About Adoptee Rage

Statistics Identify large populations of Adoptees in prisons, mental hospitals and committed suicide.
Fifty years of scientific studies on child adoption resulting in psychological harm to the child and
poor outcomes for a child's future.
Medical and psychological attempts to heal the broken bonds of adoption, promote reunions of biological parents and adult children. The other half of attempting to repair a severed Identity is counselling therapy to rebuild the self.

Thursday, September 21, 2017

The Consequence of Abuse In Adopted Childhood


ADOPTEE RAGE!


The Consequence of Abuse In Adopted Childhood
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The maltreated adopted child's childhood development  is disorganized, dysfunctional, stunted and arrested by          living in the hostile adoptive home environment. The replacement adopted child's position in the home is conditional       based on unrealistic expectations, acceptable social behaviors that are designated by the adoptive parents. 

Normal Child Development:
Physical Body and Brain Development
Emotional Development, Emotional Regulation
Verbal and Language Development
Behavioral  Development Impulse Control
Psychological Development
Primary Attachment Foundation for Social Development
Educational Development
Cognitive Development

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Complex and/or Developmental PTSD

The importance of a child’s close relationship with a caregiver cannot be overestimated. Through relationships with important attachment figures, children learn to trust others, regulate their emotions, and interact with the world; they develop a sense of the world as safe or unsafe, and come to understand their own value as individuals. When those relationships are unstable or unpredictable, children learn that they cannot rely on others to help them. When primary caregivers exploit and abuse a child, the child learns that he or she is bad and the world is a terrible place.     

The majority of abused or neglected children have difficulty developing a strong healthy attachment to a caregiver. Children who do not have healthy attachments have been shown to be more vulnerable to stress. They have trouble controlling and expressing emotions, and may react violently or inappropriately to situations. Our ability to develop healthy, supportive relationships with friends and significant others depends on our having first developed those kinds of relationships in our families. A child with a complex trauma history may have problems in romantic relationships, in friendships, and with authority figures, such as teachers or police officers.
    
From infancy through adolescence, the body’s biology develops. Normal biological function is partly determined by environment. When a child grows up afraid or under constant or extreme stress, the immune system and body’s stress response systems may not develop normally. Later on, when the child or adult is exposed to even ordinary levels of stress, these systems may automatically respond as if the individual is under extreme stress. For example, an individual may experience significant physiological reactivity such as rapid breathing or heart pounding, or  may "shut down" entirely when presented with stressful situations.  These responses, while adaptive when faced with a significant threat, are out of proportion in the context of normal stress and are often perceived by others as “overreacting” or as unresponsive or detached.     

Stress in an environment can impair the development of the brain and nervous system. An absence of mental stimulation in neglectful environments may limit the brain from developing to its full potential. Children with complex trauma histories may develop chronic or recurrent physical complaints, such as headaches or stomachaches. Adults with histories of trauma in childhood have been shown to have more chronic physical conditions and problems. They may engage in risky  behaviors that compound these  conditions (e.g., smoking, substance use, and diet and exercise habits that lead to obesity).     

Complexly traumatized youth frequently suffer from body dysregulation, meaning they over-respond or underrespond to sensory stimuli. For example, they may be hypersensitive to sounds, smells, touch or light, or they may suffer from anesthesia and analgesia, in which they are unaware of pain, touch, or internal physical sensations. As a result they may injure themselves without feeling pain, suffer from physical problems without being aware of them, or, the converse – they may  complain of chronic pain in various body areas for which no physical cause can be found.
Children who have experienced complex trauma often have difficulty identifying, expressing, and managing emotions, and may have limited language for feeling states.  They often internalize and/or externalize stress reactions and as a result may experience significant depression, anxiety, or anger.. Their emotional responses may be unpredictable or explosive. A child may react to a reminder of a traumatic event with trembling, anger, sadness, or avoidance. For a child with a complex trauma history, reminders of various traumatic events may be everywhere in the environment. Such a child may react often, react powerfully, and have difficulty calming down when upset. Since the traumas are often of an interpersonal nature, even mildly stressful interactions with others may serve as trauma reminders and trigger intense emotional responses.  Having learned that the world is a dangerous place where even loved ones can’t be trusted to protect you, children are often vigilant and guarded in their interactions with others and are more likely to perceive situations as stressful or dangerous.  While this defensive posture is protective when an individual is under attack, it becomes problematic in situations that do not warrant such intense reactions.  Alternately, many children also learn to “tune out” (emotional numbing) to threats in their environment, making them vulnerable to revictimization.     

Difficulty managing emotions is pervasive and occurs in the absence of relationships as well.  Having never learned how to calm themselves down once they are upset, many of these children become easily overwhelmed.  For example, in school they may become so frustrated that they give up on even small tasks that present a challenge.  Children who have experienced early and intense traumatic events also have an increased likelihood of being fearful all the time and in many situations. They are more likely to experience depression as well.
Although children may not be able to purposely dissociate, once they have learned to dissociate as a defense mechanism they may automatically dissociate during other stressful situations or when faced with trauma reminders.  Dissociation can affect a child’s ability to be fully present in activities of daily life and can significantly fracture a child’s sense of time and continuity.  As a result, it can have adverse effects on learning, classroom behavior, and social interactions.  It is not always evident to others that a child is dissociating and at times it may appear as if the child is simply “spacing out,” daydreaming, or not paying attention.       
 
A child with a complex trauma history may be easily triggered or “set off” and is more likely to react very intensely.  The child may struggle with self-regulation (i.e., knowing how to calm down) and may lack impulse control or the ability to think through consequences before acting.  As a result, complexly traumatized children may behave in ways that appear unpredictable, oppositional, volatile, and extreme.  A child who feels powerless or who grew up fearing an abusive authority figure may react defensively and aggressively in response to perceived blame or attack, or alternately, may at times be overcontrolled, rigid, and unusually compliant with adults.  If a child dissociates often, this will also affect behavior. Such a child may seem “spacey”, detached, distant, or out of touch with reality.  Complexly traumatized children are more likely to engage in high-risk behaviors, such as self-harm, unsafe sexual practices, and excessive risk-taking 

Children with complex trauma histories may have problems thinking clearly, reasoning, or problem solving. They may be unable to plan ahead, anticipate the future, and act accordingly. When children grow up under conditions of constant threat, all their internal resources go toward survival. When their bodies and minds have learned to be in chronic stress response mode, they may have trouble thinking a problem through calmly and considering multiple alternatives. They may find it hard to acquire new skills or take in new information. They may struggle with sustaining attention or curiosity or be distracted by reactions to trauma reminders. They may show deficits in language development and abstract reasoning skills. Many children who have experienced complex trauma have learning difficulties that may require support in the academic environment.

