Helping multiples and their loved ones to remember the music
| Post-Traumatic Stress Disorder Glossary |
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The following is a list of terms used on this site, as well as terms you may have heard elsewhere which pertain to PTSD, PTSD therapy and related disorders. Abreaction - the verbal expression of unconscious thoughts or feelings, usually in the presence of a therapist. Acute Stress Disorder -A disorder first named in DSM-IV. It is similar to Post-Traumatic Stress Disorder (PTSD) in that it is evoked by the same types of stressors that precipitate PTSD. However, in this disorder, the symptoms occur during or immediately following the trauma. The primary criteria are the same as those for PTSD, except that the disturbance lasts for a minimum of two days and a maximum of four weeks and occurs within four weeks of the traumatic event. Adapted from DSM-IV, p. 432. Adult Survivor -An adult presumed to have survived and escaped from the control and abuse of a satanic cult, especially one who has recovered repressed memories of such abuse. Affiliation - the ability and willingness to feel a part of or connected to other people or groups of people. Alexithymia -The inability to recognize or describe what one feels. This is common in post-traumatic stress disorder, somatization, dissociative disorders and conversion disorders. Amnesia -"Pathologic loss of memory; a phenomenon in which an area of experience becomes inaccessible to `conscious' recall. The loss in memory may be organic, emotional, dissociative, or of mixed origin, and may be permanent or limited to a sharply circumscribed period of time." American Psychiatric Glossary, p. 13. Anatomical Dolls - specially made dolls that have genitalia specific to sex and age, that is, those dolls that represent adults have larger genitalia with pubic hair; the female adult doll also has developed breasts. In a clinical setting, these dolls are useful tools to help the child demonstrate sexual acts or help the clinician understand the child's curiosity and relationship to various body parts. Because these dolls are often used to represent the perpetrator and victim, special attention to the child's feelings and behavior is important when the dolls are utilized to prevent retaumatization. Anniversary Reaction -The experience of reacting with feelings or behavior on the "anniversary" of a previous event. For example, an individual whose house burned down on September 22nd may for years after the event have intense feelings or reactions on or around September 22nd. In some cases the person may not even consciously recall why he or she is feeling differently on that date. A common anniversary reaction is temporary depression. Anxiety - the persistent feeling that danger or harm is imminent. Assessment - the beginning stage of therapy in which information is gathered that helps the professional understand the possible origins of the symptoms and decide the best methods in which to address and modify those symptoms. Attachment Theory - a developmental theory that emphasizes the relationship between an infant and its caretaker(s). Typically, attachment theory states that the preliminary framework for relationship patterns is established through early childhood relationships (i.e., through interactions with parents and siblings), but this framework is malleable and subject to change throughout an individual's lifetime. Attributions - beliefs or perceptions about the self, others, and the world that are derived from training, learning, or experience. Autonomic Arousal -A physical symptom of PTSD which occurs automatically when a person perceives a situation to be life-threatening. Also known as nervous system hyper-reactivity, this physical response bypasses the cognitive/thinking process and generally includes an elevated heart rate, dilation of pupils, perspiring, and other fear responses. Trauma survivors may re-experience autonomic arousal when remembering traumatic events. Behavioral Memory -A lay term for implicit (or habit) memory. This type of memory is encoded in terms of a pattern of behavior rather than explicit knowledge. This term often refers to actions or fears which may indicate unconfirmed memories. (Lenore Terr, M.D., personal correspondence, 31 August 1994). Behavioral Theory - initially established by John B. Watson, the theory that overt behavior is the sole basis for scientific psychology. Founded on operant conditioning principles, behavioral theory attempts to explain the causeeffect relationship between the class of stimulus variables and response variables, with reinforcement stimuli increasing behaviors and punishment stimuli decreasing behaviors. Body Memory -This popularly-used term is actually a misnomer. The body does not have neurons capable of remembering; only the brain does. The term refers to body sensations that symbolically or literally captures some aspect of the trauma. Sensory impulses are recorded in the parietal lobes of the brain, and these remembrances of bodily sensations can be felt when similar occurrences or cues restimulate the stored memories.