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Posttraumatic relationship syndrome: The conscious processing of the world of trauma
Abstract
This paper was aimed at describing a new trauma-based syndrome called Posttraumatic Relationship Syndrome (PTRS) which may afflict individuals who have been traumatized by physical, sexual, and/or severe emotional abuse within the context of an intimate relationship. It differs from Posttraumatic Stress Disorder (PTSD) in a number of ways, the most salient of which are the lack of a tendency toward numbing of responsiveness, which creates a very different mode of experiencing the “world of trauma”, and the inclusion of a category of relational symptoms. Whereas, in PTSD, there is overutilization of avoidant coping, PTRS involves the overuse of emotion-focused coping. The nature and psychosocial consequences of this syndrome are delineated.
... The concept of PTRS stems from the understanding that traumatic stressors like IPV can distort an individual's core functional illusions of individual invulnerability which are: (1) the world is benign or benevolent, (2) life has a meaning, (3) individual has the control of their own life, (4) positive self-worth. When an individual stops believing in these assumptions, they eventually lose faith and trust in other people (Vandervoort & Rokach, 2003). ...
... A study that led to the proposed diagnosis of PTRS did identify that individuals who have been through traumatic relationships may have long-standing anxiety symptoms similar to that of PTSD, such as mistrust in forming new relationships, hypervigilance and terror or rage towards the perpetrator who is the spouse. This trend was noticed in a few participants (Vandervoort & Rokach, 2003). ...
... The participant has persistent fear and rage towards her perpetrator which is also generalized towards new future relationships (Vandervoort & Rokach, 2003). ...
Marriage is a socially binding intimate relationship between two individuals which is expected to be stable and enduring. In many cases, there can be severe difficulties questioning the quality of one’s married life such as IPV or other kinds of abuse or exploitation which could lead to a divorce. Although divorce legally dissolves the relationship, studies suggest that the stress caused by a traumatic relationship may not end after terminating the relationship. The resemblance of these symptoms to PTSD led to the proposed diagnosis of PTRS. In this study, seven participants who have been divorced due to domestic violence for at least a year were identified and interviewed regarding their past and present life situations. The emergent themes in the data pointed to several factors that may influence one’s married life, the decision of divorce and current life situations which can affect the amount of stress an individual might face concerning their past traumatic relationship. The factors influencing stress experienced during a traumatic marriage included involvement and support from ones’ family and in-laws, nature, and cause of abuse, stress-related to children, social support and the very decision to get a divorce. The process of overcoming fear, mistrust, and grief, social and family support, child custody, and related legal processes were factors that affected stress related to the process of divorce. The grief related to child custody, ability to rationalize the decision, career, remarriage and children’s future were some factors that influenced the stress these individuals experienced currently in their life.
... The limited research on the experiences of domestic violence and relationship formation suggests that experiences of IPV are associated with negative relationship outcomes such as less likely to marry and cohabitate (Burton et al., 2009;Cherlin, Burton, Hurt, & Purvin, 2004;Macmillian, 2001;Manning, Trella, & Lyons, 2010;Vandervoort & Rokach, 2003, 2006. A potential reason for these trends is that survivors are adapting to their reality of how relationships work based on their experiences of IPV and, as a result, develop coping and defense mechanisms that are counterproductive to creating and sustaining intimate relationships (Estacion & Cherlin, 2010;Vandervoort & Rokach, 2003, 2006. ...
... The limited research on the experiences of domestic violence and relationship formation suggests that experiences of IPV are associated with negative relationship outcomes such as less likely to marry and cohabitate (Burton et al., 2009;Cherlin, Burton, Hurt, & Purvin, 2004;Macmillian, 2001;Manning, Trella, & Lyons, 2010;Vandervoort & Rokach, 2003, 2006. A potential reason for these trends is that survivors are adapting to their reality of how relationships work based on their experiences of IPV and, as a result, develop coping and defense mechanisms that are counterproductive to creating and sustaining intimate relationships (Estacion & Cherlin, 2010;Vandervoort & Rokach, 2003, 2006. For example, some survivors may purposely create emotional distance between themselves and partners or hesitate to commit to long-term relationships to protect themselves from being vulnerable and susceptible to IPV (Cherlin et al., 2004). ...
Many survivors of intimate partner violence (IPV) experience betrayal trauma, which affects future intimate relationships. Yet many services extended to victims of IPV focus on keeping the victim safe, not helping survivors establish new healthy intimate relationships. Using betrayal trauma as a lens, this phenomenological study incorporates semistructured interviews to explore the various ways betrayal trauma manifests itself and acts as barriers to forming new healthy intimate relationships among survivors of IPV. Thematic analysis with nine survivors of IPV revealed four ways betrayal trauma manifests and acts as barriers to establishing new healthy intimate relationships: (a) vulnerability/fear, (b) relationship expectations, (c) shame/low self-esteem, and (d) communications issues. This article has implications for those working with survivors of IPV.
