to be happy externally, even if drowning internally. As we go through our day, met with multiple “How’s it going?”, we invariably are trained to answer “fine” or “great”, without the slightest thought. The question we’re left with is: how would anyone know I’m drowning, when I always give them a friendly wave?

Asking for help can be deceptively difficult. Frequently I hear from clients that asking for help shows weakness, or is shameful, or too vulnerable. So, we strengthen our resolve, buckle down, and soldier on at the expense of our wellness and happiness. We become run down, exhausted, and deflated. Imagine a balloon trying to remain the same size, while its air slowly leaks. We receive messages from our families of origin, our employers, and consumer culture that tell us to harden. But the harder we get, the more brittle we become. Rather than naming our need for help, we’re now drowning with work, emotions, schedules, and isolation. 

Ultimately, this issue of asking for help comes down to a person’s struggle with taking care of themselves. Wellness, self-care, asking for help, boundary setting, etc all live in the same neighborhood: taking care of the self. A former supervisor of mine offered this metaphor:

You board an airplane, take your seat, and the flight attendant begins the safety protocols speech. They get to the section on the oxygen mask. They say, ‘please secure your own mask before attempting to assist anyone else.”

Why is that? Well, you can’t help anyone if you’re dead. The same concept applies here, albeit with less grim consequences. How can we expect to function, let alone help others, when we run ourselves ragged?

To return to the topic at hand, one way of taking care of the self is asking for help. Seeking therapy is a form of this. I often name the courage it takes for a client to find a therapist. As we know, it’s hard to find help for ourselves- especially for our mental health. As if the unfortunate stigma isn’t enough, busy schedules and work demands can get in the way. If therapy is two steps too far for you, there are smaller ways to open ourselves to the help of others.

We don’t have to instantly open up and adopt this idea. Rather we can take smaller steps that feel safer. For example, if we have created a default answer of “fine” when asked “how are you?” by random people, then that may have filtered into closer relationships. Those relationships where it may feel safer saying “Actually, I’m struggling.” So, what if we remove the automatic ‘fine’ from our vocabulary? Rather, when asked by a close friend or family member, “how are you?”, we take that question for what it is: an out-stretched hand to a drowning person.

 I think it is unfair to view this poem as an indictment of those who misread the author’s anguish. Rather, I believe it is a call to stop waving when we’re drowning. To let those looking out for our safety, save us. Only from this place of moaning, cold death does the author finally feel safe saying she was much too far out all of her life. If only we, the onlookers, knew this we could’ve helped.

 It is ok to feel you’re too far out. It is ok to feel like you’re drowning. There are those who want to help us, but only if we let them. When we don’t ask for help, we deny our friends and family the gift of being able to help someone they love.

Sexual Trauma, Triggers, & The 24-Hour News Cycle

By Concentric Counselor Katie Ho, LPC, NCC

You can hardly escape today’s current social and political climate - it’s on the news, in your social media, overheard at lunch, and even for therapists, themes in session. For those who have experienced trauma in their lifetime, past or ongoing, navigating topics like sexual assault can be overwhelming, scary, complicated and sometimes even powerful. How we take care of ourselves and the people around us who may be struggling with the complexity of their emotions has to be part of the larger conversation. It’s clear that avoiding or minimizing discussions on sexual violence and quieting the stories of survivors is not the path to atonement and reconciliation. But as we create space and lift up the voices of those who have suffered, we must also take inventory of what comes up in us and tend to those parts with kindness, care and nurturing.

The #MeToo movement, local and national advocacy groups and social justice organizations have been and continue to create a platform for those who have been victim to sexual harassment and assault. While the stories and accounts of these traumas seem to be daunting all of the sudden for those who have been unaware, statistics and experts have known for some time of these experiences. The National Sexual Violence Resource Center (NSVRC) estimates that 1 in 5 women will be raped in the United States in their lifetime, and that 1 in 3 women will experience some form of sexual violence. The majority of these acts are committed by acquaintances, partners or people who are known by the victim, and according to the Rape, Abuse & Incest National Network (RAINN), the majority of these events occur at or near the victim’s home. These of course are statistics, data and research gathered through reports from multidisciplinary agencies. There is undeniable value in knowing these numbers. And just as much, there is value in hearing the experiences and seeing the faces of survivors who have chosen to come forward.

As allegations and reports of sexual assault make the news, we are bombarded with information, opinions, commentary and even jokes on the matter. Survivors are subject to their own re-traumatization, which has an impact on psychological and physical health, triggered by both the details of these publicized allegations of assaults and non-believers who dismiss them.

In knowing that a trigger is a psychological stimulus that can be evoked through anything from sights, smells or sounds, it’s no wonder that the 24-hour news cycle is affecting so many people. Survivors are not alone in their strong reactions to the constant replaying and subsequent criticism, shaming or dismissing of survivor stories. Those who feel a connection or calling to the cause, whether it be through their empathic attunement or knowing a survivor, may also experience the distress and burnout that comes with the current climate.

