Post Traumatic Stress Disorder


Complex trauma (C-PTSD) results when there is severe and prolonged abuse and/or neglect, especially in childhood. Survivors of concentration camps, domestic violence survivors, military personnel who are exposed to ongoing violence, people who have experienced repeated sexual assaults, and kidnapping victims may experience C-PTSD. While rooted in memories of traumatising events that are dysfunctionally stored, the resulting clinical picture can be more comprehensively understood and phenomenologically elaborated by The Theory of Structural Dissociation of the Personality (TSDP).

In this framework, the traumatising events create a division of personality in terms of dissociative parts of the personality. Personality is defined as the dynamic organisation within the individual of those bio-psycho-social systems (behaviours) that determine his or her characteristic mental and behavioural actions. There are two major categories of action systems, those that have to do with everyday living (e.g. exploration, social engagement, care-taking, play, energy regulation and sexuality/reproduction) and those that have to do with defence of the individual when under threat (e.g. fight, flight, freeze, submission). As a result of the trauma, the person’s personality is unduly but not completely divided among two or more of such dissociative parts each having its own first-person perspective. The basic splitting is between the two major action systems, resulting in what is called the Emotional Part of the Personality (EP), which holds (using AIP language) the dysfunctionally stored information and the Apparently Normal Part of the Personality (ANP), focused on carrying on daily life (Van der Hart et al., 2006).

The EP is basically fixated on traumatic memories and defensive systems operating during the traumatic event. The ANP is focused on daily life functions, and because the traumatic memories are too intense and overwhelming, is fixated on avoidance. Hence, the ANP is not able to stay present (e.g. within the “window of tolerance”) when an EP is activated.

Because the person is not able to tolerate the emotional intensity of the traumatic memories (held by the EP), a Phase Oriented treatment approach is needed when treating complex trauma. A phase oriented approach consists of:

  • Stabilisation, symptom-reduction, and skills training

  • Treatment of traumatic memories

  • (re)integration of the personality

A variety of treatment methodologies are utilised in the treatment of complex trauma (including EMDR). However, special training in trauma and dissociation is essential for effective treatment:

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