Common misdiagnoses for childhood trauma

Most people, including most doctors and therapists, assume that "trauma" means "PTSD." This is wrong. Simple PTSD is in my experience actually the least common trauma diagnosis. One in four women, and a less-clear number of men (they don't want to talk about it), have been abused as children (that statistic only represents reported cases!). But this rarely results in PTSD as traditionally understood, because children's brains work differently. As a result, many cases of childhood trauma are misdiagnosed as other illnesses. I'm going to list them below.

Why does this happen? The answer is simple: in an environment of neglect, children essentially are not allowed to tell their terrible story. They are not "allowed" to have PTSD. So they put all the symptoms on a shelf, including their own terrible story. It's a matter of survival, for their story not to matter. And this causes symptoms to look like something other than PTSD when they grow up.

"Neglect" does NOT usually mean a "drug house." Perhaps mom's problems are more important. Perhaps the family's reputation can't be damaged. Perhaps the child is too busy looking for food and taking care of siblings. Perhaps the abuser is a caregiver, who should be the one hearing the story. Perhaps the abuser threatens the child, or manipulates them into thinking that if they tell, they will be shamed. Perhaps the parent knows about the abuse, or is told by the child, and tells them they are making it up for attention. From the outside, it looks like everything is normal.

But, as a child grows into an adult, the pressure of holding off what should have been PTSD because very difficult, and symptoms develop. The 20,000-person ACE study (Adverse Childhood Experiences) showed that childhood trauma affects adult life more than PTSD does, and also that it rarely looks like PTSD. It does make people more vulnerable to PTSD as adults. I find that most clients with combat-related PTSD had a horrifying childhood. The ACE study also shows what I see: childhood trauma usually looks like something other than PTSD, including physical illnesses (I will explain why later).

Common misdiagnoses for childhood trauma*

-Bipolar Disorder (I and II)

-Schizophrenia and other psychotic disorders

-Phobias

-OCD

-Insomnia

-Treatment-resistant anxiety

-Treatment-resistant depression

-Eating disorders

-IBS

-Fibromyalgia

-POTS

-Chronic UTI's

-PCOS

-Symptoms the client has never told anyone about because they are afraid people will think they are "crazy."

*This does not mean that the symptoms of these disorders are not present, it simply means that their origin in childhood trauma makes a trauma-related diagnosis more relevant. The DSM-V-TR (clinical manual of mental disorders) always states that if a particular mental illness is better explained by another diagnosis, you do not use two diagnoses. For instance someone with Bipolar II Disorder should not also be diagnosed with a depressive disorder. Depression is part of Bipolar II. This rule goes for childhood trauma as well. But the mental health and medical communities, when writing the latest version of the DSM, even in the face of the 20,000-person ACE study, and the overwhelming opinions of the world's leading researchers, chose to ignore childhood trauma.

Clinicians, therapists and doctors, often never ask about a patient's childhood. They certainly do not administer the correct tests, or ask relevant questions, even if they know about childhood trauma. Again, "no PTSD means no trauma." I learned absolutely nothing about childhood trauma in graduate school, other than how to diagnose PTSD.

If a clinician knows to ask the right questions, and administer the right tests, childhood trauma is easily identified as the origin of symptoms that have been resistant to traditional treatment with therapy and medication.

A common reason, however, is the client's lack of knowledge that some things they believe to be normal are 99% of the time symptoms of trauma. I can often ask three simple questions and know that, if the answer to two of them is "yes," childhood trauma is almost certainly the origin of treatment-resistant symptoms (although many other questions are relevant):

-Do you not remember much, or any, of childhood, or does it feel like pieces are missing?

-Do you sometimes "see" yourself from outside your body, as though you are looking at another person?

-Do you have dreams that you can't remember when you wake up, as though they are stolen from your mind?

Regarding the first and third questions, there is no such thing as a "repressed memory." If that were possible, trauma symptoms would not be present. We think of memories as images, but the client's symptoms ARE the memory, just without the image. The definition of PTSD, even, in the DSM, is that some of the traumatic memory cannot be remembered, except when the client is triggered. And sometimes this is when someone is asleep. If Joe has combat PTSD, and only has flashbacks when he has nightmares, does this mean he has a "repressed memory?" That's ridiculous. The only difference is that Joe remembers most of the images, because the trauma developed when he was an adult. Someone who has childhood trauma may only wake up following a panic attack, but without images--there's no difference. A good research paper conclusively shows that when trauma is treated, full memory is shown to have always been present--if you don't believe me, email me and I'll send it to you. I can also send you research on the creation of false memories. They are conclusively the result of pushy therapists who are obsessed with "repressed memories," and think that all mental illness can be explained by childhood trauma, even when there is zero evidence of it, no related symptoms. For instance, social contagion popular with young women in the 90's, and the widespread use of hypnotherapy, led to an epidemic of false-memory creation by irresponsible therapists.

Regarding the second question, this out-of-body experience is called "depersonalization." It occurs when the circuit of the brain stem called "explore" is used as a defense system. Properly, it is used to find resources (such as mom's nipple, when we are born). When we take this circuit away in rat research, rats cannot find their way through a maze. But, as a defense system, it is a way of emotionally "checking out" and trying to find an escape, by forming a mental map. This occurs in terrifying situations that do not become traumatic, but with a trauma disorder (like other symptoms), it is "stuck in time."

Five meta-studies (studies of many studies) show that 50%-90% of individuals who seek out therapy for ANY reason have a serious history of childhood trauma. Doing evaluations for other therapists, I stopped keeping track when I reached 85%. If a therapist has no training in treating trauma, I have no idea why they are in the field.