An Interdisciplinary Inquiry into Post-Traumatic Stress and Identity

The Collapse of the Victim/Perpetrator Binary ✨

1. The Architecture of Trauma: Clinical and Historical Foundations

1.1. Defining the Wound: The Modern Taxonomy of Post-Traumatic Stress

The formal recognition and classification of psychological trauma represent a critical step in understanding human suffering. The American Psychological Association (APA) defines trauma as any disturbing experience that results in significant fear, helplessness, or confusion intense enough to have a lasting negative effect on a person’s functioning. 1 While the experience of trauma is universal, its clinical manifestations are categorized into specific diagnostic frameworks that have evolved to capture the complexity of its impact.

1.1.1. Post-Traumatic Stress Disorder (PTSD) in the DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) provides the standard criteria for diagnosing Post-Traumatic Stress Disorder (PTSD) in the United States. A diagnosis requires the presence of symptoms across several distinct clusters following exposure to a qualifying traumatic event. 3

• Criterion A (Stressor): The cornerstone of the diagnosis is exposure to actual or threatened death, serious injury, or sexual violence. This can occur through directly experiencing the event; witnessing it in person; learning that a violent or accidental event occurred to a close family member or friend; or experiencing repeated, extreme exposure to aversive details of traumatic events in a professional capacity, such as first responders collecting human remains. 4 A key revision in the DSM-5 was the removal of the DSM-IV’s Criterion A2, which required the individual’s response to involve intense fear, helplessness, or horror. Research indicated this criterion did not improve diagnostic accuracy and excluded individuals who may have had a more numbed or dissociative initial reaction. 5
• Criterion B (Intrusion Symptoms): The traumatic event is persistently re-experienced. This cluster includes recurrent, involuntary, and distressing memories; traumatic nightmares; and dissociative reactions such as flashbacks, where the individual feels or acts as if the event were recurring. 3 These intrusions are not simply memories but are often accompanied by intense psychological distress and marked physiological reactions when exposed to trauma-related cues. 4
• Criterion C (Avoidance): The individual makes persistent efforts to avoid stimuli associated with the trauma. This manifests in two ways: avoidance of internal reminders, such as distressing memories, thoughts, or feelings, and avoidance of external reminders, like people, places, or situations that arouse these internal states. 4 This avoidance is an active, effortful process aimed at managing overwhelming distress.
• Criterion D (Negative Alterations in Cognitions and Mood): This criterion captures the pervasive negative impact of trauma on a person’s worldview and emotional state. It requires at least two symptoms, which can include the inability to remember important aspects of the event (dissociative amnesia), persistent and exaggerated negative beliefs about oneself, others, or the world (e.g., “I am bad,” “The world is completely dangerous”), and distorted cognitions that lead the individual to blame themselves or others for the event. 4 Other symptoms include a persistent negative emotional state (e.g., fear, guilt, shame), markedly diminished interest in activities (anhedonia), feelings of detachment from others, and a persistent inability to experience positive emotions. 4
• Criterion E (Alterations in Arousal and Reactivity): This cluster reflects the constant state of physiological alert that characterizes PTSD. Symptoms include irritable behavior and angry outbursts, reckless or self-destructive behavior, hypervigilance, an exaggerated startle response, problems with concentration, and sleep disturbances. 4

A crucial addition to the DSM-5 is the dissociative subtype, which applies to individuals who meet the full criteria for PTSD but also experience persistent or recurrent symptoms of either depersonalization (feeling detached from one’s own mind or body) or derealization (experiencing the world as unreal, dreamlike, or distorted). 3 This subtype is particularly common among those who have experienced severe, chronic trauma, especially in childhood, foreshadowing the need for a more nuanced diagnosis for such presentations. 3

1.1.2. Complex PTSD (CPTSD) in the ICD-11

Recognizing that the PTSD framework did not fully capture the profound developmental impact of prolonged or repetitive trauma, the World Health Organization’s International Classification of Diseases, 11th Revision (ICD-11) introduced Complex PTSD (CPTSD) as a distinct diagnosis. 9 While CPTSD requires the three core symptom clusters of PTSD (re-experiencing, avoidance, and a persistent sense of current threat), its defining feature is the presence of severe and persistent Disturbances in Self-Organisation (DSO). 9 These disturbances are categorized into three domains:

• Affect Dysregulation: This involves heightened emotional reactivity to minor stressors, violent outbursts, reckless or self-destructive behavior, dissociative symptoms under stress, and profound emotional numbing, particularly an inability to experience pleasure or positive emotions. 13
• Negative Self-Concept: This is characterized by persistent beliefs about oneself as diminished, defeated, or worthless. These beliefs are often accompanied by deep and pervasive feelings of shame, guilt, or failure directly related to the traumatic experience. 9
• Disturbances in Relationships: This includes severe difficulties in sustaining relationships and in feeling close to others. Survivors may exhibit a hostile or mistrustful attitude towards the world, leading to social withdrawal and feelings of estrangement. 9

A critical distinction is that while CPTSD is strongly associated with chronic, interpersonal trauma from which escape was difficult or impossible (e.g., childhood abuse, torture, slavery, genocide), the ICD-11 diagnosis is based on the symptom profile rather than the specific type of trauma exposure. 9 This allows the diagnosis to be applied based on the nature of the psychological injury, not just its cause.

