So, what is social support actually

mean? Does it just having people around

you? No. It is being able to re-engage

with the things that trigger your trauma

and being safe despite the trauma

signals being active in here. Really

important to understand. The way that

you heal from trauma is by teaching your

body that the reaction that you have is

actually the wrong reaction. It's

natural, it's normal, but it is

inappropriate. We don't need to react

this way. It's safe.

>> Somebody said that it must be like

exhausting how much you have to reassure

me.

>> Exhausting.

>> [laughter]

>> First of all,

uh I love reassuring. And second of all,

it's so easy. It's so easy. My job is so

easy. My super hot friend wants to be

told that she looks hot or she looks

good. Oh, no. Oh, no. The easiest a bad

And if you are with a bad

you need to have a bad mentality.

And nobody understands that. We're art.

People need to see you, okay? I My job

is to reassure you and and feel proud

when I'm out with you and everyone

stares at you. I have the easiest

job in the world, okay? So, no,

it's really not difficult.

>> Okay, this is a case of someone asking

reassurance about their need for

reassurance. Like, that's what this is.

It's like, "Hey, can you reassure me

about how much I need to be reassured?"

So, here's a couple of things to

understand. When people are like, "Oh,

reassurance is the easiest for a woman.

I wonder why men thinks it think it's so

hard." Okay. So, I don't know why people

have to bring gender into it, right? But

this is the internet where it's like,

"Let's rage bait this by making it a men

versus women thing." So, a couple of

things to understand about needing

reassurance. The first is that many

people who need a lot of reassurance,

there are two ways that this can go.

Either this can get better or it cannot

get better. So, a good example of this

is borderline personality disorder where

these people have a severe fear of

abandonment. And they need constant

reassurance that this person is not

going to leave them, not abandon them,

etc. Whereas what we know actually is

that people with borderline personality

disorder, the majority the vast majority

of them, over 90% of them get better

within 10 years of a stable

relationship. 50% of them no longer meet

criteria after 2 years of a stable

relationship. And so if you're someone

who needs constant reassurance, the vast

majority of humans who get reassurance

will be better,

but it takes years. It'll start to sink

in after years of reassurance. And And

so this is for one thing to understand,

right? Like is like that it does seem to

work. So one good example of this is,

you know, I was working with a family

that told me that they're they kept on

finding that they had adopted a child

and they said, "You know, we keep on

finding ants in the child's room." They

basically have one behavioral problem

and they always have ants. Why do they

have ants? Because they have half-eaten

food tucked away inside all their

drawers and then the ants find it. And

we've tried to explain, "Hey, you can't

have food here. There's plenty of food

in the pantry. Like please stop keeping

your food here. We have ants. We have to

call the exterminator again and again

and again." The kid keeps doing it.

Otherwise the kid like listens to

things. And so the kid grew up, was in

an environment where there wasn't food

security. And so we're talking like from

the age of three or four or five,

learned how to hide food. And then gets

adopted at the age of nine and then

tucks things away. And the parents are

like, "There's a pantry. Like they can

go into the pantry and they can grab

whatever they want. We've shown him the

pantry like 15 times. It's not

clicking." Exactly. It takes some time

to click. And this is where if we look

at

you know, this is kind of an interesting

question. What does getting better look

like in a situation like this? So there

was a great question about, you know,

why do some people develop PTSD from

traumatic events when others don't? And

this is what's really interesting. So,

if we look at one of the most protective

factors from preventing the development

of PTSD, it is social support. You can

look at people who have been experienced

some kind of trauma, like physical

assault or emotional abuse, sexual

assault, take your pick. And not all of

them end up with PTSD. And even then,

what's what's kind of interesting is

that the majority of people who end up

with PTSD, so probably the highest

indicator of trauma in some studies,

single instance of sexual assault is the

most likely to result in PTSD. But, what

we see is that more than half of people

who have PTSD will no longer have it at

the end of 1 year, even if they've had

sexual assault. Those are the people who

develop in the first place, okay? Which

is less than half of people. So, the

question is how, right? How is it that

some people do develop PTSD? Some people

don't develop PTSD? Like, what's the

difference? And for people who do

develop it, what determines whether they

get better or they don't get better? And

this is where social support, and

specifically what I would call

corrective emotional experiences, are

really, really, really important. And

this is why reassurance works. So, I

want you all to imagine for a moment

that someone has been sexually

assaulted. They have early stages of

PTSD, they've had it for about 2 months.

What does the process of healing over

that PTSD look like? Since this was

sexual in nature, when they are in a

committed relationship with their

partner and they start to get sexual,

the trauma triggers. They start to clamp

down, they go into a freeze mode, they,

you know, it's like their their body

goes into survival mode instead of

relaxing, being vulnerable with someone,

being able to engage with someone. And

this is the really important thing, what

happens next? If their partner is able

to give them the space to breathe that

way, and then they, you know, cool it

for now, try again maybe an hour, try

again a week later, not push it. Then

what we're starting to do is we're we're

starting to enroll exposure and response

prevention. Because after a sexual

assault, the body learns that sex is

dangerous. I keep seeing comments, "Dr.

