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Author Topic: C-PTSD Assessment Test (IASC)  (Read 4361 times)

Varja

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C-PTSD Assessment Test (IASC)
« on: December 19, 2012, 03:44:12 PM »
There is an assessment tool available for helping clinicians determine whether or not a patient may be suffering from C-PTSD, known as the Inventory of Altered Self Capacities (IASC.) If you don't think your current therapist "gets-it," then this could be a means whereby your symptoms are spelled-out in language they should understand.

Inventory of Altered Self Capacities

Developed by: John Briere, Ph.D., Associate Professor of Psychiatry and Psychology
Keck School of Medicine University of Southern California, Center Director USC Adolescent Trauma Training Center (USC-ATTC) National Child Traumatic Stress Network, SAMHSA, Director Psychological Trauma Program Department of Psychiatry Los Angeles County + USC Medical Center  http://www.johnbriere.com/iasc.htm

This test is available from Psychological Assessment Resources.  http://www4.parinc.com/Products/Product.aspx?ProductID=IASC

The IASC measures seven types of "self-related" psychological difficulties, such as identity problems, affect dysregulation, and interpersonal conflicts, often considered to reside diagnostically on Axis II of DSM-IV. When arising from trauma, many of these altered self-capacities are considered to be part of "complex PTSD."  The IASC is a fully standardized psychological test, with norms from 620 general population subjects and validation studies from samples of clinical and university participants.   

The 63-item IASC contains the following nine-item scales:
 
• Interpersonal Conflicts: Evaluates the extent to which the respondent endorses problems in his/her relationships with others. Specific conflicts assessed include those in romantic, friendship, and work or school contexts.

• Idealization-devaluation:  Assesses a tendency to dramatically change one's opinions about significant others, generally from a very positive view to an equally negative one.

• Abandonment Concerns: Evaluates the respondent's overall sensitivity to perceived or actual abandonment by significant others.

• Identity Impairment: The II scale measures the extent to which the respondent has difficulty maintaining a coherent sense of identity and self-awareness, both internally and in interpersonal contexts. This may include a lack of awareness of one's needs, goals, and, in some instances, the basis for one's behavior. There are two subscales of the II: Self-awareness (II-S) and Diffusion (II-D).

• Susceptibility to Influence (SI) :  Assesses the respondent's tendency to follow the directions of others without sufficient consideration and to accept uncritically others' statements or assertions.
 
• Affect Dysregulation (AD):The AD scale taps problems in affect regulation and control. As a result, the high AD respondent is often subject to mood swings, problems in inhibiting the expression of anger and other strong affects, and a relative inability to move out of dysphoric states without externalization (e.g., aggression, self-injury) or avoidance (e.g., dissociation, substance abuse). There are two subscales of the AD: Instability (AD-I) and Skill Deficits (AD-S).

• Tension Reduction Activities (TRA):  Evaluates the tendency to respond to painful internal states and affects with external behaviors that may distract, soothe, or otherwise reduce these internal experiences.

The items of the IASC are contained in a reusable test booklet. Respondents complete a separate answer sheet that facilitates rapid scoring. Each symptom item is rated according to its frequency of occurrence over the prior six months, using a 4-point scale ranging from 1 (never) to 4 (often). The IASC requires approximately 15-20 minutes to complete for all but the most clinically impaired individuals and can be scored and profiled in approximately 10 minutes.   

Because no demographic variable accounted for more than 2.3% of the variance in any given IASC scale, and most raw IASC scores varied by, at most, a single unit across these variables, IASC norms are valid across sex, age (18 years and beyond), and race without differentiation. Results of readability analysis (Flesch-Kincaid method) indicate that a sixth-grade reading ability is required to complete the IASC.