(Lenore Terr, M.D., personal correspondence, 31 August 1994). For example, a person who was raped may later experience pelvic pain similar to that experienced at the time of the event. This type of bodily sensation may occur in any sensory mode: tactile, taste, smell, kinesthetic, or sight. Body memories may be diagnosed as somatoform disorder. Brief Reactive Psychosis -One of the trauma related disorders listed in the DSM-III-R. It consists of a sudden and brief psychosis (loss of reality contact) lasting from a few hours to no more than one month. It is preceded by a major stressor which would be extremely stressful to almost anyone in similar circumstances in that person's culture. This has been renamed Brief Psychotic Disorder in DSM-IV with a slight modification in the criteria. Adapted from DSM-III-R, p. 207. Clinical Supervision - allows the therapist to seek information and share his/her clinical experience with another professional who can offer guidance, knowledge, and support. Generally, the clinical supervisor is more experienced and can share insight gained from working with the client population. Supervision helps professionals become more realistic in their expectations for themselves and their clients. It also allows therapists to share the burden of hearing and responding to numerous disclosures of child maltreatment and know that some other professional is aware of the work being done. Co-Consciousness -For a person with DID (MPD), this is the awareness of the thoughts, feelings, beliefs, needs, etc. of other personality states. Cognitive/Behavioral Treatment -A treatment approach that focuses both on observable behavior and on the thinking or beliefs that accompany the behavior. In psychotherapy, dysfunctional or maladaptive behaviors, thoughts, and beliefs are replaced by more adaptive ones. This approach is increasingly being used in the treatment of DID (MPD) and BPD. Cognitive Distortion -An error in thinking or reasoning based on drawing incorrect conclusions about past experience. For example, a trauma survivor who was sexually abused by a man with a beard might overgeneralize from the trauma experience and conclude that all men with beards are dangerous. Cognitive Functioning - awareness of objects, thoughts, or perceptions. Cognitive Theory - as a development of behavioral theory, cognitive or cognitivebehavioral approaches aim to change behavior by changing an individual's cognition. Cognitive Therapy A form of therapy that focuses on what the client thinks or believes. In this model, faulty thinking is seen as the basis for negative emotions and maladaptive behavior. Therapeutic intervention helps clients explore erroneous thoughts and beliefs and replace them with a more realistic assessment of themselves and their situation. Complex PTSD -(also complex, chronic PTSD) A term used to refer to dissociative disorders. Conjoint Therapy - therapeutic approach whereby the therapist works with a pair of clients, generally parent/caregiver victim, sibling victim, perpetrator victim (when appropriate), to facilitate communication and appropriate interaction and improve the relationship of the two individuals. Containment -The process of consciously postponing dealing with intrusive PTSD symptoms, being able to notice a symptom, communicate about it, set it aside (contain it), and revisit it later. Content and Process - two forms of information that are useful in gauging a client's participation in therapy. Content includes the specific topics or information that are discussed in the session whereas process includes information about the client's behavior and interaction. Conversion Disorder -Often precipitated by psychosocial stress, people with trauma histories have a higher than average rate of conversion disorder. The DSM-IV criteria are: One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition The initiation or exacerbation of the symptom or deficits is preceded by conflicts or other stressors The symptoms or deficits are not intentionally produced or feigned The symptoms or deficits cannot be fully explained by a general medical condition, by the direct effects of a substance, or as a culturally sanctioned behavior or experience The symptoms or deficits cause clinically significant distress or impairment in functioning or warrant medical evaluation The symptoms or deficits are not better accounted for by another mental disorder. Co-Presence -This occurs when two or more personalities are simultaneously present with or without knowledge of each other's existence or current presence. They may or may not exert influence on each other. Countertransference - the conscious and unconscious emotional reactions of the professional to the client. Delayed Memory -This term is used to describe the experience of an individual who recalls a memory for which he or she was previously amnestic. The recollection may occur spontaneously or in the context of therapy. This is a controversial concept: some individuals believe that delayed memory is an understandable response to traumatic stressors and others believe that important events, especially traumatic ones, are not forgotten. The term "delayed memory" is often used interchangeably with repressed memory, or false memory, but there are different meanings for these terms. Depersonalization Disorder -One of the dissociative disorders described in DSM-IV. The criteria include: Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body During the depersonalization experience, reality testing remains intact The depersonalization causes clinically significant distress or impairment in functioning The depersonalization experience is not attributable to another mental disorder, the effects of a substance, or a general medical condition. Derealization -A feeling of estrangement or detachment from one's environment. A sense that the external world is strange or unreal. Often accompanied by depersonalization. Developmental Milestones - important tasks and accomplishments that occur during the child's normal development including, but not limited to, walking, talking, toilet-training, school attendance, puberty, sexual interest and contact, marriage, and birth of children. Developmental Psychopathology - the perspective of understanding problems and abnormal interpersonal processes within an individual within the context of that individual's developmental abilities and skills. Diagnostic And Statistical Manual Of Mental Disorders -The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM- IV) was published in 1994 by the American Psychiatric Association. It contains standard definitions of psychological disorders. DSM-III-R refers to the third edition, revised, of the same