Judith Herman and the formulation of C-PTSD

Started by missbliss, September 27, 2015, 02:20:14 PM

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missbliss

Judith Herman and the formulation of C-PTSD

C-Ptsd is a diagnosis that was first proposed by Judith Herman, a professor of clinical psychology at Harvard University. In her book "Trauma and Recovery" she proposed the diagnosis of Complex Post Traumatic Stress Disorder (C-Ptsd). C-Ptsd has yet to be recognized as an official diagnosis, however, as a concept it is used extensively in the field of trauma by psychiatrists, researchers, psychologists and the like. It differs from the definition which currently appears in the DSM-IV-TR of PTSD as it addresses the circumstances of multiple trauma's throughout the lifetime, as opposed to PTSD, which is a diagnosis best captured by the presence of a single acute trauma (such as a car accident, single rape, or exposure to natural disaster). Although these cases of PTSD are horrific and distressful a different psychological picture emerges when dealing with clients who have been exposed to multiple trauma's.

Currently this population of patients may end up with a series of diagnosis ranging from "PTSD", "Disorder of Extreme Stress, not otherwise specified", or "personality change due to classifications found elsewhere".  All of these DSM-IV-TR diagnosis are ones that can accommodate a C-PTSD presentation.

Further complications in diagnosis arise when one considers the high levels of co-morbidity which are seen in patients who have complicated trauma histories.  Diagnosis which often accompany C-PTSD are depression, ocd, borderline personality disorder, dissociative disorders such as DID, agoraphobia and social phobia.  These common co-morbid disorders will be discussed further in later entries.

The following is a description of the diagnosis as first described by Herman in 1997 (the links will take you to quick descriptions provided by Wikipedia (warning: wikipedia is not always an accutate resource):

1. A history of subjection to totalitarian control over a prolonged period (months to years). Examples include hostages, prisoners of war, concentration-camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including those subjected to domestic battering,childhood physical or sexual abuse, and organized sexual exploitation.

2. Alterations in affect regulation, including

    persistent dysphoria
    chronic suicidal preoccupation
    self-injury
    explosive or extremely inhibited anger (may alternate)
    compulsive or extremely inhibited sexuality (may alternate)

3. Alterations in consciousness, including

    amnesia or hypermnesia for traumatic events
    transient dissociative episodes
    depersonalization/derealization
    reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

4. Alterations in self-perception, including

    sense of helplessness or paralysis of initiative
    shame, guilt, and self-blame
    sense of defilement or stigma
    sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

5. Alterations in perception of perpetrator, including

    preoccupation with relationship with perpetrator (includes preoccupation with revenge)
    unrealistic attribution of total power to perpetrator (caution: victim's assessment of power realities may be more realistic than clinician's)
    idealization or paradoxical gratitude
    sense of special or supernatural relationship
    acceptance of belief system or rationalizations of perpetrator

6. Alterations in relations with others, including

    isolation and withdrawal
    disruption in intimate relationships
    repeated search for rescuer (may alternate with isolation and withdrawal)
    persistent distrust
    repeated failures of self-protection

7. Alterations in systems of meaning

    loss of sustaining faith
    sense of hopelessness and despair

(Herman, p.121)

Whether or not C-Ptsd ever appears in the DSM (diagnostic statistical manual of mental disorders) it's conception has been very important in the field of Trauma.  Obviously, a large number of patients with mental disorders have had complicated histories which often involve catastrophic events which put a strain on the persons coping mechanisms and lead to significant distress.  One could argue that psychological trauma is indicated in too many disorders and therefore is not specified enough to merit it's own categorization.  However, the particular manifesting sequelae are extremely important to acknowledge and categorize in terms of directing research into treatment modalities and causation.  Also, the presence of C-PTSD can be quite validating for patients who have suffered silently from such atrocities throughout their lifetime.

In her book "Trauma and Recovery" Herman writes:

    Many abused children cling to the hope that growing up will bring escape and freedom.

    But the personality formed in the environment of coercive control is not well adapted to adult life. The survivor is left with fundamental problems in basic trust, autonomy, and initiative. She approaches the task of early adulthood――establishing independence and intimacy――burdened by major impairments in self-care, in cognition and in memory, in identity, and in the capacity to form stable relationships."


continues:
https://traumainform.wordpress.com/2012/07/07/judith-herman-and-the-formulation-of-c-ptsd/

woodsgnome

#1
Missbliss quoted Judith Herman's observation:

"Many abused children cling to the hope that growing up will bring escape and freedom.

    But the personality formed in the environment of coercive control is not well adapted to adult life. The survivor is left with fundamental problems in basic trust, autonomy, and initiative."

Indeed, that rings true for my experience in what I call "the graveyard of lost illusions". I still feel like I'm 12 and looking forward to the teen years...what the hey, I missed 'em the first time around. Another poster here once remarked that if "arrested development" is a symptom of cptsd, bring on the second childhood.

Except I feel like I'm still 12, stuck. Maybe there's a novel in there, but it's truly nonfiction with all the horror film memories to go along. Oddly, I use that image--my life as movie--often as a means to cope. I mean, if my life is a movie, the screen goes blank, the projector is shut off; I exit the theatre, and realize that the movie is over. Unfortunately, I still remember every scene.

Pure fantasy, again; it happens when one loses the "real". Missing something, but I already knew that.