Medical Genital exam as a child.. QUESTIONS

[Friday]

But see, that's the thing. What might be an advance to you and me might already be an assault to someone else? I do think cultural and personal differences do play a big role.

Someone can react to their goldfish dying the way someone else will react to their child being raped and murdered in front of them.

That they’ve reacted that way to their goldfish DOES mean they have serious problems, that deserve 100% to be addressed.

It also means their problems are far different. In what ways are they different will determine both diagnosis and treatment. Are they delusional? Do they have frontal brain slosh? ...

(Actual diagnosis, btw, it’s a kind of TBI where people mix up associations. A former friend of mine, who was an amazing dad/best dad ever kind of guy, would be cradling his gym bag ever so gently, and swinging his baby. Or would think he was kneeling down, to have a quiet serious talk woth his daughter, hands placed lovingly on her shoulders, but actually be holding her to the ceiling by her shoulders, screaming at her and smashing her into it. He could recognize what was happening on film but his honest recollection of the events themselves -as he described them- were completely different. It took recording him doing these things for him to actually believe what everyone was telling him, he thought people were f*cking with him, lying to him, or gaslighting him... and he was rightly furious. Until he saw film of what was happening. Frontal brain slosh has very specific treatment. If someone had half assed his DX and labeled him as paranoid? Or delusional? Or the victim of a vindictive ex Wife? He would never have gotten the treatment he so desperately needed. Which is very different treatment than for delusional disorders, or paranoia, or abuse, etc..)

...and I could list 100 more things for a DDX, but the point being? Problems being different doesn’t make them lesser. It just makes them different.

 

[Sideways]

For some people it starts at as much as a hand on a thigh or a kiss that they feel genuinely violated, for others "only" at groping or rape.

Try not to fit everything into the ptsd box.

Someone may well suffer severe psychological consequences from an unwanted advance. That’s probably less unusual than you might think.

But if that’s the case? That a hand on the thigh leads to a level of distress and dysfunction for that person rising to the level of a mental illness? They have may well have a mental illness, but it ain’t ptsd.

Ptsd isn’t about whether you “felt” distressed at the time. It’s about the way the different parts of your brain reacted to the situation. Did the hypothalamus send the information to the amydala (which is what we know can happen with criteria A trauma? Or did it send it to higher functioning parts of the brain, where more complex human interactions are processed. Stuff like the innuendo and harassment examples you’re starting to poke at.

When you start talking about “a person might feel traumatised by...”, then you’re not talking about ptsd specifically. You’re just talking about whether subjectively traumatic experiences cause mental illness. And yes, they do. Every day of the week, all over the world. But it requires more than just knowledge of ptsd - it requires a knowledge of mentall illness in a broad sense.

And that’s something that a person can’t wrap their head around in a week. The average psychiatrist has done around 10 years training to earn their qualification.

 

[Friday]

it would be difficult for the person to be completely unaware of that physiological response. Probably not impossible, though.

Just from my own trauma history...
It can be fun.
It can be exhilarating.
It can be preternaturally calm.
It can be devoid of any and all emotion.
It can be infuriating.
It can be business as usual.
It can be confusing.
It can be nauseating.
It can be too busy to notice or care.
It can be boring.
...Bunch of others.

Which, sure, includes the whole sad/scared/painful/helpless continuum. But TBH, very very rarely. At least comparatively. And far more often before/after, not during. Thumped down with reaction after the crisis is completely over is so my MO that I’ve learned to plan around it :bag: (Let’s hope it doesn’t happen this time! Damn. It happened. Argh.) During big T trauma stuff I’ve mostly either -snap- dropped all my emotions in a flicker of a second, or am having fun. Scared happens before anything starts. Not during. Action kills fear. At least, that’s my experience.

The times I’ve been the most terrified in my life? Haven’t been Trauma related. The worst pain? Grief/bereavement. Et Cetera.

:sneaky: Nothing’s impossible.... but there’s also probably that disconnect, for a lot of people, too. Not unaware of a response; but not the response they were expecting, have been led to expect, or would look for in retrospect as being important.

 

[siniang]

I feel there is some level of misunderstanding here. ?

As with OP, the person I referenced was diagnosed by a professional. It is not >my< diagnosis nor interpretation of the events or symptoms (I actually didn't even know the person was diagnosed with PTSD until a couple months ago, while I knew about the event and the mental consequences, including the suicidality and receiving mental health care, for years - I thought the person was suffering from major depressive disorder).

It was not my intention to question the PTSD definition as I very well understood the diagnostic criteria after reading up on them and them being pointed out and explained by you guys. I mentioned that what I referred to as "feeling traumatized" was a wrong memory from one of the threads, where I just misunderstood it. I very well understand that trauma can cause a large variety of mental illnesses, not necessarily PTSD, and thought I had acknowledged that and I'm actually not trying to fit everything into the PTSD box, that was never my intention.

