Talk:Complex post-traumatic stress disorder

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Contents 1 Trauma type-I and type-II 2 PTSD and C-PTSD vs. personality disorders, Borderline Personality Disorder 3 Where can we add trauma re-enactment, self-harming 4 Clarification: is C-PTSD restricted to children?

[edit] Trauma type-I and type-II

Anyone has knowledge about Lenore Terr's trauma types I and II's, trauma II corresponding to complex PTSD? Think this should be mentioned. Jalind 16:54, 10 November 2006 (UTC)

[edit] PTSD and C-PTSD vs. personality disorders, Borderline Personality Disorder

I've removed the comparison with Borderline Personality Disorder as it is one of the most dubious categories in all of Psychology. Few psychologists refer to it and there has been discussion of removing it from the DSM altogether.) 70.142.154.44 18:20, 3 July 2006 (UTC)

I really disagree. Firstly, borderline personality disorder (BPD) is the most researched personality disorder, and also it is the most common PD. Secondly, there is growing understanding on the relation between early traumatization and BPD. However I see your point, there is debate (which is quite normal in psychology) about the essence of BPD. I think BPD will in the future be conceptualized more presisely and its relation to C-PTSD will be more clarified (like in this study by Macleon and Gallop (2003) [1]). Also it is important to see that C-PTSD and PTSD are very different disorders, especially when C-PTSD has happened in childhood disrupting normal development. For more information about general connection between early traumatization (=C-PTSD) and BPD see Winston (2000) Recent developments in borderline personality disorder (figure 1 is very informative) [2]. Jalind 10:48, 3 November 2006 (UTC)

Actually, a better reason for eliminating the comparison is that Borderline Personality Disorder is a Personality Disorder, while PTSD is an axis-I disorder and C-PTSD, if it becomes a DSM diagnosis would also likely be an axis-I diagnosis. RalphLender 19:37, 3 August 2006 (UTC)

[edit] Where can we add trauma re-enactment, self-harming

Where can we add trauma re-enactment (TR)??? - for many survivors of childhood trauma, it feels impossible to stop self-harming patterns like drug/alcohol/sex abuse as they recreate the destruction from their past. Patterns of TR behaviour: alcoholic drinking, drugging, being in abusive relationships, sexual acting out — often become the survivors “best friend” because TR fools them into thinking that these ways of being are their best defence, their best chance at survival. Masiarek 02:50, 5 August 2006 (UTC)

What you are describing is a way in which suvivors of childhood trauma reduce stress and releave tension...not in a healthy growth enhancing manner. DPeterson 20:32, 5 August 2006 (UTC)

The victim may also be using these strategies as an unhealthy way of empowering themselves. If they are harming/punishing themselves, they are not somebody elses victim, as they are choosing this treatment. They are in control of their treatment.

It is a symptom of their difficulties...JohnsonRon 22:17, 15 October 2006 (UTC)

I don't think it is symptoms we are dealing here. Also I think trauma re-enactment is not necesarily self-regulation or defense, it is merely lack of self-regulation. Talking about re-enactment may produce needless guilty of survivors. It is the insufficient self-regulation (ie. lack of assertiveness, impulsiveness) that is causing the symptoms (ie. depression, anxiety, interpersonal problems) and also exposes to retraumatization. This viewpoint underlines empathy and acceptance, and is seen on central on new treatments of BPD, like Linehan's DBT. Jalind 21:01, 2 November 2006 (UTC)

Actually, trauma reenactment (or flashbacks) are often described in the professional literature as the mind's attempt at healing and integration (See J. Beiere's work, for example). the difficulty is that the individual lacks sufficient resources and/or the trauma is so overwhelming, that these normal processes are not effective, and so some formal treatment is necessary to resolve the trauma. In C-PTSD the trauma is of an chronic nature; it is early chronic trauma, which causes problems in a variety of domains (See National Trauma Center's White Paper). RalphLender^talk 21:38, 2 November 2006 (UTC)

