PTSD, Complex PTSD, and Revictimization

[David Baxter PhD]

PTSD, Complex PTSD, and Revictimization
by Anne M. Dietrich, M.A., University of British Columbia

ABSTRACT
During the 19th century, a picture was painted of trauma in which the focus was on pathologies of the victims, including notions of inherited "moral degeneracy," with little cognizance of the greater contextual factors, such as the traumatic events themselves, that contributed to the symptom picture. The role of trauma in the etiology of posttraumatic symptoms was incorporated into the DSM-III in 1980 and the PTSD category was initially viewed as an improvement over earlier categorizations of trauma, as it acknowledged that some experiences are so overwhelming that few people would escape unscathed. However, recent findings that not all persons who have suffered traumatic events develop PTSD have led some writers to discussion of a genetic component to PTSD. This article looks at this conclusion and the role of individual and contextual factors in relation to PTSD, Complex PTSD, and revictimization.

Note: Some of the material in this article may be disturbing to some readers.

...full article

 

[Justaday]

Nature or Nurture-- are they mutually exclusive, or do they work in tandem. Issues also re: prolonged repeated exposures, intensity-- the original stressors; supports at that time, or limited by the situations. . .

Some new research shows that PTSD shows up in MEG scans, affecting the hippocampus regions of the brain. Article

By Measuring Magnetic Fields in Brain, Researchers Identify Post-Traumatic Stress Disorder Biomarker
ScienceDaily (Jan. 24, 2010) — Researchers at the University of Minnesota and Minneapolis VA Medical Center have identified a biological marker in the brains of those exhibiting post-traumatic stress disorder (PTSD).

For me, it was starting to remember, recall things-- came in flashbacks and panic attacks I didn't really understand what was happening and that was contributing to the physical distress-- factors there was no support, a lot of chaos and instabity around me and for years. I didn't have a chanc to process events, into language, and when conditions are severe enough, where threat to life persists, constant crisis, processessing would be a luxury, one would have to be safe, have the conditions of safety (mental, physical, emotional, spiritually, etc.). It took a toll on the body, the alertness, the eggshells, how quickly things could turn dangerous-- it fries the 'organism' the human being, the 'fight/flight/fright' responding.

There was also another interesting study by Lenore Terr, re: school-bus hijacking/hostage-taking which was a longitudinal study of the child-survivors and into adult years, who presented PTSD, who didn't. . . I recall one result of that being those who took power, who didn't freeze with fear, were empowered to take action, were spared from more PTSD disability. . .? I should find the links to that study. I wonder if traumatic-guilt, survivor guilt plays into that? Or how those survivors were responded to vs. the ones that froze (lingering helplessness, and that maybe being re-enforced socially, vs. the 'heros' . . .?).

I also have links to a roundtable discussion, neuropsych, contextualizing PTSD as a "brain injury" and re: Veterans. With some exploration of factors re: resiliency having an impact on who develops PTSD, who doesn't. . .

I'm just putting this out there for now, and I'll return when I'm able to, to post the links.

I think there's a lot of hope in PTSD recovering, re: adaptive coping. I really like this MBSR (Mindfulness-Based Stress Reduction) and the hope this brings-- I believe the mind/brain is pliable and adaptive, it's just a matter of re-teaching it, mind/body and I think that will have an effect over the long-term in possibly reversing the 'brain injury" of PTSD.

We don't seem to invest that much in PTSD-research here (Canada), but Stateside there is a lot. Many of us PTSD-ers here-- there aren't even any statistics being gathered on us-- a lot of us, 'don't exist'.

