Cognitive ego-disturbances in the elderly who have become victims of organized violence

Abstract

It is not easy to diagnose the sequelae of organized violence as they might become manifest at older age. The concept of Posttraumatic Stress Disorder (PTSD) gives to little to hang on. A more specific diagnosis such as the DESNOS (Disorders of Extreme Stress Not Otherwise Specified) which was proposed for (but not included in) the DSM IV is lacking. In the ICD-10 we find the diagnosis "Durable personality changes after catastrofic experiences" based on five global criteria which are not validated yet. From a clinical point of view there is a need for a testable and operational concept of the enduring posttraumatic personality changes. The concept of the posttraumatic self disorder is chosen here. It consists of disorders of the physical self, the object relational self and the historical self. In this article the historical self is described in more detail. Different empirical findings are discussed to illustrate that experience of one's own life history might be disturbed after having been submitted to organized violence. This can lead to serious complaints and functional psychological interferences. Self disorders are part of these late and durable posttraumatic phenomenology.