Children learn their self-worth from the reactions of others, particularly those closest to them. Caregivers have the greatest influence on a child’s sense of self-worth and value. Abuse and neglect make a child feel worthless and despondent. A child who is abused will often blame him- or herself. It may feel safer to blame oneself than to recognize the parent as unreliable and dangerous. Shame, guilt, low self-esteem, and a poor self-image are common among children with complex trauma histories.
      
To plan for the future with a sense of hope and purpose, a child needs to value him- or herself. To plan for the future requires a sense of hope, control, and the ability to see one’s own actions as having meaning and value.  Children surrounded by violence in their homes and communities learn from an early age that they cannot trust, the world is not safe, and that they are powerless to change their circumstances.  Beliefs about themselves, others, and the world diminish their sense of competency.  Their negative expectations  interfere with positive problem-solving, and foreclose on opportunities  to make a difference in their own lives. A complexly traumatized child may view himself as powerless, “damaged,” and may perceive the world as a meaningless place in which planning and positive action is futile. They have trouble feeling hopeful. Having learned to operate in “survival mode,” the child lives from moment-to-moment without pausing to think about, plan for, or even dream about a future.
From infancy through adolescence, the body’s biology develops. Normal biological function is partly determined by environment. When a child grows up afraid or under constant or extreme stress, the immune system and body’s stress response systems may not develop normally. Later on, when the child or adult is exposed to even ordinary levels of stress, these systems may automatically respond as if the individual is under extreme stress. For example, an individual may experience significant physiological reactivity such as rapid breathing or heart pounding, or  may "shut down" entirely when presented with stressful situations.  These responses, while adaptive when faced with a significant threat, are out of proportion in the context of normal stress and are often perceived by others as “overreacting” or as unresponsive or detached.     

Stress in an environment can impair the development of the brain and nervous system. An absence of mental stimulation in neglectful environments may limit the brain from developing to its full potential. Children with complex trauma histories may develop chronic or recurrent physical complaints, such as headaches or stomachaches. Adults with histories of trauma in childhood have been shown to have more chronic physical conditions and problems. They may engage in risky  behaviors that compound these  conditions (e.g., smoking, substance use, and diet and exercise habits that lead to obesity).     

Complexly traumatized youth frequently suffer from body dysregulation, meaning they over-respond or underrespond to sensory stimuli. For example, they may be hypersensitive to sounds, smells, touch or light, or they may suffer from anesthesia and analgesia, in which they are unaware of pain, touch, or internal physical sensations. As a result they may injure themselves without feeling pain, suffer from physical problems without being aware of them, or, the converse – they may  complain of chronic pain in various body areas for which no physical cause can be found.

Children who have experienced complex trauma often have difficulty identifying, expressing, and managing emotions, and may have limited language for feeling states.  They often internalize and/or externalize stress reactions and as a result may experience significant depression, anxiety, or anger.. Their emotional responses may be unpredictable or explosive. A child may react to a reminder of a traumatic event with trembling, anger, sadness, or avoidance. For a child with a complex trauma history, reminders of various traumatic events may be everywhere in the environment. Such a child may react often, react powerfully, and have difficulty calming down when upset. Since the traumas are often of an interpersonal nature, even mildly stressful interactions with others may serve as trauma reminders and trigger intense emotional responses.  Having learned that the world is a dangerous place where even loved ones can’t be trusted to protect you, children are often vigilant and guarded in their interactions with others and are more likely to perceive situations as stressful or dangerous.  While this defensive posture is protective when an individual is under attack, it becomes problematic in situations that do not warrant such intense reactions.  Alternately, many children also learn to “tune out” (emotional numbing) to threats in their environment, making them vulnerable to revictimization.       
 
Difficulty managing emotions is pervasive and occurs in the absence of relationships as well.  Having never learned how to calm themselves down once they are upset, many of these children become easily overwhelmed.  For example, in school they may become so frustrated that they give up on even small tasks that present a challenge.  Children who have experienced early and intense traumatic events also have an increased likelihood of being fearful all the time and in many situations. They are more likely to experience depression as well.

Dissociation is often seen in children with histories of complex trauma. When children encounter an overwhelming and terrifying experience, they may dissociate, or mentally separate themselves from the experience. They may perceive themselves as detached from their bodies, on the ceiling, or somewhere else in the room watching what is happening to their bodies. They may feel as if they are in a dream or some altered state that is not quite real or as if the experience is happening to someone else. Or they may lose all memories or sense of the experiences having happened to them, resulting in gaps in time or even gaps in their personal history.  At its extreme, a child may cut off or lose touch with various aspects of the self.
Although children may not be able to purposely dissociate, once they have learned to dissociate as a defense mechanism they may automatically dissociate during other stressful situations or when faced with trauma reminders.  Dissociation can affect a child’s ability to be fully present in activities of daily life and can significantly fracture a child’s sense of time and continuity.  As a result, it can have adverse effects on learning, classroom behavior, and social interactions.  It is not always evident to others that a child is dissociating and at times it may appear as if the child is simply “spacing out,” daydreaming, or not paying attention.     
 
A child with a complex trauma history may be easily triggered or “set off” and is more likely to react very intensely.  The child may struggle with self-regulation (i.e., knowing how to calm down) and may lack impulse control or the ability to think through consequences before acting.  As a result, complexly traumatized children may behave in ways that appear unpredictable, oppositional, volatile, and extreme.  A child who feels powerless or who grew up fearing an abusive authority figure may react defensively and aggressively in response to perceived blame or attack, or alternately, may at times be overcontrolled, rigid, and unusually compliant with adults.  If a child dissociates often, this will also affect behavior. Such a child may seem “spacey”, detached, distant, or out of touch with reality.  Complexly traumatized children are more likely to engage in high-risk behaviors, such as self-harm, unsafe sexual practices, and excessive risk-taking such as operating a vehicle at high speeds.  They may also engage in illegal activities, such as alcohol and substance use, assaulting others, stealing, running away, and/or prostitution, thereby making it more likely that they will enter the juvenile justice system.

