Karen Woodall – Psychotherapist, Writer, Researcher, Trainer

3 responses to “Eating Disorders in the Context of Childhood Relational Trauma in Children of divorce and separation”

1. carol Brown

   May 2, 2023 at 11:34 pm

   I found this very interesting. In my family, my mother was morbidly obese, and my son is morbidly obese. I have not been troubled with any eating disorder. I suspect that my mother had some form of personality disorder, and I suffered somewhat as a result, and parented my son in a diametrically opposite manner to my mother’s parenting. This made me somewhat rigid and rule bound, a different style of poor parenting. I was 16 when I had my son.
   It’s taken a lot of years for me to recognise and to unveil the psychological harm that’s passed through the generations
   My son stayed with my parents when I and his father went on a holiday to try to patch up our relationship – which did not succeed. We were away for 2 weeks during which time my son, then aged 8, gained a stone in weight. I was later told that my mother had fed him until he was physically sick, and then fed him again, after he had vomited because of gorging. And so it began…
   My mother then viewed his subsequent obesity as a consequence of my failure as a mother. She continued to surreptitiously provide him with boxes of cakes and chocolates etc., and I became increasingly controlling by trying to restrict his diet.
   I have never been able to help my son stop overeating. He is now middle-aged and around 35st, and his life has been blighted by obesity.
   My son regards his grandmother as his model for good parenting, and myself as a poor parent. I think I was a poor parent to him, but he was not physically neglected, sexually abused, and psychologically abused as I was as a child. I don’t think I was as poor a mother as I had had, but it’s little comfort. I wonder what kind of parent my grandmother had been?
   I think my son cleaved to his grandma, (who was aligning him for her own needs, and gratifying his addiction to food), as a response to my inflexible over controlling parenting.
   My son wears his abuse in his abused body.
   I wish I’d never had children. It’s like falling dominoes….

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2. Bob Rijs

   May 5, 2023 at 9:34 pm

   Wouter Gomperts

   From terrified children to life-threatening adults

   Three American soldiers recently killed their wives at the US military base at Fort Bragg. Two of them then committed suicide. All three had served in the Special Forces in Afghanistan.(2) After months of working as a ‘killing machine’ in Afghanistan, they apparently could no longer turn the switch at home. Completely disrupted biologically, psychologically and socially by the constant traumatic stress of mass violence, they themselves, including their loved ones, perished.

   The condition in which these soldiers probably found themselves seems different from that of the concentration camp commander who, after the daily genocidal work, kicks a ball at home with his children and prunes the roses.(3)

   There is also a difference with the September 11 terrorist who, fashionably Western-dressed and clean-shaven, frequents the gambling palaces and strip clubs of Las Vegas in the period before he wreaks unimaginable carnage for God and martyrdom. (4)

   The real human monsters apparently also have something like ordinary, everyday life. Hannah Arendt spoke at the time about the ‘banality of evil’ and added that there is no theory about this, no explanation.

   The question in this lecture is: how do people psychologically manage to display all conceivable cruelty and destruction at certain locations and times, and outside, before or after, to behave more or less normally, as a decent citizens, as if there were nothing has happened or is about to happen?

   I do not assume that social phenomena, such as genocide and terrorism, can be explained by psychological factors. Such a view leads to reductionist simplifications. However, psychoanalysis can contribute to the description of a psychological predisposition that, under the condition of a hereditary predisposition and certain social processes, can promote the occurrence of genocidal or terrorist behavior. It is therefore not genocide or terrorism that is the subject of this lecture, but a psychological predisposition that facilitates such behavior.

   Psychoanalysts assume that the coexistence in the same person of extremely opposite behaviors is facilitated and maintained by a psychological process termed splitting, splitting, or compartmentalization. (5)

   With regard to this division or compartmentalization, the genocidal or terrorist perpetrators are faced with the question of the ever-recurring border crossing between the barbaric compartment of violence and the more or less ordinary everyday activities outside it. How do people psychologically manage to cross that border over and over again?

   Or more concretely: how do the genocidal guards, executioners, and torturers prepare to go home after a day’s work? First, wash and change, and then forget everything, hide everything at home, lie about it? Or are the events of the day told in vivid and lurid detail? And how do the terrorist mass murderers prepare to hit the road? Are they at home ‘a different person’, ‘do they switch off all feeling’, ‘do they try not to think’, or are they proud and pleased with the planned daily activities?

