Appendix:Glossary of traumatology

Contents:	A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

This glossary deals with psychological responses to extreme events and only relates indirectly to physical injuries.

0–9

• 7 Cs: Developed by Søren Buus Jensen between 1996 and 2002 as a possible framework for organizing early emergency interventions. 1 Culturally sensitive and contextually appropriate interventions. 2 Coordination of all services. 3 Community oriented public mental health approach. 4 Capacity building: training, support and supervision. 5 Clinical services. 6 Care for the Caretakers. 7 Comprehensive data collection, analysis and evaluation.

A

• Abreaction: The release of emotional energy, thought to have a cleansing effect on the traumatic experience. Sigmund Freud adopted the term from the work of Josef Breuer. Freud and his era saw abreaction as a therapeutic end in itself. A more recent, linked concept is Trauma Reconstruction. Abreactions also happen spontaneously, e.g. flashbacks.[Shabtai Noy]
• Abusive Behavior Observation Checklist: Means of assessing the extent or threat of domestic violence.
• Accelerated Recovery Program: see Compassion Fatigue.
• ACE: Adverse Childhood Experiences
• Acute Stress Disorder/Acute Stress Reaction (ASD): is a DSM-IV classification for a condition where symptoms are similar to PTSD but for where the disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event. ASR is related the ICD-10 Classification. [Paul Burns]
• Adjustment Disorder of Adult Life: DSM-II published in 1968 replaced Gross Stress Reaction with ADoAL, under the heading of Transient Situational Disturbance. ADoAL was seen to occur without a pre-existing mental disorder. DSM-II listed only three examples of ADoAL - unwanted pregnancy, combat fear and death-row prisoners. [Paul Burns]
• Agnosia: Building on Hermann Munk's concept of Mind Blindness (Seelenblindheit), Sigmund Freud introduced the term Agnosia to describe the inability to identify familiar objects. Current usage may refer to loss of perceptual recognition in sight or other senses. Agnosia is sometimes linked to reactions to extreme events. [Paul Burns]
• Amnesia: "An inability to remember certain facts and experiences that cannot be attributed to ordinary forgetting". Richard McNally (2003) It may be difficult to establish to what extent amnesia is psychogenic, e.g. major stress, as opposed to organic, e.g. a head injury. Anterograde amnesia refers to loss of memory of events after an event and retrograde to loss of prior memories. McNally states, "Psychogenic amnesia must not be confused with traumatic amnesia postulated to explain why someone might not remember childhood sexual abuse. Classic psychogenic amnesia begins immediately after the precipitating event; involves loss of personal identity; involves massive retrograde memory loss, not merely loss of memory for the precipitating event; rarely lasts more than a few weeks; and usually ends suddenly rather than gradually." (p189) [Paul Burns]
• AMT: see "Anxiety Management Training"
• Analogue Trauma: Simulation of trauma such as a stressful film shown to the subjects of an experiment. First use not known. [Paul Burns]
• Anterograde Amnesia: see amnesia
• AP: see Apparently Normal Personality
• Alexithymia: Coined by John Nemiah and Peter Sifneos (1970) to indicate a marked difficulty in experiencing, identifying, and communicating emotions. It is a description of the disruption of cognition and affect rather than a recognised disorder in itself. [Paul Burns]
• Anhedonia: The term L'anhédonie was created by Théodule Armand Ribot (1896) to describe the loss of ability to experience pleasure or the loss of interest in activities that previously gave pleasure as features of depression. Anhedonia also has become recognised as a possible symptom of PTSD. Bessel van der Kolk sees it as one of a number of numbing responses [Paul Burns]
• Anxiety.
• Anxiety Management Training (AMT): A programme of relaxation and awareness training with elements of cognitive behavioural therapy first used in 1971. AMT was devised by Richard M. Suinn (1990) to promote self-control of anxiety symptoms over 6 -8 sessions by deactivating arousal and responding to early signs of stress. [Paul Burns]
• Apparently Normal Personality: Charles Samuel Myers (1940) proposed the ANP and Emotional Personality (EP) to account for different reactions to trauma in WWI. "The EP was the part of the personality that remained fixed in the original traumatic experience, suffering vivid, painful sensorimotor memories of the trauma, i.e. hypermnesia. The ANP was the part of the personality associated with partial or complete amnesia of the trauma, detachment, and numbing."[Paul Burns]
• ARP: see "Accelerated Recovery Program"
• Associated Symptoms: "problems that don't come directly from being overwhelmed with fear, but happen because of other things that were going on at the time of the trauma". See also Secondary Symptoms. [Paul Burns]
• ASD: see "Acute Stress Disorder"
• ASR: see "Acute Stress Reaction"

B

• BASK/BASKIM: The BASK model of dissociation was proposed by Bennett Braun. B = Behaviour, A = Affect, S = Somatic Sensation, and K = Knowledge. Whitfield suggested adding Identity, Imagery, and Memory and making the mnemonic BASKIM. [Paul Burns]
• Battered Child Syndrome: First used by Charles Henry Kempe et al. (1962) and focusing on physical injuries inflicted by adult carers. While BCS is now replaced by Child Abuse, which attends to mental as well as physical health, the work of Kempe is recognised for advancing awareness of child mistreatment. [Paul Burns]
• Battered Woman Syndrome: Leonore Walker (1979) defined BWS as "the psychological, emotional and behavioural reactions and deficits of victims and their inability to respond effectively to repeated physical and psychological violence." The reactions include low self-esteem, self-blame, anxiety, depression, fear, suspiciousness and loss of belief in the possibility of change. As well as symptoms, BWS incorporates models such as learned helplessness, deficient coping mechanisms and cyclical phases within a violent relationship. The mixing of symptoms with other factors is one reason why BWS is not widely used as a distinct diagnosis even though any violence, especially when it is repeated, life-threatening and anticipated with limited chances of escape, is likely to contribute to traumatic conditions such as PTSD. Review by Mary Ann Dutton[3] [Paul Burns]
• BBTS: See Brief Betrayal Trauma Survey[4]. See Betrayal Trauma.
• Betrayal Trauma: The term was first used by Jennifer Freyd in 1991 and refers to trauma induced at least in part by the abuse of trust. Betrayal Trauma may occur without an immediate threat to life and for this reason it is sometimes contrasted with fear-based trauma. The betrayal may be by an individual, e.g. parental abuse, or by an institution, e.g. a prison ignoring violence against the vulnerable. A betrayed person might be overwhelmed by feelings of shame to such an extent that the violation of trust is not recognised. See also Betrayal Trauma Theory. Jennifer Freyd’s Own Overview[5] [Paul Burns]
• Betrayal Trauma Theory: Proposed by Jennifer Freyd (1996) and explaining how people who are abused by trusted, needed others (e.g. caregivers) process and remember information in ways that are adaptive. Betrayal trauma perpetrated by a trusted caregiver occurring in concert with a person's continuing need to depend on that caregiver, often leads to the inability to know or recollect that betrayal until such time as the betrayed person is no longer dependent on the betrayer. Such amnesia is seen as less about reducing pain and more about promoting survival by allowing people to maintain relationships with those who provide for their most basic needs. Jennifer Freyd’s Own Overview[6] [Paul Burns]
• BICEPS: Brevity, Immediacy, Centrality, Expectancy, Proximity, Simplicity - principles of Military Psychiatry, most of which are discussed under P.I.E. Centrality refers to treating combat stress reaction separately from other casualties and secluding those with behaviour that might undermine the recovery of other personnel. [Paul Burns]
• Bimodal/Biphasic: Describing the contrasting sets of trauma symptoms. Bessel van der Kolk (1994 ) writes, "... the trauma response is bimodal: hypermnesia, hyper-reactivity to stimuli and traumatic reexperiencing coexist with psychic numbing, avoidance, amnesia and anhedonia ... These responses to extreme experiences are so consistent across traumatic stimuli that this biphasic reaction appears to be the normative response to any overwhelming and uncontrollable experience." [Paul Burns]
• BP/BPM: "Blood Pressure"/"Beats per minute" - two possible measures of anxiety. See also Heart Rate. [Paul Burns]
• Breathing Retraining: An anxiety management technique in which clients learn to focus on exhalation, slower breathing and pauses between breaths. There are many web references but none that I have seen identify the source of this training or its first use as a part of therapy. [Paul Burns]
• Brief COPE: See COPE Inventory.
• Briquet's Syndrome: Another name for somatization disorder, after Paul Briquet, a French Physician who wrote about it in 1859. [Paul Burns]
• BWS: See "Battered Woman Syndrome."
• Bystander Traumatisation: See Secondary Traumatisation.

C

• CAN: "Child Abuse and Neglect"
• CAPS, CAPS-1, CAPS-2 & CAPS-CA: Versions of the Clinician Administered Post-traumatic Stress Scale which uses items based on DSM III criteria. CAPS-CA is the Child and Adolescent version Further details from NCPTDS
• CASA: Court Appointed Special Advocate, e.g. for an abused or neglected child.
• CBI / CBT Cognitive Behavioural Interventions / Therapy: For example, see Cognitive Restructuring, Implosive Therapy, Systematic Desensitization and Anxiety Management Training.
• CDSG: Criminal Death Support Group
• Child Sexual Abuse Accommodation Syndrome: Used by Roland Summit (1983) to describe how a child responds to abuse. CSAAS pays particular attention to the role of secrecy, feelings of helplessness, impact on self-concept, behaviours in response to feeling entrapped, and the stress of disclosure. There have been criticisms that CSAAS does not meet criteria for being a syndrome. Summit (1992) said that CSAAS should not be used for diagnosis or forensic purposes. The concept is relevant to understanding how delayed disclosures and retracted allegations may occur. [Paul Burns]
• Chronic Hyperventilation Syndrome: see Hyperventilation Syndrome

