Help me deal with subclinical... everything...
June 2, 2014 9:04 PM   Subscribe

Despite all my efforts and success(!) in treating myself well and recovering, I feel like my anguish over this sexual assault that happened to me over a year ago still subtly manifests itself in many aspects of my life. And it is precisely the "subtle," diffuse nature of these symptoms that makes me uncertain as to how best to proceed. Details inside.

I am high-functioning and no longer meet the strict clinical criteria for PTSD or depression. However, I can sense various disturbances that I don't know how to quite iron out. It's hard to pinpoint all the specific issues-- many times, I don't immediately recognize them as a manifestation of my reaction to the assault until I reflect a bit. Most of symptoms are seemingly minor or what I think of as "subclinical". For example:

For a while, I thought that I felt cut off from people... but I realized this week that it's not exactly that-- it's that I've been actively trying to avoid people. I've been triggered by a few perfectly well-intending, accepting friends once or twice. I must've responded by avoiding people altogether to minimize the risk of being triggered. At the same time, I've felt this need to meet and talk to people to fill some void, so I've been having a bunch of pleasant-enough conversations with strangers. These conversations are super fun and enlightening in their own right, but they're not something that can really make up for closer and longer-term relationships/friendships. This isolation is starting to catch up to me.

I also feel that I'm on this ongoing mission to separate myself from my body. I've done yoga and regular exercise and improved my sleep hygiene, and I'm sure that has all helped keep depressive symptoms at bay! But I've noticed that despite my efforts to respect my body, I've felt compelled to objectify myself, almost as if to convince part of myself that my value to men is primarily sexual in nature. I feel like my body, my sexuality... somehow does not belong to me anymore. I've developed mildly disordered eating habits that I'm almost certain are associated with the assault (although my nutritional status is fine). I am also absolutely disgusted with what turns me on sexually, in the exceedingly rare instances that I am turned on at all. I haven't had sexual contact since the assault, but there was this issue that I posted about several months ago, too.

I recognize that recovery takes time and pans out differently for everybody, although I also can't imagine living the rest of my life feeling like this. Will this dull ache ever go away? I am so tired of dragging this around. I feel like if I let this fester, I'll be on track to missing out on many facets of an enjoyable life, even though it may not seem that way to most outsiders: I'm active in my community, doing fine in school, traveling around, socializing... all that. Everything appears great. I wish I could feel that way.

I am currently in therapy and like my therapist, but it feels like there are no "real" issues at hand to address. In other words, I'm confused because my symptoms were a lot more straightforward to deal with when they consisted of outright flashbacks, panic attacks, acute guilt and depressive symptoms. Now that it has subsided into this subclinical haze, I don't know where to go from here. Do you have any advice for me?
posted by gemutlichkeit to Human Relations (9 answers total) 8 users marked this as a favorite
Best answer: I cannot say exactly when or how, but I can say that it will get better.

I sometimes think of recovering from traumatic incidents as being a multi-layer process - you dealt with the immediate crisis mode and have come a long, long way, but now that means that you're in a safe enough place for the rest of you to recover the rest of the way. This was an incident that shocked you to your very core, and there are some parts of you that just shut off because you weren't ready to handle that damage yet.

Imagine that it's as if you were a house that went through an earthquake, and everything was damaged - the foundation cracked, the windows broke, part of the ceiling collapsed, the furniture broke, a lot of stuff happened. When you have to repair a house with that much damage, you have to take care of the most pressing concerns first - you turn a blind eye to the windows and the broken furniture and work on the foundation and the roof, because you need that structure in place while you're working on everything else. But by the same token, your work isn't over if you just fix the foundation and that's it. Instead - fixing the foundation and the structure of the house first makes the house safe enough for you to start fixing the windows and taking care of the rest of the damage. So, it's kind of like you've done the work of fixing your emotional foundation, but now that that's done your subconscious is turning to the rest of you and noticing, "okay, now I can work on fixing this other stuff."

I would be proud of this, by the way - the work you did over the past year is really, really important. You got yourself to the point where you can be processing the incident on these other levels. A lot of people don't even do that - they sort of get stuck on the foundation-fixing. You are really strong and have come so far. I know it feels like things are just festering, but I suspect it's more like, the parts of you that waited their turn to process what happened are only just joining in now, but they only spoke up now because you've already come so far.

