How Comorbidities Manifest – Tentative Findings

A Warning: This article may retrigger some of you in substantial ways. Read at your own risk and discretion. It deals with tracking down my personal set of symptoms of C-PTSD and comorbidities coming from that. You may find it helpful, but at the expense of getting triggered.

update: I’ve attached my own tentative approach to findings about initially experienced trauma and its fairly complex set of outcomes as a kind of “trauma map” along with primary and secondary outcomes (comorbidities). A picture is said to say more than 1,000 words… well, hopefully it does.

Last night I went for another musical night out downtown. There is a monthly open stage night, which I try to set money aside for from the very meager monthly budget I have been depending on since around 2009-ish. For those of you not familiar with the music scene: An open stage or open mic night is usually commenced by some kind of “house band” regularly performing in the venue, while visiting musicians get to sit in upon the second set of music. If there is enough variety in terms of instruments, sometimes complete new ad hoc bands form for a set or two. I like that particular venue, where this happens for the musicians there, the nice staff, the convenient location, which is not exactly at the heart of the city, so I can find parking easily (or take the train, when feeling up to it). More than anything, I like the kind of music being performed along with the appreciative audience. Although I’m still feeling pretty weak from the after effects of all that medication that they flushed me with undergoing surgery about two weeks ago, I kind of dragged myself there as it is my one-stop-chance to socialize once a month – and I’m sorely missing the socializing aspect and having become this isolated recluse has brought about new problems I previously didn’t know I could have. But I’m digressing again. Comorbidities then…

I mentioned last night as it made me aware of another set of interrelated symptoms coming about from an underlying, only recently identified condition of complex post-traumatic stress disorder (C-PTSD). But before I go into that, I need to fill in another blank: I had been pondering hard as to my relationship with music in general and why it seemed so hard for me all of a sudden to rekindle the passion I had been feeling for it for almost all my life. I now don’t have too much doubt about that any longer: The degree of primary and secondary symptoms had aggravated to the point, where it completely overrode any potential for becoming passionate about anything. In other words: Where acute anxiety and fear culminating in panic attacks rule your days, there simply isn’t any room for the heart to beat calmly enough that you get to the place, where the Muse resides: In the quiet, still moments of the heart and mind, in the recesses of the soul seldomly visited – unless in those moments of inspiration. But you can’t feel inspired when standing on a battlefield in full riot gear all of the time, figuratively speaking. To stay in that analogy: How can you have a quiet moment when grenades, mortar fire and machine gun shots whizz by left and right? Right?! It’s been like that for me for the larger part of 2009, all of 2010 and again the larger part of 2011. Adversity had risen to unprecedented levels, which simply didn’t leave any room for even the remotest moment of relaxation or coming into myself. And simply practicing the physical movements by forcing myself to play the instruments (guitar and piano) felt weird, pointless and didn’t help to rekindle said passion. In that context: I don’t consider myself a musician as much as I’d like to think of myself as a songwriter/composer, who happens to play some instruments and sings. When I think of it and during times I afforded myself the most dedicated training, it was the song that was almost paramount to me – and certain instrumental parts that added to the overall song structure and arrangement. Whatever training on the instrument I afforded myself or received in a formal setting, I always regarded as mere “skill” to come before songwriting and arrangement. But naturally – I’m digressing again.

So last night I went to this open stage night downtown, which I had been looking forward to for some time – and more than anything for reasons of getting to socialize! (I really feel like a dying plant left in the shade about that forced on isolation, I need to feel part of some kind of group or social context of some kind. Playing in bands has always and often conveniently provided that. About the convenience – that may have become a different story. I guess, I’ll find out about that soon enough). I had not slept all that well or much the night before and gone about my regular routine, which consists of lunges and push ups after getting up, fixing myself a small breakfast, then getting on the computer for a couple of hours, usually to be followed by some going outdoors and moderately working out, like e.g. riding the bicycle or taking a walk of an hour at the very least. Since I’m still feeling the after effects of the medication from having undergone surgery in the hospital about two weeks ago, I couldn’t bring myself to doing the latter and had to rest after a late lunch. I took a shower and got myself ready for going out, went there, took a slow walk at where I arrived, then attended the event. I felt weak and a little dizzy the entire time. It wasn’t until short after midnight that I realized that my feeling weak and dizzy had been due to major fatigue along with the physical effects of the antibiotics and cortisone, which my body is still busy getting decomposed and flushed out. Despite all that, I enjoyed myself and the company there and was my old self, whom I’d describe as open minded, approaching people, being mildly talkative and generally sociable. The latter, however, I only mildly resumed after this major boost in confidence and courage that overcoming my fear of hospital has provided me with! I had literally holed myself up for the past six years on account of feeling inadequate and damaged to the point of it showing in pronounced ways, the latter of which I didn’t want to risk getting punished and bullied for one single more time! Since I had been feeling fatigued, depressed, exhausted, hopeless, utterly defeated and often times angry to the point of being raving mad with the world – and from disappointment so… – I saw no point in going out there and getting beaten up some more on account of all the aforementioned. After all, how many times can you run into a wall at full throttle and pick up the debris from the impact? I felt I had done that enough times to afford myself a break from that brutal experience. Yet, the latter had me isolated for good – or so it seemed.

