Medical Genital exam as a child.. QUESTIONS

[siniang]

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.

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.

Not what I said? ? (or at least didn't mean to imply)

& 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.

Never claimed that. Or at least didn't mean to. Probably should've worded it differently.

 

[Sideways]

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.

Yes. Been studied. Easy to find goid sources to read about it. The way the ANS works (as joeylittle referred to) is not particularly new knowledge.

Why some people go on to develop ptsd and others don’t? There are articles on that subject in the News/Studies forum.

Diagnosis of mental illness is culturally sensitive, and there’s plenty of information around about that issue as well.

Probably, if you’re genuinely interested, a better understanding of how the brain and nervous systems work would answer a lot of your questions. It’s an interesting area, but not one that lends itself to simplification.

 

[Juso]

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.”

I don't think I've ever heard of someone deciding that something is traumatic for them? Trauma mainly happens, as you've described, in the primal parts of our brains, since it is about surviving a threatening situation. The frontal lobe if of course involved in PTSD, but especially the limbic system undergoes massive changes due to trauma (someone already pointed out that the hippocampus shrinks due to high cortisol exposure). The amygdala in particular is crucial for conditioning, and conditioning lays the groundwork for PTSD, since you are constantly associating specific triggers (smells, sounds, visual stimuli, ect) with feelings during traumatic event(s). Conditioned responses to stimuli are very difficult to extinguish in patients with PTSD; thats one of the reasons why the amygdala tends to overdrive the cortex in PTSD. There also seems to be something called a functional sensory deafferentation due to traumainduced dissociation that basically impairs the communication between the higher and lower structures in our trauma brains, leading to either overmodulation (dissociation) or undermodulation (hyperarousal) of the limbic structures. That's why I am finding it hard to imagine that someone can consciously decide that a situation was traumatic for them??But maybe I misunderstood something?

One leads to the other, then leads to another - so while they can be connected, they aren't co-occurring

Yeah, I wasn't trying to say that they are co-occuring, I was only responding to Sideways statement ("PTSD isn't about whether you "felt" distressed but about the way different part of your brain reacted"). I was trying to say that because one factor causes the other factor, PTSD is very much is about both of those factors.

if for whatever reason the Amygdala misfires during an event

You cannot get PTSD from that, cause if the amygdala should randomly misfire, this would occur in a blink of an eye and you wouldn't even really notice it happening. PTSD is partially caused by a continous hyperactivation of the amygdala and the HPA axis, and this kind of hyperactivation must have a reason, it cannot happen randomly. So for someone to develop PTSD, their brain must have employed survival mechanisms such as the fight/flight/freeze reactions.

I wonder if other animals with self-awareness can develop PTSD

I think animals can develop PTSD even without self awareness. Animals can sense threats, they can experience pain and fear, they can feel safe or unsafe, they can develop conditioned fear responses in reaction to aversive stimuli. They can even dissociate, but that's usually called death feigning or learned helplessness. Its their freeze mechanism.

 

[Ronin]

Probably should've worded it differently.

:tup:
Me too, probably.

Didn't mean to rip into you and apologies if I screwed up with the tone of that, as not my intention at all. Just went off musing that identifying threats, wide range of them, is not really dependent on what we feel of things at the time, as if it were, kids likely wouldn't survive their childhoods / how different many a thing feel back then & with adult experience, not just in sex stuff respect. Yet brains sort it out well enough.

 

[Laur]

Compare contrast:

a child crying for help anywhere, because she survived FGM & watching most of her cousins and sisters come through that. She is uncomfortable, the village doctor told her she should be proud as she is now a worthy bride, but she feels just the pain, and does not want to even think of men, so she is not all that worthy bride after all. The herbs she was given do nothing, for the pain or anything else, but she so would not ask about that, on top of other things, she just wants to go back to being a worthy bride.

Vs other one, uncomfortable because a doctor touched her as a part of a *regular* check... while her mom had her back, it was a legitimate doctor with a license, who up held all the procedures & was gentle with the child, while treating their medical condition, where nothing untoward happened during the examination... Who then went on to describe the findings (and only the findings, not how hot is that girlie and cute in her knickers) to a licensing body, full of shock, other doctors... who also were not having thoughts of molesting their patients.

Now.
Which girl is the one who can have the disorder?
Surely not the uncomfortable one... because just not the kind of thing going on, right?

Now, the thing is totally different if the uncomfortable girl is actually uncomfortable with the doctor because Uncle Tom screws her every weekend without her mommy knowing.
Or because the doctor fingered her while whispering she is so sweet to her ear.

Do you see the differences?

Being touched against your will and feeling helpless is being touched against your will and feeling helpless regaurdless of who is doing the touching.

