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#388563 - 03/06/12 05:33 PM Complex PTSD
phoenix321 Offline


Registered: 09/26/11
Posts: 912
Loc: USA, FL
How does short-term trauma differ from chronic trauma?
The diagnosis of PTSD accurately describes the symptoms that result when a person experiences a short-lived trauma. For example, car accidents, natural disasters, and rape are considered traumatic events of time-limited duration. However, chronic traumas continue or repeat for months or years at a time.

Clinicians and researchers have found that the current PTSD diagnosis often does not capture the severe psychological harm that occurs with such prolonged, repeated trauma. For example, ordinary, healthy people who experience chronic trauma can experience changes in their self-concept and the way they adapt to stressful events. Dr. Judith Herman of Harvard University suggests that a new diagnosis, Complex PTSD, is needed to describe the symptoms of long-term trauma (1). Another name sometimes used to describe this cluster of symptoms is: Disorders of Extreme Stress Not Otherwise Specified (DESNOS)(2).

Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met criteria for PTSD, Complex PTSD was not added as a separate diagnosis (3). However, Complex PTSD may indicate a need for special treatment considerations.

What types of trauma are associated with Complex PTSD?
Judith Herman notes that during long-term traumas, the victim is generally held in a state of captivity, physically or emotionally. In these situations the victim is under the control of the perpetrator and unable to flee.

Examples of such traumatic situations include:

Concentration camps
Prisoner of War camps
Prostitution brothels
Long-term domestic violence
Long-term child physical abuse
Long-term child sexual abuse
Organized child exploitation rings

What are the symptoms of Complex PTSD?

The first requirement for the diagnosis is that the individual experienced a prolonged period (months to years) of total control by another. The other criteria are symptoms that tend to result from chronic victimization:

Alterations in Emotional Regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.

Alterations in Consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes or body.

Changes in Self-Perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.

Alterations in How the Perpetrator is Perceived. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.

Alterations in Relations with Others. Examples include isolation, distrust, or a repeated search for a rescuer.

Changes in One's System of Meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.

What other difficulties do those with Complex PTSD tend to experience?

Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming.

Survivors may use alcohol and substance abuse as a way to avoid and numb feelings and thoughts related to the trauma.
Survivors may also engage in self-mutilation and other forms of self-harm.

Blaming the victim
A person who has been abused repeatedly is sometimes mistaken as someone who has a "weak character." They have been misdiagnosed by mental health providers as having Borderline, Dependent, or Masochistic Personality Disorder. Survivors have been unjustly blamed for the symptoms they experience as a result of victimization. Researchers hope that a new diagnosis will prevent clinicians, the public, and those who suffer from trauma from mistakenly blaming survivors for their symptoms.

Summary
The current PTSD diagnosis often does not capture the severe psychological harm that occurs with prolonged, repeated trauma. For example, long-term trauma may affect a healthy person's self-concept and adaptation. The symptoms of such prolonged trauma have been mistaken for character weakness. Research is currently under way to determine if the Complex PTSD diagnosis is the best way to categorize the symptoms of patients who have suffered prolonged or repeated trauma.

http://www.ptsd.va.gov/professional/pages/complex-ptsd.asp

_________________________
Phoenix

A guy opens the front door and sees a snail on his doorstep. He picks up the snail and throws it across the street in a neighbor's yard. A year later, the guy opens the front door and the same snail is on his doorstep. The snail says, "What the f*ck was that about?"

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#388598 - 03/07/12 03:57 AM Re: Complex PTSD [Re: phoenix321]
1lifenow Offline


Registered: 03/07/11
Posts: 385
Loc: west coast
fucking brilliant,

It is a list that could have been read at our group the other nite, we all had ten minutes to talk about our abuse, then how it affected our lives.

the shopping list from hell.

I remember my parents saying i was going to have to get my anger under control or they would send me away. Ya, it was our fault.
For the most part we can overcome many of these symptoms, that is a belief I must and need to empbrace.

Thanks again, it helps bleed steam from the pressure cooker.

