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Dissociation was a large part of my PTSD symptom profile. Since learning how to reintegrate with my physical and emotional feelings, I've gained some potentially important perspective on how PTSD symptoms manifest in those who live with it.
Last month, during my therapy session, Doctor Courtney sent me this link:
https://i.redd.it/04vvapky82n51.jpg
to an article of the Journal Of Pain titled, "Paradoxical Pain Perception in Posttraumatic Stress Disorder: The Unique Role of Anxiety and Dissociation" which describes an experiment in which people living with PTSD and people who are not are exposed to controlled stimuli and asked to signal when they perceived pressure pain from a gradually increasing point of force, and to rate the pain on a 1-10 scale for a temperature pain from a gradually increasing point of heat.
The titular paradox of the study was that the participants who live with PTSD showed a pattern of hyposensitivity (they didn't respond to the increasing pressure stimulus as quickly as the others) and yet gave higher ratings to the pain perceived from the heat source, hyperresponsiveness. These people were numbed to the pain, but once they perceived it, they experienced it more intensely.
The hyposensitivity is consistent with experiments done with people who live with BPD and experience dissociation. The writers hypothesize that it is the combination of numbing dissociation and the pain-intensifying aspects of anxiety that are the root of this phenomenon.
Doctor Courtney gave me this link because as my dissociation faded I was left with a very strong increase in my perception of chronic body pain. Today when we spoke, she asked me what my thoughts were on this paper and did any of it apply to my experience with PTSD recovery.
I spent fifteen minutes explaining to her how this is the very soul of the PTSD experience and how it should be applied to all aspects of PTSD recovery. I got a little excited and she had to ask me to go back and clarify a few things because I was figuring it out as it came out of my mouth, but I'd like to record my observations here for other people living with PTSD and those who support them. What follows is not scientific except how I formulate theories about my experiences and then systematically test and record data. I am not a psychology professional or any type of academic writer.
Everyone has a range of perception. Let's say that 0 describes a stimulus that cannot be perceived and 100 describes a stimulus that is so overwhelming that one can do nothing but perceive that stimulus. It is possible that for most people, the range of perception has a very smooth rate of increase on it. The difference between 1 and 2 is very similar to the difference between 71 and 72.
A person with a smooth rate of increase across their full range of perception will be able to notice and respond to a stimulus once it gets strong enough to get their attention, but before it becomes so intense that it overwhelms their ability to function. From observing people we can estimate the expected level of perception pretty consistently. We try to speak to someone at 10 to avoid whispering or shouting at them. If they don't hear us we increase to 15 and then 20. We have a fairly strong sense of what other people should perceive and how they should react to it. Someone who overreacts to a mild stimulus or underreacts to a strong stimulus signals to us that there is something going on with that person.
Living with PTSD, my range of perception was not smooth in any way. Everything coming to my senses from 0 to 20 registered as 0 for me. A soft noise or a light touch wouldn't register in my mind and it would seem that I was ignoring it. Normal chronic pain was a constant hum in my body, but it was often not intense enough for me to notice it.
This is problematic because it is the subtle signals we pick up from the world that help us keep our balance. If I am standing my inner ear and my muscles are constantly working to correct every bit of leaning to any side to keep me from falling over. If I'm intoxicated or have an inner ear infection, I can't perceive the small changes as clearly and I'm much more likely to tip and then overcorrect and fall down.
If I am sitting in my desk chair and I notice that my right hip hurts a tiny bit, I can shift my weight or stretch my leg, I can get up and move around a little bit. If I don't notice and respond to that mild stimulus, it will get worse and when I do notice it it's going to be much more uncomfortable for me. If I don't take care of a cold at the first symptoms, it may grow into a worse cold and I'll end up suffering more. Sensitivity to stimuli is really important for maintaining health and comfort.
This is one half of the issue with PTSD. The other half is that the other end of the range of perception is also brought to the center. For me, every stimulus above 30 felt like it was at an intensity of 90. In that narrow band between 20 and 30, I could function like a totally healthy person. I wouldn't notice anything below 20 and I would be overwhelmed by anything over 30.
People don't respond rationally to overwhelming stimuli. Music too loud, lights too bright, pain too intense all cause shut down. When the threshold for comfortable perception is crossed, the mind dissociates to get away from it. This means that my numb until 20 becomes more like numb until 50 and everything above 50 are additional overwhelming stimuli.
This creates a cycle of overstimulation and dissociation and makes it impossible to experience a neuroception of safety. The nervous system is constantly firing at danger signals from the overstimulation and going into shut down when the circuit breaker trips. Fight/flight and freeze are engaged almost constantly and produce feedback which further stimulates the senses.
