Reactive attachment disorder (RAD) is a trauma disorder that occurs in infancy or very young childhood; however, the effects of reactive attachment disorder are long-lasting and can be seen in children and teens (Reactive Attachment Disorder in Adults). Reactive attachment disorder is caused by neglect so severe that an infant doesn’t form an attachment to a caregiver. As a result, the baby doesn’t experience a sense of safety, security, and protection, nor does he/she develop a sense of trust.

As this child grows, RAD symptoms manifest into significant emotional, behavioral, social, and academic problems because of the lack of early attachment. Children and teens with RAD can’t form appropriate social relationships. Withdrawal and avoidance are the primary ways that kids with RAD handle the world around them. The effects of reactive attachment disorder in teens and children can be felt in all areas of their lives.

Effects of Reactive Attachment Disorder Impact Children, Teens

In its Diagnostic and Statistical Manual for Mental Disorders, Fifth edition (DSM-5), the American Psychiatric Association (2013) states that a child must have a developmental age of between nine months and five years in order to receive a diagnosis of reactive attachment disorder. Reactive attachment disorder, then, isn’t first diagnosed in older children and teens. That said, RAD is a disorder that remains present; it doesn’t disappear after a child’s fifth birthday.

The effects of reactive attachment disorder in children and teens can be profound. When an infant experiences the trauma of severe neglect and consequently doesn’t form an attachment with a caregiving adult, he/she is at heightened risk for developing mental illness and experiencing emotional, behavioral, social, and academic problems.

Problems and Effects of Reactive Attachment Disorder in Children, Teens

Teens and children with RAD are withdrawn and avoidant. They neither initiate nor respond to social interaction. Because they didn’t bond with anyone at the very beginning of life, these older children and teens are unable to form connections with peers or adults. Reactive attachment disorder treatment aims to deal with these effects.

This partial list highlights the effects of reactive attachment disorder in children and teens:

• Low self-esteem
• Lack of basic social skills
• Inability to engage in exploration and play
• Peer rejection
• Acting distant, aloof (which leads to further isolation)
• Sense of fear
• Hypervigilance, looking for danger
• Self-soothing behaviors such as rocking, rubbing own arms, etc.
• Substance use (primarily in teens, but can be seen in older children, too)
• Masking feelings
• Awkwardness and discomfort in any social context, including the classroom
• Sleep problems
• Academic problems
• Depression
• Anxiety disorders

Teens and children experience multiple effects of reactive attachment disorder at home, at school, and anywhere else the child or teen goes. Not only are the effects of RAD persistent, but they tend to be cumulative. They build on each other, increasing the difficulties faced by children and teens with reactive attachment disorder.

Are the Effects of Reactive Attachment Disorder in Teens, Children Permanent?

In infancy, children and teens with RAD had virtually no opportunities to form attachments to a caregiving adult. Without this basic human connection, they were unable to trust, to feel safe, or to learn that they could count on people. As a result, these children and teens withdraw from the world and into themselves.

The rejections and lack of bonding causes reactive attachment disorder. The effects of reactive attachment disorder in teens and children are significant and damaging. It’s imperative that the adults in their lives be patient and understanding. Treatment isn’t easy, but it can happen. The effects of reactive attachment disorder in teens and children don’t have to be permanent.

article references

Sex Roles: A Journal of Research, Nov, 2004 by Alia Offman, Kimberly Matheson

How we learn to think of ourselves as sexual beings is greatly influenced by our experiences in dating relationships (Paul & White, 1990). Indeed, intimate relationships are highly valued by young adults because they can provide companionship, intimacy, support, and status. However, they also can become a source of emotional and/or physical pain, particularly when the relationship is abusive (Kuffel & Katz, 2002). When the bonds of trust, care, and affection are broken through abusive interactions, the partner experiencing the abuse may develop feelings of inferiority and worthlessness (Ferraro & Johnson, 1983). Although these developments are not surprising in long-running abusive relationships, little is known about the impact of abuse in women's dating relationships. In a recent survey of senior high school students (ages 16-20), Jackson, Cram, and Seymour (2000) found that 81.5% of their female participants reported an experience of emotional abuse in their dating relationships, 17.5% reported having had at least one experience of physical violence, and 76.9% reported incidents of unwanted sexual activity. Unfortunately, these all too common negative experiences likely set the foundation for women's sexual self-perceptions, as for many young women they represented the women's first forays into the exploration of their sexuality.

Women's Sexual Self-Definitions

Often young women's sexuality is explored not as primary, but rather as a secondary desire, that is, as a response to men's sexuality (Hird & Jackson, 2001). The tendency for women to define their sexuality within the context of the intimate relationship, or as secondary to that of their male partners, means that the quality of interpersonal functioning within the relationship may directly serve to strengthen or undermine women's sexual self-perceptions. Thus, an intimate relationship characterized by abuse and a lack of mutual respect might be expected to impact women's sexual self-perceptions negatively.

The research on women's sexual self-perceptions is sparse, and studies of sexual self-perceptions in relation to experiences of abuse are even fewer. Most notable is the work of Andersen and Cyranowski (1994), who focused on women's cognitive representations of the sexual aspects of the self. They found that women's sexual self-schema contained both positive and negative aspects. Women with more positive sexual schema tended to view themselves as romantic or passionate and as open to sexual relationship experiences. Conversely, women whose schema contained more negative aspects tended to view their sexuality with embarrassment. Andersen and Cyranowski suggested that schematic representations are not simply summaries of past sexual history; schemas are manifest in current interactions, and they guide future behaviors as well. The present study was designed to assess the positive and negative dimensions of young women's sexual self-perceptions, particularly as a function of the extent to which their current relationships are characterized by abusive interactions.

The Effects of Abuse on Women

Violence in an intimate relationship can take many forms including physical assault, psychological aggression, and sexual coercion (Kuffel & Katz, 2002). Much of the research that has assessed the impacts of abuse in dating relationships has focused on physical violence (Jackson et al., 2000; Neufeld, McNamara, & Ertl, 1999). However, the adverse messages that experiences of psychological abuse convey can also impact woman's emotional health and well-being (Katz, Arias, & Beach, 2000), and they may even outweigh the immediate effects of overt physical violence (Neufeld et al., 1999). The presence of sexual violence may also interact with physical abuse to undermine well-being (Bennice, Resick, Mechanic, & Astin, 2003). Much of the research in this respect has focused on the effects of date rape (Kuffel & Katz, 2002).

Currently, there is lack of understanding of how different experiences of abuse (i.e., physical, psychological, and sexual) within dating relationships impact young women's sense of self, including the development of sexual self-perceptions. However, some understanding of the potential impacts might be gleaned from research conducted to assess the sexual perceptions of women in abusive marital relationships. For example, Apt and Hurlbert (1993) noted that women who were experiencing abuse in their marriages expressed higher levels of sexual dissatisfaction, more negative attitudes toward sex, and a stronger tendency to avoid sex than did women who were not experiencing abuse. The psychological sequelae of abuse (e.g., depression) may further reduce a woman's sexual desire, and hence her sense of herself as a sexual being. In addition, physical, emotional, and/or sexual abuse within the intimate relationship can create feelings of inferiority and worthlessness in women (Woods, 1999), and feelings of security may be replaced by a sense of powerlessness within the relationship (Bartoi, Kinder, & Tomianovic, 2000). To the extent that abuse undermines a woman's sense of control, she may learn that she should not express her own sexual needs, desires, and limits. Although these impacts were identified in the context of marital relationships, it is likely that they would be evident at earlier stages of a relationship, particularly among young women who often lack voice or sometimes even knowledge of what they do or do not want in a dating relationship (Patton & Mannison, 1995). Even more disturbing is the possibility that women who are experiencing sexual violence may view such experiences as their own fault, and thus internalize the responsibility for the violence (Bennice et al., 2003). Unfortunately, such internalization may again be more likely among young women in the early stages of their relationships, particularly if they begin to define abusive incidents as normal.