Children with complex trauma histories may have problems thinking clearly, reasoning, or problem solving. They may be unable to plan ahead, anticipate the future, and act accordingly. When children grow up under conditions of constant threat, all their internal resources go toward survival. When their bodies and minds have learned to be in chronic stress response mode, they may have trouble thinking a problem through calmly and considering multiple alternatives. They may find it hard to acquire new skills or take in new information. They may struggle with sustaining attention or curiosity or be distracted by reactions to trauma reminders. They may show deficits in language development and abstract reasoning skills. Many children who have experienced complex trauma have learning difficulties that may require support in the academic environment.
Children learn their self-worth from the reactions of others, particularly those closest to them. Caregivers have the greatest influence on a child’s sense of self-worth and value. Abuse and neglect make a child feel worthless and despondent. A child who is abused will often blame him- or herself. It may feel safer to blame oneself than to recognize the parent as unreliable and dangerous. Shame, guilt, low self-esteem, and a poor self-image are common among children with complex trauma histories.      
To plan for the future with a sense of hope and purpose, a child needs to value him- or herself. To plan for the future requires a sense of hope, control, and the ability to see one’s own actions as having meaning and value.  Children surrounded by violence in their homes and communities learn from an early age that they cannot trust, the world is not safe, and that they are powerless to change their circumstances.  Beliefs about themselves, others, and the world diminish their sense of competency.  Their negative expectations  interfere with positive problem-solving, and foreclose on opportunities  to make a difference in their own lives. A complexly traumatized child may view himself as powerless, “damaged,” and may perceive the world as a meaningless place in which planning and positive action is futile. They have trouble feeling hopeful. Having learned to operate in “survival mode,” the child lives from moment-to-moment without pausing to think about, plan for, or even dream about a future.






Monday, September 18, 2017

The Adoptee's Perception of Relationships

ADOPTEE RAGE!

