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Introduction The purpose of this glossary is to provide definitions for the frequently used terms in the field of traumatic stress disorders. The anticipated audience is diverse, ranging from mental health professionals to consumers of mental health services and their families. Because of this diversity, we have included general mental health terms for those unfamiliar with psychological literature. The goal is to provide a common vocabulary and common meanings for both general psychiatric and trauma disorder terms. Several editorial decisions that affect the structure and format of this glossary are described below:
If you have suggestions for additional terms to be included in the future update of this glossary, send your ideas to The Sidran Foundation. A
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Dissociative Disorders Glossary abreaction The discharge of energy [emotion] involved in recalling an event that has been repressed because it was consciously intolerable. The experience may be one of reliving the trauma as if it were happening in the present, complete with physical as well as emotional manifestations (also called revivification). A therapeutic effect sometimes occurs through partial discharge of or desensitization to the painful emotions and increased insight. Abreaction can happen spontaneously or can be therapeutically induced through verbal suggestion or hypnosis. Adapted from American Psychiatric Glossary, p.1. See also flashbacks. acting out Originally an analytic term referring to the expression of unconscious feelings about the analyst, the commonly used meaning is the expression of unconscious feelings or conflicts in actions rather than words. This can take many forms including dangerous behavior such as self-harm or suicidal gestures. 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. adjunctive therapies In addition to individual psychotherapy with a primary therapist, a client may receive other therapy such as art therapy, psychodrama, dance therapy, or assertiveness training. These are considered adjunctive therapies. affect "A pattern of observable behaviors that is the expression of a subjectively experienced feeling state (emotion). Common examples of affect are sadness, elation, and anger. In contrast to mood, which refers to a more pervasive and sustained emotional `climate,' affect refers to more fluctuating changes in emotional `weather.'" DSM-IV, p. 763. age regression See regression. alexithymia The inability to recognize or describe what one feels. This is common in post-traumatic stress disorder, somatization, and conversion disorders. alter Another term for personality, alternate personality or personality state; also called an identity or dissociated part. A distinct identity or personality state, with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self. Modified from DSM-IV, p. 770. "Alters are dissociated parts of the mind that the patient experiences as separate from each other." ISSD Practice Guidelines Glossary, 1994. 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. See also dissociative amnesia. 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. assertiveness training This is a cognitive/behavioral technique that teaches clients to express their feelings and needs rather than being passive and letting other people take advantage, overwhelm, or dominate them (a characteristic of people who were abused in childhood). After a client and therapist identify problem situations, the client practices appropriate confrontation. Assertiveness, a middle ground between being passive and aggressive/hostile, may be learned on a one-to-one basis or in a group. attachment (bonding) The process of developing and maintaining a healthy relationship between people; healthy attachment between a parent and child, is characterized by a sense of security, emotional attunement and regulation of physiological functioning such that the developing child becomes able to self-regulate over time. auto-hypnosis See self-hypnosis. 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. See also flight or fight response. Axis II pathology Axis II is one component of the diagnostic system described in the DSM- IV. Axis II contains the personality disorders, such as borderline personality disorder, narcissistic personality disorder and avoidant personality disorder. Personality disorders are defined as personality traits that are inflexible, maladaptive, and cause functional impairment or subjective distress. When a person has both DID and an Axis II diagnosis the treatment may be more complicated and chaotic. A person may resolve the DID and still need to deal with the Axis II diagnosis. Adapted from DSM- IV, p. 630. BASK The BASK model of dissociation developed by Bennett G. Braun, M.D., conceptualizes dissociation as dimensions of Behavior, Affect, Sensation, and Knowledge. For example, a client with DID (MPD) may experience the behavior of other personality states as separate, or may experience the intense feelings of a personality state as separate, or may have body sensations of pain with no memory of trauma, or one personality state may have "knowledge" of trauma but no feelings or physical sensations. The goal of treatment is the integration of the BASK components over time. Braun, "The BASK Model of Dissociation," pp. 4-23. 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). blending A commonly used dissociative disorders term coined by Catherine Fine, M.D. which refers to the moment at which the personality states or fragments temporarily come together as a single entity, either spontaneously or with the help of a therapist. 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. See also somatic memory. borderline personality disorder (BPD) Borderline personality disorder is best understood as an attachment disorder. "The essential feature of Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts," as indicated by five (or more) of the following:
boundaries For the comfort and safety of the client, therapist, and other outsiders, behavioral boundaries often need to be established. These limits may affect a range of issues from details of personal and therapeutic interactions, such as length of therapy sessions; appropriate touching; number, and duration, of phone calls to prevention of assault and suicide. Setting boundaries is particularly important in the treatment of dissociative disorders since lack of boundaries is usually a part of the history of a person who has been abused. 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. brief psychotic disorder The DSM- IV criteria are:
