No Such Thing As Normal

An adoptee shares –

My adoptive mom would always have me getting diagnosed with nearly everything in the DSM growing up all the time. I’ve since come to the conclusion there is no such thing as normal. The point is, my voice was never heard as a child and I was on a million different meds and diagnosed with a million different things. I wasn’t ever diagnosed with autism specifically, but my adoptive mom suggested it many times to my doctors, as she did everything else because something clearly must be “wrong” with me (yeah normal adoption trauma, but we can’t talk about Bruno).

All I’m saying is be careful how you paint that picture. I was always pissed that my adoptive mom kept saying there was something wrong with me. All I ever wanted was to be normal. As I’ve grown older, I definitely notice I’m more intelligent than a lot of people and I’m quirky, sure. But to be diagnosed with ADD, bipolar, depression, BPD, and everything else? If I can get diagnosed with 15 things and no doctors can agree what is “wrong” with me, then isn’t it all just BS anyway?

(blogger’s comment) I loved my mom dearly (she in now deceased). My dad said she was a hypochondriac. She also did tend to think things were wrong with us too. Each of us as her daughters had experiences directly caused by that. All I can say is I’m glad we survived them. There may be some truth that much of it had to do with her being adopted (that pesky primal wound), though I can’t know that for certain.

Learn to live with how you are. Give your child the tools to do that. That’s it. That’s life. I think very few people truly require medication. Everything else is just learning who you are and having the coping skills to handle it.

The responses shared above (except my own blogger’s comments) were offered due to a post about a “child diagnosed as autistic at the age of 2, who has made huge strides (cognitively, developmentally, emotionally, socially, etc), however does not know/understand her autism diagnosis.”

(another blogger’s comment) Though it may be that all of the males in my family are somewhat Asperger’s, we never wanted them to be permanently labeled with a diagnosis. The closest we came was having the boys professionally evaluated after being homeschooled for many years, to make certain we had not failed to give them a good foundation (we had not failed). The psychologist said, I wish more parents with children like yours had your attitude about it. We have encouraged their interests, given them support regarding those but allowed them to create their own paths. Now at 18 and almost 22, they are awesome human beings with definite strengths and a strong sense of their individual character. We have no regrets about the choices we made during their childhoods.

It Is About More Than That

In my all things adoption group, a woman writes –

Let’s talk about “playing the victim”. I see this come up a lot in this group when adoptees and former fostercare youth are talking about their trauma. I can only speak for myself, but I’d like to explain why this is so bothersome.

This is a group about the realities of adoption. Our conversations are often about adoption. I talk about my adoption trauma a lot in this group. Why? Because it’s relevant to the conversation. The conversations I have in this group are not reflective of the conversations I have elsewhere in my life. This group is only a sliver of my life.

I have trauma from being adopted. I suffer from mental illness. I’ve been diagnosed with BPD (* see below). I don’t blame all of my struggles on being adopted. I can’t say for certain that it is the root of all my problems. But I also can’t separate it. I was relinquished as a newborn. This trauma has always been here. It is a part of the other problems. It is a part of me. But it’s not all of me.

* Note – BPD – Borderline Personality Disorder is a condition characterized by difficulties regulating emotion. This means that people who experience BPD feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event.

I have trauma from being adopted but I have privilege in other areas of my life. I’m very fortunate to be where I am today. I’ve met many roadblocks as a result of being an adoptee, but I’ve overcome many of them. I’ve made mistakes and suffered the consequences of those mistakes, but I own them. I don’t blame others for my actions.

Being adopted comes with trauma. Being adopted has legal implications that can make things difficult. In a group about facing the realities of adoption, I don’t think it’s “playing the victim” to acknowledge the hard things. You have no idea how anyone has lived their life. We are simply sharing experiences that are relevant to the purpose of this group.

