Table 2. Alterations in Self-Perception ● Chronic shame, guilt and self-blame, self-perception of an “evil self” ● Feeling permanently damaged, like “damaged goods” ● A chronic sense of victimhood and lack of self-worth ● Feeling like an imposter in one’s life, putting up a false front (“If they only knew”) ● Feelings of “I am guilty and responsible” rather than “I am innocent and helpless,” with the concomitant distortion of perpetrator responsibility (i.e., by finding excuses for the perpetrator’s behavior or blaming oneself or a nonoffender for the actions) ● A sense of complete difference or separation from others, reflected in such internal statements as “No one understands me; I am completely alone; I am special” or “I have no core of self” Note: Adapted from van der Kolk, B. A. (2014). The body keeps the score . Viking. Table 3. Alterations in Relationships and Perceptions of Others ● The loss of meaningful attachments ● Social avoidance or withdrawal ● An inability to trust ● An inability to sustain relationships ● An inability to self-protect, frequently leading to repeated victimization (trauma begets trauma, and revictimization has the largest correlation with childhood abuse; Fosha, 2013) ● A tendency to victimize others ● Poor judgment of others’ motives, intentions, and affect ● An ongoing search for a rescuer Note: Adapted from van der Kolk, B. A. (2014). The body keeps the score . Viking. Table 4. Alterations in Perception of the Perpetrator ● Preoccupation with one’s relationship with the perpetrator (including thoughts of revenge) ● Unrealistic attribution of power to the perpetrator (investing the perpetrator with abilities or powers beyond the scope of reality, including such things as mind reading, unlimited access, and even an ability to continue to harm one after death) ● Paradoxical gratitude (e.g., “Stockholm syndrome,” whereby prisoners come to care about, excuse the actions of, and even fall in love with their jailers) ● Sense of a supernatural or special relationship with the perpetrator, as can be seen in cases of cults with a charismatic leader who establishes himself as a godlike figure to his members and then misuses his power and authority in abuse (examples include Jim Jones, whose Peoples Temple ended in mass death in 1978; David Koresh, whose Branch Davidian stronghold fell in a cataclysmic 1993 government raid; and, more recently, Warren Jeffs, leader of a renegade branch of the Mormon religion, who was jailed for statutory rape of 220 women and teenage girls) ● Internalization or acceptance of the belief system of the perpetrator Note: Adapted from van der Kolk, B. A. (2014). The body keeps the score . Viking.
Table 5. Alterations in Worldview ● A loss of meaningfulness in life ● A loss of hope ● An impairment of basic trust ● A loss of a sense of agency or self-efficacy ● A loss of belief or faith in a higher power or previously sustaining beliefs ● The development of a negative self-attribution system (e.g., I am jinxed, cursed, a bad seed) ● Despair and hopelessness ● A loss of ability to think of or plan for the future Note: Adapted from van der Kolk, B. A. (2014). The body keeps the score . Viking. Table 6. Alterations in Affect Regulation and Consciousness ● Intrusive flashbacks or nightmares of the traumatic events Note: Adapted from van der Kolk, B. A. (2014). The body keeps the score . Viking. Case Example Michele entered therapy in her mid-30s to deal with ongoing depression and anxiety. She stated that she had been in and out of therapy since her early 20s. She had wanted to go into therapy as an adolescent, but her professional and community- minded mother refused to allow her to go, out of concern over “what it would look like if the neighbors found out.” During her first session, Michele revealed that, for her, “Sex and death are all mixed up together” and that she felt a great deal of shame for her years of self-described promiscuous behavior with multiple partners. Despite several near misses with sexually transmitted infections (STIs), she had not practiced safe sex and had experienced four abortions. During high school and college, she frequently drank to the point of blackout, and her sexual encounters often occurred while she was drinking. She developed severe obsessions about STIs and had herself tested yearly for various diseases, even though she had ceased being sexually active since starting therapy and had never had a positive test result. Her obsession included a fear that she had somehow become “contaminated,” in spite of evidence to the contrary, and that she would unwittingly transmit a horrible illness to others. She was particularly concerned about infecting children, to the extent that she would refuse to attend events if she thought that she might have to interact with them. Despite the severity of her difficulties, Michele was able to maintain a conflict-free sphere in her work life and was always successfully employed in a professional job. She described herself as “disease-ridden” and said that she had no sense of life inside of herself. When she looked in the mirror, she was always surprised to see a reflection look back at her because she felt so empty and worthless, as if she did not really exist. In subsequent weeks, she revealed a long history of bulimia, which at its height included binge-eating and purging several times a day. She stated that it was a miracle that she had lived past age 30 and, although she had done so, had no idea what her life might mean. ● Persistent self-harm or suicidality ● Persistent dysphoria or depression ● Rage attacks or fear of expressing anger ● Fear of or “hyper” sexuality ● Dissociative episodes It is clear from the previous history that Michele suffered from many aspects of complex traumatic stress disorder. Work with her over several years revealed a history of sexual abuse by her father, followed by his death when she was 12 years old, alcoholism in both parents, a gang rape when she was 16 years old, and neglect (at best) by a mother who refused to allow her daughter to receive help as a child .
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Book Code: PYFL4024
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