Research and Psychology

Complex-Trauma or Complex-PTSD

complex trauma discussionREVIEW
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COMPLEX TRAUMA EN COMPLEXE PTSS

review of Dutch Journal

 

Silence-Deafens-pngA Complex-Trauma and a Complex-PTSD is not the same

Lots of people suffer a Complex Trauma (traumatic experiences),
but not all of them meet also the criteria (symptoms) of a Complex PTSD (clinical diagnose)

* * *

Psych-traumatology handles three terms to define and indicate a Psychologically-trauma.

  1. PTSD, Post-traumatic stress syndrome
  2. Complex Trauma (multiple and divers traumatic experiences)
  3. C-PTSD or CPTSD, a clinical condition: a Complex-Trauma with typical PTSD symptoms which is indicated for Complex-PTSD treatment

Although the upcoming ICD-11 will also carry a category to classify CPTSD, the DSM-5 carries no record to the classification of a Complex – Post Traumatic Stress Disorder (CPTSD or C-PTSD). As results one is bound to the diagnose of PTSD to diagnose a CPTSD. However, the guidelines for the treatment of a PTSD and a CPTSD vary enormously.

If we talk about a ‘Complex Trauma’
we talk about multiple traumatic experiences, in other words; the traumatic experiences are complex

If we talk about a Complex-PTSD
we talk about a clinical (diagnostically) PTSD condition, in other words; the symptoms of the PTSD are complex.

And here the misunderstanding starts, because a Complex-Trauma does not automatically mean one is suffering a Complex Post Traumatic Stress Disorder; many patient groups this is not examined or are the prevalence’s relatively low. So it is very important to understand and use these terms proper. And it is also very important to specify both, a complex-trauma and complex-PTSD, in a descriptive diagnosis.

To do so we need to know ‘What do we define as complex’ ?

  1. The traumatic experience (Single Trauma or Complex Trauma – multiple traumatic experiences)
  2. The consequences of the Trauma (the symptoms mild, complex or multiple complex (comorbidity disorders).
  3. And which treatment policy is needed

In order of this line you can define:

  1. PTSD treatment is indicated if a client suffers PTSD symptoms (often caused by a single Traumatic-experience)
  2. A Complex Trauma:
    Is characterized by long duration, repetition, interpersonal context and the disruption of development phases. But… if one suffered a Complex Trauma, this means not automatically one also suffers a CPTSD. And here misunderstandings often arise !
  3. CPTSD is classified if one suffers complex-PTSD symptoms

Lots of times these terms get confused with each other because one know no distinction between a Complex Trauma ‘and’ a Complex PTSD and that brings consequences for treatment. The most characteristic difference between the treatment of a PTSD and a CPTSD is in the can or cannot lift avoidance and in the confrontation with traumatic memories.

Treatment policy:
To the treatment of a PTSD confrontation with traumatic memories is standard treatment policy (van Balkom e.a., 2013), but at the core of a CPTSD treatment we need to focus on psychosocial stabilization – the phase I of the treatment guidelines of CPTSD (Cloitre e.a.,2012) because one first needs to explore if the client is stable enough to enter a phase II of the treatment (confrontation with traumatic memories). The assessment of whether or not to directly start a phase II and skip the stabilization phase, needs much more research. Therefore Jackie June ter Heid, Rolf Kleber en Trudy Mooren (2014) call for a better understanding and use of terms.

Depersonalization_png


Situations and causes which lead to symptoms:
Until this moment there is still no agreement on which elements are typical to define a Complex Trauma. In view of the lack of agreement on what complex trauma involves, it seems wise for treating physicians in communication about their patients (such as treatment plans including reference letters) to specify characteristics of the complex trauma history, either to speak of prolonged or repeated or interpersonal or early trauma.

Translated Review of the Dutch Journal:
http://link.springer.com/article/10.1007/s12485-014-0051-y
11 Oct 2014
Auteur(s) :Jackie June ter Heide, Rolf Kleber, Trudy Mooren

Review by Nique EU Disja

 

 

Other Reference:

* Ross CA (2014) 33,3 pg 285 – question 1
* Nijenhuis ERS, TRTC Assen-Drenthe the Netherland (2014) Ten Reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder. Psichiatria e Psicoterapia 33, 1, 74-106.
The Haunted Self (Nijenhuis, vd Hart, Steele, 2005, 2006)

* And Nique EU Disja 2014 ANP EP daily life handlingsystem

 

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Dissociation in Trauma: New Definition and Comparison