   So the question is, how do the terrorist killers, the genocidal executioners, in one sector feel about themselves in the other sector?

   In psychoanalysis, the term mentalizing refers to the ability to think about yourself and others in terms of mental states. (6)

   Mentalizing ability means that people perceive and understand the doings of themselves and others in terms of feelings, beliefs, intentions, and desires.

   You are not born with this ability. An important element in psychological development is the realization that behavior and experience are related to psychological processes in yourself and others.

   The term psychic equivalent is used to denote the mode of functioning of the infant in which mentalizing does not yet exist, and thus there is no internal representation of psychic states. (7) Inner world and outer world are then equated. How something seems is still the same as how something is, ‘as if’ and ‘real’ are not distinguished from each other. The realization that one’s own feelings, desires, and fantasies distort the perception of the outside world does not yet exist. Ideas are not yet understood as ideas, and feelings are not yet perceived as feelings. Mental states are equated with events in the external, physical, and material world, both in their impact, causes, and consequences.

   Negative life events can block the development of mentalizing ability. In that case, psychological equivalence continues to dominate the functioning of the adult person.
   The thesis I am developing today is that blocked mentalizing capacity, with the inevitable by-product of psychic equivalence, makes people fit for the role of the genocidal perpetrator or terrorist.

   If no internal representation of an inner psychic world has developed, the terrorist or genocidal perpetrator is not aware that his image of the victim group is a subjective inner state. In psychologically equivalent functioning, internalized hate images from ultra-nationalist or religious-fundamentalist ideologies are equated with concrete external evil reality.

   Psychoanalysts emphasize that in the first years of life, thousands of social micro-interactions between the primary caregiver and the infant lead to the development of psychological structures in the child that form the basis of enduring behavior patterns. The development of mentalizing ability, that is, the ability to perceive and understand yourself and others in terms of inner states, occurs in the first four to six years of life. An internal psychic reality arises that is not a copy of the external reality or the reality of others.

   Mentalizing is more or less automatic and unnoticed. It is not something you do consciously or purposefully, so it is different from self-reflection or introspection. Mentalizing is an unconscious process, but not in the sense of being repressed. Such an unconscious, autonomous, reflexive procedure is stored in the implicit memory system.

   The implicit memory system is located in evolutionarily relatively old brain structures. These brain structures are already well-developed in humans at birth. Implicit memory stores information related to automatically performed skills and procedures, such as walking, cycling, swimming, and driving, but also, and this is important here, basic ways of seeing the world, and how people, how treat yourself and others.

   This implicit relational knowing lays the foundation for dealing with yourself and others in later situations. The events and experiences that lead to basic implicit relational knowing largely occur too early to be remembered explicitly (the first three years of life). It involves non-conscious information, knowing without knowledge that automatically guides behavior, such as grammar rules and the use of the native language. Information stored in implicit memory is probably indelible, which makes your basic way of behaving and experiencing so difficult to change.

   A specific form of implicit relational knowing is referred to as attachment quality. In empirical research, the parent’s mentalizing capacity appears to be an important predictor of the child’s attachment quality. Traumatized parents who have mentalizing abilities are significantly more likely to have securely attached children than traumatized parents who do not have mentalizing abilities. Secure attachment frees up the attention the child needs for mentalizing development.

   Based on research results, it is plausible that mentalizing arises in an intersubjective process during a critical period of development. During that period, at least one primary caregiver should be sufficiently able to experience and approach the child as a psychic unit, i.e. to see and understand the child in terms of its inner mental states such as impulses, needs, feelings, motives and convey that to the child in the language, body language, that it can understand. The child then gradually absorbs that resonance of his moods can be found in the inner world of his caretaker. Of particular interest would be the infant/toddler’s experiences with the caregiver’s reactions following pain, fear, and distress. As the child internalizes that the parent recognizes and regulates his inner states, he gradually becomes aware of his own motivational and emotional states as well as those of others. The child can therefore experience that his inner states correspond to or differ from those of others. In addition, he will develop the ability to absorb his psychic contents himself, and thus not be overwhelmed by them or have to react to them immediately. Thus, the initial beginnings of self-awareness, self-control, and social awareness arise in the infant’s interaction with a necessary minimum of mentalizing on the part of the primary caregiver.