Circumscribed PTSD: see Elaborated PTSD

• CISM: Critical Incident Stress Management
• Cognitive Processing Therapy: Developed by Patricia Resick and Monica Schnicke (1992) for survivors of rape. It includes elements of exposure and other cognitive therapy. [Paul Burns]
• Cognitive Restructuring: First use not yet identified. CR is a component in several approaches to therapy. The goal is to change unhelpful thinking through identification of dysfunctional thoughts, re-evaluation of beliefs, and replacing destructive ideas with constructive ones. [Paul Burns]
• Cognitive Rituals: see Compulsive Cognitions
• Cognitive Therapy for Trauma Related Guilt: Developed by Edward Kubany (1998) and building on his work identifying erroneous beliefs in survivors of extreme events. It involves a trauma history assessment, assessing guilt, identifying trauma related guilt beliefs, psychoeducation, dialogue to correct faulty thinking, and homework assignments. [Paul Burns]
• Combat Severity Indices: In his Traumatology article (available as pdf) Shabtai Noy (2001) reviews the literature and lists as objective indicators “…the length of stay at the battlefront, the number of actual combat days, the proximity of enemy fire, the number of comrades wounded and killed in action (WIA & KIA) in the vicinity of the soldier and ratios of these, e.g. number of WIA divided by combat days, etc.).” [Paul Burns] Combat Stress Determinants In his Traumatology article (available as pdf) Shabtai Noy (2001) includes the following as factors influencing the prevalence and type of Combat Stress Reaction. 1)Status of the War – e.g. winning, extent to which troops are moving when in combat 2)Quality of Leadership and Social Support 3)Norms and values of individuals and group 4)Available routes of evacuation - e.g. are psychiatric symptoms tolerated? 5)Who is available to listen and what behaviour is assumed to be most effective with them? 6)Expectation effects – e.g. someone fearing a gas attack may exhibits symptoms of poisoning without gas 7)•Intensity and duration. See also Combat Severity Indicators [Paul Burns]
• Combat Stress Reaction: According to Solomon (1993) an acute reaction of anxiety that may feature numbing, fainting, restlessness, psychomotor retardation, stuttering, withdrawal, vomiting, disorientation, paranoid thoughts and guilt. Shabtai Noy (2001) (available as pdf) proposes that CSR and the associated deterioration of functioning be seen as attempts to communicate to the system that combatants cannot take any more. See also Combat Severity Indicators and Combat Stress Determinants.
• Co-morbid / Comorbid: A simultaneous diagnosis, e.g. PTSD and Chronic Depression. See MCHP's Concept Dictionary for a fuller description of medical usage. [Paul Burns]
• Compassion fatigue: First used by Carla Joinson in 1992 in an article on nursing. The concept of CF was expanded and related more explicitly to trauma by Charles Figley (1995). Figley (2002, p.3) writes that "Compassion fatigue is a more user friendly term for secondary traumatic stress disorder, which is nearly identical to PTSD except that it applies to those emotionally affected by trauma of another..." Figley (2002) pp 4 & 7) compares PTSD and CF stressors and a list of CF symptoms. Introduction to CF by Charles Figley. See also Secondary Traumatisation [Paul Burns]
• Compassion Satisfaction: Term used by Beth Hudnall Stamm (2002) and Charles Figley for the ability to be sustained in the face of potentially distressing work. As Stamm (2002) puts it, "...as well as the cost of caring there are also positive payments that come from that caring." See also ProQOL [Paul Burns]
• Completion Principle proposed by Mardi Horowitz (1986, pp 93-94) as a contribution to explaining intrusion phenomena. The principle "summarises the human mind's intrinsic ability to process new information in order to bring up to date the inner schemata of the mind and the world." Horowitz suggests that until traumatic experiences have been integrated they are stored as a particular type of memory with an "intrinsic tendency to repeat the presentation of contents." [Paul Burns]
• Complex Trauma or complex post-traumatic stress disorder (complex PTSD): Judith Herman (1992) proposed that trauma is best understood as a spectrum of conditions rather than as a single disorder. She proposed that the syndrome following prolonged, repeated trauma be called "complex post-traumatic stress disorder." NCPTSD C-PTSD fact sheet including symptoms. See also Continuous Traumatic Stress Syndrome, Cumulative Trauma Disorder, DESNOS, Enduring Personality Change, Type I & II Trauma. [Paul Burns]
• Complicated Grief: see Traumatic Grief
• Compulsive Cognitions Term: Used by Padmal de Silva and Melanie Marks (1999) for the repeated replaying of details of an extreme event, when people feel they have no or little choice but to do so. This can include reviewing images in a strict sequence. The images may be of what was actually witnessed, or an attempt to fill in gaps caused by amnesia or lack of knowledge, or may dwell on what might have happened had some factor been different. The authors link their term to “cognitive rituals", used by Stanley Rachman (1971). [Paul Burns]
• Concentration Camp Syndrome: In the late 1940s people working with Holocaust survivors began to identify symptoms such as apathy, anger, anxiety, disturbed sleep, anhedonia, intrusive thoughts, difficulty concentrating, hypervigilance, depression, illogical feelings of guilt, impaired relationships and psychosomatic conditions. Later, Leo Eitinger (1980) and others linked the Syndrome more with the severity and length of imprisonment and less with the patient's pre-camp personality. See KZ Syndrome for first use. [Paul Burns]
• Conditioned Emotional Response: An emotional reaction to a stimulus that has been learned, perhaps with little or no conscious awareness. Lawrence Kolb (1984) described how these might be significant in some reactions to extreme events. John Briere (2002) writes; "These…responses are not encoded as autobiographical memories, but rather as simple associations between certain stimuli (e.g., the sudden raising of a hand) and certain responses (e.g., fear, leading to flinching). As a result they are not 'remembered', per se, but rather are evoked or triggered by events that are similar to the original abuse context…" Discussed in John Briere (2002) chapter available as pdf. [Paul Burns]
• Confabulation: Providing untrue details or elaborate stories, especially when not lying knowingly but in response to inability to recall the facts. Confabulation is sometimes associated with reactions to extreme events but also with brain injury and malnutrition. Roberta Sachs & Judith Peterson (1996) list reasons for confabulation. It is used to help hide gaps in time, to normalize past and present experiences, to shield against the intolerable, for secondary gain, to idealize the image of a significant other, and to keep secrets. Jacob Driesen's Glossary provides definitions of Personal , Momentary & Spontaneous Confabulations. [Paul Burns]
• Conflicts Around Nurturing and Contagion: Robert Jay Lifton (1968) reported how Hiroshima survivors had difficulty with relationships because of their ambivalent feelings about their condition. The identity of being a survivor raises suspicions that others cannot understand and therefore any help offered is counterfeit nurturance. Contagion refers to the suspicion that there is an invisible death taint. More recently these concepts have been incorporated into understanding the mental anguish of those with HIV. These conflicts are part of Lifton's Characteristics of Survivors. [Paul Burns]
• Conservation of Resources or COR Model of Coping: First proposed by Stevan Hobfoll (1989). Stress is seen to result from loss of things valued by an individual, or a threat to resources, or failure to gain resources. [Paul Burns]
• Constriction: Defined by Judith Herman as "the numbing response of surrender: detached states of calm or dissociation impeding voluntary action, initiative, critical judgment and perception of reality." She places it alongside Hyperarousal and Intrusion as one of the three main categories of PTSD symptoms. In her book (1988, p 45) Judith attributes the term to Janet who noted that amnesia could be due to a "constriction of the field of consciousness". Earlier in her book (pp 43-43) Judith writes: "When a person is completely powerless, and any form of resistance is futile, she may go into a state of surrender...the helpless person escapes from the situation not by action but rather by altering her state of consciousness... Perceptions may be numbed or distorted with partial anaesthesia or the loss of particular sensations." [Paul Burns]
• Constructivist Self Development Theory: CSDT was first expounded by Lisa McCann and Laurie Pearlman (1990). "Constructivist" refers to how each of us creates a unique, mental model of the world and events. These internal representations influence expectations, perceptions and other behaviour. "Self Development" emphasises the importance of early experiences and, in trauma work, the need to deal with disrupted development of self capacities and beliefs about self and the world. In CSDT trauma is seen as the result of interaction between experiences to date and the developing self's resources and mental models. Discussed in relation to self harm in pdf article by Pearlman et al. [Paul Burns]
• Contact Victimization: Used by Christine Courtois (1988) to describe the impact on a therapist of dealing with the trauma of others. See also Secondary Traumatization. [Paul Burns]
• Continuous Traumatic Stress Syndrome: Term coined by Gill Straker et al. (1987) to describe the plight of residents in South African townships subjected to frequent, high levels of violence by forces of the apartheid government, vigilantes and conflict within the black community. Attempts to respond to the PTSD of residents was hindered by inability to protect from further trauma. In part the term was created as PTSD was seen as insufficient in such a context. See also complex post-traumatic stress disorder. [Paul Burns]
• Convoy Fatigue: Discussed but not defined in Virtual Naval Hospital pdf Chapter by John Mateczun. See also War Sailor Syndrome [Paul Burns]
• COPE Inventory: A self-report measure developed to assess a broad range of coping responses, e.g. following disasters, by Charles Carver et al. (1989). A shorter version known as the Brief COPE is also available. View the Inventories. This website invites use and translation of COPE. There are already Spanish versions. [Paul Burns]
• COR: Conservation of Resources
• Counterdisaster Syndrome: Defined by Beverly Raphael (2000, p133) as "... a relatively non-productive behaviour pattern sometimes seen in the post-disaster and recovery phases. Here people are overactive, over-conscientious but with loss of efficiency. Bustling activity of a purposeless nature is characteristic of this syndrome. People may be unwilling to finish their shift, be over-involved and believe they are indispensable, even thought their efficiency is in fact diminished. This behaviour should as far as possible be prevented by clear lines of responsibility, tours of duty and personal awareness." [Tony Taylor]
• Counterfeit Nurturance: see Conflicts Around Nurturing and Contagion
• CPA: "Child Physical Abuse"
• CPT: "Cognitive Processing Therapy"
• CPTSD / C-PTSD: "Complex PTSD". see Complex Trauma
• C-PTSD / C-R PTSD: "Combat Related PTSD"
• CR: "Cognitive Restructuring". Also used for Conditioned Response.
• Cross Traumatisation: Disabling reactions to the traumatic experiences of others, presumably based on the metaphor of cross infection. First use not known. [Paul Burns]
• CRB: "Clinically relevant behaviour"
• Criminal Death Support Group: Based on work of Edward Rynearson (2001) and run for those who have lost someone as the result of violence and as a result are now involved in the criminal justice system. The group offers advocacy, support and information. [Paul Burns]
• Critical Incident Debriefing / Critical Incident Stress Debriefing: The use of group activities to help people involved in extreme events to make better sense of what happened and their reactions to it. The original Marshall Type Debriefing was used post-combat. There are a number of different approaches including Critical Incident Stress Management, Psychological Debriefing, Psychological First Aid, Group Stress Debriefing and Multiple Stressor Debriefing. Online information - 2002 Review by Litz et al. [Paul Burns]
• Critical Incident Stress Management: CISM is the Everly and Mitchell (1999) approach to Critical Incident Debriefing. The approach includes Introduction, Facts, Thoughts, Reactions, Symptoms, Teaching, Re-entry / what support is needed, follow-up and referral as needed. [Paul Burns]
• CSA: "Child Sexual Abuse"
• CSAAS: "Child Sexual Abuse Accommodation Syndrome"
• CSDT: "Constructivist Self Development Theory"
• CSR: "Combat Stress Reaction"
• CTD: "Cumulative Trauma Disorder"
• CTT: "Cognitive Trauma Therapy" or "Coping with Trauma Training"
• CT-TRG: "Cognitive Therapy for Trauma Related Guilt"
• Cultural Trauma: First use not yet identified. The impact on a group of people of ordeals such as enslavement, genocide, colonisation or massive disruption of traditional ways of life. The trauma may last many generations. Some individuals suffer more, perhaps because they are more aware of loss or because of other factors such as family influences, isolation or greater exposure to discrimination. Cultural trauma does not imply that all or most would display symptoms associated with, for example, PTSD. Further information. [Paul Burns]
• Cumulative Trauma Disorder: Ibrahim Kira (2001) appears to have been the first to write about CTD in relation to extreme events though the idea of compounded trauma has existed much longer, e.g. see Complex PTSD. Kira recognises different types of CTD. “There are distinct groups of cumulative trauma disorders that result from different sequences or patterns of trauma within a life. Both similar and varied traumatic events may contribute to a CTD. Thus, an infant repeatedly rejected by carers may develop Cumulative Attachment Trauma Disorder. And an adult refugee may develop Survival CTD from disparate events before, during and after flight. The much rejected infant, the oft-traumatized refugee and other kinds of accumulated trauma present distinctive, symptomatic features.” (personal communication, 2003). More information in Kira’s 2001 Taxonomy of Trauma article as pdf. Cumulative traumatic stress may be greater not simply because of repetition but also because of fearful anticipation, feelings of powerlessness and the frequency of the events. CTD is also used for the results of repeated physical traumas such as tennis elbow. [Paul Burns]