I like the promise of the MEG proof of it's existence, I feel really angry when others deny PTSD or make claims that it is 'faked', or all about having a 'weak constitution'. My PTSD makes sense to me. There's political stuff going on, re: profitability of big pharma. . ., experiemented on in the hospitals re: meds, although it's positive that some of the newer class of antipsychotic medications are helping those with ptsd. For me, they do help, e.g. the Seroquel, for breaking up hyperarousal symptoms, when it's taken too much hold via brain/body, re-firing, "fight/flight/fright'. I noticed if my hyperarousal symptoms are bad, I think it's the biolchemistry loop that happens, so not only will there be flashbacks, panic attacks, dissociation, but also at night, nightmares, even REM problems re: sleep paralysis (which is spooky experiencing, IME). I remember going through this for 4 months-- it was hellish, no break, spun.

One more area of interest and re: Complex PTSD, check out Pete Walker's site and re: emotional flashbacks.

 

[CarlaMarie]

I like Pete Walker's stuff, too. :2thumbs:

 

[phoebe22]

PTSD, Complex PTSD, and Revictimization
by Anne M. Dietrich, M.A., University of British Columbia
ABSTRACT
During the 19th century, a picture was painted of trauma in which the focus was on pathologies of the victims, including notions of inherited "moral degeneracy...full article

Probably a stupid question, but why are so many people suffering from PTSD also given dx of some variety PD? Anxiety and/or depression I can understand very well, but from this side of the desk a dx of PD feels an awful lot like blaming the victim (I hesitate to use that phrase, even in the context of vernacular, but it will have to serve).

That kind of dx makes it seem (to me) as if people who have either experienced a horrific trauma or been abused all their lives are somehow lacking, that their personalities are "flawed" (else it wouldn't be a personality disorder). This often makes me feel there's not a lot of progress made in terms of the pathologies discussed in the article. If I've missed the boat (wouldn't be the first time), would you mind helping me understand?

I think of a dog which has been mistreated regularly for years and then one day growls or snaps at one abuser too many. The natural human reaction to that behaviour is to punish (or kill) the dog, but how is it the dog's fault? How is the dog "less than"?

Which begs the question (IMO): why are people who have been treated like garbage all their lives being made to feel even more like garbage on legs by being told, in essence, that they are still somehow less worthy than others?

Just colour me confused (per usual) ...

Thanks

:crazy:
I should add that while the PD dx given me by one psych was overturned, I had to work for it. It finally came down to going over the list of dx'tic criteria point by point, and when it turned out that the one thing with which I agreed without reservation was "mood swings", doc allowed as how I had a point and updated my file. There was one other point in the list of criteria which was a kinda/sorta, but for the life of me I can't remember now. Probably something to do with anger

 

[David Baxter PhD]

Probably a stupid question, but why are so many people suffering from PTSD also given dx of some variety PD? Anxiety and/or depression I can understand very well, but from this side of the desk a dx of PD feels an awful lot like blaming the victim (I hesitate to use that phrase, even in the context of vernacular, but it will have to serve).

I don't believe the majority of people diagnosed with PTSD are given an Axis II personality disorder diagnosis. At least not if you look at the whole population of people diagnosed with PTSD.

I don't know whether this is or is not true but with PTSD secondary to early or prolonged childhood abuse I can see that a diagnosis of attachment disorder or personality disorder may be appropriately given, as part of the process of the child and adolescent attempting to adapt to and cope with abuse and neglect. But that's not likely to bne the case with PTSD following a catastophic event as an adult, for example.

 

[phoebe22]

I don't believe the majority of people diagnosed with PTSD are given an Axis II personality disorder diagnosis. At least not if you look at the whole population of people diagnosed with PTSD.

I don't know whether this is or is not true but with PTSD secondary to early or prolonged childhood abuse I can see that a diagnosis of attachment disorder or personality disorder may be appropriately given, as part of the process of the child and adolescent attempting to adapt to and cope with abuse and neglect. But that's not likely to bne the case with PTSD following a catastophic event as an adult, for example.

Hi. Thanks for responding.