Women experiencing abuse in their intimate relationships might demonstrate a change in sexual self-perceptions in the form of lower levels of sexual satisfaction (Siegel, Golding, Stein, Burnam, & Sorenson, 1990). Such changes may be most evident during times of upheaval and instability. Indeed, Rao, Hammen, and Daley (1999) found that young people's vulnerability to developing negative self-perceptions in general (e.g., depressive affect) increased during the transition from high school to college, as they coped with the insecurities that emanate from developmental challenges. Given that one of the most frequently identified buffers against the impacts of stressful events is a secure social support system (Cohen, Gottlieb, & Underwood, 2000), young women who undergo transitional life events in the context of an abusive intimate relationship may be particularly vulnerable to feelings of relationship insecurity and negative self-perceptions. Further, although Rao et al. (1999) noted that these negative feelings dissipated over time, to the extent that women's abusive relationships continue, their negative sexual self-perceptions may continue to be evident.

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This Study

The purpose of this study was to assess the relations between experiences of abuse in dating relationships and young women's sexual self-perceptions. Of particular interest were women's self-perceptions over the course of their first year at university. This study was designed to examine the following hypotheses:

1. Women who experienced abuse in their current dating relationships were expected to have more negative, and less positive, sexual self-perceptions than women had not experienced abuse.

2. Women's negative sexual self-perceptions were expected to be most evident at the beginning of the academic year (transitional phase) and to dissipate over the course of the year. However, among women in abusive relationships, the reduction of negative self-perceptions over time may not be as evident.

3. Although depressive symptoms and reduced self-esteem were expected to be associated with more negative and less positive sexual self-perceptions, it was hypothesized that even after controlling for these relations, current involvement in abusive relationships would be directly related to women's sexual self-perceptions.

METHOD

Participants

At the outset of the study, the participants were 108 women who ranged in age from 18 to 26 years (M = 19.43, SD = 1.49). All of the women invited to participate had indicated in a prior mass-testing forum that they were currently in heterosexual relationships. Participants' length of involvement in an intimate relationship ranged from a few weeks to 5 years (M = 19.04 months, SD = 13.07). Approximately 38% of participants withdrew before the final session of the study, which left a total of 78 women at the second measurement time, and 66 women in the third phase. A series of t tests revealed no significant differences between women who withdrew and those who continued in the study in terms of their initial levels of satisfaction with the amount of time spent with their partners, satisfaction with the quality of time spent together, or age. Although we could not determine whether those women who did not continue had terminated their relationships, at the second measurement time, only eight of the women reported having ended their relationships, and all of them had been in nonabusive relationships. A further five women in nonabusive relationships, and four who had been abused, had ended their relationships by the final measurement phase. All of these women were included in all of the analyses. None of the women had commenced a new serious relationship prior to the completion of the study.

Of those women who reported their ethnic or racial status, the majority were White (n = 77, 77.8%). The visible minority women self-identified as Hispanic (n = 6), Asian (n = 5), Black (n = 5), Arabic (n = 4), and Native Canadian (n = 2). Of those women who were not in abusive relationships, 82.6% were White, whereas only 66.7% of the abused women were White. The reason why a higher proportion of minority women indicated involvement in abusive relationships is unknown. Although it may stem from social circumstances that leave minority women more vulnerable to abusive relationships, it is also possible that the styles of conflict resolution defined as abusive are culture-bound, either in practice or in terms of reporting biases (Watts & Zimmerman, 2002).

Although the focus of this study was on the ongoing effects of current date abuse, the possibility of past experiences of abuse must also be considered. To this end, the women completed a Traumatic Life Events Questionnaire (Kubany et al., 2000). A minority (n = 16, 29.6%) of the women in nonabusive relationships reported past traumatic experiences of assault, including threats to their lives (n = 5), assault from a stranger (n = 4), or past intimate partner (n = 4), or child physical abuse (n = 4). Of the 21 women in abusive relationships who completed this measure, 52.4% reported past traumatic experiences of assault, including childhood physical assault (n = 6), previous partner abuse (n = 5), their lives being threatened (n = 3), and being stalked (n = 2). In several instances, women reported more than one of these experiences. Thus, as noted in previous research (Banyard, Arnold, & Smith, 2000), the effects of current abuse cannot be entirely isolated from the effects of previous traumatic experiences of assault.

Procedure

Female first-year university students involved in heterosexual dating relationships were selected on the basis of a premeasure of relationship status that was administered in over 50 first-year seminar classes in a variety of disciplines. Participants were informed that the study consisted of completing questionnaires at three times during the academic year. The first session was in October/November, the second in January (midyear), and the final session was in March (just prior to final exams).

All three sessions were conducted in small group settings. As incentives, participants were informed of their eligibility to receive course credit for their time (if they were in the introductory psychology course), as well as their inclusion in a draw for $100 that was held at the end of each week of data collection during the second and third phases of the study (7 weeks total). Informed consent was obtained in each phase. The initial questionnaire package included a measure of sexual self-perceptions, the Revised Conflict Tactics Scale, the Beck Depression Inventory, and the State Self-Esteem Scale. A Traumatic Life Events Questionnaire was included in the second phase. Only the sexual self-perceptions scale was administered in all three phases (embedded among other measures, some of which were not relevant to this study). Participants were debriefed in the final phase of the study.

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Measures

Sexual Self-Perceptions

A sexual self-perceptions scale was compiled for this study by writing some original items and selecting others from a variety of scales that covered different areas of women's sexuality. Sixteen items were taken from a measure of sexual attitudes (Hendrick, Hendrick, Slapion-Foote, & Foote, 1985), three items were taken from a measure of sexual awareness and control (Snell, Fisher, & Miller, 1991), and a further 12 items were created to assess perceptions of sexual interactions with partners. The 31 items about how they perceived their own sexuality were rated on a scale that ranged from -2 (disagree strongly) to +2 (agree strongly).

A principal components analysis was conducted to assess the factor structure of this scale. On the basis of a scree plot, three factors were identified that explained 39.7% of the total variance; the factors were then subjected to a varimax rotation. The subscales, which were based on factor loadings greater than .40 (see Table I), included an index of negative sexual self-perceptions (Factor I) with 12 items (e.g., "Sometimes I'm ashamed of my sexuality") and a positive sexual self-perceptions factor (Factor II) with nine items (e.g., "I consider myself a very sexual person"). Mean responses were calculated for each of the negative and positive sexual perceptions subscales (r = -.02, ns), and these demonstrated high internal consistency (Cronbach's [alpha]s = .84, and .82, respectively). The third factor (Factor III) included five items that appeared to concern perceptions of power (e.g., "I think good sex gives one a feeling of power"). However, not only did this factor explain less variability (6.3%) in the factor structure than the others did, its internal consistency was also less satisfactory (Cronbach's [alpha] = .59). Thus, this factor was not analyzed further.