manual, published in 1987. The diagnostic categories referred to in the trauma literature published in the late 1980s and early 1990s are those from the DSM-III-R. Dissociation -The separation of ideas, feelings, information, identity, or memories that would normally go together. Dissociation exists on a continuum: At one end are mild dissociative experiences common to most people (such as daydreaming or highway hypnosis) and at the other extreme is severe chronic dissociation, such as DID (MPD) and other dissociative disorders. Dissociation appears to be a normal process used to handle trauma that over time becomes reinforced and develops into maladaptive coping. Dissociative Amnesia -One of the dissociative disorders described in DSM-IV. The three criteria are: One or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness The disturbance does not occur exclusively during the course of another mental disorder, is not due to the effects of a substance, a neurological and/or other general medical condition. The symptoms cause clinically significant distress or impairment in functioning. There are several types of memory disturbances including: localized amnesia, selective amnesia, generalized amnesia, continuous amnesia, and systematized amnesia. Dissociative Disorder Interview Schedule (DDIS) -A structured interview developed for both clinical and research purposes to standardize the diagnosis of DID (MPD). It takes 30-45 minutes to complete. The DDIS has shown that DID(MPD) is a valid diagnosis with a consistent set of features and that both dissociative experiences and dissociative disorders are common. Developed by Ross, Heber, Norton and Anderson, the DDIS has been used in several research studies and has good clinical validity. Ross, Multiple Personality Disorder, p.135. Dissociative Disorder Not Otherwise Specified (DDNOS) -In DSM-IV this is the diagnostic category for individuals who have dissociative symptoms but do not meet the minimum criteria for any of the specific dissociative disorders. A client who has some (but not all) DID symptoms, and who does not have amnesia for important personal information, would be an example of a person with DDNOS. DSM- IV, p. 590. Dissociative Disorders -A group of psychiatric conditions with the disruption in the integrated functions of consciousness, memory, identity, or perception of the environment. DID (MPD) is one disorder in this category. See also dissociative amnesia, dissociative fugue, dissociative identity disorder, dissociative disorders not otherwise specified. Adapted from DSM-IV, p. 477. Dissociative Experiences Scale (DES) -Developed by Frank W. Putnam M.D. and Eve B. Carlson, Ph.D., the DES is a 28-item self-report instrument that can be completed in about 10 minutes. It asks the respondent to indicate the frequency with which certain dissociative or depersonalization experiences occur. An example of a typical DES question is "Some people have the experience of feeling that their body does not seem to belong to them. Circle a number to show what percentage of the time this happens to you." Dissociative Fugue -One of the dissociative disorders described in DSM-IV. The diagnostic criteria are: Sudden, unexpected travel from home or work, with the inability to recall some or all of one's past Confusion about personal identity or assumption of a new identity The disturbance does not occur exclusively during the course of DID and is not due to the effects of a substance or general medical condition The symptoms cause clinically significant distress or impairment in functioning. The onset of dissociative fugue is usually related to traumatic, stressful, or overwhelming life events. In DSM-III- R, this was called psychogenic fugue. Dissociative Identity Disorder (DID) -One of the dissociative disorders in DSM- IV. There are four diagnostic criteria: The presence of two or more distinct identities or personality states At least two of these identities or personality states recurrently take control of the person's behavior Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness The disturbance is not due to the direct physiological effects of a substance or a general medical condition. DID is the current name for multiple personality disorder (MPD), first used in DSM-IV. In addition to the name change, the criteria was increased by two items, items C and D. The term DID is felt to reflect more accurately the condition of an individual with two or more personality states. This change recognizes that MPD represents the failure to form one core personality rather than to simply create many personalities. Adapted from DSM-IV, p. 487. Documentation - information related to provision of therapeutic services. Generally, this information includes date of service, persons present during the session, brief description of topics covered, the client's responses to the subject matter, and the date of the next scheduled appointment. Suicide or homicide ideation, threat, or intent must be documented with appropriate responses, including all attempts to protect the client as well as intended victims. Any child abuse and neglect disclosures must be documented and reported to the appropriate authorities. Eating Disorders -A category of mental disorders described in DSM-IV. Individuals with these disorders, such as anorexia nervosa and bulimia, show a marked disturbance in eating behavior. Some individuals with DID (MPD) and PTSD also have an eating disorder. Ego Defenses - unconscious attempts such as denial, projection, rationalization, regression, intellectualization, and sublimation which are used to manage overwhelming emotions or experiences. Experiential Therapies -Therapeutic techniques that utilize metaphors and analogies to help clients understand and change their behaviors, traditionally in a group format. These techniques encourage the client to directly experience feelings and thoughts by participating in