   Large-scale social disasters, such as war, genocide, terrorism, ethnic cleansing, mass flight, poverty, and famine can interfere with the psychological development process described above in large numbers of children.

   Blocked mentalizing is usually described as the result of traumatization by an attachment person. I suppose that the occurrence of large numbers of adult people who have no inner awareness of psychic contents in themselves and others may be the result of mass-scale childhood traumatization. Due to large-scale social cruelty or chaos, large numbers of primary caretakers may become physically or psychologically unable to provide protection to their terrified children through their mentalizing function.

   When a mentalizing caregiver is not available to the infant to provide protection from the force of a destructive social reality, the infant has no opportunity to develop a differentiated inner awareness of its inner psychic world. After all, all the attention of the child will be directed to the external world with its great physical and emotional dangers. There is no room left for attention to an internal psychic world. The development of mentalizing capacity becomes blocked. The intolerable psychological pain that thinking about intolerable feelings and unthinkable thoughts would bring makes mentalizing its own enemy. Thus, while in a traumatic social reality, the destruction of mentalizing potential is an adaptive response, psychological development turns on itself, like a psychological autoimmune response.

   In a society that is massively traumatizing, many children grow up fearing and avoiding an internal representation of psychological states in themselves and others. This has far-reaching consequences for social and moral awareness, the internal regulation of feelings and impulses, and the internal image of oneself and others. Under disastrous social conditions, large numbers of self-absorbed and terrified children grow up who can later emerge as frightening and life-threatening adults.

   The claim here is not that everyone with a mentalizing defect will develop into a genocidal performer or terrorist. My assumption is more limited: blocked mentalizing is a predisposing factor that, in conjunction with decivilizing processes, can promote such a development.

   This is not to say that all terrorist or genocidal mass murderers lack an inner awareness of psychological states. Surely there will be those who do have mentalizing abilities. However, a mind without an inner world of mental states has an advantage when it comes to selection for a place in the terrorist or genocidal workplace. It is important for the headhunter of the mass murderer training camp to be aware of this defect.

   The psychological developmental defect blocked mentalizing can explain in some way the effortless border traffic between terrorist or genocidal acts on the one hand and more or less ordinary civilized everyday social intercourse on the other. Thinking in one sector about our own and other people’s psychological states in the other sector need not be repelled or suppressed. It is not there, it has not developed.

   In the psychologically equivalent way of functioning, feelings, and thoughts are given meaning only in a limited sense. They are seen and understood almost exclusively in terms of the actual, material, concrete sense of reality that has been rudimentary since birth.

   In the absence of awareness of the subjectivity of feelings and beliefs, internal fear signals are equated with an external objective danger that is acted upon. In the absence of an inner imagination of psychic states, there is no capacity for compassion and concern for others. Shame and guilt are out of the question. Without an inner representation of feelings and impulses, self-control is determined by external control, and without an internal theory of pain, an inner brake on cruelty is lacking. Without an internal representation of an inner psychic world, there is no awareness of inner contradictions. Depending on the social context in which one finds oneself, extreme differences in behavior occur. This applies, for example, to deal with the dog: early in the morning and late at night he is the favorite pet, and during the day and at work he is the instrument of hatred. Life is spatially, temporally, socially, and psychologically divided into strictly isolated sectors. The lack of an inner world of psychic processes is pre-eminently functional for fulfilling the role of the genocidal or terrorist perpetrator at one time and in one place, and that of a devoted family man or hard-working student elsewhere and at another time.

   The absence of an inner awareness of psychological states creates gaps in self-image, the image of others, and their boundaries. Indoctrinal hate campaigns targeting certain categories of people play on this inner emptiness. The flawed personal identity is filled and solidified with the fanaticism of the us-versus-the-bad-others group identity common to ultra-nationalist and religio-fundamentalist ideologies.

   The combination of (at the societal level) a hopeless economic condition, intensely political, cultural, and ideological group resentment, and (at the level of individuals) blocked mentalizing, inner emptiness, a hopeless life, narcissistic rage, youth, and physical strength can be life-threatening.

