Hypervigilance in Trauma Survivors #AtoZChallenge

Posted on by Astrid

Hi everyone and welcome to my letter H post in the #AtoZChallenge. Today, I want to talk about a major symptom of (complex) PTSD which I struggle with a lot: hypervigilance.

Hypervigilance is an increased awareness of one’s environment and seemingly unimportant details in it. That is, often people who experience hypervigilance constantly scan their surroundings for signs of threat, but that doesn’t mean they’re hyper aware of everything going on. In fact, they often miss out on actually important aspects of their surroundings, such as missing part of a conversation they’re having.

There is a sensory aspect to hypervigilance, ie. increased sensitivity to noise, smells or other sensory stimuli. However, there are also cognitive and emotional aspects to it. People who are hypervigilant due to (complex) PTSD often overanalyze the things happening around them and too easily perceive them as threatening.

I for one commonly overanalyze things that I perceive. It doesn’t help that people often expect me to appraise already overloading stimuli differently based on other factors involved. Like, due to being autistic, I get very easily overwhelmed by loud noises, crowded environments, etc. However, due to both autism and C-PTSD, I also overanalyze my perceptions. For example, I often judge myself for being overwhelmed because, for instance, my fellow residents “can’t help” making certain noises.

People with complex PTSD often experience hypervigilance about other people’s intentions too. I for one am always looking for signs that the people who mean the most to me are going to betray me. It’s not like I want to, but that’s been my experience most of my life.

Hypervigilance can also show up in physical symptoms. An increased startle reflex is part of the diagnostic criteria for PTSD. Many people with (C-)PTSD also struggle to relax even when there are no sudden stimuli or changes to the environment. Which, now that I type it, I realize is nonsense: the environment is always changing even when people who aren’t neurodivergent or trauma survivors or both, do not notice. I last week had a meltdown because I was overwhelmed by the sounds in the living room, only to be told by the staff that it was totally silent. Well, except for a fellow resident’s tablet, the TV, the dishwasher and I’m not even counting the relatively “minor” everyday sounds, like birds chirping outside, the staff station clock ticking, etc.

Anyway, hypervigilance like I said can show up as physical symptoms. Many people experience an increased heartrate, heavy breathing, higher blood pressure, etc. After all, stress (and hypervigilance is majorly stressful) activates the body’s nervous system.

I don’t yet know what can be done about hypervigilance. I follow movement therapy, but so far, it’s incredibly slow-going. It doesn’t help that, like I said above, the world is ever-changing. In other words, even though my therapist talks about baby steps, I know the real world doesn’t work like that.

Emotional Abuse and Neglect: What If You Were Never Hit? #AtoZChallenge

Posted on by Astrid

Hi everyone. It’s nearly 10PM as I type my letter E post in the #AtoZChallenge. Today, I want to explore emotional abuse and neglect. After all, many people who survived trauma, wonder whether their experience of complex PTSD “counts” if they were never physically or sexually abused. Unfortunately, many clinicians fail to validate the fact that, yes, emotional abuse and neglect count. I can relate to this myself: I tried countless times to get support for my symptoms of complex PTSD due to childhood emotional neglect and abuse (as well as abuse within the care system) only to be told I was being negative, had probably brought it onto myself, etc. However, when I first shared about the physical abuse I endured as a child, my support staff were pretty quickly alarmed.

Guess what? Even though I was hit many times, it isn’t that which made the most significant impact on my experience of C-PTSD. The worst was the emotional abuse, which came in some quite insidious forms. I mean, losing your temper once and yelling at a child (or someone else dependent on you, like a client in a care setting) isn’t okay, but it doesn’t usually cause lasting effects. What does commonly cause C-PTSD is a longstanding pattern of disregard for the child’s needs. And like I said, this comes in sometimes quite insidious forms.

An example is the fact that, when I learned of the things a child needs growing up, “realistic limits” didn’t ring a bell with me. The reason it didn’t ring a bell to me, was the fact that I was repeatedly told I was being selfish. I also didn’t realize at the time that, if I didn’t get realistic limits set on me (and spoiler: I didn’t!), it wasn’t something I had done to elicit my parents spoiling me. I till this day struggle with this idea, because well doesn’t the fact that I was allowed to set my own bedtime from age nine on, never had limits on screen time, wasn’t made to do chores, etc., mean I’m one giant brat of a person? I can see why my sister, who did get some limits set on her, is sometimes jealous of me.