Are you saying if you got ptsd from being shot is only acceptable if you were shot by a bank robber rather than shot by a cop? Think about how that makes sense.

When I was a child I remember the doctor touching and examining my genitals. I remember feeling violated and uncomfortabl and asking my mom if I had to let the doctor do that part of the exam. She said yes and I was forced to have another genital exam as part of my physical. I have ptsd from this and can’t have a sexual relationship with anyone because it just brings back feelings of being violated.

Is it normal for doctors to do genital exams on children?

Does anyone else have ptsd from this?

Yes, you are not alone. You felt violat3d against your will regaurdless of the reason behind it. The reason behind it didnt make you feel less violated. People have rights to their body.

Oh don’t worry @Muttly... I stop answering these questions whenever I quit giving a damn about people. Oh, you’ve been pregnant for 15 months? I may know super basic & potentially life saving information, pregnancies don’t last 15 months, but I’ll just keep that to myself. It’s not my fault if you die of a totally treatable condition. Or waste years of parenting time, and other amazing things in life, waiting for this “baby” to be born. Yep. Babies take their time. Pregnancy sucks, doesn’t it? You must be so excited! Cheers!

Someone wastes years of their life treating the wrong psychiatric disorder? Or kills themselves because of not being treated for what they reeeeally need help with? Pfft. What do I care? That I could have tossed them the info they were directly asking for -that doesn’t cause PTSD, if you have PTSD is will be from something else in your life, or you’re looking at a different disorder- doesn’t make it my fault that they haven’t studied what I’ve studied, and don’t know what I know. It’s not my responsibility to point people towards resources that could help. f*ck ‘em.

Of course, most of the time, I do care. But I go whole months of looking at posts by desperate people in pain looking for answers and don’t even spend 2 seconds of my own time trying to help.

No one but you can determine what qualifies as tramatic or not. It doesnt matter what profession they come from. You also cannot define a neatly set of black and white examples that causes trama and expect that anything outside of that list does not cause trama. Trama is personal, it is an individual emotional response and feeling as a reslut of a stimuli or situation. What tramatizes one person may not tramatize another. It is an involuntary reaponse to an action. No one has the right nor the ability to determine what is "allowed" to be tramatizing. It just is or isn't to each individual.

You can argue all you want about this but it is what it is.

Then either they’re a complete idiot... or there’s a lot more to your history than a standard medical exam.

If you have a history of CSA? Then, yeah, it makes complete sense on why you would hit the roof over a very normal life event. It’s called being triggered, or dealing with a stressor. You wouldn’t even have to have been sexually assaulted to have a symptom spike in relation to stress, just already have PTSD from something else. You could be having your skinned elbow examined, and have the exact same reaction as having your genitals examined. Because that’s simply how stress & triggers work. (More on the differences between triggers & stressors here >>> Stressor vs. Trigger - What Is A Trigger? )

But that normal life event, whilst it can activate PTSD symptoms, cannot cause PTSD.

That’s not my opinion. That’s the medical experts published opinion. The DSM & ICD. Normal life events don’t cause PTSD. Some of the most profoundly difficult experiences in life do not cause PTSD. Only a very narrow range certain types of trauma cause PTSD.

I hardly think having your elbow examined feels as violating as having your genitals examined. We dont walk around wuth our genitals exposed like our elbows do we?

Then either they’re a complete idiot... or there’s a lot more to your history than a standard medical exam.

If you have a history of CSA? Then, yeah, it makes complete sense on why you would hit the roof over a very normal life event. It’s called being triggered, or dealing with a stressor. You wouldn’t even have to have been sexually assaulted to have a symptom spike in relation to stress, just already have PTSD from something else. You could be having your skinned elbow examined, and have the exact same reaction as having your genitals examined. Because that’s simply how stress & triggers work. (More on the differences between triggers & stressors here >>> Stressor vs. Trigger - What Is A Trigger? )

But that normal life event, whilst it can activate PTSD symptoms, cannot cause PTSD.

That’s not my opinion. That’s the medical experts published opinion. The DSM & ICD. Normal life events don’t cause PTSD. Some of the most profoundly difficult experiences in life do not cause PTSD. Only a very narrow range certain types of trauma cause PTSD.

They key is that one persons trauma doesnt have to "make sense" to you or anyone else. If they connect feelings of trauma to an event that is individual.

 

[Ronin]

Think about how that makes sense.

Perfectly, in fact.

You seem to be just trolling, so reported as one. :)

In case you genuinely are not, you are wrong. Factually and in everything else.
The diagnostic criteria for trauma are not subjective.
They are not Oh, if you feel traumatized, then you are, then what you went through is a legit trauma.

