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Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders by James A. Chu
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“Unspeakable feelings need to find expression in words. However... verbalization of very intense feelings may be a difficult task.”
James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
“Self-destructiveness may be a primary form of communication for those who do not yet have ways to tame their excruciating inner conflicts and feelings and who cannot yet turn to others for support.”
James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
“THE RETURN OF THE REPRESSED: RELIVING DISSOCIATED EXPERIENCES

The reexperiencing of previously dissociated traumatic events presents in a variety of complex ways. The central principle is that dissociated experiences often do not remain dormant. Freud's concept of the “repetition compulsion” is enormously helpful in understanding how dissociated events are later reexperienced. In his paper, "Beyond the Pleasure Principle," Freud (1920/ 1955) described how repressed (and dissociated) trauma and instinctual conflicts can become superimposed on current reality. He wrote:

The patient cannot remember the whole of what is repressed in him, and what he cannot remember may be precisely the essential part of it. .. . He is obliged to repeat the repressed material as a contemporary experience instead of remembering it as something in the past. (p. 18)

If one understands repression as the process in which overwhelming experiences are forgotten, distanced, and dissociated, Freud posited that these experiences are likely to recur in the mind and to be reexperienced. He theorized that this "compulsion to repeat" served a need to rework and achieve mastery over the experience and that it perhaps had an underlying biologic basis as well. The most perceptive tenet of Freud’s theory is that previously dissociated events are actually reexperienced as current reality rather than remembered as occurring in the past. Although Freud was discussing the trauma produced by intense intrapsychic conflict, clinical experience has shown that actual traumatic events that have been dissociated are often repeated and reexperienced.”
James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
“Dissociative symptoms—primarily depersonalization and derealization—are elements in other DSM-IV disorders, including schizophrenia and borderline personality disorder, and in the neurologic syndrome of temporal lobe epilepsy, also called complex partial seizures. In this latter disorder, there are often florid symptoms of depersonalization and realization, but most amnesia symptoms derive from difficulties with focused attention rather than forgetting previously learned information.”
James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
“The term dissociation is ordinarily used to describe the phenomenon of compartmentalization or fragmentation of mental contents. It does not ascribe any particular mechanism by which the dissociative process occurs. Does dissociation occur as a result of automatic, nonconscious processes, or are there other specific mechanisms by which it occurs? Especially in the context of describing amnesia, the term repression is widely used in connection with several different mechanisms. As it is commonly used, it often implies how individuals may block our memories of uncomfortable or conflictual experiences. If done consciously, the mechanism is more accurately called suppression, which results from actively trying not to think about negative experiences.”
James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
“Posttraumatic stress disorder (PTSD) also has dissociative symptoms as an essential feature. PTSD has been classically seen as a biphasic disorder, with persons alternately experiencing phases of intrusion and numbing... [T]he intrusive phase is associated with recurrent and distressing recollections in thoughts or dreams and reliving the events in flashbacks. The avoidant/numbing phase is associated with efforts to avoid thoughts or feelings associated with the trauma, emotional constriction, and social withdrawal. This biphasic pattern is the result of dissociation; traumatic events are distanced and dissociated from usual conscious awareness in the numbing phase, only to return in the intrusive phase.”
James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
“Extreme versions of DID occasionally develop in response to particularly horrific ongoing trauma (e.g., children exploited through involvement in years of forced prostitution), with so-called poly-frgamentation, encompassing dozens or even hundreds of personality states. In general, the complexity of dissociative symptoms appears to be consistent with the severity of early traumatiation. That is, less severe abuse will result in fewer dissociative symptoms, and more severe abuse will result in more complex dissociative disorders.”
James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
“true acting out is an expression of intense underlying affects without conscious awareness of them, not just another undesirable and difficult patient behavior”
James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders