# Healing the Traumatized Self (April 2015)



## bubniakz (Jun 3, 2008)

I think this new book deserves our attention...

*Healing the Traumatized Self*​*CONSCIOUSNESS, NEUROSCIENCE, TREATMENT*​
April 2015
ISBN 978-0-393-70551-5
6.5 × 9.6 in / 480 pages

https://books.google.sk/books?id=zRN0AwAAQBAJ&printsec=frontcover&hl=sk#v=onepage&q&f=false

http://www.amazon.com/Healing-Traumatized-Self-Consciousness-Interpersonal/dp/039370551X










*A neurobiological explanation of self-awareness and the states of mind of severely traumatized people.*

Cultivation of emotional awareness is difficult, even for those of us not afflicted by serious mental illness. This book discusses the neurobiology behind emotional states and presents exercises for developing self awareness. Topics include mood (both unipolar and bipolar), anxiety (particularly PTSD), and dissociative disorders. Frewen and Lanius comprehensively review psychological and neurobiological research, and explain how to use this research to become aware of emotional states within both normal and psychopathological functioning. Therapists will be able to help survivors of trauma, mood disorders, anxiety disorders, and dissociative disorders develop emotional awareness. The book also includes case studies, detailed instructions for clinicians, and handouts ready for use in assessment/therapy with patients/clients.


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## TDX (Jul 12, 2014)

The problem is that just a minority has depersonalization because of a trauma, so the book will see the symptoms only from a very narrowed point of view.


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## bubniakz (Jun 3, 2008)

Of course, but do you heard about cumulative trauma or *complex post-traumatic stress disorder*, first described by judith herman? Im inclined to agree with Harris Harrington viewpoint that trauma in dp... "is more complex, and occurs over a period of time. In essence, it is accumulated trauma. This could be when a parent puts you in a constant state of guilt for years, it could be when you were verbally abused by someone day after day. Parents who are "too busy" and neglect their children also inflict this abuse. In dp, the trauma can be *extremely subtle, and almost not appear to be traumatic*. It could be a mother who was just a "tad distant", or father who just made you uncomfortable a lot around others."

Complex Post Traumatic Stress Disorder (C-PTSD) differs slightly from the more commonly understood & diagnosed condition Post Traumatic Stress Disorder (PTSD) in causes and symptoms. C-PTSD results more from *chronic repetitive stress* from which there is little chance of escape. PTSD can result from *single events*, or short term exposure to extreme stress or trauma. (https://outofthefog.net/CommonNonBehaviors/CPTSD.html)

After all, you can read in Maurcio Sierra´s book (Depersonalization; A New Look at a Neglected Syndrome) that...

"...it is not surprising that a significant correlation has been found between depersonalization in adulthood and experiences of emotional abuse during childhood. *Such 'abuse' or neglect can often be subtle and implicit* in certain life events rather than purposely perpetrated. For example, a number of adverse life events during childhood seem over-represented in patients with depersonalization disorder. For example, divorce of parents during childhood; having had cold and distant parents; having been sent to a boarding school at an early age; having been placed in adult-like roles of responsibility, such as caring for an ailing relative, or having been subjected to significant bullying at school without adequate protection from significant adults."

I guess that discussion in terms of accumulated trauma - depersonalization - dissociation is really missing here in the forum. This is relevant especially for sufferers with chronic and unremitting depersonalization.


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## TDX (Jul 12, 2014)

Complex post-traumatic stress disorder is not universally accepted by psychiatrie and does not appear in the DSM-IV or DSM-5. It appears in the beta-version of the ICD-11 with the following definition:

"Complex post-traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extreme and prolonged or repetitive nature that is experienced as extremely threatening or horrific and from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). The disorder is characterized by the core symptoms of PTSD; that is, all diagnostic requirements for PTSD have been met at some point during the course of the disorder. In addition, complex PTSD is characterized by 1) severe and pervasive problems in affect regulation; 2) persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the stressor; and 3) persistent difficulties in sustaining relationships and in feeling close to others. The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning."