K, how do I apply this to a situation in

my life?" That's literally why we

created a coaching program. Our coaches

are certified on an evidence-based

curriculum designed to help you get

unstuck. This involves analyzing your

patterns, increasing your understanding,

and working with you week to week to

help you develop a plan to create

lasting change. So, if y'all are

interested, check out the link in the

description below. So, what is supposed

social support actually mean? Is it just

having people around you? No. It is

being able to re-engage

with the things that trigger your trauma

and being safe despite the trauma

signals being active in here. Really

important to understand. The way that

you heal from trauma is by teaching your

body that the reaction that you have is

actually the wrong reaction. It's

natural, it's normal, but it is

inappropriate. We don't need to react

this way. It's safe. The trauma is

triggered, it's safe. Trauma is

triggered, it's safe. Trauma is

triggered, it's safe. And this is what

good social support literally does. So,

the child hides the candy bar, parents

come in, say, "Hey, you don't have to

hide the candy bar." Child doesn't get

it. No no real consequence. Okay, you

feel that way? Okay, fine. We're going

to take the candy bar because there's

ants. You can hide another one. And this

is what's really I just

You know, I was talking about this. I've

told this story for I never realized

this. No wonder the child keeps hand

hiding the candy bar because it keeps on

getting taken away by the parents. Wait,

what? I just had a breakthrough. Man,

talk about failing your patients. I I

don't know why Did you guys realize

that? Did y'all pick that up? Actually,

we're like we're doing it again. Did you

guys see that? Seems obvious now, right?

Right? So, it's so interesting. What an

[laughter] epic fit. All right, the kid

got better. So, that's the good news is

that you can miss some of these things

and you can still provide the right

support without doing things precisely

correct. But, this is what what we need

we need corrective emotional

experiences, which was originally not

related to trauma. I mean, that's been

that's a a deep part of the

psychoanalytic and psychodynamic

literature, okay? About like even the

childhood traumas that we have, we're

looking for corrective emotional

experiences through psychotherapy,

through transference,

countertransference, and all that kind

of stuff. But, the the way that we heal

trauma is by, you know, we have one

experience and then we learn, "Oh, this

is scary." And then we have to have

other experiences that show us that this

is safe. And the problem is that our

brain is wired to weight negative more

than positive. We literally will weight

a negative experience three to 10 times

as much as a positive experience. So, if

you guys ever have ever had a cat,

right? You can pat a cat for 1 year and

be friends with a cat, but if you have a

single bad altercation with a cat, the

cat will keep a grudge and remember.

They don't keep a grudge, they're just,

you know, that's just how they work.

They're now wary of you, right? And it's

like you can be married for 20 years,

one instance of betrayal heavily

outweighs 19 or even 20 19.9 years of

fidelity. That's just how we're wired.

With people who heal from trauma, we

have to have these corrective emotional

experiences. We have to have other data

points that will help us put the

negative thing in context. And because

of if we look at the example of

fidelity, this is why people need so

much reassurance, right? And this is why

if we look at I think something like 96%

95 or 90 95 to 98% of people with BPD

are in remission 16 years after

diagnosis. So, 50% at 2 years, 90% at

like 10 years, 98% at 16 years. I think

were the stats that I remember off the

top of my head. Right? So, so you need a

lot of those data points. Now, here's

why I think we're seeing a huge spike in

trauma, because those corrective

emotional experiences, those social

support structures, the repeated chances

for salvation

are disappearing from society. We live

in a world where people get blocked. We

will live in a world where we're working

remotely. We live in a world where once

I get dumped and something bad happens

to me, I go to places on the internet

where we can have an experience like

this and look at what the top comment on

Instagram is. Is this because it's

upvoted the most? Is this because

Instagram knows this is going to get the

highest level of engagement? But it's

like boom, ragebait. Ragebait, right?

It's like what? So, I think the reason

we're really seeing a spike in in

trauma-related things is because if you

kind of screw up, you get punted off the

escalator and you kind of get left

behind. And there isn't an opportunity

for corrective emotional experience.

