Tag Archive: 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

A clinical glimpse into my own DID personality

Part I & II

(c) Nique
My own therapeutic inside out 

The progress we made during the last therapeutically year 2013 -2014 

 @M  our whole personality state
         which suffers a trauma related tertiary structural dissociation (TSD – DID)

 copyrighted

I will give you all a small glimpse into my own being and functioning

 

Maybe it helps  to make even more understandable a trauma related tertiary SD by sharing the charts we made during the past therapeutically year and the progresses we had made at the end of that year. An achievement that we hadn’t accomplished without the help of our trauma specialized clinical psychologist/psychotherapist at the Dutch Top referent trauma center TRTC Assen –Drenthe.were we have our weekly private sessions.Thank you BMC !

attention
But first a note of attention:


To all the professional mental caretakers and psychotherapists out there

please inform yourself on a professional way about the trauma related structural dissociation of the personality such as given by Kathy Steele, Onno van der Hart and Ellert Nijenhuis.

And to all readers pleas note
In order to correctly understand the explanation of my own personality systems, you need some knowledge of the summary of a SD. Be ware: Switching between personality parts is not a phenomenon that only belongs to a trauma related Structural Dissociation (SD) – such as a very complex PTSD the dissociative identity disorder (DID) – or a complex PTSD Secondary SD (OSDD) – or a less complex Post traumatic stress disorder PTSD.

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. And also the tertiary SD, DID, the trauma related Dissociative Identity disorder is a polysymptomatic condition which is characterized by a hidden presentation (S.Boon & N. Draijer).
So keep in mind: Diagnoses of a ‘trauma related’ structural dissociation of the personality can only be done by an experienced clinical trauma psychologist/psychotherapist which is specially taint to do so. 

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Part I
a glimpse into my own personality systems
 

In 2006 we started visiting the trauma center and in 2010-2011 we made our first personality chart. 

Chart A
 presents only a comprehensive inventory of our personality at the beginning of a new therapeutically year 2013 – 2014. A year of hard work and weekly educational psychotherapy and therapy. Ad the beginning of that year we already knew a lot about our own being and our traumatized personality.

 huizen01aChart A:  The inventory at the beginning of another therapeutically year 2013 – 2014

 

Our ANP’s and diagnoses


House ANP 1, 2 and 3
presents “Apparently Normal Personality” states which are parts of our whole personality @m. and which presents our daily life emotion and task oriented handling systems.The middle house stands for me ‘Nique’, ANP 2. And on my left and right wing you can see two other ANP-EP’s systems which also carry their own name. I blended their name.

We are known throughout whole our life, surviving by the existence of those 3 daily life emotion and task oriented handling systems which are called ‘Apparently Normal Personality states’ ANP’s.  For this moment I call them the left-, middle and right-wing ANP/EP houses. All three the ANP houses focus purely on everyday life tasks and leave aside the EP’s of their consciousness mind.
The ANP/EP houses carry all three their own name, behavior, knowledge, history (memories of a past), their own way of  thinking and reacting. But above all their own way of handling daily life emotions and tasks. They are the same age and they all three suffer the symptoms and behavior that comes with us also being Autistic. We are born autistic, so @M carries the diagnose High Functioning Autistic with high intelligentsia. We carry a diagnostically note to the autism: Asperger level.
So yeah, it won’t surprise you all that also autistic people can suffer a severe trauma related disorder.

So the whole personality (@M) carries the diagnoses of the Axis I DSM-IV which are in our case:
a trauma related Tertiary Structural Dissociation of the personality which is related to a DID
+ Autism + and we still suffer typical PTSD symptoms. We underwent more than once very extensive diagnostically testing, We had an observation period and a diagnostically trajectory of more than a year where we had again all sorts of clinical interviews. The results; we are free of a Axis II diagnose, or a other disorder such as schizophrenia or a personality disorder.
ANP EP systems

Besides the Big ANP houses which have there own task oriented smaller ANP parts
I include a chart of only the Big ANP’s and the small task oriented ANP’s

  • The BIG houses also store EP’s
    Emotional personality parts with there own traumatic memories of the past.