Matter of fact, some of the worst trauma out there?
Leave one totally calm. Or any other number of things.

So feelings, clearly, are not the yard stick for measuring if something is trauma or not.

 

[Friday]

Trama is personal, it is an individual emotional response

That’s one definition of trauma. But it’s not the MEDICAL definition of trauma, nor is it the even more tightly defined Criterion A type of trauma that’s been proven to potentially cause PTSD. Because not all trauma causes PTSD, nor does even all CritA trauma cause PTSD. It simply allows for the possibility. 10 people can experience the exact same CritA trauma, all 10 be traumatized, but all 10 have very different end results. 1 develops PTSD, another a phobia, another develops GAD, another struggles with depression, etc.

Back to definitions for a moment... I can say “I could murder a cheeseburger.” But that doesn’t mean that I meet the legal definition of murder, nor should I be arrested and tried for murder. A pregnant pause? Doesn’t mean the pause is about to give birth. A depression in a road doesn’t mean the road is sad, much less has MDD.

Colloquialisms, metaphors, & similes? Are valuable parts of language. But not diagnosis.

When we’re talking about medical diagnosis? Lethargic means rag doll limp, NOT feeling a bit slow and run down. Depression isn’t a fleeting feeling of sadness, and CritA Trauma isn’t an indivial emotional response but

Criterion A: stressor (one required)
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

• Direct exposure
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

-Or- if we want to go off of the ICD, instead of DSM?

. A. Exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.

That “pervasive distress in almost anyone” is the key bit that tells you we’re not talking about individual responses being relevant much less foundational. There very much ARE diagnoses where individual response matters. Allergies are a great example. It doesn’t matter how the rest of the world reacts to strawberries if you’re allergic to strawberries. Your individual response -as if it’s poison, rather than harmless- is what matters. Depression is another. It doesn’t matter how most people respond to A, if you respond to A with depression.

The “exceptionally threatening or catastrophic nature” is the part that tells you that not only are we not talking about individual response, we’re also not talking about all threats, nor normal life.

Now... both the DSM & ICD are evolving documents. As our understanding of disorders and conditions changes, so too does the way that we classify them. Combat trauma and rape? Didn’t used to be linked together. But what’s been found is that both of those types of trauma (and many others; car accidents, domestic violence, kidnapping, etc.) can & do cause PTSD. If/when they find other types of trauma can cause PTSD? They’ll undoubtedly be added, also. It’s simply that -to date- every other kind of trauma (that isn’t listed in CritA) that’s been studied has either caused different conditions, or the shared symptoms a person is experiencing is better explained by a different disorder/ best treated by different protocols / and has a wholly different prognosis. Just like a person can have all the symptoms of pregnancy, but actually have cancer. Or be 103 degrees, but have heat stroke not an infection. Disorders and conditions all share symptoms. In order to have the correct diagnosis? You have to have the entire constellation not just single stars.

A diagnosis? Isn’t some kind of special club. It’s a way to get treatment. That’s it’s entire purpose. Knowing what something is, so it can be treated. ADHD, Bipolar Disorder, Catatonia, Dyslexia, etc... are all treated differently.
[

 

[Justmehere]

Is every time a baby put in a crib to sleep for the night against their choice a trauma? If we look it is purely from the angle that someone is restricting freedom of movement and the context doesn’t matter... putting a baby to sleep in a crib for the night becomes kidnapping and imprisonment.

What about every time a crying toddler has their behind wiped from an accident or touched to change a leaking diaper even if they don’t want it? What if a mother puts a coat on a 4 year old to go outside in the snow to school even after the 4 year old says “no!”? That was touching against the consent of the child. Or how about stopping a child in a bike, physically restraining movement against the will of the child because they veered into street and are about he be hit by a car. Is that physical assault by the person who did the unwanted touching or is it instead proper parenting to prevent trauma? See where this can go?

Are all actions of a parent or caregiver or other helping figure against a child’s will or consent the perpetration of trauma?

I don’t think so. In fact, we may quickly run into issues of neglect going down the road that far.

Can all these events happen in a way where they are criterion A trauma? Sure. If a mother screams they’ll kill a baby if they don’t stop crying or the butt wiper strokes the penis for sexual gratification...yeah. That’s criterion A trauma.

Context matters.

I know one can feel traumatized by anything. Life is hard. It is distressing. The feelings are real and real suffering can happen even after safe events. One can even have anxiety and depression after the events of a doctor doing an exam of genitals. Lingering and legit problems and suffering can surely endure.

