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PTSD Trauma

Recognizing Trauma and Stressor Related Disorders in Teens

Trauma and stressor related disorders, sometimes commonly referred to as post-traumatic stress disorder (PTSD), can be characterized by aberrant symptoms following a period or event of extreme stress, with various recurring reactions, behaviors, thoughts, and other symptoms ranging from restlessness jitters to panic attacks, extreme irritability, and more.

PTSD symptoms differ from age group to age group. The condition can occur at any point in a person’s lifetime. The only prerequisite for PTSD is trauma – while there is a genetic component in how likely PTSD is to occur after a harrowing event, anyone can be affected by PTSD.

When a teen develops PTSD or trauma and stressor related disorders, their stress response system is no longer functioning the way it should. This can lead to several issues during everyday situations, such as being hyperaware and constantly on-edge, or dissociating from life and reacting seemingly cold or emotionless.

While PTSD used to be considered a type of anxiety disorder, it has since been recategorized as a trauma disorder due to trauma and stressor related disorders having their phenotype characteristics, including dissociative symptoms and extreme irritability.

However, teens with PTSD are also more likely to struggle with comorbidity in the form of depression and anxiety. They may be more susceptible to co-occurring substance use disorders and high-risk behaviors such as self-harm. Recognizing trauma and stressor related disorders in teens is essential because specific symptoms can be mistaken for “normal” teen behavior.

What Does PTSD in Children and Teens Look Like?

Children and teens can react differently to trauma than some adults do. In younger school-aged children, PTSD symptoms may include reliving or re-engaging in traumatic experiences through play (either with toys or virtually). It is thought that younger children have a more challenging time recalling the order of traumatic events.

Teens are more likely than children and adults to react aggressively after trauma and are more likely to develop impulsive behaviors as part of their PTSD. From here, signs and symptoms vary wildly. Some of the signs of PTSD in children and teens include:

    • Avoidance of certain situations or events
    • Nightmares and flashbacks in older children
    • More impulsive behavior
    • Frequent nervousness, restlessness, being on-edge
    • Acting numb or distant
    • Trouble focusing on tasks and academics

The DMV-5 utilizes eight sets of criteria with their symptoms to define and diagnose PTSD in individuals, further providing information about how the disorder might manifest. These criterion sets include:

    1. A significant stressor/traumatic event(s)
    2. Intrusive symptoms (unwanted thoughts, flashbacks, and nightmares)
    3. Avoidance symptoms
    4. Adverse changes in mood and memory (i.e., trouble remembering things)
    5. Changes in arousal and reaction (greater aggression, easily startling, hypervigilance)
    6. Duration (symptoms lasting more than four weeks)
    7. Functional significance (symptoms must create distress and impact social life, school life, work, etc.)
    8. Excluding other reasons (symptoms cannot be explained by medication, other illnesses, substance use)

Some of these signs may be more obvious than others. It is also understood that there are dissociative variants of PTSD (where the primary characteristic is a “disconnection” from reality) or other trauma and stressor related disorders.

Defining Other Trauma and Stressor Related Disorders

A traumatic experience is one that leaves a lasting negative impression. Ultimately, many of us experience traumatic events in our lives. Losing a loved one, witnessing a natural catastrophe or accident, or being the victim of a crime can leave a lasting and significant impact. However, each person processes trauma in different ways.

In some cases, the damage can be so severe that it lingers for months and bleeds into every waking moment. Flashbacks, avoidance symptoms, and hypervigilance are just some of how the mind tries to cope with an event or horror that has left an impression too great to overcome without help and therapy. Some of the other ways in which trauma can leave a lasting impact include:

Acute Stress Disorder

Acute stress disorder (ASD) shares many of the same symptoms as PTSD. Still, its onset is almost immediately after a traumatic event, lasting for at least two days and less than a month. Sometimes, ASD develops into PTSD if symptoms persist past a month.

Adjustment Disorders

Adjustment disorders are defined as adverse changes in thought or behavior in a teen following a traumatic event, usually below the threshold for a PTSD diagnosis.

Reactive Attachment Disorder

Reactive attachment disorder (RAD) is characterized by withdrawn behavior. It is typically caused by extreme neglect or social deprivation. A teen with RAD may display limited or lacking emotional responses and low empathy or remorse.