The Adoptee's Perception of Relationships
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Despite the extensive history behind adoption, we are astoundingly short-sighted when it comes to understanding its impacts. Only in the last two decades have the emotional and psychological impacts been explored. Only recently have the feelings of grief, loss and abandonment been acknowledged. That adoptees have a propensity towards depression, ADHD, Post-Traumatic Stress Disorder (PTSD) and substance abuse has only recently been researched and theorised[2]. Research is still limited on the high adoptee suicide rates and disproportionate admittance to correctional institutions but the most challenging, painful and distressing aspect of adoption is routinely unacknowledged altogether: Relationship problems. 
In the face of the generosity and unconditional love it takes to bring adopt a child, this may seem an ungrateful, accusatory statement. Take a moment to baulk at such a provocative, nonsensical claim. Yet it is a warranted though hard to believe; that saving a child by adopting them could lead to a life of relationship problems.  It is a claim that is even slightly insulting, to the loving adoptive family, the diligent adoption services and to those individuals who have battled serious psychological issues stemming from adoption; as an 'impact' it pales in significance when compared to depression, PTSD or suicide.
Is there any truth to the claim?
The formation of relationships, notably the development of intimacy with a romantic partner, can be a major challenge for adoptees. Why? Because their first and most important relationship was abruptly cut short. It was severed. It was irreparably destroyed. The person who was supposed to love them most, disappeared and they were passed to strangers who they were immediately expected to trust. This terrifically terrifying, traumatic experience imprinted anger, sadness and helpless upon an infant psyche. It instilled a persistent fear of abandonment deep within.
It is this that fear impacts future relationships. Many adoptees fear the unfamiliar territory of a relationship. They fear that what happened once might happen again. That each new relationship, like the very first one, will not last. Deep in their subconscious is the persistent question: If their own mother abandoned them, then why won’t others?
The impact of that broken bond is colossal. It cannot be understated. Adoption permanently alters everything a person was destined for. It alters the course of their lives, but also how they attach to people. The abandonment that precedes adoption causes bonding problems. It interferes with emotional development imbuing in the adoptee the sense that any situation can potentially lead to rejection.
Most of all it affects the ability of the adoptee to trust, to trust themselves and others. Relationships survive on trust but adoptees' trust in adults was broken at their most vulnerable time. Distrust was imprinted early on. Connection and intimacy become associated with rejection and loneliness. The idea that their mother loved them so deeply that she gave them away is a confusing paradox. Being loved becomes forever intertwined with being abandoned. 
One of the most saddening deprivations is that of touch. Children need their mother's contact. Touch is intricately linked with early bonding and trust, but adoptees are deprived of their mother's touch and many are too afraid to allow the adoptive mother to hold or cuddle them. She might not feel right. She might have the wrong energy, wrong skin, wrong smell or she might not be an affectionate person. This will inevitably create issues for future intimate relationships.
Not being able to remember the traumatic event that was their adoption compounds the problem. Those adopted as infants cannot explain what happened, let alone ask for help. Their survival instincts took over and remained in-charge and they may have lived in a constant state of stress ever since, without realising it. For the adoptee, their whole life has been skewed to the point where it seems normal. This is why adoptees often have tumultuous relationships in adulthood.
Petulant partners
It is rarely openly acknowledged that adoptees are notorious for making life difficult for their partners. It is like traversing a minefield. Relationships with adoptees are an emotional rollercoaster ride marked by combative and argumentative attitudes. They are sensitive to criticism and have difficulty expressing feelings. They have suppressed emotions for so long that they don’t know how to deal with them. Accompanying this may be an unrelenting need for control because adults, social workers and lawyers made monumental decisions for them. They can be manipulative and intimidating to partners, making a big fuss over trivial issues to portray a sense of power. Adults adoptees need complete control over their adult relationships; they relinquished control once before and the results were devastating.
Adoptees have hair-trigger reactions and lack impulse control. They frequently over-react to seemingly minor stresses. An explosion of rage, hostility or indignation is never far away for their partners. A wrong move can quickly be met with a veil of silence, withdrawal, rejection and disapproval. They harbour a great deal of frustration and anger, even if they appear placid to others. Very often adoptees are not angry at anything in particular; it is a front to hide pervasive sorrow, sadness and hurt. Strangely, the anger can often be a sign of connection. Nobody gets overly angry at people who mean nothing to them. That is why adoptees' partners often bear the brunt of their wrath.
Nancy Verrier, the renowned adoption author, provided the most apt summation of summed adoptees' relationships[3]:
"Very often, if an adoptee is just getting to know someone, there is no fear of abandonment because there is little connection. This is why adoptees are often more true to themselves and authentic at the beginning of a relationship. The two people are still strangers and the adoptee can be more authentic. The adoptee can risk allowing more of himself to be seen. The other person genuinely likes or falls in love with the essence of the adoptee. However, as the relationship progresses and the friend or partner becomes more important to him, fear takes over and sabotaging begins. The expectations of being abandoned by the important person in his life cause behaviour which will lead to that very thing. The adoptee becomes the scared, frustrating child."
 When Verrier refers to sabotaging, she describes how adoptees are so scared of being abandoned that they employ various distancing techniques. They avoid the vulnerability of intimate relationships by withdrawing and isolating themselves. They evade closeness and commitment because they struggle with emotional expression and often act emotionally absent or completely disinterested in the relationship, ensuring that the partner feels unloved and assuming that the relationship is decaying. They constantly test the limits of their partner's patience. They push them away to see if they will leave or they push them away before they get close enough to abandon them - a counterphobic reaction of 'reject before being rejected'.
What is rarely acknowledged is that their behaviour is a sign of a stunted emotional development and unresolved childhood trauma. It shows the scared child still lives inside. It is a side-effect of trauma. It is not the rational adult who walks out and slams the door on their partners. In scary situations, the scared child takes over.
High risk, high reward?
That is not to say that adoptees do not want intimacy. Possibly the saddest aspect is that that deep down, they really do want to ‘give everything’. Behind the barriers, they long for a close, trusting connection with someone special and want to let someone ‘in’. Adoptees yearn for intimacy, but the 'closeness' required in a relationship alarms them. Petrified of being hurt, the openness and vulnerability is just too risky. Opening the door to let someone ‘in’ also opens the door to rejection. This is why many adoptees articulate that they have never felt close to anyone.
To make matters worse, they often choose partners who are equally unavailable emotionally, physically or socially. They select partners who are suffering too; that may have been half the attraction in the first place[4]. They prefer the company of those who are not committed or unable to express emotion[5].  Attractive partners include those who are angry about a previous injustice, who are not over past relationships or who have their own histories of abandonment. Adoptees are drawn to those who like themselves, are prone to avoid and run away from stressful situations, who are passive-aggressive and who always are relationship-enders, never being broken up with.[6] They are drawn to others who are deeply wounded. Why? Because these partners will collude to keep everything at a superficial level. The problem is that those partners will eventually do what they fear most - abandon them.
Even the most dedicated partners struggle to see past the deeply ingrained trauma if the adoptee is treating them badly. Living on an emotional rollercoaster is exhausting. Even if they recognise that deep, sensitive wounds exist, they become tired of walking on eggshells. Many partners simply allow the adoptee's behaviour to continue because they are intimidated into silence. They do not dare risk an outburst of pent-up angry, pain and volatility.
Some partners may also become sick of the 'parent-role'. Adult adoptees often yearn to heal childhood wounds, but this requires fulfilment of childhood needs. Thus, partners often feel as if they are a parent in some way. This only prevents an intimate, mature relationship and eventually, the partners will reach breaking point. Even if they are aware of the residual trauma, they will leave. They will realise that they cannot change the adoptee; only the adoptee themselves can do that.
What doesn't break you, makes you
It is vital that adoptees and those around them understand why close relationships can be difficult. These issues cannot be dismissed. PTSD, depression and suicide may be more dangerous impacts of adoption, but the seemingly banal problems that plague the adoptees relationships are not to be overlooked, minimised or dismissed. That initial separation of mother and child can cause persistent sadness which casts a shadow over their lives.
The adoptee may eventually mature and gain insight into their behaviour in a relationship, but by that stage, the damage may have been done. Adoptees need help to realise that avoiding intimacy will not keep them safe; it will only prevent them from having meaningful and long-lasting relationships. Distancing techniques may provide some semblance of safety, but unfulfilling relationships will leave them sad and alone. By avoiding getting close to someone, adoptees just prevent themselves from achieving their own happiness. The paradoxical yearning for intimacy but fear of connection will linger on, leaving nothing but an unfulfilling, sad and lonely existence.
No matter how difficult, adoptees need relationships. Failed relationships are undoubtedly devastating and can feel like abandonment. Failed relationships also force adoptees to admit secrets that were dormant, suppressed or hidden, even from themselves. It can floor the adoptee because they waited so long to find someone special with whom they wanted to connect, but sometimes it is only after a failed relationship that adoptees begin to realise that their coping mechanisms are what drove their partners away. For some, it is only the painful and consistent failure that causes them to recognise that there are other factors at play. That realisation is a positive, signalling a realization that the childhood trauma needs to be healed. In fact, if adoptees are ever inclined to seek help for adoption issues, it is often because those issues have been triggered by a failed or difficult relationship.
Ultimately, failed relationships can be a blessing in disguise. Is it implausible to think that deep wounds caused by a failed relationship can also be healed through a failed relationship? Sometimes it takes painful failure to achieve fulfilling happiness. Relationship success for adoptees will only come after some tough lessons have been learned. A failed relationship might merely be an important instance of failing in order to truly succeed.
References
[1] 'Adoption in Ancient Assyria and Babylonia' - http://www.jaas.org/edocs/v13n2/Paulissia1.pdf
[2] 'Issues underlying behavior problems in at-risk adopted children' -  http://www.sciencedirect.com/science/article/pii/S019074090000102X
[3] 'Identity and Relationships' - http://nancyverrier.com/identity-and-relationships/

[4] Verrier, N. (2010) 'Coming Home To Self: Healing The Primal Wound'. BAAF.

Written By Ben Acheson
Ben Acheson is the Energy and Environment Policy Adviser and Parliamentary Assistant to Struan Stevenson MEP at the European Parliament in Brussels. In addition to his expertise on Energy and Environment issues, he has an in-depth knowledge of regional security in Central Asia, animal welfare within the European Union and EU-aspects of the Scottish independence debate. In his spare time, Ben plays semi-professional American Football and was unanimously voted as the 2012 National Player of the Year in Belgium.

Friday, September 15, 2017

Normal Biological Child Development Self Concept

ADOPTEE RAGE!

