This thread is for articles which are clinical or academic in nature (not written for the public per se)
See attached for a discussion about the role of dissociation in CPTSD - "Dissociation: An Insufficiently Recognized Major Feature of Complex PTSD"
This took forever to read! But the parts on Alterations in: Self-Perception, Regulation of Affect and Impulses, Relations with Others, and Systems of Meaning all apply to me very well.
Also the concept of 2 kinds of dissociated parts of oneself--the ANP (Apparently Normal Personality) and the EP (Emotional Personalities) make so much sense too. Like different ego states, unintegrated.
I used to read a lot about Borderline PD and could always relate to their feelings (not able to regulate them, and not able to self-soothe). I also can relate somewhat to DID. It can all get very complicated.
What's always confused me is--what's really happening? How do I explain this to others, including my therapist?
1. Am I a single adult personality having a flashback (EF)?
2. Am I an adult who is regressing to an earlier age and time? or,
3. Am I switching to one of several dissociative parts that each exist in their own right inside me as individuals, so that I am more like a group than an individual?
I think they are all valid, but I do lean toward #3. Subjectively, that's how I feel--separated. I also think my ANP is my present self, who I refer to as Big Pam. And I have a few EPs with their own names and ages. No matter what I call it, it still qualifies for CPTSD, lol. Especially now that I see dissociation is part of it :)
HI Pam -- The way I understand it is that some parts of our psyche got stuck or developmentally arrested in childhood because of abuse/neglect in childhood. I don't think it's a case of having separate personalities, rather it's a separate part that is not integrated into a whole personality. So I think when we have an EF we are switching into one of a developmentally arrested part of our psyche. I think I read in Walker's book that we go to our "child-mind."
So I'm going with Door #3 as well - for now anyway. Hopefully as we all talk about these issues/concepts we'll be able to distill down the clinical to the lived experience of CPTSD.
Developmental trauma, complex PTSD, and the current proposal of DSM-5 - Article by Vedat Sar which discusses the various disgnosis relating to CPTSD - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402152/#CIT0002
While surfing (I found this on a site Kizzie mentioned elsewhere) I found this article (http://publichealth.lacounty.gov/wwwfiles/ph/media/media/TPH-409.pdf) -- it's mainly about the long-term effects of CSA, but further into the article it talks about the effects abuse can have on the brain, and I thought it was really interesting:
Quote
Magnetic resonance imaging (MRI) studies have demonstrated a 12% left hippocampal volume size reduction among adults who have been sexually abused in childhood as compared to healthy controls. Similar reductions are exhibited among subjects with trauma-spectrum disorders such as depression, dissociation, PTSD, and borderline personality disorder. In addition, the amygdala, responsible for emotional and fear regulation, is affected by early sexual trauma, resulting in similar psychopathologies.
Studies suggest sexually traumatized children are also less able to utilize both brain hemispheres to process experiences. The corpus callosum, a longitudinal fissure that connects the left and right cerebral hemispheres, is shown to be abnormal in sexually abused children. Generally, the left side of the brain processes positive emotions and logical thinking, and the right processes negative emotions such as fear. When the corpus callosum is not operating properly these processes are unable to function at the same time, thus supporting theories why many abused individuals divide people into "all good" or "all bad" and exhibit mood swings, as observed in borderline patients.
Tks for this FMV
It's a bit on the scary side to think that our brains may have been changed by the trauma we experienced, but understandable considering that with CPTSD the trauma/stress is repeated/ongoing and our bodies are constantly flooded with chemicals/hormones. I know when I have an EF I often feel hungover for a few days while the chemicals wash out of my system. I also find that I can't think during an EF, it's just a big old mish mosh of strong feelings and this article sheds some light on why this may be so.
The good news is that I have been reading more and more about our brain's plasticity and our ability to change/build neural pathways (e.g., Doige, N. 2007. The Brain that Changes Itself). I think this is the basis of CBT and DBT which focus on thinking differently, EMDR which as I understand stimulates other parts of the brain so the trauma can be processed properly, and perhaps in the emotional grief work in Relational Therapy if Walker is correct in his book "CPTSD: From Surviving to Thriving:"
Verbal ventilation, at its most potent, is the therapeutic process of bringing left brain cognition to intense right brain emotional activation. It fosters the recoveree's ability to put words to feelings, and ultimately to accurately interpret and communicate about his various feeling states. When this process is repeated sufficiently, new neural pathways grow that allow the left- and right-brain to work together so that the person can actually think and feel at the same time (2013, p. 231)
Not having much knowledge about childhood sexual abuse (CSA) specifically, I don't know if these approaches/techniques would be helpful, but in the book by Doige there are a lot of examples of people who overcame some pretty debilitating problems (e.g., stroke victims, OCD and other mental health problems). So, for trauma in general they seem to offer a fair amount of hope.
