Recently I came across a couple of articles that present a slightly different “take” on trauma, and I thought it was worth summarizing here. It piqued my interest because they examine the effects of chronic interpersonal abuse, which is not really captured in the classic DSM-IV definition of PTSD in which a person is: (1)“…confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others… “ and (2) “the person’s response involved intense fear, helplessness, or horror.”
Victims of chronic interpersonal abuse are often subjected to repeated traumatization, often in the form of physical or sexual assaults. Indeed, it has been found that recurrent interpersonal trauma can have significant psychological consequences that go beyond the standard DSM-IV-defined symptoms of re-experiencing, avoidance and numbing, and increased arousal.
Its victims are at risk for difficulties in mood regulation (and mood disorders), attachment disorders in childhood, anxiety, aggressive behavior towards the self and others, personality disorders, and more. Chronic interpersonal abuse also leads to an increased risk of chronic medical illnesses including heart disease, immune disorders, disturbances of metabolism, substance abuse, and obesity.
Taken together, these symptoms have been classified under the rubric of “Disorders of Extreme Stress, Not Otherwise Specified,” or simply DESNOS for short. It is not uncommon for victims of interpersonal trauma to also suffer from PTSD in addition to DESNOS; the longer the duration of the trauma, the more likely it is that both will co-occur.
DESNOS symptoms cover seven broad categories of psycho-social functioning and regulation of the self including impulse control and mood, biological self-regulation (such as somatization, which consists of multiple physical complaints that cannot be explained on a medical basis), alterations of attention and/or consciousness, dysfunctional attitudes toward the perpetrator(s) of the trauma (such as idealization), disturbed perceptions of the self, disturbances in interpersonal relationships, and alterations of previously held belief systems (such as loss of faith).
This distinction between DESNOS and PTSD becomes important in terms of treatment implications; the treatment of PTSD focuses on the memories of past events in order to reduce the impact of traumatic experiences. On the other hand, when confronted by a client that has experienced interpersonal abuse, it is imperative to look for the presence of symptoms compatible with DESNOS. For in clients with this syndrome, one must focus on much more than just the memories of their traumatic events.
References
Ford, J. D., Stockton, P., Kaltman, S., & Green, B. L. (2006). Disorders of extreme stress (DESNOS) symptoms are associated with type and severity of interpersonal trauma exposure in a sample of healthy young women. Journal of Interpersonal Violence, 21, 1399-1416.
Van Der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: the empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18, 389-399.