... Stress not Otherwise Specified - Briere & Scott, 2010;Herman, 2003;Perlman & Courtois, 2005, and Posttraumatic Relationship Syndrome - Vandervoort & Rokach, 2003). ...
he purpose of the study was to investigate the associations between comfort in the physical proximity of others and interpersonal trauma and body ego. Comfort in the physical proximity of others was measured using a self-report method, as well as by means of a procedure where the experimenter initiated interpersonal touch. The results show that comfort in the physical proximity of others (based on self-report) was associated with four types of trauma (emotional, physical or sexual abuse and emotional neglect) as well as with all aspects of dysfunctional body ego (e.g. disrupted perception, problems with interpreting and regulating physical states). Defying expectations, the types of trauma studied did not differentiate individuals experiencing comfort from those experiencing discomfort, in an experimental setting of being touched. As predicted, both groups differed in all aspects of body ego. Moreover body ego proved to be a mediator between trauma and comfort in the physical proximity of others (self-report measure).
Résumé
Depuis une quinzaine d’années, la forte prévalence de la co-morbidité des « troubles liés à l’utilisation d’une substance et à l’état de stress post-traumatique » a amené un nombre croissant d’auteurs à s’intéresser aux conséquences de celle-ci sur le traitement. Les données empiriques issues de ces études mettent d’abord en relief que la clientèle qui consulte pour alcoolisme et toxicomanie présente un tableau clinique à l’entrée en traitement nettement plus détérioré lorsque le trouble lié à l’utilisation d’une substance s’accompagne de l’état de stress post-traumatique. En plus de se présenter avec un profil clinique plus complexe, les usagers avec ces troubles concomitants retirent généralement moins de bénéfices du traitement de la toxicomanie.
Des programmes de traitement intégré s’avèrent prometteurs pour accroître les bénéfices lorsque les deux troubles sont présents simultanément, mais ne semblent pas contrer le problème de l’abandon prématuré du traitement. Bien qu’aucune étude n’ait été élaborée spécifiquement dans le but d’identifier les facteurs impliqués dans ce processus, la recension des écrits révèle plusieurs indices qui suggèrent trois hypothèses explicatives : l’hypothèse d’automédication, la faiblesse de l’alliance thérapeutique et le manque de soutien social sans compter la contribution potentielle d’obstacles pratiques tels que des difficultés de transport ou des contraintes financières. Ces hypothèses devraient orienter la recherche et ainsi fournir des éléments essentiels à la conception de traitements mieux adaptés à la réalité des survivants de trauma.
A treatment protocol for a newly proposed diagnosis called Posttraumatic Relationship Syndrome (PTRS) is outlined. As one of the most salient ways in which PTRS differs from Post-Traumatic Stress Disorder (PTSD) is that the former lacks the numbing of affect that the latter includes, treatment accordingly differs. Four stages of treatment are described, namely: (1) Understanding, normalization, and desensitization (which focuses on coping with the initial traumatized state); (2) Reflection and acceptance (which focuses on processing the trauma); (3) Integration of the trauma into the self-concept; and (4) Empowerment and growth. The treatment approach emphasizes that traumatic relationships can not only be survived, but post traumatic growth can, and indeed, often does occur.
PhD thesis, monography, 446 pages, in Norwegian. (See English summary in pdf-text).
Marriage and family counselors often encounter couples whose chief complaint is infidelity. Different models and interventions for couples working through the discovery of infidelity have been presented in the literature, which includes a vast array of articles addressing the interpersonal trauma associated with affairs; however, much of the literature presents a victim/offender model, which may not highlight systemic implications. Infidelity within relationships may also lead to grieving the idea of what the relationship was and what it represented. The systemic impact of the trauma-like and related grieving processes associated with infidelity is presented along with a case study to depict the application of a psychoeducational first step in the recovery process.
This case study describes the treatment of an individual with Posttraumatic Relationship Syndrome (PTRS), a newly proposed mental health syndrome that occurs subsequent to the experience of trauma in an intimate relationship. It includes the intrusive and arousal symptoms of Posttraumatic Stress Disorder (PTSD) but lacks the avoidance symptoms required for a diagnosis of PTSD due to a very different mode of coping with the traumatized state from that which is characteristic of individuals with PTSD. It also includes a category of relational symptoms that, of course, are not part of PTSD because the trauma it addresses does not have to occur in the context of an emotionally intimate relationship, as in PTRS. The treatment model developed and successfully implemented by the authors is described along with the posttraumatic growth the client achieved.
