Tag Archive: PTSS

Do all cases of PTSD have an EP ?

DISCUSSION2014

DO ALL CASES OF PTSD HAVE AN EP ?

And should PTSD be classified as a (Structural) Dissociative Disorder (DD)

This is a very nice question to think over, given by Dr. Colin Ross in his commentary (2014 pg 285) on the Ten reasons for conceiving and classifying post-traumatic stress disorder as a dissociative disorder (E.Nijenhuis 2014)

My personal response to this question:
Let us take a closer look at the Apparently Normal Personality STATE (ANP) – the self and ego states of oneself daily life handling system and a pathologically traumatized Emotional Personality PART (EP) such as given by the theory of a Structural Dissociation of the Personality (Hart, Nijenhuis, Steele 2005, 2006) to account to the basic dissociative elements which lead to the development of a Post-traumatic stress Disorder (PTSD) e.g.: a Primary structural dissociation of the personality (the Haunted Self 2006).

complex trauma discussion

My own Introduction:
Nobody likes to think over a traumatic event or experience. And if thinking about it, or get slightly reminded at a traumatizing experience triggers a pathologically behavior and or emotions (stress) we start automatically avoiding those nasty memories. Such a mental avoidant behavior towards a memory is basic dissociative behavior, and also the first sign to the development of a Post-Traumatic Stress Disorder. We avoid that pathologically (damaged/traumatized) emotional personality part (EP) during our daily life. Our normal functioning starts to develop abnormal behavior towards a memory.

Here the first personality break develops itself to the existence of an ANP and EP:

  1. Our daily life functioning goes on but at the same time starts avoiding a traumatic memory. The Personality no longer functions normal, but apparently normal  (ANP) .
  2. If the memory gets triggered (emotional respond) a pathologically stress reaction caused by an unconscious memory (EP) steps in and influences our normal daily life functioning. We no longer function as normal because we carry an EP around, so the personality – the ANP – gets influenced by an emotional damaged/traumatized personality part.

Such an EP is not in executive control because if such an EP gets triggered the ANP is aware of the nasty emotions and bodily stress. The person is able to point out which object or event in the present time makes him or her restless or stressed. But….. the traumatizing memory can stay full or partial in the dark of the unconscious mind. Thinking over the reason why the object or event triggers emotional stress is partial or fully dissociated and safely stored in the unconscious state of mind by an EP –  mental avoidance – basic dissociation.

If the partial or fully dissociated memory hits the conscious state of mind (remembers – recognition to the past), the Apparently Normal Personality state relives the traumatic event (the past) – a fully, pathologically emotional stress reaction can take over the wellbeing of daily life function – the Personality – the ANP gets overstressed (fear, panic, disturbed behavior,… etc.).

In this context you could conclude that dissociation stands on the basics of every PTSD development, because a traumatizing event or experience which causes pathologically behavior or emotional stress is bound to an Apparently Normal Personality STATE (ANP) and a pathologically (traumatized | damaged) Emotional Personality PART (EP).

The traumatizing memory of an EP can be partial or fully dissociated by the mental state of the ANP (Self and Ego States) until it gets unlocked  (confronting memory, reliving, lifting avoidance). Standard PTSD treatment policy (van Balkom e.a. 2013).

My Conclusion would be:

Dissociation belongs to the basic elements of developing PTSD symptoms.
Because this basic dissociative element leads to basic PTSD symptoms (from mild to severe), so there is no PTSD without Dissociation.
To the theory of a Structural Dissociation of the personality this is called a

Primary Structural Dissociation – PTSD (one ANP – one EP)

 

My restricted answer to a part of the first question page 285 Commentary Colin A. Ross 2014:
Yes, all cases of PTSD have an EP.

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I look forward to the answer e.g. commentary of Ellert Nijenhuis or one of his specialized team member(s) to the full commentary of Colin Ross (2014).

Nique

 

With much respect for all the clinical traumatology researchers
Just simply Nique (December 2014)
Cl.E Top Referent Trauma Center Assen-Drenthe, the Netherlands

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

 

You can find me also on

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google Complex-Trauma

The Horror of a Psychologically-Trauma

complex trauma discussionThe Horror of a Psychologically-Trauma

Is it just fear? An anxiety disorder?