Normal Biological Child Development Self Concept
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From birth and early childhood, children start to develop a "self-concept,"                                   that is based on the how their mother's perception of her world, her environment                 and how the mother regards her offspring, infant. The mother's gaze while feeding, comforting and nurturing her infant constitutes the "biological mirroring" that defines the mother-infant maternal bond. Where the infant is reflected in the biological mirror of the mother's eyes and the infant reflects the mother biological mirroring the mother back at her. The infant sees themselves as the mother sees herself in her biological offspring. The essential need for the newborn infant's first foundational maternal bonded relationship is to be biologically mirrored by one's mother many times per day in human life to establish the infant's trust and identity can only be satisfied by the dance of genetic reflecting between biological mother and child.       
The biological mother's behavior, attributes, abilities, attitudes, values are seen, received and copied and adapted to by her infant offspring. How the mother acts, her behavior is witnesses by the child constitutes the child's primary learning tool. The child mimics his mother in play and strives to copy the mother's instinctual genetic behaviors. What the mother tells the child is believed by the child and becomes defining characteristics of the child. As emotionally stable mothers have no reason to introduce fear to their offspring ad fear is a learned behavior that comes later in childhood development.                                                                                                                                                     
By age 3, (between 18 and 30 months), children have developed their Categorical Self, which is concrete way of viewing themselves in "this or that" labels. For example, young children label themselves in terms of age "child or adult", gender "boy or girl", physical characteristics "short or tall", and value, "good or bad." The labels are used to explain children's self-concept in very concrete, observable terms. For example, Seth may describe himself this way: "I'm 4. I have blue eyes. I'm shorter than Mommy. I can help Grandma set the table!" When asked, young children can also describe their self-concept in simple emotional and attitude descriptions. Seth may go on to say, "Today, I'm happy. I like to play with Amy." However, preschoolers typically do not link their separate self-descriptions into an integrated self-portrait. In addition, many 3-5 year olds are not aware that a person can have opposing characteristics. For example, they don't yet recognize that a person can be both "good" and "bad".
As long-term memory develops, children also gain the Remembered Self. The Remembered Self incorporates memories (and information recounted by adults about personal events) that become part of an individual's life story (sometimes referred to as autobiographical memory). In addition, young children develop an Inner Self, private thoughts, feelings, and desires that nobody else knows about unless a child chooses to share this information.
Because early self-concepts are based on easily defined and observed variables, and because many young children are given lots of encouragement, Preoperational children often have relatively high self-esteem (a judgment about one's worth). Young children are also generally optimistic that they have the ability to learn a new skill, succeed, and finish a task if they keep trying, a belief called "Achievement-Related Attribution", or sometimes "self-efficacy". Self-esteem is primarily supplied by the mother and in later childhood comes from several sources, such as school ability, athletic ability, friendships, relationships with others, helping and playing tasks.
As with emotional development, both internal and external variables can affect young children's self-concept. For example, a child's temperament can affect how they view themselves and their ability to successfully complete tasks. Children with easy temperaments are typically willing to try things repeatedly and are better able to handle frustrations and challenges. In contrast, children with more difficult temperaments may become more easily frustrated and discouraged by challenges or changes in the situation.
Children who can better cope with frustrations and challenges are more likely to think of themselves as successful, valuable, and good, which will lead to a higher self-esteem. In contrast, children who become easily frustrated and discouraged, often quit or need extra assistance to complete a task. These children may have lower self-esteem if they start to believe that they can't be successful and aren't valuable.
External factors, such as messages from other people, also color how children view themselves. Young children with parents, caregivers, and teachers providing them with positive feedback about their abilities and attempts to succeed (even if they aren't successful the first time) usually have higher self-esteem. On the contrary, when parents, caregivers, or teachers are regularly negative or punitive toward children's attempts to succeed, or regularly ignore or downplay those achievements, young children will have a poor self-image and a lower self-esteem.
Peers also have an impact on young children's self-concept. Young children who have playmates and classmates that are usually nice and apt to include the child in activities will develop a positive self-image. However, a young child who is regularly left out, teased, or bullied by same-age or older peers can develop low self-esteem.
As mentioned repeatedly throughout this document, each child is unique, and he or she may respond to different environments in different ways. Some young children are naturally emotionally "resilient" in certain situations. Resilient children experience or witness something seemingly negative or harmful, without experiencing damage to their self-esteem or emotional development. Resilience not only enables such individuals to withstand life stress, but quite often these children became high achievers. This ability also helps resilient children to maintain good health and to resist mental and physical illnesses. For example, many young children who are severely physically and/or emotionally bullied perform poorly in school, become aggressive or withdrawn, or depressed or anxious. Resilient children experience that same bullying and show no signs or symptoms that the experience has negatively impacted them.
Another more complex but highly important part of a child's self-identity is formed by their cultural identity. While ideas about ancestry and how their family's culture fits into the larger society are too abstract for most young people to understand, it's never too early to teach children about cultural and religious traditions. Including young people in important meals, celebrations, religious services, etc, and explaining what's going on in simple terms is very important in passing on a sense of that child's cultural background. Ideas such as, "My family goes to the synagogue on Saturdays," or "Grandma's traditional soul food is yummy," become part of the child's self-concept. As time goes by and children's capacities to understand what it means when someone says "I am Jewish", or "I am an African American," these experiences will continue to add to and to enrich their self-concept.

Wednesday, September 13, 2017

Non-Maternal Adoptive Parent Parenting Depravity

ADOPTEE RAGE!

NON-Maternal Parent Deprivation The Adoptive Mother
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  Maternal Deprivation

    pertaining to the female biological parent.
maternal deprivation syndrome  
The biological infant's failure to thrive with severe growth retardation,unresponsiveness to the environment, depression, retarded mental and  emotional development,and behavioral problems as a result of loss, absence, or neglect of the mother.

In ADOPTIVE MOTHERS "Maternity driven hormones" are Absent and do not exist in adoption. 
As the adoptive mother relies on verbal, legal and obligation commitment to care for the adopted infant for 18 years or maturity.  