activities such as art, group sculpting, outdoor challenge courses, etc. See also expressive therapies. Explicit Memory -Consciously recalled facts or events (knowing that) which have verbal components. This is the form of memory used, for example, when a person recounts the events of his or her day at work or at school. Also referred to as narrative or declarative memory. See also implicit memory. Expressive Therapies -Specific therapeutic techniques that facilitate expression of feelings through language or movement. Examples include dance, art, and poetry therapy. Most often used as adjunctive therapy to gain access to feelings or memories, expressive therapies are increasingly used for primary treatment in trauma cases. Since traumatic memories may be stored on sensory motor or visual levels, the use of these therapies may access memories not usually available through talking therapy. Eye Movement Desensitization and Reprocessing (EMDR) -A procedure which produces rapid eye movements in a client while a traumatic memory is recalled and processed. This technique seems to lessen the amount of therapeutic time needed to process and resolve traumatic memories. Developed by Francine Shapiro, this technique requires training and following of specific protocols for appropriate use. False Memory -A term developed in the early 1990s by the False Memory Syndrome Foundation to describe memories that are not based on actual events. This term is popular in the media, although the concept of false memory is not based on clinical research or accepted theoretical formulation. The terms false memory, delayed memory, and repressed memory are often used interchangeably in the popular literature but they actually have distinct meanings. Family Support Services -Community-based preventative activities designed to alleviate stress and promote parental competencies and behaviors that will increase the ability of families to successfully nurture their children, enable families to use other resources and opportunities available in the community, and create supportive networks to enhance child-rearing abilities of parents. Family Systems Theory - a view of how family members interact with one another in relationship patterns that promote and/or accommodate the functioning of the family as a unit (or system). Family Therapy - the therapist and cotherapist, when possible, work with family members, including parents, siblings, and extended family members (e.g., grandparents) in a group setting to address the changes necessary to ensure the safety and protection of the children in the family, especially the identified victim. Any problems or confusion generated by the abuse or neglect are also dealt with. Flashbacks -A type of spontaneous abreaction common to victims of acute trauma. Also known as "intrusive recall," flashbacks have been categorized into four types: dreams or nightmares dreams from which the dreamer awakens but remains under the influence of the dream content and has difficulty making contact with reality conscious flashbacks, in which the person may or may not lose contact with reality and which may be accompanied by multimodal hallucinations unconscious flashbacks, in which a person "relives" a traumatic event with no awareness at the time or later of the connection between the flashback and the past trauma. Putnam, Diagnosis and Treatment of Multiple Personality Disorder, pp. 236-237. Flight Or Fight Response -An automatic response to an experience that is perceived to be a threat to survival. The part of the brain that regulates metabolic and autonomic function and prepares muscles to act -- to either flee or fight. This survival mechanism works well when the situation allows for an active response. In repeated traumatic situations, when there is no opportunity to fight or flee, this response may result in a chronic state of physiological arousal which is very stressful to the body. Flooding -The process of becoming overwhelmed by intrusive emotions, sensory experiences, or intense re-living experiences; commonly associated with posttraumatic stress disorder. Fragment -Within the personality system of a person who has a dissociative disorder, a fragment is a dissociated part of that person which has limited function and is less distinct or developed than a personality state. Usually a fragment has a consistent emotional and behavioral response to specific situations. For example, a fragment may handle the expression of feelings through drawing. The term "special purpose fragment" refers to a part with an even more narrowly defined function. Genogram - a diagram of family members and their relationship to each other. This chart is useful to help the client understand the intergenerational aspects of child abuse and neglect and helps the client acknowledge helpful or problematic familial relationships. In DID, may be of internal family as well as external. Grounding -Reality based awareness in the here and now, a sense of connectedness to yourself and your environment. Group Therapy - treatment approach in which the therapist and cotherapist work with a group of clients similar in age and experiences (e.g., sexual abuse, physical abuse, parents of victims) to help them share their thoughts and feelings related to their situation. This approach is particularly useful with clients who feel alienated or different from their peers or who have isolated their feelings as well as clients who would benefit from learning more positive and productive ways for interacting with others. Host -In dissociative identity disorder, the personality state that most frequently has control of the body and its behavior. The host is often initially unaware of the other identities and typically loses time when they appear. The host is the identity that most often initiates treatment, usually after developing symptoms, the most common being depression. Hypermnesia -This experience