The concept of a spectrum of posttraumatic disorders has been postulated by a variety of major contributors to the field of
psychotraumatology. Although Posttraumatic Stress Disorder (PTSD) is one trauma-based mental health disorder, there are other
posttraumatic illnesses that do not qualify for PTSD, nor are they accurately described by other diagnostic categories in
the DSM-IV. The present paper proposes and delineates a new syndrome, entitled Posttraumatic Relationship Syndrome (PTRS),
which is a function of the experience of trauma in the context of an emotionally intimate relationship. It differs from PTSD
in four fundamental ways: (1) the nature of the Stressor criterion; (2) the response to the Stressor; (3) the inclusion of
a category of relational symptoms; and (4) the way of coping with the trauma (i.e., it lacks the emotional numbing and avoidance
of stimuli associated with the trauma). The latter is the most salient difference as it involves a qualitatively different
experience of the “world of trauma”-a primarily conscious experience in PTRS and an often unconscious experience in PTSD.
The qualitative aspects of loneliness in abused women were explored. 80 women, victims of domestic abuse who were staying in shelters, were compared with 84 women from the general population who had no history of abusive relationships. A 30-item loneliness questionnaire, having five qualitative dimensions of loneliness, namely Emotional Distress, Social Inadequacy and Alienation, Growth and Discovery, Interpersonal Isolation, and Self-alienation, was utilized to compare the loneliness in the two samples. Analysis supported the hypothesis that abused women experience loneliness differently from the general population. These abused women scored significantly higher on Emotional Distress, Interpersonal Isolation, and the Self-alienation subscales.
In 1996, representatives from 27 different countries met in Jerusalem to share ideas about traumatic stress and its impact. For many, this represented the first dialogue that they had ever had with a mental health professional from another country. Many of the attendees had themselves been exposed to either personal trauma or traumatizing stories involving their patients, and represented countries that were embroiled in conflicts with each other. Listening to one another became possible because of the humbling humanity of each participant, and the accuracy and objectivity of the data presented. Understanding human traumatization had thus become a common denomi nator, binding together all attendees. This book tries to capture the spirit of the Jerusalem World Conference on Traumatic Stress, bringing forward the diversities and commonalties of its constructive discourse. In trying to structure the various themes that arose, it was all too obvious that paradigms of different ways of conceiving of traumatic stress should be addressed first. In fact, the very idea that psychological trauma can result in mental health symptoms that should be treated has not yet gained universal acceptability. Even within medicine and mental health, competing approaches about the impact of trauma and the origins of symptoms abound. Part I discusses how the current paradigm of traumatic stress disorder developed within the historical, social, and process contexts. It also grapples with some of the difficulties that are presented by this paradigm from anthropologic, ethical, and scientific perspectives.
The classification and diagnosis of an illness is a noble task that, at first sight, seems to be a value-free activity, carried out in the best interest of scientific development and the health care necessities of a given patient. Unfortunately, science is never value free, and since Werner Heisenberg defined his principle of uncertainty, we definitely learned that, even in the so-called hard sciences, the way we look at things changes not only what we see but also what happens. Posttraumatic stress disorder (PTSD), as defined by the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987), was probably never meant to be a concept, a theory of the aftereffects of traumatic experiences, but it ended up being just that. The PTSD concept defines the existence of the illness based on the appearance of certain symptoms within a certain time span. Without symptoms, there is no illness. PTSD is a form of diagnosis applicable to individuals. If the illness in question were to exist between individuals and not only in them, PTSD not only would be incapable of understanding the phenomenon but would also influence the appearance of the illness. In short, PTSD is, necessarily, a concept that shapes our way of understanding trauma, that determines treatment strategies, and, last not least, that possibly influences how persons suffering from trauma will deal with their problem.
The diagnostic criteria of the DSM-III-R ([APA] 1987), which have already been discussed in various parts of this book, represent a spirit of compromise to reduce our criteria to the lowest common denominator. By limiting our criteria to the descriptive ones exclusively, we created a simple enough picture, so that we communicate about certain conspicuous essentials common to virtually all posttraumatic states. These criteria reflect the essential, but not all, points made by the leading contributors in this field. The most explicit statement which summarized the psychoanalytic experiences, as well as his own, was the work of (1941). Among Kardiner’s classic findings were: (1) a fixation on the trauma altering the perception of the whole world, (2) a typical dream life, (3) a contraction of the general level of functioning, (4) increased irritability, and (5) a proclivity to aggressive action.