Abuse

We administered the Revised Conflict Tactics Scale (CTS-2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996), which represents a commonly used measure to assess the presence or absence of abuse within an intimate relationship. Of particular interest were responses to the items that assessed the tactics women's partners used to resolve conflicts within the past month. The tactics that involved physical assault, psychological aggression, and sexual coercion were used to establish the presence or absence of abuse targeted at women in their intimate relationships. Responses were made on a 6-point scale that ranged from 0 (never) to 5 (more than 10 times in the past month). Internal consistencies for the physical assault (Cronbach's [alpha] = .89) and psychological aggression (Cronbach's [alpha] = .86) subscales were high. Although the inter-item consistency for sexual coercion was lower (Cronbach's [alpha] = .54), similar consistency has been found in other samples (e.g., Kuffel & Katz, 2002). Because reports for the past month (rather than the past year) were solicited, responses of even one occurrence of physical assault or sexual coercion were considered to constitute abuse. Within the past month, 10.2% (n = 11) of the women reported having experienced physical assault, whereas 17.6% (n = 19) reported having experienced sexual coercion from their current partners. The most common form of abuse was psychological aggression; 25.9% (n = 28) of the women scored 3 or greater (i.e., at least three to five instances within the past month). Though this cutoff score of 3 or greater for defining psychological abuse is necessarily arbitrary, we viewed it as a relatively conservative criterion that maximized the likelihood that aggressive acts (e.g., my partner shouted at me) were considered in the context of broader conflict (Kuffel & Katz, 2002). Moreover, the mean number of events that constituted psychological aggression reported by women whom we categorized as being in a psychologically abusive relationship (M = 8.27, SD = 5.69) was not considerably different from the number of such events reported by women who self-defined their relationships as psychologically abusive in Pipes and LeBov-Keeler's (1997) study (however, due to differences in scaling, a direct comparison of the means could not be made). In many instances, the women who experienced physical abuse also reported psychological abuse, r = .69, p < .001. Thus, women in the present study were categorized as being in an abusive relationship if they indicated any instances of physical assault, or if they scored 3 or greater on the psychological aggressiveness subscale. On the basis of these criteria, 31 (28.7%) of the women were identified as currently involved in an abusive relationship, whereas 77 women were not in an abusive relationship. Sexual coercion also tended to co-occur with the other forms of abuse: sexual and psychological subscales, r = .44, p < .01; sexual and physical abuse, r = .27, p < .01. However, given the specific interest in sexual self-perceptions, the effects of the presence or absence of such coercion were examined separately.

Self-Esteem

The State Self-Esteem Scale (Heatherton & Polivy, 1991) is a 20-item measure that is sensitive to changes across time and situations. Responses are made on a 5-point rating scale that ranges from 0 (not at all) to 4 (extremely true of me) to indicate the extent to which women believed that each statement applied to them at that moment. Mean responses were calculated, such that higher scores represent greater self-esteem (Cronbach's [alpha] = .91)

Depression

The Beck Depression Inventory (BDI) is a commonly used self-report measure of subclinical depressive symptomatology. We used the 13-item version (Beck & Beck, 1972) due to its brevity and demonstrated validity. This 13-item inventory uses a 4-point scale, such that responses of 0 indicate a lack of symptomatology and responses of 3 indicate high depressive symptomatology. Responses were summed, and scores could range from 0 to 39.

Trauma History

The Traumatic Life Events Questionnaire (Kubany et al., 2000) is a 23-item self-report questionnaire that assesses exposure to a broad spectrum of potentially traumatic events. Events are described in behaviorally descriptive terms (consistent with the DSM-IV stressor criterion A1). Participants report the frequency with which each event occurred by indicating the number of incidences on a 7-point scale from 0 (never) to 6 (more than five times). When events are endorsed, respondents indicate whether they experienced intense fear, helplessness, or horror (the PTSD stressor criterion A2 in the DSM-IV). Trauma history is defined in relation to four discrete categories: shock event (e.g., car accident), death of a loved one, trauma to other (e.g., witnessing assault), and assault. Scores can be determined by summing the frequencies associated with each traumatic event that participants also reported as causing fear, help-lessness, and/or horror (Breslau, Chilcoat, Kessler, & Davis, 1999). Of particular interest in the present study were events involving past assault, which included childhood physical or sexual abuse, physical assault, spousal assault, rape, being stalked, or having one's life threatened.

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RESULTS

To test whether abuse was associated with women's negative or positive sexual self-perceptions, 3 (time of measurement) X 2 (abused or not) mixed measures analyses of covariance were conducted, with length of time women had been in their current relationships as the covariate. Abuse was either defined by the presence or absence of physical/psychological abuse or by the presence or absence of sexual coercion.

The length of time women had been in their relationships represented a significant covariate in relation to negative sexual self-perceptions, F(1, 63) = 6.05, p < .05, [[eta].sup.2] = .088, in that, on the whole, the longer women were in their current relationships, the lower their negative sexual self-perceptions. A significant main effect for physical/psychological abuse was also evident, F(1, 63) = 11.63, p < .001, [[eta].sup.2] = .156, such that experiencing abuse was associated with more negative sexual self-perceptions (see Table II). Neither time of measurement, F(2, 126) = 1.81, ns, [[eta].sup.2] = .036, nor the interaction between time and physical/psychological abuse, F < 1, was significant.

When the effects of the presence or absence of sexual coercion on negative sexual self-perceptions were examined, there was a significant main effect for coercion, F(1, 63) = 11.56, p < .001, [[eta].sup.2] = .155, as well as a significant interaction between coercion and time of measure, F(2, 126) = 10.36, p < .001, [[eta].sup.2] = .141. Simple effects analyses indicated that changes of negative sexual self-perceptions occurred among women who reported having experienced sexual coercion, F(2, 18) = 4.96, p < .05, but not among women whose relationships did not involve coercion, F < 1. As seen in Table II, women who experienced sexual coercion from their partners reported more negative self-perceptions overall than did women in nonabusive relationships, but these negative perceptions were attenuated somewhat by the middle of the academic year, and then remained stable.

Analyses of women's positive sexual self-perceptions indicated that the length of time women had been in their current relationships was not a significant covariate, F < 1. Moreover, neither the presence or absence of physical/psychological abuse or sexual coercion affected women's positive sexual self-perceptions, nor did these perceptions change significantly over the course of the year (see Table II). Thus, it appears that the primary effect of abuse in women's dating relationships was more negative self-perceptions.

As seen in Table II, women who reported having experienced abuse showed greater depressive symptomatology, F(1, 104) = 11.62, p < .001, [[eta].sup.2] = .100, and lower levels of self-esteem, F(1, 104) = 14.12, p < .001, [[eta].sup.2] = .120, than women who had not experienced abuse. Similarly, the presence of sexual coercion in women's relationships was associated with greater depressive symptomatology, F(1, 104) = 4.99, p < .05, [[eta].sup.2] = .046, and lower levels of self-esteem, F(1, 104) = 4.13, p < .05, [[eta].sup.2] = .038, than was evident among women who did not report sexual coercion.

To assess whether the negative sexual self-perceptions held by women in abusive dating relationships were an artifact of the greater depressive affect and reduced self-esteem of these women, a hierarchical regression analysis was conducted in which negative sexual self-perceptions at Time 1 were regressed onto length of time in the relationship on the first step, depressive affect and self-esteem scores on the second step, followed by the presence or absence of psychological/physical abuse and sexual coercion. As expected, greater depressive symptoms and lower self-esteem were both related to more negative sexual self-perceptions, [R.sup.2] = .279, F(2, 101) = 20.35, p < .001, although only depressive symptomatology accounted for unique variance (see Table III). After these variables were controlled for, abusive experiences explained an additional 13.9% of the variance in negative sexual self-perceptions, F(2, 99) = 12.40, p < .001. As seen in Table III, these findings suggest that experiences of sexual coercion especially, and physical/psychological abuse as well, had a direct relation to women's negative sexual self-perceptions, irrespective of depressive affect.

