August 9, 2010 Jeanne Rust

Complex Trauma in Patients with Eating Disorders

At Mirasol we have been seeing much more serious trauma in clients who are currently admitting for treatment. In fact, we're seeing so much trauma that we're having all clinicians trained in EMDR, one of the most effective trauma interventions. We want to make sure that all our clinicians have the best tools available for treating PTSD and early childhood trauma.

Along with Clinical Director Diane Ryan, we are reviewing any new information available in regards to trauma and its treatment. And we are finding out complex trauma or DESNOS (extreme stress not otherwise specified) is much more common than a diagnosis of simple PTSD.

PTSD was originally developed as a diagnosis in the 1970s to explain the symptomology of Vietnam veterans. Research has shown that men are traumatized most frequently by accidents, war, assaults, and natural disasters, single event occurrences. Women, on the other hand, are most frequently traumatized by childhood sexual abuse. B.A. van der Kolk (2005) reported that between 17 and 33% of women in the general population had histories of sexual-physical abuse while women in psychiatric treatment reported 35 to 50%.

PTSD has captured only a partial snapshot of post-traumatic psychopathology. The PTSD diagnosis does not capture the facets of long-term, repeated trauma. People with a history of physical and sexual abuse over long periods of time report many psychological problems such as substance abuse, borderline and antisocial personality disorders, eating disorders, impulsivity, self-mutilation and suicidality. They will be chronically depressed with dissociative episodes of varying lengths of time. Extreme aggression and impulse control difficulties are also present.

PTSD clinically has referred to these other problems as co-morbid conditions, as if they have occurred apart from the PTSD symptoms. As a result, the authors of the DSM-IV began to separate these other symptoms under a category of extreme stress not otherwise specified (DESNOS). They found that the earlier the trauma, the more severe the symptoms of DESNOS. Studies also have shown that it is possible to experience DESNOS without having PTSD.

DESNOS represents a psychological injury from long-term social and/or interpersonal trauma that is characterized by lack or loss of control, disempowerment, and the victim is unable to escape.

As a result of our research, we evaluate all incoming clients for trauma and disassociation. If the client has a history of trauma, our clinicians immediately focus on stabilization techniques. The therapist must assume the role of teacher or guide for the client. Trauma survivors cannot teach themselves how to be safe and stable because they have no baseline, no meaningful experience of what the words "safe" or "stable" mean. Our therapists help the client learn to ground herself and to find a safe place where she can go and be protected under any circumstances.