Developmental Trauma Disorder In An Adoptee

“All diagnoses are wrong, but some are useful.” George Box

The kinds of complex issues that adoptees face can be difficult to treat. A 2013 study found that fewer than 25% of adoptive parents who sought mental health services felt that their mental health professional was adoption-competent. The symptoms and issues that adopted children experience are typically not taught in most graduate school mental health programs. Adding to the challenges faced by adoptive families, insurance companies will not cover what is really going on with these children and their families because it is not correctly conceptualized, coded, and diagnosed.

Some common diagnoses used with adopted children include Pervasive Developmental Disorders, Oppositional Defiant Disorder, Conduct Disorder, Reactive Attachment Disorder, Affective Disorders, Anxiety Disorders, Attention-Deficit Hyperactivity Disorder, Post-Traumatic Stress Disorder, and Borderline Personality Disorder. Each of these may characterize certain symptoms that these children demonstrate, but none of them systemically addresses the developmental aspect of trauma that most (if not all) adopted children experience. None take into account the sad possibility of being traumatized by birth or foster-parents. “There is no diagnosis for children that more than partially addresses the symptoms associated with these impairments in self-regulation” according to Julian Ford, PhD, who is a psychologist with the University of Connecticut.

“Developmental Trauma Disorder” or DTD includes symptoms that differentiate it from Post-Traumatic Stress Disorder PTSD more commonly associated with the “Battle-Fatigue” symptoms of WWI. Children are often traumatized in the context of relationships. Because children’s brains are still developing, this trauma has a much more pervasive and long-range influence on their self-concept, on their sense of the world, and on their ability to regulate themselves.

There are four diagnostic areas involved in DTD – [1] Exposure [2] Triggered pattern of repeated dysregulation in response to trauma cues [3] Persistently Altered Attributions and Expectancies and [4] Functional Impairment. Those who’s work has been focused on adopted children who have suffered various forms of Complex Trauma will recognize the manifestation of these. The American Psychiatric Association failed to include this in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (also known as the DSM-V).

The problem with this oversight is that after experiencing chronic trauma, the current standard of clinical practice often reveals no diagnosis, inaccurate diagnosis or inadequate diagnosis…all of which leads to misguided or complete lack of treatment plans. Further, because there is almost always considerable dysregulation of body (sensory and motor), affect (explosive/irritable or frozen/restricted), cognition (altered perceptions of beliefs, auditory and sensory-perceptual flashbacks and dissociation) and behavior (multiple forms of regression), the diagnoses of bipolar, oppositional defiant disorder/conduct disorder, attention deficit hyperactivity disorder (ADHD) or other anxiety disorders are made. Many of these disorders are co-morbid with developmental trauma disorder, as they tend to cluster in these complex families. But the importance is that the developmental trauma disorder would be primary and thus guide the treatment plan…and further, refine the inclusion (or not) of other co-morbid disorders.

Today’s blog was informed by an article Could My Adopted Teen Have Developmental Trauma Disorder? by Dr Norm Thibault, LMFT

Dialectical Behavior Therapy

I came across the letters DBT in an adoption discussion group and as I had no idea what it stood for, I do what I often do in such cases, google it. It started with this comment by an adoptive parent –

“I just had it click in a deeper way yesterday that I put a lot of thought and effort and will into trying to heal my kids. As if I’m a savior. As if I can. But in DBT, it talks about creating a change ready environment for your kids. By the way, if you can find a child DBT therapist, do it! Its expensive and it involves individual and parent and group sessions, and its work and learning, but its SUPER effective. All kinds of stuff prove its effective. Back to my point, if I’m trying to create a change ready environment, a calm and consistent environment where mean words can roll off my back, and I’m working on me setting the example that self care is important and I’m working on me so that I can hold all the pain they send my way, that’s where I make the most beneficial impact for all of the family and that’s where I love my kids the best.”

DBT stands for Dialectical Behavior Therapy. Dialectical behavior therapy is an evidence-based psychotherapy that began with efforts to treat borderline personality disorder. There is evidence that DBT can be useful in treating mood disorders, suicidal ideation, and for change in behavioral patterns such as self-harm and substance abuse. Many of these issues are aspects experienced by adoptees due to the trauma of separation from their original mothers.

