How to Be There for Someone Who Survived a Horrible Trauma

Author Article
A recent series of tragic deaths has underscored how traumatic events can claim lives years after the fact. Three people affected by mass shootings—the father of a girl killed in the Sandy Hook Elementary School shooting in December 2012 and two students who survived the Marjory Stoneman Douglas High School shooting in February 2018—have died of apparent suicides.
In the wake of these incomprehensible losses, it’s clearer than ever that trauma can lead to years-long suffering. If somebody you love has survived a traumatic event, be it public (like a natural disaster or terrorist attack) or private (such as a sexual assault), you may not be sure how best to be there for them on this journey. While survivors can have very different responses to trauma, interpersonal support is one of the core pieces of recovery, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
Here, several trauma counselors and one trauma survivor explain how to help a friend or family member who has been through something horrible. Exactly what they need from you will depend on your relationship and evolve throughout their recovery, but the suggestions below are a good place to start.

1. Validate their trauma.
“Acknowledge that what has happened to them is terrible,” Daniel A. Nelson, M.D., advisory board member of the USC National Center for School Crisis and Bereavement (NCSCB) and medical director of the Child Psychiatry Unit at Cincinnati Children’s Hospital Medical Center, tells SELF.
You can do this by saying something like, “This is a truly horrible thing that has happened. I can see you’re in an incredible amount of pain.”

It might feel like you’re saying something obvious, but this affirmation can be reassuring. “It’s about articulating that you see they are in pain and that you are OK with holding that pain,” Katherine Marshall Woods, Psy.D., a Washington, D.C.-based psychotherapist in private practice and adjunct professor of clinical psychology at George Washington University, tells SELF.
This was helpful for Manya C., 53, who was sitting in the bleachers across the street from where the first of two bombs exploded at the Boston Marathon in 2013. She appreciated when people confirmed that it really was a devastating event. “Just letting me know that they [understood] that … was validating,” Manya, who advocates for and speaks about those who are psychologically impacted by trauma, tells SELF.
2. Listen.
You might feel a natural urge to fill the silence when you want to help but don’t know what to say, says Dr. Nelson, who has counseled survivors of traumatic events including the Oklahoma City bombing of 1995, the September 11 terror attacks, and the Marjory Stoneman Douglas High School shooting. This typically comes out of wanting to “fix” the situation, Dr. Nelson says.

But you can’t “fix” someone’s trauma, especially not by talking non-stop. It’s better to be present as they work through their feelings. “It’s really hard to mess up if you’re just intent on listening,” Dr. Nelson says.
Manya remembers breaking down sobbing, seemingly out of nowhere, while at dinner with a friend a few weeks after the bombing. Her friend remained calm and stayed with her until she was done crying before asking Manya where her tears were coming from. “She didn’t tell me, ‘Don’t cry,’ or offer me advice. She just listened and was present,” Manya recalls.

3. Admit that you don’t understand.
Survivors are often reluctant to open up because they’re afraid a loved one will not have the emotional capacity to understand, says Marshall Woods, who has counseled active military personnel and their families in the Middle East and natural disaster survivors through the American Red Cross. Unless you’ve been through a very similar trauma, you don’t get it. And that’s fine. What matters most is that you’ll be there anyway.
Say something like, “I cannot begin to imagine what you’re going through right now, but I am here for you whenever you are having a hard time.” This kind of statement acknowledges the reality—that you don’t understand—while reinforcing your willingness to be there. “It’s a piece of security that can really help them feel safe,” Marshall Woods says.

Manya remembers how helpful it was when a friend expressed this. “Hearing her honestly say, ‘I don’t know what to do to help you, but I’m here’ was huge for me,” Manya says. “I didn’t know what I needed either. But I knew she was there to listen, and that started a really great conversation.”

4. Accept if they don’t want to talk.
It’s not unusual for survivors to prefer not to talk about their feelings, even with some of the people closest to them. Discussing trauma with someone who doesn’t understand can be draining. “There are things I don’t have to say to a survivor, for example, because they get it—things I would have to explain to a friend,” Manya explains.

While it’s OK (and encouraged) to ask if your loved one feels like speaking, respect that they may not want to, Dr. Nelson says. Part of being a good support system is being there for them regardless of how much they will or won’t share.
If your loved one is still navigating how much they’re comfortable sharing, Marshall Woods recommends figuring out a verbal or non-verbal cue they can give you to back off when they need space, no questions asked.