I'm not entirely clear on what you mean about PTSD as a result of prolonged abuse being more likely to produce attachment or personality disorders. I imagine those of us who fall into the life-timers catagory develop defense behaviours, but I'm not sure I understand at what point "normal" self-protection becomes a "disorder". It didn't really need a psych or dr to tell me that my disconnection isn't normal and that it's a defense response to the overwhelming, but it was very helpful to have it identified, validated, and explained in context. Being handed the NPD dx on top of everything else going on at the time was rather like being smacked in the face with a somewhat gamy halibut, but in retrospect I can see how it happened and maybe it turned out to be a good thing in the long run, but it's been very painful getting from there to here, particularly since I'd been raised by someone who well and truly was NPD (with a bit of H thrown in to keep things lively).

I suppose I made an assumption: the psych who gave me the short-lived PD dx seemed to have been giving it to nearly everyone (on the ward), which caused no end of distress, particularly he told all of us we were "incurable". Perhaps it was his "thing" at the time, which was about 12 years ago; I have no idea and it would be pointless to speculate. True enough that I had to plead my case, as it were, with the "flying shrink", but once that was done it has never again been suggested. I suppose that because no one questioned the dx til I asked for it to be revisited, I began operating on an assumption that it was commonly associated with PTSD.

On something of a side note, this fellow ended up with so many people taking him to court (or attempting to do so) and refusing to see/be seen by him, that he recently moved to the lower mainland and has set up a private practice. Evidently, the primary complaint was that he was abusive and controlling, which had certainly been my experience. It's very hard to make me cry at all, let alone grovel, but he managed it on more than one occasion, to my shame.

And before I wander any farther down memory lane ...

Thx

Phb

 

[David Baxter PhD]

I was answering a general question with a general answer. We don't diagnose people here and I don't know enough about you now or 12 years ago to speculate as to whether or not the diagnosis was accurate.

I am simply saying that your premise that people with PTSD are frequently or usually also given an Axis II diagnosis (some sort of personality disorder) is incorrect, whether or not it happened in your case.

The diagnosis of PTSD does not require or imply an Axis II diagnosis. That does not mean that it cannot coexist with an Axis II diagnosis but that it does not necessarily imply an Axis II diagnosis.

Actually, your question reminds me of an old article in a psychiatric journal with the title Mad or Bad? which looked at the question of diagnoses of psychotic disorders vs. diagnoses of personality disorders. Part of the contribution of DSM-III was the multiaxial system where practitioners did not have to choose between one or the other if the patient met the criteria for both. That was the origin of the Axis I diagnosis (e.g., Schizophrenia) which allowed the addition of an Axis II diagnosis (i.e., personality disorder).

 

[phoebe22]

I was answering a general question with a general answer. We don't diagnose people here and I don't know enough about you now or 12 years ago to speculate as to whether or not the diagnosis was accurate.

I am simply saying that your premise that people with PTSD are frequently or usually also given an Axis II diagnosis (some sort of personality disorder) is incorrect, whether or not it happened in your case.

Oh dear; now there's a perfect example of what I mean about my gift (some gift) for miscommunication. I'm very aware that there are high standards maintained here ... and I'm very grateful that no one would suggest, let alone attempt to follow through with, an online diagnosis. Please chalk it up to me thinking out loud and exploring concepts ... all very clumsily.

Having read what you had to say about the Axis II dx and pondered on it some, I realize I was operating under a misapprehension, and I appreciate the clarification.

I'm going to have to re-read your discussion regarding "Mad or Bad" before I even know what questions I might have. This presents an attractive challenge ... for another day when I have hopefully chased down at least a few of my AWOL brain cells The chronic student in me gets frustrated a lot these days, but she's a stubborn old thing ...

Meanwhile, if I find a "smilie" for open mouth/change feet, would you add it to the collection?

Cheers

 

[David Baxter PhD]

No, there was nothing wrong with your post (apart from being a little off-topic for the thread). I was merely clarifying the basis for my response.

