PS251, Lec 2, Ex. 3: 10/25/2013
Talking about object relations and trauma.
80% of borderline diagnosed people come from borderline families.
In DSM 4 BPD was an axis 2 disorder. Used to give diagnoses of BPD if child had sexual abuse. Now it’s
8 Problems with Literature: (1995)
1. Borderline children are not borderline adults.
2. Limitations of etiological theories (Mahler).
3. BPD supplanted by PTSD but not clear about implications. Used to be clumped together as clusters and
not treated separately.
4. Childhood trauma and childhood roots of adult psychopathology.
5. Resistance to looking at the experience of the traumatized child.
6. Do we recognize PTSD in children? (or is it misdiagnosed as AD/HD). Maybe. A lot of PTSD children
look like they have ADHD. Get ADHD medications which increase anxiety. Difference between PTSD and
ADHD is flashbacks and inattentiveness. PTSD kid is in crisis.
7. why does sexual trauma cause a particular pattern to occur?
Expected: In ways if a child is abused, they want to have nothing to do with sexuality and want to flee from
everything. Actually the opposite happens. But not a litmus test for us to understand trauma. Is what we see
of symptoms represent trauma itself or effects of trauma? Child needs relief from their symptoms. Need to
connect with comforting adults. PTSD kids can’t establish trust, many of them have been abused by people
they knew. A lot of groundwork needs to be done with them.
8. Treatment difficulties.
Simple Trauma: person has an ok life. Then they experience something traumatic. Might have PTSD.
820 sessions of therapy help with symptoms.
Moderate Trauma (not a lone category, overlap): half respond to treatment and half don’t.
The other half are complex trauma.
Complex Trauma: Early childhood abuse that sets up a person with a lot of problems as they get
older. Born into violence and poverty, drug abuse.
DSM 4TR introduced DES, NOS (disordered extreme stress not otherwise specified). Trying to
understand complex trauma. Used to treat those disorders as a cluster. DESNOS:
Mood Disorders: Depression
Sub Abuse DID
DESNOS methods of treatment didn’t make it to DSM 5.
Dan Brown (the hypnotist): Said these are categories for patients who come in to therapy:
Said 20% come in with PTSD.
20% come in with depression.
30% Axis 2 issues, relationships.
30% general safety issues, avoidance, anxiety and fear.