DISCUSSION

Although developing an intimate relationship is often a challenging experience, it can be more so when combined with experiences of abuse (Dimmitt, 1995; Varia & Abidin, 1999). In accordance with past research (Apt & Hurlbert, 1993; Bartoi et al., 2000; Bartoi & Kinder, 1998; McCarthy, 1998), experiences of physical or psychological abuse or sexual coercion were found to be related to women's sexual self-perceptions, in that women who had experienced abuse in their dating relationships reported more negative sexual self-perceptions than did women who were not abused. It should be noted, however, that many of the women who were in abusive relationships had experienced prior abuse or assault, a finding that is not unusual (Banyard et al., 2000; Pipes & LeBov-Keeler, 1997). It may be that prior abuse set in motion a cascade of changes related to belief systems, and perceptions of self and others, that increased the likelihood of subsequently encountering abuse (Banyard et al., 2000). Thus, given the high correspondence between current and previous experiences, these factors could not be separated, and so some caution is merited regarding the impact of current dating abuse.

Negative sexual self-perceptions among women experiencing sexual coercion in their relationships were particularly marked the outset of the study, which represented a transitional phase in these young women's lives. Women who were in abusive relationships not only lacked a key source of social support, namely that of their intimate partners, but in fact likely experienced their intimate relationships as an additional source of stress. Thus, when the stress associated with the transition to university was superimposed upon this backdrop of abuse, women's distress may have been exacerbated. This may have had the effect of undermining women's self-perceptions (Rao et al., 1999). However, given the correlational nature of this study, it may have been that women who already had negative self-perceptions were particularly vulnerable during this transition time. In line with this, women's negative self-perceptions were found to be associated with reduced self-esteem and more depressive symptoms. It is also possible, however, that within this new environment, women who were abused may become aware of how other intimate relationships compared to their own. This relative comparison might serve to increase negative sexual self-perceptions if the women question their own self-worth. Alternatively, given that the exaggerated negative sexual self-perceptions at the outset of the academic year were evident only among women who reported having experienced sexual coercion, as opposed to psychological or physical abuse, it is possible that the sexual dynamics within the relationship may have altered during this period. For example, partners may have been more neglectful in light of perceiving an increased number of alternative relationships, or conversely, may have been more coercive if they perceived a threat due to potential alternatives available for the women. As the year progressed, women and/or their partners may have readapted and their relationships stabilized (for better or worse). Hence, the women's negative sexual self-perceptions attenuated somewhat over time, although they continued to be more negative than those of women in nonabusive relationships. This interpretation is clearly speculative, and it requires a closer examination of the ongoing sexual dynamics within intimate relationships that involve coercion.

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It is interesting that experiences of abuse were not associated with women's positive perceptions of their sexuality. It is possible that this reflects a lack of sensitivity of our measure of positive perceptions. Indeed, an important next step may validate our positive and negative sexual self-perceptions against other measures that make this distinction. Assessing the relations between the current measure of sexual self-perceptions with the positive and negative sexual schemas defined by Andersen and Cyranowski (1994) might be particularly interesting for both psychometric and theoretical reasons. As schemas are internalized representations that serve to filter incoming information and guide behaviors, it is important to determine the degree to which the sexual self-perceptions of women in abusive relationships are incorporated into these relatively stable schematic structures. Integration of these beliefs into women's self-schema may have implications for women's well-being not only within their current relationships, but as well for their interactions in future relationships. The finding that positive perceptions appeared to be resistant to abuse, and were independent of women's negative sexual self-perceptions, suggests that women seem to be able to compartmentalize different aspects of their intimate relationships (Apt, Hurlbert, Pierce, & White, 1996) as well as distinguish between aspects of their sexual self-perceptions. This may be encouraging, in that, if women exit these relationships, their positive self-perceptions may provide a basis for establishing healthier relationships with more supportive partners. However, in the present study we did not assess the longer term effects of abuse on sexual self-perceptions either within women's current relationships or upon the termination of their relationships.

Consistent with previous research, women who experienced abuse in their dating relationships also reported reduced self-esteem (Jezl, Molidor, & Wright, 1996; Katz et al., 2000) and more depressive symptoms (Migeot & Lester, 1996). Thus, women's more negative sexual self-perceptions might have been a by-product of their feelings of general negative affect. Depressive affect or low self-esteem might result in the suppression of women's sexual desire or generalize to their self-perceptions in the sexual domain. Indeed, self-esteem and depressive symptoms were associated with more negative sexual self-perceptions. However, when esteem and depressive symptomatology were controlled for, women's experiences of abuse continued to have a direct relation to their more negative self-perceptions. This finding is consistent with those of others who have noted that the lack of intimacy and compatibility within the intimate relationship may impact sexual self-perceptions (Apt & Hurlbert, 1993). Moreover, the presence of abuse may promote a woman's perception of her sexuality as secondary to her partner's (Hird & Jackson, 2001) and reduce the importance of her own needs and her ability to voice those needs (Patton & Mannison, 1995).

It ought to be noted that the generalizability of the results of this study may be limited by its focus on university women. For example, these women may have a relative wealth of resources to rely on (e.g., postsecondary education, a highly social day-to-day milieu), all of which may affect their responses within the intimate relationship and, in turn, their sexual self-perceptions. Future researchers in the area of young women's experiences of date abuse should select a stratified sample of young women, both in and out of educational settings.

Table I. Items and Factor Loadings for Sexual Self-Perception Scale
Factor loading
Item	I	II	III
4. I think sex is a good way to resolve a fight.	.45
5. I have sex without a condom if my partner doesn't like them, even if I want to use one.	.61
6. I think creating sexual desire in someone is one of the best ways to keep that person.	.70
9. I may initiate sex because I enjoy it.		.67
11. I avoid talking about sex with my partner.		-.64
13. Talking about sex with my partner is fun.		.68
23. I let my partner know if I want him to touch me sexually.		.69
26. I put my mouth on my partner's genitals if he wants me to, even if I don't want to.	.63
27. I may initiate sex just to get it over with.	.57
28. If I say no, I won't let me partner touch me, even if he pressures me.	-.53
30. I have sex with my partner when he wants me to even if I don't want to.	.74
From Hendrick et al. (1985)
1. Sometimes I am ashamed of my sexuality.	.65
3. I could live quite well without sex.		-.60
7. I think sex is mostly a game between males and females.	.61
8. I believe it is possible to enjoy sex with a person and not like that person very much.	.48
10. I feel it is all right to pressure someone into having sex.	.48
12. I feel sex gets better as a relationship progresses.		.50
14. I feel a sexual encounter between two people deeply in love is the ultimate human interaction.			.64
16. I feel, at its best, sex seems to be the merging of two souls.			.54
19. I think sex is primarily the taking of pleasure from another person.			.52
22. I believe sex is fundamentally good.		.64
24. I think good sex gives one a feeling of power.			.67
25. I think sex has nothing to do with power.			-.49
From Snell et al. (1991)
15. I am in control of the sexual aspects of my life.	-.72
21. I'm the type of person who insists on having my sexual needs met.		.45
29. I consider myself a very sexual person.		.74

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Table II. Means and Standard Deviations for Negative and Positive Sexual Self-Perceptions over Time and Depressive Affect and Self-Esteem
	Physical/psychological abuse				Sexual coercion
	Absent		Present		Absent		Present
	Mean	SD	Mean	SD	Mean	SD	Mean	SD
Negative Perceptions
Time 1	-1.50 (a)	.45	-.99 (b)	.91	-1.50 (a)	.41	-1.59 (b)	1.09
Time 2	-1.56 (a)	.41	-1.15 (b)	.78	-1.50 (a)	.49	-1.11 (c)	.80
Time 3	-1.54 (a)	.39	-1.15 (b)	.77	-1.47 (a)	.49	-.97 (b,c)	.72
Positive Perceptions
Time 1	1.06	.61	.90	.65	.96	.63	1.18	.59
Time 2	.94	.62	.84	.64	.90	.65	.95	.47
Time 3	1.08	.52	.86	.62	1.00	.59	1.05	.41
Depressive affect	4.32	3.54	7.53	6.02	3.97	2.55	7.39	6.62
Self-esteem	2.64	.58	2.15	.66	2.55	.62	2.22	.68

Note. Means are adjusted for length of time in relationship. Means that do not share superscripts differ at p < .05.