 

[Justaday]

A review of literature on revictimization suggests that adults who were abused as children and who are revictimized as adults may be at higher risk of revictimization because: (a) they have learned maladaptive ways of thinking, coping, and relating to others (Messman and Long, 1996); (b) they may be attempting to attain mastery of the trauma (Chu, 1992; Levy,1998); (c) their posttraumatic symptoms may predispose them to be more vulnerable to revictimization (Chu, 1992), including a biologically-mediated "inescapable shock" response upon exposure to danger (van der Kolk, et. al, cited in Chu, 1992); (d) the abuse may result in problems with self/identity development, such that the individuals interact with abusive persons in a manner that is in accord with their negative view of themselves (Chu, 1992); (e) they may have developmental disturbances in affect regulation, which may relate to problems with self/identity, numbing responses, inescapable shock, alexithymia, and/or dissociation, and may predispose them to either not feel or not pay attention to "danger signals" (Cloitre, 1998; van der Kolk, 1996); and (f) they may experience Finkelhor and Browne’s (1985) traumagenic dynamics of child sexual abuse, which may increase the risk of subsequent revictimization (Mayall & Gold, 1995).

These factors all make sense to me:

(a) they have learned maladaptive ways of thinking, coping, and relating to others (Messman and Long, 1996); ]

There are times I (and other's I've known and witnessed), have tried to over-compensate for PTSD-fears, thus making us minimize our appraisals of threats. We can often here others say "c'mon the world is not that unsafe. . . your paranoid" or a prospective manipulative abuser, fake indignance, "what you don't trust me. . .". It can be difficult and confusing to know who is safe from who is not safe because not having had a model of safety to begin with. Or too much self-doubt, not trusting our instincts, not asserting ourselves re: our own self-protection.

Maladaptive coping: I had a cheerful child-self, it's result of trauma-splitting, which can come out when I'm nervous, be cheerful, 'everyone is happy', response to try to soothe dangerous elements from dangerous family situation. Openess, trusting. . . it's a problem. This could be misinterpreted as "flirting", but was part of my that was frozen, split off, re: dad's suicide.

Or being overly other-concerned, fear of suicide, be a nice person so that doesn't happen to others, but this also has to do with the context of their being some manipulative perpetrators out there, sociopathic, more common than we like to think-- it's a sick culture, IMO/IME-- too many stupid ideas generated, not enough basic respect for our fellow human beings, and respect of their choices.

Another example of maladaptive coping is dissociation. It happened before, I was older, and said no, and it wouldn't stop, and that's not uncommon, so eventually there's dissociation and it's frightening when that happens again.

(b) they may be attempting to attain mastery of the trauma (Chu, 1992; Levy,1998);

Mistaken believe that I have control over the actions of others, or that in being assertive enough, I can stop trouble from happening. Real power, IME, is not allowing any risks, being alone with anyone for even minutes, that's all it takes. Never lose focus on my own safety #1 and don't have to be shamed into apologizing for it.

(c) their posttraumatic symptoms may predispose them to be more vulnerable to revictimization (Chu, 1992), including a biologically-mediated "inescapable shock" response upon exposure to danger (van der Kolk, et. al, cited in Chu, 1992);

"Inescapeable shock" response, I take that to mean dissociation, fight is not working, there's freeze and inner flight And it can be automatic responding, when in those situations again. . .

(d) the abuse may result in problems with self/identity development, such that the individuals interact with abusive persons in a manner that is in accord with their negative view of themselves (Chu, 1992);

Ego states. SA to children, certainly messes this up, splitting, by the manipulation of the abuser, 'bad is good' 'good is bad', shame which can also make it hard to be assertive, protective of oneself. I didn't have too much messing as a child, one bad experience, some more in adolescence, it also hurt in my relationships, trauma re-experiencing of fear and terror, and shame. Didn't know how to stay clear of abusive people and I just thought it was me that was fkd up and I allowed myself to be labelled that way.