co-consciousness For a person with DID (MPD), this is the awareness of the thoughts, feelings, beliefs, needs, etc. of other personality states. co-existing disorders Refers to cases in which an individual has more than one mental disorder as described in the DSM-IV. Also known as co- morbidity. See also dual diagnosis. 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 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. See also Posttraumatic Stress Disorder. confabulation This term originally referred to a neurological deficit in which a person who is unable to recall previous situations or events fabricates stories in response to questions about those situations or events. It is now used more broadly to refer to "false memories" that are supposedly created in response to questions asked by a therapist or interviewer. 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. context dependent memory See state dependent memory. contracts Verbal or written agreements made between therapist and client for the express purposes of setting safe and reasonable boundaries for the client, to nurture the client's sense of cause and effect, and to encourage the internal personality system to take responsibility for its behavior. 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:
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 A therapist's conscious or unconscious emotional reactions to a client. It is a therapist's job to monitor his or her reactions to a client and to minimize their impact on the therapeutic relationship and treatment. DDIS See Dissociative Disorder Interview Schedule. 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:
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. DES See Dissociative Experiences Scale. 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. DID See dissociative identity disorder. 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:
For individuals with DID (MPD), amnesia may exist differentially between various personality states or personality fragments. In one-way amnesia Personality A is unaware of Personality B; however, Personality B knows everything about Personality A. In two-way amnesia neither Personality A or B is aware of the existence of the other. 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:
dissociative identity disorder (DID) One of the dissociative disorders in DSM- IV. There are four diagnostic criteria:
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. DSM-IV See Diagnostic and Statistical Manual of Mental Disorders. dual diagnosis This refers to the co-existence of a mental disorder and substance abuse disorder. The current term for this is co-existing disorders, also called co-morbidity. See also co-existing disorders. 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 states An organized system of behavior and experience in which the elements (ego states) are bound together by some common principle. In this theory of dissociation, developed by Helen H. and John G Watkins, ego states occur naturally in people and are separated from each other by boundaries that are more or less permeable. A problem arises only when the boundaries between ego states become non-permeable or maladaptive. The goal of treatment in ego state therapy is not the fusion or integration of ego states, but the harmonius cooperation between ego states. Watkins & Watkins, "Ego- State Therapy in the Treatment of Dissociative Disorders," in Kluft & Fine, Clinical Perspectives on Multiple Personality Disorder, pp. 277-299. EMDR See Eye Movement Desensitization and Reprocessing. empathy The ability to put one's self into the psychological frame of reference or point of view of another, to feel what another feels. executive control In the internal system of a person with a dissociative disorder, authority over the body and its behavior by a particular personality state, usually the host. 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.
False Memory Syndrome (FMS)
"False memory syndrome" is a term coined in the early 1990s by the
False Memory Syndrome Foundation (FMSF). The FMSF defines the
syndrome as "a condition in which the person's personality and
interpersonal relationships are oriented around a memory that is
objectively false but strongly believed in to the detriment of the
welfare of the person and others involved in the memory."
Goldstein, Confabulations: Creating False Memories - Destroying
Families, p. iv
flashbacks A type of spontaneous abreaction common to victims of acute trauma. Also known as "intrusive recall," flashbacks have been categorized into four types:
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. See also autonomic arousal. flooding The process of becoming overwhelmed by intrusive emotions, sensory experiences, or intense re-living experiences; commonly associated with posttraumatic stress disorder. FMS See False Memory Syndrome. 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. fugue See dissociative fugue. fusion The moment when personality states or fragments come together as a single entity. The breaking down of dissociative barriers may occur spontaneously or as part of a specific therapeutic process. Fusion is different from integration. grounding Reality based awareness in the here and now, a sense of connectedness to yourself and your environment. 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. See also executive control. 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.
iatrogenesis When medical treatment or psychotherapy causes an illness or aggravates an existing illness. In psychotherapy, this may occur as a result of the comments, questions, or attitudes of the therapist. There are those who feel that DID (MPD) is an iatrogenic illness produced by a client to meet the expectations of a therapist. There is also a concern that traditional DID (MPD) treatment approaches may encourage the development of additional personality states. However, there is no scientific research to support the idea that DID (MPD) is an iatrogenic illness. 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. 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. See also, explicit memory. impulse An action urge. informed consent In psychotherapy, informed consent occurs when a client is informed of:
inner self-helper (ISH) A personality state, often a helper or protector, that has knowledge of the system and works with the therapist to facilitate the treatment. 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.
internal system see system. International Society for the Study of
Dissociation (ISSD) Formerly the International Society
for the Study of Multiple Personality and Dissociation (ISSMP&D;).
The organization voted to change its name in the spring of 1994
after the classification of MPD was changed to dissociative
identity disorder (DID) in the DSM-IV.