The IASC has been found to be reliable in both the normative and validation samples.  Alpha coefficients for the IASC scales in the normative sample ranged from .78 (Tension Reduction Activities) to .93 (for Identity Impairment), with an average alpha of .90, whereas the scale alphas for the clinical/validation sample ranged from .86 (for Tension Reduction Activities) to .96 (for Identity Impairment).  Validity analyses in the normative, clinical, and university samples indicate that the IASC has construct, convergent, and predictive validity.  In addition to correlating with other, related tests, the IASC scales predict self-reported child abuse history (especially sexual and emotional maltreatment), attachment style, relationship problems, suicidality, and substance abuse.



PUBLICATION ON (OR USING) THE IASC:

 Briere, J.  (2000). Inventory of Altered Self Capacities (IASC).  Odessa, Florida:  Psychological Assessment Resources.

Briere, J. (2006). Dissociative symptoms and trauma exposure:   Specificity, affect dysregulation, and posttraumatic stress.  Journal of Nervous and Mental Disease, 194, 78-82.

Briere, J., & Rickards, S. (2007).  Self-awareness, affect regulation, and relatedness: Differential sequels of childhood versus adult victimization experiences. Journal of Nervous and Mental Disease, 195, 497-503.

 Briere, J., & Runtz, M.R. (2002). The Inventory of Altered Self-Capacities (IASC):  A standardized measure of identity, affect regulation, and relationship disturbance.  Assessment, 9, 230-239.

 Brown, S., & Shapiro, F. (2006). EMDR in the treatment of borderline personality disorder. Clinical Case Studies, 5, 403-420.

Dietrich, A.m. (2007). Childhood maltreatment and revictimization: the role of affect dysregulation, interpersonal relatedness difficulties and posttraumatic stress disorder. Journal of Trauma and Dissociation, 8, 25-51.

 Messman-Moore, T.L., & Coates, A.A. (2007). The impact of childhood psychological abuse on adult interpersonal conflict: the role of early maladaptive schemas and patterns of interpersonal behavior. Journal of Emotional Abuse, 7, 75-92.

 Palesh, O.G., Classen, C.C., Field, N.P., Kraemer, H.C., & Spiegel, D. (2007). The relationship of child maltreatment and self-capacities with distress when telling one's story of childhood sexual abuse. Journal of Child Sexual Abuse, 16, 63-80.
“It is no measure of health to be well adjusted to a profoundly sick society.”

~ Bodhipaksa Krishnamurti

Larimar

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Re: C-PTSD Assessment Test (IASC)
« Reply #1 on: December 20, 2012, 02:10:50 PM »
There is an assessment tool available for helping clinicians determine whether or not a patient may be suffering from C-PTSD, known as the Inventory of Altered Self Capacities (IASC.) If you don't think your current therapist "gets-it," then this could be a means whereby your symptoms are spelled-out in language they should understand.

Inventory of Altered Self Capacities

Developed by: John Briere, Ph.D., Associate Professor of Psychiatry and Psychology
Keck School of Medicine University of Southern California, Center Director USC Adolescent Trauma Training Center (USC-ATTC) National Child Traumatic Stress Network, SAMHSA, Director Psychological Trauma Program Department of Psychiatry Los Angeles County + USC Medical Center  http://www.johnbriere.com/iasc.htm

This test is available from Psychological Assessment Resources.  http://www4.parinc.com/Products/Product.aspx?ProductID=IASC

The IASC measures seven types of "self-related" psychological difficulties, such as identity problems, affect dysregulation, and interpersonal conflicts, often considered to reside diagnostically on Axis II of DSM-IV. When arising from trauma, many of these altered self-capacities are considered to be part of "complex PTSD."  The IASC is a fully standardized psychological test, with norms from 620 general population subjects and validation studies from samples of clinical and university participants.   



Hi Varja,

I checked out the links and read the descriptions for what this inventory tests for and it seems to me that it is for Borderline Personality Disorder or the inclination for another Identity Disorder. The variables are related to the literature I am familiar with that distinguish, clinically, the Borderline Personality, which is a self related psychiatric disturbance, one of the hallmarks of which is fairly profound abandonment issues that shows up as push-pull dynamics and other hallmarks such as lack of recognizing 'permanence' in interpersonal relationships. Just for starters..

