Understanding what trauma is and how it relates to PTSD and DID is vital in enabling us to see how many of us, in particular those who are autistic, experience trauma in our lifetimes.
What is trauma?
Trauma is any experience a person has which exceeds their ability to cope or process and integrate the emotions that arise as a result of it.
For this reason trauma is highly subjective, and is dependent on a persons levels of resilience, ability to regulate and previous exposure to trauma.
What is traumatisation?
Traumatisation occurs when:
- A person is overwhelmed by a situation that they perceive as threatening and which exceeds their ability to cope or self regulate.
- A person is unable to use survival responses to take action ie. fight or flight, instead becoming immobilised or freezing.
More information on trauma and traumatisation
What is Post Traumatic Stress Disorder (PTSD)?
PTSD can develop after a single traumatic episode where a person has been so overwhelmed they have been unable to process and integrate what has happened to them.
The ICD 11 uses the following experiences to define PTSD:
- Re-experiencing of past trauma in the here and now.
- Avoidance of traumatic reminders
- Continued experience of a sense of threat
What is Complex Post Traumatic Stress Disorder (C-PTSD)?
C-PTSD most often develops as a result of severe and repeated interpersonal traumas.
In addition to the experiences defining PTSD, the ICD 11 uses the following experiences of disturbance in self to define C-PTSD:
- Difficulties with affect regulation (nervous system frequently swings between hypoarousal and hyperarousal)
- Negative self image (extreme self loathing and shame, sense of worthlessness etc.)
- Disturbances in relationships (Including extreme difficulty trusting others)
More information on PTSD and C-PTSD
What is Dissociative Identity Disorder (DID)?
DID is a strategy the brain uses to survive experiences of severe and repeated interpersonal traumas, that usually start at a young age.
Through dissociation, the brain compartmentalises or splits off from overwhelming memories at the developmental age of the trauma. This enables the person to continue functioning whilst remaining amnesic to the traumatic memories.
Splitting off results in the development of different parts of self, who have specific identities and roles and who hold specific memories within a person’s system.
Everyone with DID also has C-PTSD, not everyone with C-PTSD has DID.
The ICD 11 uses the following experiences to define DID:
- Disruption in identity in which there are two or more personality states
- Each personality state has its own pattern of experiencing, perceiving, conceiving and relating to self, the body and the environment
- At least two distinct personality states take executive control of consciousness and functioning when interacting with others or with the environment
- Changes in personality state are accompanied by related alterations in sensation, perception, affect, cognition, memory, motor control and behaviour
- Episodes of amnesia, which may be severe.
References
ICD 11 – WHO (2018). International Classification of Diseases – 11th edition. Accessible at: WHO (https://www.who.int/classifications/icd/en/)