Archive for March, 2013
Judith Herman believes that recovery from C-PTSD occurs in three stages. These are: Establishing safety, remembrance and mourning for what was lost and reconnecting with community and more broadly society. Herman believes that recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship. This healing relationships need not be romantic or sexual in the coloquial sense of relationship however and can also include relationships with friends co workers, ones relatives or children and the therapeutic relationship. Complex trauma means complex reactions and this leads to complex treatments. Hence treatment for C-PTSD requires a multi modal approach. It has been suggested that treatment for C-PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional deregulation, dissociation and interpersonal problems. Six suggested core components of complex trauma treatment include: 1. safety 2. self-regulation 3. Self reflective information processing 4. traumatic experience integration 5. relational engagement 6. positive affect enhancement.
The utility of PTSD derived psychotherapies for assisting children with C-PTSD is uncertain. This area of diagnosis and treatment calls for caution in use of the category of C-PTSD.
Ford and Van Der Kolk have suggested that C-PTSD may not be as useful a category for diagnosis and treatment of children as a proposed category of developmental trauma disorder DTD. For DTD to be diagnosed it requires a ” history of exposure to early life developmentally adverse interpersonal trauma such as sexual abuse, physical abuse, violence, traumatic losses of other significant disruption or betrayal of the child’s relationships with primary caregivers, which has been postulated as an etiological basis for complex traumatic stress disorders. Diagnosis treatment planning and outcome are always relational”.
Since C-PTSD or DTD in children is often causes by chronic maltreatment, neglect or abuse in a caregiving relationship the first element of the biopsychosiocial system to address is that relationship. This involves some sort of child protection agency. This both widens the range of support that can be given to the child but also the complexity of the situation since the agency’s statutory legal obligations many then need to be enforced.
A number of practical therapeutic and ethical principles for assessment and intervention have been developed and explored in the field.
1. Identifying and addressing threats to the child’s or family’s safety and stability are the frist priority
2. A relational bridge must be developed to engage retain and maximize the benefit for the child and caregiver.
3. Diagnosis treatment planning and outcome monitoring are always relational and strengths based.
4. All phases of treatment should aim to enhance self-regulation competencies
5. Determining with whom, when and how to address traumatic memories
6. Preventing and managing relational discontinuities and psychosocial crisis.
The symptoms of PTSD apply well to people who have experienced a discreet or short-lived traumatic event such as a motor vehicle accident, natural disaster or rape. However, the symptoms of PTSD do not always completely map on to the experiences of people who have experienced chronic, repeated or long-lasting traumatic events such as childhood sexual and/or physical abuse, domestic violence or captivity such as in a prisoner of war camp. When it comes to these events, the symptoms of PTSD do not really seem to completely describe the psychological harm, emotional problems and changes in how people view themselves and the world following chronic traumatic exposure. Therefore it is important to distinguish between the type of PTSD that develops from chronic long-lasting traumatic events as compared PTSD from short-lived events. The diagnosis of Complex PTSD refers to the set of symptoms that commonly follow exposure to a chronic traumatic event.
EVENTS CONNECTED TO COMPLEX PTSD
The traumatic events connected to Complex PTSD are long-lasting and generally involve some form of physical and or emotional captivity such as childhood sexual and/or physical abuse or domestic violence. In these types of a victim is under the control of another person and does not have the ability to easily escape.
SYMPTOMS OF COMPLEX PTSD
The following symptoms stem from exposure to a chronic traumatic event where a person felt captive.
EMOTION REGULATION PROBLEMS
People with complex PTSD experience difficulties managing their emotions. They may experience severe depression, thoughts of suicide or have difficulties controlling their anger.
CHANGES IN CONSCIOUSNESS
Following exposure to a chronic traumatic event, a person may repress memories of the traumatic event, experience flashbacks or experience dissociation.
CHANGES IN HOW A PERSON VIEWS THEMSELVES
Symptoms in this category include feelings of helplessness, shame, guilt or feeling detached and different from others.
CHANGES IN HOW THE VICTIM VIEWS THE PERPETRATOR
A person with Complex PTSD may feel like he/she has no power over a perpetrator ( the perpetrator has complete power in a relationship) In complex PTSD people might also become preoccupied with their relationship to the perpetrator.
CHANGES IN PERSONAL RELATIONSHIPS
These symptoms include problems with relationships such as isolating oneself or being distrusting of others.
CHANGES IN HOW ONE VIEWS THE WORLD
People exposed to chronic or repeated traumatic events may also lose faith in humanity or have a sense of hopelessness about the future.