Whereas, Post Traumatic Stress Disorder is a physiological and affective, malaptive fear response to triggers that have become stuck in the brain of the person. With Post Traumatic Stress, there is not the history of lack of coherent sense of self and many of the other personality disordered markers that go with Personality Disorders.

I'm a bit confused as to how this test is a measure of Complex PTSD. Is it being used to distinguish between  PTSD and a Personality Disorder?




Varja

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Re: C-PTSD Assessment Test (IASC)
« Reply #2 on: December 20, 2012, 05:40:17 PM »
That's a good question. This assessment tool is designed to identify Complex Post-Traumatic Stress Disorder (C-PTSD) not PTSD. The significant difference being in the length and duration of exposure to trauma. The trauma can be physical, psychological, sexual - or a combination.

It shows you've certainly done your homework, too. It has been proposed that C-PTSD is the overarching dianosis for a syndrome that includes borderline personality disorder, somatization disorder, and dissociative identiity disorder (formerly known as multiple personality disorder.) This is probably the reason you've identified some similarities in your sources/literature.

Dr. Judith Herman, MD of Harvard University, suggested that a new diagnosis, Complex PTSD, is needed to describe the symptoms of long-term trauma. Another name sometimes used to describe the cluster of symptoms referred to as C-PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS). A work group has also proposed a diagnosis of Developmental Trauma Disorder (DTD) for children and adolescents who experience chronic traumatic events.

Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met diagnostic criteria for PTSD, Complex PTSD was not added as a separate diagnosis classification. However, cases that involve prolonged, repeated trauma may indicate a need for special treatment considerations. Although Dr. Herman didn't get the diagnosis as she originally proposed it, at least they've acknowledged the need for special treatment for surviviors of long-term trauma.

Eclipse posted a recent article that said the APA is currently off-schedule in finalizing the information to be contained in the next DSM revision - V. Evidently, they're still debating amongst themselves, and we'll just have to wait and see what they decide to include.

In her book, Trauma and Recovery, 1997, Dr. Herman states: "The mental health system is filled with survivors of prolonged, repeated trauma even though most people who've been abused in childhood never come to psychiatric attention. To the extent these people recover, they do so on their own. While only a very small percentage of abuse survivors ever become psychiatric patients (usually those with the most severe abuse histories) most psychiatric patients are survivors of childhood abuse."

"... 50 - 60% of psychiatric inpatients and 40 - 60% of outpatients report childhood histories of physical or sexual abuse - or both. In a study of emergency room psychiatric patients, 70% had abuse histories. Abuse in childhood is one of the main factors leading a person to seek psychiatric treatment as an adult..."

"... Persistent anxieties, phobias, and panic of survivors are not the same as ordinary anxiety disorders. The somatic symptoms of survivors are not the same as ordinary psychosomatic disorders. The depression is not the same as ordinary depression. The degradation of their identity and relational life is not the same as ordinary personality disorder. Survivors of prolonged abuse develop characteristic personality changes, including deformations of relatedness and identity. They are particularly vulnerable to repeated harm, both self-inflicted and at the hands of others. All too commonly chronically traumatized people suffer in silence; but if they complain at all, their complaints are not well understood..."

"...The responses to trauma are best understood as a spectrum of conditions rather than a single disorder. They range from a brief stress reaction that gets better by itself and never qualifies for a diagnosis, to classic, or simple post-traumatic stress disorder (PTSD) to the complex syndrome of prolonged, repeated trauma... "

"...Lawrence Kolb noted the heterogeneity of PTSD, remarking that "at one time or another, it may appear to mimic every personality disorder." Emmanuel Tanay observes, "The psychopathology may be hidden in characterological changes that are manifest only in disturbed object relationships and attitudes toward work, the world, man, and God." Psychiatrists who've worked with refugees have recognized the need for an "expanded concept" of PTSD that takes into account the effects of severe, prolonged, and massive psychological trauma..."