Dissociation in Trauma:
A New Definition and Comparison with Previous Formulations

Ellert Nijenhuis, Ph.D.
Onno van het Hart, Ph.D.ELLERT R. S. NIJENHUIS, PhD

Top Referent Trauma Center, Mental Health Care Drenthe, Assen,
The Netherlands

ONNO VAN DER HART, PhD

Department of Clinical and Health Psychology, Utrecht University,
Utrecht, The Netherlands

Published online: 10 Jun 2011

A New Definition and Comparison with Previous Formulations

THE PROPOSED DEFINITIONtandonline

The definition, which is not self-evident, reads as follows:

Dissociation in trauma entails a division of an individual’s personality, that is, of the dynamic, biopsychosocial system as a whole that determines his or her characteristic mental and behavioral actions.

This division of personality constitutes a core feature of trauma. It evolves when the individual lacks the capacity to integrate adverse experiences in part or in full, can support adaptation in this context, but commonly also implies adaptive limitations. The division involves two or more insufficiently integrated dynamic but excessively stable subsystems. These subsystems exert functions and can encompass any number of different mental and behavioral actions and implied states. These subsystems and states can be latent or activated in a sequence or in parallel. Each dissociative subsystem, that is, dissociative part of the personality, minimally includes its own at least rudimentary first-person perspective. As each dissociative part, the individual can interact with other dissociative parts and other individuals, at least in principle. Dissociative parts maintain particular psychobiological boundaries that keep them divided but that they can in principle dissolve. Phenomenologically, this division of the personality manifests in dissociative symptoms that can be categorized as negative (functional losses such as amnesia and paralysis) or positive (intrusions such as flashbacks or voices) and psychoform (symptoms such as amnesia, hearing voices) or somatoform (symptoms such as anesthesia or tics).


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Forms of Dissociative Amnesia

Onno van het Hart, Ph.D.
Forms of Dissociative Amnesiaamnesia o.vh.hart

Written by Ph.D. O.v.h.Hart
The DSM-IV [7] refers to possible degrees of complexity in the presentation of dissociative amnesia, defining it as a dissociative disorder in its own right and as a symptom of more complex dissociative disorders. The DSM-IV defines the negative dissociative symptom (or disorder) of dissociative amnesia as “one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness” [7, p. 481].dissociative amnesia

This definition contains a number of inaccuracies and inadequacies, including being overly abstract, vague , nonspecific, incomplete [8]. For instance, it gives clinicians no concrete signs or symptoms with which to determine the presence of amnesia; it omits any mention of the essential feature of dissociative amnesia, i.e., its reversibility. The inclusion of the expression “too extensive” is problematic: there can be many instances of dissociative amnesia with regard to brief periods of time—for instance, during the most threatening moments of traumatic experiences. And in patients with DID, most episodes of amnesia do not directly involve traumatic experiences, but rather apparently mundane actions such as buying something or writing something [8].

Adopting Pierre Janet’s categorization of dissociative amnesia [9], the DSM-IV [7] distinguishes the following types (see also [6,8,10,11]): localized amnesia; generalized amnesia; continuous amnesia;  systematized amnesia; and, not mentioned by Janet, selective amnesia. Localized amnesia pertains to the inability to recall all events that occurred during a circumscribed period of time. A basic example would be amnesia for a specific traumatizing event such as a violent rape; Janet [12] reports a young woman’s amnesia for the death of her mother that she witnessed. Generalized amnesia consists in the failure to recall encompasses the person’s entire life. This type of dissociative amnesia may occur in various degrees of severity. In some cases, it seems that the patient has to learn over again all that she or he had learned before and doesn’t seem to recognize his or her partner and family members [13,14]. Continuous amnesia, the inability to recall events subsequent to a specific time to and including the present, is rarely diagnosed. Neurological factors might be involved [15]. Systematized amnesia pertains to the loss of memory for certain categories of information. For instance, the patient is amnesic for everything that related to her or his family. Janet [9] mentioned a woman who, after confinement, forgot not only the birth of her child, but also the facts connected with it. Selective amnesia, finally, pertains to the inability to recall some, but not all, of the events during a circumscribed period of time. On a micro-scale this might, for instance, pertain to remembering a rape, but not the most threatening part of it, i.e., the pathogenic kernel [6] or “hot spot” [16]. The existence of this pathogenic kernel also may have caused amnesia to develop for the entire event; the resolution of this kernel then is essential in the recovery of the memory [17].

read the original document posted by Ph.D.: Onno van het Hart