Personality changes after complex trauma : a literature survey and case study

Van Niekerk, Lydia Mary (2002-12)

Thesis (MA)--University of Stellenbosch, 2002.

Thesis

ENGLISH ABSTRACT: A century of clinical observations and literature has repeatedly noted that trauma responses occur in across a spectrum and on a continuum of severity. The existing, DSMIV trauma response classifications include Acute Stress Disorder and PTSD as anxiety disorders. Complex PTSD or DESNOS was considered as a proposed, alternative classification during the DSM-IV PTSD Field Trials. It was not included as a separate diagnosis, but briefly mentioned as an associated feature ofPTSD. Subsequent research and replica studies have not proved conclusively whether Complex PTSD should be a separate or associated feature ofPTSD, and the controversy continues to date. Childhood traumatization is strongly associated with adult psychopathology, and various Axis I and Axis II disorders, especially Borderline Personality Disorder, and to a lesser extent, Antisocial Personality Disorder. Prolonged, repeated traumatization during adulthood is also associated with subsequent Axis II pathology, including Borderline, Obsessive-Compulsive and Avoidant Personality Disorders. Chronically traumatized people with Axis II pathology often present with comorbid Axis I disorders including Major Depression, PTSD, Substance Abuse, Somatization Disorder, and Dissociative Disorders. There are divergent views regarding the etiology of personality disorders in chronically traumatized individuals. On the one hand, repeated, prolonged trauma could cause enduring personality dysfunction in individuals despite normal premorbid functioning. On the other hand, genetics, temperament, environmental factors and even a pre-existing stress diathesis in the pre-trauma personality could contribute to the development of post-trauma personality disorders. These two views do not necessary contradict each other, but illustrate the complexity the human stress reaction. Despite the controversy the inclusion of DESNOS into the diagnostic canon, it is a valuable measure of predicting prognosis to existing treatment options. The present main psychological treatment for post-traumatic stress disorders has been a cognitive-behavioral based, exposure intervention. Alternative therapies include psychodynamic approaches, pastoral interventions and more recently, ecological and recovery based models. The Complex PTSD conceptualization contributes to a better understanding of the personality structure of chronically traumatized people. There are three main areas of disturbance. Firstly, a complex symptomatic presentation including somatization, dissociation, and affect dysregulation. Secondly, deep characterological shifts including deformations in concepts of relatedness and identity. Thirdly, and increased vulnerability to harm, either self-inflicted or at the hands of others. The usefulness of integrating these three concepts into the personality conceptualization of chronically traumatized individuals is illustrated a case study.

AFRIKAANSE OPSOMMING: Die literatuur en kliniese waarneming vand die afgelope eeu dui herhaaldelik op trauma reaksies oor 'n spektrum. In die bestaande DSM-IV stelsel, val trauma reaksies net Akute Stress Steuring and Post-Traumatiese Stress Steuring. Hoewel Komplekse PTSD in 1992 voorgestel was as 'n alternatiefin die DSM-IV, is dit nie as aparte diagnose ingesluit is nie, maar wel wel gelys as geassosieerde symptoom van PTSD. Latere navorsing en duplikaat studies het nog nie konklusiefbewys of Komplekse PTSD 'n geassosieerde or aparte simptoom van PTSD is nie, en debat duur nog voort. Trauma gedurende kinderjare word sterk geassosieer met volwasse psigopatologie en verskeie As I en As II steurings, veral Grenslyn Persoonlikheids Steuring, en tot In mindere mate, Antisosiale Persoonlikheids Steuring. Langstaande, herhaalde traumatisering gedurende volwassenheid word ook geassosieer met latere As II patologie, insluitende, Grenslyn, Obsessief-Kompulsief en Vermydende Persoonlikheids Steurings, Kronies getraumatiseerde individue met As II patologie presenteer ook dikwels met komorbiede As II steurings insluitende Major Depressie, Post-Traumatiese Stres Steuring, Somatiserings Steuring, and Dissosiatiewe Steurings. Daar is uiteenlopende sienings oor die etiologie van persoonlikheids steurings in kronies getraumatiseerde individue. Aan die een kant, kan langstaande, herhaalde trauma persoonlikheids veranderinge veroorsaak ongeag normale premorbide funksionering. Aan die ander kant, kan genetika, temperament, omgewing en'n pre-morbide stressvatbaarheid almal bydra tot die ontwikkeling van post-trauma persoonlikheids steurings. Hierdie twee sienings weerspreek mekaar nie noodwendig nie, maar dui op die kompleksiteit van die menslike stres reaksie. Ongeag die akademiese debakeloor die insluiting van die Kompleks PTSD konseptualisasie in DSM-IV diagnostiese stelsel, is dit 'n waardevolle praktiese meetinstrument van prognose onder bestaande behandelings opsies. Tot dusver word die primere sielkundige intervensies gebaseer op 'n kognitiewe-gedragsterapie model. Alternatiewe terapieë sluit in psigodinamiese, pastorale en meer onlangse ekologiese en herstel-gebasseerde intervensies. Die Kompleks PTSD konseptualisasie dra by tot beter kennis oor die persoonlikheids struktuur van kronies, getraumatiseerde mense. Daar is drie hoof areas of versteuring. Eerstens, a komplekse simptomatiese presentasie insluitende somatisering, dissosiasie en affek disregulasie. Tweedens, diep veranderings in karakter insluitende versteurings in identiteit en interpersoonlike verhoudings. Derdens, in groter vatbaarheid vir seerkry, of aan hulle eie hande, of aan die hande van ander. Die waarde van die integrasie van hierdie drie konsepte in die persoonlikheids konseptualisasie van kronies getraumatiseerde individue word geillustreer deur 'n gevallestudie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/52994
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