This person says, "Oh my god, like is it

hard to reassure me?" I want y'all and

this is beautiful and heartwarming and

whatever, right? So, I fine. But I want

y'all to think about this person's

response and how easy or difficult is it

to find someone like this to provide you

with reassurance, right? And then we run

into another problem, which is beauty is

in the eye of the beholder, totally

fine. But like what happens if you're

not the most beautiful person on on the

planet? What if you're south of five out

of 10? Then how hard is it to find a

person like this, right? And then we

begin to see not that this person is

doing anything wrong or anything like

that and I'm not saying that this person

is a 10 or whatever. I really do believe

that beauty is in the eye of the

beholder, but it's like now we begin to

see why everyone is so

traumatized all the time, because the

basic elements of what is required for

correction do not or harder to find. And

it does require a large dose. So, this

person requires reassurance about

needing to be reassured. Seems like

they're getting it. We can put this in

the W column. The challenge is that so

few people, if we're talking about

gender dynamics for a moment. Now now

there's a big movement, right? To like a

man's emotions are no longer somebody

else's responsibility. They have to

handle them on their own. And I'm not

disagreeing with the argument. I think

that self-sufficiency is really really

really important. But then the question

is like who does the work? Who does the

work of social support, trauma healing,

things like that, right? And I'm not

saying this is right or wrong. This is

just how things are. And as society

changes, the first most important thing

to do is to understand why things are

changing. What is the mechanism? Good

diagnosis precedes good treatment. Then

we can figure out what comes next,

right? And this is another I so I was

like looking at this. Why do some people

develop PTSD after from traumatic events

when others don't? So, I was trying to

answer this question. I came across this

paper. Experience of trauma and PTSD

symptoms in autistic adults. Risk of

PTSD development following DSM and

non-DSM-5 traumatic events. So,

basically, if you look at our diagnosis

of trauma, we have a kind of event that

qualifies for trauma. So, here are the

examples of things. Sexual abuse,

physical abuse, serious injury,

abduction, sudden death of close friend

or family member, suicide attempt by

close friend or family member, serious

injury to another individual, learning

witnessing sexual abuse, threats to

one's life from another individual,

suicide attempt. So, in the diagnosis of

PTSD, these are DSM-5 traumatic life

events. This is what causes PTSD, okay?

Here's what's really scary. Although

rates of criterion A trauma exposure

have been found to be 25% in individuals

with ASD, we just looked at criterion A.

That's like the bad stuff that we

normally think about with trauma. More

than 50% of individuals with autism

spectrum disorder were were reported by

a parent report to experience at least

one event in their lifetime which was

interpreted as traumatic. 47% of all

females and 70% of males reported having

experienced a life event that they found

to be traumatic which did not meet DSM-5

criteria. Bullying, non-traumatic

bereavement, and traumas relating to

mental health problems such as anorexia

or breakdowns. In addition, abandonment

by a significant other mother wife and

stress associated with social

difficulties were also reported by

multiple individuals. So, here's what's

really scary. These are the kinds of

things that people on the spectrum will

will experience as traumatic.

Bereavement, police visit to the house,

bullying, abandonment, death of a pet,

psychological therapy. Therapy is in of

itself traumatic to some people on the

spectrum. Injury of family member,

parents divorce, ASD diag- The process

of getting diagnosed with autism is in

and of itself traumatic. Own violence to

other, right? So, when they lose control

because they're behaviorally

dysregulated and hurting someone.

Boarding school, their own illness, just

having autism. Vomiting is huge. Grossly

under appreciated source of trauma for

people on the spectrum. Social

difficulties. I was like, "Okay, why do

people recover? How do people not

recover?" What I stumbled into is

actually way scarier, which is that if

we look at specifically people on the

spectrum, their capacity to experience

trauma is elevated. There are lots of

experiences that that non- I was about

to say normal neurotypical human beings

experience that are not traumatic. And

let's understand why. Because when I get

bullied, I have a brain that knows how

to form social connections. I have a

brain that empathy is more easily

accessible. I have a brain that doesn't

need a script, a strategy, or a game

plan for social interactions. I can feel

my way through life. You know, when I'm

capable of feeling my way through life,

my capacity for social support is

increased. So, on the spectrum, we have

a two challenges. The first is that the

experiences that other people may have

which are not traumatic are traumatic

for us. And that's because of the way

that our brain processes this

information. The amount of emotional

activation that we get when we get

bullied, the persistence of bullying,

the frequency of bullying. And then we

lack the social support that is

necessary to protect us from the trauma,

to stabilize us afterward. And so, one

of the things that I stumbled into,

which I was

really kind of like, honestly proud

about and also happy about, was the

realization that when you get diagnosed

with ADHD when you get diagnosed with

ADHD late in life, you also have a mood

disorder until proven otherwise. See, as

a psychiatrist, I used to think, "Okay,

this person's diagnosis is ADHD. And

they may have depression, they may have

bipolar, but I that was like a maybe."

Now, my thinking has shifted. If they

have adult diagnosed ADHD, I am assuming

the burden of proof has now changed in

my mind. They have depression until I'm

sure they don't. It's not a possibility,

it is true until it is proven otherwise.

And having worked with people on the

spectrum, what I'm now realizing after

seeing this paper, it like clicked for

me.

I was like, "Oh, these people have

trauma until proven otherwise." I'm

going to operate under the assumption

47% of women and 78% of men who are on

the spectrum. Staggering percentages are

traumatized by things that we do not

usually assess for in an intake. cuz

literally when I'm I have a script when

I'm reviewing evaluating someone for

trauma in the emergency room. Have you

ever been physically abused, emotionally

abused, sexually abused? What was

growing up like? I don't ask, "Have you

ever seen a therapist and found yourself

feeling traumatized by that process?

Have you been bullied? Have you ever

lost a pet?" Right? And I don't know

that these need to be screening

questions because I was one person that

said loss of a pet. Right? And this is

the important thing. Losing a pet is

hard for everyone, but it has a greater

likelihood of becoming PTSD if you're on

the spectrum. Right? That's what's

really scary about this.

>> [music]