   It is important to note here again that terrorism and genocide cannot be explained by psychological factors such as, for example, the blocked mentalizing of individual actors. It can be assumed, however, that if in a society the number of people without inner imagination of psychic processes exceeds a critical limit, a change from more or less civilized average behavior to large-scale barbarism becomes more likely, just as in a supercooled water solution the exceeding of a critical number ice crystals leads to ice formation.

   The number of people with mentalizing defects is determined in part and indirectly by social factors, such as war or economic disaster in childhood. And vice versa, if masses of people walk around with this psychological development defect, it has catastrophic social consequences. Thus, there is a spiraling intergenerational interaction between destructive social and psychological processes. Breaking this downward spiral is a superhuman political, economic, cultural, and psychological task.

   (1) Contribution to the lecture ‘The derailment of civilization: mass murder, the perpetrators, the system’ (met A. de Swaan), georganiseerd door Boekhandel Scheltema in samenwerking met de Nederlandse Vereniging voor Psychoanalyse, 11 september 2002.

   For an extended version see: Gomperts, W.J. (2000). ‘Dyscivilisatie en dysmentalisatie. De ontsporing van het civilisatieproces psychoanalytisch bezien’. Tijdschrift voor Psychoanalyse, 6, 4, 193-213 en ‘Dysmentalization and dyscivilization. A psychoanalytical view of the derailment of the civilizing process’. Paper presented at the XV World Congress of Sociology. Brisbane, Australia, July 7-13, 2002, te downladen via http://203.94.129.73/timetable.html.

   (2) De Volkskrant, 30 juli 2002
   (3) Gedoeld wordt op Rudolf Höss, commandant van Auschwitz (Dimsdale, J.E. (1980). Excerpts from the autobiography of Rudolf Hoess. In: Dimsdale, J.E. (ed.). Survivors, victims, and perpetrators. Essays on the Nazi Holocaust. Washington: Hemisphere Publishing Corporation, pp. 289-304).

   (4) Minstens vijf daders van de 11-september-aanslagen werden meerdere keren gesignaleerd in de gokpaleizen en striptenten van Las Vegas.

   (5) Bijvoorbeeld: Kernberg, O.F. (1966), Structural derivatives of object relationships. International Journal of Psychoanalysis 47, p. 236-353.

   (6) Fonagy, P., M. Steele, H. Steele en M. Target (1997), Reflective-functioning manual. for application to adult attachment interviews. Version 4.1. Unpublished manuscript. Psychoanalysis Unit. Sub-department of Clinical Health Psychology. University College London.

   Zie voor een uitgebreid actueel overzicht Fonagy, P., G. Györy, Jurist, E.L. & M. Target (2002) Affect regulation, mentalization and the development of the self. New York: Other Press.

   (7) Fonagy, P. & Target, M. (1996). Playing with reality: I. Theory of mind and the normal development of psychic reality. International Journal of Psychoanalysis, 77, p. 217-233.

   Dr. W.J. Gomperts is klinisch psycholoog/psychoanalyticus. Hij is verbonden aan het Nederlands Psychoanalytisch Instituut en aan de programmagroep Klinische Psychologie van de Universiteit van Amsterdam.

   Waldeck Pyrmontlaan 15 B

   1075 BT Amsterdam

   E-mail: kp_gomperts@macmail.psy.uva.nl

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3. Bob Rijs

   May 6, 2023 at 1:35 am

   Nurturing Resilience: Helping Clients Move Forward from Developmental Trauma

   Kathy L. Kain and Stephen J. Terrell

   The Faux Window of Tolerance

   We can extend the Window of Tolerance model to include the understanding of how clients utilize various strategies for managing their dysregulation and uncontained responses when they leave the Window of Tolerance and enter into hyper-or hypo-arousal states, particularly if they are chronically unable to access the Optimal Arousal Zone (the ventral parasympathetic and low-tone dorsal physiology). In such cases, defensive accommodations develop to manage chronic levels of hyper-and hypo-arousal states. On top of the Window of Tolerance model, we can overlay what we have come to call the Faux Window of Tolerance. The model of the Faux Window provides a representation of what occurs when someone is chronically outside of his Window of Tolerance, and has developed defensive accommodations that effectively provide him with the experience of being within his Optimal Arousal Zone—when, in fact, he is operating chronically outside of that zone.