Table III. Regression Analysis to Assess Relations Between Negative Sexual Self-Perceptions and Abuse After Controlling for Length of Time in Relationship and General Negative Affect
	Pearson r	B	[R.sub.change.sup.2]
Step 1			.029
Length of time	-.17	-.16*
Step 2			.279***
Self-esteem	-.35***	-.02
Depressive symptoms	.53***	.37***
Step 3			.139***
Physical/psychological	.35***	.24**
Sexual coercion	.42***	.31***

Note. Although the proportion of variance explained is the contribution made at each step of the hierarchical regression, the standardized regression coefficients represent final step weights. *p < .05. **p < .01. ***p < .001.

ACKNOWLEDGMENTS

We greatly appreciate the contributions made by Irina Goldenberg, Alexandra Fiocco, and Alla Skomorovsky. This research was funded by the Social Sciences and Humanities Research Council of Canada and the Canadian Institutes for Health Research.

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next: Sexual Healing After Sexual Abuse

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Alia Offman (1,2) and Kimberly Matheson (1)

(1) Department of Psychology, Carleton University, Ottawa, Ontario, Canada.

Caffeine-induced anxiety isn’t just a real thing; it’s an officially accepted condition. With enough research into caffeine and its effect on brain health and behavior, the American Psychiatric Association added caffeine to the substance-related and addictive disorders section in their Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This tome is considered the authority on mental disorders, and caffeine is also included among causative substances in substance/medication-induced anxiety disorder. Caffeine-induced anxiety is one officially recognized cause of anxiety

Have you ever experienced symptoms such as

• Shakiness/trembling
• Rapidly-beating and/or pounding heart
• Sweating
• Agitation
• Nervousness
• A sense of impending doom

Experiencing these things can be frightening. Whether it’s the first time or the fifty-first, people often wonder what in the world just happened. Was it:

• An anxiety attack because of a stressful or worrisome event?
• A panic attack brought on by the distressing thought of panicking?
• The effects of the pot of coffee or energy drinks downed to get through the long morning?

That experience could have been an anxiety attack or a panic attack. It could have been caffeine-jitters anxiety. It could have been solely the physical effects of too much caffeine. There’s a high likelihood that these symptoms of anxiety were caused by caffeine because of the high caffeine and anxiety connection.

Caffeine-Induced Anxiety in the DSM-5

Caffeine is one of 10 classes of drugs included in the DSM-5. Substance/medication-induced disorders in general share common characteristics. Typically, disorders brought on by substance use, like caffeine-induced anxiety disorder, can be severe. They’re also temporary; however, sometimes central nervous system (CNS) syndromes develop that persist.

Caffeine-induced anxiety, then, can be quite serious, with strong, disruptive symptoms. It’s also temporary, with anxiety symptoms disappearing once substance use has stopped and the CNS has had time to recover from the caffeine overload. Duration varies from person to person, but many people notice their anxiety and panic almost completely vanish after about one month without caffeine.

It’s Not Hard to Develop Caffeine-Induced Anxiety

Caffeine is a common ingredient that we put into our bodies. We know we drink it. Sometimes we don’t know we’re eating it.

If you are consuming anything with the word “energy” in the description, it probably contains caffeine. Energy jerky has caffeine. Chocolate is a source of caffeine, as is coffee ice cream. Some gum is caffeinated. Check the labels on over-the-counter pain relievers, because many contain caffeine. Watch for names and descriptions with words like jolt, buzz, blast, blitz, perky, spark, oomph, vitality, zing, and any other catchy word that makes you feel jittery just by reading it.

With so many overt and insidious sources of caffeine, it is easy to take in too much. Generally, anything more than 250 mg of caffeine per day is generally considered excessive, but every person is different. Some may be able to tolerate a bit more, others can feel negative effects with much less. Caffeine-induced anxiety has more to do with the symptoms you feel than the milligrams you consume.

Caffeine-induced anxiety disorder is a legitimate diagnosis. The prevalence, though, is low. The DSM-5 estimates that in any 12-month period, less than 0.002% of the population is diagnosed with the disorder.

The low number can be deceiving. While it’s true that a diagnosis of this anxiety disorder is rare, it’s also true that the number of people experiencing anxiety caused by caffeine is significantly higher. Caffeine can, and often does, cause, trigger or worsen anxiety.

Some argue that anxiety is anxiety no matter the cause; therefore, knowing if you have caffeine-induced anxiety is unimportant. Sometimes knowing anxiety’s cause doesn’t make a difference. When it comes to anxiety and caffeine, though, knowing how caffeine affects anxiety is important.

Knowing if caffeine is making you anxious can help you reduce and possibly even eliminate your anxiety. You can begin making dietary and lifestyle changes to reduce anxiety. Seeing a doctor for evaluation and a safe treatment plan is a great first step to eliminating caffeine-induced anxiety

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Many foods help calm anxiety and stress. It can be daunting to how and when to make dietary changes to reduce anxiety and lower the effects of stress. Starting small is a great way to go about it, substituting a few healthy foods for processed ones - one at a time. To that end, we have five foods that help calm anxiety and stress that you can add to your diet immediately. Small changes make big differences in mental health.

Knowing why certain options are good foods for anxiety and stress can motivate you to eat healthily. In general, consuming the proper nutrients:

• Allows the brain to produce necessary neurotransmitters such as serotonin, dopamine, and gamma-aminobutyric acid (GABA), chemicals needed to regulate mood and decrease anxiety
• Decreases cortisol, adrenaline, and other stress hormones
• Lowers blood pressure, which is not only good for heart health but also will positively affect anxiety
• Boosts your immune system, which will keep you healthy—when we’re physically unwell, we suffer stress, anxiety, and other mental health problems
• Increases blood flow to the brain to help the brain function well, thus reducing brain-based causes of anxiety
• Decreases stress-related negative emotions

Incredibly, foods for anxiety and stress are easy to find, prepare, and eat. They’re everyday foods found in your local grocery store or farmer’s market. 

5 Foods That Help Calm Anxiety and Stress and How they Work

This short list of foods that help calm anxiety and stress can make a huge, positive impact.

1. Dark Chocolate. Pure dark chocolate is made with cacao. The higher the percentage (it’s usually indicated on the label), the better for your brain. Dark chocolate drops the levels of the stress hormone cortisol. Cortisol contributes to symptoms of anxiety.
2. Pistachios. (And almond and walnuts, too). These are a source of Omega-3 fatty acids, healthy fats essential for brain functioning. Omega-3s form brain chemicals, facilitate better nerve transmissions, contribute to new cell creation, and reduce inflammation. Through these important functions, Omega-3s contribute to the reduction of anxiety and stress.
3. Grilled or Baked Chicken on Whole Grain Bread. A sandwich like this provides your brain with amino acids (from the protein) it needs to make neurotransmitters, hormones, and enzymes and improve anxiety on the neurochemical level. Whole grains are a type of complex carbohydrate that also stimulate the production of neurotransmitters as well as provide the energy needed to combat stress. Further, complex carbs have a calming effect, a welcome experience when you’re accustomed to anxiety and stress.
4. Salt. Season your chicken sandwich with a pinch of salt (and only a pinch, because salt can cause harm such as increased blood pressure). The adrenal glands, which produce cortisol and another stress- and anxiety hormone called aldosterone, need sodium for regulation.
5. Salad. Add a salad to your sandwich. Don’t like salad? Deconstruct it and eat the produce in separate bits. Fruits and vegetables are foods that help calm anxiety and stress.
   
