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PART III: THEORY
Developing a complex PTSD
A description( or diagnostic category) of the reactions of those who have been exposed to enduring trauma during childhood has long been needed. It would cover‘ chronic situations of trauma’, such as on-going violence, prolonged neglect, and abuse including multiple rape. Such situations may result in what is termed‘ complex PTSD’.
Symptoms occur in three main areas:
• Deficient regulation of affective and somatic states. Individuals oscillate between states of intense emotion, are depressed, hypersensitive, experience delayed motor development, suffer sleeping and eating disorders, are not conscious of their own feelings.
• Deficient awareness, concentration or regulation of behaviour. Individuals often focus in a narrow or restricted manner on threats, are impulsive, are prone to self harm.
• Lowered social and emotional functioning. Individuals often do not trust themselves or others, and constantly expect or prepare for rejection.
Trauma, risk and resilience
Resilience is not rare and indicates healthy adjustment. It is therefore important to understand the factors that help healing and enable people to cope.
It is also helpful to distinguish recovery( during which survivors heal over time after being destabilised and showing symptoms of distress) from resilience( the ability to remain stable and keep going during and after catastrophes).
Research has shown that resilience is not just a personal characteristic. An individual’ s ability to cope is complemented by external factors that protect her against risk. To take an obvious example, survivors will be more resilient if they have support from their communities.
Some elements of resilience seem to be universal, while culture influences others.( See the chapter on culture and understandings of trauma in Part III, pages 134-136).
Whether an individual has light or extreme symptoms is likely to be influenced by protective or risk factors.
1. Her genetic inheritance. We are born with various degrees of robustness or vulnerability. 2. Her experiences before exposure to trauma. 3. The character of the trauma event. 4. Her situation immediately after the trauma event( for example, how quickly she received help). 5. Her situation in the long term( for example, the quality of rehabilitation support she received).