of heightened memory is a symptom of PTSD. It is the opposite of amnesia, which is the forgetting of events. Hypermnesia consists of abnormally sharp or vivid recall. For example, a trauma survivor may vividly remember a traumatic event with total recall of all details--sight, sound, feel, smell, and touch. Hypermnesia may be intrusive and may interfere with everyday functioning. Hypervigilance -One of the symptoms of PTSD. In this state an individual is overly sensitive to sounds and sights in the environment, scans the environment expecting danger, and feels keyed up and on edge. In addition, a traumatized person may have an exaggerated startle response and problems with memory and concentration. Hypnosis -An altered state of consciousness which is subjectively experienced by an individual as different from normal alertness. This may occur spontaneously, as in spontaneous trance, or may be suggested by a therapist or hypnotist. The individual who is hypnotized may experience altered perception or memory. Hypnosis is often used in the treatment of DID (MPD) to facilitate communication between personality states, to overcome amnesiac barriers and to promote healing through managed abreaction. Before using hypnosis in treatment it is recommended that the client be provided with enough information to give his or her informed consent and that this be documented. Hypnosis is also referred to as being in a trance state. The process of dissociation itself may be a form of self-hypnosis. Ideation - the formation of images and objects in the mind. Ideomotor Signaling -A hypnotic technique wherein the client and therapist agree on prearranged body movements to answer questions non-verbally. The most common technique uses finger signals to stand for "yes," "no," and "stop." This allows nonverbal communication of unconscious material during hypnosis. Often the client will experience the movement of the fingers as "outside conscious control." The technique may be used to contact personality states without direct emergence of those personality states. Imagery -Using your imagination to manage stress responses and feelings. Immunity - established in all child abuse laws to protect reporters from civil lawsuits Implicit Memory -Behavioral knowledge of an experience (knowing how) without conscious recall or verbal components; habit memory. Driving, riding a bicycle, or reading are examples of skills which people implicitly remember how to do without consciously remembering steps involved. This type of memory is almost always irretrievable in words. (Lenore Terr, M.D., personal correspondence, 31 August 1994.) Also called procedural or sensorimotor memory. Individual Therapy - treatment approach in which the therapist and client work together in a one-to-one relationship to address thoughts, feelings, and behavior generated by the experience of abuse or neglect. Integration -The ongoing process of bringing together all dissociated aspects of self, whether they are thoughts, feelings, behavior, or are organized as personality states or fragments. This process begins before the fusion of specific personality states and continues throughout the psychotherapy. There is lack of agreement about the end goal of DID (MPD) treatment. Some therapists and clients consider integration the treatment goal while others do not. This complex decision is best discussed together by therapist and client. International Society for Traumatic Stress Studies, Inc. (ISTSS) -A non-profit organization to "promote the advancement of knowledge about the immediate and long-term human consequences of extraordinary events and to promote effective methods of preventing or ameliorating the unwanted consequences of them." ISTSS Membership Directory, 1993, p. iii. Interpersonal Development - developmental processes between the child and other persons in his/her life (e.g., parents, siblings, extended family members, or peers). Interpretation - a hypothesis about seemingly random symptoms or behavior that is connected to meaningful experience. During interpretation, the client connects his/her symptoms with a reasonable explanation that helps him/her make sense of the experience. Intimacy - the need and/or ability to feel close to other persons, especially an age-appropriate responsive and willing partner. The ability to feel intimate usually involves sharing one's most personal thoughts, feelings, and/or behaviors. Intrapersonal Development - developmental processes that occur within the child (e.g., development of affects, empathy, or intelligence). Learned Helplessness -A term developed by Martin Seligman, pioneering researcher in animal psychology, to describe what occurs when animals or human beings learn that their behavior has no effect on the environment. The impact of this experience leaves an individual apathetic, depressed, and unwilling to try previous or new behavior. This concept is relevant to people with dissociative disorders who may show some degree of learned helplessness due to repeated exposure to traumatic events which they could not change or avoid by their behavior. Learning Theory - in clinical work and therapy, learning theory is typically referred to as social learning theory, which assesses the synergistic effects of behavior, personal factors, and the environment. This may involve observational learning, modeling, and/or cognitions. Medical Personnel -A person employed by a medical facility or practice, including physicians, physician assistants, nurses, emergency medical technicians, dentists, dental assistants and technicians, chiropractors and coroners. Memory -"The ability, process, or act of remembering or recalling; especially the ability to reproduce what has been learned or explained." American Psychiatric Glossary, p. 126. The question, "What is a memory?" has become increasingly controversial in the last decade. As PTSD and dissociative disorder clients report delayed