1.1.3. The Neurobiology of the Traumatized Brain

The symptoms of PTSD and CPTSD are not mere psychological constructs; they are rooted in profound and often lasting changes to the brain’s structure and function. Neurobiological research reveals that trauma fundamentally alters the neural circuits responsible for threat detection, memory, and emotional regulation. 15

• The Amygdala: Often called the brain’s “smoke detector,” the amygdala is responsible for processing fear and initiating the fight-or-flight response. In individuals with PTSD, the amygdala becomes hyperactive and hypersensitive. 15 It triggers an alarm in response to stimuli that are only vaguely reminiscent of the original trauma, leading to the hypervigilance, exaggerated startle responses, and intense emotional reactions characteristic of the disorder. 19 This overactivity helps explain why the feeling of danger persists long after the actual threat has passed.
• The Hippocampus: This brain region is crucial for forming and retrieving declarative memories and, importantly, for placing those memories in their proper context (time and place). In PTSD, the hippocampus often shows reduced volume and decreased activity. 17 This impairment disrupts the ability to contextualize memories, making it difficult for the brain to recognize that a traumatic memory belongs to the past. As a result, the individual cannot effectively distinguish between past danger and present safety, contributing to the vivid, in-the-moment nature of flashbacks and the overgeneralization of fear to safe situations. 15
• The Prefrontal Cortex (PFC): The PFC, particularly the medial prefrontal cortex (mPFC), acts as the brain’s “watchtower” or executive control center. It is responsible for emotional regulation, impulse control, and decision-making. A key function of the mPFC is to inhibit the amygdala’s fear response once a threat has been assessed and deemed no longer present. 21 In PTSD, the PFC is typically underactive. 15 This hypoactivity results in a failure to “put the brakes” on the hyperactive amygdala, leading to the persistent state of hyperarousal and the difficulties with emotional regulation seen in the disorder.
• The Hypothalamic-Pituitary-Adrenal (HPA) Axis: This is the body’s central stress response system, regulating the release of the stress hormone cortisol. In PTSD, this axis is often dysregulated. Paradoxically, many individuals with PTSD exhibit blunted or lower-than-normal cortisol levels, a state which is thought to enhance the consolidation of fear memories and perpetuate an exaggerated adrenergic (adrenaline) response to stress. 19

The clinical distinction between PTSD and CPTSD finds a compelling basis in this neurobiological evidence. While PTSD can be understood as a dysregulation of a mature fear circuit caused by a traumatic event, CPTSD is more accurately conceptualized as a developmental disruption. The prolonged, relational trauma that often underlies CPTSD occurs during critical periods of brain development, affecting not just the fear circuit but the very architecture of the self. It can impair the development of the PFC, the corpus callosum (which connects the brain’s hemispheres), and the neural systems underlying attachment and self-awareness. 22 This provides a biological rationale for why CPTSD symptoms are so deeply embedded in identity, self-concept, and the capacity for relationships. The wound is not just to the memory of an event, but to the formation of the self.

1.2. From Shell Shock to CPTSD: A Historical Genealogy of a Diagnosis

The evolution of the trauma diagnosis is not a simple story of scientific progress. It is a narrative deeply intertwined with social history, warfare, and political advocacy, reflecting a continuous struggle to define and validate human suffering. This history reveals a profound paradigm shift: from viewing the psychological wounds of trauma as evidence of an individual’s inherent weakness to recognizing them as the predictable consequence of an overwhelming external event.

1.2.1. Early Formulations: Nostalgia, Soldier’s Heart, and Shell Shock

For centuries, the symptoms of trauma have been documented in literature, from Homer’s epics to Shakespeare’s plays. 26 Formal medical attempts to classify these responses began in earnest in the 18th and 19th centuries. Swiss physicians in the late 1600s used the term “nostalgia” to describe soldiers suffering from sleeplessness, anxiety, and despair. 27 During the American Civil War, physicians identified “soldier’s heart” or “Da Costa’s Syndrome,” attributing symptoms like rapid pulse and anxiety to an overstimulation of the heart’s nervous system—a physical, rather than psychological, explanation. 27

The industrial-scale warfare of World War I brought an epidemic of psychological casualties, giving rise to the term “shell shock”. 31 Initially, this was believed to be a physical concussion of the brain caused by the blast waves of artillery shells. 33 However, this theory crumbled when countless soldiers who had never been near an explosion began exhibiting the same symptoms: uncontrollable tremors, mutism, nightmares, and debilitating anxiety. 33 This forced a reluctant turn towards psychological explanations. Even so, the prevailing attitude, particularly among military command, was that these symptoms were a sign of a “character flaw,” “moral weakness,” or cowardice. 29 This perspective led to brutal and punitive “treatments,” such as electric shocks, and in some cases, soldiers were court-martialed and even executed for desertion. 33