"Non-Maternal Parenting Depravity"  
Similar to maternal depravity but without biological connection, the infant is traumatized by the separation and severed biological bond from the infant's genetic connection the real mother.
The condition characterized by developmental retardation that occurs as a result of physical and emotional deprivation. It is seen primarily in infants. Typical symptoms include lack of physical growth,  height, weight below the third percentile for age and size; malnutrition; pronounced withdrawal; silence;  apathy; irritability; and a characteristic posture and body language, featuring unnatural stiffness and rigidity  with a slow response reaction to others. Causes of the syndrome are usually multiple and complex, involving such factors as parental indifference; emotional instability or insecurity of the adoptive mother; lack of, disorganized and delayed development of the adopted child- adoptive mother attachment process; 
Unrealistic expectations or disappointment concerning the sex, appearance,or adaptability of the adopted child; or unfavorable socioeconomic conditions within the adoptive family. 
Treatment often requires hospitalization, especially in cases of severe malnutrition. 
Care includes assessment of the family situation, and treatment often involves psychotherapy, counseling,  special nursing instruction to help the adoptive parents learn to deal with and provide for the adopted child. 
The nature and extent of the effects of the condition on later physical, emotional, intellectual,  and social development vary considerably and depend on the age at which deprivation occurs, the degree  and duration of the adoption situation, the adopted child's constitutional genetic makeup, and the substituted adoption care giver that is provided. 
Emotionally deprived adopted children often remain below normal in intellectual development, fail to learn  acceptable social behavior, and are unable to form trusting, meaningful relationships with others. 
In severe cases of early and prolonged deprivation, the damage to an adopted infant may be irreversible.

Monday, September 11, 2017

Adopted Childhood History of Abuse Perpetrated By Adoptive Parents

ADOPTEE RAGE!

Adopted Childhood History of Abuse Perpetrated by Adoptive Parents
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Childhood Stress Histories

LINK:www.nature-nurture.org/

Interviewing a group of individuals who share similar behavioral characteristics or conditions is a common method to help one to understand commonalties between individuals. Adults with major depressive disorder report chronic responses to stress, such as anxiety or substance abuse (Hayden & Klein, 2001), in response to histories of severe childhood physical abuse (Weiss et al., 1999; Brodsky et al., 2001; Jaffe et al., 2002; Harkness and Monroe, 2002), sexual abuse (Hayden and Klein, 2001; Harkness and Monroe, 2002), caregiver antipathy and neglect and poor maternal and paternal relationships (Hayden & Klein, 2001). Childhood sexual abuse along with paternal and marital violence, maternal indifference and a general sense of lack of personal safety have all been associated with the later development of depressive symptoms along with concurrent borderline personality characteristics of avoidance, self-defeating tendencies, and parasuicidal and self-injurious behaviors (Gladstone et al., 1999). In addition, adults with later bipolar disorder (Leverich et al., 2002) and borderline personality disorder (Byrne et al., 1990) present childhood histories of both physical and sexual abuses. Adult and adolescent antisocial personality disorder is a condition that has also been associated with histories of severe physical abuse and tendencies for dissociation (Lewis et al., 1997) and paranoid ideation (Lewis et al., 1988), respectively. In a longitudinal study childhood victimization and histories of abuse and neglect are found to be predictors of later lifetime symptoms of antisocial personality disorder (Luntz and Widom, 1994). Adults who share neurobiological markers and symptoms for affective and personality disorders tend to share adaptations to stressful histories of childhood abuse and neglect over time and in their lifetime.
Histories of childhood adversity and physical abuse seem to underlie the later development of future psychiatric conditions like post-traumatic stress disorder (PTSD) (Bremner et al., 1993). Genes probably dictate how the response to stress will later be expressed. Twin studies (Stein et al., 2002) have demonstrated that there is a significant variance in PTS symptom expression, as some individuals from twin pairs go on to develop PTS symptoms and others do not. Considering that monozygotic twins are genetically comparable it is likely that the variance in PTS symptom expression is due to each individual twin’s responses to the frequency and degree of perceived stress throughout one’s life at any point in time. It cannot be understated enough stressful adaptations to childhood adversity occur during a time in an individual’s life when the brain and CNS is undergoing critical, rapid neural growth and expression.
References
Bremner JD, Southwick SM, Honson DR, Yehuda R, Charney DS (1993): Childhood physical abuse and combat-related posttraumatic stress disorder in Vietnam veterans. Am J Psychiatry, 150(2): 235-9.
Brodsky BS, Oquendo M, Ellis SP, Haas GL, Malone KM, Mann JJ (2001): The relationship of childhood abuse to impulsivity and suicidal behavior in adults with major depression. Am J Psychiatry, 158: 1871-77.
Byrne CP, Velamoor VR, Cernovsky ZZ, Cortese L, Losztyn M (1990): A comparison of borderline and schizophrenic patients for childhood life events and parent-child relationships. Can J Psychiatry, 35: 590-95.
Gladstone G, Parker G, Wilhelm K, Mitchell P, Austin MP (1999): Characteristics of depressed patients who report childhood sexual abuse. Am J Psychiatry, 156(3): 431-37.
Harkness KL & Monroe SM (2002): Childhood adversity and the endogenous versus nonendogenous distinction in women with major depression. Am J Psychiatry, 159: 387-93.
Hayden EP & Klein DN (2001): Outcome of dysthymic disorder at 5-year follow-up: The effect of familial psychopathology, early adversity, personality, comorbidity, and chronic stress. Am J Psychiatry, 158: 1864-70.
Jaffee SR, Moffitt RE, Avshalom C, Fombonne E, Poulton R, Martin J (2002): Arch Gen Psychiatry, 59: 215-22.
Leverich GS, McElroy SL, Suppes T, Keck PE, Denicoff KD, Nolen WA, Altshuler LL, Rush AJ, Kupka R, Frue MA, Autio KA, Post RM (2002): Early physical and sexual abuse associated with an adverse course in bipolar illness. Biol Psychiatry, 51(4): 288-97.
Lewis DO, Pincus JH, Bard B, Richardson E, Prichep LS, Feldman M, Yeager C (1988): neuropsychiatric, psychoeducational, and family characteristics of 14 juvenile condemned to death in United States. Am J Psychiatry, 145(5): 584-89.
Lewis DO, Yeager CA, Swica Y, Pincus JH, Lewis M (1997): Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder. Am J Psychiatry, 154(12): 1703-10.
Luntz BK & Windom CS (1994): Antisocial personality disorder in abused and neglected children grown up.Am J Psychiatry, 151(5): 670-74.
Stein MB, Jang KL, Taylor S, Vernon PA, Livesley WJ (2002): Genetic and environmental influences on trauma exposure and posttraumatic stress disorder symptoms: a twin study. Am J Psychiatry, 159: 1675-81.
Weiss EL, Longhurst JG, Mazure CM (1999): Childhood sexual abuse as a risk factor for depression in women: psychosocial and neurobiological correlates. Am J Psychiatry, 156: 816-28.