"... In survivors of repeated, prolonged trauma, the symptom picture is usually very complex, and they often appear with a bewildering array of symptoms. Their general levels of distress are often higher than that of other patients. Considering these patients as a whole, the most impressive finding is the sheer length of the list of the symptoms correlated with a history of childhood abuse..."

"... Psychologist Jeffrey Breyer and his colleagues report that women with histories of physical or sexual abuse have significantly higher scores than other patients on standardized measures of somatization, depression, general anxiety, phobic anxiety, interpersonal sensitivity, paranoia, and "psychoticism" (probably dissociative symptoms.)..."

"...Psychologist John Briere (Who developed the ASIC) reports that survivors of childhood abuse display significantly more insomnia, sexual dysfunction, dissociation, anger, suidicality, self-mutilation, drug addiction and alcoholism than other patients. Sadly, the symptom list can be prolonged almost indefinitely. . ."

". . . Psychologist Denise Gelinas states that when survivors of childhood abuse seek treatment, they have a "disguised presentation." Typically, they come in because of difficulties in relationships, problems in intimacy, excessive responsiveness to the needs of others, and repeated victimization. All too commonly, neither patient nor therapist recognizes the link between the presenting problem and the history of chronic trauma..."

"...Survivors of childhood abuse are frequently misdiagnosed and mistreated within the mental health system. Due to their characteristic difficulties in close relationships, they're particularly vulnerable to revictimization by caregivers. They can become engaged in ongoing, destructive interactions wherein the mental health system replicates the behaviors of the abusive family system...."

"...Survivors of childhood abuse often accumulate many different diagnoses before the underlying problem of a complex post-traumatic syndrome is recognized. Sadly, they're very likely to receive a diagnosis  carrying with it - some strong negative connotations:

- Somatization Disorder (SD)
- Borderline Personality Disorder (BPD)
- Dissociative Identity Disorder (DID)

All three of these diagnoses were once subsumed under the now obsolete heading of "hysteria." Patients, usually women, who receive these diagnoses, evoke unusually intense reactions in caregivers. Their credibility is often suspect and they're frequently accused of manipulation or malingering.  Often the subject of furious and partisan controversies, sometimes they're even hated. Some clinicians argue that the term "borderline" has become so prejudicial that it should be abandoned altogether, just as its predecessor term, hysteria, had to be abandoned..."

"...These three diagnoses have many common features, and they often cluster and overlap with one another. Patients qualifying to receive these diagnoses usually qualify for several others as well. Most patients with SD also have major depression, agoraphobia and panic in addition to their numerous physical complaints. Over 50% of these patients are given additional diagnoses of "Histrionic," "Anti-Social," and "Borderline" personality disorder..."

"...Similarly, people given diagnoses of BPD often suffer as well with major depression, substance abuse, agoraphobia or panic, and SD. The majority of patients diagnosed with DID experience severe depression and most also meet the diagnostic criteria for BPD. They generally have numerous psychosomatic complaints including headache, unexplained pains, gastro-intestinal disturbances, and hysterical conversion symptoms...."

"...All three disorders share high levels of hypnotizability or dissociation, and patients diagnosed with DID are in a class by themselves. Often their symptoms are so bizarre that they're frequently mistaken for schizophrenia. Patients with BPD also have abormally high levels of dissociative symptoms but fall short of the mark set by those with DID. Those with SD are also reported to have high levels of hypnotizability and psychogenic amnesia..."

"...Patients with all three disorders also share characteristic difficulties in close relationships. Interpersonal difficulties have been described most extensively in patients with BPD. Indeed, a pattern of intense, unstable relationships is one of the major criteria for making this diagnosis. BPD patients find it very hard to tolerate being alone but are exceedingly wary of others. Terrified of abandonment on the one hand and domination on the other, they oscillate between extremes of clinging and withdrawal, between abject submissiveness and furious rebellion. They need to form special relations with idealized caretakers in which ordinary boundaries aren't observed..."