In analyzing my personal outcomes in a more structured, commonly viable way, I tentatively identify more or less chronic fatigue coming from a somewhat excessive need for good sleep, the latter in turn being the result of constant hyperarousal from getting triggered on a more or less permanent basis. I now seem to better grasp the full impact of trauma, in particular since Jean’s sharing of this article, which pinpoints the facilitating neurological processes predominantly located in the limbic system, with some involvement of the amygdala and other “fear-based”, ancient/archaic systems in the brain circuitry. So, depending on the type of trauma incurred – by the way, in looking through this list, I have identified repeated and ongoing exposure to eight seven of all twelve types of traumatizing experiences… talk about a full plate in that regard…. – the number of triggers will vary and thus create a more or less densified, intense situation of being triggered with varying degrees of retraumatization, which in turn and again make for depletion of physical resources more rapidly than in non-affected individuals. I would mention those days as proof, when I had the opportunity to find sleep for no less than eight hours – individual needs may very and generally decrease as one gets older, the latter in affected as well as non-affected individuals alike: On those days, I felt satisfyingly energized, settled and resilient, which in turn generated enough confidence in myself to take on the challenges of the day. On days that followed a night of sufficient and fairly healthy sleep with alternating healthy patterns of NREM and REM sleep, I would feel productive and self-sufficient and go about my routines in an organized and sufficiently efficient manner. Days following poor sleep typically feel like a hangover, even when no previous alcohol consumption is involved. (I have quit drinking alcohol altogether to eliminate yet another source of maladpative self-medication).

Feelings of exhaustion, lonliness and despair seem to have gradually brought about my eating disorder of occasional binge eating – in order to drive away that feeling of thorough exhaustion and from not giving myself permission to simply be exhausted or endure otherwise negative feelings! (The latter, I’d tentatively identify as yet another outcome of perpetuated abuse in the form of self-abusive, self-deteriorating behavior in so far as I don’t seem to have been given the opportunity of expressing negative feelings without ensuing reprimand or emotional and occasional physical abuse in earlier life). What is more and from my experience, an eating binge not only caters to dissipating exhaustion, it temporarily – though with taxing side effects – takes care of other basic needs largely unmet during my early development and leaving behind major emotional deficiencies: Depending on the type of food, there typically is a burst of endorphines that gets rapidly released into the system and binding to the opioid receptors in the brain, resulting in feelings of rapid relaxation and feelings of being safe and nurtured beyond physical needs. From the mechanism of action brought about, it is no surprise any longer how hard it becomes to break that vicious cycle of dependency. In other words: With the bulk of basic emotional need having remained unmet throughout my earlier personal development – or rather lack thereof -, binge eating seems to deliver in regards to all residual deficiencies.

And there is another aspect to it, which had crossed my mind a few years ago and which I had meant to monitor more closely and keep in better check: Eating binges and often so at unusual times, like e.g. late in the evening or even at night, seem to mess up the messages of physical needs in general – or their correct interpretation thereof, to be more accurate. In other words: I seem to have been mixing up feelings of fatigue and hunger and vice versa, typically resulting in an eating binge, when I should have tried to find sleep instead. One could go as far saying that I haven’t eaten or slept in a normal, healthy manner throughout my entire adult life! Last night strongly reminded me of that tentative finding. I had felt weak from the medication along with some recurring fatigue, but dragged myself to that venue in – successfully met – hopes of having a good time out with other people. Given my still fragile condition following surgery and heavy medication, I noticed this strange dizziness throughout the night, while displaying behavior of natural, authentic exhiliration. Around midnight, I notice a critical point of my body giving way to the physical exhaustion. I had some water and had to sit down, then quickly excused myself and rode back home for about 45 mins and went to bed immediately. This time, I had managed to correctly interpret the signals sent by my body. At other times… I seem to resort to some self-abuse in the form of a late eating binge, which then naturally results in insomnia and/or poor sleep.