But when the event is a medical exam and not rape part of the solution to the distress is understanding the doctor was helping. It was safe. Not that it was trauma by a perp. There wasn’t actual danger. Continuing to state or believe “I was a victim” over and over to one’s self for a safe situation is a good way to feel like sh*t. That will make the safe seem dangerous when that’s not the case.

When it’s rape, the solution to the distress is different. The processing of the event and calling it for what it is matters.

It does harm to declare one is a victim for normal responsible parenting and medical care. It can help to accept “wow, my distress is real, I deserve support to work it through, and that was weird and uncomfortable and a bit embarrassing and It’s ok to feel all those things… and feelings are not fact.., it’s time to connect to the reality that it was safe despite how bad it felt.”

That’s true even for someone with PTSD.

An example: Today, I got a letter about a decision. I felt really bad about it. My hands shook, I felt uneasy, I didn’t want to be close to anyone. I felt like I was going to die. I felt so much better when I spent some time connecting to the reality that while considerable hardship might happen as a result of this decision, there was no actual gun to my head. While I don’t like what is being done, it’s not with my consent, I am still safe, and it felt really good to finally be able to sit in that reality. If I sit here and say “I’m a victim of trauma” whenever it feels that way, even when that’s not what is occurring, I’m going to feel like crap. I’m going to go through very real suffering.

Instead, reminding myself there is no danger here I’m not actually under threat, helped me get out of the distress. This would be the case if I have do or do not have PTSD. Correct identification of what poses an actual threat or cause of trauma is essential. Professionals do have the ability to help on this issue. Even if we want to throw out all definitions of trauma under Criterion A, and declare that a normal genitals medical exam would lead to PTSD, part of the solution would be to identify that the doctor was not committing sexual molestation. Many medical procedures can feel really uncomfortable. No doubt. It doesn’t mean there was danger and that can help someone feel safer and less distressed in new situations... which I think is part of the goal of the OP.

 

[siniang]

the shared symptoms a person is experiencing is better explained by a different disorder/ best treated by different protocols / and has a wholly different prognosis.
[

I think - at least that was my understanding - that this is the underlaying reasoning of changing the ICD diagnostics to take out all the depression/anxiety-related symptoms. Which probably makes sense. I personally think it's better to assume comorbidity than a "all symptoms fit one diagnosis" approach. Because, as you mentioned, different treatments and prognoses.

 

[Muttly]

They key is that one persons trauma doesnt have to "make sense" to you or anyone else. If they connect feelings of trauma to an event that is individual.

What often gets missed in these discussions is that the statement that a "trauma" does not meet the DSM or ICD criterion of a trauma and therefor didn't *cause* PTSD, doesn't mean the person doesn't have legitimate issues. Changing context for a moment. Say like someone has a lump. They are told that the lump isn't cancerous but it is a symptom of a very serious glandular disease.

The lump is still an indicator of something very wrong. If that person appeared on a cancer forum talking about how they have cancer, they might get told that they don't actually have cancer and that some of the experiences and advice given aren't necessarily all going to fit the person's disease. Now, the person could react by saying "No, I have cancer and you aren't being sympathetic!" and feel rejected and misunderstood. Or the person could say, "ok, it sure feels like I have cancer, you mind if I stick around and find out what advice/experiences match mine, while I also try to understand my specific issues better." And that will work to some degree, but the shared language and treatments will be different in some areas. Stage 1 in cancer and stage 1 for the glandular disease could well mean very different things and chemotherapy might never be used for the glandular disease.

Another possibility is that the lump is a symptom, not the cause. So the person says "This lump caused my cancer!". Again when folks say that the lump doesn't cause cancer, that person has different ways to approach it. They could say "It causes cancer, you are all wrong." Or the person could choose to respond by saying that they have all these symptoms of cancer and they want to learn more about cancer. In that process of learning more and talking with folks who have cancer they could come to understand that the lump is a symptom and the real cause of the cancer happened years earlier or they could learn that what is going on really doesn't match cancer and that understand helps them to reach out for better treatment and support.

In either case, the real issue to explore isn't a back and forth insistence on what is and isn't the cause or disease of cancer, but the willingness to learn and have a discussion. Back to the OP. If there was no past trauma history and it was a completely ordinary and harmless doctor's appointment and the person feels traumatized years later from it, something is going on. That is real. Is it PTSD? In one sense, that doesn't even matter because clearly the person is struggling. Clearly the person *feels* traumatized. The sense that it matters, and folks here have been trying to explain, is that to get proper understanding and treatment, categories (diagnosis) matters

 

[Neverthesame]

@Muttly Thus far, that's the best analogy I've read on this site to explain that.

 

[somerandomguy]

@Muttly. I'm gonna bookmark that and send people who come here who don't have PTSD to your explanation in the future!