Browsing by Author "Van Niekerk, Lydia Mary"
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- ItemPersonality changes after complex trauma : a literature survey and case study(Stellenbosch : Stellenbosch University, 2002-12) Van Niekerk, Lydia Mary; Wait, J. W.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.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.