Tag Archive: BPD-OSDD

Complex-Trauma or Complex-PTSD

complex trauma discussionREVIEW
review and own commentarry in pdf 


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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Dissociative Handling-system of the personality

complex trauma Handling systemsPsychologically-Trauma & Dissociation

The ANP ᶧ ² and EP ³  handling-system

cptsd

Literally Trauma means ‘injury’

  1. An event causes Injury
  2. Injury causes pain
  3. Pain causes physically and psychologically suffering
  4. Psychologically suffering can cause psychologically-injury
  5. Psychologically-injury can cause pathological emotions and pathological somatic responses
  6. a mental illness
  7. A mental health diagnose caused by Trauma

It can happen on every age and has no age boundaries. Someone with a PTSD can suffer a Partial or Full dissociation. Which means he or she can’t recall | remember the traumatic or a part of the traumatic event.

We all own one Personality which is given color by our Self states¹ and Ego states².
To the understanding of, suffering a psychologically-Trauma:
all traumatic events (psychologically and mechanically) can cause Dissociative Behavior | psychologically-Trauma
and all mental disorders caused by psychologically-Trauma hold Dissociative symptoms

Let us take a closer look at our main personality-states which handle every day life,
the self-states and the ego-states;

SD  = Structural Dissociation
ANP =  Apparently Normal Personality Part
EP = Emotional Personality Part (the part that holds a traumatic memory)

  1. The Self-States (SD ANP parts)
    are parts of our personality which function fully autonomic and are daily life task oriented.
    These parts of our personality own their own consciousness and self-awareness.
    Examples of Self-states are:
    You need to clean the house and you instinctively know what to do and how to do it. You know how the vacuum cleaner works or what you have to use to clean the windows etc. To every little task you remember what is needed or what to do at that moment: like cooking, doing your finances, call your friend at his/her birthday, etc.. those are all different self-states (SS’s) which we call smaller Apparently Normal Personality parts of the total personality ANP-EP(’s) handling system.
    Note:
    If a person suffers a PTSD or CPTSD or a Dissociative Disorder like OSDD
    The self-states we call smaller ANP ‘parts’ which belong to the total personality (1 ANP-EP handling system).
    Those Self-state parts¹ (ANP parts) are vulnerable to the influence of Ego-States² and or EP parts³

Beside the Self-States we all also own Ego-states
which influences also our Self-Sates…

  1. Ego States
    are personality states which react emotion oriented. They respond to emotional daily live needs or events and provide us with normal and healthy reactions which color our own personality.
    But… they also can develop a pathologically behavior such as Borderline-, Narcissistic personality disorder, pathological sociopathic- or psychopathic behavior, etc. – and otherwise described dissociative disorders including switching behavior to other personality states (not DID).
    Examples of Ego States are:
    The need for attention, or personal comfort, or the need to be someone (to be recognized), the need to feel proud of what you do or did, the need of being loved or to give love to another person, the need for sex or erotic responses, the need to express your anger or sadness etc. Al those needs are normal human emotions (feelings) which we all carry inside of us. And we also carry all biologically given narcissistic genes or psychopathically genes (we are all able to get triggered to unthinkably or unhealthy behavior). It’s human nature.
    Note:
    Pathologically (damaged, sick, unhealthy, etc.)  Ego-States can cause switching behavior, because they are very vulnerable to the influences of pathologically genes and or biologically given vulnerability. But they also can be controlled or influenced by traumatized EP parts such as most commonly seen within OSDD. Traumatizing experiences and or Childhood neglect can contribute to development of a Borderline Personality Disorder + Dissociative symptomps. Those pathologically Dissociative Ego-States can express itself also by switching behavior to different personality states. That is also the reason why so many people get wrongly diagnosed with a dissociative Identity disorder and the other way around, or misdiagnose with another mental disorder such as Schizophrenia.


