The disorder-specific psychological impairment in complex PTSD: A flawed working model for restoration of trust

ABSTRACT

This article methodically gathers concepts and findings from related disciplines to propose that there is a fundamental, disorder-specific psychological impairment, which defines Complex Posttraumatic Stress Disorder (PTSD) as etiologically different from simple PTSD. This impairment is a flawed working model for restoration of trust when one partner fears betrayal. This working model is legacy of childhood relationships with manipulative caretakers who kept the child powerless to test the trustworthiness of their reasons to break promises and to fail the child’s expectations. Manipulative caretakers invert the respective roles and responsibilities for restoration of trust, which constitutes perversion of intimacy. This article describes how that fundamental flaw becomes the cause of patients’ disorder, by episodically rendering them powerless to ascertain a perception of grave betrayal as true or false in later relationships. Repeated failure with experiments for certainty about others’ love explains the characteristic personality traits and beliefs of persons with Complex PTSD, i.e., cynicism about the world’s benevolence, self-derogation and sense of a foreshortened future. This article closes with reference to a study that investigated the efficacy of a crisis intervention designed to remediate this fundamental impairment.

KEYWORDS:

• Fundamental impairment
• disorder specific
• flawed working model
• restoration of trust
• intimacy
• perversion

Notes

^1. The cited references state that (a) intrusions in various disorders differ mostly thematically, about the kind of past adversity; (b) symptoms about danger of betrayal happen in the context of preoccupation with social danger in the present or a dreaded future, a context characteristic of crises in Complex PTSD.

^2. Intrusions and flashbacks evolve over time. They range from the reconstruction of a real event to the construction of an entirely hypothetical situation, scenarios that nevertheless had a strong thematic connection to multiple events.

^3. These chapters cover an array of elements that comprise the conditions for mental disorder. Persistence with a single goal begins with appraisal of its desirability, feasibility, and urgency. Subsequent “goal shielding” automatically biases attention for developments in reality or in the mind that favor its completion.

^4. The authors reviewed 1958 studies of crisis intervention efficacy for patients with BPD. Their review included crisis interventions of up to 1-month duration. The authors noted insufficient randomization as a methodological shortcoming for the Laddis study, but they selected it among 15 that “merited further inspection.”