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COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

COSIG CONFERENCE BROCHURE.pdf - Drexel University College ... COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

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COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006 Emotional Vulnerability and Invalidating Environment = Child with some emotional problems already Major TRAUMA • Sexual Abuse • Physical Abuse • Emotional Abuse NOW…………… ADD 19 • Severe Neglect 20 BPD 1. AVOID ABANDONMENT 2. INTENSE RELATIONSHIPS 3. PROBLEMS WITH SELF- IMAGE 4. IMPULSIVITY IN SELF- DAMAGING AREAS 5. RECURRENT SUICIDAL PARASUICIDAL BEHAVIOR 6. AFFECTIVE INSTABILITY 7. FEELINGS OF EMPTINESS 8. INTENSE ANGER 9. DISSOCIATIVE SYMPTOMS BPD and PTSD PTSD 1. EXPOSURE TO TRAUMA INVOLVING INTENSE FEAR 2. RE-EXPERIENCING TRAUMA 3. AVOID STIMULI ASSOCIATED WITH TRAUMA 4. NUMBING OF RESPONSES 5. INCREASED AROUSAL 6. SYMPTOMS LAST LONGER THAN 1 MONTH 7. IMPAIRS IMPORTANT Comorbidity of BPD and PTSD (Freeman, 1998) • 1/3 of persons with BPD fulfill criteria for PTSD • 75% of whom are women • Hx of physical or sexual abuse in the developmental background of 60%-75% of persons with BPD • Women with BPD who report Hx of sexual abuse engage in more lethal self-injurious behavior than women not reporting abuse AREAS OF FUNCTIONING 21 22 Substance Abuse and Trauma • PTSD –5 times likelihood of alcohol abuse & dependence • PTSD and veterans - 75% met criteria for alcohol abuse • 60% women & 20% men in alcohol recovery programs – sexual abuse as child • 80% men and women report physical abuse as children in above recovery Complex Posttraumatic Syndrome (Van der Kolk, 1994) Conglomeration of syndrome tends to occur together: • Chronic affect dysregulation • Destructive behavior against self and others • Learning disabilities • Dissociative problems • Somatization/physical complaints program • Distortions in concepts of self and others 23 24 4

COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006 A New Diagnosis: Complex Posttraumatic Stress Disorder (Herman, 1992) Complex Posttraumatic Stress Disorder (Cont’d) (Herman, 1992) • Alterations in perception of perpetrator (preoccupation with perpetrator, acceptance of beliefs of perpetrator, etc.) • Alterations in relations with others (isolation, distrust, searching for rescuer, failures at self-protection, etc.) • Somatization (unexplained or exacerbated physical complaints) • Alterations in system of meaning (sense of hopelessness and despair, etc) A history of subjection to totalitarian control over a prolonged period ( e.g. survivors of childhood sexual abuse) • Alterations in affect or impulse regulation (chronic suicidal ideation, selfinjury, explosive anger, etc.) • Alterations in consciousness or attention (dissociative episodes, reliving trauma, depersonalization, etc.) • Alterations in self-perception (selfblame; sense of helplessness, etc.) 25 26 Multi-Dimensional Biopsychosocial Assessment • Mental Health • Substance Use • Psychosocial • Medical • Developmental Examples Of Assessment Domains (APA, 2001) • Presence of risk-taking & impulsive behaviors • Mood disturbance and reactivity • Risk of suicide • Risk of violence to persons or property • Substance abuse 27 28 Assessment Domains (cont’d) (APA, 2001) • Ability to care for self or others (e.g. children, aging parent) • Achievements, skills • Financial resources • Psychosocial stressors and supports • Motivation and readiness for treatment 29 Engagement Start where the person is, including developmentally Balance client-centered expectations, goals regarding behavioral change with therapist goals of balancing safety issues and placing responsibility on the individual Maintain a dialectical abstinence approach Complete and total emphasis on abstinence on one hand with on other hand a planned approach for lapses that mitigates harm and increases resumption of abstinence 30 5

<strong>COSIG</strong> Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006<br />

Emotional Vulnerability<br />

and<br />

Invalidating Environment<br />

=<br />

Child with some emotional<br />

problems already<br />

Major TRAUMA<br />

• Sexual Abuse<br />

• Physical Abuse<br />

• Emotional Abuse<br />

NOW…………… ADD<br />

19<br />

• Severe Neglect<br />

20<br />

BPD<br />

1. AVOID ABANDONMENT<br />

2. INTENSE RELATIONSHIPS<br />

3. PROBLEMS WITH SELF-<br />

IMAGE<br />

4. IMPULSIVITY IN SELF-<br />

DAMAGING AREAS<br />

5. RECURRENT SUICIDAL<br />

PARASUICIDAL BEHAVIOR<br />

6. AFFECTIVE INSTABILITY<br />

7. FEELINGS OF EMPTINESS<br />

8. INTENSE ANGER<br />

9. DISSOCIATIVE<br />

SYMPTOMS<br />

BPD and PTSD<br />

PTSD<br />

1. EXPOSURE TO TRAUMA<br />

INVOLVING INTENSE<br />

FEAR<br />

2. RE-EXPERIENCING<br />

TRAUMA<br />

3. AVOID STIMULI<br />

ASSOCIATED WITH<br />

TRAUMA<br />

4. NUMBING OF<br />

RESPONSES<br />

5. INCREASED AROUSAL<br />

6. SYMPTOMS LAST<br />

LONGER THAN 1 MONTH<br />

7. IMPAIRS IMPORTANT<br />

Comorbidity of BPD and<br />

PTSD (Freeman, 1998)<br />

• 1/3 of persons with BPD fulfill criteria for PTSD<br />

• 75% of whom are women<br />

• Hx of physical or sexual abuse in the<br />

developmental background of 60%-75% of<br />

persons with BPD<br />

• Women with BPD who report Hx of sexual abuse<br />

engage in more lethal self-injurious behavior<br />

than women not reporting abuse<br />

AREAS OF FUNCTIONING 21<br />

22<br />

Substance Abuse and Trauma<br />

• PTSD –5 times likelihood of alcohol abuse<br />

& dependence<br />

• PTSD and veterans - 75% met criteria for<br />

alcohol abuse<br />

• 60% women & 20% men in alcohol<br />

recovery programs – sexual abuse as<br />

child<br />

• 80% men and women report physical<br />

abuse as children in above recovery<br />

Complex Posttraumatic<br />

Syndrome (Van der Kolk, 1994)<br />

Conglomeration of syndrome tends to<br />

occur together:<br />

• Chronic affect dysregulation<br />

• Destructive behavior against self and<br />

others<br />

• Learning disabilities<br />

• Dissociative problems<br />

• Somatization/physical complaints<br />

program • Distortions in concepts of self and others<br />

23<br />

24<br />

4

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