The traumas that the definition of CPTSD requires correspond to the traumas of PTSD. So Harris Harrington is wrong. A trauma that is "extremely subtle, and almost not appear to be traumatic" is simply not a trauma. This is also true, for the "emotional abuse" that Sierra mentions. These experiences are not above the threshold for a trauma. While it is true, that patients with depersonalization report more emotional abuse in their childhood than controls, a cause and effect relationship has not been established.

In CPTSD the diagnostic reqirements of PTSD must be met, too. This means that CPTSD is a subset of PTSD. In a case series of 117 cases by Simeon et al less than 2% had PTSD. So less than 2% should have CPTSD.

It should also be noted that in many mental disorders, like for example anxiety and depression, the patients are more likely to have experienced emotional abuse. So, this is nothing special. It does not make a disorder a trauma-based disorder. And even if someone had emotional abuse, the therapeutic significance is often near zero.


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## luctor et emergo (May 22, 2015)

"a cause and effect relationship has not been established." that might be the case but the way one experiences trauma is subjective .

Maybe it is not *the* cause for dp, dr, but it certainly is a building block. The results of emotional abuse can feed dp, dr.

I'm practicing EMDR for CPTSD, it's is interesting to understand how all your personal life experiences can lead up to:

"1) severe and pervasive problems in affect regulation; 2) persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the stressor; and 3) persistent difficulties in sustaining relationships and in feeling close to others"


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## inferentialpolice (Nov 26, 2012)

> I think this new book deserves our attention...
> 
> *Healing the Traumatized Self*​*CONSCIOUSNESS, NEUROSCIENCE, TREATMENT*​
> April 2015
> ISBN 978-0-393-70551-5


Here is what I posted on a Dissociation interest group list about this book's premise:

Dr. Lanius has just recently published a freely available article
summarizing her book's "4D" model and its relation to neuroscience and
implications for future research, which can be downloaded here:
http://www.ejpt.net/index.php/ejpt/article/view/27905

I have read that paper, but not yet her book, and I have a number of
questions and comments that I hope you can address:

1) Dr. Lanius uses the terms "trauma-related altered states"(TRASC) and
"normal waking consciousness" (NWC), yet even with her use of the term
"altered states", she doesn't seem to connect this to the notion of a
dissociative disorder. Her model seems to imply that the NWC has no
dissociative symptoms, yet (for instance) she doesn't seem to account for
the fact that this NWC she posits may have either no or restricted memory
for a trauma. While I am still trying to get my head around the
Structural Dissociation model, at least that one considers the normal
waking consciousness "state" to be a dissociated one, calling it an
APPARENTLY normal state, and reflecting that such NWC's can have the
hallmarks of laboring under a dissociative process: "a disruption and/or
discontinuity in the normal integration of consciousness, memory,
identity, emotion, perception, body representation, motor control, and
behavior", ie, dissociative manifestations. How does one
square her use of "state" concepts and yet maintain the notion of a
"normal waking consciousness" that it appears is posited to be laboring
under no dissociative symptomatology?

2) I noted that she doesn't seem to require that the patient be AWARE
they they've had trauma, or does she??? (It would seem to me that her
neurobiological arguments would necessarily have to be separate from the
patients awareness of having had trauma) If patients are not required to
endorse having had trauma, then how does she distinguish in her model
between PTSD-subtype and plain old dissociative disorders which have all
the symptoms AND STATES she describes yet may not endorse any memory of
trauma? Or is it if trauma is endorsed, then its PTSD-subtype where NWC
is not dissociative, and if not, its DD with all states dissociative (even
in the "NWC")?

3) In Dr. Lanius's overview linked above, she references a remarkable
paper by Reinders, Loewenstein, et al that in effect shows that the
neuroimaging markers in what Lanius calls TRASC and NWC (Hypo- vs Hyper-
reactive states) are the same neuroimaging markers in DID patients
comparing their switched states between "apparently normal" and reactive
ones. That paper can be downloaded here: http://ge.tt/9jbB8lp1/v/2
If the neuro-imaging is the same, then what evidence is there that Dr.
Lanius' Normal Waking Consciousness is not in fact a dissociative state
within a dissociative system?

