Post-traumatic stress disorder and complex post-traumatic stress disorder
The cause and effect of this problem and intergenerational trauma.
Two diagnostic systems: Dsm diagnostic system in America and international diagnostic standard of ICD.
International diagnostic standard ICD-1/trauma was introduced in 20 18.
The word psychological trauma is popular in China, which is considered to be closely related to the Wenchuan earthquake.
First of all, we should clarify several basic psychopathological concepts about psychological trauma.
The field of trauma is full of controversy, especially the diagnosis of PTSD. Such as the understanding of traumatic events in diagnostic criteria. The concept of post-traumatic stress disorder emphasizes human vulnerability rather than resilience.
The new DSM fifth edition system tells us that trauma is divided into:
1, trauma and stress-related diseases:
Irritability, sleep disorder
2. Dissociation barriers:
I am in a trance, and I don't even know my identity.
3, physical symptoms and related obstacles:
Somatization disorder
Diagnostic criteria: a, b, c, d, e, f.
A. traumatic events.
How to define a traumatic event? Individual differences. Controversy between generality and individuality.
The focus is on human vulnerability, not resilience. So don't emphasize toughness.
B, aggressive symptoms. Flash, nightmare.
C, avoid. Don't touch anything that hurts at all "I'm pretty sure." "I always see the positive side."
D, negative changes in cognition and emotion.
E, irritable.
F, symptoms last for more than a month.
It depends on which period: childhood, adolescence, middle-aged crisis, retirement, etc.
Symptoms usually start in the first three months after the incident, and appear immediately after the incident, and the performance is delayed. It is usually caused by acute stress. Acute three days to a month, lasting for one month is called PTSD. PTSD usually recovers within three months. 12 months or more, 20 years or more, 50 years for life.
ICD-1 1 (2018,11) New diagnosis: simple type (type I trauma. ): Recover within three months. Complex PTSD (psychoanalysis, known as type II trauma for decades)
First, the nature of trauma.
(1) At the moment of trauma, the victim was pushed to a helpless position by overwhelming force. Traumatic events flooded the traditional nursing system with sense of control, emotional connection and meaning of life, leaving people with traumatic memories.
Three points: the care system of life.
1, sense of control:
The negative person has a strong desire for control. "Will I be crazy?" ——
2. Emotional connection. Together.
3. The meaning of life.
Trauma is to destroy or destroy these three systems.
(2) compulsive repetition.
1, forced repetition
This kind of memory has an "instinctive tendency to repeat the content of memory." Only when the victims of trauma rebuild their instinct to deal with the information destroyed by trauma and develop new mental "internal planning" to understand what happened can the trauma be solved.
Re-present, re-connect, and rebuild.
2. Traumatic memory.
Psychiatrist Marty Holovitz put forward a "conclusion principle". This principle holds that "there is an instinct in people's minds to deal with new information, so that this new information can adapt to the rules of the self and the world." This "conclusion principle" is understandable.
Freud was the first person to call this incomprehensible and annoying phenomenon compulsive repetition. Freud found in clinical work that patients spend most of their time repeating some complete or potential painful memories. Find repetitive behaviors that lead to traumatic pain. Patients have a strong motivation, which seems to be to avoid pain, but it usually leads to the recurrence of events that patients want to avoid. Freud believed that forced repetition was related to and driven by human death instinct. It can be said that Freud was desperate and helpless for this kind of patient. He found this pathological phenomenon, because there was no effective treatment at that time, so he gave such a desperate analysis
3. The relationship between repetition and trauma.
Because this phenomenon is not widely accepted, it leads to special follow-up exploration.
Successors think:
One possibility is that the original trauma brought harm and left a scar.
Another possibility is that some cracks and inherent shortcomings of individuals have caused the inevitable repetition of special forms of pain.
This involves two aspects: traumatic events and personality defects. In other words, the same traumatic event is related to the event itself and the soundness of the recipient's personality development.
So it needs to be evaluated, and then how to work?
Key groups: orphans, elderly people who have lost their independence, families of the deceased, and frontline staff who are in close contact with the deceased.
General worker: Like all the people involved in this epidemic.
4. Why do you want to repeat?
After Freud, scholars tend to think that whether traumatic events cause harm to people depends on whether the individuals who suffer from traumatic events are "overloaded". This "overload" must be crushed and removed by repeated times. That is, every time the patient repeats it, the subconscious hope is to unload this overload, or desensitization. In order to rebuild the destroyed sense of control, patients will cling to the devil they know. For this preconceived devil, patients have their own coping methods, even if this method is destructive, it will make patients feel able to control it. Patients can also seek a needed but lost relationship in this repetition and so on.
-blame yourself (it's my fault) to have a sense of control.
Repetition is not waiting for death, but subconscious repair.
Trauma is a kind of kinetic energy. If it is repaired, it can promote the development of society.