One woman commented – “DBT absolutely SAVED MY LIFE. The skills helped me stop with SI and I then went on to lose 140 pounds.” I had to google SI too. Introverted sensing (or Si for short) is one of the most misunderstood cognitive functions in the personality community. Introverted sensing is a perceiving (information-gathering) function. It focuses on the subjective, internal world of personal experience and compares and contrasts new experiences to past experiences and memories. Si-users tend to notice patterns repeating themselves and are quick to spot changes or inconsistencies in their environment. They trust personal experience and subjectively explore the impact of current events, choices, and consequences.

So back to DBT . . . .

Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others. DBT can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors (eating disorders and substance use disorders). DBT is sometimes used to treat post-traumatic stress disorder (PTSD).

DBT incorporates a philosophical process called dialectics. Dialectics is based on the concept that everything is composed of opposites and that change occurs when there is a “dialogue” between opposing forces. The process makes three basic assumptions:

All things are interconnected.
Change is constant and inevitable.
Opposites can be integrated to form a closer approximation.

Mindfulness skills help you slow down and focus on using healthy coping skills when you are in the midst of emotional pain. The strategy can also help you stay calm and avoid engaging in automatic negative thought patterns and impulsive behavior. BTW, I am a BIG believer in mindfulness.

Distress tolerance techniques help prepare you for intense emotions and empower you to cope with them with a more positive long-term outlook. There are 4 techniques – distraction, improving the moment, self-soothing and thinking of the pros and cons of not tolerating distress.

Emotion regulation lets you navigate powerful feelings in a more effective way. The skills you learn will help you to identify, name, and change your emotions. When you are able to recognize and cope with intense negative emotions (for example, anger), it reduces your emotional vulnerability and helps you have more positive emotional experiences.

Interpersonal effectiveness helps you to become more assertive in a relationship (for example, expressing your needs and be able to say “no”) while still keeping a relationship positive and healthy. You will learn to listen and communicate more effectively, deal with challenging people, and respect yourself and others.

Is It This Or That ?

An adoptee blogging friend wrote – Borderline Personality Disorder or Adoptee?

This attracted my reading attention right away because for quite a few weeks, months?, I’ve been reading a book titled Healing the Split – Integrating Spirit Into Our Understanding Of The Mentally Ill by John E Nelson, MD. Because there is evidently a severe case mental illness (likely paranoid schizophrenia) in one of my childhood siblings, this book has really spoken to a heart that will always have concern about her well-being, even if my relationship with her has become hostile from her side of the equation. But the book goes into much more than merely mental illness but deeply into how spirituality evolves in a human being. As a matter of fact, I had my own spiritual emergency in my early 20s and but for my own realization around that, I might have ended up very much like my sister who has had a multi-year stint of homelessness (but not presently, thanking all that is good).

One of the topics that gets touched on – but mostly very briefly overall – is borderline personality disorders. There are nine classic symptoms from chronic emptiness to uncontrollable anger, and there is a lot of variation from symptom to symptom. You can read about all of them at The Mighty from where today’s graphic was sourced. The 5 types briefly are Affective, Impulsive, Aggressive, Dependent and Empty. These are also discussed more in depth at the link.

In the blog I refer to at the beginning of my own, she says that it is a disorder of instability and impulsivity. In relationships, moods and behavior and sense of self. She goes on to ask – “OK how many adoptees reading this have already put their hands up as recognizing themselves in that description?” She prefers to call the traits of borderline personality disorder – “adoptee functioning.” She goes on to say of the 9 traits – “this is pretty typical behavior for someone who has experienced being relinquished at birth, and it is the way that adoptees function, rather than it being dysfunctional.”

She concludes – “I am going to re-label Borderline Personality Disorder as Adoptee Adaptive Personality, caused by relinquishment.”