What else do children need from their parents? Like I’ve shared, they need to have their autonomy encouraged. This may contradict the idea of limits, but really, it’s a matter of balance.

None of the things a child needs from their parents are black-or-white when it comes to emotional neglect and abuse. I mean, obviously a parent should never lay a hand on their child and one incident of physical or sexual abuse can cause significant trauma. With emotional neglect, it’s a matter of “good enough”. What I mean is, a parent doesn’t need to be attuned to their child’s emotional needs all the time (no-one can realistically meet such a standard!). However, when a parent isn’t in tune with their child’s needs most of the time, chances are the child will develop complex PTSD.

Dissociation and the Dissociative (Freeze-Based) Trauma Response #AtoZChallenge

Posted on by Astrid

Hi everyone and welcome to my letter D post in the #AtoZChallenge. Today, I want to talk about dissociation and the dissociative (freeze-based) trauma response.

Readers who’ve followed my blog for years or who’ve read my “About” page, know that I used to have a diagnosis of dissociative identity disorder (DID). Dissociation exists on a continuum from everyday daydreaming on to full-on, polyfragmented DID. I am somewhere in the middle.

First, what is dissociation? Dissociation is a disconnect between the usually integrated functions of identity, perception, thinking and memory. There are basically five different forms of dissociation:


  • Amnesia (memory problems), which can range from brief moments of “spacing out” to years of “lost time” in your personal life history. It can also be full-on lack of memory but also lack of emotional memory. I, for example, often experience the thing where I act as though I have no memory of doing or experiencing something, but do remember it at the back of my mind.

  • Depersonalization, which refers to the phenomenon of not feeling real. Parts of your body may feel numb without a medical explanation. It can also refer to the experience of “watching yourself”.

  • Derealization: the phenomenon of feeling like the world around you is unreal. I experience this on a regular basis, when it feels as though I’m interacting with the world through an invisible wall.

  • Identity confusion. This one has always baffled me and for a long time I thought this is actually normal. I mean, I have no clue who I am, but doesn’t everyone at my age? And even at nearly forty, I struggle to realize that no, in fact most people don’t experience this.

  • Identity alteration. This, at its most severe, refers to the experience of having “multiple personalities”. It can, however, also refer to distinct patterns of behavior, thinking and perception that “do not feel like you”, even if these distinct personality states do not have their own names, ages, etc.

Pete Walker refers to dissociation as the freeze-based trauma response. I’ve always struggled with this, because I rarely literally freeze. I, however, do often “space out”, watching myself from a distance. I also experience the existence of several distinct personality states. Now that I’m older, they are no longer as separate as they used to be when I was in my teens and twenties. However, the identity confusion is still very real, like I said. In fact, I believe it’s a lot worse now than it used to be when my “pieces” still were more separate.

Codependent (Fawn-Based) Trauma Responses #AtoZChallenge

Posted on by Astrid

Hi everyone and welcome to my letter C post in the #AtoZChallenge. Last year during this challenge, I discussed codependency for my letter C post. Today, I want to talk about the same topic, but specifically as it relates to people who experienced complex trauma.

You are probably familiar with the fight or flight response when it comes to fear. However, there are several other ways people can respond to perceived threats. One of them is fawning. This has always been a confusing term for me, particularly because I’m a non-native speaker of English and there is no proper translation of this word in Dutch as far as I’m aware.

Fawning, if I’m correct, in the context of trauma means being overly compliant with the wishes of other people and being unable to protest. It’s similar to people-pleasing, for which I haven’t found a proper Dutch translation either by the way.

Pete Walker, the author through whom I know of the fawn-based trauma response, has an entire chapter on this topic in his book on complex PTSD. I just opened the book to the chapter on fawning and oh my did it hit hard! Walker starts out by explaining how he learned that he himself gravitates towards a fawn response when he apologized to a chair for bumping into it. I have done that too.

