PTSD and DESNOS

Recovery is something I have talked about on this blog.  A lot.  If we have experienced an iota of abuse or trauma in our lives, then we will have to commit to the process of healing and recovery.  That’s life.  That’s how we clean up our metaphorical rooms (See Cleaning Up Messes).

I carry around a diagnosis of PTSD.  PTSD isn’t supposed to be longterm.  One experiences a traumatic event.  How one handles that experience is what often leads to the PTSD diagnosis.  Studies have revealed that the size of one’s hippocampus often determines how one bounces back from a trauma (Hippocampal volume and resilience in PTSD).  One person can witness or experience the same act of violence as another person yet process the event differently.  Person A might get over it.  Just a bad memory and a weird story to tell at a bar one day.  Person B might not get over it at all and end up on medications and in therapy with PTSD.  All because Person A’s hippocampus was bigger than Person B’s.  The good news here is that one of the richest sources of neurogenesis in the brain lies in the hippocampus.  Engage in a healing process and take advantage of that neurogenesis.  The nature of the trauma also matters as does the age at which the trauma occurred.  A car accident or a natural disaster is very different from trauma within a familial or intimate relationship.

So, what is PTSD exactly?

“For an individual to be diagnosed with PTSD, he or she must: have experienced an event in which the life, physical safety, or physical integrity of the patient or another person was threatened or actually damaged; and the patient must have experienced intense fear, helplessness, or horror in response; continue to re-experience the traumatic event after it is over (e.g., flashbacks, nightmares, intrusive thoughts, and emotional and physiological distress in the face of reminders of the event); seek to avoid reminders of the event (e.g., avoidance of thoughts, feelings, and conversations about the event; avoidance of people, places, and activities that are associated with the event; difficulty recalling aspects of, or the totality of the event; diminished interest in formerly pleasurable activities; feelings of detachment; and a sense of a foreshortened future); exhibit signs of persistent arousal (e.g., difficulty with sleep, increased irritability, concentration problems, scanning of environment for danger, and heightened startle responses).” (Toni Luxenberg, PsyD, Joseph Spinazzola, PhD, and Bessel A. van der Kolk, MD)

What about Complex PTSD (C+PTSD) or DESNOS, Disorders of Extreme Stress, Not Otherwise Specified? What is that all about? This feels somewhat nebulous.  Let’s talk about it for a moment.

DIAGNOSTIC CRITERIA FOR
DISORDERS OF EXTREME STRESS
(DESNOS)
I. Alteration in Regulation of Affect and Impulses
(A and 1 of B–F required):
A. Affect Regulation
B. Modulation of Anger
C. Self-Destructive
D. Suicidal Preoccupation
E. Difficulty Modulating Sexual Involvement
F. Excessive Risk-taking
II. Alterations in Attention or Consciousness
(A or B required):
A. Amnesia
B. Transient Dissociative Episodes and
Depersonalization
III. Alterations in Self-Perception
(Two of A–F required):
A. Ineffectiveness
B. Permanent Damage
C. Guilt and Responsibility
D. Shame
E. Nobody Can Understand
F. Minimizing
IV. Alterations in Relations With Others
(One of A–C required):
A. Inability to Trust
B. Revictimization
C. Victimizing Others
V. Somatization
(Two of A–E required):
A. Digestive System
B. Chronic Pain
C. Cardiopulmonary Symptoms
D. Conversion Symptoms
E. Sexual Symptoms
VI. Alterations in Systems of Meaning
(A or B required):
A. Despair and Hopelessness
B. Loss of Previously Sustaining Beliefs

It is possible to have both DESNOS (or C+PTSD) and PTSD at the same time.  Why does this matter? Consider a story like this:

“Awareness of the characteristic backgrounds of individuals who meet criteria for DESNOS will aid in effective case conceptualization and treatment planning. Often these individuals have histories of a large variety of traumatic events, spanning years and even decades. Such individuals may not have had discrete traumatic experiences so much as ongoing, chronic exposure to untenable environments. An example of a typical DESNOS history would be a woman who reports that she was never held as a child and was sexually abused throughout her childhood by her alcoholic father, who also physically assaulted her mother in her presence. Even when sober, her father frequently called her names and insulted her intelligence, attractiveness, and capabilities. As an adolescent, she may have witnessed the serious injury of several friends during a drunk-driving accident. As an adult, this woman may have been raped and had a series of emotionally and physically abusive partners. A history of chronic traumatization, however, will not always lead to the development of DESNOS symptomatology.” (Toni Luxenberg, PsyD, Joseph Spinazzola, PhD, and Bessel A. van der Kolk, MD)

 Now consider this:

“In the National Comorbidity Study carried out by Kessler and colleagues, it was found that while approximately one fifth of all individuals diagnosed with PTSD did not meet the criteria for another diagnosis, the remaining 79% met criteria for at least one additional disorder, and a full 44% met the criteria for at least three other diagnoses For a substantial proportion of traumatized patients the diagnosis of PTSD captures only limited aspects of their psychological problems. The combination of post-traumatic symptoms represented by DESNOS and PTSD criteria, rather than by PTSD alone, causes people to seek psychiatric treatment.” (Toni Luxenberg, PsyD, Joseph Spinazzola, PhD, and Bessel A. van der Kolk, MD)

This certainly drives the point home that exposure to trauma leaves a mark.  It changes humans sometimes for the better part of their lives.  What is to be done about it?

There is a lot that can be done about it.

Please allow me to introduce you to some excellent articles I found this morning.

May they inspire you to continue moving forward if you count yourself among those learning to thrive after trauma.

Resources:

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click image for link

 

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