Quarterly theme on complex PTSD and dissociative symptoms

From Mad in the Netherlands: Many mental health professionals are trained in the treatment of single traumatic events. However, in the case of complex trauma and dissociative symptoms, clients come to therapy with an extensive trauma history that often begins in childhood and continues into adulthood with many underlying factors, such as personal, relational, social or cultural abuses. In addition to a very painful history, clients also have well-developed defense structures to protect themselves against that pain.

Read the full article here, and the English translation here


  1. Kinda reading the article I remember how in my not that good old days part of the diagnostic process was to use pieces of information to exclude a given suspected diagnosis. Using mostly the physiopathology, not just the “clinical picture”, the explanation link between the “injury” and it’s expression.

    The refered article mentions a series of pressumably observables: hypervigilance, avoidance, etc. It narrates a neural basis: cortisol, lymbic arousal, etc. It describes symptoms: flashbacks, nightmares. It adduces causes: violence, neglect, captivity, forced migration. Speaks of normal: curiosity, learning, self-development.

    So, among the way multiple relationships between the symptoms, signs, causes and it’s relationship to normality, how is someone expected to link all of those in a manner that is rational, objective, scientific and evidence based?.

    And what would an average person do, if there was a mechanism, a hypothesis that linked all of those in an explanatory manner in a given person, only to find out that the mechanism, say personality, character, temperament, whatever passes as “structural”, were not there?

    Would that exclude the diagnosis when everything else is there?

    To be concrete: Someone gets 10 out of 10 on a C-PTSD scale, whichever, but has no “mental structure” that links all of those in an explanatory manner, how to handle that diagnostically?. When a C-PTSD high scorer remains curious, learning and self-developing?.

    Do then the claim the diagnostic method is flawed enough gets beyond doubt merit?

    And of course there’s the differential diagnosis, for each particular configurational relationship between the categories and each member of.

    And the refered article contains at least one antinomy: hyperarousal and hypoarousal.

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  2. I’m not sure if I understand your question correctly. Let me answer what I think is what you are looking for. I think we are going too deep into the events that cause trauma. Ultimately, all those events can be traced back to one feeling: “lonelyness”. In theory, then, the solution would be to be allowed to experience what it is like to be “not alone.” To still be allowed to experience “motherly warmth”. To still feel “really heard” when you tell what happened. To still feel “comforted”. To dare to feel, preconditions such as safety, equality, mutuality, timelessness, physical contact, are needed. To be able to find that with someone when you don’t really know what that is, because it is your missing piece of the puzzle, is extremely difficult. But once you find it, in my experience, it takes very little to even develop something as complicated as insecure attachment. The biggest problem really is that it’s hard to find an elephant if you have no idea what an elephant is or don’t even know it exists.

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    • So, sorry if I’m intruding in your anwer.

      But, without going too deep into specifics, what of a high C-PTSD scorer who never had, and still does not have a problem with loneliness?.

      What if when appropiate, desirable and available, this peculiar individual can have deep, enriching healthy relationships?. Then what? the method implies keep digging until the loneliness is found?, despite this individual does not feel lonely above the mean, and over the course of his or her entire life has shown to those around him, except perhaps the psych pros, that he or she has no problem nor effect of loneliness. It might be from my point of view a choice, like self gender, gender of partner, religion, belief, profession, celibacy, “promiscuity”, polygamy, monogamy, seriality in any of those, etc. Even undefinition in apearance, belief, thought, etc…

      Then how those “mechanismS” work for the ideas of genesis, continuation, aggravation and “repair” of C-PTSD would work in such case?.

      Of course without transgressing the legal part: the right to live one’s life as one seems fit. Which includes to me, not be forced to search or accept an explanation, particularly if, cognitively and emotionally apparatusically intact, seems irrational, seems not to apply in one’s case, even bullying, perhaps in the extreme if it can’t be shopped around differently: mobbing.

      Son in abstract form: what if every observable is there, but some other observable, even fact or a bunch of them, shut down the link, the mechanism of the proposed disease model/interpretation?. It’s an abstract question beyond the specifics of C-PTSD.

      I am formulating it that way, because in medicine, there is almost always a how to rule something out, even everything else being there, precisely because the physiopathology gives firm grounding in reality to the diagnositc procedures. Acknowledging that they are abused, missused, or not used at all. They aren’t perfect, but they do help.

      Sorry for intruding, I might have been unclear in my post, and yours gave an opportunity to clarify. I apologize sincerely if I impinged.

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  3. Well, that was a very simplistic article. cPTSD is just that: complex!!! I’ve been walking with my wife for 16 years thru her dissociation. It’s labyrinthine to put it very, very mildly. And the example given in this article demeans the complexity, sigh. It was almost like watching a tv show, and the problem is neatly resolved by the end of the episode. If only it were that simple, sigh…

    By the way, I really miss the old way comments worked. Now I can’t follow a blog, and it’s comments anymore because I don’t get notified in my email. I really, really, think this is a step backwards unless there is a setting I’ve simply missed so I can get the notifications again.

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