However, it’s harder for me when I find myself apologizing to people, because too often my apology gets seen as being insincere when I truly have a reason to apologize. That makes sense, especially because I can also show a fight-based response when triggered.

The thing for me is that I overadapt until I can no longer take it anymore and then I have an aggressive meltdown. This sometimes makes me doubt I actually fawn at all. It doesn’t help that my parents from a young age on ingrained the thought that I am selfish into my psyche. I can indeed be self-centered, but that’s not the same.

I am still unsure whether I am a primarily fawning trauma survivor rather than a fight type. However, reading Walker’s chapter makes me realize I’m probably closer to the fawn end of the fight-fawn continuum than many people, including myself, believe. I, after all, experience a deep-seated lack of understanding and even deeper lack of appreciation of myself. Walker calls this self-abandonment and self-abnegation. I wonder whether, because my most outwardly noticeable reaction when triggered is fight, I have been conditioned to see myself as primarily a fight-based type.

Fear (Or Another Four-Letter F Word)

Posted on by Astrid

Fear. I’ve used this word as a starting point for my writings many times. The idea comes from Mari L. McCarthy’s journaling prompts. The idea is to pick a four-letter F word and write about it or use it as a prompt. Well, I’m doing that now, but I doubt I’m actually going to write about fear. I honestly don’t know what to write at this point and am not feeling anything in particular. That is, I guess I “should” be feeling something, but I don’t know what. Alexithymia. That’s what I believe this is called. Any emotional state for me is “good”, “bad” or “neutral” like right now. I don’t ever feel totally relaxed I believe. There’s always some level of stress or anxiety or fear in my body or mind.

My movement therapist tries to tell me that my body needs to get used to the feeling of being relaxed, because due to my early childhood trauma, it never learned to trust this feeling. That makes some sense, in that I almost always feel like I’m on high alert even when I’m half asleep. Is that even possible? And if so, isn’t it just normal? Do I even know what “normal” is, being that I’m autistic and otherwise neurodivergent, multiply-disabled and a trauma survivor? I doubt it. But if I’ve lived my life like this for nearly four decades, is there any way of changing it? I hope there is, because this feeling of always being on high alert is exhausting.

This is another freewrite I originally typed up in Google Keep, then finished here.

“One Chance!” Still Haunts Me…

Posted on by Astrid

Today, I’m feeling like writing but am uninspired, so I’ve been checking out a ton of writing prompts and the like. I’ve been fiddling with various notetaking apps too so that I can finally write snippets without them needing to be finished right away. I know I could do WordPress drafts, but I for whatever reason don’t like that. I’m now trying out Google Keep.

One of the writing prompt series was Halloween-themed and the question was about my most recent nightmare. I can’t remember and, thankfully, I rarely get vivid nightmares anymore. I do get snippets of conversations that replay in my dreams. “One chance!” yells the staff trying to force me to accept her new colleague. Those two words haunt me. I have had this experience before.

I recently learned that PTSD nightmares do not necessarily involve the details of your trauma. I don’t know whether the Redditor who said this, based this idea on the DSM, as I’m fairly certain that in the criteria for PTSD, nightmares do need to be trauma-specific except in young children. However, even just reading that someone else experienced vivid dreams that aren’t necessarily connected directly to their trauma, feels validating.

When I was living on my own, I experienced extremely vivid dreams almost nightly and, even when those dreams weren’t directly connected to my trauma, they were disturbing nonetheless.

In a somewhat similar fashion, the staff’s comment haunting me, in itself, might sound rather innoceous. I mean, I know that it doesn’t necessarily take physical or sexual abuse for someone to be traumatized (again, contrary to what the DSM says), but if this comment were a one-off experience rather than a symptom of the rather traumatizing power dynamics involved in institutional care settings, it wouldn’t have stuck with me. Or it might have, but it wouldn’t have had the negative connotation it has now.

There’s a reason secondary triggers are a thing. I often feel shame about the numbers of triggers I have. Usually though, when the context isn’t in itself distressing, I’m able to point out that something is a trigger for me and move on.