1.2.2. The Mid-20th Century: Battle Fatigue and the DSM

During World War II, the terminology shifted to “battle fatigue” or “combat exhaustion”. 28 This change reflected a growing, if incomplete, understanding that prolonged exposure to the stress of combat could overwhelm any individual, regardless of their prior constitution. 31 Military psychiatrists observed that after a certain number of days in combat, virtually all soldiers became psychiatric casualties. 36 In 1952, the first edition of the DSM included “gross stress reaction,” acknowledging that psychological issues could stem from traumatic events like combat. 28 However, this diagnosis was critically flawed, as it assumed the symptoms were short-lived and would resolve within six months, failing to recognize the chronic, debilitating nature of the condition for many survivors. 28

1.2.3. The Post-Vietnam Era and the Birth of PTSD

The formalization of Post-Traumatic Stress Disorder in the DSM-III in 1980 was a watershed moment, marking the culmination of decades of social and political struggle. 29 This was not a purely scientific development but was driven by powerful advocacy from several fronts. Vietnam veterans returned home to a society that was often hostile or indifferent, and their profound psychological suffering was frequently misdiagnosed as alcoholism, depression, or schizophrenia. 35 Their organized efforts to demand recognition and care were instrumental in forcing the psychiatric establishment to act. 27 Simultaneously, the feminist movement was shedding light on the widespread trauma of sexual assault, coining the term “rape trauma syndrome” and challenging the societal tendency to blame victims. 29 Advocacy by Holocaust survivors also contributed to a deeper understanding of the long-term consequences of extreme trauma. 27

The creation of the PTSD diagnosis represented a monumental conceptual shift. It explicitly located the etiology of the disorder outside the individual and in the traumatic event. 26 This move from an internal “traumatic neurosis” to an external “post-traumatic stress disorder” was revolutionary. It reframed the survivor not as a person with a pre-existing weakness, but as a normal individual who had endured an abnormal event. This act of diagnostic re-framing was profoundly destigmatizing and validated the suffering of millions. The history of the diagnosis, therefore, is not merely a record of evolving medical knowledge, but a testament to a successful socio-political struggle to redefine the meaning of trauma, shifting the burden of responsibility from the wounded to the wound itself. The subsequent inclusion of CPTSD in the ICD-11 can be seen as the next chapter in this ongoing struggle, representing a further refinement of our understanding to better validate the unique suffering of those exposed to prolonged, relational forms of violence. 11

2. The Self Under Siege: Philosophical and Cultural Contexts

Moving beyond the clinical and historical frameworks, a deeper understanding of trauma requires an engagement with philosophy and anthropology. These disciplines reveal how trauma is not merely a disorder of the brain but a profound crisis of the self, one whose experience and expression are shaped by the cultural and social worlds we inhabit.

2.1. The Shattering of Identity: Trauma, Memory, and Consciousness

At its core, trauma is an assault on the continuity of the self. Philosophical inquiry into personal identity provides a powerful lens through which to understand the depth of this psychic rupture.

2.1.1. The Lockean Self and the Traumatic Rupture

The philosopher John Locke proposed one of the most influential theories of personal identity, arguing that the self is not a static soul or a continuous body, but is constituted by consciousness—specifically, by the chain of memory that links our present self to our past experiences, thoughts, and actions. 40 In this view, “personal Identity consists…in the identity of consciousness”. 40 To be the same person over time is to have conscious access to one’s own past.

Trauma launches a direct and devastating attack on this very foundation. A core symptom of PTSD is dissociative amnesia, an inability to recall key features of the traumatic event. 4 This is not ordinary forgetting; it is a fracturing of the conscious narrative, a literal gap in the chain of memory that constitutes the Lockean self. When a survivor states, “I am not the same person I was before,” or “The person I was died in that event,” this is not simply a metaphor. 42 From a Lockean perspective, it is a statement of philosophical truth. The psychological continuity that defined their identity has been irrevocably broken. 42 Trauma, therefore, precipitates a crisis of personal identity by severing the conscious link between the past self and the present self.

2.1.2. Philosophical Paradigms of Traumatic Experience

The nature of this traumatic rupture in memory and consciousness is the subject of intense philosophical debate, which can be understood through three primary paradigms. 44

• Empiricism: This paradigm views the traumatic experience as a direct, unmediated sensory imprint on the mind. It posits that the event is so overwhelming that it bypasses normal cognitive processing and is seared into the psyche as a raw, literal trace. 45 This aligns with the neurobiological model of trauma, where an event overwhelms the prefrontal cortex’s capacity for meaning-making and is encoded directly by the amygdala. From this perspective, a flashback is not a narrative memory but the “literal return of the event,” an unassimilated piece of the past erupting into the present. 46
• Poststructuralism: Building on the idea of a psychic break, this paradigm argues that trauma is fundamentally unrepresentable, a void or hole in experience that defies language and narrative. 44 Because the event was not consciously experienced or integrated as it occurred, it cannot be turned into a coherent story. Instead, it exists as an unspeakable “other” that haunts the survivor. From this viewpoint, any attempt to narrate the trauma is a betrayal of its essential incommunicability, forcing a singular, incomprehensible event into a generic and reductive story. 45
• Hermeneutics: This paradigm offers a middle path, challenging the notion of unmediated experience. It argues that all experience, including trauma, is interpreted through the lens of our existing cultural, social, and personal frameworks of meaning. 45 Trauma is therefore not the imprint of an event itself, but the shattering of the survivor’s entire meaning-making system. The world, once seen as predictable or just, is revealed to be chaotic and hostile. 2 Healing, in this view, is not about recovering a literal memory but about the difficult work of constructing a new life narrative that can accommodate and make sense of the traumatic rupture, thereby restoring a sense of agency and meaning. 45

These philosophical tensions reveal how trauma challenges our very understanding of consciousness. The unified “stream of consciousness” described by William James is fragmented by the dissociative gaps and intrusive returns that characterize the post-traumatic mind. 48 The self is no longer a coherent narrator of its own story but a fractured subject haunted by a past it can neither fully remember nor escape.

