Dear Katie:

I asked you about the Trauma in your daughter’s diagnosis of PTSD. You answered that your daughter suffered abuse by her father starting at about the age of six: she witnessed him “smashing objects.. punched holes in walls”, “talk very loudly in the house… screamed in her face, ‘If you don’t stop crying, I’m going to punch you in the f’n face!'”, and  she witnessed him verbally and physically abusing her mother.

PTSD was included in the third Diagnostical and Statistical Manual, DSM-3, in 1980, to  include the lingering effects of combat stress suffered by a large number of American combat veterans of the Vietnam War. Later on, the concept of Complex PTSD was developed and submitted to the DSM-4 and DSM-5 committees, but it was not approved. Nonetheless, CPTSD is used in the context of professional psychotherapy in the treatment of children and adults who have suffered repeated trauma (chronic maltreatment, abuse, neglect, witnessing domestic violence, etc.)  in childhood, by a parent or parents (psychology. wikia. org/ cptsd).

For these children, PTSD and the treatment for it is not adequate because the complexity of chronic, or repeating trauma during childhood, by a parent, during the time the brain is forming (multiple connections take place) – cause damage that is significantly more complex than damage caused by trauma during adulthood outside the childhood home.

The complexity of damage, as described in the website I mentioned is about damage in seven domains (the following are quotes, except for what’s in parentheses):

1. Attachment- uncertainty about the reliability and predictability of the world, distrust and suspiciousness, social isolation, interpersonal difficulties, difficulties attuning to other people’s emotional states and points of view.

2.  Biology- hypersensitivity to physical contact, analgesia (ex., being hit but not feeling the pain), somatization (vague physical complaints), increased medical problems.

3. Affect or emotional regulation- easily aroused, high intensity emotions, difficulty deescalating (difficulty calming down), difficulty describing feelings and internal experiences, chronic and pervasive depressive mood or sense of emptiness and deadness, chronic suicidal preoccupation, overinhibition or excessive expression of anger.

4. Dissociation- distinct alterations in states of consciousness, amnesia, depersonalization and derealization.

5. Behavioral control- poor modulation of impulses, self destructive behavior, aggressive behavior, sleep disturbances, eating disorders, substance abuse, oppositional behavior, excessive compliance.

6. Cognition- difficulties in attention regulation and executive functioning, problems focusing on and completing tasks, difficulty planning and anticipating, learning difficulties, problems with language development.

7. Self concept- lack of continuous and predictable sense of self, low self esteem, feelings of shame and guilt, generalized sense of being ineffective in dealing with one’s environment, belief that one has been permanently damaged by the trauma”.

Does this match your daughter’s symptoms?

anita

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