The Need for Control
As you know, patterns of self-harmful activity reflect the need
for control. This need often drives the TRS (Trauma Reenactment Syndrome) woman’s daily
activities as well. For example, she may clean compulsively. Always
striving for control may make her unable to enjoy leisure activities
or to function well at work. It is often at the root of her problems
with her children, other family members, and friends. It pervades
her efforts to seek help from professionals and peers, which she
then rejects.
In the struggles around control in relationships,
Trauma Reenactment Syndrome creates a generalizable pattern in
which the TRS woman alternates between avoiding social contact
and then frantically clinging to partners, friends, family members,
and sometimes colleagues. The results of this pattern are horribly
uncomfortable for her. She feels unhappy and anxious when alone,
but then equally unhappy and anxious when with others. She endures
seemingly endless cycles of restlessness and discomfort. This
pattern is an important part of her inability to establish or
maintain intimacy.
Bette Midler, playing the role of Janis Joplin in
the movie “The Rose”, pushes everyone away and then
cries out in a moment of desperate, lonely intoxication, “Where
is everybody?” The TRS victim’s ambivalence about
her need for nurturance and her need to control creates a contradictory
communication to all those involved with her: “Where is
everybody?” and “Why don’t they leave me alone!”
This rapid shift between asking for help and then rejecting it
exhausts others. Both personal and professional caretakers withdraw
in exasperation. The TRS victim may experience this withdrawal
as rejection, reinforcing her mistrust of relationships, and so
the cycle escalates.
Extreme reactivity marks the TRS woman’s behavior
and is often a clue to her history of abuse. Because she has experienced
relationships as both unpredictable and unsafe, she is quick to
imagine snubs and criticisms. She may question the motives of
everyone around her. She is also hypervigilant, a clinical term
used to describe anyone who is always on guard, always watchful,
quick to perceive any incipient danger, whether real or imagined.
Karen, As A Child
“I always sleep on the floor of my room, not in my bed.
I wake up if someone comes in my room. I keep my light on even
though I get punished. I need to see if everything is where I
put it when I went to sleep. My teddy has to be right next to
me, just like this. If I move him, something will happen.
“I know how to make Mommy’s coffee for
her just right in the morning. I know if she’s going to
be nice or mad by how she takes the cup from me when I bring it
to her in bed. I know it’s very important to be neat and
clean and brush my hair before I bring her the coffee. I know
how much Mommy loves me. That’s why I have to do things
right.
“I know if Mommy is mad at Daddy by how she
gets ready for him to come home at night. If she waits and has
her first drink with him, she’s not mad. If she tells me
to make her a drink before he comes home, I know they’ll
fight. It’s my fault they fight, but I can’t figure
out what I do wrong.
“I am in the first grade. I’m always
a very good girl at school. My teacher says I’m trying to
be too good. She says, “Go have fun, Karen,” but I
don’t know how to do that.”
Going to Extremes
Boundaries are problematic in many different ways for TRS women.
The definition of the self in relationships is affected by both
the weakness and rigidity of their boundaries. Karen offers a
good example of the problem with rigid boundaries:
“My friend at work, Julia, keeps talking to
me about her AA meetings. She tells me at lunch all about how
she used to get high, how screwed up her life was. She seems so
comfortable talking to me about this stuff. Julia even talks about
really embarrassing moments like when she was still married and
she would be so high she would get into sexual situations with
other guys.
“Then there is Alice, another one of the girls
I eat lunch with at the hospital. She’ll talk about her
period or tell funny stories about birth control and what happened
with some guy she’s seeing. I just can’t get over
being amazed by what these other nurses talk about so openly.
I feel shocked, but sometimes I also envy them.
“They give me a real hard time about what
a clam I am. “Hey, Karen,” Julia says, “why
are you holding out on us? I know you’re seeing someone,
so what’s going on?”
“I feel angry and also really scared when
they tease me about this. I know I’m secretive, but I just
can’t trust anyone enough to be different.”
When she first began therapy with me, Karen was
locked inside of herself, her armor a pleasant and sociable exterior.
For example, when I asked standard questions about where she lived,
who she lived with, and what her friendships were like, she hesitated
before answering. Her answers were very brief and told me little
about her.