You're doing the right thing by continuing to speak to your therapist, too. She can help you a lot. I had a friend who had a sudden flashback to her own assault years after the fact, and she started seeing a therapist - even though there really weren't any "symptoms" she had other than that flashback (and it was actually caused by a really strong visual reminder of the incident). The therapy really, really helped.

But you will find a way to move forward. I promise.

Good luck.
posted by EmpressCallipygos at 9:25 PM on June 2, 2014 [7 favorites]

Response by poster: And by "mildly disordered" eating habits, I mean a possible eating disorder that I don't know how to take seriously (because it doesn't fall clearly into any diagnosable category ED). I'm sorta in denial about that at the moment, though.
posted by gemutlichkeit at 9:45 PM on June 2, 2014

Best answer: I think the concept of the stages of Rape Crisis Syndrome can be helpful. This description has more detail about the symptoms normal in the "Outward Adjustment Stage," which is basically when the severe trauma has been resolved and there's kind of that almost-lull you describe, where things feel "off" but not in crisis.

I think survivors at this stage kind of have two options (or a third option of going back and forth between the other two options): Go deeper or float shallower. Deeper would be symbolic work -- dream work, journaling, art therapy, meditation. Shallower would be stepping aside from any more deeper examination for a while and just letting things settle for a bit.

Both options are totally valid and can be totally helpful, and I think that going back and forth between the two, depending on your internal resources and external circumstances at any point, is probably the most helpful for the most people. Our bodies and minds naturally process trauma in stages, which lets us deal with one chunk of the trauma, then take a break to recalibrate, and then take on the next chunk. Respecting that ebb and flow can help survivors feel a bit more in control.
posted by jaguar at 10:36 PM on June 2, 2014 [6 favorites]

Maybe you could find a meditation course to take? I have a feeling vipassana meditation could be helpful. I wouldn't start with one of those multiple-day courses that they mention there, that site is more just for info about meditation and that particular tradition.

I think it sounds like you are doing really well. And if it's any consolation, many people feel a disconnect between mind and body. Some people have built religious traditions on it. Not that I'm saying you should, but don't beat yourself up for it!
posted by Athanassiel at 10:58 PM on June 2, 2014

EmpressCallipygos is right. At first I balked at the house analogy but quickly realized that's because I hate having "allowed" sexual assault to shake me to the core. The fact is it does have that kind of impact, and we should not be okay with assault of any kind, so you're more of a right-thinking person than you feel at this time.

So much of what you've described is familiar to me (separating self from body, loss of ownership of sexuality, and more), and again, EmpressCallipygos is right that you will continue to heal and should continue therapy to aid that process.

I know (too well) that therapy is tricky when it feels as though you've covered the issue(s), or at least can't point to a glaring one. Stick with it. (This assumes you like and respect your therapist and s/he likes and respects you.) Maybe you've had some "breakthrough" experiences in therapy, and it's frustrating to talk about what you call subclinical, but I promise you it's good to keep a dialogue going with a trusted therapist, even if/when it feels more like shooting the shit than addressing huge problems.

I'm going out on a limb here, so please forgive me. I am not judging, just wondering about this:
I've been having a bunch of pleasant-enough conversations with strangers
This reminds me of conversations I had in bars... often just after a therapy session, even. Of course I had other conversations with strangers, and I don't want to project my experience on you. You asked for advice though, and I'd be remiss if I didn't say, though it felt pleasant enough at the time, in hindsight that was a period that my therapy stalled out quite a bit. Again, that was me; I'm not saying it's you.

OP, you're amazing. You've worked hard and you're able to recognize your success. It's bullshit that you've had to put in the work for someone else's wrongdoing, but the fact that you've done so demonstrates a zen-like acceptance most people don't have. I know you're tired of this. I know "hang in there" and "don't beat yourself up" seem shallow. I've been there (I know it's different for everyone, but the sex-negative upbringing, unwanted attractions, etc.). You're welcome to MeMail me any time you want a listening ear.
posted by whoiam at 11:01 PM on June 2, 2014 [1 favorite]

Also, what jaguar said. So true.
posted by whoiam at 11:05 PM on June 2, 2014

I have had a very similar reaction to my own trauma, an abusive relationship. I think trauma can fundamentally alter our core permanently. For me, it is helpful at this stage of healing (almost 2 years out now) to think of it not as damage but as an alteration. Life is change.

