Resurrection After Rape Community Group
Discussion, question-and-answer, general social support, and journal processing for progress-oriented rape survivors. No crisis, no damaging or triggering conflicts--this is for individuals who want to contribute to collective, cooperative action toward the goal of making actual PROGRESS through rape trauma. Much of this work is based on the book "Resurrection After...
As i was looking over the proposed changes for to the DSM (scheduled to be published in May of 2013) I decided to check out PTSD.
Here is the current version:
http://behavenet.com/posttraumatic-stress-disorder
Here is the proposed version:
http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=165
What initially got me thinking of sharing this was the change in Criterion A
Here is the first version:
A. The person has been exposed to a traumatic event in which both of the following were present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior
Here is the proposed change:
A. Exposure to actual or threatened a) death, b) serious injury, or c) sexual violation, in one or more of the following ways:
1. directly experiencing the traumatic event(s)
2. witnessing, in person, the traumatic event(s) as they occurred to others
3. learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental
4. experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.
I found it interesting that sexual violation was specifically listed.
Here is the current version:
http://behavenet.com/posttraumatic-stress-disorder
Here is the proposed version:
http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=165
What initially got me thinking of sharing this was the change in Criterion A
Here is the first version:
A. The person has been exposed to a traumatic event in which both of the following were present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior
Here is the proposed change:
A. Exposure to actual or threatened a) death, b) serious injury, or c) sexual violation, in one or more of the following ways:
1. directly experiencing the traumatic event(s)
2. witnessing, in person, the traumatic event(s) as they occurred to others
3. learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental
4. experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.
I found it interesting that sexual violation was specifically listed.
More theoretically - what happened to self concept in this definition? Notice that there is no violation of selfhood anywhere in the DSM V definition. There is however a few mentions of dysfunction of self. A full list of "self" phrases in new definition:
* persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
* distorted blame of self or others about the cause or consequences of the traumatic event(s)
* reckless or self-destructive behavior
* sense of unreality of self or body
Somehow this seems off kilter : there are disruptions in self concept but no concept of "violation of selfhood"? It almost seems like any perceived injury to self is just in the victim/survivors head as a set of distorted self-perceptions.
IMHO this is not good. Viewing cancer as an act of violation is arguably questionable. ALthough cancer is traumatic, cancer doesn't have moral will. However, rapists, batterers, bullies, suicide bombers, going postal and the like are without question perpetrating a moral assault and violation. Much of the moral outrage and many of the spiritual and ethical issues of rape depend very much on the idea that the body is a psychological and moral symbol of the self.
Certain kinds of trauma I don't think are fully understandable without reference to violation. In violent crime the trauma comes precisely from the cognitive dissonance created by one's idea of what the self ought to be and how it ought to be treated and the impossible reality of what really happened and how society responded. There are many ways to resolve that dissonance: healthy one's acknowledge the fact of violation and the randomness of suffering. They preserve the idea that one is deserving of respect even though a deeply violating and disrepsectful event occurred. Unhealthy ones try to make sense and create predictability in the world by constructing a divide between how others are treated (according to the rules) and how oneself is treated (placed outside the rules and deserving of abuse).
MHO this is not good. Viewing cancer as an act of violation is arguably questionable. ALthough cancer is traumatic, cancer doesn't have moral will. However, rapists, batterers, bullies, suicide bombers, going postal and the like are without question perpetrating a moral assault and violation. Much of the moral outrage and many of the spiritual and ethical issues of rape depend very much on the idea that the body is a psychological and moral symbol of the self.
For myself, dealing with a chronic progressive illness, I very much feel that my "self" is threatened. Everything that I thought my future would be has shifted. I constantly find myself questioning who I am and who I will be as this disease progresses. I have panic attacks and nightmares about being in a wheelchair, the potential to lose access to healthcare, eventually being unable to work, eventually being dependent on others. I don't know how much of my personal reaction to this is colored by my pre-existing PTSD. Who knows, if I wasn't already prone to nightmares and panic attacks, I might handle all this with more grace and aplomb.
I think I get what Elisheva was saying though... I think that the "physical integrity of self" phrasing neatly summed up the real crux of the matter with PTSD. That being said, I understand why the change is being made and I hope that it will be beneficial to those of us unfortunate enough to have to deal with American insurance companies.