5. Keep checking in.
Survivors often get a lot of support immediately after the traumatic event, but attention from the media, the public, and loved ones tends to dwindle soon after. “It feels like other people have gone on living their lives normally as if the trauma has not even happened, when it’s still very much alive for them,” Marshall Woods explains.

Let the person you love know that you’re still continuing to think of them by checking in accordingly. “Knowing that someone has their eyes on them can be a real source of support and security,” Marshall Woods says. She also suggests offering to sit in silence with the person if they don’t feel like talking but don’t want to be alone.
Manya’s family members called her every day for longer than she expected after the attack. The conversations weren’t long, but the constant reminder of their presence and concern was comforting. “It meant a lot to me just to get those calls,” she says.

6. Offer to help limit news coverage.
If your loved one has been through a highly publicized trauma, such as a mass shooting, the early deluge of media coverage may continually retraumatize them. If you think they’re having this problem, you can ask if they want help limiting their media exposure. You can do this by changing their news alerts and muting certain hashtags or words on Twitter, for instance. This helps some people feel safer throughout the recovery process, Marshall Woods says.
But it’s possible your friend may want to stay up with the news coverage because it helps them feel less alone. “They [may be] grateful that people are taking notice of the pain they’re experiencing and that people are grieving with them,” Marshall Woods explains. So, even if your friend is visibly upset by news stories about what happened, keep in mind that this may be a part of their healing process.

7. Avoid clichés.
Looking for a silver lining can be great in many situations. The aftermath of a trauma usually isn’t one of them. “When someone is feeling this pain, you need to meet them there,” Marshall Woods says. “You want them to feel better now, but that is not the reality of where they are.”

Urging your friend to be optimistic or not “dwell” on the tragedy communicates that you’re not accepting how they’re feeling. What you mean as an expression of hope (“Things will get better!”) can come off as a dismissal of their suffering and make them feel misunderstood. “Usually when the individual hears something like that, they think ‘You’re trying to fix me, and you don’t know the first thing about what’s wrong,’” Dr. Nelson explains.

8. Help them find mental health support.
If you’re concerned for your loved one’s well-being—like if they are struggling to eat, get out of bed, go to work, or otherwise function months after the event—you can offer to help connect them with some professional resources like a therapist or support group, Dr. Nelson says. (Even if they are currently receiving mental health treatment, if it doesn’t seem effective, you may be able to help them find a better option.)
This is also a good idea if you begin to feel overwhelmed with the level of support they need from you. “Sometimes it’s really hard to hear these stories,” Dr. Nelson says, “and it’s important to have the proper tools to metabolize it.” Friends and family of survivors can even experience secondary trauma, according to SAMHSA. It’s OK to be mindful of your limits and communicate those needs in a compassionate way.
In that situation, Dr. Nelson suggests saying something like, “What you’re telling me sounds like it really deserves the appropriate level of support, and it may be more than I know what to do with. I would love to know you’re with somebody who really knows what they’re doing. Can we hit pause and work on finding you that help?”

9. Be patient.
The aftermath of trauma is complex, evolving, and inscrutable at times—not just to outsiders, but also to the people who are in it. “Trauma generally is an experience of something that is so chaotic that our brains really struggle to … make meaning out of what has happened,” Marshall Woods explains.

Be prepared for emotions to be intense and fluctuating, Dr. Nelson says. Also keep in mind that your loved one may struggle to understand why they are feeling the way they are, or to even know what it is they’re feeling. This was Manya’s experience in the first few months after the bombing, before she was diagnosed with post-traumatic stress disorder. “At the time, ‘I was thinking I should be better, I shouldn’t feel like this,’” she says.
You can’t speed up the recovery process for your loved one, but you can remain a steady, patient, and adaptable source of love throughout. “It can be a rollercoaster,” says Manya. “But people should understand it’s normal to feel this way and that they can heal.”

How Domestic Violence Affects Women’s Mental Health

Author Article

Every week in Australia, a woman is murdered by someone she knows. And it’s usually an intimate male partner or ex-partner.

One in three women has suffered physical violence since the age of 15. In most cases (92% of the time) it’s by a man she knows.

Added to this, one-quarter of Australian women have suffered emotional abuse from a current or former partner. This occurs when a partner seeks to gain psychological and emotional control of the woman by demeaning her, controlling her actions, being verbally abusive and intimidating her.

Physical and emotional abuse is not only distressing, it’s psychologically damaging and increases women’s risk of developing a mental illness.