The rclationshp between childhood sexual abuse (CSA) and borderline personality disorder (BPD) in 50 women psychiauic inpatients was examined. Inpatienfs were inletviewed using he Diagnostic Interview for Borderlines (Revised) (DIB-R). Women sexually abused as children (n = 30) scored significantly higher than those who were not (n = 20) on the total DIB-R and three of its four section scores. Women sexually abused as children were significantly more likely to have a definite diagnosis of BPD than women not sexually abused as children. who largely exhibited symptom patterns indicative of diagnoses other than BPD. An unexpected finding was that women sexually abused as children were more likely to have eating disorders than those who were not. Treatment for borderlines should explicilly address and validate the tremendous consequences of CSA on etiology and course of symptoms.
This volume is intended as a guide for doing social support research, as a compendium of . . . work in this field, and as a source of information on the implications of existing work for social policy. . . . We focus on nonprofessional (informal) social support provided by friends, relatives, and acquaintances.
This book is of special interest to the large interdisciplinary group of research professionals concerned with the role of psychosocial factors in both physical and mental health. It is also of special interest to practitioners involved in the increasing number of programs designed to support or establish natural helping networks. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
existential psychotherapy is not a specific technical approach that presents a new set of rules for therapy / it asks deep questions about the nature of anxiety, despair, grief, loneliness, isolation, and anomie / it also deals centrally with the questions of creativity and love
overview / basic concepts / the "I-Am" experience / normal and neurotic anxiety / guilt and guilt feelings / the three forms of world / the significance of time / our human capacity to transcend the immediate situation
other systems / behaviorism / orthodox Freudianism / the interpersonal school of psychotherapy / Jungian psychology / client-centered approach
history / current status / theory of personality / the Freudian model of psychodynamics / the interpersonal (neo-Freudian) model of psychodynamics / existential psychodynamics / death / freedom / isolation / meaninglessness
variety of concepts / specialness / the belief in the existence of an ultimate rescuer / theory of psychotherapy / process of psychotherapy / mechanisms of psychotherapy / death and psychotherapy / death as a boundary situation / death as a primary source of anxiety / existential isolation and psychotherapy / meaninglessness and psychotherapy
applications / problems / evaluation / treatment / management / case example
existential therapy is concerned with the "I Am" (being) experience, the culture (world) in which a patient lives, the significance of time, and the aspect of consciousness called transcendence (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The current study investigates the relationship between social support and mental and physical health. Results indicate that
poor functional support (or quality of support) is related to physical health problems while structural support (or social
network size) is not. Moreover, although both poor functional and structural support are related to depression and anxiety,
functional support is more strongly related to these outcome variables, the strongest relationship being associated with depression.
Depression and hostility are also related to social isolation, although the relationship is again stronger for depression.
The results suggest that the quality of social relationships is more important than quantity for optimal mental and physical
health. The clinical relevance of these findings is that the quality of social support in the lives of individuals is central
to recovery and should be addressed in medical and mental health treatment planning whenever it is an etiological or maintaining
factor.
Aquí se expone la influyente teoría interpersonal de la psiquiatría desarrollada por Sullivan a partir del psicoanálisis.
The authors took advantage of a 50-year prospective study of World War II veterans to examine the predictors and correlates of combat exposure, symptoms of posttraumatic stress disorder (PTSD), and trait neuroticism.
The subjects were 107 veterans who had been extensively studied before and immediately after serving overseas in World War II. All served as members of the study until the present time, and 91 completed questionnaires of both PTSD symptoms and neuroticism.
In this study group, variables associated with positive psychosocial health in adolescence and at age 65 predicted combat exposure. Combat exposure and number of physiological symptoms during combat stress--but not during civilian stress--predicted symptoms of PTSD in 1946 and 1988. Combat exposure also predicted early death and study attrition. Psychosocial vulnerability in adolescence and at age 65 and physiological symptoms during civilian stress--but not during combat stress--predicted trait neuroticism at age 65.
Combat exposure predicted symptoms of PTSD but not nonspecific measures of psychopathology. Premorbid vulnerability predicted subsequent psychopathology but not symptoms of PTSD.
This paper presents a concise, fully-referenced, state-of-the-art review of psychological trauma and Posttraumatic Stress Disorder (PTSD) for emergency mental health practitioners. The nature of traumatic events, their common symptomatology, their disruptions to normal psychological and biological functioning, and the negative health consequences of untreated incidents are presented. Implications for the treatment of victims of traumatic events within the context of a Critical Incident Stress Management (CISM; Everly & Mitchell, 1999) approach are discussed.
Traumatic relationships and serious mental disorders
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Stalking the soul: Emotional abuse and erosion of identity
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Domestic violence and child abuse sourcebook
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The severity of trauma: Issues about its role in Posttraumtic Stress Disorder
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