Page 227 - Creating Spiritual and Psychological Resilience

196 Creating Spiritual and Psychological Resilence

or Holocaust survivors’ responses to retirement (Danieli, 1994a, 1994b).
Retraumatization has also been referred to in the context of a therapeutic
or other helping relationships, or in a research context as possibly provok-
ing traumatic reactions by untimely and insensitive inquiries.
A brief overview about trauma and posttraumatic stress disorder
(PTSD) symptomatology (see Diagnostic and Statistical Manual of Mental
Disorders, 4th ed., American Psychiatric Association, 1994, for the full
criteria) sheds light on the many components of the experiential process of
repetitive reenactment and ripple effect of trauma. Specifically, Criterion
B for the diagnosis of 309.81 posttraumatic stress disorder in particular
(see below) acknowledges the internal dimension of (re)traumatization in
both adults and children, while Criteria C and D describe their internal
attempt at coping with this (self-)retraumatization.
Criterion B: The traumatic event is persistently reexperienced in at
least one (or more) of the following ways:

1. Recurrent and intrusive distressing recollections of the event, including
images, thoughts, or perceptions.
Note: In young children, repetitive play may occur in which themes
or aspects of the trauma are expressed.
2. Recurrent distressing dreams of the event.
Note: In children, there may be frightening dreams without recog-
nizable content.
3. Acting or feeling as if the event were recurring (includes a sense of
reliving the experience, illusions, hallucinations, and dissociative
flashback episodes, including those that occur on awakening or when
intoxicated).
Note: In young children, trauma-specific reenactment may occur.
4. Intense psychological distress at exposure to internal or external cues
that symbolize or resemble an aspect of the traumatic event.
5. Physiological reactivity on exposure to internal or external cues that
symbolize or resemble an aspect of the traumatic event.

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

1. Efforts to avoid thoughts, feelings, or conversations associated with the
trauma
2. Efforts to avoid activities, places, or people that arouse recollections
of the trauma