Psychologists love alphabet soup, right? Well, I have an entrée that I predict will one day be added to the diagnostic manual. It won’t be in our lifetime, though. It will take hundreds of years and perhaps a loud and bloody revolution for people to wise up to that extent. It’s this -- CBT/DBT PTSD. Yes, it means PTSD symptoms caused in part by CBT and/ or DBT. And I would be willing to bet that the vast majority of sufferers will be trauma survivors like me. They will be people who were powerless against adults as little children. They will be people who were repeatedly beaten, ridiculed, tormented, threatened, molested, sodomized and otherwise raped when they were children, were never allowed to tell the truth and whose pain was marginalized or ignored. They will be people who were hated, punished, rejected and abandoned for telling the truth in childhood and then also in adulthood. Some of these CBT/DBT PTSD sufferers will be highly dissociative. Because that’s what happens to brutalized children who have no safe place to go for comfort and then grow up to be marginalized and psychologically and emotionally assaulted as a punishment whenever they cry out in pain and confusion.



Case Study:

Ursula Underpants was a 40 year-old woman who became very angry and began to withdraw from her therapy. She began verbally abusing the therapist, shouting, cursing and sending hateful and insulting emails whenever he said words and phrases like wise mind, use your wisdom, present moment, mindfulness and discipline. She also displayed these behaviors after she cried excessively or had panic attacks in therapy and was met with suggestions to use drugs, store her emotions and memories away in containers or rely too heavily on distraction. Upon further investigation, it was found that Ms. Underpants had already used these methods for many, many years. She experienced problems with them, including alcoholism, drug abuse and suicidality, because the amount of energy needed to maintain the dissociation from her memories and feelings was very exhaustive and she would often collapse. She was always given drugs to treat these collapses. They had many serious and negative effects on her health, physically and mentally. Whenever she could no longer use drugs with any measurable success and also remain reasonably healthy, she sought therapy and was again instructed to distract, store and otherwise dissociate her thoughts and emotions and the cycle repeated many times until Ms. Underpants gave up her work and her social life in an effort to stay alive. She didn’t feel she could be depended upon to commit to anything outside of her home because she was too busy maintaining her dissociation to be reliable and she had no energy for anything else. It was all she could do to keep up with the needs of her family and distract herself by renovating her home. After she isolated herself, she did the renovation alone and on her own schedule so her sleeping disorder and frequent breakdowns would not disrupt her nonexistent friends or job and thus require treatment that she had unconsciously recognized was unhealthy and not working.

When she contacted her current therapist, she presented with anxiety and difficulty adjusting to a change in life circumstances. Three months later she experienced a full-blown flashback in which she uncovered the memory of a rape that had occurred a decade earlier and had previously been available only in memory fragments and sensory associations which produced distress ranging from hypochondria to anxiety and depression, severe panic attacks and dissociative episodes. With the support and care of her therapist, she was able to integrate this experience in a six month time frame and no longer experienced intrusions related to the rape. She still suffered from some anxiety, but felt much better and was attempting to regain some of the activities she had abandoned before she discovered and worked through the memory and emotions of the rape.

Shortly thereafter, Ms. Underpants experienced another full-blown flashback from an earlier sexual assault which her therapist handled differently. He broke the warm connection that she had with him and behaved coldly and clinically, suggesting that she either use drugs or focus on the present moment. She confronted him with her true feelings about this and he quickly apologized. Ms. Underpants lost contact with this event and dissociated the pain and the feelings of betrayal that were part of that experience. This began a decline for Ms. Underpants during which she began displaying hostility toward the therapist. The feelings of hostility further undermined her self-esteem because she did not know why they occurred and she loved and respected the therapist and was not in the habit of being hostile toward people about whom she felt warmly. Her decline was greatly exacerbated by the shock and fear she experienced when she began to understand the implications of having more than one ‘forgotten’ rape while recognizing the existence of other anxiety producing memory fragments and sensory associations that she knew did not belong with anything she had already remembered. It took her much longer to process the second memory than it did to process the first.

A few months after the second assault memory had been integrated, Ms. Underpants had a dissociative episode outdoors in the cold after suffering for weeks with increased anxiety in response to the weather. She sent her therapist an email in which she confessed that she thought drizzle was really snowflakes hitting her face and that she had been overcome with the fear that she would begin to run down the street and 'lose track of herself’. She was very suddenly 'cured’ of her waking anxieties (via dissociation) after making this disclosure and only the sleep disorder remained. Weeks later, and a full year and a half after the upsetting event in the relationship with the therapist, Ms. Underpants was again faced with the full recollection and feelings of a stored trauma. This time, it was the negative event with the therapist. She told him and he was understanding and willing to work through it with her. It was difficult for her to do this and it had to be done in small bits and pieces over a large amount of time. It is still being processed to some degree. In the meantime Ms. Underpants suffers because frightening sensory associations often dominate her time and dissociated memory fragments rise to the surface of her consciousness even though they cannot be placed in time and context. She has a lot of difficulty accepting these things without being able to fully feel the care and support of her therapist. When she uses her old skills and ‘stores’ them, her sleep disorder becomes even worse and she also experiences severe somatic symptoms which trigger hypochondria which triggers more dissociation. She is often reluctant to mention certain problems to her therapist because she fears he might say things to further perpetuate the old cycle of distraction, denial, minimization and invalidation as he has on a few occasions, with each one further eroding her trust, hope and self-esteem. Ms. Underpants feels she has spent her life being further damaged by very popular philosophies and therapies which mimic the dissociation that first saved her life and then destroyed it. She feels stalked by these philosophies and sees no escape and no sufficient refuge. She is afraid to trust anyone and currently has a drinking problem that began recently after thirteen years of sobriety. Ms. Underpants has CBT/DBT PTSD.



edited to add: 4-22-2010

If you think you might have CBT/ DBT PTSD, click here. You are welcome to leave your story in the comments. Both Grace and I will be happy to read it. Believe me - WE UNDERSTAND YOUR PAIN. We wish we didn't because of how much it hurts us to know these things so personally, but we do understand and you are not alone.