D

• Da Costa's Syndrome / Disease: First described by Arthur Myers (1870) but named after Jacob Da Costa (1871) who related the condition to reactions of soldiers in the American Civil War. Symptoms include breathing difficulty, palpitations, chest pain, sweating, dizziness, fainting, great fatigue, exhaustion following minor effort, numbness and paresthesia. The symptoms of the more recent Hyperventilation Syndrome overlap. Also known as Soldier's or Irritable Heart, Effort Syndrome and Neurocirculatory Asthenia. [Paul Burns]
• DARVO: Deny, Attack, and Reverse Victim and Offender. Acronym first used by Jennifer Freyd (1997) to describe the responses that wrong doers, particularly sexual offenders, may display when confronted. "Reverse Victim and Offender" describes attempts to reverse roles so that the accused presents as victim and the accuser is cast as perpetrator. Jennifer Freyd’s Own Overview [Paul Burns]
• Death Guilt: A survivor's misgivings about having survived when others did not. The guilt may be compounded by beliefs that may have no or little rational basis, e.g. that certain actions if taken or avoided might have made a difference. Death Guilt is one of Lifton's Characteristics of Survivors. [Paul Burns]
• Death Imprint: Robert Jay Lifton first used this term in relation to the use of atomic weapons in Japan. In his 1979 book he wrote that, "The death imprint consists of the radical intrusion of an image-feeling of threat or end to life." (pp 169 -170). The intrusion may be sudden or gradual. The degree to which death as represented by the image is unacceptable is linked to the level of anxiety. Anxiety and difficulty assimilating the experience are linked to the image being sudden, extreme, protracted or its association with the grotesque, absurd, premature and unacceptable dying. The Death Imprint is one of Lifton's Characteristics of Survivors. [Paul Burns]
• Debriefing: see Critical Incident Debriefing. This also lists a number of different types of debriefing. The APA Historical Database records the first use of debriefing in psychology was in a 1964 article by Stanley Milgram describing the post-experimental measures taken in his stress-inducing studies of obedience. [Paul Burns]
• Defusing: An NCPTSD article which includes guidelines on defusing says the term has been used "to describe the process of helping through the use of brief conversation... Broadly speaking, defusings are designed to give survivors an opportunity to receive support, reassurance, and information. In addition, defusing provides the clinician with an opportunity to assess and refer individuals ... More specifically, defusing may help the survivor shift from survival mode to focusing on practical steps to achieve restabilization. It may also help survivors to better understand the many thoughts and feelings associated with their experience." Others (e.g. Council for Exceptional Children and Joseph A. Davis) put more emphasis on emotional venting. As yet I have not found a source that identifies the origin of "defusing" in relation to support for people who have undergone extreme events. [Paul Burns]
• Delayed PTSD: DSM-IV advises to specify PTSD "with delayed onset" if the symptoms appear at least six months after the stressor. In his NCPTSD overview of PTSD, Matthew J. Friedman notes that, "Longitudinal research has shown that PTSD can become a chronic psychiatric disorder that can persist for decades ... Patients with chronic PTSD often exhibit a longitudinal course marked by remissions and relapses." [Paul Burns]
• Demobilization: Within debriefings, particularly in the CISM approach, a short, transitional group intervention following an extreme event. Further information from Battle Born. [Paul Burns]
• Depersonalisation / Depersonalization: (UK / US spellings) First used by Gerard Heymans (1904). A form of dissociation involving emotional detachment and disorientation relating to the perception of self, body or mental processing. E.g. having the sense of watching oneself or a feeling like a character in a dream. There is a different usage in existentialism referring to a loss of personal identity and feelings of anonymity in complex society. [Paul Burns]
• Derealisation / Derealization: (UK / US spellings) First used by Edward Mapother (reference sought) Changes in perception such that the environment seems unreal or alien or has the feel of a movie or stage set. [Paul Burns]
• DESNOS: Disorders of Extreme Stress, Not Otherwise Specified - often equated with Complex Trauma and sometimes linked to Enduring Personality Change. Significant disturbances in the following are linked to DESNOS. 1)Awareness (including amnesia, dissociation & depersonalisation)2)Perception of Self, Perception of Perpetrator 3)Relationships with Others 4)Personal Beliefs. According to Bessel van der Kolk (1996a), DESNOS was an attempt to make DSM-IV more comprehensive by reflecting research that linked persistent trauma to the compromise of the fundamental sense of self and ability to trust. However, the American Psychiatric Association did not formally recognize DESNOS as a diagnostic entity and instead listed it as a proposed additional criteria set to PTSD. A Trauma Center 2001 pdf article by Toni Luxenberg et al. includes DESNOS diagnostic criteria and a discussion of these. [Andrew Leeds & Paul Burns]
• DET: Direct Exposure Techniques / Therapies. See also DTE.
• Dialectic of Trauma: Judith Herman's (1992) term for "The conflict between the will to deny horrible events and the will to proclaim them aloud..." with their associated symptoms of numbing and reliving horrific experiences. [Paul Burns]
• DID: Dissociative Identity Disorder, see under Tertiary in Dissociation
• Disassociation: Robert Dilts (see below) attributes this concept to Milton Erickson. According to Dilts "Disassociation involves moving to or 'associating' into a different perspective" and is therefore distinct from dissociation which involves loss of elements of experience without necessarily changing perspective. Robert Dilts includes information on both terms in his online Encyclopaedia of NLP. [Paul Burns]
• Disaster Syndrome: was first use by Anthony Wallace (1956) to describe responses to a tornado but since used for behaviour following a variety of extreme events. The phases noted by Wallace were: 1)Dazed, disorientated, stunned, apathetic and passive 2)Heightened suggestibility, altruism, grateful for help, personal loss minimised, and concern for loved ones or the wider community 3)Euphoric identification with the community that has suffered and energetic involvement in restoration 4) Euphoria diminishes and more ambivalent feelings emerge, perhaps with the need to search for an explanation. The syndrome has been questioned by other researchers, e.g. the extent of apathy has been challenged. [Paul Burns]
• Disenfranchised Grief: Kenneth Doka's (1998) term for a griever receiving significantly less support because the loss is not socially acceptable. Lack of support may contribute to traumatic grief or other complications. [Paul Burns]
• Disorder.
• Disorders of Extreme Stress Not Otherwise Specified: - see DESNOS
• Dissociation: Colman (2001) defines dissociation as: Partial or total disconnection between memories of the past, awareness of identity and of immediate sensations, and control of bodily movements..." Van der Kolk, van der Hart & Marmar (1996b) propose that dissociation is used in three distinct but related ways. 1)Primary - when confronted with overwhelming threat and unable to integrate all that is happening into consciousness, sensory and emotional elements may not be integrated into personal memory and identity, remaining separated from ordinary consciousness. Fragmentation is accompanied by ego states that are distinct from normal states of consciousness - e.g. flashbacks 2) Secondary - once in a traumatic / dissociated state further disintegration of elements of the experience can occur, such as the sensation of leaving the body and observing what happens at a distance thereby limiting the experience of pain. 3)Tertiary - (also known as Dissociative Identity Disorder) when people develop distinct ego states that contain the traumatic experience. One state may contain and express the fear or anger and another may appear to be unaware of the trauma. See also Somatoform Dissociation
• Dissociative Flashback Episode: Now usually abbreviated to Flashback.
• Dissociative Identity Disorder: see under Tertiary in Dissociation
• Double Dissociation: see Visual Kinesthetic Dissociation
• DSM-IV / DSM-IV-TR: The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorder, 4th Edition, published 1994. It specifies criteria for mental disorders, including PTSD and Acute Stress Disorder. DSM-IV is reproduced in part at BehaveNet. Conditions linked to extreme events are listed under Anxiety Disorders and Dissociative Disorders. TR refers to Text Revision. DSM-IV-TR was updated in 2000 but without changes directly related to traumatic conditions. DSM-IV is listed in this dictionary's References under APA. See also ICD-10. [Paul Burns]
• DTE: Direct Therapeutic Exposure - collective name for therapies involving controlled exposure to stimuli that produce unpleasant affect.
• Dual Representation Model of PTSD: Chris Brewin et al. (1996) proposed that the complex phenomena of trauma is the result of the interplay between situational accessible memories (SAMS) and verbally accessible memories (VAMS). SAMS lead to spontaneous, intrusive images using sensory and visio-spatial cues rather than verbal information. Brief pdf article by Brewin. Updated model in Brewin & Holmes (2003). [Paul Burns]

E

• Early Insomnia: see Insomnia.
• Effort Syndrome: see Da Costa's Syndrome
• Elaborated PTSD: Robert Kohlenberg and Mavis Tsai (1998) propose that the symptoms of PTSD are elaborated through repetitive, more frequent and longer-lasting trauma at the hands of a trusted caretaker. They suggest this has implications for treatment and contrast EPTSD with Circumscribed PTSD. CPTSD symptoms develop from limited physical trauma and correspond with the DSM-IV PTSD symptoms. [Paul Burns]
• Embedded Trauma: As yet no definitions or first use found. The term usually suggests that the shock of an overwhelming event has become fixed in one or more parts of the body, often resulting in disrupted energy flows. The client now may have no awareness of the extreme event or even the resulting dysfunction. Less frequently the implication is that the trauma is fixed more in the nervous system. I have found one author who has used embedded trauma to refer to the sort of situations peace keeping forces are asked to respond to. [Paul Burns]
• EMDR: see Eye Movement Desensitization and Reprocessing
• Emotional [[[contagion|Contagion]]: Defined by Katherine Miller et al. (1988, p254) as an affective process in which "an individual observing another person experiences emotional responses parallel to that person's actual or anticipated emotions". [Paul Burns]
• Emotional Debriefing: I have not been able to identify the origin of this term or a comprehensive description of the approach. ED appears to be a form of critical incident debriefing. One site lists the aims of ED as "... to recognize potential stress, acknowledge it as a normal response and provide a supportive and structured setting to allow people to cope more effectively", and appears to link this text to a UK Health & Safety Publication. [Paul Burns]
• Emotional Hotspots: see Hot Spots
• Emotional Personality (EP): see under Apparently Normal Personality
• Emotional Processing: Defined by Stanley Rachman (2001) as "a return to undisrupted behaviour after an emotional disturbance has waned." Acknowledging that "most people successfully process the overwhelming majority of the disturbing events that occur in their lives", Rachman identified four factors that give rise to difficulties or facilitate emotional processing: 1)State (fatigue vs. relaxation) 2)Personality (neuroticism, inner-oriented vs. broad competence, self-efficacy, stability) 3)Stimulus (predictable, mild, safe, progressive, small chunks, controllable) 4)Associated Activity (concurrent stressors, need to suppress expression, intense concentration on separate task). Since residual emotional disturbances may not be evident, Rachman proposed "test probes" involving exposure to relevant stimulus material to evaluate the degree of emotional processing. [Andrew Leeds]
• Enduring Personality Changes (EPC): Those not attributable to brain damage and disease ICD-10 lists this diagnostic category under "Disorders of Adult Personality and Behaviour" and specifies that it "includes permanent changes after catastrophic experiences (such as hostage taking, torture, or other disaster) or severe mental illness” but excludes changes due to brain injury or disease. The changes include permanent hostility and distrust, social withdrawal, feelings of emptiness and hopelessness, increased dependency and problems with modulation of aggression, hypervigilance and irritability, and feelings of alienation. EPC is sometimes linked to Complex PTSD and DESNOS but the latter two are not part of ICD. See DESNOS for how this features in DSM-IV. [Paul Burns]
• EP: "Emotional Personality", see under Apparently Normal Personality
• EPTSD: "Elaborated PTSD"
• Extreme Event: A term preferred by some as, unlike "Traumatic Event" or "Potentially Traumatic Event", it does not risk suggesting that it is the event alone that leads to trauma. While an extreme event may traumatise some, others may be relatively unscathed. Hence "reactions to extreme events" rather than "traumatic reactions" or "PTSD". See discussion in a chapter of a thesis by Anthony Theuninck (Thesis contents) [Paul Burns]
• Eye Movement Desensitization and Reprocessing: An approach to psychotherapy developed by Francine Shapiro. While it uses elements of longer-established therapies EMDR is most distinctive in its use of induced eye movements. 1999 review at NCPTSD. [Paul Burns]