and dissociated memories of childhood trauma, the accuracy or validity of these memories has been questioned. At the present time there is no reliable scientific method to assess the self-report of traumatic events. While the presence of corroborating evidence (or witnesses) may support a survivor's memories, it does not in itself determine the validity of abuse reports. Mental Health Personnel -A person employed by a mental health facility or practice, including psychologists, psychiatrists, therapists, etc. Mental Status Exam (MSE) -The MSE, which is conducted by a mental health professional, is a formal evaluation of a client's current psychological, emotional, and behavioral functioning. Areas of assessment include: orientation to time, place, and person as well as thought content, cognition, mood, affect, insight, and general intelligence. This evaluation is usually summarized on the five axes of DSM-IV and in a narrative report. Metaphor - a phrase or story that represents themes and offers the client insight into his/her feelings, thoughts, and behavior. Modalities - approaches to psychotherapy that include individual, group, or family therapy. Non-Amnesic Dissociator -A person who uses partial dissociation as a defense mechanism. Numbing -A symptom common to individuals with PTSD. It represents an individual's attempt to compensate for intrusive thoughts, memories, or feelings of the trauma by shutting down and becoming numb to internal or external stimuli. Also called psychic numbing. Original Personality -This term is no longer commonly used but is found frequently in the historical MPD literature. In earlier MPD theory, this refers to the personality state with which an individual is born and from which other personality states were "split off." Passive Influence -Individuals with dissociative disorders often experience their actions or thoughts as being controlled by dissociated aspects of the self. Some may feel that a passive outside or inside force has control without an overt or visible expression of that influence. Automatic writing is an example of passive influence. Personality Disorders - the implication of inflexible and maladaptive patterns of behavior, of sufficient severity to cause either significant impairment in adaptive functioning or subjective distress. Posttraumatic Stress Disorder (PTSD) -An anxiety disorder based on how an individual responds to a traumatic event. According to DSM-IV, the following criteria must be met: The person has experienced a traumatic event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and the person's response involved intense fear, helplessness, or horror The traumatic event is re-experienced in specific ways such as recurrent and intrusive distressing recollections or dreams of the event Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness Persistent symptoms of increased arousal, such as hypervigilance or irritability Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month The disturbance causes clinically significant distress or impairment in functioning. PTSD may be acute, chronic, or with delayed onset. Many individuals with DID (MPD) also have PTSD. The literature sometimes describes DID(MPD) as complex and/or chronic PTSD. Adapted from DSM-IV, p. 427-429. Prognosis - anticipated outcome for the client participating in therapy. Outcome is often affected by factors such as the client's developmental and cognitive capacity and ability, parent/primary caretakers' availability and response to therapy, and client's willingness to participate in and utilize the therapeutic relationship. Psychopathology - the branch of medicine that deals with the causes and nature of mental disease. Psychotherapy - a method of treatment designed to produce a response by mental rather than physical stimuli; it includes the use of suggestion, persuasion, reeducation, reassurance, and support as well as hypnosis and psychoanalysis. Regression - behavioral state in which the client reverts to an earlier or younger developmental stage and demonstrates behavior such as increased dependency, soiling or wetting problems, or temper tantrums. Repetition Compulsion -Originally defined by Freud as the repetitive re-enactment of earlier emotional experiences, this type of behavior may be seen in the lives of trauma survivors. For example, a survivor of traumatic abuse may put herself in a situation where there is a risk of additional abuse in an attempt to psychologically master the previous traumatic experiences. Repression -An unconscious defense mechanism which occurs when unacceptable ideas, images, or fantasies are kept out of awareness. This is done without an individual consciously knowing that it has taken place. Repression is one psychological mechanism that may account for amnesia of traumatic events. Re-Traumatizing -Re-enacting or reinforcing a traumatic experience or belief. Revictimization -Describes the experience of a survivor being victimized or traumatized after the original trauma. Examples of revictimization include psychological abuse that may occur in a survivor's interactions with authorities such as the courts, law enforcement personnel, or therapists. This process is important to address in therapy. In some cases it seems that a survivor may unconsciously allow or encourage this subsequent trauma to occur. Revivification -The vivid remembering of past experiences. When remembering traumatic events the client may see, hear, taste, smell, and feel as though the event is happening in the present. This is common during an abreaction or flashback of previous trauma. Risk Assessment - an assessment and measurement of the likelihood that a person will be maltreated in the future, usually through the checklists, matrices, scales, and/or other methods of measurement. Role Play - therapeutic approach which presents the opportunity to "try out" various roles or positions that are unfamiliar or