Disinhibited Social Engagement Disorder

Disinhibited social engagement disorder (DSED) is characterized by a lack of inhibition when interacting with strangers. Children and teens with DSED may be overly friendly or welcoming towards people they don’t know, for no apparent reason. It’s a different form of response to extreme neglect and social deprivation.

Other Dissociative Disorders

Dissociative disorders, such as dissociative identity disorder (DID), dissociative amnesia, and depersonalization disorder, are often the result of an extreme stressor or traumatic experience, causing a person to separate themselves from the experience of reality itself.

Grief-Related Trauma

The loss of a loved one causes bereavement disorders. While it’s normal to be in pain when we lose someone we love, specific symptoms – such as intense grief over a year after the death, significant impairment due to distress, preoccupation with the deceased, etc. – may indicate a disorder.

Treating Trauma and Stressor Related Disorders in Teens

Treatments for trauma and stressor related disorders depend on the severity of the condition and the types of symptoms present. Talk therapy is an integral part of the treatment process, and therapists may leverage specific techniques to help teens better process their emotions and regulate responses or gradually approach and confront particular events. Trauma-specific treatments meant to address stressors include:

Eye Movement Desensitization and Reprocessing (EMDR)

This approach to treatment utilizes guided eye movements to change how a person reacts in response to triggers.

Exposure Therapy

Although it sounds drastic, exposure therapy encompasses several different therapy types to overcome their fear or trauma in a safe environment.

Cognitive Therapy

This type of talk therapy aims to help patients become aware of the relationship between their thoughts, behaviors, and mood and recognize patterns in thinking and behavior associated with their PTSD. Identifying these patterns can help in slowly altering them over time.

Treating PTSD in teens is difficult at any age, under any circumstances. Trauma is powerful, and it takes time and support to overcome these emotional and physical responses slowly. However, with consistent therapy and help from friends and family, long-term treatment can significantly reduce symptoms.

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PTSD Trauma

Recognizing the Symptoms of PTSD in Teens

Post-traumatic stress disorder (PTSD) is a serious and potentially underreported issue among teens. Sources of trauma are varied and can include both acute and chronic causes such as child abuse, school shootings, gang violence, and automobile accidents. Left undiagnosed or inadequately treated, PTSD can lead to several comorbid mental health conditions, a much higher rate of suicide, and trouble with social interaction.

Among children and teens, about 14-43 percent experience a type of trauma. Roughly 3-15 percent of young girls and 1-6 percent of young boys are diagnosed with PTSD. Among teens identified with PTSD, 47 percent were recorded to struggle with depression as well. Diagnosed teens were more likely than their peers to engage in high-risk behaviors and self-harm, and had trouble adjusting to and interacting with peers without PTSD.

While it’s a condition that affects millions of Americans, PTSD (and trauma in general) can often be misunderstood. It’s important to recognize the early symptoms of PTSD in teens and children, in order to seek help as early as possible.

Defining Trauma

Trauma and traumatic events are two separate concepts. Trauma is a personal emotional response to a severe event, or a chronic accumulation of overwhelming stressors. Not all traumatic events cause trauma in a person, and not all instances of trauma lead to a disorder. Trauma is, despite its terrible nature, a normal response. We go through emotional and physical shock after a sudden loss, assault, or other type of traumatic event.

Similarly, being exposed to upsetting situations repeatedly can also cause trauma, such as with first responders to mass casualty events, social workers, medical professionals, soldiers, and police officers confronted with violent cases. Like a buzzer, some of these examples can eventually cause shock to run through our system. In rare occasions, a traumatic response can leave the buzzer on almost permanently.

Rather than being in a state of shock and denial for a few days to a few weeks, the symptoms and feelings of trauma might persist for months and years. When the personal response to a traumatic event is particularly severe or long-lasting, it becomes a disorder. While the main cause of PTSD is trauma, there are factors that make it more or less likely for teens to develop PTSD. Recurring trauma increases the chances of PTSD, for example, as does a history of anxiety and traumatic stress in the family.

Being left alone or having no system for support or recovery after trauma can also cause it to linger for much longer and develop PTSD. PTSD can cause a change in the brain’s reaction to stress, especially anything reminiscent of the trauma, and one aspect PTSD is that it causes the body’s fight-flight-freeze response to go haywire.

