Professional Approach

 Date: 12-02-91   7:28

From: Robin Gober

Subj: Professional Approach,

John HI! Thought I would post this for everybody.

   Diagnostic criteria for Post-traumatic Stress Disorder.

   A. The person has experienced an event that is outside the range of usual

   human experience and that would be markedly distressing to almost anyone,

   e.g., serious threat to one's life or physical intergrity; serious threat

   or harm to one's childern, spouse, or other close relatives and friends;

   sudden destruction of one's home or community; or seeing another person

   who has recently been, or is being, seriously injured or killed as the

   result of an accident or physical violence.

   B. The traumatic event is persistenly reexperienced in at least one of the

   following ways:

      (1) recurrent and intrusive distressing recollections of the event (in

      young children, repetitive play in which the themes or aspects of the

      trauma are expressed)

      (2) recurrent distressing dreams of the event

      (3) sudden acting or feeling as if the traumtic event were recurring

          (includes a sense of reliving the experience, illusions,

          hallucinations, and dissociative [flashback] episodes, even those

          that occur upon awakening or when intoxicated.

      (4) intense psychological distress at exposure to events that symbolize

          or resemble an aspect of the traumatic even, including

   anniversaries of the trauma.

    C. Persistent avoidance of stimuli associated with the trauma or numbing

    of general responsiveness (not present before the trauma), as indicated

    by at least three of the following:

       (1) efforts to avoid thoughts or feelings associated with the trauma

       (2) efforts to avoid activities or situations that arouse

       recollections of the trauma.

       (4) markedly diminished interest in significant activities (in young

       children, loss of recently acquired developmental skills such as

       toilet training or language skills)

       (5) feeling of detachment or estrangement from others

       (6) restricted range of affect, e.g., unable tohave loving feelings

       (7) sense of a foreshorted future, e.g., does not expect to have a

       career, marriage, or children, or long life

   D. Persistent symptoms of increased arousal,not present before the trauma,

      indicated by at least two of the following:

      (1) difficulty falling or staying asleep

      (2) irritability or outbust of anger

      (3) difficulty concentrating

      (4) hypervigilance

      (5) exaggerated stratle response

      (6) physiologic reactivity upon exposure to events that symbolize or

      resemble an aspect of the traumatic event (e.g.,a woman who was raped

      in an elevator breaks out in a sweat when entering any elevator)

   E. Duration of the disturbance (symptoms in B,C, and D) of at least one

   month.

   Specify delayed onset if the onset of symptoms was at least six months

   after the trauma.

     "Growth of Co-dependence

      1. Invalidation and repression of internal cues, such as our

         observations, feelings and reations

      2. Neglecting our needs

      3. Beginning to stifle our Child Within

      4. Denial of a family or other secret

      5. Increasing tolerance of and numbness to emotional pain

      6. Inability to grieve a loss to completion

      7. Blocking of growth (mental,emotional,spiritual)

      8. Compulsive behaviors in order to lessen pain

      9. Progressive shame and loss of self-esteem

     10. Feeling out of control. Need to control more

     11. Delusion and projection of pain

     12. Stress-related illness develops

     13. Compulsions worsen

     14. Progessive deterioration

            Extreme mood swings

            Difficuty with intimate relationships

            Chronic unhappiness

      To get to the point of recovery, we must survive. Survivors are by

   necessity co-dependents. We use many coping skills and ego defenses to do

   this. .... survive by dodging, hiding, negotiating, taking care of others,

   pretending, denying and learning and adapting to stay alive using any

   method that works. They learn other often unhealthy ego defense

   mechanisms, as describe by Anna Freud (1936) and summarized by

   Vaillant(1977) These include: intellectualization, repression,

   disassociation, displacement and reaction formation (all of which if

   overused can be considered neurotic) and projection, passive-aggressive

   behavior, acting out, hypochondriasis, grandiosity and denial (all of

   which if overused can be considered immature and at times psychotic)."

   _Healing the Child Within_ Charles L. Whitfield M.D.