Read more: Revealed: the hidden problem of economic abuse in Australia


How violence increases the risk

Women who have experienced domestic violence or abuse are at a significantly higher risk of experiencing a range of mental health conditions including post-traumatic stress disorder (PTSD), depression, anxiety, substance abuse, and thoughts of suicide.

In situations of domestic violence, an abuser’s outburst is commonly followed by remorse and apology. But this “honeymoon” period usually ends in violence and abuse. This cycle means women are constantly anticipating the next outburst. Women in these situations feel they have little control, particularly when the abuse is happening in their own home.


It’s no wonder living under such physical and emotional pressure impacts on mental and physical well-being.

One review of studies found the odds of experiencing PTSD was about seven times higher for women who had been victims of domestic violence than those who had not.

The likelihood of developing depression was 2.7 times greater, anxiety four times greater, and drug and alcohol misuse six times greater.

The likelihood of having suicidal thoughts was 3.5 times greater for women who had experienced domestic violence than those who hadn’t.

Survivors of domestic abuse are often reluctant to talk about their experiences. From shutterstock.com

An Australian study of 1,257 female patients visiting GPs found women who were depressed were 5.8 times more likely to have experienced physical, emotional or sexual abuse than women who were not depressed.

Not only is domestic violence and abuse a risk factor for psychological disorders, but women who have pre-existing mental health issues are more likely to be targets for domestic abusers.

Women who are receiving mental health services for depression, anxiety and PTSD, for instance, are at higher risk of experiencing domestic violence compared to women who do not have these disorders.


How do mental health services respond?

Although survivors of domestic violence are more likely to suffer mental illness, they are not routinely asked about domestic violence or abuse when getting mental health treatment. So they’re not provided with appropriate referrals or support.

One study found only 15% of mental health practitioners routinely enquired about domestic violence. Some 60% reported a lack of knowledge about domestic violence, while 27% believed they did not have adequate referral resources.

One-quarter (27%) of mental health practitioners provided women experiencing domestic violence with information about support services and 23% made a referral to counselling.

In the absence of direct questioning, survivors of domestic violence are reluctant to disclose abuse to health service providers. If mental health providers are managing the symptoms of the mental illness but ignoring the cause of the trauma, treatment is less likely to be successful.

Practitioners need to routinely ask women about present or past incidents of domestic violence if they are diagnosed as depressed or anxious, or if they show any other signs of mental distress.

Practitioners should be able to provide referrals to specialist services and need to be adequately trained to respond to those who disclose domestic violence. This means not focusing solely on medical treatment, but also on referrals and support.

11 Warning Signs of Emotional Abuse in Relationships

Psych Central Article
By Jessica Cline

You never really know someone until you’ve tried to leave them.

Many women who witnessed various forms of physical abuse and domestic violence in their parents’ marriages swear they will never settle for the same kind of treatment in their own relationships.

However, many are so focused on physical forms of abuse that they too often miss the warning signs of emotional abuse, at least, until they find themselves caught in the trap of an emotionally abusive relationship or marriage themselves.

Having set the bar at physical abuse, which is where our society still keeps that bar to a large extent as well, women in these situations often feel that if they aren’t being hit, they aren’t being abused, and they therefore have no right to complain, let along initiate a divorce or breakup.

If you were raised in an environment of abuse, you may feel more comfortable living within a cycle of violence, which includes emotional forms of violence such as threats to your privacy and control of resources, than you realize.

And even if you do realize this and feel certain that you want to get divorced or leave the toxic relationship, abusers have plenty of tricks up their sleeves for making you believe that doing so impossible.

Signs You’re Being Quietly Abused (and Don’t Even Know It)

Check out YourTango for relationship advice

You can leave, and you should and you will, but before you do, you should know what to look out for so you can be as prepared to deal with it all as well as possible.

Here are 11 signs of emotional abuse in relationships and marriages, and how each may affect you in a divorce or breakup.

1. Withholding Affection.

Withholding affection from a partner is a way to punish the partner and to exercise power and control. This is done intentionally and is sometimes stated to the partner by saying something like, “No kisses until you can be nice again.”

Some partners withhold affection after a disagreement because they don’t feel connected or they don’t feel like offering loving gestures in the moment, but in such cases, the behavior happens only occasionally, rather than on a frequent basis.

2. Threats.

An abuser might threaten to expose you in a way you find embarrassing, or they may threaten to take something important away from you, such as money, your home, or even your own kids.

Some might threaten to leave you if they don’t get their way, or they may say they will tell your friends and/or family something personal about you, which is doubly damaging, as not only are they threatening you, but they are implicitly stating that there is something so wrong with you that you should feel ashamed.