"...Psychoanalytic authors attribute this instability to a failure of psychological development in the formative years of early childhood. One authority describes the primary defect in BPD as a "failure to achieve object constancy," meaning a failure to form reliable and well-integrated inner representations of trusted people. Another speaks of the "relative developmental failure in formation of introjects that provide to the self a function of holding-soothing security;" that is, people with BPD cannot calm or comfort themselves by calling up a mental image of a secure relationship with a caretaker..."

"...Similar patterns of stormy, unstable relationships are also found in patients with DID. Patients with SD also have difficulties in intimate realtionships, including sexual, marital, and parenting problems. Disturbances of identity formation are also characteristic of patients with both BPD and DID, although they haven't yet been studied systematically in SD. BPD patients lack the dissociative capacities found in those with DID in forming fragmented alter-egos but they have a similar difficulty developing a integrated identity. Inner images of the self are split into extremes of good and bad. An unstable sense of self is one of the major diagnostic criteria for BPD and the "splitting" of inner representations of self and others is considered by some theorists to be the central underlying pathology of the disorder..."

"...The common denominator of all three of these disorders is their origin in a history of childhood trauma. In Frank Putnam's study of 100 patients with DID, 97 had histories of major childhood trauma; most commonly sexual abuse, physical abuse or both. In BPD, investigations have documented severe childhood trauma in the great majority of cases - a staggering 81%. This abuse generally began early in life and was severe and prolonged, though it rarely reached the lethal extremes described by patients with DID...."

"...The earlier the onset of the abuse, and the greater its severity, the greater likelihood that the survivor would develop BPD. The specific relationship between the symptoms of BPD and a history of childhood trauma has now been confirmed in numerous other studies. Evidence for the link between SD and childhood trauma is not yet complete. However, a recent study of women with SD found that 55% had been sexually molested in childhood, usually by relatives. Systematic investigation of the childhood histories of patients with SD has yet to be undertaken though..."

"...These three disorders might perhaps be best understood as variants of C-PTSD, each deriving its characteristic features from adaptation to the traumatic environment. The physioneurosis of PTSD is the most prominent feature of SD, the deformation of consciousness is most prominent in DID, and the disturbance in identity and relationship is most prominent in BPD. The overarching concept of a complex post-traumatic syndrome accounts for the particularity of these three disorders and their interconnection. C-PTSD also reunites the descriptive fragments of the condition that was once called hysteria and reaffirms their source in a history of psychological trauma..."

"...Many of the most troubling features of these three disorders become more comprehensible in the light of a history of childhood trauma. More important, survivors become comprehensible to themselves. When survivors recognize the origins of their psychological difficulties in an abusive childhood environment, they no longer need to attribute them to an inherent defect in the self. Thus the path is opened to the creation of a new meaning in experience and a new, unstigmatized identity...."

"...Understanding the role of childhood trauma in the development of these severe disorders also informs every aspect of treatment. This understanding forms the basis for a cooperative therapeutic alliance that normalizes and validates the survivor's emotional reactions to past events, while recognizing that these reactions may be maladaptive in the present. Moreover, a shared understanding of the survivor's characteristic disturbances of relationship and consequent risk of repeated victimization offers the best insurance against unwitting reenactments of the original trauma[/i] in the therapeutic relationship. Recognition of the trauma is central to the recovery process...."

Personally, I believe Dr. Herman nailed-it with the C-PTSD diagnosis. In my personal experience, and in the stories of the thousands of Adult Children abused by disordered parents I've spoken with over the years - it is the only diagnosis that really makes sense. Of course, I could be wrong - but I'm reminded of the parable of three blind men and the elephant as it relates to the withering array of symptoms seen in this special group of survivors.