The Three Main Symptoms

When trauma lingers and develops into PTSD, it continues to leave a mark on a person’s life in one or more ways, usually along the lines of three basic symptoms:

    • Re-experiencing: Symptoms people usually think of when they think of PTSD tend to be forms of re-experiencing – flashbacks, bad dreams, sudden images and intrusive thoughts, and unwanted recollection. Sometimes, symptoms of re-experiencing are triggered by outside reminders. At other times, they can occur out of nowhere.
    • Avoidance: Some people develop emotional numbness to anything associated with the trauma. They avoid or grow distant towards people, places, and things. Avoidance in PTSD can be extreme and may even include signs of dissociation or disconnection from oneself or reality.
    • Agitation: These are symptoms of extreme alertness and arousal. Someone who is excessively jumpy, easily angered, and struggles with sleep may be experiencing symptoms of agitation.

Most symptoms of PTSD fall within the three major categories of symptoms and represent intense unresolved fear and unconscious attempts at coping with that fear. Due to PTSD’s effects on the brain and the way we perceive stress, teens diagnosed with PTSD may be more likely to develop comorbid mental health conditions and are more susceptible to things like substance use disorder.

Common Signs and Symptoms of PTSD in Teens

Some of the signs of PTSD in teens include:

    • Panic attacks
    • Recurring nightmares after the fact
    • Restlessness and insomnia
    • High irritability
    • Easily startled
    • Emotionally numb or distant
    • Isolating oneself from friends and family
    • Avoiding places and things
    • Struggling at school or work
    • More open to high-risk behavior
    • More likely to react violently towards others (this is more common among teens than children or adults)
    • Struggling to maintain a relationship
    • Openly discussing suicidal ideas
    • Reacting viscerally to traumatic triggers (heart rate hikes, hyperventilation)

Researchers find PTSD symptoms differ slightly between children, teens, and adults. For example, children are likely to incorporate elements of their trauma into play, because they are reliving their trauma by re-enacting it. Teens tend to display more violent behavior if exposed to violence versus children or adults.

PTSD vs. Acute Stress Disorder

Acute stress disorder (ASD) is a different condition that arises in the first month after a traumatic event. When someone is exhibiting severe symptoms similar to PTSD immediately after a horrific event, they are generally experiencing ASD. These symptoms become PTSD when they last longer than a month.

Another difference is that PTSD symptoms can and do sometimes occur with a delay – a teen can survive a tragic accident or terrible assault and be “fine” for weeks and months, and then begin displaying symptoms of PTSD months after the event occurred. Extremely rare cases have even recorded PTSD onset occurring a year after trauma.

Seeking Help

A diagnosis of PTSD is not made lightly. It is normal to feel shaken up after a traumatic event. But it is equally important not to dismiss what might be a mental disorder. PTSD can leave its mark on the brain and turn every day into a nightmare. Seeking help as early as possible can help reduce the impact PTSD has on a teen’s life. Consider seeking a diagnosis from a psychiatrist or take a screening test and bring the results to a mental health professional.

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Mental Health PTSD Recovery

Treating PTSD in Children and Adolescents

Post-Traumatic Stress Disorder (PTSD) is not just for adults:

it also occurs in children and adolescents. Children and teens that witness violence and have post-traumatic stress symptoms require psychological care, but studies are suggesting that while children may experience the full range of post-traumatic stress symptoms, the manifestation of symptoms can differ from that of an adult.

 

The Journal of Pediatric Psychology says, “in the DSM-IV, eight criteria require verbal descriptions of experiences and emotional states. The lack of developmental modifications may result in an under-diagnosis of PTSD. “(Pynoos, Steinberg, & Goenjian, 1996). Scheeringa et al. (1995) Additional  “evidence suggests that children may experience disabling PSS (post-traumatic stress symptoms) that warrant treatment, but not meet criteria for PTSD (Carrion, Weems, Ray, & Reiss, 2002).

 

What has become crucial in defining this diagnosis for adolescents is the way in which clinicians understand how PTSD presents in youth. There is still a debate within the field of pediatric psychology about whether or not distinct youth criteria should be established — thus far, post-traumatic stress symptoms have been assessed primarily using criteria outlined for adults.  When assessing youth for PTSD, the adaptation for youth includes the “simplification of language and concepts.” However, there continues to be discussion amongst clinicians about the need for separate qualifiers for youth.