I am relatively new to all this, but it seems to me that the implications
of accepting Dr. Lanius's model (of a "stateless" normal state) is that
folks with higher order dissociative conditions who are shuttled down the
PTSD path will have their true dissociative psychopathology overlooked and
will be miss-and-under-treated.

------------------------------

This posting of mine was June 28th, and immediately thereafter by invitation one of the authors of the book joined the discussion list, but as of today he has not yet posted a response to the list.

PDW


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## Zed (Jul 25, 2015)

TDX said:


> The problem is that just a minority has depersonalization because of a trauma, so the book will see the symptoms only from a very narrowed point of view.


A minority of suffers of DPD have it because of trauma? Really? Wow .. sorry matey but that's totally wrong. You need to get your facts straight on this.


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## luctor et emergo (May 22, 2015)

Looking forward to the mentioned debate in the topic "anti-depersonalization medication"


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## TDX (Jul 12, 2014)

> A minority of suffers of DPD have it because of trauma? Really? Wow .. sorry matey but that's totally wrong. You need to get your facts straight on this.


In Simeon et al's case series of 117 cases less than 2% had a comorbid PTSD. In this study they also asked what triggered the disorder:

Idiopathic: 49%

Emotional stress: 25%

Cannabis: 13%

Panic attack: 12%

Depressive episode: 9%

Infection: 4%

Ecstasy: 2%

Ketamine: 1%

Trauma does not appear in this list.


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## Zed (Jul 25, 2015)

TDX said:


> In Simeon et al's case series of 117 cases less than 2% had a comorbid PTSD. In this study they also asked what triggered the disorder:
> 
> Idiopathic: 49%
> 
> ...


Triggers? PTSD? I don't see either of these having any connection with a discussion about trauma being the underlying cause of DPD. A week or so ago a member 'inferentialpolice' posted an excerpt of a communication from a leading psychiatrist who specialised in dissociative disorders. In this he clearly stated 'he had yet to meet somebody with DPD who DIDN'T have a background of trauma.' or words to that effect. I think that's fairly clear and concise. It's very much along the lines of what my therapist (who is considered an expert in the field of trauma and dissociation amongst her peers) says regarding the overwhelming underlying reason for dissociative disorders as well.

FYI... Trauma doesn't always result in PTSD.

The list of triggers in this list doesn't mean anything and is of no consequence in this discussion. A 'Mars bar' could be a trigger for someone with DPD.


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## TDX (Jul 12, 2014)

> A week or so ago a member 'inferentialpolice' posted an excerpt of a communication from a leading psychiatrist who specialised in dissociative disorders. In this he clearly stated 'he had yet to meet somebody with DPD who DIDN'T have a background of trauma.' or words to that effect.


Which shows that there is no empirical support for the assumption that most DPDs are caused by trauma (while there is empirical support for the opposite), because otherwise he would have brought it up.

And that he is a "leading psychiatrist who specialised in dissociative disorders" doesn't help either. These psychiatrists are shunned by the majority of the other psychiatrists, because many of them are dubious. So it doesn't come as a surprise that they have no convincing treatment approach and no clinical trials, but are lying to the patients and the public that they can treat DPD.



> FYI... Trauma doesn't always result in PTSD.


But if DPD was a trauma-based disorder a much higher comorbidity with PTSD should be expected.


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## Zed (Jul 25, 2015)

TDX said:


> But if DPD was a trauma-based disorder a much higher comorbidity with PTSD should be expected.


DPD is on a scale of dissociative experiences. As you move further along the scale, the prevalence of PTSD increases until you get to the end of the scale - where everyone with DID has PTSD.



TDX said:


> And that he is a "leading psychiatrist who specialised in dissociative disorders" doesn't help either. These psychiatrists are shunned by the majority of the other psychiatrists, because many of them are dubious. So it doesn't come as a surprise that they have no convincing treatment approach and no clinical trials, but are lying to the patients and the public that they can treat DPD.


So the fact that this person is a leading psychiatrist and managing director of a hospital which specialises in treating people with dissociative disorders means nothing to you? His words are baseless - is that what you're saying?

These psychiatrists (who claim to treat DPD) are shunned by the majority of their peers because they're considered dubious? haha Wow, what a bold statement.