Yes, I am familiar with this functional view (=restoration, healing) of flashbacks from work of Janoff Bullman. But Masiarek uses the term "re-enactment" and describes revictimization or unconsciously motivated behavioral repeating of the trauma event. Freud refers to this as repetition compulsion (did you by the way ment Breuer, Josef 1842-1925?). Flashbacks or intrusive symptoms of trauma are more mental phenomena, ie. repeatative memories, but not behavior. As van der Kolk (1989) - one of the leading authors on the field nowadays - says: "Freud thought that the aim of repetition was to gain mastery, but clinical experience has shown that this rarely happens; instead, repetition causes further suffering for the victims or for people in their surroundings." [3] To underline my point here is one example: It is known that women abused in childhood, are more often raped in adulthood. Is this because of their mental need for experience their trauma again (ie. to integrate traumatic experience into self), or might it be because of their general inability to protect theirselves (ie. lack of skills, accepting of maltreatment)? Jalind 10:35, 3 November 2006 (UTC)

I meant to cite, Principles of Trauma Therapy by John Briere & Catherine Scott, 2006, Sage Publications. Again, much of the flash-back and re-enactments described in the trauma lit can be viewed as the mind's efforts to integrate the trauma and heal. In fact, current practice protocols on trama treatment call for the this very thing to occur in a controlled and supported therapeutic relationship when it does not occur "naturally." DPeterson^talk 11:29, 3 November 2006 (UTC)

Thank you for clarifying the source, it seems wery interesting and updated. I agree about the therapeutic value of reliving the trauma in therapeutic setting. I still doubt that revictimization and intrusive symptoms are functionally related. (Firstly: How much is their correlation, do they load on same factors in factor analysis, do they cause relief in any circumstances?). I have been thinking about scientific criterions to clarify the issue, and glanced a few empirical studies. In study by Noll, Horowitz, Bonnanno, Trickett and Putnam (2003) [4] they explored what factors explain revictimization. They explored the unique predictive value of several predictors (see table 4: ie. early sexual, physical and emotional maltreatment; experienced symptoms like PTSD symptoms, dissociation and sexual permissiveness). When taking into account the intercorrelations between these predictors, dissociation and sexual permissiveness but not PTSD-symptoms (including intrusive and avoidant symptoms) were predictive of physical revictimization. They concluded that "victims who adopt pathological dissociation as the primary defense strategy in adolescence or adulthood may be less able to engage in self-protection when physically threatened." Their results support my view that revictimization is caused by lack of skills, not by psychological need to experience again a traumatic event (I suggest that we accept intrusive and avoidant PTSD-symptoms as a measure of this psychological need to revictimization/re-experiencing). The supposition about revictimized patient's psychological need for retraumatization in vivo may in itself be destructive, untherapeutic and not scientificly based. It increases victims guilt and deteriorates self-esteem.

Very interesting study is also Gladstone, Mitchell, Malhi and Austin (2004) [5] . The study design demonstrates that this problem in hand is open to empirical solution. In their study there was both a mediated (and direct link) between physical abuse as a child TO personality dysfunction TO adult retraumatization (see fig 1). Jalind 10:47, 4 November 2006 (UTC)

This is a very useful discussion. I wonder if you would be willing to take what you've written above (in the section about Noll, Horowitz, et.al. and put that into the article itself? I think it is very relevant and clearly based on a verifiable source. It would help clarify this point. RalphLender^talk 14:09, 3 November 2006 (UTC)

Thank you for suggesting, I could do this (when have more time), meanwhile anyone else is also free to contribute. Any suggestions for subtopic, like: Some possible consequences of C-PTSD. This topic could contain Borderline personality disorder and Revictimization? Jalind 10:47, 4 November 2006 (UTC)

[edit] Clarification: is C-PTSD restricted to children?

The first paragraph implies there's no restriction. This seems especially true in the comparison with PTSD. The rest of the article is specific to children, though, and someone not already familiar with the diagnosis could be confused by this (I am).

Greybirds 09:32, 5 February 2007 (UTC)

Complex Post Traumatic Stress Disorder is caused by chronic 'early' trauma. The outcome of this is not limited to children, although it's impact on children is what most of the literature focuses on. DPeterson^talk 13:57, 5 February 2007 (UTC)