Generally speaking, victims of trauma will attribute their pain to their own shortcomings, and they fantasize that if I do well enough, disaster will not happen to me. "If I had done better than others asked, such a bad thing would not have happened."
Therefore, they repeat the traumatic situation again and again, "to revive the past things that are accused, can't remember, and can't enter the memory and emotional heart." The expectation is that I must do better this time than last time.
-Be sure to talk about feelings during the treatment. Because you can't feel it in a traumatic situation, because you have to fight.
Compulsive repetition seems to have two aspects.
(1) It is the core of the emotional incompetence system.
(2)
5. What is the driving force of compulsive repetition?
Psychiatrist and psychoanalyst Paul Russell regards traumatic emotional experience, rather than traumatic cognitive experience, as the driving force of compulsive repetition. What is valued is "what kind of feelings people need in order to repair the damage." He believes that compulsive repetition is an overwhelming feeling of trying to reproduce and control the traumatic moment. The main ones are terror, helplessness and anger, or just a simple and indiscriminate "adrenaline shock" when facing the danger of survival.
The so-called whistleblower is that kind of highly sensitive.
Recreating the trauma may provide an opportunity to regain control.
Second, post-traumatic stress disorder.
1980, when PTSD was first introduced into the diagnostic manual, the American Psychoanalytic Association described traumatic events as "beyond the scope of conventional human experience".
Traumatic events are unexpected, not because they rarely happen, but because they subvert the normal adaptation of human beings to life.
The common background of psychological trauma is the feeling of "intense fear, helplessness, loss of control and the threat of being destroyed"
-you can't label it, but you can have a psychological education.
During World War I, these were related to morality or demons. The appearance of this disease name saved those people.
Poisoning symptoms of post-traumatic stress disorder can be divided into three categories.
We call it: high arousal, intrusion and compression. A high level of arousal reflects continuous preparation for danger. The invasion reflects the permanent impression left by the traumatic period. Compression reflects the numbing reaction of the surrenders.
The strong either fight or flee.
Weak, compressed-frozen, frozen,
Children are the weak and the closest to animals. I turned off my sensory system when I was very scared, and I didn't feel anything at that time. To avoid being scared to death. After a long time, it becomes a symptom, which is injury.
Invasion:
Long after the danger has passed, the injured person will experience it again, just as it continues to happen now. They can't return to their normal life process, because trauma will continue to interrupt their lives. It's like time stopped at the moment of trauma. Traumatic moments are encoded into an abnormal memory form, which will be produced by flashbacks during awakening and nightmares during sleep, and these memories will be vividly reproduced with strong feelings about the initial events.
A vivid flashback.
Compression.
These changes in consciousness are the core of oppression or numbness. This is the third main symptom of PTSD. Some inevitable dangerous scenes will not only cause terror and anger, but also cause alienated calm in this compressed state, in which terror, anger and pain seem to disappear. The consciousness of the event still exists, but the patient's feelings are numb or distorted, partially missing, or partially lost. The sense of time may change, usually accompanied by a sense of slow motion. At this time, people's emotional experience completely loses its ability to contact with the essence of reality under normal conditions.
Is the trauma patient here? And the pole of numbness. They are trapped between the impact of strong emotions, overwhelming feelings and barren state without any feelings, which is more annoying than being trapped.
Third, complex post-traumatic stress disorder.
Simple types and complex types.
The study of simple trauma and burden trauma also promoted the revision of ICD- 1 1.
The characteristics of simple trauma (type I trauma) include: trauma or traumatic events can occur at any stage of an individual's life experience. Generally, the duration of trauma after a one-time trauma or traumatic event is short, generally less than three months, and some of them will develop into complex trauma.
Characteristics of complex trauma (type II trauma): the key to trauma or creation can occur at any stage of an individual's life, but mostly in early childhood; Generally speaking, repeated, repeated and long-term injuries are the most unforgettable and common; It affects the individual's body and mind in many ways, generally unable to heal itself, and the symptoms are diverse, and most individuals show various diseases.
In ICD- 1 1 model, PTSD includes a subset, which Reflects three symptoms: (1) reliving the current trauma (re), (2) AVoiding trauma tips (av), and (3) persistent sense of threat, which is manifested as awakening and excessive vigilance. These symptoms define PTSD as a reaction, which is characterized by a certain degree of fear or panic related to a specific traumatic event.
In contrast, the symptoms of CPTSD include three subsets of PTSD and three other symptoms defined as self-organization disorder (DSO): (1) affective disorder (AD), (2) negative self-concept (low self-concept) (NSC) and (3) interpersonal disorder (DR).
After ICD- 1 1 revised these two concepts, many researchers began to pay attention to the research of these two concepts. Post-traumatic stress disorder closely related to traumatic events is not difficult to find. Clinically, some chronic trauma survivors have different symptoms from post-traumatic stress disorder. Their persistent anxiety, terror and panic are also different from ordinary anxiety, many of their physical complaints are also different from ordinary psychosomatic disorders, their depression is also different from ordinary depression, their identity and related life degradation are also different from ordinary personality disorders, and their psychotic symptoms are also different from schizophrenia.