I too struggle with human connection and with an eating disorder and to me both of those things are very much about control. It has been helpful for me to see these things as a natural and logical manifestation of wanting control over myself and my own life. I am at a point in my life where I really don't much feel like being close to people. I would much rather have superficial relationships and have my closer relationships firmly rooted in developing a shared closeness in the present rather than dwelling on the past. Because people from my past know about my abuse and my trauma and my struggles I find myself pushing away from them as a way for me to move forward on my own - and as a way for me to maintain control over how much my personal relationships are affected by my trauma. If people do not know, or the information they have is minimal, it feels more like they are getting to know me as I currently am, not the "me" that existed before my abuse or the "me" that was desperately and often ham-fistedly crawling my way out of it.

And that brings me to another big project that I am working on which is: I am never going to get the "old" soccermom back. That person that I was no longer exists. The abuse fundamentally changed me in ways that I recognize and ways that I am as of yet completely unaware. So I am also getting to know this new self, the new me, a person who is different - not damaged, different than I was before. Often I learn new things about myself when I interact with new people.

So perhaps thinking more about why you are pushing away from people you know well might help you draw parallels between that issue and the food issue. Like I said, for me both are entirely wrapped up in the notion of control. It may be similar for you but it might be something different.

I think that your focus might be better getting to know this new and changed you. Trauma changes us but it's not damage after a certain point: it's just different. There are a lot of things about me that are really wonderful qualities that I cherish about myself that I did not possess before I was abused. Embracing these changes, good and bad, as natural and normal, has been helpful for me.

I wish you the best of luck on this journey. It's hard but you're strong and you'll get there.
posted by sockermom at 7:12 AM on June 3, 2014 [5 favorites]

I think part of the problem is sometimes when you worked with a therapist to deal with big deal symptoms and they've helped you get those down, they feel kind of comfortable with where you are because it's so much better than before. If that hapens, you might feel the same, except you're still dealing with all this other stuff that feels bad but you're not sure how to process that because it's still better than the really bad symptoms you had before. So you're not sure what to bring up or whether to just try and be grateful you've got this far.

Instead, I would suggest, either looking for a new therapist or telling your therapist exactly the subclinical stuff you're struggling with and that you want to work on that more specifically and in a deeper way. Some types of therapy, like ongoing talk therapy, don't get deep down to things that are kind of hanging out inside you. I feel like EMDR and somatic experiencing are useful tools to start talking about exactly what those feelings are and what's going on with them, and how to move forward and really get healing and the support you need with them. In some ways CBT is very geared toward stopping symptoms. You might succeed with CBT but then feel like you stopped these major symptoms but now there's a lot under the surface that just overall doesn't feel right.

I don't think CBT helps with that as much CBT helps more with immediate symptoms or thought patterns and creating behaviors that shift or stop them-- but it doesn't always help bring up the emotions you need to feel and work through. It can kind of be the opposite of that some times (which can be needed when there are so many symptoms you don't even know what you're feeling). But now as things have settled a little, it might be time to take out some things here or there that you know you want worked on.

It sounds like your therapist isn't doing much actual work, you're doing the talk therapy thing I've done that winds up being maybe comforting and helpful in that there's security there, but it's not really healing work. I think you might benefit from trying some new approaches to help you grow from where you are now. You could even ask your therapist for a referral to someone who does EMDR or somatic experiencing. Good luck to you!
posted by xarnop at 8:58 AM on June 3, 2014 [3 favorites]

I don't have a whole lot to add to these good responses, but I just wanted to say I think the house analogy is an excellent one.

Just because you don't fit the diagnosis for major depression or a specific eating disorder or PTSD doesn't mean that your issues around your sexuality, or socializing, or eating aren't real issues that you might benefit from addressing with your therapist. They are affecting your life negatively. You are conscious of them affecting your life negatively. To me, that means they are not "subclinical" even if they don't amount to some kind of specific psychiatric disorder. Plenty of people still get a lot of help from therapists even without having psychiatric conditions - I know I have.

Don't think about yourself in terms of diagnoses or what medically or psychiatrically "counts" as a problem. Life and relationships are so much more complicated than that. The issues that you bring up are absolutely valid issues and you don't have to prove to anyone that they are "bad enough" to be worth working on. Best of luck, you sound very self aware and perceptive. Hope it gets better soon.
posted by treehorn+bunny at 4:25 PM on June 3, 2014 [2 favorites]

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