A 32-year-old woman presents for evaluation after being referred by her primary care provider for persistent nightmares and hypervigilance following years of childhood physical and sexual abuse by a caregiver. In addition to re-experiencing symptoms, avoidance of trauma reminders, and hyperarousal, the PMHNP notes a pervasive pattern of negative self-concept characterized by feeling permanently damaged and worthless, chronic difficulties in maintaining relationships due to mistrust and emotional detachment, and severe difficulty regulating emotions with frequent dissociative episodes under stress. Which of the following best describes the additional symptom domains that distinguish this presentation from standard PTSD?