Hypervigilance seems a totally logical solution for this situation. I tried to be so aware of everything around me so that I could consciously notice the things I wasn't perceiving, and deal with them effectively before they became overwhelming stimuli. If I can control everything around me I can make sure that I don't ever get tripped by overstimulation.
In my experience, medication served to artificially raise my threshold of overwhelm from 30 to about 60. This gave me room to work on the beliefs and examine the facts of my traumatic experiences, and process them the way my traumatized brain could not physically do in the time of the trauma.
Once the trauma events/memories were successfully processed and my brain wasn't firing randomly at me to try and deal with them, I still had to do work to develop a healthier range of perception or I was going to continue trying to control my environment at all costs to avoid overwhelm. Somatic therapy helped me get in touch with my senses and my perceptions so that I could get used to feeling things, even very subtle things, without reflexively panicking that those feelings were going to overwhelm me. This is a difficult and delicate process but it can be as delightful in some places as it is intimidating in others.
When there is a very thin zone between feeling nothing and feeling everything it's really hard to function. There is no subtlety in PTSD. Because there is no subtlety there can be no sense of safety. Uncertainty goes from meaning, "Something bad could happen or something good could happen." to "Whatever happens, it's going to be too much to handle." I believe that understanding how this range of perception functions for PTSD can help caregivers and people with PTSD to be more patient with their reactions to things and allow them to understand why everything feels either dead or utterly terrifying.
The paradox of pain shows us one way in with the perceptions of people living with PTSD differ from people who are not living with it. I believe that this framework can be applied to cognitive and emotional aspects of perception as well. Thoughts can zero out at a depressed dial tone or be as manic as a storm. Emotions can go from flat deadness to extreme joy or rage with almost nothing in between.
I do not believe that this would only apply to people living with PTSD. The combination of dissociation and anxiety is not uncommon and may explain the patterns of behavior that I've witnessed in otherwise mentally healthy people struggling with pandemic living. When "I just want to go numb until this is over" butts heads with, "The world is ending!" nothing really functional is going to come from it.
This is not the answer to all things PTSD, but for me it is a very important framework within which I can hang my own experiences and through examination, better understand where I have been and where I am going. If you live with PTSD, or support someone who does, I hope this can be a useful tool for you to understand what may be going on beneath the surface of confusing behaviors.
Last month, during my therapy session, Doctor Courtney sent me this link:
https://i.redd.it/04vvapky82n51.jpg
to an article of the Journal Of Pain titled, "Paradoxical Pain Perception in Posttraumatic Stress Disorder: The Unique Role of Anxiety and Dissociation" which describes an experiment in which people living with PTSD and people who are not are exposed to controlled stimuli and asked to signal when they perceived pressure pain from a gradually increasing point of force, and to rate the pain on a 1-10 scale for a temperature pain from a gradually increasing point of heat.
The titular paradox of the study was that the participants who live with PTSD showed a pattern of hyposensitivity (they didn't respond to the increasing pressure stimulus as quickly as the others) and yet gave higher ratings to the pain perceived from the heat source, hyperresponsiveness. These people were numbed to the pain, but once they perceived it, they experienced it more intensely.
The hyposensitivity is consistent with experiments done with people who live with BPD and experience dissociation. The writers hypothesize that it is the combination of numbing dissociation and the pain-intensifying aspects of anxiety that are the root of this phenomenon.
Doctor Courtney gave me this link because as my dissociation faded I was left with a very strong increase in my perception of chronic body pain. Today when we spoke, she asked me what my thoughts were on this paper and did any of it apply to my experience with PTSD recovery.
I spent fifteen minutes explaining to her how this is the very soul of the PTSD experience and how it should be applied to all aspects of PTSD recovery. I got a little excited and she had to ask me to go back and clarify a few things because I was figuring it out as it came out of my mouth, but I'd like to record my observations here for other people living with PTSD and those who support them. What follows is not scientific except how I formulate theories about my experiences and then systematically test and record data. I am not a psychology professional or any type of academic writer.
Everyone has a range of perception. Let's say that 0 describes a stimulus that cannot be perceived and 100 describes a stimulus that is so overwhelming that one can do nothing but perceive that stimulus. It is possible that for most people, the range of perception has a very smooth rate of increase on it. The difference between 1 and 2 is very similar to the difference between 71 and 72.