2.2. The Social Life of Suffering: Anthropological and Intersectional Perspectives

The philosophical crisis of the self created by trauma is not resolved in a vacuum. The ways in which individuals experience, express, and heal from trauma are profoundly shaped by the social and cultural contexts in which they live.

2.2.1. Cultural Scripts of Distress

The Western diagnostic categories of PTSD and CPTSD, while clinically useful, are not universal templates for suffering. Anthropological research demonstrates that culture provides “scripts” or “idioms of distress”—locally understood ways of expressing and interpreting suffering that may differ significantly from Western psychiatric models. 51 For example, in some cultural contexts, trauma may be expressed primarily through somatic complaints like body heat or shortness of breath, or through spiritual afflictions like being haunted by ghosts, rather than through the psychological symptom clusters privileged by the DSM. 51 Applying Western diagnostic tools in these contexts risks misinterpreting or medicalizing culturally normative expressions of suffering, imposing a framework that may not align with the individual’s lived experience. 53

These cultural scripts are not merely different labels for the same phenomenon; they shape the experience of trauma itself, providing a ready-made framework for making sense of an otherwise chaotic and shattering event. They offer the language and rituals that can begin to bridge the gap between the shattered individual self and a shared, collective understanding of suffering, functioning as a vital hermeneutic resource for healing.

2.2.2. Collective Trauma and Cultural Memory

Trauma is not limited to individuals; it can wound the psyche of an entire community or people. “Cultural trauma” occurs when a horrendous event leaves an indelible mark on a group’s collective consciousness, fundamentally altering their identity and memory. 57 Events like slavery, the Holocaust, or genocide become central to a group’s identity, not necessarily through direct experience but through a process of collective remembrance. 58 This collective memory is actively constructed and maintained through shared narratives, art, memorials, and rituals, which serve to preserve the memory of the trauma and create a sense of shared identity and experience rooted in that history. 61

2.2.3. The Intersectional Nature of Trauma

Vulnerability to trauma is not distributed equally across society. The framework of intersectionality reveals how multiple, overlapping systems of oppression—such as racism, sexism, classism, and heterosexism—create compounded disadvantages that increase both the risk of trauma exposure and the severity of its impact. 63 An individual’s social location, defined by the intersection of their various identities (e.g., a Black, transgender woman), shapes their unique experience of trauma and the resources available for recovery. 63

Research consistently shows that women, racial and ethnic minorities, and individuals of lower socioeconomic status are disproportionately exposed to traumatic events. 66 Furthermore, the protective effects of resources like income and education may be diminished for marginalized groups. 68 For example, the concept of “racial trauma” describes the unique psychological injury that results from the cumulative impact of racism, including both overt discrimination and subtle microaggressions. 69 This perspective challenges the standard PTSD model, which often focuses on a discrete, life-threatening event.

For individuals holding multiple marginalized identities, trauma is often not an anomalous rupture in an otherwise safe existence, but the baseline condition of their environment. The constant, pervasive stress of navigating oppressive systems is more akin to the prolonged, inescapable stressor profile that gives rise to CPTSD. This makes the CPTSD framework, with its focus on developmental disruption and pervasive damage to self-concept and relationships, a more fitting and necessary lens for understanding their suffering. Intersectionality is thus not just a social modifier of trauma; it can be a determinant of its fundamental nature, shifting it from an “event” to an “environment.”

3. The Internal Battlefield: Self-Generated Trauma and the Case of Dissociative Identity Disorder

While trauma is typically understood as an injury inflicted by an external force, some of its most complex and painful manifestations arise from within the self. This internal landscape of conflict and harm challenges our most basic assumptions about agency, responsibility, and the unity of identity. Dissociative Identity Disorder (DID) serves as a powerful microcosm for exploring this phenomenon, revealing how the mind’s attempt to survive the unthinkable can create a new, internal source of trauma.