3. Ultimatums.

Ultimatums are really a covert threat, with the abuser placing the blame for “having” to make you decide about something back on you.

The way they see it, the fact that they are giving you a choice through which you can rectify the situation (by doing what they want you to do) is a way in which they are actually being “generous” to you, and that, therefore, all blame for the situation and any possible consequences are entirely your fault.

4. Lack of Respect for Your Privacy.

This is often a subtle sign of emotional abuse. Your partner may check your private messages or voicemails, either by hacking into them or directly insisting you give them the passwords for all of email and social media accounts.

They might even go so far as to insist your share email and social media accounts, so they can analyze everything you do and say.

5. Property Damage.

This skirts the line between physical and emotional abuse. An abusive partner may break or “lose” something they know is meaningful to you as a way to punish you and remind me you of the power they hold over you.

8 Critical Things Loving an Emotional Abuser Teaches You

6. “Magic Tricks.”

Many emotionally abusive behaviors are “magic tricks”, meant to distract you from the reality of the ways in which you are being mistreated, i.e., “Look at this here (so you don’t notice what my other hand is doing there)!”

This might take the form of redirecting blame for their bad acts back to you, starting fights, and firing accusations at you immediately before or after being especially nice and loving, but the sole purpose of all these things is to distract from the abuse that they are subjecting you to repeatedly.

7. Playing the Blame Game.

Partners using power and control in a relationship often aren’t insightful enough to notice the profound effects of their own behavior, nor are likely to ever be willing to taking responsibility for any of it.

Instead, they prefer to blame you, saying things like, “If you just hadn’t done that, I wouldn’t have had to act that way in response.”

8. Alienation.

Abusive partners often want to control who you are allowed to have meaningful connections with, and how deep those connections should be allow to run. This means that, over time, you may feel as though you have lost some of your most supportive relationships with friends and family, because your partner didn’t approve.

9. Excessive Gift-Giving.

Some abusers give gifts following a fight as an indication of how much they care about you — or, as a threat reminding you of all their generosity you might lose as a consequence should you choose to leave.

In such cases, you may hear them say things like:

  • “Of course I love you. I bought you this ______.”
  • “I buy you so many nice things, even though you don’t appreciate anything I do.”
  • “Everyone else sees what you have and wishes their spouse was as giving as I am.”
  • “If you leave me, you will never have this ______.”

10. Controls of Resources.

Partners may control financial or other resources as a form of punishment or as a way of maintaining control in the relationship, causing you to believe you won’t be able to care for yourself (and your children, if you have them) if you try to leave.

The resources in question aren’t necessarily limited to money. An abuser might limit your access to your car, your cell phone, health insurance, and more.

11. “Micro-Cheating.”

Micro-cheating is considered by some to be ways in which your partner connects with others and hides it from you.

This can take the form of secret messages, code names in their phone’s contact list, going out and refusing to tell you where he’s headed, or giving attention to someone else while withholding attention from you.

You never really know someone until you have divorced them.

Often, we see an even worse side of our partner when we try to leave the relationship. Sometimes divorces and breakups are amicable, however, if you’ve experienced emotional abuse during your marriage or relationship, you can expect these tactics to continue long after you leave.

Leaving partners who are emotionally abusive requires more planning and more support than typical, and it often requires the advice of professionals as well.

If you detect these signs in your relationship, reach out for help from friends, family, a therapist, or a counseling network.

This guest article originally appeared on YourTango.com: 11 Signs Of Emotional Abuse In Relationships — And How Abusers Try Using Them Against You If You Leave.

If You’re Often Angry Or Irritable, You May Be Depressed

See NPR Article Here
By

GIF

Registered nurse Ebony Monroe of Houston recently went through a period of being quick to anger about every little thing. She didn’t realize then what it might mean for her health.

“If you had told me in the beginning that my irritability was related to depression, I would probably be livid,” Monroe says with a laugh. “I did not think irritability aligned with depression.”

She’s not alone. Many people — including physicians — associate depression with feelings of hopelessness, sadness and a lack of motivation or concentration, but not anger. Some researchers say that’s a problem, given that there appears to be a strong link between irritability and depression.

If you pick up what is often called the “bible of psychiatry,” the Diagnostic and Statistical Manual of Mental Disorders, you’ll find that the list of core symptoms for major depression doesn’t include anger.