How much EP’s do we own?
We don’t know and probably we will never know because we don’t want to know and we don’t count them. We work on this moment, in the present time and only with the most nasty parts which prevent us from living – we survive but we don’t live.

The 3 ANP houses such as presented by Chart A, are the big ANP/EP’s every day handling systems. And each handling systems has their own good memories and daily life task ANP’s – smaller ANP’s, but also very nasty memories which are retained by trauma related emotional personality parts (the EP’s). Some of those EP’s are partial dissociated and some EP’s are fully dissociated by an big ANP house. And some EP’s can’t or don’t dare to go in contact with an other EP or ANP which are a part of another ANP/EP system. And in each cellar of the ANP houses life very scared and dark EP’s which don’t like human approach.

  • The smaller houses on the pictures Chart A and C, are also holding EP clusters 

We call them our small ANP ‘garden cottagesand such a cottage stores more then one memory part of a repetitive abuse during childhood which took place over a longer period of time. Each ANP/EP system, the big houses, own some garden cottages. Although we mapped on chart A and C only the garden cottages we were working with on that moment. Those cottage caretakers are also  (smaller) ANP/EP systems which belong to that particularly big ANP/EP house. But I prefer to call them our cottage caretakers which take care of a daily life task and a cluster of EP’s.
Very ofthen they also bin called a host or a alter part (ANP’s). 

On the left wing house, Chart A, we mapped a couple of those little garden cottages (small AN/EP systems).
And each cottage goes under the care of one or more stronger cottage caretaker –   which also has the ability to take care of a daily life task (small ANP) such as my shower and psychical care EP (further-on more about this cottage).

tertiary SD

Chart B

This left picture, Chart B, which I made to explain the development of SD levels

  • the purple EP’s presents the care takers of a cottage (cluster /  whit there own layered EP’s) which store memories of a repetitive abuse during childhood over a longer period of time
  • the orange EP parts are single Emotional Personality parts  (EP’s) which store a part of, or a whole memory of a traumatizing experience of the past
  • the light blue color presents our ANP’s, Apparently normal personality states, which presents the daily life emotion and task systems. Emotional life systems which didn’t integrate during infancy by the cause of very early child abuse and trauma. Those emotional life systems didn’t learn to function proper as team players of a bigger system ‘the personality’.
    Click here if you want to read a definition of the ANP and EP parts


EP clusters
, cottages which belong to that particularly ANP/EP system. 

Sometimes a cottage EP or a couple of EP”s from a particularly ANP/EP system wanders of and tries to disturb, or to influence, a other ANP/EP handling system (Big House). But the house where they don’t belong to, don’t accept or recognize them as an own experience or own memory because the EP’s don’t belong to that other ANP/EP daily life handling system. They didn’t learn that they all are a part of each other and a bigger @M system – the personality.

  • Identity and names:

The 3 big ANP/EP houses are identifiable by the use of their name and by their very recognizable stable and distinctively different behavior. And also by their ability to function autonomic on a daily base (in the present time). We don’t have, don’t need and don’t want to give names to the smaller ANP’s (daily life task oriented) and smaller ANP/EP systems (cottages). So in our case only the big ANP/EP systems, the big houses, carry their own name. The EP’s which are stored by the 3 big houses we eventually recognize by their traumatizing memory / experience they store. I’m Nique, the middle house.
We are aware of those three names as far as we can remember, but then we didn’t recognize them as a part of our own being and a bigger system, the other ‘self @M’.
Those three names and houses are the big survival players of our being, history and daily life.
Our personality

Part II
The progress we made during this therapeutically year

 

Copyrighted NiqueChart C, the progress we made during the past yeas

On Chart C you see even more smaller houses. ANP/EP Cottages:  EP clusters which are going under the care of one or more strong cottage caretaker. Such a cottage caretaker can also partially function autonomic on one daily life task.
For example: none of the three big ANP houses likes to shower, so a cottage caretaker takes care of that daily life task, but such a small ANP/EP cottage system is not able to functioning totally autonomic throughout all daily life emotions and tasks.

