Understanding the Range of Disorders Post-Trauma: Complex PTSD and Dissociative Disorder
Two conditions can be identified in a comprehensive, psychological assessment of an individual who has survived trauma. If a person has been exposed to repeated traumatic episodes or threats (e.g., incest, physical abuse, numerous grief episodes related to poverty or disaster) during childhood, he or she may be suffering from complex PTSD. Complex PTSD is not a formal diagnosis in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders currently in its fifth edition). It has received significant attention in the scientific and clinical literature because clinicians like myself have witnessed and worked with so many survivors of severe abuse and trauma who indeed are different from other PTSD patients and require adaptations to the typical approaches to treatment. DSM-5’s new PTSD diagnosis has expanded to include additional symptom features to address this forgotten patient. Complex PTSD patients often have problems trusting anyone, even their therapists, may have tendencies to harm themselves (i.e, cutting or other self-injury, suicide attempts, and high risk acting out such as extreme drug or alcohol intoxication leading to hospitalization), and often have a number of other psychological disorders such as borderline personality disorder, eating disorder, substance abuse or dependence, panic disorder, schizoid and/or schizotypal personality disorder.
Dissociative disorder, in contrast to complex PTSD, is, in fact, a recognized diagnosis in the DSM. People with dissociative disorder typically have endured numerous, extremely severe traumas over the course of their lifetime, but especially in childhood. Dissociative identity disorder (DID), once referred to as multiple personality disorder (MPD) in DSM-III, involves the overuse of a psychological defense or way of coping called dissociation. Simply described, dissociation is an experience of going away in one’s mind. Some have described this as a discontinuity of consciousness. In the face of intolerable stress or fright, a child will reflexively distance herself from the here-and-now, step outside of herself. In the development of dissociative disorder, this method of coping becomes automatic and often uncontrollable and has severe consequences for managing the demands of everyday relationships, work and self-care. Consciousness is often altered for the dissociative patient, especially under stress such that the experience of time, place or one’s sense of self is profoundly altered. This not a psychotic condition: dissociative patients can exhibit islands of exceptional functioning and resilience. But similar to the complex PTSD patient, the dissociative patient can struggle with numerous additional mood and anxiety problems and find it challenging to stick with therapy. We take pride in developing a gentle and accepting stance with patients who struggle with this disorder. Not unlike laying a foundation to a solid house, patients accepted into treatment at TraumaResource will learn to feel safe again in the context of a strong therapeutic alliance with Dr. Abueg. The healing experience of psychotherapy involves learning how the disorder has intruded upon one’s life, and finding another way of understanding or making meaning of a history of victimization. Paradoxically, most severe trauma survivors with trauma-related problems learn that evidence of their resilience has been present throughout their lives, especially when they faced the harshest abuse. Recognizing and cultivating one’s unique, signature way of rising above those events is what makes for the deepest cures.