PTSD and complex-PTSD (including Dissociative Disorders)

If we get Psychologically-Traumatize we develop pathologically personality parts which hold memories of a traumatic experience. Those parts we call:

raamDissociated Emotional Personality Parts (EP’s)

  1. A traumatized personality part(s) !!
    Like the Self-states those EP’s own their own consciousness and self-awareness
    Within the structural dissociation of the personality we call those parts EP’s which cause dissociative behavior. These psychologically traumatized parts of the personality hold a total memory of a traumatic event or a part of a traumatic event – physical and emotional memories which belong to the past.Those parts can be:
    1. totally dissociated by the personality (full dissociation)
    2. partly dissociated by the personality (partial dissociation)

    Examples of EP’s are:

    Someone who experienced a very severe accident on a particular crossroad, can start to avoid that particular crossroad, or even worse: don’t go nearby a crossroad again. And this (phobic) fear exists without realizing or thinking over the full memory (EP) which caused her/him to develop this pathologically behavior towards crossroads.
    Or someone who experienced severe traumatic events during a war can develop irritated and avoidant behavior towards lots of things in the present time without realizing his behavior is being influenced by the traumatic events he/she experienced during war and which didn’t process in to his own personality sate – the EP’s got stuck in the past. He/she avoids thinking on those traumatic events and develops irritated and or defensive, aggressive behavior under the influence of the EP’s.
    Note:
    If an Self-State or Ego-State gets triggered by ‘recognition’ – by a particular daily life subject or event – the EP that got triggerd by that recognition influences the behavior of the Self-state and Ego-State. On such a moment the ANP-EP system – which we call a handling system – gets in to pathologically behavior (not healthy behavior). The biologically stability of the whole personality will also play a very big role towards ‘how this behavior will express itself’ (including switching behavior to different personality states). But the cause of that particular behavior on such a moment gets triggered and influenced by an EP.

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Personality and Identity:
Above we gave a summary of a normal to a pathologically Personality and the different personality states. Everything above can develop itself without suffering a DID. The expression of the total of our personality-states plus our biologically (determinants) and biographically presentation will give form to our own Identity.

The Dissociative Identity Disorder

All traumatic events can cause Dissociative Behavior e.g. Psychologically-Trauma as we explained already above. So again what is the difference between a primary and secondary Structural dissociation (PTSD CPTSD OSDD) and the Tertiary Structural dissociation (DID)?

Note of importance: One can suffer a Dissociative Identity Disorder (DID)without suffering a Personality Disorder !
Borderline is a symptom diagnose and can develop itself during all ages of childhood, likewise a structural dissociation of the personality OSDD or PTSD.

DID though is another story:
DID Research has shown us that the development of a DID starts during the very early stage of life.

Hypothetically to the explanation of “why could such a very young child develop more than one ‘handling system’”;
We are all born with biological determinants and four autonomic emotional handling/respond systems (the 4 head emotions). Emotional handling systems which immediately after birth are able to react by instinct or reflex. If a baby feels distress caused by hunger it starts to cry. If you have eye contact with a baby which has already its vision and you slap your hands the baby gets scared (you will see the reflex) caused by the loud noise even though its sees you slapping your hands, etc.. The baby is not yet able to mentalize hearing with vision, it’s not yet enough developed to do so (recognition). The emotionally systems pleasure/fun and fear are not yet enough integrated to function as proper team players.
If something disrupted this proses (like repeating Trauma – see part I pnt 1) an infant needs to activate by instinct repeatedly a (survival) reflex which causes that the autonomic functioning emotions can’t synthesize prober with one and other on a natural given way to learn prober functioning as team players. This can lead to the development of a DID cause by Trauma.

A tertiary structural dissociation of the personality
Someone who suffers a Dissociative Identity Disorder developed in a very early stage of life two and sometimes even three of those ANP-EP’s handling systems. Each of those handling systems own their own distinct behavior, knowledge and memories. This causes also a lack of recognition of one’s own autobiographically memories. The switching between those ANP-EP’s systems can occur very subtle but also very recognizable if you know the total personality for a longer time. DID is a poly-symptomatic condition which is characterized by a hidden presentation.

In case of a Dissociative Identity Disorder the ANP’s (self-states) also function task oriented within each main ANP-EP’s handling.
But beside that the main ANP-EP’s handling systems functions also head emotion oriented.
So here we also need to have knowledge about the four head emotion of humanity which within DID form the base to develop a pathologically survival mechanism such as a Dissociative Identity Disorder is.

1 The 4 head emotions
of every human being
Joy, (Pleasure, laughter, sex, etc.)
2 Fear (defense, Freeze, etc.)
3 Anger (defense, physical attack, etc.)
4 Sadness (tears, loneliness, mourning, etc.)

