A 38-year-old woman presents with a history of prolonged childhood physical and sexual abuse by a caregiver from ages 5 to 14. She reports recurrent intrusive memories of the abuse, hypervigilance in public spaces, avoidance of relationships that involve trust or vulnerability, and frequent nightmares. Beyond these symptoms, she describes a persistent sense of being fundamentally damaged and worthless that pervades her self-concept even in objectively successful domains of her life. She reports chronic difficulty maintaining emotional equilibrium, with episodes of dissociative numbing alternating with uncontrollable rage that she describes as feeling like she is someone else entirely during these states. She has had no stable close relationships in the past decade, reporting that she oscillates between desperately wanting connection and pushing everyone away when they get close. Her PCL-5 score is 58.