F

• Fear Networks: see Fear Structure
• Fear Structure: Along with Fear Network, Fear Structure refers to how information about frightening experiences has been organized in the nervous system to produce anxiety in response to certain stimuli. Lang (1977, 1979) described "fear structures" as consisting of information about: 1)•the feared stimulus 2)verbal, physiological and behavioral responses 3)meaning of the stimulus and response. Foa & Kozak (1986) state that for anxiety to decrease the fear structure must be activated and cognitive and affective information incompatible with fear be made available and integrated. [Andrew Leeds]
• FGC / FGM Female Genital Cutting (or Circumcision) / Mutilation: Further information The FGM Education and Networking Project.
• Flashback: Defined by Stephen Sonnenberg (1985) as "altered states of consciousness in which the individual believes he or she is again experiencing the traumatic event." Sonnenberg went on to say that, "As dramatic as a full-blown flashback can be, it is but one point on a spectrum of more or less subtle alterations in consciousness experienced by those suffering from PTSD." This is consistent with DSM IV which, under PTSD, lists "dissociative flashback episodes" as one way of acting or feeling as if the traumatic event were recurring. Flashbacks may be visual, auditory, olfactory, felt in the body or involve a combination of senses. Chris Brewin & Emily Holmes (2003) note that the "..images and sensations are typically disjointed and fragmentary." First use in relation to trauma sought. [Paul Burns]
• Flashbulb Memory: Roger Brown and James Kulik (1977) proposed that sudden, dramatic, and emotionally arousing events leave vivid, detailed and enduring memories. There have been questions about the extent to which such memories are accurate. More Information - article by Ebbesen & Konecni. [Paul Burns]
• Flooding: Imaginal Flooding / Implosive Therapy
• Formulation of Meaning: Robert Jay Lifton's (1968) term for a survivor's need to find meaning that makes sense of the trauma and the world she or he now inhabits. One of Lifton's Characteristics of Survivors. [Paul Burns]
• FR: "Full Remission"
• Fright
• Frozen Fright: Martin Symonds (1980) describes this as terror induced, pseudo-calm, detached behaviour. He suggested a victim of sudden and unexpected violence might experience frozen fright after initial shock and disbelief. [Paul Burns]
• Fugue: A form of dissociation in which an individual leaves one lifestyle and starts a different one for a period of time, possibly in a new location. During the fugue state the person may claim no recollection of identity though habits and skills are retained. Later, the person may claim amnesia of the fugue period. From Latin fuga - a flight and implying a flight from reality. [Paul Burns]

G

• Ganser Syndrome: After Sigbert Ganser who in 1898 noted in prisoners brief psychoses followed by amnesia. Modern usage refers to behaviours such as "approximate answers" (e.g. replying that a cow has five legs); clouding of consciousness; somatic conversion symptoms; and hallucinations. DSM II categorised trauma as an Adjustment Reaction to Adult Life and listed Ganser Syndrome as a possible identifier. DSM IV lists the syndrome as one of the identifiers for Dissociative Disorder Not Otherwise Specified. Further information from Emedicine and Who Named It. [Paul Burns]
• Gross Human Rights Violation (GHRV): Exaples include torture, disappearance or murder. [Paul Burns]
• Gross Stress Reaction: The 1952 DSM I term for stress following exposure to an environmental trauma and appearing under Transient Situational Personality Disorders. DSM I made no reference to delayed after-effects. Information on the evolution of PTSD. [Paul Burns]
• Grounding: There are different meanings but often often related to being connected calmly to the here and now, awareness of the body and the free flow of energy within and beyond the body/mind. The first therapeutic use of grounding was in the 1950s by Alexander Lowen and John Pierrakos (Lowen,1975). In trauma work grounding often refers to interventions used to avoid further dissociation or limit distress, e.g. as a flashback begins. Clients might also be helped to develop the ability to ground themselves. Types of grounding within trauma work include: 1) A series of questions about features in the room - e.g. What colour is the door? 2) Drawing attention to features in a room - e.g. Notice the grain of the wooden bowl. 3) Directing attention to parts of the body - e.g. Notice how your left foot is touching the floor. 4) Providing information about time and place - e.g. Remind yourself it is August 2003 and you are in ... 5) Changing physiology - e.g. What happens when you look up at the ceiling? / Breathe more slowly. [Paul Burns]
• Group Stress Debriefing: An approach to Critical Incident Debriefing developed by Lars Weisæth (2000) for emergency services and the military. It requires briefing prior to the risk of exposure to extreme events. The debriefing examines what happened, actions, compares what happened to what was expected and planned, and personal responses. [Paul Burns]
• Guilt: see Trauma Related Guilt

H

• Historical Group Debriefing: see Marshall Type Debriefing
• Historical Trauma: First use not yet identified. HT appears to be used in two senses. One refers to an individual having experienced trauma previously, especially if unresolved or contributing to current trauma. The second usage is similar to Cultural Trauma. E.g. Robert Prince (1998) uses HT "...to denote an event of a social nature ...that has an impact both on the development of individual persons and the further stream of history." [Paul Burns]
• Homicide Trauma Syndrome: Term given by Ann Burgess (1975) to symptoms linked to violent death and which she described as, "... acute grief reaction to the double impact of untimely death and homicide of a loved one, followed by a long-term reorganization process of the life style of the family. This trauma syndrome develops as a result of the bereavement process and the complicating socio-legal factors of homicide'. Symptoms include terror, avoidance, flashbacks and dreams of dying. [Paul Burns]
• Hopelessness Theory: Building on the theory of learned helplessness, Lynn Abramson et al. suggests that perceptions of how negative the event is and how long its impact will last for are major determinants of the extent of hopelessness. See also Psychological self-tools. [Paul Burns]
• Hostage Identification / Response Syndrome: see Stockholm Syndrome
• Hot Spots: aka Peritraumatic / Emotional Hot Spots "...refer to the specific parts of the trauma memory that cause high levels of emotional distress, that may be difficult to recall deliberately to mind, and that are associated with intense reliving of the trauma." (Nick Grey et al. 2001, p367). First use within trauma sought. [Paul Burns]
• HR / HRR: "Heart Rate" / "Heart Rate Response". Elevated heart beat in the acute posttrauma period may also be associated with subsequent PTSD. See Richard Bryant et al. (2003).
• HTQ: "Harvard Trauma Questionnaire"
• HVS: "Hyperventilation Syndrome"
• Hyperaccessibility: First used by Daniel Wegner and Ralph Erber (1992) to describe a form of heightened memory recall. Wegner notes that, "People trying not to think about a target thought show such hyperaccessibility - the tendency for the thought to come to mind more readily even than a thought that is the focus of intentional concentration - when they are put under an additional mental load or stress." Writing about posttraumatic reactions, William Flack et al. (1998) refer to hyperaccessibility as the "extreme ease of retrieval...of trauma related memories." [Paul Burns]
• Hypermnesia: Enhanced powers of memory linked to use of drugs, hypnosis or reactions to trauma. [Paul Burns]
• Hyperventilation Syndrome: Edward Newton points out that HVS has long defied precise definition but summarises it as "a condition in which minute ventilation exceeds metabolic demands, resulting in hemodynamic and chemical changes that produce characteristic symptoms." Stuart Turner & Alexandra Hough in a chapter on HVS and Torture Survivors present a table from C.J. Margarion listing symptoms (abridged below) under the headings: 1) General - e.g. fatigue, sleep disturbance, headache, poor concentration 2) Neurologic - e.g. Numbness, giddiness, visual disturbance, impaired thinking 3) Respiratory - e.g. breathing difficulties, yawning, frequent clearing of throat 4) Cardiovascular - e.g. Chest pains, palpitations 5) Gastrointestinal - e.g. bloated sensation, belching, flatus, heartburn, lower chest pain, dry mouth, lump in throat 6) Musculoskeletal - e.g. muscular tightness, cramps 7) Psychiatric - e.g. anxiety, irritability, depersonalisation, phobias, panic attacks. [Paul Burns]
• Hysteria: Alluding to its varied usage in history, in 1884 Ernest-Charles Lasègue ruled that, "The definition of hysteria was never given and never will be." It had been seen as a disease of women but by the time of Lasègue hysteria implied a nervous disorder. Andrew Colman (2001) lists hysteria as, "A once-popular name for a mental disorder characterised by emotional outbursts, fainting, heightened suggestibility and conversion symptoms..." Many of the notions of hysteria overlap with modern terms for reactions to extreme events. See also Traumatic Hysteria. [Paul Burns]

I

• ICD-10: The World Health Organisation International Classification of Diseases, 10th Revision, 1992. ICD-10 Mental Disorders summary. ICD-10 definition of PTSD. ICD-10 also includes Enduring Personality Change following extreme events. [Paul Burns]
• IES & IES- R: "Impact of Event Scale" and a revised version. The IES is a 15 item, self-rating questionnaire which also provides ratings for intrusion and avoidance - more information from Grant Devilly. The IES-R has 22 items and also assesses hyper-arousal - more information. [Paul Burns]
• IHT: "Image Habituation Training"
• Illusion of Centrality: The experience of those who believe a disaster is impacting only on them and not on a wider population or area. This is most likely to happen in the early stages of a sudden catastrophe. As yet I have not established who first used the term or noted the phenomenon. [Paul Burns]
• Image Habituation Training (IHT): IHT is a form of imaginal flooding developed by Kevin Vaughan and Nick Tarrier (1992) that uses audio tapes made by the trauma survivor and visualisation. [Paul Burns]
• Imagery Rehearsal Technique: An approach to alleviating frequent nightmares using cognitive imagery, developed by Barry Krakow and colleagues since 1988. Individuals learn that disturbing dreams are part of a larger dysfunction of the human imagery system. Imagery exercises are taught, at the core of which is the capacity to change waking imagery. Learning this skill is seen to promote changes in sleeping imagery and reduce bad dreams. Discussed in NCPTSD article. [Barry Krakow & Paul Burns]
• Imagery Rescripting: A treatment devised by Mervin Smucker et al.(1995) using imaginal exposure, cognitive restructuring and mastery imagery (replacing negative images with positives). [Paul Burns]
• Imaginal Flooding / Implosive Therapy: An exposure therapy using systematic imagining or recall of the incident that led to trauma. The aim is to eliminate the fear response through repeated exposure. The approach was first used by Thomas Stampfl building on the work of N. Malleson. NCPTSD article. [Paul Burns]
• Implosive Therapy: see Imaginal Flooding / Implosive Therapy
• Initial Insomnia: see Insomnia.
• Injury Severity Score: An anatomical scoring system that provides an overall score for patients with multiple injuries. One use if to provide a measure of injury after a driving accident. Further information. [Paul Burns]
• Insomnia: Disrupted sleep is a symptom of many complaints, including reactions to extreme events. Initial or Early Insomnia is difficulty falling asleep after retiring. Middle Insomnia or Broken Sleep refers to interrupted sleep which is then difficult to return to. Late or Terminal Insomnia refers to early morning awaking, especially when tired yet unable to sleep. People with PTSD often report insomnia and this may involve all three stages. For many people insomnia has less stigma than other symptoms and therefore exploring sleep patterns may be a good place for a clinician to begin developing a fuller understanding. [Paul Burns]
• Intergenerational Trauma: First use not yet identified. The transmission of trauma from one generation to another. Depending on context this might be within a family, a local community or people and the trauma might be precipitated by a wide range events. While IT might be limited to two generations it should not be assumed this is the case. Multigenerational Trauma conveys more clearly transmission over several generations.
• Interoceptive Exposure / Desensitization Interoceptors: Changes within the body, such as altered blood pressure, breathing or sugar levels may act as stimuli to fear and other resposnes. IE aims to extinguish negative reactions to such fluctuations. First use not identified. [Paul Burns]
• In vivo Exposure Therapy: Systematic and careful use of actual or "live" stimuli rather than imaginal ones to reduce the level of fear response. This might involve bringing the stimuli to the client, such as the aftershave used by a rapist, or taking the client to a specific environment. [Paul Burns]
• IR: "Imagery Rescripting"
• IRT: "Imagery Rehearsal Technique"
• Irritable Heart: see Da Costa's Syndrome
• ISS: "Injury Severity Score"
• Istanbul Protocol: A set of UN adopted guidelines for documentation of torture and its consequences also known as The Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. Available as pdf from Physicians for Human Rights. [Paul Burns]

K

• KED: "Kendrick Extrication Device".
• Kindling: Using the analogy of a small fire being used to start a large one, a progressively increasing, neural response that leads to a profound change in behaviour. The phenomenon was first observed in rats tha, after conditioning, began to have epileptic fits in response to voltages that would normally be too low to cause fits. It has been suggested that extreme events may sensitise similarly areas of the brain. Further information Robert Scaer 2001 on David Baldwin's site. [Paul Burns]
• Krigsseilersyndromet: see War Sailor Syndrome
• KZ Syndromet / Syndrome: see Concentration Camp Syndrome. Abbreviated from Konzenstrationlager. Frederick Hocking (1981) thought the first use of KZ Syndrome was probably by Knud Hermann and Paul Thygesen (1954).