It’s going to become crucial to be more observing of my physical needs, particularly so after having recovered from the outcomes of that heavy medication (antibiotics and a messed up bowel tract from it being the most resilient, longest lasting outcome, resulting in said feelings of physical weakness beyond previous compare…). In this context, having been at the hospital seems to have “reset” my system in unexpected ways, thus shedding some light on the interdependencies of physical triggers of one or the other kind. Finding good sleep seems to be the pinnacle in thwarting and deactivating this vicious cycle of (physical) dependencies and co-dependencies. And sadly, sleep deprivation has been a given throughout my entire adult life and remains to be the core problem, as the routines of my landlady’s along with the proximity here run counter to my own. I have pinpointed the set of problems to the initial one. But with so many other issues that arise from it – I don’t see a solution there, not short term and not in the long run, either. I’m going to push for a higher degree of disability coming from my recent formal diagnosis of C-PTSD along with an attempt of pushing for extended, special needs in regards to social welfare. The latter… equals the beginning of yet another battle with the system, quite expectably spanning several years and with no clearly anticipated outcome yet. That’s my life for you…

P.S. I’ve tried to organize the interdependencies of trauma and behavioral outcomes the way I seem them or have experienced them so far. This is my personal “trauma & outcomes map”.

trauma map

My own tentative approach to experienced emotional trauma and its outcomes, W. Nieke 2013


7 thoughts on “How Comorbidities Manifest – Tentative Findings

  1. I read your entire post very carefully, going back over anything that was not clear to me. I also studied your schematic carefully. I may not be, as they say, “the sharpest tool in the shed,” but what I see is that you are gradually, in your own way, bringing this chaos and “mess” into a focus that will enable you to see more clearly how to manage it. Wow! You have done a phenomenal piece of work here! Or, I should say, you ARE DOING a phenomenal piece of work because it’s not over yet. It’s a work in process. But you appear to be getting there! Once you reach a certain point, I believe you will find even more tactics for managing all this. That’s just my intuition talking.

    The problem, of course, is hanging in there throughout the process. As my inner Cowboy says, “It’s a damned rough ride!” I see you hanging onto the saddle pommel for dear life as you ride the bucking bronc. The gate to the chute opened long ago . . . Your staying power is amazing!! Keep riding!

    As you know, coming across that article has had a powerful influence on me, too, and I still have not processed it. I squandered ink and printed it out last night so I could take my time reading it. According to my retired shrink friend who specialized in infant trauma in her own way–she treated toddlers in a therapeutic pre-school connected with a big east-coast hospital–what Schore says is well researched and pretty much the bottom line as we know it now. Maybe the future will reveal more, and I hope it does. But for now, the information in that article, according to her, is “it.” Sadly, in some respects.

    Thinking about the information in that article and in your post makes me feel overwhelmed. However, once I sort things out in my mind, I will, as you have, figure out how to use the info for my own good purposes. It will take a while, but maybe seeing my therapist tomorrow will help the process along. When I talked to her, she wanted the URL so she could read it before she sees me tomorrow, and I hope she does that. Having her input would help. Maybe she can soften the blow a bit. Ya never know . . . She has been at this for over thirty years . . .

    Presently, I am trying to get into more heavily subsidized housing up in Washington state in a rural area. The gunshots I hear where I live now are disturbing, as are the drug deals I witness. Leaving here will put paid to my therapy because in the rural areas it’s rare to find a therapist who knows how to help people with C-PTSD–as evidenced by my fruitless search through the years 1983-2010. But I’m praying that by the time an apartment opens for me, I will be able to deal with symptoms on my own–should they arise again. In the meantime, I plan to make as much progress as I can with the support of my therapist. After my relocation, I will be–as Gene Autry, the singing cowboy, sang–“back in the saddle again” and solo this time. (I don’t know how many of the old cowboy songs you have heard. You might enjoy The Sons of the Pioneers just for kicks. Pretty hokey to your generation, but very familiar to mine! Life was simple then . . .)