 

** People who suffer a DID have developed two or even (very rare) 3 ANP-EP handling systems which are not only task orientated but also act head emotion orientated. ANP-EP systems behave Apparently Normal – and carry an own distinct, stable over time and growth, identifiable behavior. An identity disorder caused by psychologically-Trauma


Reference doc
:
3-2014 E.R.S..Nijenhuis, Ph.D. – Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder
Book advise:
The Haunted Self,- authors Ellert R.S. Nijenhuis Ph.D., Onno.van der.Hart Ph.D. and Kathy Steele

(c) Nique
11 october 2014

 

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Complex Trauma PTSD

Trauma disorders, Borderline- and Dissociative Disorders

(c) Nique(c) Nique TRTCenter NLI did receive the question:

Could you try to explain in your own words and average understandable language; the different types of Trauma disorders (diagnoses), versus a Borderline Personality Disorder and the relation of both with Dissociative Disorders – without the interference of the understanding of a Structural dissociation of the personality.

And my answer to it is: Yes I feel very honored to give it a try in my own words.

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I. TRAUMA and Posttraumatic Stress Disorders – PTSD & CPTSD

Very simplified we know 3 main groups of diagnoses to a mental disturbance caused by Trauma:childabuse

1 an acute short term mentally disturbance (ASD)
2 a middle long term mentally disturbance (PTSD)
3 a long term e.g. chronically disturbance (CPTSD)

a bit more defined:

  1. Acute Stress Disorder
    an acute short term mentally disturbance / reaction to a one time experienced Traumatic event
    for example: witnessing a very heavy train accident
  2. PTSD
    Post-Traumatic Stress disorder – middle long term mentally disturbance caused by experiencing a dead scary Traumatic event
    for example: a kidnapping or a onetime rape experience, or other dead scary experiences
  3. C-PTSD
    Complex Post-Traumatic Stress disorder – a long term e.g. chronically mentally disturbance caused by experiencing more than one Traumatic event
    a. Childhood trauma like sexually and or physically abuse
    for example: incest or other repeated child molestation e.g. child abuse
    b. War experiences (veteran care), etc.

To simplify: above we have mentioned the different types of Trauma disorders (diagnoses).

And keep in mind that those diagnoses can be given to everyone who experienced a Traumatic event. So also to people with Borderline, with Autism, with no mental disorder, etc.. From the policeman to the house wife – they can all experience a dead scary traumatic event which can lead to a post traumatic stress disorder.

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II. DISSOCIATIVE DISORDERS – DD

The Second mental disorders I want you all to get acquainted with is the category
Dissociative Disorder – abbreviation = DD (watch out, it’s no DID)

  1. Dissociative identity disorder – DID a trauma related polysymptomatic condition which is characterized by a hidden presentation
  2. Other Specified Dissociative Disorder – OSDD
  3. Dissociative Amnesia
  4. Depersonalization/Derealization Disorder
    sub group:
  5. Unspecified Dissociative Disorder (DDnos)

Are dissociative disorders with switching behavior to different personality states always related to a Dissociative Identity Disorder (DID)………   :  NO

Switching between personality parts is not a phenomenon that only belongs to a Dissociative Identity Disorder (trauma related).There are other disorders that have symptoms of identity problems and switching behavior between personality states such as a theatrical personality disorder, a Borderline Personality disorder, a bipolar disorder or schizophrenia.
A Dissociative Disorder (DD) has a wider range of being a co-morbidity disorder.

PTSD and it’s relation to Dissociative Disorders (OSDD and DID):
Within the category Dissociative Disorders, we know two types of diagnoses which are related to Psychologically-Trauma:

1. Otherwise Subscribed Dissociative Disorders (OSDD) and
2. the Dissociative identity Disorder (DID) – caused by Psycholotically-Trauma

Those two Dissociative disorders are both categorized by Trauma specialists as Complex Psychologically-Trauma disorders.
Sometimes also knows as a Trauma type – II and type – III

And both disorders are known with a wide range of dissociative problems. From Amnesia, Depersonalization to Derealization to somatic dissociation, etc.. The difference between a trauma related OSDD and DID is the comorbidity of disorders and the presentation of the Switching behavior. Both disorders are likewise severe and don’t tell a thing about more or more severe Trauma experiences – because both disorders are categorized as likewise very severe disorders ! they cause severe clinically distress and agony in life.

A Trauma related diagnose tells you only something about the complexity of the disorder(s).

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III. BORDERLINE PERSONALITY DISORDER – BPD

not C-PTSD related – Abbreviation BPD

A Borderline personality disorder is a personality disorder which causes severe agony to life. It’s also a disorder which very often is misunderstood and stigmatized. People with a BPD suffer a lot, so please don’t judge them by the disorder but try to understand them.

