Date: 12-02-91 - 7:28  
    From: Robin Gober 
    To  : John Powell
    Subj: Professional Approach, 

    John HI! Thought I would post this for everybody. 

   Diagnostic criteria for Post-traumatic Stress Disorder.

   A. The  person  has  experienced an event that is outside the  range  of 
      usual  human  experience  and that would be markedly  distressing  to 
      almost  anyone,   e.g.,   serious threat to one's  life  or  physical 
      intergrity;   serious threat or harm to one's childern,  spouse,   or 
      other  close relatives and friends;  sudden destruction of one's home 
      or community;  or seeing another person who has recently been,  or is 
      being,   seriously injured or killed as the result of an accident  or 
      physical violence. 

   B. The  traumatic event is persistenly reexperienced in at least one  of 
      the following ways: 

      (1) recurrent  and intrusive distressing recollections of  the  event 
          (in  young  children,   repetitive play in which  the  themes  or 
          aspects of the trauma are expressed) 
      
      (2) recurrent distressing dreams of the event 

      (3) sudden  acting or feeling as if the traumtic event were recurring 
          (includes   a  sense  of  reliving  the  experience,   illusions, 
          hallucinations, and dissociative [flashback] episodes, even those 
          that occur upon awakening or when intoxicated. 

      (4) intense  psychological  distress  at  exposure  to  events   that 
          symbolize or resemble an aspect of the traumatic even,  including 
          anniversaries of the trauma. 

    C. Persistent  avoidance  of  stimuli associated  with  the  trauma  or 
       numbing  of general responsiveness (not present before the  trauma), 
       as indicated by at least three of the following: 

      (1) efforts to avoid thoughts or feelings associated with the trauma 
      
      (2) efforts   to   avoid   activities  or  situations   that   arouse 
          recollections of the trauma. 
      
      (4) markedly  diminished interest in significant activities (in young 
          children,  loss of recently acquired developmental skills such as 
          toilet training or language skills) 
      
      (5) feeling of detachment or estrangement from others 
      
      (6) restricted range of affect, e.g., unable tohave loving feelings 
      
      (7) sense of a foreshorted future,  e.g.,  does not expect to have  a 
          career, marriage, or children, or long life 

   D. Persistent  symptoms  of  increased arousal,not  present  before  the 
      trauma,indicated by at least two of the following: 
      
      (1) difficulty falling or staying asleep
      
      (2) irritability or outbust of anger
      
      (3) difficulty concentrating
      
      (4) hypervigilance
      
      (5) exaggerated stratle response
      
      (6) physiologic reactivity upon exposure to events that symbolize  or 
          resemble  an aspect of the traumatic event (e.g.,a woman who  was 
          raped  in  an elevator breaks out in a sweat  when  entering  any 
          elevator) 

   E. Duration of the disturbance (symptoms in B,C, and D)  of at least one 
      month. 

      Specify  delayed  onset  if the onset of symptoms was  at  least  six 
      months after the trauma. 


      "Growth of Co-dependence 

      1. Invalidation  and  repression  of  internal  cues,   such  as  our 
         observations, feelings and reations 

      2. Neglecting our needs

      3. Beginning to stifle our Child Within

      4. Denial of a family or other secret

      5. Increasing tolerance of and numbness to emotional pain

      6. Inability to grieve a loss to completion

      7. Blocking of growth (mental,emotional,spiritual)

      8. Compulsive behaviors in order to lessen pain

      9. Progressive shame and loss of self-esteem

     10. Feeling out of control. Need to control more

     11. Delusion and projection of pain

     12. Stress-related illness develops

     13. Compulsions worsen

     14. Progessive deterioration

            Extreme mood swings
            Difficuty with intimate relationships
            Chronic unhappiness

     To  get to the point of recovery,  we must survive.  Survivors are  by 
   necessity co-dependents.  We use many coping skills and ego defenses  to 
   do this.  ....  survive by dodging, hiding, negotiating,  taking care of 
   others,   pretending,  denying and learning and adapting to  stay  alive 
   using  any  method  that works.  They learn other  often  unhealthy  ego 
   defense mechanisms,  as describe by Anna Freud (1936)  and summarized by 
   Vaillant(1977)    These   include:   intellectualization,    repression, 
   disassociation,   displacement  and reaction formation (all of which  if 
   overused can be considered neurotic) and projection,  passive-aggressive 
   behavior,  acting out,  hypochondriasis,  grandiosity and denial (all of 
   which  if overused can be considered immature and at times  psychotic)." 
   _Healing the Child Within_ Charles L. Whitfield M.D.