Some clinicians focus on ‘one’ emotion if they talk about cause, diagnose and treatment of a ‘psychologically-Trauma’. There are even clinicians which carry the opinion that a Psychologically-Trauma is an anxiety disorder caused by fear. Because fear alone can trigger unimaginable human strength or unimaginable human surviving capacities

complex-trauma

Some say: fear is Horror and Horror is fear.
But is horror really only fear?

I dare to disagree with such an underestimating statement to the suffering of a psychologically-trauma. Because a psychologically-trauma is a lot more than fear that causes an anxiety disorder. That is also why PTSD is not categorized as an anxiety disorder but as a disorder caused by suffering extreme stress.

Fear is just one of the unbearable sensations which tortures the body and mind of a psychologically-traumatized daily life handling-system of once personality (the self- and ego- states). Fear can make you Run away, fear can make you Freeze, fear can make you Cry, fear can make you suffer without you even knowing ‘why’. Nobody will disagree that fear can cause all that, but does it mean you suffer a psychologically-trauma if you suffer or suffered only Fear: NO !

The word  ‘pain’ barely used . . .
But the definition of suffering pain says a lot:. “an unpleasant sensory and emotional experience associated with acute or potential tissue damage or described in terms of such damage”. Suffering physical pain, mental pain, emotional pain and psychologically pain all at once, will cause an ‘injury’ – psychologically and or physically. And (Child) sexual and or physical abuse causes such an ‘injury’ because it’s an horrific event.

A psychologically-injury

An horrific event triggers bodily responses, sensations, feelings and emotions all at once. Horror overloads your daily life handling-system (ego- and self-states), your mental state and common sense with extreme stress.  Even by witnessing a ‘horrific event’ you can get emotionally and bodily over-stressed and it even can cause a phobia for experiencing (witnessing or remembering) it ever again

Horrific events or a horrific experiences can make us lose our common sense, activate unwanted bodily responses, can cause uncontrollable sensations, feelings and emotions or can even cause an unimaginable strength which can lead us to do the unthinkable as if we are in a hypnotic state. .

Stop Child AbuseEver heard of:
Blind madness?
Blind sadness?
Blind fear?
Or over excitement – uncontrollable joy which make one scream and or shiver ?

Ever heard that someone who broke his leg or finger was able to pull it right back on its place right after the event happened? Ever heard that pain can reach a level of numbness? Ever heard that people weren’t able to notice their physical wounding’s (or the pain) right after they injured themselves or right after a severe accident? Ever felt the pain your muscles causes if your laugh gets out of control? Ever felt that powerless feeling caused by intense out of control laughing? Ever heard that over activated emotions can cause you leaving and or losing your common sense?

The unimaginable can occur if our daily life handling-system, our personality, gets overloaded (stressed out), it can force you in to a survival mode. And afterwards, if we get back in our mindful state, we feel the physical and psychologically chaos and shock that starts torturing our mind and body; some get cold and or start to tremble, some feel the pain of their muscles if they start to unlock (relax) again, some get scared by an instant only by the thoughts (memory) of what they did during that over-activated personality state, some shut bodily and mindfully down and or are extremely exhausted afterwards, some feel pain all over their body by the muscles which where over contracted, some experience a huge headache afterwards, and some just start laughing as a response to a severe accident that just happened.

artlimited

If we think over what just happened to us during a horrific event or what we just experienced or did in a total over-stressed personality state – collecting or doing the impossible or the unthinkable – afterwards; we realize we lost or did leave our mindful state for that short moment of time.

Suffering a psychologically-trauma is all above mentioned.
Suffering a psychologically-trauma is an ongoing, repeating, over activation of the body and mind, of feelings and emotions, of more than one personality-state.

Suffering a psychologically-trauma eats your life !
We start dissociating to survive, because It relieves the suffering. And if you unlock the Traumatic Memory the unthinkable can happen all over again, so it’s very important to reach out for proper and very experienced Help.

Don’t underestimate suffering a psychologically-trauma.
Because suffering a psychologically-trauma is a whole lot more than suffering the emotion of fear. A psychologically-trauma will force you to live your life in an ongoing on-guard state and or survival mode.

Seek help
Seek very good and experienced help if you suffer a psychologically-trauma.

Regards,

© Nique
CE at the Dutch Top Referent Trauma Center Assen-Drenthe,
National Mental Healthcare Department, The Netherlands

 

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

 

You can find me also on

acc_googleacc_eduacc_wordpress

                                   

google Complex-Trauma

 

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