Not with this one, but then again it was actually a boundary that was crossed. If this had happened with three people who aren’t professionally related, it’d have been considered a form of harassment. I still struggle with this concept: that what is considered “normal” in a care setting, would be considered a violation anywhere else.

Grief: Dealing With Loss (Of Any Kind) #AtoZChallenge

Posted on by Astrid

Hi everyone. I’ve been struggling a lot lately again and, as a result, today am particularly late writing my #AtoZChallenge contribution. Today’s letter is G and I want to talk about grief.

Grief can refer to a person’s reaction to losing a loved one to death. That’s the most heard of definition anyway. Grief for a loved one who has passed away can last very long and, in fact, isn’t considered abnormal for the first year. If a person still experiences significantly distressing symptoms of grief more than a year after their loved one has passed, they may be diagnosable with prolonged grief disorder (also known as complicated grief).

Grief, of course, can also refer to the distressing symptoms experienced after losing a beloved pet. It doesn’t matter in this respect that the pet isn’t human; grief can still be experienced very deeply. I mention this because, like I said on Saturday, my spouse and I lost our cat Barry that day.

Grief, however, can also relate to distressing symptoms experienced after a loss that isn’t due to death. For example, heartbreak is in a way grief too. So are the distressing symptoms I experienced when losing my sight and, later on, many acquired skills due to autistic burnout.

Most people will be familiar with the five stages of grief described by Elisabeth Kübler-Ross. These stages are denial, anger, bargaining, depression and acceptance. In reality though, many people will not necessarily experience these stages in order and they may fall back due to stress. Still, many of the symptoms associated with the earlier stages in this model, made it into the criteria for prolonged grief disorder. Symptoms of prolonged grief include:


  • Identity disruption (eg. feeling as though a part of oneself has died).

  • Marked sense of disbelief about the death.

  • Avoidance of reminders that the person is dead.

  • Intense emotional pain (eg. anger, bitterness, sorrow) related to the death.

  • Difficulty reintegrating, such as problems engaging with friends, pursuing interests or planning for the future.

  • Emotional numbness (absence or marked reduction of emotional experience).

  • Feeling that life is meaningless.

  • Intense loneliness: feeling alone or detached from others.

Of course, people can experience many of these symptoms without having lost a loved one to death. Emotional numbness and avoidance of triggers, after all, are also symptoms of post-traumatic stress disorder. Many other symptoms occur in people who were traumatized in some way too. As an example, I relate to all symptoms when the aspect of bereavement is removed, and not just since Barry was put down. I don’t know whether that makes sense, but oh well.

#WeekendCoffeeShare (September 21, 2024)

Posted on by Astrid

Hi all on this beautiful Saturday in September. I’m joining #WeekendCoffeeShare today. It’s 7:30PM, so I just had my last cup of coffee for the day. I also had a delicious smoothie I made. I must admit, I normally don’t make the best smoothies, or at least I don’t really like them myself. This one though was absolutely great! I used banana, pineapple, coconut water and a bit of cinnamon. The cinnamon was old, so even though I’m pretty sure I put quite a bit into my smoothie, I only got a slight taste of it. I shared what I had left with my fellow residents, but since this is a virtual get-together, you are invited to grab a virtual cup.

If we were having coffee, first I’d share about the weather. It’s been absolutely gorgeous with daytime temperatures of about 23°C most of the week. It’s also been quite sunny. Mornings are chilly, but then again it’s September, so that makes perfect sense. Tomorrow is supposed to be the last warm day and then next week daytime temps are supposed to drop to as low as 13°C.

If we were having coffee, I’d probably be stating the obvious if I said I’ve been walking a lot. I sometimes feel guilty when this is pretty much all I do during my allocated activity time. Then again, I tell myself the weather isn’t going to be as beautiful as it is now forever.

I also have been taking photos on my walks. That is, I usually hand my phone to my staff, who then will be snapping the pictures. I enjoy it nonetheless. Yesterday, we were able to capture a bunny.

I have also been loving using Be My Eyes and other image description apps. Be My Eyes was even able to correct me and my staff on what type of bird was swimming in the institution pond.