Dissociation and CBT:
When I have an EF that is a younger, hurt, emotionally unstable, and unhealthy part of me coming out. But I swear if someone does CBT on me, some other part of me, a healthier more mature and stable part shows up for that and can do it perfectly. But then everyone wonders why it doesn't work, why I still have EFs or go right back to feeling the same ways.
I think if a person is very dissociated, a T would have to always make sure they are treating the right "part"! Or else it's not getting thru to who it should be. (kind of like DID) It's like I have to consciously go out of my way to try to "bring" the right part of me (such as my inner 9 yr old) to therapy!
An example is I told my T last time about a major negative event that had happened. Days later i remembered that I forgot to tell him the most stressful part of it (where I was in an EF and was extremely upset just like when my 2 girlfriends turned on me in preteen yrs, altho it didn't last very long, only a few hrs). I was like How could I forget that?!? Well, I guess that's evidence for how dissociated I am. I literally don't feel all my feelings in one mind. Another part knew about it, but didn't actually feel it herself. The part who showed up for therapy didn't feel the feelings of the EF. I guess that's why CBT doesn't reach the part of me that needs help. And if that's true for others, then yes it will appear as if CBT is helping when it's possible that it really isn't.
Not being able to get better from CBT used to make me feel like real crap, like I was too far gone. Until I figured out that part of me wasn't even there for it. Now I at least clearly understand why and that it's not my fault.
Great article here "Understanding Complex Trauma, Complex Reactions, and Treatment Approaches" by Dr. Courtois - a bit on the academic side but quite comprehensive.
http://giftfromwithin.org/html/cptsd-understanding-treatment.html
The EMDR Institute - comprehensive description of EMDR, how it works and list of research regarding its efficacy - http://www.emdr.com/faqs.html
Korn, D. (2009) "EMDR and the Treatment of Complex PTSD: A Review" - Available: http://webcache.googleusercontent.com/search?q=cache:7RqPLN-WsmUJ:www.traumacenter.org/products/pdf_files/Korn_JEMDR_2009.pdf+&cd=1&hl=en&ct=clnk&gl=ca
Huso, D. (2010), "Treating Child Abuse Trauma With EMDR" Available: http://www.socialworktoday.com/archive/032210p20.shtml
Forgash, C. (2002). "Treating Complex Posttraumatic Stress Disorder with EMDR and Ego State Therapy" Available: http://www.advancededucationalproductions.com/publications-articles/treatingCPSD.htm
van der Hart, O., Nijenhuis, E. & Soloman, R. (2010). "Dissociation of the Personality in Complex Trauma-Related Disorders and EMDR: Theoretical Considerations." Available: http://webcache.googleusercontent.com/search?q=cache:9vYmQoAiOhsJ:https://www.myptsd.com/c/gallery/-pdf/1-78.pdf+&cd=7&hl=en&ct=clnk&gl=ca.
Interview with Bessel van der Kolk: "Restoring the Body - Yoga, EMDR and Treating Trauma" Available: http://www.onbeing.org/program/restoring-the-body-bessel-van-der-kolk-on-yoga-emdr-and-treating-trauma/5801
FMV,
Thank you for posting this article. I have suspected that I have the exact problem they describe (and you quoted) but I don't remember reading anything that describes it so accurately to my experience as this does.
I have read many books on CPTSD stuff and this is the first I have read this.
I have really done a lot of research on this and from what I am finding BPD and CPTSD are so simile. I know this can strike a coward with some of us because our abusers may have been diagnosed with this. I have taken so many on line personality tests and many times have come up with numerous flags of BPD. This being said I went to a specialist, She said what I had thought, BPD is now being more looked at as a coping mechanism then a PD and it is strikingly a like with CPTSD. The trauma brain CAN heal. check into RESILIANCE! The brain is amazing and can be rewired with a lot of love and acceptance. I have been researching Capt's and I find a lot of similarities to Autism as well. Both a sensory integration disorders, CPTSD is more emotional integration and regulation( just like BPD) then senses BUT for people who have never been allowed to display feelings or where punished for showing emotion... your brain just learns to take different Nero pathways that avoid those emotions. However, your body will still exhibit physical signs of what ever emotion you are suppressing. Many people find that bodily awareness is rewiring the brain and REVERSING the trauma PTSD response of basically shutting down your frontal lobe which is responsible for logical adult thought. PTSD sort pf activates the reptile brain and so we are living in a constant state of now .... the catch is now is experienced though the lens of the past due to subjoins triggers.
So after all that ranting my point is, healing is possible through recovery work, getting both sides of the brain communicating and regulating the amigdyla in whatever ways we need to.
That is the one thing that gives me hope more than anything else... I can heal IF I work through the abuse/neglect/ sexual abuse. I can get better! I could be off meds. I am diagnosed with Bi-polar...but I think without CPTSD being in the DSM that I have a fair diagnosis that I can work with!
