Unfortunately, many people experience violent or near death experiences. Some of those folks go on to have symptoms fitting the diagnosis of Posttraumatic Stress Disorder (PTSD): intrusive memories/flashbacks cause them to reexperience the event coupled with attempts to numb themselves in some way and yet still finding themselves in a heightened state of vigilance all of the time.
Since the Vietnam War, we’ve learned a lot about this set of problems. The primary forms of treatment touted now are controlled and imaginal exposure to the traumatic event(s) coupled with relaxation, distraction, and cognitive reframes. And we continue to learn about the presence of PTSD in violent family dynamics as mentioned last Monday (3/10/08).
But here are two articles pointing to somethings I hadn’t thought much about:
1. Perpetrators of violent crimes sometimes experience PTSD from their crimes. A group of English researchers did a study of 105 prisoners who had committed intentional violent crimes. 46% experienced distressing intrusive memories (one aspect of PTSD) and 6% met criteria for PTSD. The more antisocial the criminal before the crime, the less likely they would actually experience distressing intrusive memories. So, those who are most uncaring don’t really struggle with these problems. Here’s a question: should you try to help perpetrators with their distressing, intrusive memories? Does having them lead them to be less likely to re-victimize? Or do they make them more distressed, more hypervigilant and therefore more likely to attack?
Biblio: Evans et al. (2007). Intrusive memories in perpetrators of violent crimes: Emotions and cognitions. Journal of Consulting and Clinical Psychology, 75, 134-144.
2. Why is it that attachment literature and adult PTSD from child abuse literatures have been separate? Stovall-McClough & Cloitre of NYU ask this very question and review the literatures from each area. Attachment literatures come out of developmental theories while PTSD research tends to be CBT based. But the two are quite connected. Consider the authors points:
“As many as 48-85% of survivors of childhood abuse show a lifetime prevalence of PTSD…”
“As many as 80% of maltreated children [are] classified as [having a disorganized attachment pattern]…”
“…the theoretical mechanisms underlying the expression of both PTSD and [attachment problems], although developed separately, are notably similar.” How so? Both see powerful events stored in the mind that shape one’s sense of self and the world. Powerful and negative events are avoided in an “effort to contain the intensity of emotions triggered by attachment injuries or traumatic events
“When traumatic events are kept locked away or otherwise chronically avoided, the result is often long-term struggles with PTSD symptoms and ongoing fragmentation of memory and fear-related belief systems.”
Both unresolved attachment problems and PTSD lead to dissociative and intrusive self-focused thought patterns
Unresolved childhood attachment problems (as opposed to secure or dismissing attachment styles) may predict PTSD in adults
Avoidance strategies which help the individual manage distress from the abuse may, in fact, increase emotional distress and cognitive disorganization. This is sad in that those best able to divorce themselves from those early experiences (which may protect them as a child) may set themselves up for the most pervasive PTSD. I suspect that avoidance strategies hinder the person from being able to carefully evaluate themselves in a clear and helpful manner. Thus at a later point when they can no longer avoid, they have little sense of self to use to understand their place in the world.
Biblio: Stovall-McClough & Cloitre (2006). Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories. Journal of Consulting Psychology, 74, 219-228.