Simplifying the Complex?
Well I have booked my first two EMDR counselling sessions for next week and the week after. I also spoke with my counsellor who seemed a lovely, capable person.
We needed to differentiate in our conversation about suffering from PTSD and Complex PTSD.
I suffer from C-PTSD although I also fulfill the symptoms of PTSD as do the vast majority of those who suffer C-PTSD.
“The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms, such as 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 the cluster of symptoms referred to as Complex PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS) (2). A work group has also proposed a diagnosis of Developmental Trauma Disorder (DTD) for children and adolescents who experience chronic traumatic events (3).
Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met diagnostic criteria for PTSD, Complex PTSD was not added as a separate diagnosis classification (4). However, cases that involve prolonged, repeated trauma may indicate a need for special treatment considerations.
What additional symptoms are seen in Complex PTSD?
An individual who experienced a prolonged period (months to years) of chronic victimization and total control by another may also experience the following difficulties:
- Emotional Regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
- Consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body (dissociation).
- Self-Perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
- Distorted Perceptions of the Perpetrator. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
- Relations with Others. Examples include isolation, distrust, or a repeated search for a rescuer.
- One’s System of Meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.
What other difficulties are faced by those who experienced chronic trauma?
Because people who experience chronic trauma often have additional symptoms not included in the PTSD diagnosis, clinicians may misdiagnose PTSD or only diagnose a personality disorder consistent with some symptoms, such as Borderline Disorder.”
I mention these points because I have found that my wife, who has PTSD, reacts in very different ways to me and has different symptoms although I have PTSD as well as part of my C-PTSD.
I have a history, for example, of disassociating when very very distressed or angry which is linked to C-PTSD not PTSD. It is a maladaptive survival strategy and coping mechanism from childhood which is not longer required today. It once allowed me to abruptly distance myself from emotional turmoil. To cut myself off from what was happening around me, as if it wasn’t happening. This is often done in the face of extreme trauma/abuse.
I have other symptoms different from my wife too.
If you have been following this blogsite you will have appreciated some of my constant subject areas such as insecure attachment, co-dependency, emotional dysregulation, negative self schemata, and emotion processing deficits.
It appears that much of this actually comes under the umbrella diagnostic criterion of C-PTSD. This is actually a good thing as I can seek treatment for much of the difficulties of my past at the same time. It may and probably will take longer than your average PTSD therapy but I am hoping it will be worth it.
“Cook and others describe symptoms and behavioural characteristics in seven domains:
- Attachment – “problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to other’s emotional states, and lack of empathy”
- Biology – “sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems”
- Affect or emotional regulation – “poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes”
- Dissociation – “amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events”
- Behavioural control – “problems with impulse control, aggression, pathological self-soothing, and sleep problems“
- Cognition – “difficulty regulating attention, problems with a variety of “executive functions” such as planning, judgement, initiation, use of materials, and self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with “cause-effect” thinking, and language developmental problems such as a gap between receptive and expressive communication abilities.”
- Self-concept – “fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self”.
Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization as children as well as prolonged trauma as adults. This early injury interrupts the development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or older siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon.
This can become a pervasive way of relating to others in adult life described as insecure attachment. The diagnosis of …PTSD do not include insecure attachment as a symptom. Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant risk of revictimization.
Six clusters of symptoms have been suggested for diagnosis of C-PTSD. These are (1) alterations in regulation of affect and impulses; (2) alterations in attention or consciousness; (3) alterations in self-perception; (4) alterations in relations with others; (5) somatization, and (6) alterations in systems of meaning.
Experiences in these areas may include:
- Difficulties regulating emotions, including symptoms such as persistent dysphoria, chronic suicidal preoccupation, self injury, explosive or extremely inhibited anger (may alternate), or compulsive or extremely inhibited sexuality (may alternate).
- Variations in consciousness, including forgetting traumatic events (i.e., psychogenic amnesia), reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation), or having episodes of dissociation.
- Changes in self-perception, such as a chronic and pervasive sense of helplessness, paralysis of initiative, shame, guilt, self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings
- Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator (caution: victim’s assessment of power realities may be more realistic than clinician’s), becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge, idealization or paradoxical gratitude, a sense of a special relationship with the perpetrator or acceptance of the perpetrator’s belief system or rationalizations.
- Alterations in relations with others, including isolation and withdrawal, persistent distrust, a repeated search for a rescuer, disruption in intimate relationships and repeated failures of self-protection.
- Loss of, or changes in, one’s system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.”
As I research C-PTSD it seems this disorder describes many of my symptoms and behaviours very accurately and there is also reportedly a high co-occurrence with C-PTSD and alcoholism and addiction.
I will be interested in how it “treats” my addictive behaviours too as I believe much of these addictive behaviours were borne out on childhood traumas and abuse.
In other words, the symptoms of C-PTSD and other related areas like attachment, co-dependency, abuse, maltreatment, neglect and other adverse circumstances appear to affect the human brain in similar ways and each contribute to an increase in addiction severity.
I wonder in some ways if I will be treating the “roots of all my troubles” in more ways than one.
I will keep you posted as best I can. It will no doubt be painful at times. I am glad to have made start anyway.
I will post before the first two sessions are done of the following areas
What is EMDR?
Treating C-PTSD with EMDR?
How does EMDR work?
- Herman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
- Ford, J. D. (1999). Disorders of extreme stress following war-zone military trauma: Associated features of Posttraumatic Stress Disorder or comorbid but distinct syndromes? Journal of Consulting and Clinical Psychology, 67, 3-12.
- van der Kolk, B. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401-408.
- Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for Posttraumatic Stress Disorder.Journal of Traumatic Stress, 10, 539-555.