Best article I've read to date on what happens internally.
A Trauma-Weakened Ego Goes
Seeking a Bodyguard
David Hartman and Diane Zimberoff*
Abstract: Unbearable trauma causes fragmentation of the child's structure of
the self, her wholeness. And this fragmentation occurs on the level of
personality (behavioral changes, or shadows in Jungian terms) and on the
level of physiology (nervous system changes, or shock in our terms).
We want to distinguish between traumatic dissociation and the "soulloss"
of traumatic shock. A helpful aid to understanding that difference is an
analogy of dissociation as slipping away from the triggering experience into
dream sleep. It is creating a distraction to get caught up in, an escape that
allows another, dreamlike, experience to replace the threatening one: "I have
abandoned you." This requires defenses of the ego, such as rationalization,
denial, sublimation, or suppression.
In contrast, shock would be analogous to slipping into dreamless sleep,
recognizing that there is no escape, nowhere to go to escape. It is thus not
escape into an alternate reality but rather into the annihilative nonbeing of the
withdrawal of one's soul, temporary oblivion: "I have abandoned myself."
This is a second-line of defense, when the ego-defenses have been penetrated
resulting in unacceptable levels of anxiety. This level of wounding requires
primitive archetypal defenses of the self, such as splitting, trance-states,
switching among multiple centers of identity, or psychic numbing.
And fortunately, when the ego falls into the abyss opened by unbearable
trauma, it falls into something already there to catch it – the archetypal world
functions to defend the traumatized psyche against further trauma.
Download PDF here: http://www.wellness-institute.org/images/Journal15-1HartmanTrauma-WeakenedEgo.pdf
If anyone is interested I have a bunch of articles about:
-clinicians guide to PTSD
-Exposure Therapy
-Chapters from "An Unspoken Voice"
-Chapters from "Invisible Heros: Survivors of Trauma"
-Chapters from "The Body Bears the Burden"
-Chapters from "The Body Remembers Casebook"
-Therapist's Guide to Brief CBT
-Child Trauma work sheets
-Articles on sexual dysfunction (can be caused by trauma)
-Articles on mindfulness based stress reduction/mindfulness based cognitive therapy
-tons of articles on mindfulness and ACT
I know that not all of these are scholarly articles, but I have all these in PDF. Feel free to email me/quote me if you want me to send you something or upload something on here. ;D
Links! Some of my mindfulness stuff is geared towards older adults (because of my job ;D), enjoy!
Trauma (possible trigger warnings!):
https://app.box.com/s/9j76l86ezfcgbx80285v
CBT Manual:
https://app.box.com/s/p5qr1j61ladsznedabdn
Art Therapy:
https://app.box.com/s/wlxm8rybbcb0jo5nktsc
Mindfulness:
https://app.box.com/s/rm1g7gxd0x663l3bmqrd
I recommend the article by Sandra Bloom, pete walker mentions it in his book. There is probably nothing new there if you have been reading for some time, but its a nice document for relatives or people new to CPTSD, it has given me a lot of comfort.
Here's a link.
http://www.sanctuaryweb.com/Portals/0/Bloom%20Pubs/2000%20Bloom%20Email%20Grief%20that%20Dares%20Ravages%201.pdf
http://sanctuaryweb.com/Portals/0/Bloom%20Pubs/2000%20Bloom%20Email%20Grief%20That%20Dares%20Ravages%202.pdf
http://sanctuaryweb.com/Portals/0/Bloom%20Pubs/2000%20Bloom%20Email%20Grief%20That%20Dares%20Ravages%203.pdf
Since my current stint of employment is coming to an end, very likely due to my irritability and hyper-sensitivity to stress and anxiety, I saw certain things in my employer as potential threats and over reacted, such as late payment of salary and excessive deductions, I have tended to wonder how much of this is "me" and how much is attributed to past events. As a society we tend to judge people on their behaviour, and we are told that we are responsible for it. If I lose my temper because I see no other way to respond to a certain threat, it is me or my CPTSD? Since my parents have often blamed me as a child for the outcomes of situations between us, and as an adult I have been constantly in trouble of one kind or another, it seems that these problems are getting worse. I started to think that perhaps I have inherited traits from past generations, I come from three generations of soldiers, all saw active service from Flanders, through Dunkirk and North Africa to Aden and myself in the middle east in 1991. On the one hand soldiering felt comfortable and on the other I am unable to fit into normal interactions on an everyday level. I wondered if animals pass of traits for survival, which are epi-genetic, could we be inheriting PTSD "behaviours" and traits from our famillies. In this paper they did a review of research into inheritability of PTSD, what I read into it is that on some level we are pre-coded to deal with high levels of trauma. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136568/