COMPLEX TRAUMA DISORDER
-- COMPLEX POSTTRAUMATIC STRESS DISORDER (CPTSD)
PRIMARY PROBLEMS FOR SUFFERERS OF COMPLEX TRAUMA DISORDER
To gain a "personalised" introduction to this topic see this video -- [LINK] See related videos on the GFW site here -- [LINK] Note: these video segments are on YouTube.
The above video is from the GFW (Gift From Within PTSD) website here -- [LINK]
As an initial caveat, I must preface these comments by noting the existence of considerable research, and controversy in the discussion of that research, about the effects of disturbed or disrupted attachment. This literature has often NOT been well integrated into the clinical psychology of abuse, or the general psychology of such things as the recognition of others' emotions. These are huge areas of research in their own right, and at this stage I shall only be making comment in passing, but in fairness to myself I must acknowledge publicly my awareness and "occasional" tracking of this area as well as the psychology of childhood abuse. It is particularly from the area of attachment research that one draws the unfortunate conclusion that unless well directed and well conducted clinical intervention occur in the lives of those who have suffered significant abuse and neglect that the problems these survivors experience could well last the entire course of their lives.
(For a recent discussion of these issues surrounding Complex Trauma, by noted researcher and clinician Dr Christine Courtois see here -- [LINK])
DIFFICULTIES WITH THERAPEUTIC RELATIONSHIPS
- Difficulties with self-acceptance, shame, and "acceptance" of problems
- Difficullties with trust in therapeutic relationships, "adherence", and appropriate self-disclosure
The above problems are well-discussed by van der Kolk (2005) but are less well examined in the National Child Traumatic Stress Network submission. However, recent research by Dorahy and in the field of attachment research provide valuable inights into these areas.
Affective and Physiological Dysregulation
The individual exhibits impaired normative competencies related to arousal regulation, including at least two of the following:
- Inability to modulate, tolerate, or recover from extreme affect states (e.g., fear, anger, shame), including prolonged and extreme temper outbursts, or immobilization -- discussed in more detail here -- [link]
- Disturbances in regulation in bodily functions (e.g. persistent disturbances in sleeping, eating (including suffering from eating disorders); over-reactivity or under-reactivity to touch and sounds;
- Diminished awareness/dissociation of sensations, emotions and bodily states
- Impaired capacity to describe emotions or bodily states
Attentional and Behavioral Dysregulation
The individual exhibits impaired normative competencies related to sustained attention, learning, or coping with stress, including at least three of the following:
- Preoccupation with threat, or impaired capacity to perceive threat, including misreading of safety and danger cues
- Impaired capacity for self-protection, including extreme risk-taking or thrill-seeking
- Maladaptive attempts at self-soothing (e.g., rocking and other rhythmical movements, compulsive masturbation, alcohol or substance abuse, gambling, gorging/purging/bulimia)
- Habitual (intentional or automatic) or reactive self-harm
- Inability to initiate or sustain goal-directed behavior
Self and Relational Dysregulation
The individual exhibits impaired normative competencies in their sense of personal identity and involvement in relationships, including at least three of the following:
- Intense preoccupation with safety of the partner or other loved ones
- Persistent negative sense of self, including self-loathing, helplessness, worthlessness, ineffectiveness, or defectiveness
- Extreme and persistent distrust, defiance or lack of reciprocal behavior in close relationships with others
- Reactive physical or verbal aggression toward others
- Inappropriate (excessive or promiscuous) attempts to get intimate contact (including but not limited to sexual or physical intimacy) or excessive reliance on others for safety and reassurance
- Impaired capacity to regulate empathic arousal as evidenced by lack of empathy for, or intolerance of, expressions of distress of others, or excessive responsiveness to the distress of others
Posttraumatic Spectrum Symptoms
The individual exhibits at least one symptom in at least two of the three PTSD symptom clusters B, C, & D.-- symptoms involving reexperiencing of the traumatic event (Criterion B); symptoms involving avoidance of, or emotional numbing in the presence of trauma-related stimuli (Criterion C), and symptoms involving hyperarousal (Criterion D).
The disturbance causes clinically significant distress or impairment in at two of the following areas of functioning:
- ? Scholastic: under-performance, non-attendance, drop-out, failure to complete degree/credential(s), conflict with school / college or University personnel, learning disabilities or intellectual impairment that cannot be accounted for by neurological or other factors.
- ? Familial: conflict, avoidance/passivity, excessive attachment or detachment from family members, attempts to physically or emotionally hurt family members, non-fulfillment of responsibilities within the family.
- ? Peer Group: isolation, deviant affiliations, persistent physical or emotional conflict, avoidance/passivity, involvement in violence or unsafe acts, age inappropriate affiliations or style of interaction.
- ? Legal: arrests/recidivism, detention, convictions, incarceration, violation of probation or other court orders, increasingly severe offenses, crimes against other persons, disregard or contempt for the law or for conventional moral standards.
- ? Health: physical illness or problems that cannot be fully accounted for by physical injury or degeneration, involving the digestive, neurological (including conversion symptoms and analgesia), sexual, immune, cardiopulmonary, proprioceptive, or sensory systems, or severe headaches (including migraine) or chronic pain or fatigue.
- ? Vocational : disinterest in work/vocation, inability to get or keep jobs, persistent conflict with co-workers or supervisors, under-employment in relation to abilities, failure to achieve expectable advancements.