   Particularly good choices are avocados, spinach, and oranges.
   
   Avocados contain Omega-3s and potassium; potassium decreases blood pressure and helps stress. Spinach has magnesium, which is used by the hypothalamic-pituitary-adrenocortical (HPA) axis. This is our stress-response system, and improper functioning is linked to anxiety. Magnesium also facilitates proper communication between neurons. Oranges and other foods rich in vitamin C curtail creation of stress hormones.
   
   We hear the message so often: eat your fruits and vegetables. It’s repeated for a reason. The nutrients in plants are good for our entire mind-body system. They’re high on the list of foods that help calm anxiety and stress.

When choosing foods that help anxiety and stress, think simplicity. So often in life, simple things are best. These five foods, eaten regularly, will make a big difference in your mental health (learn which foods cause, trigger or worsen your anxiety). Customize them to your own tastes, and gradually add others. Your brain will thank you by functioning well to stave off anxiety and stress.

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A positive mental attitude is not something we associate with depression. In fact, the symptoms of depression tend to bring about quite the opposite. However, working on developing positive thoughts can be highly beneficial for your mental health. A positive attitude does not mean faking a smile and feeling optimistic about everything, either ("Does False Positivity, Fake Positivity Help or Hurt You?"). As we all know, doing either of these things can be impossible when you have depression. Luckily, there are things you can do to develop a positive mental attitude despite your mental illness.

Achieving a Positive Mental Attitude During Depression

A positive mental attitude is a great defense against mental illness. Thinking positively can help you approach your mental health with constructive actions and techniques with the belief that you can and will get better. This last part is particularly important, as hopelessness is a common feature of depression, and it can make you feel as though you will never get better.

This is the illness talking, however. Although your suffering feels personal to you, depression is not unique. Millions of people suffer from depression in various forms, and millions of people recover. The commonality of the illness means it is one of the easiest mental health conditions to treat. Some people with depression go on to do inspiring things with their lives, such as write books, become movie stars or become politicians, so there is no reason to hold yourself back.

Positive Actions for Depression

Let’s turn to positive actions you can take against depression ("How to Be More Positive When You’re Depressed"). A technique often used in therapy is to look at a problem and come up with a list of positive actions you can take to resolve it. You can do this in your head, but it is most effective written down on a piece of paper.

• Problem-Solving

Create two columns. The first column should be entitled “Problems”. This section can be filled out with negative thoughts, things about your life you would like to change, circumstances such as a job loss or break up and just about anything that makes you feel negative.

The second column is for “Solutions.” This is where you will write down the possible actions you could take to resolve or improve upon the problem.  If you come across a problem you have no control over, simply move it to a new page called “Trash.” You are still writing these problems down, but they are no good to you. Hence, you are mentally moving them to your “trash” folder. 

• Self-Soothing

During depression, you won’t always have the motivation for problem-solving. This is why it’s important to self-soothe when you need a little extra care. Examples of self-soothing include anything that makes you feel calm and positive, such as taking a warm bath, journaling, listening to music or exercising. According to CBT techniques, you should focus on five senses when self-soothing: touch, taste, smell, feel and hear. Experiment with self-soothe activities to discover what grounds and calms you most effectively.

Achieving a Positive Mental Attitude with Depression

With a little work and self-care, achieving a positive attitude with depression is not so far-fetched as you might think. There are plenty of things you can try to help yourself recover from a mental illness, whatever recovery looks like for you. They key is building habits into your daily lifestyle and keeping track of your symptoms. That way, if you feel yourself slipping into low moods, you can use the techniques you’ve acquired to help yourself feel better.

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Good foods for anxiety nourish your brain so it functions well. Anxiety can have a strong neurochemical component, which means that the brain is operating in ways that cause you to feel anxious. The brain’s workings—production of neurotransmitters and operation of all its areas and structures—are powered by the food we eat and liquids we drink. Good foods for anxiety, foods that help anxiety, are those that provide what the brain needs for wellness. Here’s a look at which good foods help anxiety.

It’s important to have the right mindset when thinking about foods for anxiety. Despite occasional claims to the contrary, there isn’t a miracle food out there that will cure anxiety. A nutritious, balanced diet is an important component in creating and maintaining a life with lessened anxiety.

Because anxiety is always there (at least for now), it’s important to reduce it by doing something steady and constant. Ingesting good foods for anxiety for meals and snacks supplies a continuous stream of nutrients for the brain to get well and stay well.

Nutrients Found in Good Foods for Anxiety

Researchers have pinpointed some of the essential nutrients for brain health in foods for anxiety relief. These include:

• Magnesium
• Iron
• Zinc
• The B vitamins (folate, B12, niacin, and many more)
• Tryptophan
• Antioxidants
• Omega-3 fatty acids
• Probiotics

The brain uses these vitamins, minerals, fats, amino acids, and bacteria (probiotics) to do its job. For example, the brain makes its own neurochemicals (serotonin, dopamine, GABA, and others). How does it make them? By using amino acids such as tryptophan in the protein we eat. Some nutrients increase blood flow to the brain. Others reduce molecules called free radicals that are known to damage cells.

Foods that help reduce anxiety contain these vital nutrients. It’s easy to find these foods, and there are so many that you’ll quite likely find several that you can enjoy while simultaneously lowering your anxiety.

Examples of Foods that Help Anxiety

Good food for anxiety comes from a variety of sources. The above nutrients are found in proteins, complex carbohydrates/grains, fruits, vegetables, and dairy.

Important to foods and anxiety is to what degree they are natural versus processed. The closer a food is to its natural state, the better it is for brain health. As foods are refined and processed, natural nutrients are removed, and oftentimes unhealthy ingredients like msg, trans fats, and hydrogenated oils are added.

Good foods for anxiety are pure rather than processed. These examples are categorized for convenience, but you will likely notice that food in one category could also fit into others. Here, each item is placed in only one category for the sake of space.

Dairy

• Cheese
• Milk

Grains

• Brown rice
• Oats
• Quinoa
• Whole grain bread
• Whole grain pasta
• Whole grain rice

Nuts and Seeds

• Almonds
• Sesame seeds
• Sunflower seeds
• Walnuts

Omega-3 Fatty Acids

• Albacore tuna
• Salmon

Probiotics

• Fermented foods (pickles, sauerkraut, kefir, etc.)
• Yogurt with probiotics

Produce

• Asparagus
• Apricots
• Artichokes
• Avocados
• Bananas
• Beets
• Blackberries
• Broccoli
• Carrots
• Celery
• Dark chocolate (in this category because, like some produce, it has antioxidants)
• Dark green leafy vegetables
• Leeks
• Onion
• Oranges
• Peaches
• Pineapples
• Potatoes
• Raspberries
• Squash
• Strawberries

Proteins

• Beef
• Chicken
• Eggs
• Legumes
• Peanut butter (and other nut butters)
• Pork
• Soy products
• Turkey

Good foods for anxiety sometimes aren’t foods. Beverages have an impact on brain health, too. As with food, opt for pure. Water, green teas, and herbal teas help anxiety by hydrating your body and brain and calming anxiety and stress. If your anxiety is exacerbated by caffeine, avoid coffee.

