Is it CPTSD or ADHD?

After almost three years of treatment, it seems almost absurd to revisit my diagnoses and re-examine my symptomology.  However, my recent self-education in how ADHD can impact adults has been an eye-opening experience, and I have to ensure my recovery takes this into account.  

Determining the differences in symptoms between Complex PTSD (CPTSD) and ADHD, both of which I have been diagnosed as having, is actually extremely challenging.  Even clinicians find disentangling the two to be quite difficult, and this is especially true when there’s child abuse involved in the diagnostic equation... and a traumatic childhood is certainly involved in my differential diagnosis of CPSTD vs ADHD.

I'm going to start from square one to ensure I haven’t been misdiagnosed with CPTSD, ADHD, or possibly both.  To begin with I don’t need a research study to definitively conclude I experienced repeated traumas over the course of my entire life until age 20..  

My previous night terrors, hyper-vigilance, and panic/anxiety problems are clearly linked to that abuse because they became serious problems as I approached fatherhood and began examining how I was parented.  This is not an unexpected development during midlife introspection regarding a childhood such as mine. 

To finally put this question to rest, I bear the actual physical scars and disfigurements from those experiences. It’s clear that I suffered serious repeated childhood traumas and have experienced substantial complications from Complex PTSD as a result later in life.

Chronic and persistent childhood traumas result in long-lasting changes to the brain including difficulty with attention, struggles with creating lasting and close relationships, impatience and restlessness, addictive behaviors, harmful risk-taking, tendency towards distraction, inability to prioritize, and emotional regulation problems.  Sounds a lot like the challenges we often associate with ADHD doesn’t it?

This presents serious frustration for me for obvious reasons, not the least of which is that I’m unsure whether my recovery plan properly accounts for this overlap.  Again, I want to emphasize that I am in no way questioning the capabilities or performance of my psychologist and/or psychiatrist, both of whom I hold in the highest regard... otherwise I wouldn't continue to see them.  Anyway, I noted how CPTSD is so symptomatically similar to ADHD, so I have to question whether I even have ADHD.  

This question is infinitely more complicated because the causes of ADHD have not been conclusively identified by well-designed scientific research studies.  There is a criteria test included in the DSM-5, the diagnostic manual used by mental health clinicians, that I “passed” indicating I have ADHD.  

Furthermore, I was diagnosed at age 4 but never treated in any fashion at my father’s behest.  My present and past diagnostic results seem to clearly indicate the presence of ADHD, but my problem is meeting that criteria could just as easily be due to how my CPTSD presents. 

For example, my father enjoys telling a story from one of my misadventures when I was three years old that, in his mind, was an early demonstration of my intelligence and abilities.  It actually is a demonstration of how early I endured traumatic experiences no child should ever experience, much less one that young.  I was raised by my father during the day as he worked nights while my mother worked days until I went to kindergarten. 

Somehow I was neglected long enough to go into the garage, pull out a toolbox to remove a flathead screwdriver, open a can of paint, and proceeded to paint various parts of our home: the wrought iron fence, the exterior brick work, the shag carpet in the living room (yes, this was the late 70’s!), and generally made a magnificent mess over the course of an extended period of time. 

He ends the story by saying how he beat me “good enough” to make sure I never did something like that again.  While I’m not privy to any other similar stories of beatings, neglect, and maltreatment, I feel it’s safe to say this wasn’t a singular event.  It’s very likely that this was a microcosm of my formative years overall.

So, the behavioral issues with which I was plagued as a young child resulting in an ADHD diagnosis at age 4 could have been directly related to this type of abuse.  There’s another aspect of ADHD which could help me make this determination, though: the hereditary factor.

While not definitively conclusive, there is strong evidence that ADHD is genetically-based according to the American Journal of Medical Genetics.  I won’t go into fine details here, but my father and mother both have behavioral tendencies indicative of ADHD given everything I’ve seen and know about them.  