 

Symptoms of PTSD might include classic stress responses such as nightmares, fear and a general response to distress, but according to the American Academy of Child and Adolescent Psychiatry, there may be some symptoms unique to children and adolescents like:

 

  • Reenactment of the event
  • Regressed behavior
  • Separation anxiety,
  • Specific forms of behavioral, academic, and somatic problems”

Did you know: Between 25 and 87% of youth report experiencing at least one traumatic event before age 20, with girls reporting more episodes (Elklit, 2002)

 

Noelle Rodriguez, Psy.D. and Visions Outpatient Psychological Assistant shared some of her experience working with teens who suffer from PTSD. She listed some of the manifestations she sees and how she helps treat them:

  • High levels of depression because PTSD is misdiagnosed
  • Inability to formulate trusting relationships
  • Drug use to attempt to access or regulate feelings

Noelle also finds teens with PTSD also present with some or all of the following:

  • Poor time management
  • A need to find a voice but feels silent inside
  • Loss of self, feeling fragmented
  • Somatic symptoms i.e., body pains, headaches, etc.
  • Disassociation
  • Sexual promiscuously–looking to feel connected
  • Paranoia
  • Lack of boundaries, which leads to more mistrust

Noelle takes her PTSD clients through a process of deep, insightful work that helps them strive toward shifting their paradigm to include:

  • Empowerment;
  • Sobriety (if applicable) on their own terms;
  • Replacing maladaptive behavior with healthy behaviors, for example:
  • Learning to ask for help, finding a support group, becoming able to  recognize and identify PTSD symptoms before they have a chance to fully manifest
  • Self-care
  • Learn how to identify danger vs. safety
  • Develop tools with which to to deal with blame, shame and doubt
  • Time management
  • Honesty in relationships
  • Finding their voice and learning how to speak up for themselves
  • Learning to get grounded when one is in emotional pain.

 

Peter A. Levine, Ph.D, originator and developer of Somatic Experiencing and the Director of the Somatic Experiencing Trauma Institute has transformed the way in which I personally view PTSD.  He says in his book In an Unspoken Voice, “I hope to convey a deeper appreciation that their lives are not dominated by a ‘disorder’ but by an injury that can be transformed and healed.” Like Noelle, he talks about the need for someone working with PTSD to learn to self-regulate. Levine says this self-regulation “allows us to handle our own states of arousal and our difficult emotions,” and that it is what fosters the ability to “evoke a sense of being safely ‘at home’ within ourselves, at home where goodness resides.” Trauma work is a deep process. It involves learning how to hold ourselves with a sense of compassion while we look at the darkness that has swaddled our hearts.

 

So whether or not the DSM catches up, knowing that we have clinicians who are well versed in trauma work and who are willing to guide our youth to recovery is profound. Triggers eventually become tools we work with instead of against. And ultimately, with deep, consistent work, we develop the skills to change our relationship to our trauma and to heal.

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Depression Feelings Mental Health PTSD Recovery

Grief and Mental Health: Picking up the Pieces

(Photo credit: Wikipedia)

New trauma and despair is front and center in the US as the Sandy Hook Elementary School shooting unveiled the deaths of 20 children and 6 adults. The death of children is always shocking. The innocence and futures lost are rapidly exonerated from our grasp, leaving us breathless and frozen in grief. Families will begin to face the emptiness of their loss and the depth of their grief as the days continue. Additionally, the survivors, both children and adults, will potentially suffer from PTSD as a result of seeing and surviving such horrors. There will be deep sadness, depression, and self-doubt. There will be mental-health issues that need to be tended to, whether we like it or not.  Remember, grief is a staged process with no specific order or end date.

 

Mental health is once again in the headlines, screaming at us to pay attention and dive in to find a solution to a problem which is no longer able to sustain its place as the “elephant in the room.” The list of tragic and heinous events where someone possibly suffering from untreated mental health issues and acts out in egregious violence is getting longer and longer. We blame guns, we blame the parents, we blame the circumstances surrounding the events, but mental illness tends to be an afterthought or worse yet, an excuse. Parents who sit in denial of their child’s mental illness is a problem; poor circumstances and/or degenerative environments are a problem; and untreated mental illness is a problem. There are solutions to all of these problems, especially when we address them early on.