To be sure, the above lists aren’t comprehensive. The foods named have all been found by researchers to be good foods for anxiety. There are other foods, too, that help anxiety. The more natural they are, the better they are for your brain.

When it comes to foods for anxiety control, strive for a healthy balance. Select items from the above categories every day, and reduce the number of processed foods you consume. When your brain is equipped with the proper tools—nutrients—it requires, it will run smoothly. Good foods truly do help anxiety.

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The connection between caffeine and anxiety is as strong as a double shot of espresso. Caffeine stimulates the central nervous system (CNS) and therefore has a direct impact on the brain and spinal cord. The caffeine we put into our bodies irritates the CNS, leading to multiple responses. One such response is felt in the connection between caffeine and anxiety. Caffeine can aggravate existing anxiety and panic disorders, and it can contribute to the development of new anxiety. Understanding caffeine and the CNS can help you make caffeine-related decisions that are right for you and your anxiety.

The Connection Between Caffeine and Anxiety: What Does Caffeine Do?

The US National Library of Medicine’s Medline Plus lists people who should avoid caffeine. On that list are people experiencing anxiety. When you consider just a few of the effects of caffeine in the body, it makes sense. For the average person, more than 250 mg of caffeine per day (the equivalent of 1 or two cups of coffee, several cans of soda, or two eight-oz energy drinks) can cause:

• Restlessness
• Nervousness
• Shakiness or the "caffeine jitters"
• Agitation
• Pounding heart
• Sweating
• Sense of impending doom
• Fearful, worrisome thoughts and emotions
• Insomnia

These are all symptoms of anxiety. If you don’t have anxiety, caffeine can make you feel like you do, and in some cases, caffeine causes anxiety (see more foods that cause, trigger or worsen anxiety).

But why? Why is there a strong connection between caffeine and anxiety? We ingest caffeine, and it wreaks havoc.

There are many ways caffeine contributes to and aggravates anxiety. Caffeine:

• Increases stress hormones
• Reduces levels of important neurotransmitters
• Decreases blood flow to the brain
• Depletes magnesium in the body
• Depletes the body’s B vitamins
• Conflicts with female hormones estrogen and progesterone

All these effects work in concert. For example, with the caffeine-induced depletion of magnesium and B vitamins, the neurotransmitters that calm us and reduce anxiety—serotonin, dopamine, epinephrine, and gamma-aminobutyric acid (GABA)—aren’t produced in the quantities the CNS needs. GABA is associated with panic attacks; without enough of this neurotransmitter, many people become more prone to panic.

Magnesium is an important mineral that caffeine unduly excretes from the body. Magnesium plays a significant role in our mental health, including staving off depression and anxiety. The more caffeine we consume, the fewer essential nutrients stay in our bodies to feed the brain well for mental health.

Blood flow supplies the brain with everything it needs to operate well. Caffeine partially dries up this rich river, thus restricting the oxygen, water, glucose, amino acids, vitamins, and minerals the brain uses to make neurochemicals and function smoothly in all its roles. Researchers have discovered that caffeine can reduce blood flow to the brain by 27% (Addicot, et al., 2009).

Think of your own health, wellbeing, and functioning when you are dehydrated and hungry. You might get weak, cranky, have a hard time focusing and making decisions, and anxious. So does your brain, and a depleted brain can be an anxious brain.

Caffeine can cause anxiety problems in women by disrupting the production and flow of female hormones. Symptoms of both menopause and PMS—including anxiety—can worsen with caffeine consumption.

Another Reason for the Connection Between Caffeine and Anxiety

Caffeine and anxiety team up to cause angst. A big part of the reason for this is the way caffeine acts in the body and impacts the brain. Another explanation that can be relevant for some people in some circumstances is that the brain thinks there is something other than caffeine causing anxiety.

It’s a learned association, and it happens as a self-protection mechanism. Someone has a panic attack or experiences severe anxiety in a given situation. The bran associates the circumstances and the environment with the anxiety and panic, and the relationship to caffeine consumption is lost.

Of course, this isn’t always the case. It happens often enough, though, that it’s worth paying attention to. If you’re prone to panic attacks, what, exactly, is happening when you have them? Can you point to a consistent connection between caffeine and your anxiety or panic attack? For example, do you experience horrible anxiety when you arrive at work every morning? Maybe it’s situational, but is there a chance that it is courtesy of your morning coffee?

Also, watch for when your anxiety spikes. Caffeine’s effects typically peak about an hour after consumption, but the effects can last for up to six hours. If your symptoms are striking hours after that energy drink, you could be experiencing caffeine withdrawal anxiety.

Each person’s sensitivity to caffeine is unique. The knowledge that caffeine can cause new anxiety to begin and existing anxiety to worsen can be a useful tool for reducing anxiety. If you consume caffeine and experience anxiety, you might consider tapering the caffeine to see if your anxiety goes down with it.

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PTSD nightmares and flashbacks keep people trapped in the trauma they survived (PTSD Causes: Causes of Posttraumatic Stress Disorder). Giarratano (2004) explains that living with PTSD is like living in two worlds at once: the trauma world and the now world. The trauma survivor lives and tries to function in the now world, but nightmares and flashbacks keep him/her simultaneously stuck in the world of the trauma. Understanding PTSD nightmares and flashbacks can help people leave the trauma world behind.

What are PTSD Nightmares and Flashbacks?

PTSD nightmares and flashbacks are part of the intrusion effects of PTSD. With both, distressing memories repeatedly and disruptively intrude into the person’s life and functioning.

PTSD nightmares involve terrifying dreams that plague survivors at night, while PTSD flashbacks are recurrent, involuntary memories of the trauma that torment people during waking hours. Both nightmares and flashbacks are disruptive to someone’s life in the now world.

Understanding PTSD Nightmares

Nightmares are common among trauma survivors experiencing PTSD. Between 71 and 96 percent of people living with PTSD have nightmares multiple times per week; when people also have other mental disorders such as depression or anxiety, the likelihood of nightmares increases (National Center for PTSD, 2015).

Whether they directly replay the trauma or include patchy elements of the trauma, PTSD nightmares are frightening because they involve both emotional and physiological reactions. These intrusive experiences cause

• Fear
• Anxiety
• Helplessness
• Panic (sweating, pounding heart, difficulty breathing, thrashing about)
• Screaming or crying in sleep

As horrible as PTSD nightmares are in the moment, their negative effects don’t stop there. PTSD nightmares can have devastating consequences for someone’s sleep. When dealing with PTSD nightmares, someone has

• More REM sleep activity than normal
• More night-time awakenings and longer periods of being awake
• Decreased amount of deep, restorative sleep
• Decreased total sleep time
• Problems functioning well in all areas of life (work, school, relationships, etc.) during the day

PTSD nightmares have other harmful consequences. Nightmares

• Keep someone in the trauma world of fear and heightened arousal
• Can make people avoid sleep because sleep has become as scary as being awake
• Can lead to substance use as an attempt to escape

The nightmares of PTSD are about so much more than vivid, disturbing imagery in dreams. Nightmares are emotional and physiological, and they become a quality-of-life issue.

Understanding PTSD Flashbacks

Flashbacks are strong, overwhelming memories that involve all of the senses, and they are reinforced by crushing emotions. A PTSD flashback keeps someone rooted in the trauma world because it is a living memory.

In PTSD, the memory of the trauma is never far away, so it doesn’t take much to make a memory intrude into someone’s now world. Sometimes, flashbacks are triggered by something, anything that is in some way reminiscent of the trauma. A reminder wraps itself around the person, intrudes into his/her mind, and takes over all senses and emotions so that he/she is reliving the trauma as if it were happening now.