Maybe the reasons for their behaviors are just as convoluted by past experiences as mine appear to be.  I'm a fairly statistically-oriented individual, though, and this confluence of coincidences is highly improbable.  It's quite likely I have been genetically "endowed" with ADHD, but that's not sufficiently conclusive for me.

After my most recent diagnostic ADHD indication I was prescribed Adderall.  I have intermittently taken it for various periods of time over the past 18 months to essentially experiment the efficacy of the medication.  Fortunately (or unfortunately), the medicine seems to ameliorate many of my daily challenges: it allows me to stay on top of my scheduled routine; I maintain consistent effort on tasks for longer than 15 minutes; and it grants me the ability to be productive in general. 

While it’s true that amphetamines allow virtually anyone to be more productive, I don’t mean productive in the work-for-9-hours-straight-without-blinking type of productivity.   It’s so difficult for me to stay on task, sustain any modicum of attentiveness (unless it’s something I absolutely love to do), or even get started on virtually anything productive while not taking the medication regularly and appropriately.  I don't receive an unnecessary performance-enhancing effect as someone without ADHD typically does.

As a result of the early and recent diagnostic tests, the probable genetic aspect, and the symptomatic improvement Adderall provides,  it seems reasonable to conclude that I do have ADHD.  Awesome.

It appears I am “lucky” enough to in fact have both CPTSD and ADHD, so now it’s time to deal with addressing the symptoms of each.  That will have to wait until I do some more work with my clinicians and adjust my recovery plan.  

Until then, I hope this helps you or your loved one if faced with similar challenges and divining their provenance.  I'm NOT clinically trained and simply present my experiences to encourage you to hopefully work closely and cooperatively with your clinician(s) in determining whether the challenges you experience are from ADHD, CPTSD, or like me a combination of both.  It takes time, a lot of patience, significant research, some deductive experimentation, and a lot of work.  We're worth all of that work and more, though!

"It takes courage to grow up and become who you really are." - EE Cummings

My Frozen World: CPTSD-induced Dissociation

It’s Sunday night a bit past 9pm, the curfew during “winter hours” at the wellness center I now find myself in.  I haven’t had a curfew since I was a sophomore in high school.  It’s not that I was forced here, however.  I can come and go as I please and can grab my stuff and walk out that front door right now.  Thing is, though, I’m actually glad to be here… to a certain extent, anyway.

I was homeless for a relatively short period of time because I had to immediately move out as I was allergic to black mold which began to spew its spores once the heat and humidity of summer hit.  I had to get everything out and into storage so the spores didn’t infiltrate all of my belongings.

I couldn’t find another apartment quickly enough because of my credit, which was in tatters for much the same reason that I became homeless: a confluence of circumstances sent me spinning into my “Frozen World.”  This is my euphemism for what happens to me when a stressor or a combination thereof induce the fight-flight-freeze response.

My Complex PTSD, stemming from physical and psychological childhood traumas, indirectly brought my Frozen World into existence.  I was cognitively aware of these repeated events from my youth but I never emotionally approached them. 

I chalked them up to “childhood as usual" and unknowingly threw up a psychological defensive barrier against feeling any of the related emotions.  This is my Frozen World, but it existed solely in regards to those childhood traumas until relatively recently.

Outside the context of dealing with my childhood experiences, I never previously froze up except for extremely short-term situations.  I fought like hell to defeat the daunting challenges of my life.  That’s the only way I could have made it as far as I had in this world considering the lack of opportunities due to my original socio-economic status (that would be “white trash”).

Finding out I was to be a father caused me to reflect on what kind of father I had.  This brought out so much internal darkness and pain that it swamped my brain’s defenses and swept away the boundaries of my Frozen World. 

The flood of emotions was such that I only dealt with everything thereafter by freezing instead of fighting or fleeing.  I was never one to run away from anything, but I simply lost the capacity to fight.  My Frozen World had now expanded to encompass my entire life.

I progressively began freezing in a state of denial and inaction whenever presented with any type of significant stressor.  With regard to my apartment, I failed to quickly find a landlord willing to risk my credit score.  I had nowhere else to go and no natural support since my family is 900 miles away. 