L

• Late Insomnia: see Insomnia.
• Learned helplessness: Martin Seligman et al. (1968) first used this concept in relation to animals and later related it to humans and trauma (Seligman et al.1971). Learned Helplessness is most likely to develop in children or adults placed in situations where over time attempts to reduce stress make no useful difference. Individuals appear to learn to respond with passivity and numbing strategies. Discussed in relation to the development of PTSD and addiction in NIAAA article available as pdf. [Paul Burns]
• LEC: "Life Events Checklist"
• Life Beliefs Model: Ronnie Janoff-Bulman (1992) suggested that susceptibility to trauma may be linked to shattered assumptions, challenges to three types ofbeliefs acquired as we grow: 1) That we are invulnerable / bad things happen to other people 2) Life has meaning and purpose 3) We are reasonably good, respectable people with ability to cope. [Paul Burns]*Life Events Checklist: The trauma assessment part of CAPS.
• Lifton's Characteristics of a Survivor: Robert Jay Lifton (1968) listed five psychological issues in survivors of major trauma - the death imprint, death guilt, psychic numbing, conflicts around nurturing & contagion, and struggles with the formulation of meaning. Further information [Paul Burns]
• LOC: "Loss of Consciousness"
• Loss of Consciousness: Onno van der Hart et al. (2000) suggested that LOC "is an important contributing factor to fixation in trauma" as it reduces the ability to integrate experience. The paper is available at David Baldwin.

M

• Marshall Type Debriefing: Also known as Historical Group Debriefing. A group process used after an organic unit (e.g. military, school, police, fire fighters) has gone through an extreme event. Led by the commander, the process is focused on what happened rather than what individuals feel. Expression of feelings, however, is respected and legitimized. The goals of this debriefing are to promote group functioning, unity, cohesion and leadership by minimizing the inherent conflicts and anger that may come from not seeing the whole picture. As unit cohesion and leadership are supportive, it is assumed that through strengthening the organization such debriefing also prevents individual pathology. Named after Brigadier General S.L.A. Marshall whose work influenced the development of Critical Incident Debriefing. [Shabtai Noy] Further information from Virtual Naval Hospital.
• MCET: "Multiple Channel Exposure Therapy"
• Medical Illness-Related Psychological Distress: For some individuals receiving a diagnosis or dealing with a serious illness may produce symptoms consistent with PTSD. For some patients aspects of their treatment might induce intense fear, helplessness or horror. The relationship between PTSD and Medical Stressors is discussed by Elizabeth Mundy & Andrew Baum 2004. [Paul Burns]
• Medical Stressors: see Medical Illness-Related Psychological Distress
• Memory Recovery Therapies: As yet the earliest identified use of this term was by D. Stephen Lindsay & J. Don Read (1994, p282). They used MRT to refer to psychotherapies that place a high value on actively searching for repressed, traumatic memories in such a way as to leave the client vulnerable to suggestions resulting in implanted memories. Discussed in Ken Pope Article on Memory, Abuse, and Science. See also Trauma Search Therapy [Paul Burns]
• Mental Defeat: Developed by Anke Ehlers and others since 1997 and defined as "the perceived loss of all autonomy, a state of giving up in one's own mind all efforts to retain one's identity as a human being with a will of one's own" (Ehlers et al. 2000). Mental defeat has been shown to predict chronic, posttraumatic stress disorder, and poor response to exposure treatment. [Anke Ehlers]
• Middle Insomnia: see Insomnia.
• Mowrer's Two-Factor Theory: Orval Hobart Mowrer (1960) proposed that fear is acquired by classical conditioning and maintained by operant conditioning if the subject finds that avoidant behaviour reduces anxiety. More information in TRAUMATOLOGYe article [Paul Burns]
• Multigenerational Trauma: First use not yet identified and a formal definition is sought. See Intergenerational Trauma
• Multiple Channel Exposure Therapy: Developed since 1991 by Sherry Falsetti as a treatment for comorbid PTSD and panic disorder, using elements of Cognitive Processing and Panic Control Treatment. Discussed in 1997 NCPTSD Quarterly article by Falsetti. [Paul Burns]
• Multiple Loss Syndrome: Multiple Loss Syndrome refers to the impact of multiple losses leading to complex grief and mourning issues that do not allow sufficient opportunity to work through thoughts and feelings. The earliest use of this term is found in a paper presented to the 1992 International AIDS Conference by Sandra Jacoby Klein. MLS can be interpreted in a broader sense to reflect losses other than death that are experienced by a grieving population. These include but are not limited to loss of health and energy, community, hope for the future, job stability, independence, and validation of relationships. In a 1993 article Klein describes three symptoms; "Grief that people feel, a posttraumatic stress type response, and burnout affecting a person's ability to be present." Multiple Loss Syndrome may also refer to the experience of a community devastated by deaths and other losses. See also Klein (1998). [Paul Burns & Sandra Jacoby Klein]
• Multiple Stressor Debriefing: An approach to debriefing developed by the American Red Cross (1991) for use at disasters, especially those where people travel to be of service. The model has four phases - identifying what was distressing, exploring feelings, coping strategies, and preparation for return home. Discussed in article by Armstrong et al. [Paul Burns]
• Muselman: Nazi concentration camp prisoners' slang for an inmate who had given up. As a result of repeated traumatisation, starvation, exposure to the elements, exhaustion and despair, a person who reached the Muselman stage usually died within weeks. Muselmänner is a German word for "Muslim" and Robert Lifton (1968) writes that the slang term derives from mistaken notions of fatalism in Islam. See also Mental Defeat [Paul Burns]
• MSD: "Multiple Stressor Debriefing "
• MVA: "Motor Vehicle Accident". See also MVC.
• MVC: "Motor Vehicle Crash". Alan Stewart and Janice Lord (2002) have suggested that "crash" replace "accident " in traumatology for two reasons. Firstly, crash encompasses a wider range of causes. Secondly, most fatal crashes are not accidents as they result from avoidable behaviour such as intoxication. [Paul Burns]

N

• Narrative Exposure Therapy: A treatment for trauma resulting from organised violence using ideas from Testimony Therapy and CBT developed by Frank Neuner, Margarete Schauer and Thomas Elbert. "A form of exposure for clients with PTSD which encourages them to tell their detailed life history chronologically to someone who writes it down, reads it back to them, helps them integrate fragmented traumatic memories into a coherent narrative, and gives that to them at the end as written testimony..." Neuner's full definition Further information. [Paul Burns]
• Narrative Memory: Bessel van der Kolk & Rita Fisler (1995), citing earlier works as well as their own research, distinguished between Narrative and Traumatic Memories. The former contain semantic and symbolic meaning, are adaptive, evoked at will by the narrator and can be condensed or expanded depending on context. Traumatic memories are dominated by images, sensations and feelings, do not condense or change over time and are automatically triggered. Their article is available at David Baldwin's Trauma Information. [Paul Burns]
• NAT: "Non-accidental trauma", especially in relation to children's physical injuries. [Paul Burns]
• Natural Debriefing: Informal talking to family, friends and co-workers about an extreme event, feelings during and afterward the event and other reactions to it. Discussed in APA article by Fullerton et al. [Paul Burns]
• Natural Protest Sequence: definition sought
• Negative Symptoms of PTSD: see Positive and Negative Symptoms of PTSD
• NET: "Narrative Exposure Therapy"
• Neurocirculatory Asthenia: see Da Costa's Syndrome
• Nightmares: By themselves bad dreams are not evidence of previous trauma. In DSM-IV “Nightmare Disorder” is not used if there is another diagnosis, such as PTSD. Further information: James Pagel’s medical overview of Nightmares and Disorders of Dreaming and Alan Siegel’s Mini-course for Clinicians and Trauma Workers on Posttraumatic Nightmares. [Paul Burns]