BPD is a diagnose of a mental disorder which points out a list of ongoing disturbed, unstable and or harmful symptomatically behavior caused by a broad range of influences during childhood and a biologically given mental weakness. Examples of causes:

  • too less love and attention (negative child neglect)
  • too much negative love and attention (positive child neglect)
  • broth up by parents with harmful addictions
  • broth up by parents with social problems
  • broth up in a harmful e.g. stressful living environment
  • etc.
  • and the most upper handed cause to develop BPD:
    is most likely a mental weakness given by biologically genes (Borderline structure).
    A by nature given, not being able to handle or coupe well with stressful situations. A biological basis to develop a BPD.
    Note: Not everyone born with the biologically genes will develop a Borderline Personality Disorder during life –  A Borderline structure (is not a BPD) only tells something about the mental straight to coupe or handle with stressful situations.

Some psychologist e.g. mental clinicians like to call the causes to the development of a BPD – ‘childhood trauma’. But if you understand the clinical definition of Trauma you can’t place those causes in a direct line of Traumatic experiences. So I fully disagree with people who think and or declare that a Borderline Personality disorder is per definition caused by Trauma, and or is always trauma related, because it isn’t.

A Borderline Structure or a Borderline Personality Disorder by itself isn’t caused by Trauma !

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And now we end up to the most spoken CLINICAL DISPUTE * * *

BPD and It’s relation with Dissociative Disorders  (OSDD and or DDnos):

attentionOf course it all needs research and a global acceptance to define the difference and or relation of causes and the influences of different comorbidity disorders, but I will give you a bit of an explanation in the line of both clinical streams which are still arguing about the cause and understanding of a BPD in combination with Dissociative Disorders and or dissociation caused by Trauma:

A bit Freudiaans and a bit Janetiaans – I think; both theoretically streams do have a point

                      1. BPD + DDnos not Trauma related
                        BPD + Dissociative symptoms and switching behavior to different emotional personality states NOT Trauma related
                        (BPD + comorbidity DDnos)

People who suffer a Borderline Personality Disorder very often can’t coupe (independently) with stressful situation. They clamp on to addictive behavior to escape the inner stress and daily life stress, and or they clamp on to other people which can guide them through a stressful situation of life. If stress comes in to (such) a relation someone who suffers a BPD wants also to escape this relation (again) by clamping on to another person. They don’t attach on a healthy way and it’s not uncommon that someone with a BPD has a storrmy history of different relationships or switches back and forward towards and between more than one relationship. They easily panic if they are left alone. And they show very often impulsive and or addictive behavior.  It’s also not uncommon that someone who suffers a BPD seeks attention, I prefer to call it   they seek HELP because they are scared – they do this to escape the inner stress and the fear of being left alone. Life itself is sometimes even too much to handle and the fear of loneliness then also gets enormous, almost unbearable.
Graphed by this fear they sometimes develop different somatic problems with no physical cause, or they even start to develop their own internal family and play mates to escape the fear of being left alone. They start to Dissociate by the development of emotional personality parts.

                      1. BPD + (CPTSD) OSDD Trauma related
                        BPD + Dissociative symptoms and switching behavior under the influence of emotional personality parts:Trauma Related
                        (BPD + CPTSD + OSDD)

Like every human being also someone who suffers a BPD can experience a dead scary traumatic events or have suffered also Childhood sexual and or physical abuse which leads to the symptoms of a PTSD or a CPTSD with dissociative symptoms.
It’s also not oncoming that you see also severe Dissociative symptoms and dissociative Switching behavior in this category of a double mental disturbance and category of diagnosis.

But it’s also very difficult for diagnosticians to diagnose BPD + Dissociative Symptoms and the Switching behavior to other personality states of this category, because they need to determine if the Dissociative symptoms are caused by the BPD or by trauma related Dissociation (OSDD). And that is not an easy thing to do.

 

Fact or Factious:
ptsd vrijSomeone who suffers a BPD + Dissociative symptoms (DDnos and or OSDD) suffers severe agony in life. We know that this group is also the most difficult group to treat because of the underlying BPD and wide range of dissociative symptoms. Prognosis of treatment aren’t much positive because of the severity of the combinations of disorders. And although researches are doing their best to develop better diagnostically instruments (differential instruments) and treatment possibility’s, it’s still a group which gets to less global attention and understanding.

For the difference between a OSDD and DID dissociative disorder
I refer to the following link: The difference between OSDD and DID

(c) Nique

Complex Trauma PTSD