My initial question really was (and then I think my thoughts just ran away, trying to explain myself)

It’s about the way the different parts of your brain reacted to the situation. Did the hypothalamus send the information to the amydala

Can this happen from the potential of a threat from the Criterion A list. An actual event (assault, rape, accident) is very obvious. But what constitutes "threat"? Even when no actual action is taken/finished, can we sense this potential threat which then leads to the above described physical reactions?

I guess from OP's example that would be: The physician is a pedophile and the child somehow sensed that. There was the >potential< of a >threat< of sexual violation, but the actual sexual violation was never there (nor was there a threat because the physician was never alone with the child).

Again, not questioning anything. I also don't think that OP has PTSD (but obviously something else going on). I'm really sorry if there has been any misunderstanding that has caused frustration.

Edit:

@Friday: Thank you very much for this insight!

 

[siniang]

Again, my sincere apologies as I really didn't mean to cause any conflict or fights. If I came across as unnecessarily argumentative (stubborn?) or confrontational, this was not my intention. ?

 

[joeylittle]

Not unaware of a response; but not the response they were expecting, have been led to expect, or would look for in retrospect as being important.

Honestly, I think you said what I was trying to say but clearer.

It's hard to imagine there isn't a something - but that's the physical (chemical/neurological) event. The feelings we use to describe that event can be radically different, person to person; the way we label the event is subjective, but the actual physical response is (hypothetically) objective.

But what constitutes "threat"? Even when no actual action is taken/finished, can we sense this potential threat which then leads to the above described physical reactions?

That's exactly the question. It's where a lot of the research is (and has been) - trying to (better) understand what constitutes "threat", not from a subjective psychological perspective, but the biological event of it.

Again, not questioning anything. I also don't think that OP has PTSD (but obviously something else going on). I'm really sorry if there has been any misunderstanding that has caused frustration.

Oh, I don't think you caused frustration at all. Your question is a great one, and totally worth talking about, IMO.

 

[Juso]

Ptsd isn’t about whether you “felt” distressed at the time. It’s about the way the different parts of your brain reacted to the situation.

But that's essentially the same, isn't it? You feel a certain way because of how your brain reacts to stimuli (e.g. feeling detached when dissociating, feeling hyperalert due to high sympathetic nervous system arousal, ect). I could be wrong tho, there's lots of disagreement regarding theories of emotion.

what constitutes "threat"

I think a threat is what your brain categorizes as a threat, as counterintuitive as that may sometimes seem. It's easy to rank somebody's experience as "not stressful enough", but as we already discussed a thousand times in this forum - we shouldn't compare traumas. Every brain reacts to everything differently and that's why I think it's impossible to objectively determine what constitutes a threat from the perspective of a brain. We would also have to ascertain if we ARE our brains or if we HAVE brains. Do you know what I mean? Nobody has yet found out how consciousness works, for example. We cannot find regions in the brain that could be responsible for the experience of consciousness, not even a pattern of activation across many regions of the brain. We don't even know if there is something else that influences who we are and how we think. But I think I got off topic here, I just find this topic soooo fascinating??

If I came across as unnecessarily argumentative (stubborn?) or confrontational, this was not my intention.

No, not at all! ?I think you came across as polite and curious.

 

[Sideways]

But that's essentially the same, isn't it?

Not exactly.

I see what you’re getting at, and yes, we ‘feel’ a certain way about things because of the way our brain has processed it.

What I’m referring to though, and what ptsd is fundamentally based around from a neurological position, is the way the amygdala in particular works.

Most stressful and subjectively traumatic situations, our brain has processed the stimuli in the higher levels of our brain, like up in the frontal lobe, used all of the information it’s gathered over your lifetime, and decided “This is traumatic to me, and I’m going to feel X and react in this particular way.”

Pulling apart our brain, though, in the very middle near the base of your brain, we have the amygdala. This is a really primitive part of our brain - cue tired example of caveman escaping lion...

So, from an evolutionary angle, back when we were still primitive humans, not as evolved as we are now (including our brain, which has evolved quite a bit - caveman brains were physically very different), when a person encountered a sudden, imminent threat to their life, like a lion about to chase them? That’s when the amygdala kicked in.

Instead of sending all the stimuli up to higher functioning parts of the brain, the amygdala steps in at the moment of that sudden threat, and forces the body to react. Without thinking.

The amygdala is primitive - so the way it reacts in that instant? Is limited. The amygdala doesn’t know how to problem solve, consider memories, consider options. It isn’t culturally sensitive. It doesn’t consider legal specifics.

It simply identifies “immediate threat to life”, and forces physical and chemical reactions in the body that produce a limited number of responses (fight, flight, freeze, flop).

The amygdala is a time-saver in this regard. It can have your body reacting to protect itself from a threat before the rest of your brain has even realised what’s going on, let alone what to do about it.