As with many things medical, it seems the best the mental health community has been able to do - up to a point, is treat the individual symptoms, with little success. However, those who use Dr. Herman's recommended treatment models often realize tremendous success rates. So, maybe the proof of her diagnosis is found in the results of her treatment model.
“It is no measure of health to be well adjusted to a profoundly sick society.”

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Varja

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Re: C-PTSD Assessment Test (IASC)
« Reply #3 on: December 20, 2012, 05:56:32 PM »
This may be helpful in addition to the on-site information about C-PTSD. This is taken directly from Trauma and Recovery, 1997 by J. Herman M.D.:


Complex Post Traumatic Stress Disorder


1. A history of subjection to totalitarian control over a prolonged period (months to years.) Examples include hostages, prisoners of war, concentration-camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and organized sexual exploitation.

2.  Alterations in affect regulation, including:

•   persistent dysphoria
•   chronic suicidal preoccupation
•   self-injury
•   explosive or extremely inhibited anger (may alternate)
•   compulsive or extremely inhibited sexuality (may alternate)

3. Alterations in consciousness, including:

•   amnesia or hypermnesia for traumatic events
•   transient dissociative episodes
•   depersonalization/derealization
•   reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

4. Alterations in self-perception, including:

•   sense of helplessness or paralysis of initiative
•   shame, guilt, and self-blame
•   sense of defilement or stigma
•   sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

5. Alterations in perception of perpetrator, including:

•   preoccupation with relationship with perpetrator (includes preoccupation with revenge)
•   unrealistic attribution of total power to perpetrator (caution: victim's assessment of power realities may be more realistic than clinician's)
•   idealization or paradoxical gratitude
•   sense of special or supernatural relationship
•   acceptance of belief system or rationalizations of perpetrator

6. Alterations in relations with others, including:

•   isolation and withdrawal
•   disruption in intimate relationships
•   repeated search for rescuer (may alternate with isolation and withdrawal)
•   persistent distrust
•   repeated failures of self-protection

7. Alterations in systems of meaning, including:

•   loss of sustaining faith
•   sense of hoplessness and despair

“It is no measure of health to be well adjusted to a profoundly sick society.”

~ Bodhipaksa Krishnamurti

Larimar

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Re: C-PTSD Assessment Test (IASC)
« Reply #4 on: December 20, 2012, 07:49:39 PM »


That's a good question. This assessment tool is designed to identify Complex Post-Traumatic Stress Disorder (C-PTSD) not PTSD. The significant difference being in the length and duration of exposure to trauma. The trauma can be physical, psychological, sexual - or a combination.

It shows you've certainly done your homework, too. It has been proposed that C-PTSD is the overarching dianosis for a syndrome that includes borderline personality disorder, somatization disorder, and dissociative identiity disorder (formerly known as multiple personality disorder.) This is probably the reason you've identified some similarities in your sources/literature.

Dr. Judith Herman, MD of Harvard University, suggested that a new diagnosis, Complex PTSD, is needed to describe the symptoms of long-term trauma. Another name sometimes used to describe the cluster of symptoms referred to as C-PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS). A work group has also proposed a diagnosis of Developmental Trauma Disorder (DTD) for children and adolescents who experience chronic traumatic events.




I've done some homework, primarily in a lifelong healing and actualizing quest. It's apparent I haven't done as much homework as you have though, Varja  :tongue2: What you have written and shared is daunting to say the least. Thanks for the resources. This is interesting.

I have a couple of thoughts about what you've shared re Judith Herman MD and her thesis, if I understand it correctly.