International Society for the Study of Multiple Personality & Dissociation (ISSMP&D;) The original name of the ISSD when it was founded in 1984. It was changed in 1994 after the term MPD was changed to dissociative identity disorder (DID). See also International Society for the Study of Dissociation. 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. intrapsychic The complex processes that occur within the mind of an individual rather than the dynamics between individuals or between an individual and the environment. ISH See inner self-helper. ISSD See International Society for the Study of Dissociation. ISTSS See International Society for Traumatic Stress Studies. journal writing The process of using structured exercises to write about thoughts, feelings, and stress responses in an effort to increase self-awareness and decrease symptomotology. 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.
losing time Specific to the dissociative disorder field, having no recollection of one's activities during a given time period (hours, days, years). Unaccounted-for periods of time are generally confusing and frightening to an individual who has DID (MPD) and may allow for the person's re-victimization. mapping A technique used in psychotherapy with DID (MPD) clients to gain knowledge about the internal personality system. The client is asked to draw a map or diagram of the personality states to explain the inner world of personalities. This provides useful information about the system, such as the connections or lack of connections between personality states. The map may need to be updated as therapy progresses and can be used for integration work to help ensure that all internal parts have been integrated. Also known as personality mapping; system mapping. Mapping can also be used to understand the relationships among feeling states as well. medical model The view that abnormal behavior results from a physical/biological cause and should be treated medically. This emphasis on biological causes of mental disorder is in contrast with cognitive/behavioral approaches that see beliefs and socially reinforced behavior as a cause of mental disorder. As non-medical disciplines have become more involved in the treatment of mental disorders, the conflict between the medical model and social/behavioral models has become heightened. 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.
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. MPD See multiple personality disorder. multiple personality disorder (MPD) In DSM-III-R, MPD was classified as a dissociative disorder. The diagnostic criteria were:
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." See also splitting. 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 see personality states. personality mapping see mapping. personality states In the dissociative disorders field, this refers to an entity that has the following:
personality system see system 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:
presenting personality The personality state that first comes to therapy. It is often the host personality. pseudo-memory A non- technical term to describe memory of events that did not occur. This term is often used interchangeably with false memory, another non-technical term coined by members of the False Memory Syndrome Foundation. pseudoseizures
"Pseudoseizures are sudden changes in a person's behavior and/or
mental state that resemble epileptic seizures but which are not
caused by a physical disorder of the brain. They may look like any
type of epileptic seizure: staring unresponsively, generalized
stiffening and rhythmic jerking, movements of only a few body
parts, or alterations of awareness. During these spells, brain
cells are firing normally and the brain wave tracing does not show
the changes which are characteristic of epileptic seizures.
psychic numbing see numbing psychodrama A group psychotherapy technique. Under the direction of a therapist, individuals re-enact life situations or feelings in order to gain insight or learn new ways of coping. It is one of the adjunctive therapies used in treating trauma disorders. psychodynamic A theoretical orientation that recognizes the role of the unconscious in determining behavior. It also considers the interplay of the unconscious with the current situation, cognitive ability, and life experience. psychogenic amnesia A type of dissociative disorder described in DSM-III-R. The name was changed to dissociative amnesia in DSM-IV. See also dissociative amnesia. psychogenic fugue A type of dissociative disorder described in DSM-III-R. The name was changed to dissociative fugue in DSM-IV. See also dissociative fugue. PTSD See posttraumatic stress disorder. Rational Emotive Therapy (RET) A cognitive psychotherapy approach developed by Albert Ellis which focuses on the client's thoughts and beliefs. The goals of therapy are to identify unrealistic and illogical thoughts (such as "I must always be happy"), question these thoughts or beliefs, and replace them with more reasonable and constructive views. In this school of thought, behavior is understood to be based on beliefs rather than external conditions. This form of therapy is used to help trauma survivors to identify mistaken beliefs brought on by the traumatic experiences. reality check A technique that helps you to become aware of the true state of affairs in a particular experience. regression The return to earlier or younger behavior and thinking. Trauma often overwhelms everyday defenses and brings about behavioral regression. Child personality states are an example of trauma-based regression. In "age regression," a person experiences him or herself at a specific earlier age. The person does not always return to the age of a child, however; age regression may take a client back a few years earlier in adult life. 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. ritual abuse This term has
been defined in a variety of ways by different authors and
researchers. One definition developed for a study of abuse in child
daycare defined ritual abuse as "abuse that occurs in a context
linked to some symbols or group activity that have a religious,
magical, or supernatural connotation and where the invocation of
these symbols or activities, repeated over time, is used to
frighten and intimidate the children." Finkelhor, D., & Meyers, L.