_________________________
The need for love lies at the very foundation of human existence. Dalai Lama

WoR Barrie 2011

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#388612 - 03/07/12 08:55 AM Re: Complex PTSD [Re: 1lifenow]
traveler Offline
Greeter
MaleSurvivor

Registered: 02/07/06
Posts: 3211
Loc: back in the USA
Sounds like this pretty accurately describes most of us...

_________________________
We are often troubled, but not crushed;
sometimes in doubt, but never in despair;
there are many enemies, but we are never without a friend;
and though badly hurt at times, we are not destroyed.
- Paul, II Cor 4:8-9

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#388635 - 03/07/12 03:06 PM Re: Complex PTSD [Re: traveler]
MaxEnnis Offline


Registered: 03/06/12
Posts: 9
Loc: San Francisco Bay Area
I don't remember how I stumbled upon the term Complex-PTSD several months ago, but I've been trying to read more about it. I know it overlaps tremendously with PTSD, but the differences seem important to me. It is a different experience, however similar the resulting symptoms may appear. I've brought it up with a couple of psychologists, but they sort of dismiss it the way pyschs do when you talk about something they don't know about. They can never say, "I don't know jack about it. I need to learn." My husband is seeing one of the few therapists I've found that sort of specializes in it.
+++++++++
Complex PTSD

by Julian Ford, Ph.D.


People who experienced personal trauma when they were very young, or even in infancy, are at risk for not only post-traumatic stress disorder (PTSD) but also for a range of difficulties that result from the disruptions of self-regulating systems. These have been called "Complex" PTSD or "disorders of extreme stress not otherwise specified."

Many individuals who have been diagnosed with personality disorders or severe mental illnesses (such as schizophrenia, bipolar disorder, or dissociative disorders) have experienced early life personal trauma. The lasting effects that early life trauma can have on emotional and social functioning and physical health therefore are of potential interest to these persons, their families, the advocacy organizations that represent them (such as the National Alliance on Mental Illness and the Mental Health Association), and the mental health professionals who provide them with treatment. Although early life trauma does not appear to cause serious mental illnesses, the emotional and bodily problems that trauma can cause may worsen the symptoms of these illnesses. Therefore, recovery from mental illness may be enhanced if Complex PTSD is recognized and treated effectively.

PTSD has been recognized by the medical and mental health professions for almost a century, dating back to the identification of soldiers with "shell shock" in World War I. It was recognized officially as a diagnosis by the American Psychiatric Association in 1980, largely as a result of advocacy by Vietnam military veterans and their families, and by women who suffered domestic violence. People with PTSD have persistent anxiety, fear, and bodily arousal which can lead to problems with anger, irritability, sleeplessness, intimacy, and a loss of the ability to feel most emotions.

People suffering from Complex PTSD typically have experienced psychological traumas that caused them to experience intense insecurity and fear in early childhood, such as maltreatment (abuse or neglect), the death of a caregiver, or family violence.

Complex PTSD involves three different fundamental problems with features that set it apart from PTSD's otherwise recognizable problems with anxiety, anger and emotional numbing. With Complex PTSD the defining features include (1) emotion dysregulation, (2) pathological dissociation, and (3) stress-related breakdowns in bodily health.

When emotions are dysregulated, they can shift unpredictably so that a person never knows what she or he will be feeling from moment to moment. Emotions may be extreme in their intensity, appearing as terror, rage, despair, or paralyzing guilt, shame, and self-loathing. And the person cannot get over the distress and regain the ability to think clearly for prolonged periods, even when attempting to calm down or when other people attempt to provide support or reassurance. It is a state that is very similar to the inconsolable distress that young children experience if they are unable to form a secure attachment to primary caregivers.

The second feature of Complex PTSD is pathological dissociation. This involves a sudden and involuntary loss of the ability to know who you are, where you, are, and what you are feeling and thinking. When people dissociate, they tend to feel as if they have become unpleasantly divided within themselves. Dissociation may take the form of feeling confused and "in a daze," as if they are "on automatic pilot" or "in a dream." These are normal feelings that can come and go for anyone, but when they persist and the person feels that it is not possible to "get my mind back in focus." The dissociation can lead to feeling that you are not in control of your own mind and body, like you're not really yourself or where you are seems like it's not real.