    So, to wrap this response up, I am amazed and awed by how you have managed to make some sense of the chaos you are dealing with. Just know that you are supported by your readers–and keep on ridin’! If you get bucked off, we’ll hold the critter until you climb back on. Peace . . .

    • *smile* at “we’ll hold he critter until you climb back on.” Yes, you are very right, Jean: The gate to the chute opened a long time ago – about 10 days into my life, to be exact. That’s 17,696 days – and partial nights – of riding that bronc, 17,696 days and nights of clutching that saddle pommel and getting my behind and back shaken and yanked and bumped. 17,696 days and some nights of carefully selected moves so as to not have to stare down a gaping abyss of annihilation. I should hope to have rewarded myself with some residual positive outcomes from that crazy yankfest – and I’ll identify them, too, as I go along. Today’s blog might fall into that category and it’s there for two reasons: To inspire fellow travellers, to remind myself not to let go of that saddle pummel and if I really did at some point and didn’t manage to climb back on (something I hope, won’t happen) – to bear witness of the ride. The latter sounds dramatic, I’m aware of that. But as of late, I feel it needs to be done. Not for myself, but for people like your therapist and other inclined personnel, who might derive some insights from this.

      As far as Schore’s work: Maybe it’s not meant to be read by people like you and I. And personally, I think I will take a position of denying findings like hers if I feel they disempower me (which parts of her findings seem to lend themselves to). There was a movie I recently watched, starring Michael Keaton, in which he learns of having contracted terminal cancer at the peak of his career and personal life. ( I was particularly impressed with one scene: The doctor tells him of his remaining life expectancy in clear, non-negotiable words (as they tend to do). He stomps back into his office and yells at him, how he (the doc) has no right in taking the one thing he got left: Hope! I found that to be a very accurate sentiment and response. And I think, I’ll be better if I hang on to a similar stance, in spite of all odds or findings or whatever. Because survival instinct doesn’t obey numbers or statistics, calculations or anything along those lines. And survival instinct is what I’ve employed in my darkest hours along with some stubbornness to just show that darn bronc right! Anger – when channeled in this way – can be a very productive feeling. Why not use it in this way? In ways of removing ourselves from the role of a victim that others thought to have assigned us in their mind-blowing narcissism and neglect of others? Why not let that cowboy hurl a rope and shake that pistol in their face and cock that barrel vociferously? I think, a part of that journey can be about showing THEM right: They may have bent and twisted and hurt us – but I believe we can choose to deny them BREAKING us. Because I seem to find that inspite of it all, there is a still a beating heart, there is genuine joy of being alive (though these moments may seem rarer than in other’s lives) and there are moments of near ecstasy when experiencing the joy of having successfully overcome another fear (like that hospital stay the other week. I must have had a silly look of exhiliration on my face when I woke up from that anesthesia and for a minute, my heart seemed to explode into a 1,000 pieces with triumph and joy).

      Thank you also for your kind words about my resilience and about putting things in perspective for myself. It’s from necessity as a) I don’t trust “them” any longer (and Schore’s paper is proof of why) and b) I am my own and best expert – or becoming one. And you are, too. We know without a doubt what feels good and what doesn’t. Any outside person can come close at best, but they’ll never get there all the way. In other words: We can use our sensitivity from all that in productive ways, if we put our mind and heart to it. We – are our own and best qualified guardians. Again, as far as the map – I now know better, why I’ve become desperate about finding some working medication to soften the hypervigilance and hyperarousal when it happens.

      Another thought: I think, more positive feelings and higher self esteem can come from focussing on our accomplishments rather than where we failed. And last, not least: We must demand our own sets of standards to live by and pull the special needs card no matter what, when required. They won’t always heed it everywhere and then it will be about identifying where they’re more likely to and where not. Or something like that.

      Anyway – thanks 😉

      • You and I have different voices, but I believe firmly that our song is the same. Tell me if I’m wrong about this.

        As I said yesterday, that article was a real downer for me once I “got it.” However, I never seem to stay down for too long. Yesterday, I visited the open house fundraiser for the Portland Mounted Patrol. The city had cut the patrol out of the budget, but a group of supporters put together a nonprofit corporation and is now trying to raise the money to keep the mounted patrol afloat. So I, being a horse-lover, went to the open house, was kissed by a couple of horses, had my picture taken with a critter, got the full benefit of the aroma of horse shit, etc. Somewhere in my brain all this, including the horse shit, was floating around. And this morning while I wrote to you I did the research to find the link I sent you. There is hope!