M., Nursery Crimes: Sexual Abuse in Day Care, p. 59.
sadistic abuse Describes "extreme adverse experiences which include sadistic sexual and physical abuse, acts of torture, over-control, and terrorization, induction into violence, ritual involvements, and malevolent emotional abuse. Sadism was defined by Freud's mentor, Krafft-Ebing (1894-1965), in the nineteenth century, as follows: 'The experience of sexual or pleasurable sensations... produced by acts of cruelty, as bodily punishment inflicted on one's own body or witnessed in others, be they animals or human beings. It may also consist of innate desire to humiliate, hurt, wound, or even destroy others. . . .'" See also ritual abuse. Goodwin, "Sadistic Abuse: Definition, Recognition, and Treatment," Dissociation, 6:3, pp. 181-182. 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. satanic abuse Abuse that evokes the name, image, or concept of satan as part of the abuse. Even though this term is used interchangeably with ritual and sadistic abuse they each have specific meanings. Abuse could be ritual and sadistic but not satanic if the concept of satan is not used as a part of the abuse. See also ritual abuse for a more detailed explanation of that term. 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. SCID-D See Structured Clinical Interview for DSM-IV Dissociative Disorders. 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.; secondary PTSD See vicarious traumatization. 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. See also self-mutilation. self-inflicted violence See self-harm. self-injury See self-harm. 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. sodium amytal A hypnotic
sedative drug occasionally used in psychotherapy with trauma
clients to access repressed or unconscious material including
feelings and memories. This procedure, an IV drip infused with
sodium amytal, is usually done on an inpatient basis due to the
slight risk of medical complications. Even though sodium amytal has
been referred to as a "truth serum" it does not guarantee truth any
more than any other interview technique.
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. See also body memory. 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. split screen phenomenon A hypnotic therapeutic technique which enables a client to see the past trauma on a mental screen in which one half is the historical event and the other half is the current therapeutic situation. This allows the client to deal with a traumatic memory without being emotionally overwhelmed. The technique may be helpful for abreactive and intense memory work. splitting In general
psychiatric literature splitting is "a mental mechanism in which
the self or others are reviewed as all good or all bad, with
failure to integrate the positive and negative qualities of self
and others into cohesive images. Often the person alternately
idealizes and devalues the same person." American Psychiatric
Glossary, p.199. Splitting is a symptom of borderline personality disorder.
spontaneous trance See self- hypnosis. 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. Structured Clinical Interview for DSM-IV Dissociative Disorder (SCID-D) This is the first diagnostic instrument for the comprehensive evaluation of dissociative symptoms and disorders. It was developed by Marlene Steinberg, M.D., to enable a clinically trained interviewer to assess the nature and severity of dissociative symptoms in a variety of clinical disorders (including Posttraumatic Stress Disorder, eating disorders, etc.) and to make diagnoses of disociative disorders, based on DSM-IV criteria. switching The process of changing from one already existing personality state or fragment to another personality state or fragment. Switching may be set off by outside stimuli such as an environmental trigger, or by internal stimuli, such as feelings or memories. Switching may be observable, such as changes in posture or facial expression, as well as changes in voice tone or speech patterns. Switching may also be observed by changes in mood, regressed behavior, and variable cognitive functioning. system A descriptive term for all the aspects or parts of the mind in an individual with DID (MPD). This includes personality states, memories, feelings, ego states, entities, and any other way of describing dissociated aspects of an individual. Understanding the parts as a system rather than as separate personality states provides an important frame of reference for treatment. Also called internal system or personality system. 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. trance Used interchangeably with hypnosis. A person in a trance or in an altered state of focused attention is in a hypnotic state. 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. transference "The unconscious assignment to others of feelings and attitudes that were originally associated with important figures in one's early life." The psychodynamically oriented clinician uses this to help the client understand the origins of emotional problems. The transference phenomena is complicated in MPD because each alter may have its own transference relationship with the therapist. American Psychiatric Glossary, p. 211. See also traumatic transference. 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.
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. 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. unification "An overall, general term that encompasses both fusion and integration." Kluft, "Clinical Approaches to the Integration of Personalities," in Clinical Perspectives on Multiple Personality Disorder, p.109. V-codes These are categories of problems that may need therapeutic intervention but are not considered psychological disorders or mental illness. Conflict between parents and teenagers would be an example of this. Adapted from DSM-IV, p. 681. vicarious traumatization Describes the experiences of mental health providers who become overly empathic after listening to accounts of abuse or violence by trauma survivors. Symptoms of vicarious traumatization are similar to those experienced by individuals with PTSD, and include psychic numbing, hypervigilance, difficulty sleeping, and intrusive thoughts of the trauma, which were reported by the client. Also called secondary PTSD or compassion fatigue. Kluft and Fine, Clinical Perspectives, p.164.
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