We are still learning about our brain. But that’s the amygdala in a nutshell. And PTSD specifically? Is when a person has had an experience where the amygdala has had to take over at some point (criteria A trauma are “lion chasing me” traumas which we know can trigger the amygdala), and for some (unknown) reason, the amygdala has begun to malfunction and override the rest of the brain too often. That’s why you get symptoms like your hyperarousal stuff - amygdala on steroids.

When people experience trauma that higher functioning parts of their brain have decided “this is traumatic”, and suffer mental illness as a consequence? There is something different going on with their brain to cause their illness...so it’s diagnosed differently.

 

[joeylittle]

But that's essentially the same, isn't it? You feel a certain way because of how your brain reacts to stimuli

One leads to the other, then leads to another - so while they can be connected, they aren't co-occurring. That's the foundation of cognition. They don't happen with much of a perceptible gap - which is why it's easy to confuse a feeling with a thought, with a reaction.

We have physical reactions that happen without thought or feeling - the autonomic nervous system regulates those. The sympathetic nervous system (responsible for fight/flight/freeze/fawn) is a component of the autonomic nervous system. We aren't consciously in charge of those reactions. We can, however, learn to consciously control what follows, including the thoughts we have as a result of the reaction, as well as the feelings - or feelings then thoughts.

A thought doesn't necessarily come before a feeling, it can come immediately after, and then be replaced by a different feeling, or a conscious physical reaction, or an un-conscious physical response.

So yes, they are happening very very close together. That's why we perceive them as happening essentially at the same moment, as you suggest - but they do not occur at the exact same moment, and that is why the diagnostic criteria can be separated from the sufferer's subjective response.

 

[siniang]

The amygdala is primitive - so the way it reacts in that instant? Is limited. The amygdala doesn’t know how to problem solve, consider memories, consider options. It isn’t culturally sensitive. It doesn’t consider legal specifics.

Genuine question, has there been studies looking at this? Which also leads towards the question as to why, upon being in the same traumatic situation, some people go on to develop PTSD and others won't. Did the Amygdala not fire in the latter group? And if not, what are the underlaying differences?

It's easy to rank somebody's experience as "not stressful enough", but as we already discussed a thousand times in this forum - we shouldn't compare traumas.

So, if for whatever reason the Amygdala misfires during an event that for most everybody else would not be traumatic (an unexpected advance, for example), either because of a physical defect or another different underlaying mental disorder, and the person goes on to develop PTSD symptoms specific to that event, who are we to dismiss that person having PTSD just because the event doesn't fit our definitions and understandings of what is "sufficiently" traumatic to cause the Amygdala to misfire. Yes, most PSTS symptoms overlap with other mental disorders, but what about Criteria B and C? What if the intrusive symptoms as well as avoidance are specific to that event?

However, touching on my initial question. Since it's the primitive part of the brain that's reacting to trauma that then causes PTSD, basically a subconscious process, it would only make sense that our subconscious could sense threats as a survival mechanism (our subconscious is an amazing place, and there are many great examples, for example the in the internet often referenced "dad-reflexes") - and react. I wonder if threats that are experienced subconsciously (particularly looking at CSA, because I don't think most children are aware of what's happening, at least on a conscious level) are more prone to cause PTSD. On the other hand, it makes me wonder whether delayed-onset PTSD develops when they slip into a cognitive phase where they can consciously process what's happened and actually realize the threat which they didn't realize at the time (because for example they were children). When they start being able to think about and analyze the event on a more rational level.

On a different note, if PTSD stems from the Amygdala, a primitive part of the brain, I wonder if other animals with self-awareness can develop PTSD or if it also requires a theory of mind.

 

[EveHarrington]

it makes me wonder whether delayed-onset PTSD develops when they slip into a cognitive phase where they can consciously process what's happened and actually realize the threat which they didn't realize at the time (because for example they were children). When they start being able to think about and analyze the event on a more rational level.

No, this isn’t how it works, it’s not like we suddenly mature and bam, ptsd. Ptsd isn’t a mature adult disorder. Children don’t suppress this stuff until they can deal with it. It comes out when it comes out.

 

[Ronin]

Genuine question, has there been studies looking at this?

Re. cultural sensitivity? Sure.
The trauma? The same thing.
The treatment, & expression of the trauma? May be best suited differently in different means... though the basics are still fairly consistent. Same core stuff worked on differently, the same ground, different clothing.

Misfire? For that to happen, you would be dealing with *other* damage to the part of the brain, and likely *other* disorder. (To take, literally, other threats as if life threatening, & react to them that way.)

Quite a few trauma + stress disorders out there. But they are not this one. Just like not every fever is a yellow one.

& Kids are kids. Being / not being aware of threats is not very CSA specific.
Kids take dangers differently, all sorts of dangers, just because they are kids.
That is not something concrete to just sexual violence.

& Ditto Eve on, delayed onset is not about when you begin to process trauma, that is something else. It is when symptoms manifest. Not how you would like to feel about it, or if you are ready for it, or what not.