Temporary mild dissociation is common when people experience psychological trauma. However, persistent severe dissociation is not. Why some continue to have problems with dissociation and others do not is not fully understood. However, dissociation appears to be a form of biological, emotional, and cognitive "overload" that can become a persistent problem if it begins (like emotion dysregulation) with psychological trauma in early childhood.

The third core feature of Complex PTSD is a breakdown in bodily health that cannot be fully explained by physical injuries or medical illness. Individuals with Complex PTSD often describe their bodies as "falling apart," or "damaged and broken," or "in constant pain." Children who experience maltreatment, extreme poverty, or violence in their families or communities are prone to develop medical illnesses. When these physical health problems fail to respond as expected to medical treatment or become a main focus and preoccupation in the person's life, this is a sign of possible Complex PTSD. It does not cause serious medical illnesses (or physical pain), but it is a condition of staying on "high alert" that is stressful not just emotionally but also creates a strain on the body. The physical health problems that occur are real medical conditions, but they are more severe and distressing, and less amenable to medical treatment, because the body is under stress.

As a result of the combination of emotion dysregulation, persistent dissociation, and bodily breakdowns, people suffering Complex PTSD tend to have serious problems in self- esteem, relationships, and finding a sense of meaning in their lives. They tend to feel self- critical or even self-hatred. They often engage in risky behavior such as exposing themselves to physical danger in the form of accidents, fights, or unprotected sex. They have major ups and downs in relationships. And they often feel that life is pointless and hopeless. When past traumas involved being the victim of purposeful assaults, abuse, torture, or war atrocities, complex PTSD also may include "altered perceptions of perpetrators" --beliefs that include chronic hatred, intimidation, or sympathy for those who caused harm.

There is some debate and controversy about whether Complex PTSD is distinct from PTSD, a subset of it, or another name for other psychiatric disorders. Complex PTSD was proposed as a separate psychiatric diagnosis from PTSD in the early 1990s when the American Psychiatric Association was revising the DSM-IV. However, it was not codified as a separate diagnosis because it was judged to be similar to other diagnoses. This question is again being debated in the mental health professions as a new guidebook for psychiatric diagnoses, the fifth revision of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-V), is being created. This revised guide for mental health diagnosis will not be finalized until at least 2012, while study groups discuss the evidence for and against different diagnoses. Clinicians who view Complex PTSD as a useful distinct diagnosis are making that case, but the outcome will not be known for another five years.


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#388691 - 03/08/12 01:20 AM Re: Complex PTSD [Re: phoenix321]
pufferfish Offline
Member
MaleSurvivor

Registered: 02/26/08
Posts: 6719
Loc: USA
I think this is excellent.

The only thing I would add is that "Complex PTSD" might be developed in a short period of time. My treatment in the scout camp only lasted 2 weeks but because it was so horrendous it produced what you are thinking of as Complex PTSD. Of course I had prior abuse. This camp experience was my 5th episode of abuse (pufferfish story part 5)

Puffer

P.S. Probably a whole additional term is needed for "Complex PTSD". When it is very severe, it throws the whole game into a different ball park. Maybe it's comparable to the term "metastatic carcinoma". It has a major affect on the outworking of every personality issue.






Edited by pufferfish (03/08/12 01:26 AM)

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#388693 - 03/08/12 01:30 AM Re: Complex PTSD [Re: pufferfish]
pufferfish Offline
Member
MaleSurvivor

Registered: 02/26/08
Posts: 6719
Loc: USA
I also think the categories of dissociative orders need to be redefined and maybe renamed*. For instance, the term DID is really too broad a category. To overuse the baseball analogy, DID goes all the way from "little league" to "professional".

This really makes the term DID much less useful as a diagnostic term. It includes too much that is quite distinct.

Also the relationship between DID and PTSD is often blurred and the the system of nomenclature doesn't distinguish them.

