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

[摘要] ENGLISH ABSTRACT:A century of clinical observations and literature has repeatedly noted that traumaresponses occur in across a spectrum and on a continuum of severity. The existing, DSMIVtrauma response classifications include Acute Stress Disorder and PTSD as anxietydisorders. Complex PTSD or DESNOS was considered as a proposed, alternativeclassification during the DSM-IV PTSD Field Trials. It was not included as a separatediagnosis, but briefly mentioned as an associated feature ofPTSD. Subsequent researchand replica studies have not proved conclusively whether Complex PTSD should be aseparate or associated feature ofPTSD, and the controversy continues to date.Childhood traumatization is strongly associated with adult psychopathology, andvarious Axis I and Axis II disorders, especially Borderline Personality Disorder, and to alesser extent, Antisocial Personality Disorder. Prolonged, repeated traumatization duringadulthood is also associated with subsequent Axis II pathology, including Borderline,Obsessive-Compulsive and Avoidant Personality Disorders. Chronically traumatizedpeople with Axis II pathology often present with comorbid Axis I disorders includingMajor Depression, PTSD, Substance Abuse, Somatization Disorder, and DissociativeDisorders.There are divergent views regarding the etiology of personality disorders inchronically traumatized individuals. On the one hand, repeated, prolonged trauma couldcause enduring personality dysfunction in individuals despite normal premorbidfunctioning. On the other hand, genetics, temperament, environmental factors and even apre-existing stress diathesis in the pre-trauma personality could contribute to thedevelopment of post-trauma personality disorders. These two views do not necessarycontradict each other, but illustrate the complexity the human stress reaction.Despite the controversy the inclusion of DESNOS into the diagnostic canon, it isa valuable measure of predicting prognosis to existing treatment options. The presentmain psychological treatment for post-traumatic stress disorders has been a cognitive-behavioral based, exposure intervention. Alternative therapies include psychodynamicapproaches, pastoral interventions and more recently, ecological and recovery basedmodels.The Complex PTSD conceptualization contributes to a better understanding of thepersonality structure of chronically traumatized people. There are three main areas ofdisturbance. Firstly, a complex symptomatic presentation including somatization,dissociation, and affect dysregulation. Secondly, deep characterological shifts includingdeformations in concepts of relatedness and identity. Thirdly, and increased vulnerabilityto harm, either self-inflicted or at the hands of others. The usefulness of integratingthese three concepts into the personality conceptualization of chronically traumatizedindividuals is illustrated a case study.

[发布机构] Stellenbosch University