   In this representation, in figure 11, the Window of Tolerance is shown as being narrowed, making it very challenging for the client to stay within that window once any sort of stimulus appears. This is what typically occurs in the face of developmental trauma. The chronic dysregulation that commonly accompanies early trauma usually forces this narrowing of the Optimal Arousal Zone to the point that almost anything bringing challenge to the system will push someone over the threshold of the window. In figure 11, we can see how this would occur with chronic hyper-arousal.

   The Window of Tolerance is at the bottom of the diagram. On the hyperarousal side of the Window of Tolerance, we have indicated an additional window, which we term the Faux, or artificial, Window. In this range, the client manages her hyper-arousal states with defensive accommodations—selfsoothing behaviors like dissociation or compulsive eating—that hold her responses within a range that she experiences as manageable. The movement in and out of the Faux Window will occur much as it does within the Window of Tolerance, but the client may not actually reenter the Window of Tolerance, only stabilizing as best she can within a hyper-arousal state that is “workable” or “manageable” for tolerating her sympathetic activation symptoms and responses.

   As with the Window of Tolerance, there can be a Faux Window on the hypoarousal side of the true Window of Tolerance. In this case, the client will manage his hypo-arousal states with defensive accommodations that would substitute for either the ventral parasympathetic system (social engagement) or the sympathetic (active response) system—perhaps by using stimulants, acting out, or entering hyper-sexuality—to keep his experience of the low-energy states of the dorsal physiology within a range that feels tolerable. Again, the defensive accommodations may not be sufficient to move the client back within the Window of Tolerance, instead stabilizing as much as possible within the collapsed, disconnected dorsal physiology. Figure 12 shows this version of the Faux Window.

   This is not regulation, but it will sometimes feel that way to clients who have not experienced genuine and sustained self-regulation. Many clients who have experienced developmental trauma have never fully developed a Window of Tolerance—they chronically operate beyond their threshold of regulation.

   Because they don’t have access to genuine self-regulation, they will come as close as they can by applying defensive accommodations.

   For ease of discussion, the Faux Window for both hyper-and hypo-arousal responses has been overlaid on the Window of Tolerance in figure 13.

   Let’s look at the hyper-arousal portion of the Faux Window, in the instance of chronic arousal that developed early in life. Under such conditions, when the sympathetic system rises, the ventral parasympathetic response lacks the capacity to adequately reduce activation and restore equilibrium, or a return to the Window of Tolerance. Perhaps the ANS is operating outside the reciprocal range, and there is now coactivation of both the sympathetic and parasympathetic systems. In that case, as the sympathetic activation rises, so too will the dorsal parasympathetic, provoking simultaneous but contradictory physiological responses. The result is the felt sense that our bodies, our responses, are out of control.

   As a substitute for actual regulatory capacity in the parasympathetic system, we will likely develop some type of management strategy, or defensive accommodation, to address the hyper-arousal. It’s unworkable to live and function in a constantly elevated state of arousal, so we find ways to manage that activation and create some form of secondary equilibrium—the Faux Window.

   As noted in chapter 5, defensive accommodations can take many forms. They may be physiological, behavioral, mental-emotional, or relational. We consider attachment styles, for example, to be a type of defensive accommodation.

   Obsessive self-soothing behaviors, such as uncontrolled eating, might be another type.

   Overusing our dorsal physiology and moving into collapse and numbing is another common physiological strategy related to early trauma. The high-tone (freeze) dorsal physiology is not meant to be used on a chronic basis, but if we have limited access to the ventral parasympathetic system, we sometimes learn (physiologically) to use the dorsal system as the primary control mechanism for the sympathetic system. As noted in chapter 4, the low-tone dorsal physiology is dominant when we are experiencing immobility without fear, which occurs during sleep, quiet bonding behaviors, and other resting states. However, in the absence of healthy co-regulation, we may have experienced limited exposure to the ventral physiology, and so we used what was available to us at the time—the dorsal physiology. Having successfully used this “trick” once, the body may again utilize that same neurological route under similar circumstances in the future, and again repeatedly over time. Once the pattern is formed, we may chronically use immobility responses and conservation physiology to dampen sympathetic arousal the moment we feel any level of activation at all. However, this is still conservation physiology, which does not provide proper support for social engagement, activity, or the full range of self-regulation responses, and so it carries a high allostatic load. In other words, the physiological defensive accommodation of overusing the dorsal physiology brings a high cost of doing business. It holds us within a physiological range that is more affiliated with the survival response, which means we have less energy available for other critical physiological functions and we begin to deplete ourselves.