Sometimes, flashbacks happen without triggers. When a person is already stressed, anxious, fatigued, or emotionally upset he/she is more easily sucked back to the trauma. It’s almost as if the person’s fragile or volatile emotional state is the trigger that pulls them deep into the disturbing memory.

Treating PTSD Nightmares and Flashbacks

Treating the nightmares and flashbacks of PTSD is possible, but it can be a slow process (Treating Anxiety Related Sleep Disorders). Therapy can help someone end these intrusion symptoms that negatively affect his/her quality of life.

Ideally, treating nightmares and flashbacks is a component of overall PTSD treatment. Some specific treatment approaches for PTSD nightmares and flashbacks include:

• Image Rehearsal Therapy (IRT) for nightmares involves, during the day, changing the ending of the nightmare and replaying this over and over so that eventually the new dream will replace the PTSD nightmare
• The PTSD medication, Prazosin, for nightmares (sometimes)
• Exposure to traumatic imagery to desensitize one’s reaction to flashbacks
• Stress reduction and relaxation techniques
• Orientation techniques to ground someone in the now world during a flashback or after a nightmare

PTSD nightmares and flashbacks take over someone’s body and emotions and plant him/her in the middle of the trauma world. Understanding PTSD nightmares and flashbacks can help someone stay rooted in the now world.

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Sometimes, we need anxiety relief right now. Of course, working on long-term solutions to overcome anxiety is the ultimate goal, but while we’re progressing toward this, there are times when relief in the moment is essential.

Get Anxiety Relief Right Now with These Tools

The following techniques can help you get stress and anxiety relief.

• Distraction. Shifting our thoughts and attention onto something else in the vicinity reduces anxiety in the moment. Carry a small object with you that you can manipulate, focus on unwrapping a piece of gum and then on the experience of chewing it. Count things around you. Give your mind a distraction from anxious thoughts.
• Be mindful. Using mindfulness for anxiety is similar to distraction and involves being fully present right here, right now. Use all of your senses to pay attention to anything other than anxiety.
• Move. Walk up and down stairs, walk around the block, do jumping jacks, or jog in place. Do anything that gets you moving in order to reduce stress hormones like cortisol and increase endorphins, decrease muscle tension, and shake loose stress and worry.
• Plug into music. Carry with you your music player and earbuds to have on hand for a quick relief from anxiety. Create a playlist of music that you like. Music can be either calming or energizing, depending on your needs at the moment. Some research has shown that Mozart, Gregorian chants, New Age, and jazz have a particularly strong impact on reducing anxiety (Clark, 2006). Feel free, however, to use any music that is helpful to you.
• Laugh. Take a humor break from what you’re doing. YouTube is a great source of humorous videos. You can also use audio books of comedians you enjoy. When your anxiety skyrockets, laugh. Humor is a useful, and pleasant, anxiety relief technique.
• Breathe. When anxiety strikes with a vengeance, step away from what you’re doing and engage in deep breathing exercises because slow, deep breathing induces relaxation in the brain and parasympathetic nervous system.
  • An effective quick-relief technique is to combine slow, deep breathing with muscle tensing and relaxing. Even balling your fists while inhaling, holding, and then releasing them slowly while exhaling is enough to relieve anxiety.
  • Another quick relaxation breathing technique is to inhale slowly while raising your arms overhead and exhale slowly while lowering them back to your sides.
  • See Breathing Exercises for Anxiety Work! Try These for more suggestions.
• Run through the LLAMP technique, named by Dr. Chad Lejune (2007). The LLAMP process is meant to be practiced over time for a long-term solution to anxiety; however, it can be very effective for quick-relief too, once you know the process.
  • Label your worry thoughts (are you catastrophizing, engaging in all-or-nothing thinking, or other automatic negative thoughts that are part of anxiety?).
  • Let go of the impulse to control your situation and your anxiety
  • Accept: just notice your thoughts and feelings, and accept them rather than fighting against them.
  • Mindfulness: Pay attention to what is around you in the present moment. Notice with your senses.
  • Proceed in the right direction. Move toward what you need to do.
• Just be with your anxiety, an anxiety relief technique that is similar to the LLAMP technique. When we fight with and struggle against anxiety, it actually grows stronger and more powerful because we’re giving it our energy and attention. So when your anxiety escalates in a certain situation and you need quick relief, relax and let your anxiety hover while you ignore it, giving you space to shift your attention. If you’d like, you can visualize your anxious thoughts drifting through and away on fluffy clouds.

These techniques for stress and anxiety relief can be immediately helpful in an anxious moment. Rather than complete eradicating your anxiety, they allow you to let off some steam, calm and relax your mind, or both, so you can keep going right now, despite anxiety. Anxiety relief techniques provide the quick relief needed so you can say, “I’ve got this,” as you keep moving forward.

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Sex Facts:

1. More than 44 percent of men and women initiate sex as often as their partners. Unfortunately, that means that at least half of us are less than equal in the bedroom.
2. About 36 percent of American men and women have sex a few times a month. While "a few" may sound vague, it means something like not every week but not just twice a year, either.
3. About 70 percent of Americans make love for 15 minutes to one hour. Maybe because there's a 45-minute leeway? Who knows? Across all boundaries -- gender, age, marital status, education, religion, race, and ethnicity -- this is the time frame that most of us work within.
4. Most men's erections are five and a half to six inches long. Although men's penis sizes tend to vary greatly when they're soft, the smaller ones expand more when erect than the larger ones. So, don't go by your locker-room size 'cause in the bedroom, they're all pretty much the same!
5. As long as it's not interfering with your real-time relationships and responsibilities, there's nothing wrong with thinking about sex a few times a day. If you're a guy, you more likely to fantasize about sex with strangers, sex with more than one person, or forcing someone to have sex with you. If you're a woman, your sexual thoughts most likely involve romantic locations and being forced to have sex. Remember, though: FANTASY IS NOT REALITY!! We all have the power to control what goes on in our own little minds which we don't always have in real life. Keep 'em separate!
6. Rates for male sterilization have actually dropped slightly over the years, while rates of female sterilization have gone up.
7. About 51 percent of 18- to 44-year-old women and 49 percent of 45- to 59-year-old women are somewhat turned on by watching their partners undress. About 43 percent of younger men (18 to 44) and 47 percent of older men (45 to 59) are somewhat turned on. That's an awful lot of you! Strip poker anyone?
8. About 59 percent of men and 84 percent of women think any type of "extra" stimulation (cybersex, porno, strip clubs, etc.) is filthy, illegal, and unnecessary. You're probably also not as sexually satisfied as some of the folks who do take advantage of the stuff. Just so you know, there are sensual movies (rather than the more hardcore stuff) and erotica written by and for women. It's not ALL "filth."
9. One out of every six people has had hepatitis, urethritis, PID, or syphilis. And these diseases are much more likely to be transmitted from person to person than HIV.
10. A reputable research study found that "most" of the men they interviewed "have experienced performance failure." In the infamous, most recent, Hite Report on Sexuality, 70 percent of the men said that they had ejaculated more quickly than they'd liked to at least once. So, if it's only happening occasionally for you, you've got nothing to worry about. On the days it happens, simply lavish your sexual attentions on your partner!
11. Just so know, here's more sex trivia: 42 percent of women usually have orgasms during sex with their primary partner, 29 percent always have an orgasm during sex, 25 percent sometimes or rarely have orgasms, and 4 percent of women in America are not orgasmic with their partner.
12. One study states that 70 percent of married men and women sometimes stimulate themselves. Funny, married folks, who also are supposed to be "getting it" more, are masturbating more too. Sounds like a good sign!