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Trauma in Infancy

My son is 19 and he has struggled with anxiety & depression. It became very apparent when he started school and got worse each year. At the time I didn’t know what he was struggling with I just knew he was struggling. Doctors didn’t help so I started researching.

I adopted my son when he was 2 yrs old. I had physical custody of him at approximately 14 months old. He was born with methamphetamine in his blood and alcohol. Both of his biological parents had mental health issues and drug issues. He was removed from his bio mother and in foster care for 3 months before I gained custody.

He had been neglected, often left alone and in foster care, according to the caretaker, never stopped crying. He had night terrors his first year with me. He would never sleep alone and still has difficulty with this at times.

He went through years of therapy but wouldn’t talk. He self medicated. He is my son and watching him go through this without answers is at best heartbreaking. The last 2 yrs he has been researching everything he can find to feel “normal”. He believes he has borderline personality disorder. Over the years he has been diagnosed with several labels, including bipolar, intermittent explosive disorder, clinical depression etc.

How can I help him?

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by: Cheryl Rivas

I'm so sorry to hear about the struggles your son and your family have been facing. It's clear that you deeply care about your son's well-being, and your proactive approach in seeking answers and support is commendable. I hope you find the following information useful.

Understanding the Context and Impact of Early Experiences:

Your son’s early life experiences, including prenatal exposure to substances and early neglect, can have a profound impact on his psychological development. Research indicates that children exposed to prenatal alcohol and drugs are at higher risk for various developmental and mental health issues, including anxiety, depression, and behavioral problems (Behnke et al., 2013). Additionally, early neglect and inconsistent caregiving can disrupt attachment formation, leading to difficulties in emotional regulation and a sense of safety (Cook et al., 2005).

Potential Diagnosis and Complex Presentation:

Given his complex history and array of symptoms, it is possible that your son’s condition is multifaceted. The overlapping symptoms of bipolar disorder, borderline personality disorder (BPD), anxiety, depression, and intermittent explosive disorder can be challenging to differentiate. Misdiagnosis or multiple diagnoses are not uncommon in such cases, particularly when a person has a history of trauma and substance exposure.

Borderline Personality Disorder (BPD):

BPD is characterized by emotional instability, intense interpersonal relationships, impulsive behavior, and an unstable sense of self (American Psychiatric Association, 2013). Given your son’s symptoms and his own belief that he may have BPD, this diagnosis warrants consideration. However, a thorough evaluation by a mental health professional with expertise in personality disorders is essential for an accurate diagnosis.

Therapeutic Approaches:

Trauma-Informed Therapy:

Since early trauma appears to be a significant factor, finding a therapist who specializes in trauma-informed care is crucial. Trauma-informed therapy acknowledges the impact of trauma on mental health and aims to create a safe and supportive environment for healing. Modalities such as Eye Movement Desensitization and Reprocessing (EMDR) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) have been shown to be effective (Bisson et al., 2007).

Dialectical Behavior Therapy (DBT):

DBT is an evidence-based treatment specifically designed for individuals with BPD. It focuses on teaching skills in emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness (Linehan, 1993). DBT has been proven to reduce self-harm, suicidal behaviors, and improve overall functioning in individuals with BPD (Stoffers et al., 2012).

Comprehensive Psychiatric Evaluation:

A comprehensive evaluation by a psychiatrist experienced in complex cases is essential. This evaluation should consider his entire history, including prenatal substance exposure, early trauma, and current symptoms. A thorough assessment may help clarify his diagnosis and guide appropriate treatment.

Medication Management:

While therapy is crucial, medication may also play a role in managing his symptoms. Mood stabilizers, antidepressants, and antipsychotic medications can be beneficial for certain conditions. A psychiatrist can help determine the most appropriate medication regimen.

Supporting Your Son:

Open Communication:

Encourage open and non-judgmental communication. Let your son know that you are there to support him and that his feelings and experiences are valid.

Empathy and Validation:

Validating your son's feelings and experiences can help him feel understood and supported. Empathy goes a long way in building trust and safety.

Education and Advocacy:

Continue educating yourself about his potential diagnoses and treatment options. Advocate for his needs within the healthcare system to ensure he receives the appropriate care.

Self-Care:

Supporting a loved one with mental health challenges can be emotionally taxing. Ensure you are also taking care of your own mental health and seeking support when needed.

Final Thoughts:

Your son’s journey to understanding and managing his mental health is complex, but with the right support and interventions, there is hope for improvement. Collaborating with mental health professionals who specialize in trauma and complex presentations, such as those with expertise in DBT and trauma-informed care, can make a significant difference. Your continued support, empathy, and advocacy are invaluable as he navigates this path.

References:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.

Behnke, M., Smith, V. C., & Committee on Substance Abuse, Committee on Fetus and Newborn. (2013). Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus. Pediatrics, 131(3), e1009-e1024.

Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder. British Journal of Psychiatry, 190(2), 97-104.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., ... & van der Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390-398.

Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.

Stoffers, J. M., Völlm, B. A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, (8).

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