A person with a smooth rate of increase across their full range of perception will be able to notice and respond to a stimulus once it gets strong enough to get their attention, but before it becomes so intense that it overwhelms their ability to function. From observing people we can estimate the expected level of perception pretty consistently. We try to speak to someone at 10 to avoid whispering or shouting at them. If they don't hear us we increase to 15 and then 20. We have a fairly strong sense of what other people should perceive and how they should react to it. Someone who overreacts to a mild stimulus or underreacts to a strong stimulus signals to us that there is something going on with that person.
Living with PTSD, my range of perception was not smooth in any way. Everything coming to my senses from 0 to 20 registered as 0 for me. A soft noise or a light touch wouldn't register in my mind and it would seem that I was ignoring it. Normal chronic pain was a constant hum in my body, but it was often not intense enough for me to notice it.
This is problematic because it is the subtle signals we pick up from the world that help us keep our balance. If I am standing my inner ear and my muscles are constantly working to correct every bit of leaning to any side to keep me from falling over. If I'm intoxicated or have an inner ear infection, I can't perceive the small changes as clearly and I'm much more likely to tip and then overcorrect and fall down.
If I am sitting in my desk chair and I notice that my right hip hurts a tiny bit, I can shift my weight or stretch my leg, I can get up and move around a little bit. If I don't notice and respond to that mild stimulus, it will get worse and when I do notice it it's going to be much more uncomfortable for me. If I don't take care of a cold at the first symptoms, it may grow into a worse cold and I'll end up suffering more. Sensitivity to stimuli is really important for maintaining health and comfort.
This is one half of the issue with PTSD. The other half is that the other end of the range of perception is also brought to the center. For me, every stimulus above 30 felt like it was at an intensity of 90. In that narrow band between 20 and 30, I could function like a totally healthy person. I wouldn't notice anything below 20 and I would be overwhelmed by anything over 30.
People don't respond rationally to overwhelming stimuli. Music too loud, lights too bright, pain too intense all cause shut down. When the threshold for comfortable perception is crossed, the mind dissociates to get away from it. This means that my numb until 20 becomes more like numb until 50 and everything above 50 are additional overwhelming stimuli.
This creates a cycle of overstimulation and dissociation and makes it impossible to experience a neuroception of safety. The nervous system is constantly firing at danger signals from the overstimulation and going into shut down when the circuit breaker trips. Fight/flight and freeze are engaged almost constantly and produce feedback which further stimulates the senses.
Hypervigilance seems a totally logical solution for this situation. I tried to be so aware of everything around me so that I could consciously notice the things I wasn't perceiving, and deal with them effectively before they became overwhelming stimuli. If I can control everything around me I can make sure that I don't ever get tripped by overstimulation.
In my experience, medication served to artificially raise my threshold of overwhelm from 30 to about 60. This gave me room to work on the beliefs and examine the facts of my traumatic experiences, and process them the way my traumatized brain could not physically do in the time of the trauma.
Once the trauma events/memories were successfully processed and my brain wasn't firing randomly at me to try and deal with them, I still had to do work to develop a healthier range of perception or I was going to continue trying to control my environment at all costs to avoid overwhelm. Somatic therapy helped me get in touch with my senses and my perceptions so that I could get used to feeling things, even very subtle things, without reflexively panicking that those feelings were going to overwhelm me. This is a difficult and delicate process but it can be as delightful in some places as it is intimidating in others.
When there is a very thin zone between feeling nothing and feeling everything it's really hard to function. There is no subtlety in PTSD. Because there is no subtlety there can be no sense of safety. Uncertainty goes from meaning, "Something bad could happen or something good could happen." to "Whatever happens, it's going to be too much to handle." I believe that understanding how this range of perception functions for PTSD can help caregivers and people with PTSD to be more patient with their reactions to things and allow them to understand why everything feels either dead or utterly terrifying.
The paradox of pain shows us one way in with the perceptions of people living with PTSD differ from people who are not living with it. I believe that this framework can be applied to cognitive and emotional aspects of perception as well. Thoughts can zero out at a depressed dial tone or be as manic as a storm. Emotions can go from flat deadness to extreme joy or rage with almost nothing in between.
I do not believe that this would only apply to people living with PTSD. The combination of dissociation and anxiety is not uncommon and may explain the patterns of behavior that I've witnessed in otherwise mentally healthy people struggling with pandemic living. When "I just want to go numb until this is over" butts heads with, "The world is ending!" nothing really functional is going to come from it.
This is not the answer to all things PTSD, but for me it is a very important framework within which I can hang my own experiences and through examination, better understand where I have been and where I am going. If you live with PTSD, or support someone who does, I hope this can be a useful tool for you to understand what may be going on beneath the surface of confusing behaviors.