 

In the midst of our deep grief, it’s time to find a way to look at the causative factors that drives a human being to take the lives of innocent children. Our cultural denial and stigmatization of mental health is detrimental to the ultimate well being and healing of our society. In the 1980s, when the government closed several mental health facilities, placing many on the streets with their illnesses left untreated, we had a first glimpse of what mental health looks like when left out in the open: unaddressed and swept aside. This denial lends itself to putting our blinders on when it comes to the imbalances of our minds, pretending they’ll “work themselves out.” They usually don’t. The field of psychiatry has made great strides to discover and treat the varying mental illnesses that affect individuals, but the greatest barrier is typically the denial of the illness by families and the individuals themselves. We have to begin by asking for help. We must begin unraveling the stigma wrapped so tightly around mental illness and replacing it with treatment.

Some signs to watch for in your kids:

  • Often angry or worried
  • Feel grief for a long time after a death
  • Using alcohol or drugs
  • Sudden changes in weight
  • Withdrawal from favorite activities
  • Harming self or others
  • Recklessness
  • Destroying property: yours or others

The only stigma left is the stigma of denial.

SAMSHA also lists the following as types of people and places that will make a referral to, or provide, diagnostic and treatment services.

  • Family doctors
  • Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
  • Religious leaders/counselors
  • Health maintenance organizations
  • Community mental health centers
  • Hospital psychiatry departments and outpatient clinics
  • University- or medical school-affiliated programs
  • State hospital outpatient clinics
  • Social service agencies
  • Private clinics and facilities
  • Employee assistance programs
  • Local medical and/or psychiatric societies
Visions is just a phone call away. We are here to help!
Committed to the Family; Committed to the Future: 866-889-3665.
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Addiction Alcoholism Anxiety Mental Health PTSD Recovery

Addressing Recovery and Trauma

Image by Southworth Sailor via Flickr

A history of sexual violence can create an ideal environment for a variety of mental-health issues, addiction, and alcoholism. Often, the triggering event or events are hidden in the annals of one’s mind and perceived as shameful, deep, dark secrets too horrible to share…with anyone. As a result, drugs, alcohol, and risk-taking behaviors are often seen as the primary issue when one enters treatment. Time and again, we see that this isn’t always the case; That becomes clear when we look at it in terms of statistics:

  • One out of every 6 American women has been the victim of an attempted or completed rape in her lifetime (14.8% completed rape; 2.8% attempted rape)[1];
  • 29% are age 12-17;
  • 44% are under age 18;
  • 80% are under age 30.; 12-34 are the highest risk years.
  • Girls ages 16-19 are 4 times more likely than the general population to be victims of rape, attempted rape, or sexual assault;
  • 7% if girls in grades 5-8 (approx. ages 10-13) and 12% of girls in grades 9-12 (approx. ages 14-17) said they had been sexually abused;
  • 3% of boys grades 5-8 and 5% of boys in grades 9-12 said they have been sexually abused[2].

As I frequently tweet Intervention, one of the things I notice on a regular basis is the consistency in which the women on the show are frequently struggling with a history of sexual violence, and are using drugs, alcohol, and promiscuity as their  primary coping skill. From the outside looking in, it’s clear that the goal is to try to desensitize and anesthetize feelings of shame and guilt, et cetera; in other words, do anything and everything NOT to feel, remember, re-experience, or suffer from the emotional attachment to the event itself.

Twelve-step programs were written with specific goals in mind: to stop the alcoholic/addict from drinking and using. The steps work well in that regard, mostly because they are based on the disease model, addressing issues of alcoholism and addiction accordingly. However, the same tools provided to address addiction issues don’t always work in concert with mental-health issues, particularly those attached to sexual violence. We know the steps adequately provide an alcoholic/addict with the necessary skills needed to learn to take responsibility for and subsequently change their negative behaviors. They do so by asking the addict/alcoholic to take responsibility for their actions, face their fears, and acknowledge that they took part in creating their own demise. However, being sexually abused or raped isn’t a negative behavior to be changed but rather a causative, biting factor in things like:

  • Depression
  • Post-Traumatic Stress Disorder (PTSD)
  • Alcohol and Drug Abuse
  • Suicidal Ideation
  • Eating Disorders

