Complex post traumatic stress disorder
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Complex post-traumatic stress disorder (C-PTSD) is a clinically recognized condition that results from extended exposure to prolonged social and/or interpersonal trauma, including instances of physical abuse, emotional abuse, sexual abuse (including sexual abuse during childhood), domestic violence, torture, chronic early maltreatment in a caregiving relationship, and war. A differentiation between the diagnostic categorizations of C-PTSD and that of Post traumatic stress disorder (PTSD) has been suggested, as C-PTSD better describes the pervasive negative impact of chronic trauma than does PTSD alone.[1][2]
As a descriptor, PTSD fails to capture some of the core characteristics of C-PTSD. These elements include psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be revictimized, and, most importantly, the loss of a coherent sense of self. It is this loss of a coherent sense of self, and the ensuing symptom profile, that most pointedly differentiates C-PTSD from PTSD.[3]
Symptom profile
C-PTSD is characterized by chronic difficulties in many areas of emotional and interpersonal functioning. Symptoms may include:[3][2]
- Difficulties regulating emotions, including symptoms such as persistent sadness, suicidal thoughts, explosive anger, or covert anger, which is characteristic of passive-aggressive behavior
- Variations in consciousness, such as forgetting traumatic events, reliving traumatic events, or having episodes of dissociation (during which one feels detached from one's mental processes or body)
- Changes in self-perception, such as a sense of helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings
- Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge
- Alterations in relations with others, including isolation, distrust, or a repeated search for a rescuer
- Loss of, or changes in, one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair
Treatment
Treatment for C-PTSD tends to require a multi-modal approach.[4] It has been suggested that treatment for C-PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems.[5] Six suggested core components of complex trauma treatment include:[4]
- Safety
- Self-regulation
- Self-reflective information processing
- Traumatic experiences integration
- Relational engagement
- Positive affect enhancement
Multiple treatments have been suggested for C-PTSD. Among these treatments are group therapy, cognitive behavioral therapy, eye movement desensitizations and repossessing, and psychodrama. As C-PTSD is a fairly new concept, therapeutic protocols are just being developed.[6]
As C-PTSD shares symptoms with both PTSD and borderline personality disorder,[7] it is likely that a combination of treatments utilized for these conditions would be helpful for an individual with C-PTSD, such as dialectic behavior therapy and exposure therapy.
Footnotes
- ↑ van der Kolk BA, Courtois CA (2005). "Editorial comments: Complex developmental trauma". J Trauma Stress. 18 (5): 385–8. doi:10.1002/jts.20046. PMID 16281236.
- ↑ 2.0 2.1 Julia M. Whealin, Ph.D. and Laurie Slone, Ph.D. "Complex PTSD". National Center for Posttraumatic Stress Disorder. United States Department of Veteran Affairs.
- ↑ 3.0 3.1 Herman, Judith Lewis (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. Basic Books. pp. p119–122. ISBN 0465087302.
- ↑ 4.0 4.1 Cook, A. (2005). "Complex trauma in children and adolescents". Psychiatric Annals. 35 (5): 390–398. Retrieved 2008-03-29. Unknown parameter
|coauthors=ignored (help) - ↑ van der Kolk BA, Roth S, Pelcovitz D, Sunday S, Spinazzola J (2005). "Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma". J Trauma Stress. 18 (5): 389–99. doi:10.1002/jts.20047. PMID 16281237.
- ↑ Treating Complex PTSD http://www.cavalcadeproductions.com/ptsd-treatment.html
- ↑ http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VDK-4GG8VTW-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4a4aaaa994fc3490d0406f64e9b87050
References
- Appleyard, K. (2003). "Parenting after trauma: Supporting parents and caregivers in the treatment of children impacted by violence". Infant Mental Health Journal. 24 (2): 111–125. doi:10.1002/imhj.10050. Unknown parameter
|coauthors=ignored (help) - Scott, Catherine V.; Briere, John (2006). Principles of Trauma Therapy : A Guide to Symptoms, Evaluation, and Treatment. Thousand Oaks: Sage Publications. ISBN 0-7619-2921-5.
- Ford JD (1999). "Disorders of extreme stress following war-zone military trauma: associated features of posttraumatic stress disorder or comorbid but distinct syndromes?". J Consult Clin Psychol. 67 (1): 3–12. PMID 10028203.
- Roth S, Newman E, Pelcovitz D, van der Kolk B, Mandel FS (1997). "Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder". J Trauma Stress. 10 (4): 539–55. PMID 9391940.