   This overuse of the dorsal physiology is one of the common physiological strategies that develops in response to early trauma, and is implicated in some of the symptoms the ACE Study has linked with early trauma. Learning to work effectively with the dorsal physiology is a critical aspect of supporting clients in the development of regulation, which in turn supports greater resilience. Later in this chapter, we present more information on that topic.

   In the upper range of the Faux Window, we may reach the edge of anger or rage. We verge toward panic or other responses affiliated with hyper-arousal.

   Because the Faux Window is often well outside the Optimal Arousal Zone, we need to understand as clinicians that within that Faux Window, the client is not in fact within a regulated state and does not have reliable access to the ventral physiology that supports social engagement behaviors, as well as regulation.

   Instead, the client is overstimulated, even when appearing to function within his Window of Tolerance.

   Even strong defensive accommodations may not be sufficient to return us to the Window of Tolerance. They may be just enough to return us to the Faux Window, but, again, that is not within the self-regulation range, and someone who has had little experience with self-regulation may mistake the Faux Window for actual regulation. This maladaptive regulation system feels normal to him— it’s all he knows.

   The clinician may also be fooled by defensive accommodations if the client’s capacity for managing her responses is effective and well developed. A clinician can easily misunderstand or misjudge the client’s capacity to tolerate more stimulus. A client’s return to the Faux Window may be mistaken for a return to regulation, and the clinician may proceed with further interventions that only serve to strengthen the client’s defensive accommodations as she struggles to manage her overstimulation.

   The same process can occur in the mirror image of the Faux Window, on the hypo-arousal side. In this case, as we move into dorsal parasympathetic dominance, neither the ventral parasympathetic nor the sympathetic systems have enough capacity to restore equilibrium and return the physiology to the Optimal Arousal Zone. As may be true with the upper range of the Faux Window, we may be operating outside the reciprocal range of the ANS, in this case with coinhibition occurring. When the parasympathetic system reduces its effect, so too the sympathetic system reduces its effect, again creating contradictory impacts in the physiology.

   Jerry is fifty-six, single, and employed as a typesetter for a local printing company. He works the overnight shift with one other employee. Jerry was born prematurely and spent the first two months of his life on a respirator in the neonatal intensive care unit. Jerry’s mother and father were not able to touch Jerry until he was almost six weeks old. He was surrounded by machines without the nurturance of loving touch for nearly two months.

   Jerry’s mother and father were farmers, and he was the fifth of eleven children. Because of their work on the farm, they were able to visit Jerry in the hospital only one day a week. This separation was not planned, but had long-term consequences for Jerry and his emotional development.

   Jerry was considered a “good” baby when he came home. His mother remarked that he slept most of the time and rarely cried until he was two years old. Jerry’s mother was expecting Jerry’s younger sibling before Jerry was three months old. Jerry’s mother did not have the energy necessary to care for Jerry’s needs, and she often propped up bottles to feed him and rarely interacted with him.

   By age three, Jerry seemed wild to his family. He frequently ran away from the family and broke toys without reason. When he entered school, he was labeled ADHD and placed on medications to regulate behavior and mood. He struggled to learn and had no meaningful relationships.

   In middle school, Jerry refused to take his medication any longer, complaining that the side effects were too disturbing. His mood changed drastically, to constant high arousal and agitation. He began to drink his father’s vodka to help himself relax. It wasn’t long before he added pot to the mix and would drink and smoke pot several times a day. He was passed through school by teachers who didn’t know what to do or how to help him.

   During high school, Jerry had several run-ins with the law. He was arrested for intoxication and for possession of marijuana. He continued to drink and smoke pot. It was only when Jerry was high or intoxicated that he could tolerate being around his family. He would get very quiet, and no one noticed his emotional pain. He was reenacting the role that his parents seemed to love the most—the quiet, sleeping infant who didn’t cry.

