Tag Archive: Topreferent Trauma Centrum

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.

underline

 

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

 

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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

 

You can find me also on

acc_googleacc_eduacc_wordpress

                                   

google Complex-Trauma

OPROEP lotgenoten Regio Groningen

OPROEP

Ik zou graag in contact komen met
lotgenoten in de regio Groningen

Ik moch al vele malen Caleidoscoop een verzoek zenden om in contact te worden gebracht met de lotgenotengroep provincie groningen, toch dit mocht tot op heden nog geen enkele respons ontvangen anders dan de antwoorden zoals op alle mails: Uw antwoord is doorgestuurd.

Dus ik probeer het ook nog maar een keer via deze weg

Ik zou dolgraag in contact komen met lotgenoten Dissociatieve Stoornissen prov Groningen.

00-mijn-email

Ik hoop dat het me nog gaat lukken om dit via onze landelijke vereniging geregeld te krijgen, toch daar wordt nagenoeg op geen enkele mail gereageerd.

 

lotgenoten contact

 

google Complex-Trauma