        The equine therapy ranch is right near where I want to live, and I’m going to write to see if there is a possibility that I can take advantage of what the program there has to offer. I think my insurance will cover their program. I had heard that the ranch was moving to California pending property purchase, etc., but so far, it’s still located in Chehalis, Washington. So I’ll find out what I can.

        One way or another, by some circuitous means, my mind finds a way to reveal new possibilities that give me hope. Your mind appears to do the same, albeit through a different process. I propose that we celebrate that process today! After all, our minds–all minds–are pretty damned amazing! While I’m celebrating, I’m going to be writing to the horse therapy people and also filling out the forms to apply for my new housing. I always feel better if I know I’m DOING something toward improving my situation. The worst times are those when I don’t feel that there is anything I can DO.

        In the meantime, as either Roy Rodgers or Gene Autry sang, “Happy trails to you.” Pretty hokey, eh? Then there is “Give me land, lots of land, under starry skies above, but “Don’t Fence Me In.” Now, there is some wisdom we can live with, speaking metaphorically . . . I’ll let you know what I find out about the equine therapy. Ride ’em Cowboy! Jean

      • Was our song the same? I’d say it has overlapping parts, in particular in regards to early childhood, although the abuse didn’t start for me until later, around ages 5 or 6 going forward. (as far as I remember, could have been even earlier; I think, partial neglect happened sooner, some of which I REMEMBER although it’s before the time actual memory forms according to neurologists and psychologists – goes to show that they’re not always right. Recently, more distinct memories have reemerged from the subconscious – verfiable memory, b.t.w.! – Which is one of the main reasons for me to have hope for genuine healing – or becoming MUCH better at least!!)

        I strongly agree on DOING being beneficial. Self-efficacy is the buzz word to mention here. This is why the past few years have been extra brutal for me as I found that the way the system works, they’re REMOVING options instead of OFFERING them! (Not to mention making them easily accessible and easy to navigate – both of which DOES NOT happen, on the contrary so!) And reclaiming self-efficacy with or likely without the system has become my main motto again since throat surgery. In this context: Getting this done and confronting my BIGGEST FEAR of getting retraumatized – which has NOT happened, fortunately, or not to any notable degree! – almost had an effect of ERADICATING some outcomes of the trauma. I’m beginning to think that the persisting issues might not even have anything to do with hypervigilance or hyperarousal – at least not, where they pertain to the trauma endured in hospital. The latest issues all seem to revolve around the abuse I endured later and seem to be linked to my landlady, as she seems to fit the bill in all aspects of triggering fear of getting abused again. I need to move out, that much has become clear.

        Congrats on having identified all that info on the equine therapy ranch and fingers crossed they won’t move it to CA or at least leave a branch site out there where you live. In that regard and stressing this again: Yes, mind over matter. I am convinced of that. Only – in my case, there are so MANY issues and endured trauma – I mentioned seven out of twelve listed types in my schematic – it will take a great deal of patience. And patience isn’t one of my stronger traits, unfortunately – but even there, I seem to have made some progress. So again – mind over matter along with resilience and MAJOR shares of perseverance! And keeping at practicing and training the mind into positive thoughts! (The latter is crucial, absolutely CRUCIAL) I say we have reason to celebrate EACH day that we’ve bravely conquered and made into OUR OWN!

        Nothing wrong with a good cowboy song here and there – ideally enjoyed at a campfire, guitar in one hand, beer and steak in the other (or whatever better system-compliant equivalent I can think of for me… LOL). Here’s to cowboys, horses, riding and some country music here and there 😉 And to embracing LIFE! Because we were meant to and it’s our birthright, like everyone else’s! Here’s to CLAIMING what’s ours!

      • Bravo! Well said! I’m certainly up for a celebration. I have housework to do today–washing, clearing up clutter, etc.–but I’m going to celebrate by filling out all those housing forms so I can send them off tomorrow. To the future! And to embracing life! And to horses minus the asses! I’ll let you know what happens. . . In the meantime, Happy Trails! Jean BTW, I meant the “song” in general terms. You are right, in some specifics we overlap, but you, Kimberly, all the people who read our blogs and want to know–we are all struggling and recovering. And per my increasing readership, it looks like our song is becoming audible. Is it okay if I put a link to your blog on mine? I’m going to ask Kimberly, too. That might help all of us and everyone else.

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