In staying by the example of this shower Cottage caretaker, it’s the little yellow one.
This cottage stores traumatic experiences (EP’s) which came with childhood physical pain and abuse during psychical care moments. The EP”s of this cottage holds memories of the past which caused pain, physical pain reflexes, fear, hate to the own body and being, pictured memories, physical memories, etc. which came with psychical care.
Two of the big houses are gone when you mention ‘shower’. In their cellar live dead scared EP’s for showering and hate EP’s to the own body. So they can’t handle the daily life task ‘showering, bathing and or body care’. The cottage caretaker has to handle those daily life task and this cottage belongs to the garden of Nique. So the middle house has to take care of making room for the yellow cottage caretaker in order to handle daily life hygiene and physical care.  And at the same time this cottage caretaker keeps in place all the nasty memories of the past (EP’s which are stored in this cottage). You could think of a archive where all nasty experiences of a repetitive event are stored and where a cottage ANP carries the key to it.

  • Although I can’t explain everything of our progress, I can explain the most important progress

At the end of this therapeutically year (chart C) the middle and the right wing house are connecting with each other. They start recognizing each other’s presence, feelings, emotions, and they already start to integrate some of their own but also some of each other’s EP’s (marked on the chart with a +).

Results and Prognoses:

The daily gapes of not remembering are slowly starting to shrink. But they (the big houses) aren’t yet so much progressed that they can integrate with each other. And maybe the maximum achievable is better teamwork and reducing the PTSD and dissociative symptoms, because there are still a lot of ANP and EP’s which can’t connect or don’t dare to go in contact with other human beings, each other or the outside world. And also, the EP’s which are in rest we don’t want to disturb or bring to life again. If they don’t interfere and mes up our daily life on a frequently base, then we let them rest and we choice not approach them.
We don’t stir in the mud when its better to stay away of it.

ptsd vrijOur goal
Our biggest goal is more inner teamwork, don’t have so much gapes in remembering things, get a knowledge of our own biographical being and history, to get writ of the not explainable and painful defense reflexes, and learn how to handle a more emotional awareness of living without a constant high alert feeling and the need to stay on guard, a high vigilance that comes with a none stop survival mode. We don’t live, but we survive. And learn to handle a more social and human contact.
For the first time in our life we learn carefully to fly as a butterfly from one to another blue rose

We start connecting one ANP house to the other ANP house.

The switching behavior that comes as a symptom of a DID

 

To make this even more understandable . . .

Although this isn’t the case in our situation, in other cases of DID and OSDD (1 big house), cottage caretakers or smaller ANP parts can present itself as a child or a teenager or likewise different Emotional Personality states. But we @M, the left, middle and right wing ANP don’t switch to such a Personality states under the influence of an EP. We switch only between the ANP/EP systems – the Apparently Normal Personality states which protect us against the influence of cottage EP’s or single EP’s. Our big ANP/EP systems are so strong that they usually stay in control as long as possible. And if all three the big ANP/EP systems lower or suffer a lower consciousness state at the same time, and none of them is able to stay in control, then the whole personality system risks a severe panic moment, a mental black-out and in the most severe cases a neurological black-out that presents itself as a serious ‘epileptic seizure’.

 

So our ANP/EP systems don’t like ‘the past at all’ and therefore they don’t leave a lot of room to the EP’s to take controle. So it’s hard for us to explore and integrate the parts which are messing up our live.