What then, do we do from a recovery standpoint when the predominant disease model isn’t geared to address issues of this caliber? The Big Book, the 12-step primer, was written by men addressing men’s issues, in a time when women were typically viewed as the ones affected by their spouse’s alcoholism and not as the alcoholics themselves. As more women began to come forward as alcoholics and addicts, the tools didn’t always adapt to the new issues that arose because of gender disparity, but rather, they stayed the same, assuming a one-size-fits-all mentality.  In the cases of women dealing with sexual violence, being asked to take responsibility for an abuse event has the potentiality to create more or actually deepen the existing trauma, particularly if the innate issues of shame and guilt associated with it are ignored. The reality is, being victimized by sexual violence is not the fault of the victim. What does need to be addressed, however, is the anger, self-victimization, and negative behavioral byproducts occurring as a result.

We clearly have a multi-layered healing process on our hands, so first, the negative coping skills must be eliminated: Sobriety is an obvious first step and necessary component to support the healing process. Additionally, working with meditation and mind-body awareness techniques are also useful in helping one manage their anxiety, negative feelings toward oneself, and in re-building self-esteem. A therapist skilled in treating PTSD and this sort of trauma is also important, particularly since this is often a lifelong process.

It is in forgiving ourselves that we have the ability to become free.



[1] National Institute of Justice & Centers for Disease Control & Prevention. Prevalence, Incidence and Consequences of Violence Against Women Survey. 1998.
[2] 1998 Commonwealth Fund Survey of the Health of Adolescent Girls. 1998

Sources and support:
RAINN
One in Four
National Coalition Against Domestic Violence

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Addiction Anxiety Depression Mental Health Obsessive-Compulsive Disorder (OCD) PTSD Recovery Therapy Treatment

MDMA: Is This Psychotropic Drug Helpful, Harmful, or Both?

Image via Wikipedia

Last time I wrote about ecstasy, it was about the rise in ER visits and the inherent dangers of using a drug that inevitably depletes one’s levels of serotonin and has the potentiality of long-term brain damage. So, when I came across an article talking about using MDMA (ecstasy) to treat post-traumatic stress syndrome (PTSD), my curiosity was sparked. Psychedelic drugs have been used to treat mental illness before, and with some success: In the 50s and 60s, psychology was in a Freudian phase, viewing psychological issues as conflicts between the conscious and unconscious minds. At that time, psychedelics were used to allow patients to face their unconscious minds while awake, which purportedly eliminated the variables of memory retrieval. Still, these methods of treatment weren’t without controversy.  With the influx of street use, and folks like Timothy Leary telling people to “”Turn on, tune in and drop out,” the use of psychedelia to treat mental illness was met with great discernment and fell to the wayside.

Currently, interest in using MDMA and other psychedelics to treat depression, obsessive-compulsive disorder (OCD) and PTSD is gaining traction. MAPS is doing extended research on this subject, and states that MDMA isn’t the street drug we call ecstasy, noting that while ecstasy contains MDMA, it also may contain ketamine, caffeine, BZP, and other narcotics and stimulants. According the MAPS site they are “undertakinga 10-year, $10 million plan to make MDMA into an FDA-approved prescription medicine.” They are also “currently the only organization in the world funding clinical trials of MDMA-assisted psychotherapy. For-profit pharmaceutical companies are not interested in developing MDMA into a medicine because the patent for MDMA has expired. Companies also cannot profit from MDMA because it is only administered a limited number of times, unlike most medications for mental illnesses which are taken on a daily basis.”

The use of this drug has leaned so far from its psychotherapeutic roots, proving to be one of the most popular, highly sought-after street drugs around. Because of this, the useful aspect of this drug may easily be overlooked, forcing us to question how we can take something that has morphed into a social enigma and call it useful. I’m curious, will sufficient research place this drug at the discerning hands of medical professionals once again? And how do we, as a recovery community accept this when we have kids coming in suffering from the long-term, negative effects caused by this very drug?

Related articles:

MDMA May Help Relieve Posttraumatic Stress Disorder(time.com)

Ecstasy As Treatment for PTSD from Sexual Trauma and War? New Research Shows Very Promising Results (alternet.org)

Clinical Study of MDMA Confirms Benefits Noted by Therapists Before It Was Banned (reason.com)

Neuroscience for Kids

Ecstasy Associated With Chronic Change in Brain Function