Their chronic traumatic environment can be traced back to their childhood. The psychiatric diagnosis of these patients seems to lack an integration ability, that is, the ability to link their symptoms, personality defects and their long-term chronic traumatic environment.
They may receive many medications: some for headaches, some for insomnia, some for anxiety, some for depression, and some for mental disorders. But all these treatments are of little use because they do not involve the potential problems of trauma. When patients continue to be unhappy and the treatment is not progressing, relatives will be very tired and doctors will be extremely depressed, so it is an urgent choice to give patients a diagnosis with contempt tendency. Such as borderline personality disorder, somatization disorder, multiple personality disorder or more serious mental disorder, etc.
Lack of accurate and complete diagnosis concept will bring serious consequences to treatment, because the connection between patients' current symptoms and traumatic experiences is often forgotten. Forcibly embedding patients into the existing diagnostic framework will at least lead to one-sided understanding of patients' current problems and fragmentation of treatment.
Therefore, in the past twenty years, in psychoanalysis and psychiatrists in Europe and America,
Academic circles began to generalize these patients with new diagnosis of complex post-traumatic stress disorder. At the same time, in order to distinguish, they call PTSD type I trauma and complex PTSD type II trauma. (The disease has been recorded in 2018icd-11).
This kind of trauma has the following characteristics:
1 experienced a long period of violent control (from several months to several years). Such as large-scale natural disasters, hostages, prisoners of war, survivors of concentration camps, survivors of certain religious groups, survivors of domestic violence, survivors of physical abuse, verbal abuse and sexual abuse in childhood, survivors of organized sexual exploitation, etc.
2. Changes in emotional regulation
Persistent uneasiness
Trends and concepts of chronic suicide
mutilate oneself
Explosive or extremely repressed anger (which may alternate)
Obsessive or extremely self-suppressed sexual desire (may appear alternately)
3, the change of consciousness, including:
(1) Amnesia or memory enhancement in traumatic events
(2) a brief dissociative attack
(3) Personality disintegration/reality disintegration
(4) Re-experience is either an aggressive symptom of post-traumatic stress disorder or a preemptive silence.
4. Changes in self-perception, including:
(1) Helplessness or active paralysis
(2) Shame, guilt and remorse
③ Dirty or shameful.
(4) Feeling completely different from others (which may include special feelings, absolute loneliness, distrust of anyone's understanding and inhuman recognition).
5. Changes in perceptions of persecutors, including:
(1) The relationship with the persecutor takes precedence (including revenge)
(2) Unrealistically think that the persecutor has all the power.
(3) Idealized or contradictory attitude
(4) Special feelings or supernatural relationships
(4) The belief system of the persecutor or the rationalization of the persecutor.
6. Changes in relationships with others, including
Isolation and retreat
Damage to intimacy.
Repeat rescuer (isolation and evacuation may alternate)
Persistent distrust
Self-protection has repeatedly failed.
7, changes in the meaning system, including:
Lose lasting faith
A feeling of hopelessness and despair
When we see that a patient has more than one diagnosis, such as borderline personality disorder, somatization disorder and multiple personality disorder, we should be alert to the possibility of complex post-traumatic stress disorder.
A common factor of these three obstacles is that they all have a history of childhood trauma. These three obstacles are all related to high-level hypnotic susceptibility or dissociation, and they also have the same characteristic difficulties in intimate relationships.
Understanding the role of childhood trauma in development and these serious obstacles can affect all aspects of treatment. This understanding provides a basis for the formation of cooperative therapy alliance, which normalizes and stabilizes the emotional responses of survivors to past events, and survivors realize that these responses are just some wrong adaptations in the past. Moreover, if therapists understand that it is difficult for survivors to establish relationships and often become victims repeatedly, they can effectively avoid the unintentional recurrence of the original trauma in the therapeutic relationship.
Fourth, a warning: pay attention to intergenerational trauma.
Case:
Researchers later found that post-traumatic stress disorder not only affects the second generation, but also manifests itself in the third generation. Then there are the concepts of intergenerational trauma and historical trauma. Historical trauma is an example of intergenerational trauma. There is another manifestation of intergenerational trauma: collective trauma. In short, intergenerational trauma is a new concept separated from PTSD, including historical trauma and collective trauma.
From the first generation to accept violence to their children. Generation after generation unconsciously transfers violence. Why does violence transfer to children and not to others?
This is because the first generation of traumatized parents did not go through a complete mourning cycle.
There is also a core point of trauma: the guilt of survivors. Some people punish themselves, others serve others.
"When a person can feel and realize suffering, this kind of suffering is the real pain.
When a traumatized person doesn't know what his or her pain is, such a person just uses some primitive defenses.
This kind of suffering will be passed on to the next generation. "
-(wilfred Bean) Bean
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