If we were having coffee, I’d talk a little about the new iOS and WatchOS versions that came out on Monday. They’re quite stable and there aren’t many bugs affecting VoiceOver or Braille use. That’s a rarity with the first release of a major software update. I didn’t initially think I’d care for iOS 18, but WatchOS 11 does have some nice features and I’d need iOS 18 for that. I am looking forward to seeing my Vitals trend in a few weeks.

If we were having coffee, I’d tell you that I’ve been struggling a little with flashbacks and nightmares. I am, thankfully, for the most part still able to cope.

If we were having coffee, I’d share that on Wednesday, I celebrated one year in my current care home. I treated the entire home to burgers again, like on my birthday, but this time the salad I made as a side dish was the highlight for me.

If we were having coffee, lastly I’d tell you that on Thursday, it was my and my spouse’s thirteenth wedding anniversary. We drove to Nijmegen to have lunch at what I consider to be my favorite restaurant, Dromaai. Not that the food is exceptionally good, but I have fond memories of eating out here with my partner when I still lived in Nijmegen.

September Dreams and Memories

Posted on by Astrid

Last night I dreamt of being admitted to the psych hospital. It’s no wonder, since the anniversary of my actual admission isn’t very far away, on November 3. September 23 is my anniversary of going into long-term care and last Wednesday, I celebrated one year in my current care home.

I was reminded yesterday that September is a bittersweet month. That is, I was reminded of the sweet aspect, ie. it being me and my spouse’s wedding aniversary yesterday. The bitter aspect has overshadowed my days with flashbacks and my nights with dreams more than I’d like. I am, thankfully, still coping.

I am hoping that, as I acquire more pleasant memories here at this home, the flashbacks and nightmares will lessen. I know I was saying something similar when reclaiming November in 2021. I hope this time around I will choose following my dreams and aspirations over re-enacting the past.

Sharing this post with Friday Writings #145, for which the optional theme is dreams and memories. This was more of a freewrite than anything else, but oh well.

My Medication Musings: Topamax

Posted on by Astrid

Hi everyone. I had a med review today, which prompted me to write a post in my series discussing the various medications I’ve been prescribed. Today’s med review mostly concerned topiramate (Topamax), so I’ll write about that.

Topamax is an anticonvulsant usually prescribed for epilepsy. It has also shown effectiveness in treating migraines. How exactly it works is not known, but it does in these cases, although it’s not the first choice of treatment for either epilepsy or migraines.

I have neither epilepsy nor migraines. Besides, the highest dose of Topamax I ever took, 75mg/day, is far lower than the effective dose for these conditions. The reason I took Topamax is because it is also believed to help with PTSD-related nightmares and flashbacks. The way my psychiatrist explained it to me back in 2021, it might even lower my general distress level slightly. Well, it didn’t.

Topiramate can have significant side effects, including cognitive impairment, tingling in the hands and feet, and others. On 75mg, I experienced slight tingling, but I honestly don’t know whether I ever had any other side effects. I do have quite horrible tremors in my hands and legs, but these could be from any of my medications or from something unrelated altogether, although my doctor didn’t say what.

I, after some tweaking, eventually settled on a dose of 25mg twice daily. I never really questioned its effectiveness until I was wanting to taper another medication, Abilify, about two months ago and my prescribing physician and I reviewed all of my current psych meds. I said that none of my meds except for my antidepressant, Celexa, seemed particularly effective. The doctor then decided I could discontinue my morning dose of Topamax.

Today, I had a review. Though I have been a bit more distressed lately than usual, this could have many causes, including fellow clients being in distress more than usual too. Furthermore, I don’t experience an increase in nightmares or flashbacks. I admitted that most of my flashbacks are emotional, in the sense that I get dysregulated when triggered rather than having a visual reliving. I’m not sure whether these have increased.

When the doctor asked me what I wanted, I was clear: to discontinue my other 25mg of Topamax as soon as possible. This will happen in mid-August.

I am, honestly speaking, also guided by general principles in addition to personal experience: I learned about a year ago that a then recent systematic review had disproven the effectiveness of topiramate for PTSD-related symptoms.