TRAUMA THEORIES
What I’ve gathered from reading a bunch of websites and academic articles is that the psychologists’ bible, the Diagnostic and Statistical Manual (DSM), is really not helpful for classifying trauma. (There was drama around this apparently during the last revision of the DSM). This is my synthesis, with some links that helped me come to it.
Individual psychological responses to trauma can be thought of as occurring on a spectrum of dissociation.
Dissociation- There may actually be two separate types of dissociation. One involves alteration of consciousness and the other involves something called structural dissociation.
Everyone dissociates sometimes to some degree, which typically involves alterations of consciousness (such as daydreaming or not remembering all of a drive home). If part of someone splits off to cope with trauma though, structural dissociation occurs.
Primary structural dissociation means only one part split off to cope with trauma. Not remembering all or part of a traumatic event (dissociative amnesia) allows someone to contain their trauma memory and continue life more or less as before. Dissociative amnesia, feeling that life is surreal (derealization), or that you are numb or robotic (derealization), is common in Acute Stress Disorder.
Acute Stress Disorder is a response to recent stress that may or may not develop into PTSD. Supposing the trauma memory is integrated, structural dissociation may no longer exist. If episodes of feeling like life is surreal or you’re hollow continue though that may indicate derealization/depersonalization disorder, which also need not have an acute trauma to occur. Flashbacks (typically associated with PTSD) occur when the part that split off to cope with trauma is active; flashbacks may be a way of ‘rehearsing’ for future trauma or an opportunity to work towards integrating the trauma memory.
In Complex PTSD, Borderline Personality Disorder, Other Specified Dissociative Disorder-1, and Dissociative Identity Disorder, more than one part split off to cope with trauma. When these parts are relatively simple they are called emotional parts and secondary structural dissociation occurs. When some of the parts are more elaborate, they may handle parts of daily life (such as work, school, or care-giving) and have their own emotional parts. These more elaborate parts are called apparently normal parts and tertiary structural dissociation can be said to have occurred.
Tertiary structural dissociation is associated with Dissociative Identity Disorder, although it may also manifest as Other Specified Dissociative Disorder-1. The reverse might also happen; that is, more elaborate emotional parts may present as Dissociative Identity Disorder. In reality the difference between apparently normal parts and emotional parts may be blurry rather than clear-cut. Parts that are not clearly emotional parts or apparently normal parts are believed to happen in cases of even further structural dissociation. Personally I believe that the line between emotional parts and apparently normal parts may just be blurry, and that parts with characteristics of both do not necessarily indicate further structural dissociation. (This is because in my experience ‘Broken Me’ and ‘The Image of Me’ have felt blurry). Some people think of Other Specified Dissociative Disorder-1 and Dissociative Identity Disorder as subtypes of Complex PTSD.
HOW IS STRUCTURAL DISSOCIATION EXPERIENCED?
The different degrees and different types of structural dissociation mean there are many ways that structural dissociation is experienced. This blog is about my experiences with Complex PTSD. There are many great blogs by multiple systems (people with Dissociative Identity Disorder and some people with Other Specified Dissociative Disorder-1) though that internet searching turns up. There are also many great blogs by median systems (where parts are experienced as different facets of a whole; many median systems would be classified as having Other Specified Dissociative Disorder-1) that can be found with an online search.
Feeling fragmented and experiencing thoughts or emotions ‘out of nowhere’ are experiences that people with Complex PTSD, Borderline Personality Disorder, Other Specified Dissociative Disorder-1, and Dissociative Identity Disorder share to some degree. Some multiple and median system blogs talk about passive influence from another part when thoughts or emotions come ‘out of nowhere’. People with Complex PTSD might talk about emotional flashbacks when thoughts or emotions come ‘out of nowhere’. Language is imperfect: I’m not sure that either ‘passive influence’ or ‘emotional flashback’ can actually describe what it is like to have such experiences. Fortunately the diversity of stories online about experiences of structural dissociation is more than sufficient.
WHAT DO WE STILL NEED TO LEARN?
…ABOUT STRUCTURAL DISSOCIATION?
(Here’s where my PhD student background comes out… sorry!)
-If someone has developed secondary structural dissociation in childhood, is it possible for parts to become more developed in adulthood and present as Other Specified Dissociative Disorder-1 or Dissociative Identity Disorder over time?
-Is it possible for a Mixed or Apparently Normal Part to split off, perhaps temporarily, without there being multiple emotional parts (perhaps this explains Dissociative Fugues)?
-Is Complex PTSD from childhood trauma (i.e., Developmental Trauma Disorder) somehow different in nature from Complex PTSD that develops solely from adult trauma (i.e., after a non-traumatic childhood)?
…ABOUT TRAUMA RESPONSES?
While I think we would understand trauma better if the DSM were reorganized (so that PTSDs, Dissociative Disorders, and Borderline Personality Disorder are all classified as Traumatic Stress Disorders), there is still so much more that we have to learn about trauma! Before I write more, I will say that I like the framing of Traumatic Stress Disorders because it puts the focus on what was done to us and normalizes our responses rather than pathologizing us. Given the ways psychiatry and medicine has focused on ‘individual character flaws’ and ignored the realities of social environments (e.g., colonialism, racism, and enslavement); and given how this has been used to used to oppress whole groups of people (e.g., eugenics), the importance of focusing on what was done to us cannot be understated. It’s just that this approach of focusing on what was done to us is not yet applied comprehensively to trauma.
Complex PTSD is said to result from situations in which perpetrators have control, and from which there is little to no hope of escape. This also describes the nature of systemic racism and other systematic forms of oppression, which are built into the very fabric of society. Collective trauma follows systematic oppression since it affects whole groups of people; it exacts a toll, which is often seen as physical health inequities since –remember- mental health inequities are still not quite understood. Both life-time and childhood experiences (and experiences during other life transitions) of such trauma shape us. The current Traumatic Stress Disorders framework acknowledges interpersonal trauma (i.e., harm done to someone by another person) but an intersectional lens is also necessary to understand collective trauma.
Others have already written about how the Myth of Individualism/Meritocracy and Colorblind Racism are forms of gaslighting (emotional abuse) against whole groups of people (e.g., people of color). Microaggressions, which can be quite macro actually, have also been called out as abuses targeted on identity (i.e., against whole groups of people). Collective trauma then shapes our exposures to abuse, which differentially weathers us.
Both interpersonal and collective trauma affects us. A comprehensive approach to how trauma affects people will have to consider them jointly and separately. Some topics that I think a comprehensive understanding of trauma would have to address include:
-How does the source of trauma (i.e., interpersonal or collective) affect people’s responses to trauma?
So for example:
- How does caregiver abuse (interpersonal trauma) affect people differently than racial microaggressions (collective trauma)?
- How do experiences of racism in early childhood (collective trauma) affect people’s future trauma responses and allostatic load?
- How does racialized caregiver abuse (interpersonal and collective trauma) and not being able to develop perspectives from within one’s culture of birth (boarding schools being an extreme example) affect trans-racial adoptees?
-What role do resources have in offsetting the harms of collective trauma?
So for example:
- How do caregivers help children be resilient in a racist society?
- How does racial identity, knowledge, pride, and community keep people resilient?
Systemic oppression, through provider bias and by shaping who has access to what care, affects who is likely to be accurately diagnosed with a traumatic stress disorder. Because of privilege, I could access care within a system that normalizes Whiteness, and was able to get my Complex PTSD diagnosis. Everyone should have access to care, and access to care that normalizes them. This is why it is imperative that we embrace an intersectional understanding of Traumatic Stress.
addressingtrauma 