confusing to the client. Role play is also an opportunity for the client to practice skills (e.g., a teenager practicing "no" to a sexual activity for which he/she is not ready). Sand Tray Therapy -A therapeutic technique, similar to play therapy, in which a tray of sand with figures and toys is provided for a client to create a scene or story to be discussed with a therapist. The "world" that a client creates may directly or symbolically represent previous life experiences, conflicts, feelings, or fears. This technique, when used to process traumatic events, allows a client emotional distance and the opportunity to process the feelings, thoughts, and beliefs that may accompany a traumatic experience. Screen Memory -A partially true memory that an individual subconsciously creates because the actual memory is intolerable. For example, a client may report abuse by a distant uncle when actually the abuser was the father. This disguised presentation allows the client time to adjust to aspects of the abuse before accepting the total reality of the situation. Script Memory -A type of memory that is created during ritual or cult abuse when a person is given a scripted identity and memories. For example, a victim may given a historical identity and the information and memories related to that identity. Mungadze, "Scripts and screen memories in victims of ritual abuse: etiological and treatment implications," November 1992 Conference, ISSMP&D. Self-Harm -The action of harming oneself without the intent to commit suicide. The many forms of self-harm include cutting, burning, eating disorders, etc. For trauma survivors, self-harm can function as tension reduction, punishment, trauma re-enactment, or rage expression. Also called self-inflicted violence or self-injury. Self-Hypnosis -"Spontaneous or purposeful hypnotic trance states produced within his or her own psyche. These states may include any or all of the full range of hypnotic phenomena such as sensory alterations, anesthesia, time distortion, relaxation, age regression, and alterations in physiological functioning." ISSD Practice Guidelines, Glossary, 1994. Self-Mutilation -A form of self-harm motivated specifically by the desire to scar or disfigure one's body; "Defined by Walsh and Rosen (1988) as `deliberate, non- life-threatening, self-effected bodily harm or disfigurement of a socially unacceptable nature' (p.10), self-mutilation most typically involves repetitious cutting or carving of the body or limbs, burning of the skin . . . ." Briere, Child Abuse Trauma: Theory and Treatment of the Lasting Effects, p. 66. See also self-harm. Self-Regulation -The process of consciously managing different internal states by 1. experiencing them as they come up, 2. expressing what you are experiencing, 3. consciously postponing dealing with traumatic material or overwhelming aspects of feelings, and 4. retrieving part of what you have contained when you are better able to manage it. Sleep Disorders -A category in DSM-IV which includes various disorders of sleep: primary sleep disorders such as insomnia and secondary sleep disorders due to medical conditions. Sleep disturbances are common in people with PTSD. Social Desirability - the tendency for an individual to alter his/her response to a question in a manner that is consistent with his/her perception of the interviewer. Social Skills Group - therapeutic experience that focuses on teaching types of social interaction that facilitate appropriate relationships with peers and responsible adults. Communication skills such as listening, asking questions, sharing information, learning assertiveness, resolving conflict, and learning behaviors that appropriately express nurturing and affection are often practiced within this type of group. Somatic Memory -"A physical sensation or change in physical functioning without the presence of organic illness, that represents a dissociated aspect of a traumatic or abusive experience." ISSD Practice Guidelines, Glossary, 1994. Somatoform Disorder -According to DSM-IV, the common feature of somatoform disorders is the presence of physical symptoms that suggest a general medical condition but are not fully explained by a general medical condition, by the direct effects of a substance, or by another mental disorder. These conditions may represent the unconscious conversion of psychological conflicts to medical problems or medical concerns. Examples of somatoform disorders include: somatization disorder, conversion disorder, and hypochondriasis. Adapted from DSM-IV, p. 445. Startle Reaction -This symptom of both PTSD and generalized anxiety disorder occurs when an individual reacts strongly to new and unexpected stimuli in the environment. An example of a startle reaction would be jumping out of a chair when a door is slammed. Also called startle response. State Dependent Memory -A similar concept to state dependent learning. Based on research and clinical experience, it appears that information and events may be best remembered in the same emotional or physiological state in which it was learned. For trauma survivors an event that produced extreme fear may not be recalled during normal everyday conditions, including psychotherapy. Recall of this past event may only be available to consciousness at another time of extreme fear. This is one reason why a current traumatic event, with all the feelings and high arousal state, may trigger memory of forgotten earlier trauma. Also referred to as context dependent memory. Stigma - negative meaning associated with experience or behaviors. Support Systems - individuals or groups of people who are helpful and responsive to the client. These individuals or groups may include family, friends, and professionals such as therapist, social worker/caseworker, or group member. Symptoms - emotional or behavioral reactions to the experience of abuse and/or neglect. Talking Through -The therapeutic