3.1. A Microcosm of Conflict: Dissociative Identity Disorder and Internal Trauma

3.1.1. The Etiology of DID: A Radical Adaptation to Unbearable Trauma

Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, is not a character flaw or a choice, but a complex and creative survival strategy. It is understood to be a developmental response to severe, repetitive, and inescapable trauma in early childhood, most commonly extreme physical, sexual, and emotional abuse. 71 When a child’s reality is unbearable, the mind may utilize the profound defense mechanism of dissociation, “shutting off” from the experience to survive. 75 In what becomes DID, this process is so extreme that it prevents the integration of a single, unified identity. Instead, different aspects of experience—memories, emotions, sensations—are compartmentalized into distinct states of consciousness, which over time develop into alternate identities, or “alters”. 76

These alters form a “system” within the individual, each with its own name, age, gender, memories, and traits. 71 There is often a “host” or “Apparently Normal Part” (ANP) who manages daily life, frequently with amnesia for the trauma and for the existence of other alters. 78 Other common alter types include child parts who hold the raw trauma memories, protectors who manage threats, and gatekeepers who control access to memories or switching between alters. 78 A common misconception is that there is an “original” personality that has been fractured. A more accurate metaphor is that of a shattered glass: there is no single original piece, but rather a failure of the pieces to ever form a whole vessel in the first place. 78

3.1.2. The Trauma of Inter-Alter Conflict

The internal world of a DID system, created to escape external threat, can itself become a battlefield—a source of ongoing, inescapable trauma. This internal conflict is a primary form of self-generated trauma. A particularly potent source of this is the presence of “persecutor” alters. These parts often internalize the abuser’s aggression and beliefs, turning them inward against the system. 78 A persecutor may verbally abuse other alters, inflict self-harm on the body, or sabotage healing efforts, believing this is necessary for protection or punishment. 78 This creates a horrifying paradox where the survivor is simultaneously the victim of this internal abuse and, through one of their own dissociated parts, the perpetrator.

Beyond the actions of persecutors, the very existence of multiple alters with conflicting needs, desires, and memories can be profoundly traumatic. A child alter may desperately want to play and feel safe, while a protector alter may enforce rigid, isolating rules to prevent any perceived risk. This constant internal war, with its power struggles and emotional turmoil, is akin to living in a high-conflict, abusive family environment, but one from which there is no physical escape because it resides within one’s own mind. 81

3.1.3. The Trauma of Vicarious Perpetration

The second form of self-generated trauma in DID arises when the actions of one alter in the external world cause profound distress to others within the system. An alter might engage in reckless driving, theft, substance abuse, or aggressive behavior that the host and other alters do not remember and would never consciously choose. 72 When the host “wakes up” to the consequences—a car crash, a lost job, a broken relationship, or legal trouble—they are faced with an unbearable reality. They must bear the responsibility and shame for actions they did not commit, yet which were carried out by their own body.

This experience creates a profound moral and psychological injury. The individual is trapped in an irresolvable position: they are an innocent victim of the original abuse that created the system, yet they are also, in the eyes of the world and often in their own, a perpetrator.

This lived reality represents the ultimate collapse of the victim/perpetrator binary. It is not a theoretical concept but an embodied, daily experience. DID demonstrates with startling clarity that victimhood and perpetration are not fixed, mutually exclusive identities but can be fluid, coexisting roles enacted within a single human consciousness, all driven by the fractured logic of survival.

3.2. The Weight of One’s Own Actions: Moral Injury and Perpetrator Trauma

The internal dynamics of DID, while extreme, illuminate a broader and more common form of human suffering: the trauma that arises from one’s own actions or inactions. This category of trauma, centered on guilt and shame rather than fear, requires a distinct conceptual framework.

3.2.1. Defining Moral Injury (MI)

Moral Injury (MI) is the profound psychological, behavioral, social, and spiritual distress that results from events that transgress an individual’s deeply held moral beliefs and expectations. 82 It is a wound to the conscience. Such events, often called Potentially Morally Injurious Events (PMIEs), can involve:

• Acts of Commission: Perpetrating an act that violates one’s moral code (e.g., harming someone). 82
• Acts of Omission: Failing to prevent an act that one feels a moral duty to stop. 82
• Witnessing: Observing others commit immoral acts without intervening. 82
• Betrayal: Being betrayed by leaders or peers in a high-stakes situation, which shatters one’s trust and sense of right and wrong. 82

While PTSD is primarily driven by fear and helplessness, MI is characterized by hallmark emotions of guilt, shame, disgust, and anger. 82 A critical distinction lies between guilt and shame. Guilt is the feeling “I did something bad,” a remorse focused on a specific action. Shame is the far more corrosive feeling “I am bad,” where the transgression is generalized to one’s entire self-concept, leading to feelings of worthlessness and a desire to hide. 82

This shattering of one’s self-concept as a “good” or moral person is the core wound of MI. It is a trauma of identity, not just of memory, explaining why it often precipitates a spiritual or existential crisis and requires treatments focused on meaning-making and self-forgiveness, not simply desensitization. 84

3.2.2. Perpetration-Induced Traumatic Stress (PITS)

Perpetration-Induced Traumatic Stress (PITS), also known as perpetrator trauma, is a specific form of trauma where PTSD-like symptoms are caused directly by an act of killing or participating in horrific violence. 88 While it overlaps with MI, PITS specifically focuses on the traumatic stress response. Research, particularly with combat veterans, indicates that symptoms in PITS can be more severe than in victim-based PTSD. 88 The symptom profile is also distinct. Intrusive imagery is not of a threat to the self, but of the act of perpetration. Dream motifs often involve the tables being turned, with the perpetrator being killed by their victim, or the victim appearing to accuse them or ask why they did it. 88 Explosive anger and substance abuse are also more prominent.

