Trauma, Grief and Personality Disordered Symptoms
Dr. Dawn-Elise Snipes
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Objectives
~ Explore the similarities between grief, traumatic reactions and personality disordered symptoms.
~ Explore possible etiology of symptoms
~ Change the language from why are you doing this, to How does this make sense?/What happened to you?
~ As we go through the presentation, continually ask yourself…How could this behavior be an adaptive reaction?
Grief, Trauma & Personality Disorders
~ Persistent Complex Bereavement Disorder
~ Conditions for Further Study (DSM-V p. 789-792)
~ PTSD
~ Personality Disorders
~ Pervasive, long-standing ways of being
~ Ways of perceiving and interpreting self, others and events
~ Range, intensity and appropriateness of emotional response
~ Interpersonal functioning (empathy, trust, desire for relationships)
~ Impulse control
Emotional
~ Shock, denial, or disbelief
~ Guilt, shame, self-blame
~ Feeling sad or hopeless
~ Feeling disconnected/numb
~ Dysregulation
~ Anxiety
~ Separation anxiety
~ Reactive Attachment
~ Angry/Irritable
~ Depression
~ Loneliness
Cognitive
~ .
~ Confusion, difficulty concentrating
~ Difficulty concentrating
~ Short attention span
~ Difficulty learning new material; short term memory loss
~ Difficulty making decisions
~ Lack of a sense of purpose
~ Inability to find meaning in the events and life itself
Physical
Most physical effects of grief/trauma are effects of stress/anxiety
~ Fatigue
~ Being startled easily
~ Racing heartbeat
~ Aches and pains
~ Muscle tension
~ Appetite disturbances
~ Sleep disturbance
~ Gastrointestinal disturbance
~ Compromised immune response; increased illness
Social
~ Isolation/detachment
~ Avoidance
~ Withdrawal
~ Distrust/suspicion
~ Self absorption
~ Searching
~ Clinging/dependence
~ Insecurity
~ Distorted self image
~ How could these symptoms lead to PD behaviors?
Putting It Together
~ Personality Disordered Behavior in Context
~ PD behavior must be traceable back to adolescence or early adulthood! (not early childhood as most of us were taught)
~ ~1% of children are victims of (reported) abuse or neglect each year
~ 37% of American children are reported to Child Protective Services by their 18th birthday
~ 48% of US Children experience at least one “serious trauma” / Adverse Childhood Experience
http://www.invisiblechildren.org/2016/12/29/1-in-3-children-investigated-for-abuse-by-18-washington-university-study/
https://www.childhelp.org/child-abuse-statistics/
https://acestoohigh.com/2013/05/13/nearly-35-million-u-s-children-have-experienced-one-or-more-types-of-childhood-trauma/
Behavioral
~ Cluster A
~ Paranoid: Suspiciousness, hold grudges, jealousy
~ Schizoid: Social detachment, restricted emotions, oblivious to social cues
~ Cluster B
~ Antisocial: Disregard for rights of others, aggression, poor impulse control, blame victims, lack of empathy
~ Histrionic: Uncomfortable being alone, need to be CoA, easily influenced by others
~ Narcissistic: Sense of entitlement, disregard the rights and feelings of others, lack empathy, need to be admired
~ Borderline: Unstable sense of self, dichotomous thinking, emotional dysregulation, impulsivity—self-destructive, difficulty interpreting the motivations of others
Behavioral
~ Cluster B
~ Borderline: Unstable sense of self, dichotomous thinking, emotional dysregulation, impulsivity—self-destructive, difficulty interpreting the motivations of others
~ Cluster C
~ Avoidant: Social inhibition, feelings of inadequacy, hypersensitivity to criticism
~ Dependent: Strong need to be taken care of by others (submission, serial relationships), challenged to make decisions or begin a task without help
~ Obsessive Compulsive: Preoccupied with rules and order, devoted to work, perfectionistic, unable to delegate
Summary
~ Grief and trauma symptoms overlap considerably
~ Many of the symptoms of personality disorders can be seen as adaptive responses after a trauma which occurred in early adulthood or before.
~ Clinicians should evaluate for a history of trauma and/or symptoms of reactive attachment disorder, disinhibited social engagement disorder in childhood
~ Before diagnosing someone with a personality disorder, it is essential to rule out other issues such as
~ Persistent Complicated Bereavement Disorder
~ Post Traumatic Stress Disorder
~ Substance Abuse (which often masks PTSD)