Stay in though with your inner self
@Nique  who is coming out of the Dark box

 

Complex Trauma PTSD

 

Some educational N€uro Brain cracking

Let’s do a little educational N€uro brain cracking 🙂

(the magic of our brain complexity)

Hypnotic Thoughts

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Broadcasted by:  HypnoticThoughts


Paul RamsayHypnotist Paul Ramsay

 

Paul Ramsay is a board certified hypnotist in private practice, hypnotizes over 1500 people per year, and tours as a stage hypnotist. For over 10 years, Paul Ramsay has been entertaining college and high school students as a stage hypnotist. In 2011, Paul introduced his exclusive interactive show called Mind Games. Paul’s video series Hypnotic shows a day in the life of a traveling stage hypnotist. Paul’s private practice is dedicated to helping individuals stop negative habits such as smoking, fingernail biting, and overeating. Ramsay’s private practice also offers customized, individual personal coaching programs to help his clients achieve their goals and maximize their potential. www.PaulRamsay.com

and
mani-saint-victor

Cognitive Neuroscientist Manuel Saint-Victor

M.D. Dr. Saint-Victor is Chief Neuroscientist at Mindful360, which he co-founded. Dr. Saint-Victor is focused on using a non-pathological approach to helping people get better by becoming more self-aware of their strengths and resources. Dr. Saint-Victor trained under Dr. Eva Ritvo, M.D. and Dr. Ray Ownby, M.D., MBA, Ph.D. as a Psychiatry Resident at Jackson Memorial Hospital; attended Medical School at UNC Chapel Hill School of Medicine; and conducted cognitive neuroscience research under the supervision of Stephen M. Kosslyn, Ph.D. as an undergraduate at Harvard University. Dr. Saint-Victor’s white paper about Core Value Alignment will be released in July 2014.

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amygdala

What is the Amygdala? What Does it Do?

The amygdala, part of the brain’s limbic system, is the integration site of emotional learning. It sits in front of and connected to your hippocampus (the seat of episodic and autobiographical memory). Although you often hear it associated with fear, the amygdala is also involved in pleasurable emotions. If you’re experiencing intense emotions you can bet that your amygdala is active. Without it you would have what’s called a flat affect. You would not make the connections between dangerous signs or social situations and the anxiety that motivates you to act.

Go to see the interview broadcast

 

pre frontal cortex

 

What is the Pre-Frontal Cortex?

The Prefrontal Cortex is the site of executive function, social functioning, decision-making. The cortex, which means “bark” in latin is where you represent the value of decisions. You represent your goal-directed behaviors and impulse control here.

Go to see the interview broadcast
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hippocampus

 

What is the Hippocampus?

The hippocampus, named for its seahorse-like shape, is the site of episodic and autobiographical memory. Memories with “What, where, when” components are woven into narrative form thanks to the hippocampus. It also manages spatial navigation and combines previous memories with new events to create novel precepts.

Go to see the interview broadcast

 

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Insular Cortex

 

What is the Insular Cortex?

The insula is the site of integration of the signals from the rest of your body systems. We often refer to this sense as interoception. Think of it as your Spidey sense.
In that way, the insula is the seat of consciousness, your sense of self, managing homeostasis (your internal chemical, temperature, immune and emotional balance). It also calculates your social emotions based on your body sensations. Next time you have a gut feeling about someone or you get goosebumps during a scary scene to go with the chills down your back…thank your Insula.

Go to see the interview broadcast

 

Anterior Cingulate Cortex
Pay Attention!
What is the Anterior Cingulate Cortex?

Got conflict?
The anterior cingulate cortex is the place in your brain that monitors errors, surprises, and violated expectations. It fires off when you do something as simple as write a sentence that you disagree with. It’s not your moral center of your brain. It just manages expectations in a way. It’s simplest to think of it as the alert function in your brain. When it’s time to divert your attention and bring something into conscious awareness, that’s your ACC at work. In labs we would watch for findings in the event-related potential(ERP) like Error-related negativity.

Go to see the interview broadcast