لایب سان

You suddenly have sleep disorders with stressful nightmares, experience a trau- matic event over and over again, see images, get strong fears associated with unu- sual physical symptoms. You have a flashback in a board meeting or in the checkout line at the super- market. You suddenly have a dissociation in the spotlight on a stage or in a train. You suddenly lack half a day. You are unusually startled in everyday life. Your need to wash suddenly becomes burdensome and compulsive. You avoid any memories and potentially threatening situations out of fear of re-experiencing. Traumatic and existential threatening situations happen suddenly and af- fect many people. But only a part of them develop post-traumatic stress disorder (PTSD). What protects the one from it and how can the affected person deal with the symptoms independently? Why is he affected and why not? What makes a trauma a trauma, what are the symptoms of post-traumatic stress disorder at all? And is it a weakness to have such symptoms? Maybe even a strength? How can one deal constructively with traumas and post-traumatic stress dis- orders, especially in exposed positions? Use and overcome these perhaps even as a competitive advantage, regain personal happiness? Does this only concern me, or are there others as well? And how do I deal with a person who has experienced a trauma? By the combined look of an experienced psychiatric medical therapist and a long-time manager, this book is the fusion of a practice-oriented textbook with a professional guide. Interrelationships and solutions for coping with trauma, espe- cially for exposed persons, are shown. Self-initiative and a possible need for profes- sional support are expressly not replaced. The aim is to gain knowledge. Sometimes the female, sometimes the male form is used below. Of course, un- less otherwise stated, all genders are meant to be equal. For reasons of efficiency, given the target group of media/management/public, only the most essential infor- mation is focused on and thus dispenses with detailed descriptions and background information. An extensive bibliography serves as a guide for deepening individual interests. The index helps the reader to quickly find specific information, sorted by keywords. Trauma and management, fear and public, and also all connecting media—all these aspects are closely related. Often it is precisely such inner drives as traumatic experiences and their consequences that make people particularly successful in management and public. But knowledge, understanding and the right approach are decisive. This also applies to the optimal use of one’s own resources, both in terms of professional career and in the simultaneous pursuit of personal happiness. It is important and unavoidable to accept what has happened radically and to use it ac- tively to your advantage. This means not closing your eyes, accepting the challenge and growing from it. Not easy at all, but is there really any alternative?

IX Contents 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Trauma and Posttraumatic Stress Disorder (PTSD)—Definition, Classification, Epidemiology and History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2.1 What is a Trauma?—Trauma Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2.2 What Traumas are There?—Classifications of Traumas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.3 Posttraumatic Stress Disorder (PTSD). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2.4 Trauma-Related Disorders in Different Classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.5 What is How Often?—Epidemiology of PTSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.6 The History of PTSD as a Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3 Physiology of a Traumatic Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.1 Why Feelings?—Basics of Emotions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 3.2 Acute Traumatisation and the Traumatic Pincer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.3 The Unbearable can be Borne!—Dissociation in the Traumatic Situation . . . . . . . . . . . 19 3.4 Early Intervention and Debriefing—Does Quick Help Help Quickly?. . . . . . . . . . . . . . . . 20 3.5 What Protects?—Resilience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 3.6 What is at Risk?—Risk Factors for PTSD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 4 Symptoms of PTSD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 4.1 Core Symptoms of PTSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 4.1.1 Intrusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 4.1.2 Hyperarousal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 4.1.3 Avoidance Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 4.2 Symptoms of Complex PTSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 4.3 Dissociation and Dissociative Identity Structure as a Result of Severe, Complex and Chronic Traumatization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 4.4 If Something Else Happens!—Comorbidities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4.4.1 Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 4.4.2 Depressions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 4.4.3 Dependency Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.4.4 Other Mental Illnesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.4.5 Somatic Comorbidities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.5 Self-Injury and Suicidal Thoughts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 5 Dealing with Trauma and PTSD Privately and in Public . . . . . . . . . . . . . . . . . . . . 53 5.1 Am I or the Others Going Crazy?—The Question of the What and Why. . . . . . . . . . . . . . 54 5.2 Am I to Blame?—The Question of Why. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 5.3 Break the Silence? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 X Contents 6 Trauma Coping and Professional Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 6.1 What Can I Do Myself—Strategies for “Self-Therapeutic” Help. . . . . . . . . . . . . . . . . . . . . . 61 6.1.1 If the Memory Keeps Coming Back!—Dealing with Flashbacks, Nightmares, Traumatic Memories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 6.1.2 Not the Same Thing Again!—Dealing with Avoidance Behavior . . . . . . . . . . . . . . . . . . . . . . 65 6.1.3 Always under Pressure!—Dealing with Hyperarousal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 6.1.4 When Half the Day is Missing!—Dealing with Dissociations . . . . . . . . . . . . . . . . . . . . . . . . . . 72 6.1.5 When the Mind Falls into the Trap!—The 10 Most Important Cognitive PTSD Traps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 6.1.6 Thought Carousel!—Dealing with Thought Circles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 6.1.7 When Fears Determine Life!—Dealing with Fears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 6.1.8 What to Do about Pain?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 6.1.9 When the Night Becomes Day!—Dealing with Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . 80 6.1.10 When Addiction has You in its Grip!—Dealing with Addiction. . . . . . . . . . . . . . . . . . . . . . . . 81 6.2 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 6.3 General Basics of Trauma Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 6.4 Behavioral, Psychodynamic and Trauma-Specific Approaches. . . . . . . . . . . . . . . . . . . . . . 84 6.4.1 Stabilization Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 6.4.2 Confrontation Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 6.4.3 Reorientation Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 6.5 Confrontation Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 6.5.1 EMDR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 6.5.2 Narrative Exposure Therapy (NET) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 6.5.3 PITT and Observer Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 6.5.4 IRRT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 6.6 Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 7 How the Social Environment of Those Affected by Trauma and PTSD Deals with the Topic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 8 Disease Prevention and Primary/Secondary Traumatization . . . . . . . . . . . . . . 99 8.1 Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 8.2 Secondary Traumatization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 9 Trauma and PTSD in Film and Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 9.1 Movies with the Theme of Trauma and PTSD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 9.2 Literary Works with the Theme of Trauma and PTSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 10 Future Prospects, Manage Business and Everyday Life. . . . . . . . . . . . . . . . . . . . . 109 10.1 What Can I Do? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 10.2 Understanding as the First Step to a Solution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Supplementary Information Recommended Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

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