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Treating PTSD: Natural Disasters, Sexual Abuse & Combat
Treating PTSD: Natural Disasters, Sexual Abuse & Combat

Section 7
Track #7 - Treating 'Victim Thinking' and the 'Loss of an Orderly World'

CEU Question 7 | CEU Answer Booklet | Table of Contents | PTSD
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs, Nurse CEUs

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On the last track, we discussed survivor guilt and other self-destructive behaviors arising from it such as:  self-mutilation, substance addiction, and eating disorders.

On this track, we will examine the three levels of victimization regarding shattered assumptions; secondary wounding; and victim thinking.  We will present PTSD resulting from sexual abuse and natural disasters.

3 Levels of Victimization

Share on Facebook #1 Shattered Assumptions
The first level of victimization is shattered assumptions.  Often, such traumatic events as tornadoes, hurricanes, or flash floods up heave conceptions that clients once had about themselves and their lives such as invulnerability, an image of an orderly world, and a positive self-image.  Most clients grow up with the idea that something terrible could never happen to them. 

When a crisis does occur, however, this assertion is thrown out the window.  When the assumption of an orderly world is challenged, clients conclude that life is meaningless and incomprehensible or that fate singled them out for punishment. 

Sheryl, a PTSD I was treating, suffered from loss of her orderly world.  From the age of 8 to 11, Sheryl’s uncle had sexually abused her.  When she finally told her parents about the abuse at the age of 16, they considered the abuse unimportant and her uncle’s wife accused Sheryl of lying and trying to break up the family. 

Years later, at 20, Sheryl was involved in a traumatic car accident which her aunt attributed as her punishment for her lies.  A member of Sheryl’s church also saw the accident as Sheryl’s punishment for having orgasms during the incest and for not forgiving her abuser. 

Consequently, Sheryl suffered from a loss of positive self-image and considered herself a dirty and unworthy person who even God hated.  At the end of this track I will explain how the Primary Effects technique was beneficial to Sheryl.

Share on Facebook #2 Secondary Wounding
The second level of victimization is secondary wounding.  Secondary wounding results from the negative effects of other people in the client’s life.  Such attitudes that encompass secondary wounding are: “You weren’t injured enough to be entitled to benefits” or “It happened weeks or years ago.  You should be over it by now.”  These attitudes augment the pain already suffered by trauma survivors. 

Recall the story of Sheryl that we related earlier on in this track.  Her parent’s apathy towards her abuse, her aunt's attacks, and her friend’s belief that she deserved the accident are all examples of secondary wounding. 

There are three forms of secondary wounding: 
-- 1. Disbelief, Denial, or Discounting
The first, disbelief, denial, or discounting, occurs when others belittle the effects of the client’s trauma.  After Hurricane Katrina, Ronaldo, a concert pianist, was told that three of his fingers were to be amputated. He began to cry, but the nurse told him, “Hush now, you big crybaby.  Look around you.  Bed number one lost his arm and bed two has to have both legs removed.  Count your blessings.” 
-- 2. Blaming the Victim
The second type of secondary wounding, blaming the victim, is much like what happened in Sheryl’s story in which her friend blamed her for the accident. 
-- 3. Stigmatization
The third type of secondary wounding, stigmatization, occurs when others judge the client negatively for normal reactions to the traumatic event. 

These judgments can take several forms: 
a. Condescension toward the survivor;
b. Misinterpretation of the survivor’s psychological distress;
c. Implication that the survivor’s symptoms reflect his or her desire for financial gain, attention, or unwarranted sympathy; or
d. Punishment of the victim rather than the offender. 

Share on Facebook Technique:  Primary Effects of Secondary Wounding
To help Ronaldo and Sheryl cope with the effects of their secondary wounding, I asked them to complete an exercise in their journals that I call “Primary Effects of Secondary Wounding”. 

I asked both of them to answer the following questions concerning the various situations in which they encountered secondary wounding:

  1. Did it alter your views of your social, vocational, and other abilities?
  2. Did it change your attitudes towards certain types or groups of people and/or certain government and social institutions?
  3. Were your religious or spiritual views affected?
  4. Did it affect your family life, friendships, or other close relationships?
  5. Did it alter your ability to participate in groups or belong to associations or your attitudes towards the general public?
  6. Now, review the attitudes you just listed and ask yourself, “Which of these attitudes do I wish to retain?  Which of them are in my best interest to reconsider?  Which ones would I like to discard because they hamper my life in the present?

Share on Facebook #3 Victim Thinking                                                                           
In addition to shattered assumptions and secondary wounding, the third level of victimization is victim thinking.  This occurs when a client acts and speaks as though they are still a victim when in fact the danger has been removed.  States Dr. Barry McCarthy, “The third level of victimization involves the person adopting a lifelong label as a victim.” 

In essence, the traumatic event and its aftermath becomes the central theme in the client’s life, negating all other experiences.  The feelings of hopelessness, helplessness, defilement and betrayal embody victim thinking. 

There are four sources of victim thinking: 

  1. Intolerance of mistakes in others and in self.  During traumatic events, even the tiniest of mistakes can result in death or injury.  Those suffering from victim thinking begin to adopt this mindset and may soon develop into perfectionists.
  2. Denial of personal difficulties.  Those working in such fields as medicine, combat, or rescue work come in contact with traumatic events day after day.  Because their occupations demand solid and calm thinking, they develop a mindset that any display of emotional weakness renders them incompetent for their job.  As a result, they start to downplay their fear.
  3. All-or-nothing thinking.  Clients suffering from PTSD that are encased in this mindset begin to see issues as good or bad, friends or enemies.  Children, teens, and young adults tend to suffer the most from this mindset. 
  4. Continuation of survival tactics.  Because some clients are still stuck in the emotional victim gear, they continue the survival tactics they utilized during the trauma in their everyday lives.  For instance, if their survival tactic was anger, a PTSD client with a victim thinking mindset of continuation of survival tactics will use seem easily irritated or angered.

On this track we discussed the three levels of victimization:  shattered assumptions; secondary wounding; and victim thinking.

On the next track, we will present the effects of triggers on PTSD clients and also various types of triggers:  anniversary triggers, current stresses, and bodily triggers.

Online Continuing Education QUESTION 7
What are the three levels of victimization? To select and enter your answer go to CEU Answer Booklet.

 
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Treating PTSD: Natural Disasters, Sexual Abuse & Combat

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