“It’s not included at all in the adult classification of depression,” says Dr. Maurizio Fava, a psychiatrist at Massachusetts General Hospital and a professor at Harvard Medical School.

But he points out that irritability — a reduced control over one’s temper that results in angry outbursts — is listed as a core symptom of depression for children and adolescents. It has never made sense to him that it’s not included for adults. “Why would someone who happens to be irritable and angry when depressed as an adolescent suddenly stop being angry at age 18?” he asks.

Anger is an emotional and physical feeling that makes people want to warn, intimidate or attack a person who is perceived as threatening. Fava says a depressed adult with lots of anger is often assumed to have bipolar disorder or a personality disorder.

“We see in our clinics patients who are labeled as having other diagnoses because people think, ‘Well, you shouldn’t be so angry if you are depressed,’ ” says Fava. The diagnosis matters because it affects the kind of treatment people get.

Back when he was trained decades ago, Fava says, he was taught that in depression, anger is projected inward — that depressed people would be angry at themselves but not at others. That didn’t match what he was seeing in a lot of his patients with depression.

“I would say 1 in 3 patients would report to me that they would lose their temper, they would get angry, they would throw things or yell and scream or slam the door,” says Fava. Afterward, these people would be filled with remorse.

Fava thinks these “anger attacks” may be a phenomenon that is similar to panic attacks. His research found that this kind of anger subsided in the majority of patients treated with antidepressants.

Psychiatry has carefully studied how anxiety and depressed mood are experienced by patients, notes Fava, but anger has been relatively neglected. “I don’t think that we have really examined all the variables and all the levels of anger dysregulation that people experience,” he says.

That view is shared by Dr. Mark Zimmerman, a professor of psychiatry at Brown University. “The field has not sufficiently attended to problems with anger,” says Zimmerman.

“The most frequently used scales to evaluate whether or not medications work for treating depression don’t have any anger-specific items,” he notes.

Yet Zimmerman says clinicians frequently see increased anger in people who come to doctors seeking help. “Irritability is not that much less frequent than sadness and anxiety in patients who are presenting for psychiatric treatment,” he says.

Zimmerman and some colleagues recently surveyed thousands of patients who were making their first visit to the Rhode Island Hospital’s outpatient psychiatric practice. All were asked about the level of anger they had felt or expressed in the preceding week.

“Two-thirds of individuals reported notable irritability and anger,” he says, “and approximately half reported it at a moderate or severe level.”

Another large study by a different research group looked at more than 500 people who had been diagnosed with major depression. It found that more than half showed “overt irritability/anger,” and that this anger and irritability appeared to be associated with more severe, chronic depression.

Monroe, the nurse, was lucky enough to have a concerned friend who gently suggested that maybe she should talk to someone. “The way that she approached me decreased that wall of anger and anxiety,” says Monroe, “and that’s when I decided to seek the help.”

Monroe came to realize that traumatic events from her childhood had left her depressed and full of unresolved anger. With nowhere for that anger to go, she was lashing out at loved ones like her sister and husband. “So they caught the back end of my irritability when, in fact, they had nothing to do with the source of it,” she says.

After about a year of counseling, her life has improved a lot, Monroe says. She now works with a group called Families for Depression Awareness to help others recognize the signs of depression. Its list of symptoms that families should watch for includes “picking fights, being irritable, critical, or mean.”

Still, people with depression can have a hard time recognizing this in their own lives.

When I called up the Depression and Bipolar Support Alliance to ask about anger, I reached its communications person, Kevin Einbinder. He initially thought to himself, “I’m sure somebody else certainly deals with anger, but I don’t have anger issues associated with depression.”

Then he started reflecting on his life with depression over the past three decades. “I thought of all the people in my life who have interacted with me — my family, the counselors, psychiatrists, even employers, significant others,” he says, “and I realized that anger was an underlying factor in all those relationships.”

For example, he used to use caustic, sarcastic humor to put people down. “This really drove people away,” says Einbinder. He also recalls sending angry emails late at night after lying awake and ruminating about things that had happened during the day. A counselor helped him see why this wasn’t such a good way to handle problems.

Overall, though, he and his caregivers never focused on anger.

In hindsight, he says, he really wishes they had.

“I think that would have provided a tremendous amount of context for what’s adding to my depression and in helping me, early on in my life, with more effective coping mechanisms,” Einbinder says.

With medication and therapy, he is doing much better now. Einbinder hopes that sharing his experiences will help people understand that if they’re dealing with depression and anger, “they’re not alone and there’s loads of resources out there.”