Firstly, as I understood C-PTSD it is in a nutshell the same reactions (extreme stress reaction) as for PTSD except that the cause is prolonged repeated trauma, as opposed to for PTSD which is generally defined as being caused by an 'out of the norm', one time or short duration extreme trauma (ie. war, natural disaster, violent crime, life threatening accident). Post Traumatic Stress Disorder (without the "Complex" prefix) can be summed up as having been a victim of or subject to a life threatening one time or short term event. The reason for the ongoing trauma reaction is that it is held in the brain and body as a memory and can be brought back by 'triggers' such as a smell, for example, because the trauma is not processed or healed. Or to put it another way, that I have read it described by neurological oriented experts, it changes our brains and circuitry. There have been brain scans on people with trauma that, as far as i know corroborate this. So, going from my own reading and personal experience with trauma, some of which were one-time isolated events, I can vouch for the 'flashback'. It's as real as if it were happening again and it is triggered by deep sensory memory in the brain. I have no doubt about this.

With regard to Complex PTSD, there is something much more pernicious about it. I do believe it belongs, if we are going to classify all of these dysfunctions, with PTSD more correctly than with personality disorders, even though there is significant overlap. Overlap,  does not mean 'the same'. Perhaps, I have to read more on your resources, but from how you have written Herman's proposal there seems to be some kind of theoretical blurring of PTSD 'into' personality disorders, which I believe have a fundamental difference.

Even though the presenting picture of someone's life and repeated 'failure to thrive' can look remarkably similar, how this becomes a syndrome "including" the disorders you quoted is questionable, to me and needs deeper analysis. For example, a person can develop any number of neurotic coping mechanisms to deal with lacking parenting (anything from just dysfunctional parenting to outright abusive or neglectful). There is a wide spectrum here that also includes a person's genetic makeup (vulnerabilities, susceptabilities, weaknesses, strengths, talents, resilience, natural temperament and character) and how they will 'react' to whatever parenting they get. 

They could turn into dependent, avoidant, schizoid, obsessive-compulsive, reactionary (hysteric), anti-social, narcissistic, dissociative (which goes along with somatization and depression, I believe), or bipolar, etc. From my reading, I believe "Borderline" was originally catch all term for those suffering from disturabances bordering or more aptly 'straddling or overlapping' neurotic defenses (such as the aforementioned) and into psychotic cognitive disturbance.

Thus, whilst a person who could 'score' or have observable clinical repeated dysfunction in many areas of life, but not necessarily all, depending on the severity and the person's very individual life history, they could be classified as traumatized and having Complex-PTSD. It does not follow, though, in my estimation that being traumatized and even having a history of repeated re-victimization means the person has the same underlying 'glitch' as those in the Axis II (dramatic/reactionary disorders).

It's backwards logic, in other words. Axis II sufferers, are almost guaranteed to be suffer from 'trauma' as the histories corroborate. However, those who were traumatized could conceivably cope with their trauma in a smorgasbord of ways, not necessarily devolving into serious cognitive distortions.

What has profoundly stayed with me in having met a number of people over my lifetime who have suffered for many different reasons (war in the Middle East and the former Yugoslavia, rape, child abuse, domestic abuse, neglect, self-neglect, substance abuse, etc.) is that there is one distinguishing and vital characteristic that marks a 'damaged by life' (which we all are time just by living), is that awareness, as in consciousness, is crucial. 

I believe that those who have Personality Disorders have 'given up' on consciousness because it was too painful and they are truly the most difficult to 'cure'. Those suffering from trauma (sometimes unspeakable trauma) can and do lead fulfilling lives even afterward, if they are conscious.




Varja

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Re: C-PTSD Assessment Test (IASC)
« Reply #5 on: December 21, 2012, 12:28:29 PM »
I appreciate your well-considered thoughts, and I'd encourage you to read Trauma and Recovery. It is available through through the book link on site.
“It is no measure of health to be well adjusted to a profoundly sick society.”

~ Bodhipaksa Krishnamurti

Larimar

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Re: C-PTSD Assessment Test (IASC)
« Reply #6 on: December 22, 2012, 01:18:29 AM »

Varja, Thanks. Yes, I've checked it out. It's on my list of possible books to read.