3.2.3. Self-Inflicted Trauma and Self-Harm

Non-suicidal self-injury (NSSI), such as cutting or burning, represents another complex form of self-generated trauma. 89 Often originating as a desperate coping mechanism to manage overwhelming emotional pain, regulate intense feelings, or break through a state of emotional numbness, the act itself can become a source of trauma. 91 The cycle of self-harm often leads to intense feelings of shame, guilt, and self-loathing, which in turn fuel the urge to self-injure again. 89 This dynamic mirrors the function of persecutor alters in DID, demonstrating a parallel mechanism where an act intended to regulate distress ends up perpetuating a cycle of self-inflicted psychological injury.

4. Deconstructing Binaries and Fostering Empathy

The exploration of trauma, from its clinical definitions to the internal battlefields of DID and moral injury, culminates in a necessary challenge to the simplistic social and legal binaries that shape our understanding of harm. The rigid distinction between “victim” and “perpetrator” obscures the complex realities of human suffering and erects barriers to both healing and justice.

4.1. Beyond Good and Evil: The Social and Psychological Construction of Victim and Perpetrator

The labels of victim and perpetrator are not objective truths but social constructs, shaped by cultural narratives, legal frameworks, and implicit biases. These constructs, while offering a sense of moral clarity, often fail to capture the nuanced and painful realities of those who have experienced or caused harm.

4.1.1. The Social Construction of the “Ideal Victim”

Society often reserves its deepest empathy for the “ideal victim”—a figure who is perceived as entirely innocent, passive, weak, and blameless. 93 This construction creates a narrow and often exclusionary standard for who is considered a legitimate recipient of compassion and support. Those who do not fit this mold—individuals who fought back, who have a criminal record, who belong to marginalized groups, or whose behavior is deemed imperfect—may find their own experiences of victimization questioned or dismissed. 95

The victim/perpetrator binary serves as a convenient social and legal shorthand, dividing the world into the morally pure and the irredeemably evil. 97 This rigid dichotomy, however, creates a vast “grey zone” where the overlapping experiences of countless individuals are rendered invisible, misunderstood, and unaddressed. 93

4.1.2. The Victim-Offender Overlap

Sociological and criminological research overwhelmingly demonstrates that the categories of victim and perpetrator are not mutually exclusive. Instead, there is a profound and well-documented victim-offender overlap. 99 The vast majority of individuals who perpetrate violence were first victims of violence, often beginning with severe maltreatment in childhood. 99 This is not a coincidence but a causal pathway. Childhood trauma can lead to long-term changes in brain structures involved in emotion regulation and aggression, impair decision-making, and normalize violence as a means of resolving conflict or asserting control. 99

The cycle of violence is often a cycle of trauma, where unaddressed wounds from being victimized become a driving force in the perpetration of harm against others.

4.1.3. The Narrative of the Antagonist

To be cast by society—or to cast oneself—into the role of the “perpetrator” is itself a source of profound psychological trauma. As demonstrated by the dynamics of moral injury and PITS, the internal experience of having caused harm can lead to debilitating shame, self-loathing, and social alienation. 82

When society applies this label exclusively, ignoring the individual’s own history of victimization, it reinforces this toxic shame and creates a formidable barrier to healing and accountability. 97 This one-dimensional narrative of the antagonist denies the complexity of their humanity, forecloses the possibility of change, and perpetuates the very cycles of trauma that lead to violence in the first place.

4.2. Conclusion: Toward a More Compassionate and Complex Understanding of Trauma

This interdisciplinary inquiry began with the clinical architecture of trauma, traced its historical and philosophical contours, and delved into the internal world of self-generated suffering. The journey reveals that trauma is not a monolithic entity but a spectrum of experiences that shatters our sense of safety, identity, and moral coherence. The most profound lesson from this exploration is the inadequacy of our simplistic binaries and the urgent need for a more complex and compassionate framework for understanding human harm.

4.2.1. Synthesis of Findings

The report has established that post-traumatic stress manifests in distinct forms, with the fear-based model of PTSD being insufficient to capture the identity-based wounds of CPTSD or the shame-based wounds of moral injury. Historically, the very definition of trauma has been a site of social struggle, evolving from a marker of individual failing to a consequence of external events. Philosophically, trauma creates a crisis of the self by fracturing the continuity of memory and consciousness, a crisis that individuals attempt to resolve through culturally provided narratives and scripts of distress. The case of DID provides a stark, living illustration of how the roles of victim and perpetrator can collapse within a single individual, born of a need to survive the unsurvivable. This internal dynamic is mirrored in the broader phenomena of moral injury and perpetrator trauma, where the source of the wound is one’s own actions. Finally, sociological analysis reveals that the victim/perpetrator binary is a social construction that ignores the vast overlap between these categories and can itself be a source of harm.

4.2.2. Implications for Healing and Justice

A truly trauma-informed approach must be a truly complex one. It demands that clinicians, legal professionals, and society at large move beyond one-size-fits-all models.