Autoimmune Disease Created and Fueled in Adopted Childhood

ADOPTEE RAGE!

Autoimmune Disease Created and Fueled In Adopted Childhood
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Autoimmune Disease & Histories of Stress

Adults having functional (symptoms without apparent cellular alterations) and organic (observable cellular changes in target tissue) diseases also have childhood stressful histories. Patients with rheumatoid arthritis not only report chronically stressful adult histories (e.g. unhappy marriages or relationships, difficulties at work, or with children, etc.), but also present histories of difficulties in earlier interactions with their mothers and experiences of considerable chronic threat (Baker, 1982). In addition, rheumatoid arthritis patients report childhood histories that are characterized by emotional neglect and abuse (Walker et al., 1997a). Later adult joint swelling is associated with an increased sense of depression in response to difficulty managing interpersonal conflict as well as conflictual coping with flares (Zautra et al., 1994, 1999; Marcenaro et al., 1999). Higher stress levels in this patient population are associated with androgen-stimulated estradoil negative feedback and higher stress neurohormonal prolactin activity. Both hormones have been positively correlated with the rheumatoid arthritis patient’s sense of depression (Zautra et al., 1994). With disease progression (or just prior to disease expression) patients assess and conclude that they cannot garner control over and cope with aversive interpersonal life events. This sense of “giving up” appears to underlie the chronicity of their physical illness (Zauntra et al., 1999). The intensity of this sense of loss of control is also associated with the degree of disease flare reactivity to stress.
Patients with systemic lupus erthymatosis present histories of marked childhood emotional deprivation (Otto & Mackay, 1967). Just prior to symptom expression, patients emit a sense of helplessness and hopelessness, “I give up”, that relates to the SLE patient’s inability to cope with the effects of current and prior stress (Blumenfeld, 1978).
The majority of multiple sclerosis (MS) patients, like healthy controls, tend to portray their childhood home life and themselves as moderately to very happy and also as relaxed and taking things in stride, respectively (Warren et al., 1982). Despite these similarities MS patients rated that they experience more anxiety in response to current stressors. Upon further inquiry MS patients disclose disturbing memories relating to wartime combat, an unpredictable urban attack, a major automobile accident and minor injury, raising oneself at the age of twelve years, and persistent beatings by step-father, etc (p. 829). Numerous adult stressors precede the initial onset of MS symptoms (Warren et al., 1982). Despite MS patients more positive outlook on life, psychiatric assessment has revealed that MS patients differ from healthy subjects in the insecurity that drives their need to seek greater love, their use of rigid defense mechanisms, i.e. as denial and minimization, and difficulty at resolving inner conflicts due to poor coping skills. Many of these personality characteristics date back to early childhood and correlate positively with symptom severity (Diana et al., 1985).
Chronic stress also appears to play a more obvious role in functional diseases like fibromyalgia and irritable bowel disease. Fibromyalgia (Taylor et al., 1995) is condition that is associated with different types of pain and other symptoms, e.g. headaches, stiffness, backaches, abdominal cramps, fatigue, numbness, etc. with no apparent structural abnormality in the tissue. The extent of pain is measured by tender point counts. Fibromyalgia patients report (Imbierowicz & Egle, 2003) having had very poor emotional relationships with one or both parents, particularly fathers (McBeth et al., 1999), and rated low levels of emotional security. The parents of fibromyalgia patients have also been described as being emotionally neglectful, abusive, and as of being psychologically unavailable (Walker et al., 1997b) to their children. In addition fibromyalgia patients seem to have difficulties in talking about and expressing emotional difficulties with their own parents as well as affection in the course of their roles as marital partner and parent (Imbierowicz & Egle, 2003). Fibromyalgia patients report witnessing parental violence in their families of origin (Imbierowicz & Egle, 2003), family disruption (Goldberg et al., 1999), and as having experienced physical and sexual abuse themselves (Boisset-Pioro et al., 1995) or the unwanted touch of another (Taylor et al., 1995). Childhood maltreatment is highly correlated with both psychiatric distress as well as fibromyalgia symptom severity as measured by higher tender point counts (Walker et al., 1997b; McBeth t al., 1999). A far greater percentage of women having experienced wide areas of intense pain, are those same individuals who tend to report prior childhood (and/or adult) sexual abuse (Finestone et al., 2000). Patients in this group, especially those with histories of emotional trauma (Aaron et al., 1997), tend to seek health care and report the greatest number of family physician visits and number of surgical operations (Firestone et al., 2000). In response to their stressful histories, fibromyalgia patients present symptoms of a lifetime of depression, history of somatization, anxiety, hysteria, and psychasthenia (Ahles et al., 1984; Hudson et al., 1985; Burckhardt et al., 1993; Walker et al., 1997b) as well as deficits in emotional and social role functioning.
Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder (with symptoms of abdominal pain, bloating, and changes in bowel patterns in the absence of cellular abnormalities) that also presents comorbity with fibromyalgia and vice versa (Veal et a., 1991; Canataroglu et al., 2001). IBS patients also bring their chronic emotional and visceral responses to their histories of childhood (and adult if appropriate) physical and sexual abuse (Walker et al., 1995), exposure to threat (Dill et al., 1997), psychological family disruption (Lowman et al., 1987) as well as emotional and verbal abuse (Talley et al., 1995) into their current emotional and physical experience. They are more likely to present chronic depression, generalized anxiety, and symptoms of somatization (Walker et al., 1995) than patients with symptoms of inflammatory bowel disease (IBD) or ulcerative colitis. IBS patients who had endured chronic threat throughout their lives and prior to symptom expression are less likely to respond positively to treatment’s effects (Bennett et al., 1998). In a group of symptomatic IBS patients, psychosocial stress was negatively correlated with recovery from post-infective symptoms. Rectal biopsy specimens showed increased chronic inflammatory cell counts when compared with remitted IBS patients despite recovery from active infection (Gwee et al., 1999). Those patients with both inflammatory bowel disease (IBD) and psychiatric diagnoses tend to present histories of adult victimization of physical and sexual abuses (Walker et al., 1996) and suffer significantly greater symptom distress than an IBD population without psychiatric diagnoses.