technique of talking to the personality system as a whole or talking to one or more personality states that are not in executive control. For example, a therapist may say "I want everyone inside to listen," or "I want to talk to Mean Bill inside who made that angry phone call last week." Talking this way encourages the system to work together and to dissolve the dissociative barriers. Therapeutic Alliance/Therapeutic Relationship - the understanding that the client gains that the purpose of the interaction between therapist and client is intended to benefit the client and is organized to help the client explore and learn from painful and/or overwhelming experiences. The client's willingness to accept and acknowledge the value of the therapeutic relationship is based on the therapist's ability to be trustworthy, responsible, and useful to the client. Trance Logic -The ability of a hypnotized person to tolerate the existence of inconsistent perceptions or ideas. "The inconsistent perceptions are not kept isolated but appear in juxtaposition . . . The essence of this phenomenon seems to be the suspension of critical thinking." Udolf, Handbook of Hypnosis for Professionals, pp.108-108. Trance State -A dissociative state one enters when hypnotized in which memory and perception are altered. The dissociative effects of the trance state can also be induced by other conditions such as physical or mental exhaustion, terror, repetitive chanting, rituals, or drugs. Not all individuals are equally susceptible to trance or to dissociation. Research has shown that those people who show a high degree of susceptibility to hypnosis are likely to possess some apparently biological predisposition to it. They are also more likely to have been victims of abuse as children. Some states of trance seem to be self-induced and function as a defense against experiencing the overwhelmingly painful stimuli of an abusive environment. For some individuals, the use of self induced trance and dissociative states in the face of severe abuse can be associated with the development of multiple personality disorder. Trances also can be induced by another person who functions as a hypnotist. The hypnotist can give post-hypnotic suggestions to the individual in trance to carry out certain carefully defined actions or to experience certain emotions or physical sensations after the trance state is over. These actions or emotions are usually triggered by certain discrete cues that have been suggested to the subject while s/he was in trance. The mind control from which many ritual abuse victims suffer is in part a result of having been put into trance states repeatedly and given a complicated series of post-hypnotic suggestions (see RITUAL ABUSE AND THE USE OF MIND CONTROL). However, hypnosis and trance states also have an important role to play in treating ritual abuse victims. In trance employed in a therapeutic environment, victims are often able to retrieve memories which have been dissociated from their conscious awareness. This process constitutes a very significant aspect of the ritual abuse victim's recovery. Transference - the unconscious transfer of feelings of hostility or affection from the client to the professional. Trauma -A medical term for any sudden injury or damage to an organism. Psychological trauma is an event that is outside the range of usual human experience and which is so seriously distressing as to overwhelm the mind's defenses and cause lasting emotional harm. Psychological traumata include natural disasters, accidents, or human actions, such as child abuse, rape, torture, etc., which cause the victim to be terrified, helpless, and under extreme physical stress. Most individuals with DID (MPD) have been victims of repeated trauma and generally also exhibit symptoms of post traumatic stress disorder. Traumagenic Dynamics - a model developed by Finkelhor that describes the short-and long-term sequelae of child sexual abuse (i.e., betrayal, traumatic sexualization, stigmatization, and powerlessness). Traumatic Transference -The unconscious assignment to a therapist of feelings and attitudes associated with an abuser during earlier traumatic events. For example, recalling being beaten in childhood, a client may ask the therapist not to hit or hurt her, as if she were talking to the abuser. Working through the traumatic transference may be an important aspect for understanding early childhood trauma. Triggered memories - These are forgotten memories that come rushing back suddenly into consciousness as a result of a trigger, such as the name, the voice, a photograph, a newspaper article about the perpetrator, etc. Trigger -An event, object, person, etc. that sets a series of thoughts in motion or reminds a person of some aspect of his or her traumatic past. The person may be unaware of what is "triggering" the memory (i.e., loud noises, a particular color, piece of music, odor, etc.). Learning not to overreact to triggers is a therapeutic task in the treatment of dissociative disorders. Type I and Type II Trauma -Terms developed by Lenore Terr to describe different types of trauma. A single traumatic event such as a fire or single rape episode is considered to be Type I Trauma. Repeated, prolonged trauma, such as extensive child abuse, is considered to be Type II Trauma. According to Terr's formulation of this concept, these two types of trauma result in different coping styles. Individuals with Type I Trauma receive support from family and friends and usually remember the trauma event. Individuals with Type II Trauma are more likely to have severe PTSD symptoms, such as psychic numbing, and dissociation. Type II Trauma is often kept a secret and support from family and friends may be absent. Terr, Unchained Memories, p. 11, 30. Validation - acknowledgment that the client's thoughts and feelings are worthy of attention. |
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