For clinical practice, this means recognizing that different types of trauma require different interventions. Applying a fear-based exposure therapy, which can be highly effective for PTSD, to a shame-based moral injury may be ineffective or even harmful. 88 The treatment of moral injury requires modalities that focus on meaning-making, self-forgiveness, and values clarification, such as Acceptance and Commitment Therapy (ACT) or Adaptive Disclosure. 87 Similarly, the treatment of DID requires a careful, phase-oriented approach that prioritizes safety and stabilization before any processing of trauma can begin, acknowledging the complex internal system of alters. 104

4.2.3. A Call for a New Narrative

Ultimately, fostering empathy and breaking cycles of violence requires a new societal narrative. We must move away from a purely carceral logic that sees punishment as the only response to harm, and toward more restorative models that prioritize accountability, repair, and healing. 97 Acknowledging the trauma history of a person who has caused harm is not to excuse their actions or absolve them of responsibility. It is to recognize the full, complex truth of their humanity and to understand the root causes of their behavior. It is the first step toward creating pathways for genuine change.

By deconstructing the false dichotomy of victim and perpetrator, we can begin to see the shared humanity in those who have been wounded and those who have wounded others. In understanding the fractured self, in all its complexity, we find the possibility of mending not only individual lives but also the torn fabric of our collective social life.

Works Cited

1. Trauma - American Psychological Association

2. Trauma - APA Dictionary of Psychology

3. Understanding PTSD in the DSM-5 - Criteria, Causes, and Treatment - Neuralia TMS

4. DSM-5 Criteria for Posttraumatic Stress Disorder - MDCalc

5. PTSD and DSM-5 - PTSD: National Center for PTSD - PTSD.va.gov

6. DSM-5 Criteria for PTSD - Brainline.org

7. Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD - Trauma-Informed Care in Behavioral Health Services - NCBI Bookshelf

8. Table 3.14, DSM-IV to DSM-5 Posttraumatic Stress Disorder Comparison - NCBI

9. Complex post-traumatic stress disorder: a new diagnosis in ICD-11 | BJPsych Advances

10. CPTSD (Complex PTSD): What It Is, Symptoms & Treatment - Cleveland Clinic

11. Acute Stress Disorder, Posttraumatic Stress Disorder and Complex PTSD - Phoenix Australia

12. Literature on DSM-5 and ICD-11 - PTSD.va.gov

13. Complex Posttraumatic Stress Disorder (C-PTSD) symptoms and diagnostic criteria

14. Complex PTSD: History and Definitions - PTSD: National Center for PTSD

15. Advances in Posttraumatic Stress Disorder … - Psych Scene Hub

16. The Neurobiology and Pharmacotherapy of Posttraumatic Stress Disorder (PTSD) - PMC

17. Post-traumatic stress disorder: the neurobiological impact of psychological trauma - PMC

18. The science and biology of PTSD

19. Traumatic stress: effects on the brain - PMC - PubMed Central

20. The brain’s response to trauma: Understanding the impact of PTSD - Medical News Today

21. How Trauma and PTSD Impact the Brain - Verywell Mind

22. Trauma and the brain - Traumatic Stress Wales

23. 2-Minute Neuroscience: PTSD - YouTube

24. Neurobiology and Treatment of Posttraumatic Stress Disorder - Psychiatry Online

25. The Effects of Complex Trauma on Brain Development

26. PTSD History and Overview - PTSD: National Center for PTSD

27. History of PTSD in Veterans: Civil War to DSM-5 - PTSD: National Center for PTSD

28. PTSD and Shell Shock - History.com

29. Historical Account of Trauma - Trauma-Informed Care in Behavioral Health Services - NCBI

30. 175 Years of Progress in PTSD Therapeutics: Learning From the Past - Psychiatry Online

31. (PDF) Psychological trauma: a historical perspective - ResearchGate

32. Voices of the First World War: Shell Shock - Imperial War Museums

33. Shell shock - Wikipedia

34. From shell-shock to PTSD, a century of invisible war trauma | PBS News

35. A Brief History of Trauma and PTSD | Danielle Rousseau - Boston University

36. WWII Post-Traumatic Stress | The National WWII Museum | New Orleans

37. History, Diagnostic Criteria, and Epidemiology - Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations - NCBI

38. Post-traumatic stress disorder - Wikipedia

39. The PTSD History Timeline - Banyan Treatment Center

40. Personal identity - Wikipedia

41. Locke on Personal Identity - Stanford Encyclopedia of Philosophy

42. Psychological Continuity: A Discussion of Marc Slors’ Account, Traumatic Experience, and the Significance of our Relations to Others

43. One Outliving Oneself Trauma, Memory, and Personal Identity | 2 | Femi - Taylor & Francis eBooks

44. THE ROUTLEDGE COMPANION TO LITERATURE AND TRAUMA - OAPEN Library

45. (PDF) Philosophies of Trauma - ResearchGate

46. Trauma and Memory (Chapter 9) - Trauma and Literature - Cambridge University Press

47. Trauma: Culture, Meaning and Philosophy - PMC - PubMed Central

48. Consciousness as a Memory System - PMC - PubMed Central

49. Body Memory and the Unconscious - Duquesne Scholarship Collection

50. The Interplay Between Consciousness and Memory - Number Analytics

51. Cultural Scripts of Traumatic Stress: Outline, Illustrations … - Frontiers

52. Beyond the DSM-5 Diagnoses: A Cross-Cultural Approach to Assessing Trauma Reactions

53. Culture, Trauma, and the Social Life of “PTSD” in Haiti - MIT Anthropology

54. Post-Traumatic Stress Disorder and Urban Violence: An Anthropological Study - PMC

55. Cultural Perspectives on Trauma and Healing - Mindful Synergi

56. Culturally-Sensitive Trauma-Informed Care | Patient Centered Care and Trauma Informed Care for Pediatric Patients - HEALTHCARE TOOLBOX