   Jerry had several short-term relationships after high school. The relationships all ended because of Jerry’s substance abuse, or his rage, which would surface from time to time. Women would say they were afraid of Jerry and where his anger could lead. Jerry struggled to keep jobs and lived on the edge of society until he found his current job as a typesetter.

   Jerry seemed to do his best working alone at night. He was able to drink and smoke pot and still hold down a job, but he often became angry during his shifts and screamed at his coworker. His coworker confronted him about his alcohol and drug use, but Jerry had one response: he was not addicted, and he denied being an alcoholic.

   Jerry used denial and substances as defensive accommodations. During his younger life, he used medications as an artificial parasympathetic brake for his sympathetic arousal. He rarely had the experience of his parasympathetic response coming on naturally—his ANS was out of sync with itself. Jerry blamed others for his problems, but desperately wanted to be accepted and loved by his family. He had never experienced a natural Window of Tolerance, but existed only in a Faux Window. This Faux Window at one edge was dark and quiet, and, at the other, filled with anger and rage. He used substances to manipulate his regulation within the Faux Window.

   With his lack of access to co-regulation and soothing during his first weeks of life, Jerry’s physiology tuned more toward overuse of the dorsal conservation physiology. Once home with his family, his quietness was misinterpreted as his being a “good” baby who never cried. Because his mother was already overwhelmed with child care, she felt relief at having a baby who seemed to need so little from her.

   As Jerry matured, that fundamental lack of regulation began to show more in his inability to manage his own responses, and he began to use substances as a defensive accommodation to support what felt like a “smoother” experience, rather than the wild ride he had when he wasn’t using his medication.

   In Jerry’s case, working to help him stay within his Window of Tolerance, offering attachment repair and consistent co-regulation, is likely to make a big difference in his ability to regulate his responses. Because of his tendency to overuse his dorsal physiology, he has as much defensive accommodation on the hypo side of his physiology as he does on the hyperarousal side.

   As occurred in the hyper-arousal side of the Faux Window, defensive accommodations will be used as a substitute for the regulatory functions of the sympathetic or ventral physiology. This could include the use of stimulants or self-stimulating behaviors that bring us out of the lethargy and numbing that typically accompanies the dorsal freeze states. It could also manifest as hypersexuality or other almost obsessive attempts to experience a sense of social connection. By contrast, such defensive accommodations might include the avoidance of social situations that feel too stimulating. But this avoidance can plunge us further into numbing and lethargy.

   On the hypo side of the Faux Window, we may be on the edge of complete collapse, struggling with a sense of depression and hopelessness. We may spend an inordinate amount of time managing our energy, limiting our exposure to stressors, and finding ways to conserve our limited physical resources.

   Again, the defensive accommodations themselves tend to occupy even more of our life’s energy, further narrowing our Window of Tolerance and provoking more defensive accommodations. Already, we can see how some of the symptoms affiliated with early trauma, as seen in the ACE Study, for example, can arise from these dynamics of responses related to the Faux Window.

   As with the hyper-arousal range of the Faux Window, if defensive accommodation strategies are well developed and effective on the other (hypoarousal) side of the Faux Window, both the client and the clinician may misinterpret the client’s state and believe she is within the Window of Tolerance.

   The clinician may therefore prepare for further interventions that might ultimately challenge her response system rather than restore it.

   Another common physiological “habit” that may develop in the face of developmental trauma is an oscillation between high arousal and a deep dive into the dorsal physiology. We would typically see this in the context of foundational dysregulation, as discussed in chapter 5. In this case, one would see a client who alternated between the upper and lower ranges of the Faux Window, showing symptoms related to each, and having a complex system of defensive accommodations.

   Any version of the Faux Window can be affiliated with somatic symptoms related to overuse of survival physiology, the types of symptoms we see with patients who score higher on the ACE scale.

   Most people who operate within the Faux Window are not aware that they are not actually within a regulated state. If this is all they have ever known, this is as close to regulation as they can get, and they are likely to have normalized the Faux Window to the point that they would say they are relaxed and settled, even when they are well outside the Optimal Arousal Zone. With experience, clinicians can learn to recognize these defensive accommodations, and recognize when a client is operating within her Faux Window, rather than within her Window of Tolerance, and adjust interventions accordingly.

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