But not as bold as this one - 'It comes as no surprise they have no convincing treatment approach'. Ohhh.. and they're lying to patients and the public. Really? They're lying are they? These are baseless and ridiculous statements.

Maybe it's a just a coincidence that I've come so far using talk based therapy as my primary mode of treatment... not to mention all the the other people with dissociative disorders my therapist has helped recover.. Yeah.. just a coincidence huh?


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## inferentialpolice (Nov 26, 2012)

TDX, on 27 Jul 2015 - 6:28 PM, said:



TDX said:


> But if DPD was a trauma-based disorder a much higher comorbidity with PTSD should be expected.


DSM5 recognizes the co-morbidity of DP and PTSD, even establishing a "Dissociative subtype of PTSD". It is estimated that 15-30% of PTSD suffers report DP symptoms:

http://www.ptsd.va.gov/professional/PTSD-overview/Dissociative_Subtype_of_PTSD.asp


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## TDX (Jul 12, 2014)

> So the fact that this person is a leading psychiatrist and managing director of a hospital which specialises in treating people with dissociative disorders means nothing to you? His words are baseless - is that what you're saying?


Yes. I'm relying on facts not what an self proclaimed authority says without any scientific rigor.



> These psychiatrists (who claim to treat DPD) are shunned by the majority of their peers because they're considered dubious? haha Wow, what a bold statement.


I never said that psychiatrists "who claim to treat DPD" are shunned by their peers. I said that psychiatrists who *claim to treat dissociative disorders* are shunned by the other psychiatrists.



> But not as bold as this one - 'It comes as no surprise they have no convincing treatment approach'. Ohhh.. and they're lying to patients and the public. Really? They're lying are they? These are baseless and ridiculous statements.


The fact that the premises of their treatment approaches are not emperically supported for DPD and the absence of clinical trials while they claim to have treated DPD succesful for *decades* speaks for itself.



> DSM5 recognizes the co-morbidity of DP and PTSD, even establishing a "Dissociative subtype of PTSD". It is estimated that 15-30% of PTSD suffers report DP symptoms


Which does nothing to disprove my statement, because this just says how many people with PTSD have depersonalization symptoms. If DPD was a truly trauma-based disorder the contrary should be true: Much more people with DPD should also have PTSD, which is just not true.


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## TDX (Jul 12, 2014)

> Obviously it would have to be well-designed but those guys must be rolling in money from all the patients they milk for years at a time.


I remember that someone said they spend *decades* in therapy. Dependency to the therapist is often a sign that the therapy is fraud, because psychotherapy should enable the patients to lead their life without help.


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## Zed (Jul 25, 2015)

King Elliott said:


> This is my biggest problem with the trauma crowd. If their approach works, why have they never devised a trial to prove it? Obviously it would have to be well-designed but those guys must be rolling in money from all the patients they milk for years at a time.


Why have they never devised a trial to prove their approach?.. That's a good question and one I've talked to many people about. I believe the bottom line is, there's no money in proving therapy works. You can't put a patent on talk therapy, or even more specifically, a particular type of talk therapy, so who'd fund a study? That's not a very attractive business proposition at all is it?

Yeah, I have no doubt the psyches and counsellors who treat people with dissociative disorders would be rolling in money. Hell, there's more than enough clients for them. The ones I've seen over the years have their books consistently full. The length of time one sees a therapist is mostly based on the complexity of the clients difficulties more than anything else. It's the client that ultimately makes the choice to continue in therapy, not the therapist.

And on that note.. Don't underestimate the intelligence of people who seek therapy. It's pretty unlikely anyone would continue to give their money to a therapist for years if they weren't getting anywhere. I'm sure there're a few charlatan psyches out there.. but where ever you look, an any industry, there's always going to be a few bad apples. It's not wise to use the bad apple MO as the general rule. My experiences have been incredibly positive and I've made great progress. I've seen a few who weren't up to the task but I moved on from them quite quickly and made an effort to find the people who could help me.

