PTSD, C-PTSD, & Dissociative Disorders

"Trauma is much more than a story about the past that explains why people are frightened, angry or out of control. Trauma is re-experienced in the present, not as a story, but as profoundly disturbing physical sensations and emotions that may not be consciously associated with memories of past trauma.... The challenge in recovering from trauma is to learn to tolerate feeling what you feel and knowing what you know without becoming overwhelmed. There are many ways to achieve this, but all involve establishing a sense of safety and the regulation of physiological arousal." Bessel van der Kolk  

WHAT RESEARCH IN NEUROSCIENCE HAS TAUGHT US

Traumatic injury occurs when we believe our lives are in danger and we feel powerless to affect the outcome. A traumatic response can be evoked whether experienced by the person themselves or witnessed. Research in the field of neuroscience has shown that trauma's legacy is not only psychological, but also somatic (the body continues to respond as if still under threat). This is because we do not think our way through trauma. Instead, at the time of danger we rely on our "animal brain" to mobilize our automatic survival "animal instincts." When our five senses are alerted to imminent danger our brain automatically activates our survival response system, triggering animal defensive responses (Fight, Flight, Freeze, Submit/Collapse) depending on what makes the most sense at the given moment. When we experience this threat our prefrontal cortex (the "thinking brain") is actually inhibited in order to increase the response time of our "animal instincts." This is helpful in the moment as it allows us to "act fast," however, as a result of the inhibition of our prefrontal cortex we are left with an incomplete understanding (and often an incomplete memory) of what happened to us and how we made it through. 

Still, if someone receives adequate support and reaches a sense of safety afterwards they will likely be able to move forward and put the event behind them. However, if we are young or vulnerable when the event occurs or if we receive inadequate support afterwards the survival response system can become chronically activated, resulting in a body that perpetually responds as if still under threat even when there is no danger. "To make the challenge even greater, therapeutic approaches that emphasize talking about the events often result in more, not less, activation of trauma responses and symptoms." Janina Fisher

DIFFERENTIATING PTSD FROM COMPLEX PTSD

PTSD typically results from short-lived trauma or trauma of limited duration. Symptoms include re-experiencing of the trauma, avoidance of trauma-related stimuli, and hyperarousal. First described by Judith Herman in 1992, Complex PTSD stems from chronic, long-term exposure to trauma in which a victim has limited belief it will ever end or cannot foresee that it might. This can include: child abuse, long-term intimate partner violence, living in a war or in crisis conditions, victims of human trafficking and slavery, and defectors of cults or cult-like organizations. Symptoms that emerge from these types of traumas include the PTSD symptoms named above, as well as difficulties in emotion regulation, self-concept, and relational capacities.

DISSOCIATION

According to the International Society for the Study of Trauma and Dissociation (ISSTD), “dissociation is a word that is used to describe the disconnection or lack of connection between things usually associated with each other. Dissociated experiences are not integrated into the usual sense of self, resulting in discontinuities in conscious awareness. In severe forms of dissociation, disconnection occurs in the usually integrated functions of consciousness, memory, identity, or perception. For example, someone may think about an event that was tremendously upsetting yet have no feelings about it. Clinically, this is termed emotional numbing, one of the hallmarks of post-traumatic stress disorder. Dissociation is a psychological process commonly found in persons seeking mental health treatment.

Dissociation may affect a person subjectively in the form of “made” thoughts, feelings, and actions. These are thoughts or emotions seemingly coming out of nowhere or finding oneself carrying out an action as if it were controlled by a force other than oneself. Typically, a person feels “taken over” by an emotion that does not seem to make sense at the time. Or someone may find themselves doing something that they would not normally do, but unable to stop themselves, almost as if they are being compelled to do it.

There are five main ways in which the dissociation of psychological processes changes the way a person experiences living: depersonalization, derealization, amnesia, identity confusion, and identity alteration. A dissociative disorder is suggested by the robust presence of any of the five features.”

For more information on trauma and dissociation please visit the Frequently Asked Questions page of the International Society for the Study of Trauma and Dissociation