Karen was also extremely reluctant to share any
information with me about her intimate life. I asked her if she
was dating, if she was sexually active, and if she had any sexual
issues. She finally told me that she was angry because I seemed
to feel entitled to such personal information. When I explained
that these were questions I often asked when getting to know a
new client who presented relationship problems as the reason for
entering therapy, she was clearly astonished that anyone would
answer such questions.
As I got to know Karen better, I learned that she
was such an intensely private person that even her closest friend,
Ellen, knew very little about her intimate relationships. Although
Karen professed a willingness to try to share more of herself
with Ellen, she had a difficult time doing so.
Because of rigid personal boundaries, Karen and other TRS women experience chronic loneliness and a
sense of being both different from others and invisible. It is
therefore logical that they also feel unloved and unlovable. Some
TRS women manifest rigid boundary problems in an extreme avoidance
of normal social or physical contact. One of my clients left her
house only to go food shopping or to a weekly twelve-step meeting.
She could not go to work because she felt unsafe in any situation
that involved flexible social contact. She also stopped seeing
her friends and would not answer the telephone or the doorbell.
Her contact was limited to a noncommunicative relationship with
her husband, who worked an afternoon/evening shift, and her eighteen-year-old
son, who was at work or with his girlfriend most of the time.
The only reason this woman could tolerate her weekly AlAnon meeting
was because it was highly structured and therefore predictable.
She was not really able to make the program work for her, however,
because she could not make use of the essential ongoing social
support outside of meetings. She was stuck, refusing to go to
additional twelve-step groups because that would mean going to
a new place and meeting new people.
This kind of pattern, when it becomes severe enough
to render the person dysfunctional, is called “agoraphobia,”
or fear of open spaces. Although it is considered a serious disorder
in its own right, it is one of many possible symptoms of Trauma
Reenactment Syndrome. In extreme cases, an agoraphobic is completely
unable to leave her home under any condition. Mental health professionals
often treat agoraphobia as an anxiety disorder, using behavioral
conditioning and medication. When I encounter it in TRS women,
I approach it as part of an understandable response to trauma,
and I attend to the client’s need to develop the capacity
for relational attachment.
June’s relational patterns represent the other extreme of boundary problems: loose or diffuse
boundaries. Her personal boundaries are not only diffuse, but
unpredictable. One day she may scream if her daughter comes into
the bedroom without asking permission (even though the door is
almost always open), and another day she will leave the bathroom
door open when she is in the shower and tell her daughter, or
even her teenage son, an intimate sexual episode while she dries
off, fully visible through the open door.
Nancy manifests inappropriate boundaries in another way. She is careless, in fact indifferent, in regard
to divulging personal details about her clients at the travel
agency. When one client complained that Nancy had chatted with
another about the financial and personal details of his trip,
Nancy was genuinely bewildered by his outrage.
- Miller, Dusty; Women who Hurt Themselves: A Book of Hope and
Understanding; Basic Books: Massachusetts; 1994
Self-Mutilation and Pharmacotherapy
- Smith, Bryan, Self-Mutilation and Pharmacotherapy, Michigan State University Department of Psychiatry B119 West Fee Hall East Lansing, MI 48824-1316, 2005
Personal
Reflection Exercise #6
The preceding section contained information about issues
of control and boundaries in self-injurers. Write three case study
examples regarding how you might use the content of this section
in your practice.
Peer-Reviewed Journal Article References:
Bustamante Madsen, L., Eddleston, M., Schultz Hansen, K., & Konradsen, F. (2018). Quality assessment of economic evaluations of suicide and self-harm interventions: A systematic review. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(2), 82–95.
Evans, C. M., & Simms, L. J. (2019). The latent structure of self-harm. Journal of Abnormal Psychology, 128(1), 12–24.
Hasking, P. A., Bloom, E., Lewis, S. P., & Baetens, I. (2020). Developing a policy, and professional development for school staff, to address and respond to nonsuicidal self-injury in schools. International Perspectives in Psychology: Research, Practice, Consultation, 9(3), 176–179.
Online Continuing Education QUESTION
20 What are the two extremes of boundary issues experienced by
women with Trauma Reenactment Syndrome? Record the letter of the
correct answer the CEU Test.