O

• Ongoing Traumatic Stress Syndrome: see Continuous Traumatic Stress Syndrome

P

• Panic Control Treatment: Developed by Michelle Craske and David Barlow (1993) from a cognitive-behavioral perspective. It aims to reduce panic through education, cognitive restructuring, breathing retaining and interoceptive exposure. Discussed in 1995 article by Barlow and Julia Turovsky. [Paul Burns]
• Paraesthesia / Paresthesia: (UK / US spellings) An abnormal sensation with no obvious cause which may be linked to reactions to extreme events. Symptoms include numbness, tingling, pins & needles, burning, or creeping sensations. The skin is often involved but sensations deeper within the body are also reported. [Paul Burns]
• PCL: PTSD Checklist
• PCT: "Panic Control Treatment"
• PD: "Peritraumatic Dissociation"
• PE: "Prolonged Exposure"
• Peritraumatic Dissociation: Term used by Charles Marmar (1997) for dissociation experienced as a traumatic event happens. PD "... may take the form of altered time sense... profound feelings of unreality... experiences of depersonalization; out-of-body experiences; bewilderment, confusion, and disorientation; altered pain perception; altered body image or feelings of disconnection from one's body; tunnel vision; and other experiences reflecting immediate dissociative responses to trauma." Marmar and others have noted that the extent of PD may be an important indicator of later difficulties following an extreme event. See also Dissociation. 1997 article as pdf. [Paul Burns]
• Peritraumatic Distress: Distress experienced as an extreme event unfolds. [Paul Burns]
• Peritraumatic Emotional Hotspots: see Hot Spots
• Phase Oriented Treatment: see Stage Oriented Treatment
• P.I.E., P.I.E.B. & P.I.E.S.: These abbreviations represent principles used for dealing with traumatic stress, especially in battlefield conditions. Proximity, Immediacy, Expectancy plus Brevity or Simplicity. Proximity refers to treatment near to the front line. Immediacy refers to a response as soon as stress symptoms interfere with effectiveness. Expectancy requires that those treated are encouraged to expect to return soon to their units. Brevity indicates that treatment is brief. Simplicity means that treatment uses simple methods and the use of readily understood terminology. See also BICEPS. P.I.E. is discussed by Arieh Shalev in an ISSTS pdf .[Paul Burns]
• Positive and Negative Symptoms of PTSD: Positive (in the sense of present) symptoms are intrusive thoughts, nightmares and flashbacks. Negative (in the sense of missing or reduced functionality) include anhedonia, numbing and feelings of detachment and estrangement. [Paul Burns]
• Posttorture Distress Syndrome: Andreas von Wallenberg Pachaly (2000, p 269) argues that PTDS should be distinguished from PTSD because both the traumatic events and effects of torture are more severe. While he makes clear that the final definition of PTDS needs to be agreed, von Wallenberg Pachaly suggests it is a "..diagnostic entity in which victims of torture manifest at least several of the following symptoms..." - anxiety, depression, feelings of resignation, guilt, apathy, fear, suspiciousness, aggressiveness, sudden weeping, intensive rage, irritability, suicide attempts, introversion, drowsiness, exhaustion, memory difficulties, lack of concentration, disorientation, sleeping difficulties, paresthesia, sexual and psychosomatic disturbances. [Paul Burns]
• Posttraumatic /post-traumatic
• Posttraumatic Embitterment Disorder: Michael Linden (2003) has proposed PTED as a distinct subgroup of adjustment disorders. Core criteria include a single, precipitating negative life event, an ensuing negative state marked by embitterment, intrusive memories of the event, multiple additional somatic and psychological symptoms, impairment in daily activities and no obvious other mental disorder that can explain the reaction. PTED may apply when symptoms persist for longer than 3 months and everyday performance is impaired. [Paul Burns]
• Posttraumatic Growth: Richard Tedeschi and Lawrence Calhoun report that among survivors of diverse traumatic circumstances they have found five forms of posttraumatic growth - 1) more intimate, emotionally open relationships with others; 2) the recognition of new possibilities for one's life path; 3) a more profound appreciation for what life has to offer; 4) an enhanced sense of personal strength; 5) religious or spiritual development. [Paul Burns]
• Posttraumatic Psychosis: This term has at least two meanings. It may refer to a psychosis that follows a head injury. This is sometimes called Psychosis Secondary to Traumatic Brain Injury - more information. Alternatively, it refers to psychotic comorbidity or PTSD with Psychotic Symptoms. How extreme events and psychosis relate to each other, including the possibility of psychosis itself being a traumatic experience, is reviewed in a 2003 pdf article by Anthony Morrison et al. [Paul Burns]
• Posttraumatic Stress Disorder Model: The model assesses and describes the effects of sexual abuse in terms of DSM-IV PTSD symptoms. Clinicians who follow the PTSD model focus on helping traumatized children reduce symptoms of PTSD by verbalizing repressed emotions. Other ways of conceptualising and responding are the Trauma Outcome Process and the Traumagenic models. [Paul Burns]
• Post-Vietnam Syndrome: This appears to have been used first by Chaim Shatan (1972, 1973). Robert Jay Lifton is also associated with the origins of this term. Shatan identified that PVS onset was typically 9 to 30 months after Indo-China service. Those afflicted reported apathy, cynicism, alienation, depression, mistrust, fear of betrayal, poor concentration, insomnia, nightmares, restlessness and impatience. Shatan linked these symptoms to delayed and massive trauma, grief, guilt, resentment at being a scapegoat, anger and numbing. In time PVS symptoms were seen to be similar to responses to other types of extreme event, leading to the emergence of PTSD. The origins of PVS and how it contributed to the development of PTSD is documented by Ben Shephard (2000). [Paul Burns]
• PPT: "Post Traumatic Therapy"
• PR: "Partial Remission"
• Primary Dissociation: see Dissociation
• Primary / Secondary Stressors: Primary Stressors are those inherent in the extreme event, such as what was immediately experienced or witnessed, especially those things most contributing to a traumatic response. Secondary stressors follow the period of immediate threat or horror. They include pain and other physiological factors such as dehydration through internal bleeding as well as psychological stressors such as isolation, confusion, lack of information about loved ones, or treatment that is experienced as uncaring or humiliating. Discussed in Arieh Shalev pdf chapter.
• Primary / Secondary / Tertiary Traumatic Stress Disorder: In 1992 Charles Figley proposed Primary Traumatic Stress Disorder should refer to those with symptoms derived from direct exposure to an extreme event, Secondary Traumatic Stress Disorder be used for disorders displayed by those supporting those with primary experience, and Tertiary Traumatic Stress Disorder refer to the supporters of supporters. Secondary Traumatic Stress Disorder is used as a collective name for forms of Secondary Traumatization but Primary and Tertiary are less frequently used. See also Secondary Traumatic Stress. More information in pdf. [Paul Burns]
• Professional Quality of Life Scale: - see ProQOL
• Prolonged Exposure: Extended use of imaginal or in vivo exposure.
• ProQOL: Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Subscales, formerly called Compassion Satisfaction and Fatigue Test. It was developed by Beth Hudnall Stamm and her colleagues. There are French and Spanish versions. Free use of ProQOL is allowed and the manual is available as a pdf file. More Information. [Paul Burns]
• Proximity Effect / Stress: Sandra Verbosky and Deborah Ryan (1988) first used Proximity Effect in their report on partners of Vietnam veterans to describe the stress of living with another's unresolved trauma. [Paul Burns]
• PTA: "Post Traumatic Amnesia". May refer to physical trauma such as concussion. See also Traumatic Brain Injury [Paul Burns]
• PTE: "Post Traumatic Epilepsy". Generally refers to epilepsy following physical trauma. See also Traumatic Brain Injury [Paul Burns]
• PTH: "Post Traumatic Headache". Generally refers to headaches following physical trauma. [Paul Burns]
• PTSD Checklist: A self report rating scale available in both Military and Civilian versions. Further info. [Paul Burns]
• PTSD-FR / PTSD-PR: PTSD in Full Remission - no clinically significant residual symptoms of PTSD / Partial Remission - still some clinically significant symptoms of PTSD. Further info. - Dawn Johnson et al. (2003) article on clinical relevance of PR - abstract. [Paul Burns]
• PTSD: spelling of Both DSM-IV and ICD-10 use "Posttraumatic Stress Disorder", as do several dictionaries. Some dictionaries use "Post-traumatic Stress Disorder". I have found no dictionary using Post Traumatic Stress Disorder. This glossary uses Posttraumatic Stress Disorder unless quoting. [Paul Burns]
• PTSD Model: "Posttraumatic Stress Disorder Model". The use of "model" may imply another way of understanding trauamtic stress.
• PTSD-O: "Posttraumatic Stress Disorder - Organic". A clinical distinction suggested by Wolfram Schüffel and Tilmann Schunk (2001). While some with PTSD are very aware of psychological symptoms such as intrusive thoughts others present somatic or organic symptoms. However, psychological symptoms of PTSD may precede an individual's focus on somatic symptoms. More information in pdf format. [Paul Burns]
• PSEI: "Potential Stressful Events Interview." Assesses recent, low magnitude stressors, high magnitude events through life, and responses to these. More information from NCPTSD
• Pseudodissociation: The presentation of DID symptoms because people believe they have such symptoms or that this behaviour is expected of them. James Chu (1988, p196) suggests poor therapeutic practices may encourage pseudodissociation. [Paul Burns]
• Psychache: Edwin Shneidman's (1993, p51) word for "... the hurt, anguish, soreness, aching, psychological pain in the psyche, the mind. It is intrinsically psychological - the pain of excessively felt shame, or guilt, or humiliation, or loneliness, or fear, or angst, or dread of growing old, or of dying badly, or whatever. When it occurs, its reality is introspectively undeniable. Suicide occurs when the psychache is deemed by that person to be unbearable." [Paul Burns]
• Psychic numbing: Term used by Robert Jay Lifton (1968) to describe the muted emotional response of Hiroshima survivors. He suggests that cessation of feeling begins as a defence against death anxiety and death guilt. Psychic numbing now appears to be used interchangeably with numbing and emotional numbing to describe reduced affect, whether or not fatalities or a threat of death was involved. Psychic Numbing is one of Lifton's Characteristics of Survivors. [Paul Burns]
• Psychogenic.
• Psychogenic Amnesia: see Amnesia
• Psychogenic Death: Death resulting from psychological causes, especially when death is believed to be imminent and unavoidable. This might follow a curse, being told of a serious illness or from multiple causes such as in Muselman. James Tyhust (1958) appears to be the first to use the term in relation to disasters. In his Impact Phase people typically react adaptively to threats but occasionally remain in a state of denial or psychogenic death that adds to their danger. Discussed in Carole Tarantelli (2003). [Paul Burns]
• Psychological.
• Psychological Debriefing: This term is often used to refer to the family of early interventions using debriefing after an extreme event. This dictionary uses Critical Incident Debriefing for the collective term as Psychological Debriefing is used by Atle Dyregrov (1997) and Beverly Raphael (1986) for their respective approaches. Raphael's process begins with Introduction/rules and then works through Initiation into disaster, Experience, Negatives and positives, Relationships with Others, Feelings of victims, Disengagement, and Review/close. Dyregrov's approach uses seven stages - Introduction, Expectations & what did happen, Thoughts & sensory impressions, Emotional reactions, Normalisation, Future planning & coping, and Disengagement. Further information online: brief -Lynn Seiser, more detailed - Litz Review 2002, Dyregrov 1988 - Psychological Debriefing – An Effective Method? [Paul Burns]
• Psychological First Aid: First used by Robert Pynoos and Kathi Nader (1988) in relation to a fatal shooting at school. PFA can be seen as a approach to Critical Incident Debriefing in which more emphasis is placed on support and less on revisiting experiences. One format developed by Chris Freeman et al. (2000) promotes at the initial stage practical help, comfort, education about trauma, protection from further stress, care of immediate needs. The middle stage involves some telling of the trauma story, identifying support and a final stage of identifying future needs. [Paul Burns]
• Psychosocial Trauma: The Liberation theologist and psychologist Ignacio Martin-Baró (1984) used "trauma psicosocial" to describe the social impact of political, cultural and economic oppression. While some individuals witness or endure more than others, pervasive fear, grief and poverty take their toll on the wider community. At its worst, adults become so overwhelmed that they care inadequately for traumatised children. Martin-Baró's usage is discussed in an article by Yaya de Andrade & Joan Simalchik in a CPA pdf newsletter. Others use PT in a less politicised sense while still referring to the wider consequences of social strife. Occasionally PT is used in relation to accidents and natural catastrophes. The implication in all usages is that there needs to be a response which goes beyond immediate or obvious casualties. [Paul Burns]
• PTE: "Potentially Traumatising Event". See also Extreme Events.
• PTED: "Posttraumatic Embitterment Disorder"
• PVS: "Post-Vietnam Syndrome"

R

• RAMH: "Rapid Assessment of Mental Health Needs of Refugees"
• RTS: "Rape Trauma Syndrome"
• Rape Trauma Syndrome: First used by Ann Burgess and Linda Holmstrom (1974) who identified the syndrome from interviews with survivors of sexual assault. DSM III subsumed RTS under PTSD. Some are critical that PTSD was developed largely from studies of adult, male war veterans and offered little to those working with survivors of rape. RTS is seen as is a cluster of emotional responses to sexual assault including the profound fear associated with such attacks. Further information [Paul Burns]
• Recovered Memory: Defined by Heidi Sivers et al. (2002, p169 pdf file) as, "The recollection of a memory that is perceived to have been unavailable for some period of time." Jennifer Freyd Overview. See also Traumatic Amnesia.
• Repetition Phenomena: Defined by Roderick Ørner and Peter Stolz (2002) as "Contemporaneously observed or reported reactions, manifested behaviours, feelings, cognitions, memories, or physical sensations, expressed on their own or in combination, that involve some degree of reexperiencing of significant past events (e.g. intrusive reexperiencing of trauma, recreation of trauma, transference, recurrent dreams, and acting out)." Their article reviews repetition and its relationship to memories, drawing on both empirical and therapist sources. [Paul Burns]
• Resilience: The capacity to be relatively unscathed by events. Frederic Flach (1990, p40 ), writing about PTSD, defines resilience as, "The efficient blending of psychological, biological and environmental elements that permits human beings... to transit episodes of chaos necessarily associated with significant periods of stress and change successfully.” [Paul Burns]*Restorative Retelling Group: Based on the work of Edward Rynearson (2001) and run for those struggling to come to terms with a violent loss at least six months after the death. The group seeks to moderate trauma, separation, distress and promote resilience before more direct engagement of images of death. [Paul Burns]
• Retraumatisation: (1) stressful and unhelpful re-experiencing of trauma. (2) being reminded of something unpleasant. (3) a further experience of a traumatic event, such as repeated violence. [Paul Burns]
• Retrograde Amnesia: see Amnesia
• Revictimization: (1) Physical, sexual or emotional abuse experienced by an adult who was abused as a child. (2) Becoming a serial victim, such as a road accident victim who then witnesses loss of family in a natural disaster. (3) Further abuse of a person already victimised, especially when the trauma is compounded or symptoms are reactivated. 94) The process of seeking redress for victimization requires the complainant to undergo other unwelcome or emotionally draining experiences, e.g. a medical assessment or court appearance. (5) The revival of trauma symptoms that occur through chance encounters or unfortunate interventions. (6) Attempting to deal with unresolved traumatic experiences, e.g. by re-enacting or exposing oneself to further risks of being abused. [Paul Burns, with help of Trauma-Professional & Traumatic-Stress Forums]
• RRG: "Restorative Retelling Group"
• RTA: "Road Traffic Accident". See also MVC.