I couldn’t live with my girlfriend at the time because she had a clause in her divorce agreement preventing that due to her young daughters.  I stayed in hotels the other 80% of nights and ate at restaurants three or four times daily, all of which quickly drained my finances.

I could no longer keep my own girls for overnights, which devastated both them and me.  It also placed me in my ex’s crosshairs because I just knew she would use it against me in court to take the 45% custody I was awarded.  The stress and frustration of it all was simply too much, so I entered my Frozen World and simply acted as though there was no problem at all. 

It’s not like I went into a deep depression or anything.  I didn’t go on some substance abuse bender.  I was happy with my new girlfriend, enjoyed summertime Chicago, went camping, was hanging out socially for the first time in years, and was more or less free of my ex-wife and her manipulative family.  I simply enjoyed life while completely ignoring all of the problems I cognitively knew about but could not emotionally handle.  There’s no room for emotion on my Frozen World.

I eventually began sleeping in my SUV, but that wasn’t so bad because it’s designed for that purpose when camping.  This became my norm for many weeks, even though I still sometimes stayed in a hotel when my spinal fusion acted up. 

Then the money essentially ran out altogether.  Even still I was safely ensconced within my Frozen World, so I just kept on living as normally as I could.  It was fairly normal actually, and yet also simultaneously de-stabilizing in ways which I only now understand after the fact.

So I’m basically homeless, almost completely out of money, the bond between me and my girls was straining, and then my girlfriend ran for the hills (or Lincoln Park).  She knew about everything, but it became too much for her to handle.  She tried to tough it out, but her heart couldn’t bear the weight of it all and she had to kill our special connection to save herself.  I don’t blame her at all.  It’s what I would have told my own daughters to do.

Once she left me, however, I completely came apart at the seams.  Her resilience was a crutch allowing my mind to continue its presence on my Frozen World.  I almost immediately had two bouts of suicidal ideation within 10 days, but these were little more than elaborate cries for help.  Suicide could never have happened because to kill myself would have been either a fight or flight response.  All I seem to be able to do anymore is freeze. 

Fact is, I love this life.  Even with all the horrific things I went through and how I’m currently reduced to essentially nothing, I am so grateful to be alive.  I need only to think of this past summer in order to reflect on the simple wonders this world provides.  Even if I didn’t feel this way, the fact is that I have two little girls who deserve to grow up with their Daddy.  I could never be so selfish as to willingly abandon them via suicide or any other means.

The social worker at the hospital I checked myself into at the end of my final ideation suggested I come to the wellness center from which I now write this.  I went on the wait list and luckily just a week or so later I found my sanctuary.  This is a place for persons with various mental health challenges to get short-term stabilization in their lives, tame or control the effects of their condition(s), and get back to successfully restart their lives.

In only my third night here I have already developed a sense of safety, stability, and hope I wasn’t sure I’d ever get back.  This has unfortunately been intermittently interrupted by thoughts of that which I once was, had, and dreamed.  

It’s impossible to not be introspective given the opportunities and successes I’ve already experienced.  Yet I need only to look around at the significance of what other residents here face to confirm just how fortunate I am to have the abilities and talents Mother Nature has lovingly bestowed upon me.

I’ve been stripped almost completely of my confidence, pride, and ego.  Yet I consider this to be a positive development.  My life can now be reconstructed in a healthy way and be cognizant of all that which I could never admit or even know about myself before now.  

For the first time in my life I have support from people without any ulterior motives.  They aren’t invested in specifically what I do with my life like the “support” I had before with my family, my ex-wife, and her family.  Now it’s simply about me being healthy and happy regardless of what form that takes.  

It’s akin to being forced to demolish and then rebuild your dream home because it had a poorly-constructed foundation hidden beneath a façade of finery.   I’ve cried a monsoon of tears as my old life caved in on itself, and I will continue to weep on occasion for the wonderful yet irreplaceable parts of my life which were irretrievably destroyed.  