Puffer

* P.S. added later. I understand we cannont redefine these things on our own. They are voted on by the psychologist's organization.




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#388695 - 03/08/12 01:37 AM Re: Complex PTSD [Re: MaxEnnis]
phoenix321 Offline


Registered: 09/26/11
Posts: 912
Loc: USA, FL
Originally Posted By: MaxEnnis
eople suffering from Complex PTSD typically have experienced psychological traumas that caused them to experience intense insecurity and fear in early childhood, such as maltreatment (abuse or neglect), the death of a caregiver, or family violence.

Complex PTSD involves three different fundamental problems with features that set it apart from PTSD's otherwise recognizable problems with anxiety, anger and emotional numbing. With Complex PTSD the defining features include (1) emotion dysregulation, (2) pathological dissociation, and (3) stress-related breakdowns in bodily health.


1st paragraph, CHECK!

2nd paragraph:
1. Emotional dysregulation (ED) - Bipolar, GAD qualifies so CHECK!
2. Pathological dissociation - DID qualifies me so, CHECK! Still have, ain't getting rid of either.
3. Stress-related breakdowns in bodily health - CHECK! I used to have welts appear on my arms, side, legs from stress. Luckily, I took Valium and the went away. A bunch of nervous breakdowns from teen years to mid-30s. Detachment disorder would qualify me too.

_________________________
Phoenix

A guy opens the front door and sees a snail on his doorstep. He picks up the snail and throws it across the street in a neighbor's yard. A year later, the guy opens the front door and the same snail is on his doorstep. The snail says, "What the f*ck was that about?"

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#388744 - 03/08/12 01:24 PM Re: Complex PTSD [Re: phoenix321]
son Offline


Registered: 03/06/12
Posts: 9
Loc: New York
yep... C-PTSD is a monster. And so few people understand it. My therapist uses the dx of PTSD for me and anyone with long-term abuse from childhood. But after doing my own research I knew I C-PTSD was a better de>

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#388755 - 03/08/12 03:32 PM Re: Complex PTSD [Re: son]
Magellan Offline
Member
MaleSurvivor

Registered: 12/31/10
Posts: 1363
Loc: California
Hi Son,

Thanks for your input on this. What is "imaginal exposure therapy"? I've never heard of it. I'll google it, but I'm curious to know your personal experience with it.

Many thanks,

D

_________________________
It's a heroes journey, and you are the hero.

-- I must remind myself that sugar is my enemy. I can't control my sugar consumption and sugar makes me mentally unstable. I'm reminding myself (because I forgot again).

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#388762 - 03/08/12 04:28 PM Re: Complex PTSD [Re: Magellan]
son Offline


Registered: 03/06/12
Posts: 9
Loc: New York
Sure thing D smile

Imaginal Exposure is a method of processing traumatic memories that predates EMDR. I have no experience with EMDR but there is some overlap in the procedure, in the sense that you talk about the memories a lot.

First off, this was how I began dealign with my csa... last summer. I was terrified. And I usually am real strong about these things.

We picked the first memory of csa I could recall. From when I was 4. I described what happened in as much detail as I could recall. Where I was, what time it was, where my family was, what was the room like, how did I feel etc. How did it start, how did it end. The story is recorded, and then I had to listen to the recording of me telling the story every day for a week—until the next therapy session. Where I would record myself telling the same story. The process is repeated.

Some amazing things happened: Each time I told the story of that first incident, the feelings of fear decreased noticeably. Because I wasnt just telling the story, but hearing it all week long. The story slowly became part of me... just a story. A story no more scary than any other part of my life.

And more details emerged. After a while I could describe the walls, the quality of light, sounds, the time of day and year.

Something else as well: during the week, other memories became unlodged and floated to the surface. I could recall other very difficult things suddenly... on the train to work. But I put them on hold and focused on that first narrative.

After only 3 sessions of this, I felt incredible. All that pain and shame (shame was always the worst for me) dissolved. I felt free and peaceful. And happy smile

I have more of this to do for sure. But what I like about it is that its focused, has a concrete start and end, and I know that first memory can never bother me again smile


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