S

• SAFER Model: James Chu (1998 pp 78-84) uses this acronym to emphasise the important components of the initial work in Stage Oriented Treatment, before abreaction is considered. S = Self-care and Symptom Control, A= Acknowledgement of the impact of traumatic experiences, F = Functioning and living a more normal life, E = Expression of unspeakable feelings and learning to dispel unwanted ones, R = building relationships that are mutual and collaborative. [Paul Burns]
• SAMS: "Situationally Accessible Memory". See Dual Representation Model.
• Script-Driven Imagery / Script-Driven Symptom Provocation Paradigm: As there was concern about the effectiveness of using identical stimuli for all subjects in an experiment aiming to recreate symptoms of trauma or other phenomena, the script-driven approach was developed. A subject constructs a personal narrative of the relevant experience and a script derived from this is later read as the stimulus. Changes in physiological or brain activity are recorded. Discussed in NCPTDS article. [Paul Burns]
• Secondary Dissociation: see Dissociation
• Secondary Symptoms: Defined by Eve Carlson & Joseph Ruzek in an NCPTSD article as "problems that come about because of having post-traumatic re-experiencing and avoidance symptoms". See article for examples . See also Associated Symptoms. [Paul Burns]
• Secondary Stressors: see Primary / Secondary Stressors
• Secondary Traumatic Stress: Charles Figley (1995, 2002) defines STS "as the emotional, cognitive, and physical demands to cope with the traumatic and emotional material of clients." Beth Hudnall Stamm (1997 pdf) suggested using STS as "the broadest term" for conditions associated to working with the effects of trauma on other. She envisaged STS including "...other terms, such as 'compassion fatigue' and 'vicarious traumatization', and even some forms of 'countertransference' ..." See also Primary / Secondary / Tertiary Traumatic Stress Disorder [Paul Burns]
• Secondary Traumatic Stress Disorder: see Primary / Secondary / Tertiary Traumatic Stress Disorder
• Secondary Traumatization: Term first used by Robert Rosenheck and Peter Nathan (1985) to describe their observations that the children of trauma survivors displayed PTSD symptoms, but to a lesser extent than the traumatised parent. Their term is now used for other forms of secondary traumatic stress. [Paul Burns]
• Shareability: Jennifer Freyd's (1983) term for the extent to which information is shareable, and easy to communicate to another individual without loss of fidelity. Lack of language to describe subjective experiences limits shareability. Freyd's Shareability Theory proposes that over time low shareability contributes to memories, e.g. a child's experience of abuse, being altered to forms that are more readily communicated. Jennifer Freyd's own overview [Paul Burns]
• Self-efficacy: Refers to self-belief rather than skills. Albert Bandura (1977) proposed that an individual's sense of personal mastery has significant effects on mood and behaviour. Some have suggested that self-efficacy measures predict longer-lasting reactions to extreme events. e.g. Guido Flatten et al. pdf [Paul Burns]
• Self-soothing: Part of healthy development for a child is learning to do things that reduce anxiety or provide comfort in ways that are not likely to add to our problems. Children growing up in disturbing environments often fail to acquire appropriate self-soothing skills. Adults reacting to more recent trauma may need to be encouraged to use former skills and to acquire additional ways of self-soothing. A web reference for self-soothing skills further information is sought. No definition or first use found as yet. [Paul Burns]
• Self-Trauma Model: The model, developed by John Briere since 1992, suggests that dissociation is often used as a way to avoid being overwhelmed by traumatic stress. This may happen after early and severe mistreatment produces both easily triggered conditioned emotional responses and disrupted learning of affect regulation skills. Reduced affect regulation makes it easier for an individual to feel overwhelmed by distress associated with traumatic memories and thus encourages avoidance, including dissociation. Avoidance reduces chances of learning new ways of coping and may mean there is never sufficient exposure to traumatic memory; thereby blocking the processing of the conditioned emotional response. For a fuller explanation and implications for treatment see John Briere (2002) chapter available as pdf. [Paul Burns]
• Sense of Coherence: Aaron Antonovsky (1987) suggests individuals tend to see the world as more or less comprehensible, manageable, and meaningful but that some events may disrupt these beliefs, especially when the event is viewed as a random or senseless. According to Antonovsky's salutogenic model, the nature of an individual's SOC has implications for how she or he responds to stressful situations. More information in a 1999 pdf German government report in English on the Antonovsky's Salutogenic Model. [Paul Burns]
• SD: "Systematic Desensitization"
• SDR: "Stress Response Dampening"
• Sequela / Sequelae: From the Latin sequi, to follow. Symptom(s) or a condition that result from a disease or events that have gone before. [Paul Burns]
• Sequential Traumatization: First used by Hans Keilson (1979 / 1992) following his study of child survivors of Nazi persecution. He identified different stages of trauma, such as occupation leading to heightened fears, direct persecution including deportation, separation and concentration camp experiences, and post-war experiences. Discussed in Berghof Handbook for Conflict Transformation. [Paul Burns]
• Seven C's: - see 7 C's
• Shattered Assumptions: see Life Beliefs Model
• SIA: "Stress Induced Analgesia"
• SIDES & SIDES SR: "Structured Interview for Disorders of Extreme Stress" & "Self-Report Instrument for Disorders of Extreme Stress": More information from The Trauma Center and in David Pelcovitz et al. 1997. [Paul Burns]
• Silencing Response: Anna Baranowsky coined the term in 1997, building on Yael Danieli’s (1980) studies describing a "Conspiracy of Silence" among therapists of trauma survivors. Danieli reported a tendency for therapists to limit their work when the client's memories appear unbelievable or incomprehensible or arouse strong feelings in the therapist. Baranowsky (2002) conceptualises the Silencing Response as the inability of caregivers to listen attentively due to their own emotional response to the client's experiences. The response may involve redirecting the client to other topics, minimizing or neglecting discussions of the client's trauma memories. A series of assumptions lead to the Silencing Response, e.g. 1) this will hurt the client or me 2) this cannot be true 3) if this happened to you it could happen to me [Paul Burns]
• SIT: "Stress Inoculation Training"
• Situationally Accessible Memory: - see Dual Representation Model
• Sleep Paralysis: "...a condition in which someone, most often lying in a supine position, about to drop off to sleep, or just upon waking from sleep realizes that s/he is unable to move, or speak, or cry out. This may last a few seconds or several moments, occasionally longer. People frequently report feeling a "presence" that is often described as malevolent, threatening, or evil. An intense sense of dread and terror is very common." (J. Allan Cheyne, University of Waterloo website on this topic) The term appears to have been coined by Samuel Wilson (1928) though Silas Weir Mitchell (1876) called similar symptoms “night palsy.” Cultural interpretation and folk terms for sleep paralysis such as "incubus experience", "witch riding" and "old hag attack" are discussed by Cheyne et al. (1999). [Paul Burns helped by correspondence from J. Allan Cheyne]
• SoC: "Sense of Coherence"
• Soldier's Heart: see Da Costa's Syndrome
• Somatization: The process through which people express emotional distress and conflict in a physical rather than a verbal language. The individual may communicate dissociated, trauma-related feelings through the language of uncomfortable or painful physical sensations, health symptoms, and sometimes anxiety about having a physical illness. More information - Article by Hal Rogers [Paul Burns]
• Somatoform Dissociation: The lack of the normal integration of sensorimotor components of experience, e.g., hearing, seeing, feeling, speaking, moving, etc. In an article, available online, on this topic Onno van der Hart et al (2000) sets out a schema for somatoform dissociative symptoms Negative (or Continuous) and Positive (or Intermittent). These two categories are further broken down into Symptoms of Motoric Dissociation and Symptoms of Sensory or Perceptual Dissociation. See also Dissociation. [Paul Burns]
• SPAARS: "Schematic Propositional, Associative & Analogical Representation Systems". A model developed by Tim Dalgleish and Mick Power (Dalgleish 1999) which accounts for emotional responses in terms of order of meaning, different types of representation and memory. A short critique is included in an online paper by Carien van Reekum. [Paul Burns]
• Stage Oriented Treatment / Phase Oriented Treatment: James Chu (1998, pp 75-91), among others, advocates psychotherapy for serious traumatic conditions should be in three stages. The first, which may need to be lengthy, focuses on "fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning and establishing a basic positive self-identity." See also SAFER above and ISTSS article. [Paul Burns]
• [Stockholm syndrome]]: A form of Traumatic Bonding. In 1973 a bank robbery in Stockholm resulted in hostages being held for five days. Irka Kuleshnyk (1984) proposed that the syndrome features one or more of the following: 1)Positive feelings by the captive to his or her captor 2) Negative feelings by the captive towards the police and authorities 3)Positive feelings by the captor to his or her captives. Terror has been suggested as one of the factors contributing to the syndrome. The term has been linked to other forms of abuse such as concentration camp prisoners, POWs, cult members and incest survivors. There are a number of related terms including Survivor Identification Syndrome, Hostage Identification Syndrome, Common Sense Syndrome and Hostage Response Syndrome. Wikipedia states Nils Bejerot coined Stockholm Syndrome but provides no reference. [The syndrome is discussed in a report (.pdf) by Trevor Markesteyn and a paper by Dwayne Fuselier; Paul Burns]
• Stress.
• Stress Inoculation Training: Developed by Donald Meichenbaum (1985), SIT uses a cognitive behavioural framework to help people be more aware and better interpret perceptions, reduce stress through relaxation and better problem solving, and apply the learning to real life situations. In the first stage client stressors are explored and ways of better coping with them. The first stage of SIT is called ‘conceptualisation’. In stage two the individual learns positive coping for stressful situations. The last stage consolidates gains and promotes increasing healthy interactions with the external world. [Paul Burns]
• Stress Response Dampening: Robert Levenson et al. (1980) proposed a link between alcohol use and its potential to reduce of the awareness of stress. [Paul Burns]
• Stroop Test: Sometimes used in research on trauma. Subjects are shown lists of words in different colours and asked to name the colour of words. An individual’s response time for a word with emotional charge usually takes significantly longer. [Paul Burns]
• Structured Interview for Disorders of Extreme Stress: see SIDES
• STS: "Secondary Traumatic Stress". See also Primary / Secondary / Tertiary Traumatic Stress Disorder
• STSD: "Secondary Traumatic Stress Disorder". See also Primary / Secondary / Tertiary Traumatic Stress Disorder
• Subjective Units of Discomfort: SUDS were first used by Joseph Wolpe (1958) and are perhaps now better known from their use in EMDR. Clients or experimental subjects are asked to rate their discomfort on a numerical scale. In EMDR the SUDS scale goes from 0 (neutral or no disturbance) to 10 (the highest disturbance imaginable). [Paul Burns]
• Subthreshold PTSD: First use not yet identified. Defined by Randall D. Marshall et al. (2001) as having some but not all of the symptoms of PTSD listed by DSM IV. Marshall's research suggests that there may be significant symptoms and impairment without the full criteria for PTSD being met. Information on Marshall Research. [Paul Burns]
• SUDS: "Subjective Units of Discomfort"
• Survivor Syndrome: Between 1960 and 1980 it was reasonable to assume this term referred to survivors of Nazi Concentration Camps. Now the term by itself may refer to surviving other forms of extreme event and even experiences, e.g. job loss, that are unlikely to involve the type of threat usually associated with trauma. See also Concentration Camp Syndrome [Paul Burns]
• Systematic Desensitization: A treatment introduced by Joseph Wolpe (1958) and mainly used for phobia and specific anxieties. SD involves understanding what provokes least and most anxiety, learning relaxation techniques, then associating relaxation with the least provoking stimuli. Confidence in ability to relax is developed by associating with progressively more threatening stimuli. (SD was one of the influences on EMDR in which Shapiro replaced muscle relaxation with eye movements - see NCPTDS.) [Paul Burns]