Those tears are no longer ones of regret or shame, though.  Those are feelings which breed self-loathing and can quickly spiral me down back into my Frozen World.  These are tears of grieving and, like all grief, they will diminish over time.

I understand myself so much better and have a deeper trust in what my therapy/recovery can accomplish.  There's no lingering doubt in my mind about whether I'm capable of true change.  I’m no longer on my Frozen World and I endeavor to never return but, if I do, I know how to better handle it.  My second life will be vastly superior because it’s to be built on a stronger and more secure foundation like that second dream home... and I'm finally ready to start pouring the concrete.

The Difference Between PTSD and Complex PTSD

The world of psychology has been wrestling with a differentiation between Complex PTSD (CPTSD) and "regular" PTSD since such a distinction was initially publicized in 1992 by Judith Herman in her book Trauma and Recovery.  So it stands to reason that for many of you this is the first time you’ve ever heard of CPTSD.  

You’ve heard plenty about PTSD in reference to soldiers, rape victims, and others who have experienced a traumatic episode.  The “Complex” version of PTSD, a new addition to the DSM-5, speaks to the disorder sometimes suffered by victims of repeated and prolonged traumatic episodes: child abuse survivors, prisoners of war, those coming from concentration camps, etc. 

Most reading this will fall into the category of prolonged/repeated traumas as opposed to a singular incident, but if I can help anyone challenged by the commonly-known type, then wonderful!  I'm writing this blog in general to raise awareness of the difference between the two and help those like me who have CPTSD.

Coming across CPTSD earlier this year was a monumental turning point for me because I had never felt that my official clinical diagnoses of PTSD; Panic Disorder with Agoraphobia; Generalized Anxiety Disorder; and ADHD were truly appropriate for describing my particular set of symptoms. 

This is not a shot at my clinicians, both of whom are incredible.  Clinically speaking, the diagnoses were made correctly, but they just never sat well in my mind.  My now ex-wife, who’s a juvenile psycho-therapist, opined that I was also Bi-Polar, but a psychiatrist dismissed that quickly.  

(I mention this situation with my ex-wife as a warning to you that you need professionals who aren’t related to you in order to get the most appropriate care.  You obviously can’t be your own therapist, but your mother the doctor, your uncle the psychiatrist, or your best friend the barista are simply too close to you to make clear-minded diagnoses or treatment plans.  It’s wonderful to use them as a resource and emotional support, of course, but only for those purposes.) 

Anyway, it was so difficult to wrap my head around how to approach, design, and execute my recovery plan with this array of diagnoses.   

(Here's another tip I want to interject here: You should have an integral role in setting up your treatment plan, or you will run the risk of not owning the plan and therefore not following it.  If your therapist pushes back on this, then go find another one because this is a relationship unto itself and needs to be functional for you to recover effectively.)

Then I came across CPTSD and could safely relegate the PD/A and GAD to being offshoots of CPTSD instead of having 3 different disorders simultaneously.  I consider ADHD as my secondary diagnosis but it has very little, if anything, to do with the abuse I experienced as a child so I won't talk about it much on this blog. 

Therefore, I went from juggling four or five discrete and sometimes conflicting diagnoses to one primary and one secondary.  Remember I'm not a clinician, this is simply how my experience turned out, what works for me, and why I've made CPTSD the fulcrum of this blog upon which each post pivots.  

My diagnostic re-focus allowed me more progress in a couple of months than I had in years (though my therapist would point out that it took those years of work for me to be position to make such good use of those months… and he would be right!) 

Anyway, since I'm not a trained clinician, here are 2 amazing links from someone who is and which further explain CPTSD:

http://www.psychologytoday.com/blog/hijacked-your-brain/201306/ptsd-becomes-more-complex-in-the-dsm-5-part-1

http://www.psychologytoday.com/blog/hijacked-your-brain/201306/ptsd-becomes-more-complex-in-the-dsm-5-part-ii