Wednesday, January 13, 2010

Post Traumatic Stress Disorder: Characterized as a Psychiatric Injury, Differentiated from Mental Illness

Post Traumatic Stress Disorder: Characterized as a Psychiatric Injury, Differentiated from Mental Illness

Filed under: Child Custody Battle, Child Custody Issues, Domestic Abuse, Domestic Relations, Domestic Violence, Family Court Reform, Family Courts, Family Rights, Help for Victims of Domestic Violence, Intimate Partner Assault, Legal abuse, Post Traumatic Stress Disorder, Violence against women, battered women— justice4mothers @ 7:12 pm

I am going to have a series of posts related to Post Traumatic Stress Order (PTSD) because I went to an interesting workshop dealing with this at the Battered Mothers Custody Conference this past weekend.  I have been doing some research on this topic to provide some background before presenting the workshop material, and provide some validity to it.  I will let on though that it has to do with use of the Americans with Disabilities Act.  Stay tuned. This is from Bullying Online:

PTSD, Complex PTSD and bullying

It’s widely accepted that PTSD can result from a single, major, life-threatening event, as defined in DSM-IV. Now there is growing awareness that PTSD can also result from an accumulation of many small, individually non-life-threatening incidents. To differentiate the cause, the term “Complex PTSD” is used. The reason that Complex PTSD is not in DSM-IV is that the definition of PTSD in DSM-IV was derived using only people who had suffered a single major life-threatening incident such as Vietnam veterans and survivors of disasters.

Note: there has recently been a trend amongst some psychiatric professionals to label people suffering Complex PTSD as a exhibiting a personality disorder, especially Borderline Personality Disorder. This is not the case – PTSD, Complex or otherwise, is a psychiatric injury and nothing to do with personality disorders. If there is an overlap, then Borderline Personality Disorder should be regarded as a psychiatric injury, not a personality disorder. If you encounter a psychiatrist, psychologist or other mental health professional who wants to label your Complex PTSD as a personality disorder, change to another, more competent professional.

It seems that Complex PTSD can potentially arise from any prolonged period of negative stress in which certain factors are present, which may include any of captivity, lack of means of escape, entrapment, repeated violation of boundaries, betrayal, rejection, bewilderment, confusion, and – crucially – lack of control, loss of control and disempowerment. It is the overwhelming nature of the events and the inability (helplessness, lack of knowledge, lack of support etc) of the person trying to deal with those events that leads to the development of Complex PTSD. Situations which might give rise to Complex PTSD include bullying, harassment, abuse, domestic violence, stalking, long-term caring for a disabled relative, unresolved grief, exam stress over a period of years, mounting debt, contact experience, etc. Those working in regular traumatic situations, eg the emergency services, are also prone to developing Complex PTSD.

A key feature of Complex PTSD is the aspect of captivity. The individual experiencing trauma by degree is unable to escape the situation. Despite some people’s assertions to the contrary, situations of domestic abuse and workplace abuse can be extremely difficult to get out of. In the latter case there are several reasons, including financial vulnerability (especially if you’re a single parent or main breadwinner – the rate of marital breakdown is approaching 50% in the UK), unavailability of jobs, ageism (many people who are bullied are over 40), partner unable to move, and kids settled in school and you are unable or unwilling to move them. The real killer, though, is being unable to get a job reference – the bully will go to great lengths to blacken the person’s name, often for years, and it is this lack of reference more than anything else which prevents people escaping.

Common features of Complex PTSD from bullying

People suffering Complex PTSD as a result of bullying report consistent symptoms which further help to characterise psychiatric injury and differentiate it from mental illness. These include:

Fatigue with symptoms of or similar to Chronic Fatigue Syndrome (formerly ME)
An anger of injustice stimulated to an excessive degree (sometimes but improperly attracting the words “manic” instead of motivated, “obsessive” instead of focused, and “angry” instead of “passionate”, especially from those with something to fear)
An overwhelming desire for acknowledgement, understanding, recognition and validation of their experience
A simultaneous and paradoxical unwillingness to talk about the bullying (click here to see why) or abuse (click here to see why)
A lack of desire for revenge, but a strong motivation for justice
A tendency to oscillate between conciliation (forgiveness) and anger (revenge) with objectivity being the main casualty
Extreme fragility, where formerly the person was of a strong, stable character
Numbness, both physical (toes, fingertips, and lips) and emotional (inability to feel love and joy)
Clumsiness
Forgetfulness
Hyperawareness and an acute sense of time passing, seasons changing, and distances travelled
An enhanced environmental awareness, often on a planetary scale
An appreciation of the need to adopt a healthier diet, possibly reducing or eliminating meat – especially red meat
Willingness to try complementary medicine and alternative, holistic therapies, etc
A constant feeling that one has to justify everything one says and does
A constant need to prove oneself, even when surrounded by good, positive people
An unusually strong sense of vulnerability, victimisation or possible victimisation, often wrongly diagnosed as “persecution”
Occasional violent intrusive visualisations
Feelings of worthlessness, rejection, a sense of being unwanted, unlikeable and unlovable
A feeling of being small, insignificant, and invisible
An overwhelming sense of betrayal, and a consequent inability and unwillingness to trust anyone, even those close to you
In contrast to the chronic fatigue, depression etc, occasional false dawns with sudden bursts of energy accompanied by a feeling of “I’m better!”, only to be followed by a full resurgence of symptoms a day or two later
Excessive guilt – when the cause of PTSD is bullying, the guilt expresses itself in forms distinct from “survivor guilt”; it comes out as:

  • an initial reluctance to take action against the bully and report him/her knowing that he/she could lose his/her job
  • later, this reluctance gives way to a strong urge to take action against the bully so that others, especially successors, don’t have to suffer a similar fate
  • reluctance to feel happiness and joy because one’s sense of other people’s suffering throughout the world is heightened
  • a proneness to identifying with other people’s suffering
  • a heightened sense of unworthiness, undeservingness and non-entitlement (some might call this shame)
  • a heightened sense of indebtedness, beholdenness and undue obligation
  • a reluctance to earn or accept money because one’s sense of poverty and injustice throughout the world is heightened
  • an unwillingness to take ill-health retirement because the person doesn’t want to believe they are sufficiently unwell to merit it
  • an unwillingness to draw sickness, incapacity or unemployment benefit to which the person is entitled
  • an unusually strong desire to educate the employer and help the employer introduce an anti-bullying ethos, usually proportional to the employer’s lack of interest in anti-bullying measures
  • a desire to help others, often overwhelming and bordering on obsession, and to be available for others at any time regardless of the cost to oneself
  • an unusually high inclination to feel sorry for other people who are under stress, including those in a position of authority, even those who are not fulfilling the duties and obligations of their position (which may include the bully) but who are continuing to enjoy salary for remaining in post [hint: to overcome this tendency, every time you start to feel sorry for someone, say to yourself "sometimes, when you jump in and rescue someone, you deny them the opportunity to learn and grow"]

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