TTC Complex Trauma & Dissociation 2 — Questions and Answers
Question 1: Which structural model of dissociation distinguishes between the 'Apparently Normal Part' (ANP) and the 'Emotional Part' (EP) of the personality?
- Ego State Theory
- Theory of Structural Dissociation (Correct answer)
- Polyvagal Theory
- Attachment Theory
Correct answer: Theory of Structural Dissociation
The Theory of Structural Dissociation (Van der Hart, Nijenhuis & Steele) divides the personality into ANP, which manages daily functioning, and EP, which holds traumatic memories and emotional responses.
Question 2: A client with complex trauma reports feeling like a detached observer watching themselves during a therapy session. This experience is BEST described as:
- Derealization
- Depersonalization (Correct answer)
- Dissociative amnesia
- Emotional numbing
Correct answer: Depersonalization
Depersonalization involves feeling detached from one's own body or mental processes, as if one is an outside observer of one's thoughts, feelings, or actions.
Question 3: In complex trauma treatment, 'windows of tolerance' refers to:
- The time limit for each therapy session
- The optimal arousal zone for processing trauma without overwhelm or shutdown (Correct answer)
- The number of trauma memories a client can safely process per week
- The therapist's capacity to sit with client distress
Correct answer: The optimal arousal zone for processing trauma without overwhelm or shutdown
The window of tolerance (Siegel) describes the zone of optimal arousal where a client can process trauma material without becoming hyper- or hypo-aroused.
Question 4: Which of the following is a PRIMARY difference between simple PTSD and Complex PTSD (C-PTSD)?
- C-PTSD requires a single severe traumatic event
- C-PTSD includes disturbances in self-organization such as affect dysregulation and negative self-concept (Correct answer)
- C-PTSD is diagnosed only in combat veterans
- C-PTSD does not involve re-experiencing symptoms
Correct answer: C-PTSD includes disturbances in self-organization such as affect dysregulation and negative self-concept
C-PTSD includes the core PTSD symptoms plus disturbances in self-organization (DSO): affect dysregulation, negative self-concept, and interpersonal disturbances.
Question 5: A therapist notices their client rapidly alternates between intense emotional flooding and complete emotional detachment within a single session. This pattern is MOST consistent with:
- Bipolar II disorder
- Borderline personality disorder switching
- Oscillation between hyper- and hypo-arousal states in complex trauma (Correct answer)
- Malingering
Correct answer: Oscillation between hyper- and hypo-arousal states in complex trauma
Rapid oscillation between emotional flooding (hyperarousal) and emotional detachment (hypoarousal/dissociation) is a hallmark presentation in complex trauma, reflecting dysregulated nervous system responses.
Question 6: The ICD-11 formally recognizes Complex PTSD as a distinct diagnosis. Which of the following symptom clusters is UNIQUE to ICD-11 C-PTSD and NOT required for PTSD?
- Intrusive re-experiencing
- Avoidance of trauma reminders
- Disturbances in self-organization (DSO) (Correct answer)
- Sense of current threat
Correct answer: Disturbances in self-organization (DSO)
The ICD-11 C-PTSD diagnosis requires all three PTSD criteria PLUS disturbances in self-organization (DSO), which includes affect dysregulation, negative self-concept, and relational disturbances.
Question 7: Which therapeutic approach is specifically designed to work with dissociative parts by facilitating communication and integration between ego states?
- Prolonged Exposure Therapy
- Eye Movement Desensitization and Reprocessing (EMDR)
- Ego State Therapy (Correct answer)
- Dialectical Behavior Therapy
Correct answer: Ego State Therapy
Ego State Therapy (Watkins & Watkins) directly addresses dissociative parts or ego states, facilitating communication, cooperation, and integration among them.
TTC Complex Trauma & Dissociation 2
Which structural model of dissociation distinguishes between the 'Apparently Normal Part' (ANP) and the 'Emotional Part' (EP) of the personality?