So how do we take care? How do we balance the righteous anger and complexity of our other emotions, promote advocacy and change, all while healing and taking gentle care of ourselves? In doing this, one of the most important things to know is nothing can replace the support of others. So find someone, or a group of someones, who can help to support, validate and foster a safe environment for processing.

Find a tribe, or maybe even create one. Pay attention to your body, as our physical being can often tell us when stress is increasing and it’s time for tending and healing. Maybe that means physical exercise, movement, touch or a practice of progressive muscle relaxation (a quick YouTube search is all you need!). Set boundaries. Limit your intake of news and dialogue on the topic by knowing how much mental and emotional labor you’re able to give without overextending yourself. And if you find yourself overwhelmed, triggered or lost, use mindful grounding techniques to bring yourself back into your here and now. Feel your feet on the floor, describe and notice something around you, use your five senses to bring a consciousness into your physical environment and current moment in time and add in a quick reminder - “I am safe. I am in control. I am okay.”

Adolescents, Teens, Depression & The Warning Signs

By Concentric Counselor Katie Ho, LPC, NCC

At a time in life when the only thing certain is constant change, recognizing and being aware of depression during adolescence can be a challenging feat without the knowledge of warning signs and risk factors. Mental health and the seriousness of depression continue to be topics of conversation following the headlines of national news and tragedies - but an equally, if not more urgent conversation is the one that needs to be started at home. The pressures of adolescence and impact of today’s culture of social media appearances and limited interpersonal connection only reinforce the need for education and awareness on depression. Parents and caregivers can provide their support and intervention through having the skills and knowledge to address their young person’s greatest mental health needs.

The answer to why we should talk about depression with teenagers is becoming more clear as the topic continues to be normalized, de-stigmatized and commonplace in the discussion of healthy emotional development; but the answer of how is where the light could shine a little brighter. How do you initiate a conversation around feelings, emotions and concerns of your child or loved one’s changes in mood and psychological health? How do you create a safe environment that fosters and promotes honest, sometimes uncomfortable dialogue about profound sadness or even thoughts of self-harm or suicide? Many of those answers involve one important action: listening.

In order to fully understand and be prepared for a conversation around your young person’s mental health, it’s vital to know the warning signs and symptoms involved with depression during adolescence. These characteristics can be different than how they typically manifest in adults, and can oftentimes be mislabeled as expected changes during a new phase of life. It’s important to distinguish between depression and normal sadness. Depression can consume their day-to-day life; interfering with the ability to work, eat, sleep, study and have joy. It can involve feelings of helplessness, hopelessness and worthlessness with little to no relief.

Here are some signs and symptoms of adolescent depression:

● While some individuals may appear sad - many and most appear irritable (unrelenting)
● Negative view of self and/or the world and future
● Withdrawal from family and friends (isolation)
● Anger/Rage
● Overreaction to criticism
● Excessive sleeping
● Significant change in appetite
● Increased reckless or impulsive behaviors
● Substance use or acting out in an attempt to avoid feelings
● Violence
● Running away

If you suspect your teenager is struggling with depression or begins showing signs of concerning behavior, finding the time, the patience and the space is the first step in creating an environment for an honest discussion.

❖ Remember the value in listening over lecturing: initiating a conversation about emotional pain or hardships means being willing to hear their truth without judgment or criticism.
❖ With unconditional love will need to come unconditional support; let them know you’re committed to helping them fully and in a way that respects their experience, choice and voice.
❖ Be gentle, but persistent - if your teenager claims nothing is wrong, but is otherwise unable to explain the concerning observations and behaviors, trust your intuition and consider options for getting them to open up. The most important goal is to get them talking - whether it’s to you or to a reputable third party, give them the resources and options to share with someone they can trust.
❖ Validate their feelings - always. Try to avoid talking them out of their feelings or giving them an alternative perspective in which to view their experience. Acknowledging and communicating that you believe and hear them will foster trust and empathy. In combating adolescent depression, it can be effective to take a holistic approach - making their physical health as much of a priority as their social and emotional health. Encourage movement!

Physical activity can be incorporated in a number of ways, whether it’s a sports team, individual activity, dance class, walking the dog or riding their bike - all movement is good movement! Healthy, balanced eating and limited screen time are essential requirements for anyone’s lifestyle, but particularly those in adolescence. These items can also be partnered with the important aspect of positive interactions with family or loved ones. Sharing a meal or spending quality time can help that young person feel connected and valued.

Should the need for professional help and intervention be determined, be sure to involve your teen in those decisions. Respect their thoughts and opinions, and talk openly about their options for treatment. It may be a struggle for them to feel connected or comfortable talking with a professional, and collaborating with them on identifying someone who could meet their needs may help to bridge that gap. Depression and recovery can feel scary to both parent and child, but having open conversations with clear understandings of love, validation and support can make helping them more manageable so that they can live their most meaningful life.