57. Cultural Trauma and Collective Identity - ResearchGate

58. Cultural trauma and collective memory - Assets - Cambridge University Press

59. Cultural Trauma and Collective Identity by Jeffrey Alexander, Ron Eyerman, Bernard Giesen, Neil Smelser, Piotr Sztompka - Paper - University of California Press

60. Cultural trauma and collective memory (Chapter 1) - Cambridge University Press

61. Cultural Trauma and Memory - Number Analytics

62. Collective Trauma and the Social Construction of Meaning - PMC - PubMed Central

63. Understanding Intersectionality in Trauma - Number Analytics

64. Issue 15: Intersectionality - Learning Network - Western University

65. Compound Fractures: Healing the Intersectionality of Racism, Classism, and Trauma in Schools with a Trauma-Informed Approach as Part of a Social Justice Framework - ERIC

66. Racial, Ethnic, Gender, and Economic Disparities and Trauma | Request PDF

67. Association of Trauma History with Current Psychosocial Health Outcomes of Young African American Women - MDPI

68. Family Socioeconomic Status and Exposure to Childhood Trauma: Racial Differences - PMC

69. Posttraumatic Stress Disorder and Racial Trauma - PTSD.va.gov

70. Coping with Racial Trauma | The Department of Psychology

71. Dissociative Identity Disorder (DID): Symptoms & Treatment - Cleveland Clinic

72. Dissociative Identity Disorder | Sheppard Pratt

73. Dissociative identity disorder - Wikipedia

74. Dissociative Identity Disorder (Multiple Personality Disorder) - WebMD

75. Inside DID: A Closer Look at Dissociative Identity Disorder - McLean Hospital

76. DID Fact Sheet | NAMI Michigan

77. DID Myths and Misconceptions - Beauty After Bruises

78. Understanding Dissociative Identity Disorder - The Psychology Practice

79. What are the Types of Alters in DID? - Alter Behavioral Health

80. Alters in Dissociative Identity Disorder (MPD), OSDD and Partial DID

81. Parents in Conflict and the Children Who Live Through the Trauma - thewaveclinic.com

82. Moral Injury - PTSD: National Center for PTSD

83. What is Moral Injury

84. Understanding Moral Injury - Durham University

85. Moral Injury - PTSD.va.gov

86. Moral Injury - MIRECC / CoE

87. (PDF) Emerging Interventions for Moral Injury: Expanding Pathways to Moral Healing

88. Perpetrator trauma - Wikipedia

89. Self-Harm (Nonsuicidal Self-Injury Disorder) - Cleveland Clinic

90. Self-inflicted injury: Definition, causes, signs, and how to help - Medical News Today

91. Self-Harm and Trauma - PTSD: National Center for PTSD

92. Emotional and Psychological Trauma - HelpGuide.org

93. Defying the Victim-Perpetrator Binary: Female Ex-combatants in Colombia and Guatemala as Complex Political Perpetrators∞ | International Journal of Transitional Justice | Oxford Academic

94. Intergroup struggles over victimhood in violent conflict: The victim-perpetrator paradigm - White Rose Research Online

95. CHAPTER 2: The Fluidity of Victimhood - Conflict 180

96. RESISTING SIMPLE DICHOTOMIES: CRITIQUING NARRATIVES OF VICTIMS, PERPETRATORS, AND HARM IN FEMINIST THEORIES OF RAPE

97. “Perpetrator” vs. “Victim” and the Impact of Carceral Logic - Virginia Sexual & Domestic Violence Action Alliance

98. Victim-Perpetrator Dichotomy in Transitional Justice: The Case of Post-Genocide Rwanda1 - Mason Publishing Journals

99. The Victim-Offender Overlap: Examining the Relationship Between Victimization and Offending - ICJIA | Illinois Criminal Justice Information Authority

100. The Victim-or-Perpetrator Dichotomy harms both those who commit crime and those who suffer it. - Children and Young People’s Centre for Justice

101. Victim, perpetrator, or what else? Generational and gender perspectives on children, youth, and violence. Sociological Studies on Children and Youth, vol. 25. Bingley: Emerald | Request PDF - ResearchGate

102. The roles of family factors and relationship dynamics on dating violence victimization and perpetration among college men and women in emerging adulthood - PMC

103. Claudine Kuradusenge-McLeod, “Narratives of Victimhood and Perpetration: The Struggle of Bosnian and Rwandan Diaspora Communities in the United States” (Peter Lang, 2021) - New Books Network

104. Dispelling myths about dissociative identity disorder treatment: an empirically based approach. - Virginia Department of Criminal Justice Services

105. Moral Injury & PTSD Treatment for Women | San Diego - Monima Wellness

106. What treatments are there for dissociative disorders? - Mind