T

• T, T - 1, T-2 & T + 1: Notation developed by David Grove to represent "moments" relating to a traumatic event.
  • T-1 = Trauma minus 1, the moment just before the worst moment of the experience.
  • T-2 = Any experience before T-1.
  • T = The worst moment of the experience as perceived by the client, when affect is at its most intense.
  • T+1 = The moment after the trauma when the memory is resolved. Duration of these "moments" may range from one tenth of a second to several hours. In this model, while other parts of the person continue to evolve a trapped fragment does not move beyond T-1 and symptoms develop linked to this. [Paul Burns]
• Terminal Insomnia: See Insomnia.
• Terror Management Theory: Developed and researched by Sheldon Solomon, Jeff Greenberg & Tom Pyszczynski from 1991 onwards. TMT suggests that individuals adopt certain beliefs to alleviate the fear of death. The research has explored the role of terror management processes in many areas ranging from altruism to terrorism. TMT is discussed in an article on Growth and Terror Management by Davis & McKearney, available as pdf. [Paul Burns]
• Tertiary Dissociation: see Dissociation.
• Tertiary Traumatic Stress Disorder: see Primary / Secondary / Tertiary Traumatic Stress Disorder.
• Testimony Therapy: An approach to working with victims of political violence first used in Chile by Elizabeth Lira & Eugenia Weinstein (1983, published under the pseudonyms Cienfuegos, J. & Monelli, C. and listed under these names here). Those who have experienced or witnessed human rights violations are encouraged to talk or write about their traumatic experiences with a view to promoting emotional recovery and, if the survivor agrees, providing a resource for social justice. Further information at University of Konstanz, in article by K.S. Pope and CMHR Bosnia. [Paul Burns]
• TIR: "Traumatic Incident Reduction"
• TMI: "Traumatic Memory Inventory"
• TMT: "Trauma Management Therapy" or "Terror Management Theory".
• TOP: "Trauma Outcome Process"
• Torture: Defined under UN Human Rights as "... any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity..." Other references in CODT are Istanbul Protocol and Posttorture Distress Syndrome. Further resources at Ken Pope. [Paul Burns]
• Transitional States: James Tyhurst (1958) proposed three phases for extreme events. 1) Impact is the period of danger, typically with a focus on what is happening and what needs to be done. Often there are clear memories of this time. Occasionally an individual responds unhelpfully - see Psychogenic Death. 2) Recoil is the intermediary phase, marked by strong emotional expression, disbelief and possibly exhaustion. 3) The Posttraumatic Phase sees an attempt to integrate the extreme event and return to some sort of normality. [Paul Burns]
• Trauma.
• Trauma Management Therapy: TMT was developed by B. Christopher Frueh et al (1966). It combines individual flooding with group work to develop social skills, anger & issue management and emotional rehabilitation. [Paul Burns]
• Trauma Membrane: For those who have experienced an extreme event, a social network that reduces the chances of encountering stimuli that might add to or reactivate trauma. The membrane may be functional or dysfunctional, perhaps depending on how long it is kept in place. The term was first used by Jacob D. Lindy et al (1981, p 476) who noted that family, friends or professionals often acted to protect a survivor from from what they perceived as further stress and in so doing defined what was helpful and unhelpful. In the case of a group who share an extreme event, the membrane might be largely made up by group members' own attitudes and actions. Occasionally Trauma Membrane has been used to refer to an individual's internal defence mechanisms but, as yet, I have found nothing arguing for an extension of the original meaning. [Paul Burns]
• Trauma Outcome Process: TOP was first proposed by Lucinda Rasmussen et al. (1992) and further developed as a practice model for assessing and treating survivors and perpetrators of child sexual abuse. It is based on the premise that there may be three possible outcomes in response to a traumatic experience. 1) Internalisation of emotions leading to self-destructiveness 2) externalisation of their emotions leading to abusiveness, and 3) expression of emotions leading to understanding and integration of the experience. Further information in pdf format See also PTSD Model. [Paul Burns]
• Trauma Reconstruction: A concept linked to the older one of Abreaction. The construct of "Trauma Reconstruction" emphasizes revisiting the traumatic memory in order to reconstruct cognitively a whole picture from the disassociated fragments. More information - online article "PTSD and the Consciousness Restructuring Process". [Shabtai Noy]
• Trauma Related Guilt: Edward Kubany (1998) and others have shown that guilt is a common response among survivors of different types of extreme events. Kubany has also identified a number of different types of erroneous thinking that generate or sustain guilt. The broad headings for these errors are - Faulty beliefs about pre-outcome knowledge, Faulty conclusions about justification, Faulty conclusions about causal responsibility, Faulty conclusions about wrongdoing, and Assuming affect associated with a thought is evidence of its validity. [Paul Burns]
• Trauma Search Therapy: Involves a therapist assuming that the client's current issues are due to traumatic experiences, usually in childhood. Such therapy would focus on helping the client to discover such memories. The term Traumatic Search Therapy was not created by therapists using such an approach but by people highly critical of the work of a number of therapists seen to be exposing their clients to the risks of implanting or exaggerating memories. The first identified use is by Pamela Freyd in 1993. See also Memory Recovery Therapies and Recovered Memory. [Paul Burns]
• Trauma Treatment Protocol: TTP was developed by Grant Devilly (1999) from the work of Edna Foa (1991). It uses prolonged imaginal and in vivo exposure, elements of Stress Inoculation Training. Extended cognitive therapy is interwoven with the exposure during the final stages of treatment. Further information in slide format. [Paul Burns]
• Traumatic.
• Traumagenic Model / Dynamic: David Finkelhor & Angela Brown (1986) put forward this model to explain how and why sexual victims have a range of responses. Their dynamic variables are traumatic sexualization leading to distortion of attitudes and feelings, perceptions of betrayal, feelings of powerlessness, and stigmatisation. The latter refers to negative thoughts and feelings such as guilt, shame and lowered self-esteem. See also PTSD Model. [Paul Burns]
• Traumatic Amnesia: This could refer to amnesia following a physical injury but in the context of psychological trauma usually refers to the a loss of memory of abuse in childhood. The possibility of such loss has been much challenged. E.g. See McNally quote under Amnesia.
• Traumatic Bonding: First written about by Donald Dutton and Susan Painter (1981). Dutton (personal communication 2003) defines Traumatic Bonding as "the development of strong emotional ties between two persons in a relationship characterized by a power imbalance and intermittent reinforcement such as those developed in a battering relationship where abuse is used in short bursts followed by a cessation of abuse. Over time this pattern constitutes negative reinforcement. Both affective and cognitive aspects of the interpersonal relationship are affected.” [Paul Burns]Traumatic Brain Injury Refers to neurological damage following physical trauma. Rollan Parker (2001, pp 179 - 188) has written about the overlap between concussive brain trauma and dissociative disorders. Stephen Joseph & Jackie Masterton (1999) discuss two theoretical routes through which PTSD might develop in people with brain injuries. [Paul Burns]
• Traumatic Grief: Holly Prigerson et al (1995) listed symptoms that might distinguish between ordinary and traumatic or complicated grief. These symptoms are included in an online article - Managing Grief after Disaster. Complicated grief has elements of separation distress (e.g. crying, searching) and posttraumatic stress (e.g. disbelief, shock). Prigerson suggests that complicated grief comprises a discrete set of symptoms above and beyond bereavement-related depression and anxiety. [Paul Burns]
• Traumatic Incident Reduction: or TIR was developed by Frank Gerbode. The TIR website describes it (in part) as, " is a brief, one-on-one, non-hypnotic, person-centered, simple and highly structured method for permanently eliminating the negative effects of past traumas. It involves repeated viewing of a traumatic memory under conditions designed to enhance safety and minimize distractions." See also article at David Baldwin [Paul Burns]
• Traumatic Memory: see Narrative Memory
• Traumatic Memory Inventory: The TMI instrument gathers data on characteristics of traumatic memories that distinguish them from non-traumatic memories. Discussed in pdf. chapter on traumatic memory by Bessel van der Kolk et al. [Paul Burns]
• Traumatic Hysteria: Jean-Martin Charcot's term for an hysteria caused by heightened emotions or sensations during an injury. Charcot (1825 - 1893) identified that the victim's beliefs about injury were significant both in determining the severity of the hysteria and speed of recovery. [Paul Burns]
• Traumatic Neurosis: Coined by Hermann Oppenheim, a German Neurologist who published a book with this title in 1889, based on work with survivors of accidents. He believed the physical and mental shock of concussion could alter molecules in the brain leading to either "hysteric and neurasthenic phenomena" or a combination of these neuroses. Other meanings were given to traumatic neurosis over time. The term is much less used since the introduction of the PTSD and Acute Stress Disorder. Andrew Colman (2001) defines it as "any neurosis precipitated by a trauma". Article outlining historical views on traumatic injury and neurosis. [Paul Burns]
• Traumatic Stress Schedule (TSS): A 117-item interview to assess traumatic experiences in the general population that have occurred within the past year, developed by Fran Norris (1990). [Paul Burns]
• Traumatology.
• TRGI: "Trauma-Related Guilt Inventory more information"
• TSS: see "Traumatic Stress Schedule"
• Two-Dimensional Model of Trauma: Jennifer Freyd (2001) suggests that more severe traumatic reactions are likely following both terror and social betrayal. Freyd hypothesizes that these two dimensions relate to somewhat separate reactions. The terror dimension leads to arousal and anxiety and betrayal leads to dissociation. More information by Jennifer Freyd. [Paul Burns]
• Two Factor Model: Mardi Horowitz (1976) proposed that reactions to extreme events could be seen as alternating phases of intrusive phenomena and avoidance or denial. The model emphasises the importance of the individual's belief system at the time of an extreme event and suggests a process that runs from Event, through Outcry, Denial, Intrusion, Working Through and Completion. The flow is generally one way apart from those who alternate between Denial and Intrusion. [Paul Burns]
• Type I & Type II Trauma: Lenore Terr distinguishes the effect of a single traumatic event, which she calls "Type I" trauma, from the effects of prolonged, repeated trauma, which she calls "Type II." Her description of the Type II syndrome includes denial and psychic numbing, self-hypnosis and dissociation, and alternating between extreme passivity and outbursts of rage. Type II is similar to Complex Trauma and DESNOS. [Paul Burns]

U

• UCR: "Uniform Crime Reports". FBI collated statistics on felonies.

V

• Validity of Cognition: The VoC is a seven point rating scale devised by Francine Shapiro (1995) as part of the EMDR procedure. It is used to assess the strength of beliefs. 1 = feels completely false, 7 = feels totally true. [Paul Burns]
• VAMS: "Verbally Accessible Memories". See Dual Representation Model.
• Verbally Accessible Memory: see Dual Representation Model.
• Vertical Splitting: Heinz Kohut (1971) described two kinds of splitting of awareness. The traditional view was of horizontal layering of conscious, pre-conscious and the unconscious. Studies of dissociation have led to a model where consciousness is also split vertically, such that in one state an individual can access certain information and feelings which are not available or fully available in another state. More information in online article Dissociation and Disorders. [Paul Burns]
• Vicarious Traumatisation: First used by Lisa McCann & Laurie Anne Pearlman (1990) and described as referring to "a transformation in the therapist (or other trauma worker's) inner experience resulting in empathetic engagement with the client's trauma material." Pearlman and Karen Saakvitne (1995, p. 31) More information in pdf Work-related secondary traumatic stress, 1997 NCPTSD article by Beth Hudnall Stamm. [Paul Burns]
• Visual Kinesthetic Dissociation / Rewind / Reframe: Also known as Fast Phobia Cure, and Double Dissociation Method. Generally attributed to Richard Bandler and John Grinder (1979) though Robert Dilts (see below) traces elements back to Milton Erickson and Fritz Perls, and Paul Koziey & Gordon McLeod (1987) see similarities in the work of Eric Fromm. Lewis R. Wolberg (1945) describes using a private theatre to view events as a form of hypnotic intervention. VKD aims to help an individual view fearful stimuli without the usual physical or kinesthetic response. Traumatology review of VKD and its application to trauma by Anne Dietrich. Dilts discusses and includes instructions for VKD in his online Encyclopaedia of NLP. [Paul Burns]
• VKD: "Visual Kinaesthetic Dissociation"
• VoC: "Validity of Cognition"
• VRGET: see "Virtual Reality Graded Exposure Therapy".

W

• War Sailor Syndrome: From Krigsseilersyndromet. A high proportion of the Norwegian merchant sailors who took part in WWII convoys displayed symptoms of traumatic stress, sometimes much delayed, linked to their inability to exert control over the great and prolonged risks facing wartime crews. WSS symptoms included anxiety, disturbed sleep, fatigue, irritability, apathy, impaired memory and concentration, dizziness, profuse sweating, loss of appetite, impotence, and somatic pains. WSS symptoms were first described by Adam Egede-Nissen and the term was coined by Finn Askevold (1976-77). Askevold noted the similarity between the symptoms of war sailors who had suffered largely from psychological stress and those of Holocaust survivors who had suffered physically as well as mentally. The comparison of WSS and Concentration Camp Syndrome helped to establish the role of psychological stressors. See also Convoy Fatigue. [Paul Burns]

Z

References

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