The literature suggests that there is some link between childhood histories of adversity, (i.e. emotional neglect, disruption, and trauma, as well as physical and sexual abuse) and adult populations having autoimmune disease. Histories of adversity elicit chronic persistent stress arousal (as the reader will see later in this web site) that have the capacity to underlie the later development of physical disease by chronically stimulating stress neurocircuitry, neurohormones, and proinflammatory cytokines. Stress induced inflammation is not easily extinguished in persistently and chronically stressful environments, especially during early childhood when the brain and central nervous system is undergoing a remarkable rate of growth. Neurohormonal mechanisms for negative feedback and anti-inflammatory immune markers to cool chronic arousal and inflammation provide strategies that only work on limited complementary inflammatory responses. The interaction of all these neurobiological components allow for the later expression of physical symptoms.
Future sections of this web site will demonstrate how chronic stress underlies the later genetic expression for psychiatric symptoms (e.g. depression, PTSD, anxiety, aggression associated with anti-social personality disorder, etc.) and organic and functional disease (e.g. rheumatoid arthritis, systemic lupus erythematosis, multiple sclerosis, chronic fatigue syndrome, polymyalgia rheumatica, as well as fibromyalgia and IBS). The later expression of adult symptoms is dependent on both one’s genetic predisposition and the degree and duration of chronic stress. The intensity of the stress response is more important to an individual’s neurobiological response than its nature. The interaction of both these variables will determine the nature of neuroendocrine and neuroimmune synthesis, release, and secretion to life stressors at any point in the life cycle.
References
Ahles TA, Yunus MB, Riley SD, Bradley JM, Masi AT (1984): Psychological factors associated with primary fibromyalgia syndrome. Arthritis Rheum, 27(10): 1101-6.
Baker GH (1982): Life events before the onset of rheumatoid arthritis. Psychother Psychosom, 38(1): 173-7.
Bennett EJ, Tennant CC, Piesse C, Badcock CA, Kellow JE (1998): Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut, 43(2): 256-61.
Blumenfield M (1978): Psychological aspects of systemic lupus erythematosus. Prim Care, 5(1): 15-71.
Boisset-Pioro MH, Esdaile JM, Fitzcharles MA (1995): Sexual and physical abuse in women with fibromyalgia syndrome. Arthritis Rheum, 38(2): 235-41.
Burckhardt CS, Clark SR, Bennett RM (1993): Fibromyalgia and quality of life: a comparative analysis. J Rheumatol, 20(3): 475-9.
Canataroglu A, Gumurdulu Y, Erdem A, Colakoglu S (2001): Prevalence of fibromyalgia in patients with irritable bowel syndrome. Turk J Gastroenterol, 12(2): 141-44.
Diana R, Grosz A, Mancini E (1985): Personality aspects in multiple sclerosis. Ital J Neurol Sci, 6(4): 415-23.
Dill B, Sibcy GA, Dill JE, Brende JO (1997): Abuse, threat, and irritable bowel syndrome: what is the connection? Gastroenterol Nurs, 20(6): 211-5.
Finestone HM, Stenn P, Davis F, Stalker C, Fry R, Koumanis J (2000): Chronic pain and health care utilization in women with a history of childhood sexual abuse. Child Abuse Negl, 24(4): 547-56.
Gwee KA, Leong YL, Graham C, McKendrick MW, Collins SM, Walter SJ, Underwood JE, Read NW (1999): The role of psychological and biological factors in postinfective gut dysfunction. Gut, 44(3): 400-6.
Imbierowicz K & Egle UT (2003): Childhood adversities in patients with fibromyalgia and somotoform pain disorder. Eur J Pain, 7(2): 113-9.
Lowman BC, Drossman DA, Cramer EM, McKee DC (1987): Recollection of childhood events in adults with irritable bowel syndrome. J Clin Gastroenterol, 9(3): 324-30.
Marcenaro M, Prete C, Badini A, Sulli A, Magi E, Cutolo M (1999): Rheumatoid arthritis, personality, stress response style, and coping with illness. A preliminary survey. Ann N Y Acad Sci, 876: 419-25.
McBeth J, Macfarlane GJ, Benjamin S, Morris S, Silman AJ (1999): The association between tender points, psychological distress, and adverse childhood experiences: a community-based study. Arthritis Rheum, 42(7): 1397-404.
Talley NJ, Fett SL, Zinsmeister AR (1995): Self-reported abuse and gastrointestinal disease in outpatients: association with irritable bowel-type symptoms. Am J Gastroenterol, 90(3): 366-71.
Veale D, Kavanagh G, Fielding JF, Fitzgerald O (1991): Primary fibromyalgia and the irritable bowel syndrome: different expressions of a common pathogenic process. Br J Rheumatol, 30(3): 220-2.
Walker EA, Gelfand AN, Gelfand MD, Katon WJ (1995): Psychiatric diagnoses, sexual and physical victimization, and disability in patients with irritable bowel syndrome or inflammatory bowel disease. Psychol Med, 25(6): 1259-67.
Walker EA, Gelfand MD, Gelfand AN, Creed F, Katon WJ (1996): The relationship of current psychiatric disorder to functional disability and distress in patients with inflammatory bowel disease. Gen Hosp Psychiatry, 18(4): 220-9
Walker EA, Keegan D, Gardner G, Sullivan M, Katon WJ, Bernstein D (1997a): Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: I. Psychiatric diagnosis and functional disability. Psychosom Med, 59(6): 565-71.
Walker EA, Keegan D, Gardner G, Sullivan M, Bernstein D, Katon WJ (1997b): Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual, physical, and emotional abuse and neglect. Psychosom Med, 59(6): 572-7.
Wallace DJ (1987): The role of stress and trauma in rheumatoid arthritis and systemic lupus erythematosus. Semin Arthritis Rheum, 16(3): 153-7.
Warren S, Greenhill S, Warren KG (1982): Emotional stress and the development of multiple sclerosis: case-control evidence of a relationship. J Chronic Dis, 35(11): 821-31.
Zautra AJ, Burleson MH, Matt KS, Roth S, Burrows L (1994): Interspersonal stress, depression, and disease activity in rheumatoid arthritis and osteoarthritis patients. Health Psychol, 13(2): 139-48.
Zautra AJ, Hamilton NA, Potter P, Smith B (1999): Field research on the relationship between stress and disease activity in rheumatoid arthritis. Ann N Y Acad Sci, 876: 397-412.