You need to be aware also, that treating dissociative disorders is a very different therapy to the 'norm'... and because of that I wouldn't be surprised if people had had a bad experience with an untrained therapist. That's what happens. An untrained therapist can actually make people feel worse. I don't think it's fair to let a bad experience with an untrained therapist tarnish ones thoughts on a whole community.


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## bubniakz (Jun 3, 2008)

https://en.wikipedia.org/wiki/Scientism

*Scientism* is belief in the universal applicability of the scientific method and approach, and the view that empirical science constitutes the most authoritative worldview or most valuable part of human learning to the exclusion of other viewpoints. Accordingly, philosopher Tom Sorell provides this definition of scientism: "Scientism is a matter of putting too high a value on natural science in comparison with other branches of learning or culture." It has been defined as "the view that the characteristic inductive methods of the natural sciences are the only source of genuine factual knowledge and, in particular, that they alone can yield true knowledge about man and society." The term scientism frequently implies a critique of the more extreme expressions of logical positivism and has been used by social scientists such as Friedrich Hayek, philosophers of science such as Karl Popper, and philosophers such as Hilary Putnam and Tzvetan Todorov to describe the dogmatic endorsement of scientific methodology and the reduction of all knowledge to only that which is measurable. "Scientism" has also been taken over as a name for the view that science is the only reliable source of knowledge by philosophers such as Alexander Rosenberg.


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## inferentialpolice (Nov 26, 2012)

> Inferential said: DSM5 recognizes the co-morbidity of DP and PTSD, even establishing a "Dissociative subtype of PTSD". It is estimated that 15-30% of PTSD suffers report DP symptoms





> TDX said: Which does nothing to disprove my statement, because this just says how many people with PTSD have depersonalization symptoms. If DPD was a truly trauma-based disorder the contrary should be true: Much more people with DPD should also have PTSD, which is just not true.


First, it is not "just" saying how many with PTSD have depersonalization SYMPTOMS. Here is the DP criteria to earn the additional PTSD moniker of PTSD-Dissociative subtype: "Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one's mental processes or body (eg, feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly)", and here is the DP criteria for DPD: "Experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (eg, perceptual alterations, distorted sense of time, unreal or absent self, emotional and or physical numbing)" As you might appreciate, those meeting the PTSD dissociative subtype criteria likely meet the DPD criteria, so we ARE in fact saying 15-30% of PTSD would, if assessed from the point of view of a dissociative disorder, have DPD.

Second, DPD is a function of chronicity of "truama" -- what I call chronic invalidation of self -- but folks can get PTSD from isolated traumas (car crashes, etc) and one wouldn't expect those sufferers to have persistent DP symptoms. So there are lots of PTSD instances without DPD, but the fact that so many PTSD suffers do not have DPD does not mean DPD is not a trauma-related disorder. And PTSD has certain elements of awareness of trauma and types of trauma that would exclude some DPD suffers from qualifying even if they had been subjected to, for example, chronic emotional invalidation. Taken together: Types of traumas (eg, non chronic) that give rise to PTSD do not necessarily give rise to DPD, and "traumas" that give rise to DPD are not fully incorporated into what PTSD criteria describe as trauma. The sort of trauma that gives rise to DPD is increasingly recognized by the PTSD world as "Complex PTSD", which I call "A dissociative disorder".


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## TDX (Jul 12, 2014)

> As you might appreciate, those meeting the PTSD dissociative subtype criteria likely meet the DPD criteria, so we ARE in fact saying 15-30% of PTSD would, if assessed from the point of view of a dissociative disorder, have DPD.


They might fail to fulfill criterion E.

And I said _"Much more people with DPD should also have PTSD, which is just not true."_. You are talking about the contrary.



> The sort of trauma that gives rise to DPD is increasingly recognized by the PTSD world as "Complex PTSD", which I call "A dissociative disorder".


It's not accepted as a mental disorder.


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## inferentialpolice (Nov 26, 2012)

And I said "And PTSD has certain elements of awareness of trauma and types of trauma that would exclude some DPD suffers from qualifying even if they had been subjected to, for example, chronic emotional invalidation. ", which explains why the criteria of PTSD do not fit chronic invalidation sufferers, and hence why it is not the case that "much more people with DPD should also have PTSD".


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