It is important to understand the symptoms of trauma and dissociation. In this installment we will focus upon the symptoms/signs of Posttraumatic Stress Disorder (PTSD),  dissociation, being one of them. In particular, the focus will be upon Complex or Type 2 PTSD. The Diagnostic and Statistical Manual of Mental Disorders is the compendium used in the field to aid in diagnosis and research. There are some differences between the criteria in the DSM and identified by researchers in the field, which, if you research the topic, you may find. The following is based upon the DSM-5 Criteria.
 
Criteria: A:

• The person was exposed to:
  • Death
  • Threatened death, actual or threatened serious injury, or actual/threatened sexual violence.
• These are experienced as a
  • Direct exposure
  • Witnessing it
  • Learning about the issue from a close associate
  • Indirect exposure to details of the trauma (common among first responders)

Criteria B:

• Re-experiencing the traumatic incident by
  • Unwanted distressing memories
  • Nightmares
  • Flashbacks
  • Emotional Distress
  • Physical/somatic reactivity

Criteria C

• Avoidance of things related the trauma
  • Avoidance of thoughts/feelings
  • Avoidance of trauma-related reminders

Criteria D

• Negative thoughts or emotions that worsened after the trauma
  • Problems recalling elements of the trauma
  • Excessive negative thoughts bout oneself or the world
  • Exaggerated blame of self or others for causing the incident
  • Persistent negative emotionality
  • Decreased interest in activities
  • Feeling isolated
  • Problems feeling positive emotions

Criteria E

• Trauma related anxiety/arousal/vigilance
  • Increase in irritability and aggression
  • Increase in risky and/or distractive behavior
  • Hypervigilance/mistrust
  • Heightened startle reaction
  • Problems concentrating associated with the trauma
  • Difficulty sleeping associated with the trauma

Criteria F

• Symptoms present for 1 month

Criteria G

• Symptoms create substantial distress and problems in one’s ability to function, socially, occupationally, etc.

Criteria H:

• The symptoms are not caused by medications, substances, or a medical condition

 
 
In the next installment, I will explore specific elements of these symptoms and how you may be able to help your loved one. 


​Ron

​It has come to my attention that there are few, if any, resources for the family members of those who suffer from Posttraumatic Stress Disorder and/or Dissociation. Given that this is an area of expertise for me, I thought I might start providing some basic information for those families. 

In this short introductory post, I will outline what will come in this blog series. I will work diligently to add content at least a few times a month. Okay, I will try my best. Anyways, back to our topic.

Families should understand the following things: 

1. If a person suffered severe, long lasting, interpersonal trauma (trauma by another person), their resolve to trust people is likely limited. 

2. The closer the relationship the greater the vulnerability. The greater the vulnerability, the greater the risk of being hurt again. Therefore, the person is more likely to act out with those closest to them. 

3. This acting out is often, but not always, an unconscious effort to determine if they can actually trust you and if they are safe. A single violation (or perceived violation) of trust, can have devastating consequences to the person and the relationship. 

4. The acting out and other symptoms/signs of trauma and dissociation are a coping strategy to help a person survive worst case scenarios. Unfortunately, when a person is not in a worst case/traumatic situation, the coping strategies can become maladaptive. 

5. There are several different degrees of dissociation, ranging from normal to abnormal. Everybody experiences some degree of dissociation. It can range from basic daydreaming all the way to the development of separate personality states. 

6. Dissociation is a form of coping. 

7. We all have different personality states. The difference between the average person and someone with Dissociative Identity Disorder is the degree of separation between the core self and the personality states, as well as the purpose of the personality states. 

8. Treatment is typically broken down into three stages: Stabilization, Remembrance and Mourning, and Reconnection. Treatment of Dissociative Identity Disorder incorporates several other elements within these stages, but it follows the same basic pattern. 

9. Stabilization comprises most of the work and includes six primary areas of focus: Understanding the symptoms/signs, self-care, self-soothing, felt safety, trust, and boundaries. 

10. Trust, safety, and boundaries are the essential factors that cause a person to act out in close relationships. Vulnerability requires a person to trust, feel safe, and know boundaries will be respected. 

In the next installment, I will start by helping families understand the symptoms/signs of Posttraumatic Stress Disorder and the more severe form of dissociation, Dissociative Identity Disorder. 

​Ron