Complex post-traumatic stress disorder

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. It has been suggested that a differentiation between the diagnostic categorizations of C-PTSD and that of Post traumatic stress disorder (PTSD), as C-PTSD better describes the pervasive negative impact of chronic trauma than does PTSD.^[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]

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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

C-PTSD and Borderline Personality Disorder

Complex post-traumatic stress disorder (C-PTSD) is a condition that is often attributed to an individual suffering chronic traumatic stress, who is also exhibiting a breakthrough characteristics similar to those expressed by a borderline personality (BPD).

Borderline Personality Disorder is, from a psycho-social perspective, an on-going inability to regulate emotions (a dysregulation of affect) consequent to an antecedent disability or dysfunction in the development of appropriate social skills. The magnitude of difficulty is disabling. Complex Post Traumatic Stress Disorder is characterized by a breakdown of previously effective social skills in the face of, or consequent to, trauma. Trauma, by definition, overwhelms established coping skills.

In the first case, BPD is thought to develop in part through the maladaptive experience, perception and interpretation of preconscious or pre-verbal experiences on the part of an infant who has a predisposition to anxiety and/or depression. In the second case, the trauma associated with C-PTSD is seen as causing a breakdown in the social skills that previously allowed for the adaptive management of overwhelming social and psycho-social stressors.

In both cases, future trauma, on-going trauma, and/or symbolic re-enactment of a past trauma can exacerbate the failure of response, as informed by emotional dysregulation.

Sources

• Briere, J., and Scott, C., (2006) Principles of Trauma Therapy: A guide to symptoms, evaluation, and treatment. Thousand Oaks, CA: Sage.
• Cook, A., Blaustein, M., Spinazzola, J., and van der Kolk, B., (2003) Complex trauma in children and adolescents. White paper from the National Child Traumatic Stress Newtork Complex Trauma Task Force.
• Cook, A., Spinazzola, J., Ford, J., Lanktree, C., et al., (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35, 390-398.
• Ford, J. D. (1999). Disorders of extreme stress following war-zone military trauma: Associated features of Posttraumatic Stress Disorder or comorbid but distinct syndromes? Journal of Consulting and Clinical Psychology, 67, 3-12.
• Judith Lewis Herman (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
• Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for Posttraumatic Stress Disorder. Journal of Traumatic Stress, 10, 539-555.

See also

• Post-Traumatic Stress Disorder or PTSD
• Dissociative Disorders (DSM-IV Dissociative Disorders); Structured Clinical Interview for DSM-IV
• Cognitive Behavior Therapy
• Eye Movement Desensitization and Reprocessing or EMDR
• Emotional Dysregulation
• Borderline Personality Disorder or BPD
• Dissociation (psychology)
• Depersonalization Disorder (DSM-IV Dissociative Disorders 300.6)
• Psychogenic amnesia; Dissociative Amnesia (formerly Psychogenic Amnesia) (DSM-IV Dissociative Disorders 300.12)
• Fugue state; Dissociative Fugue (formerly Psychogenic Fugue) (DSM-IV Dissociative Disorders 300.13)
• Dissociative Identity Disorder (formerly Multiple Personality Disorder) (DSM-IV Dissociative Disorders 300.14)

References

• Appleyard, K. & Osofsky, J.D. (2003). "Parenting after trauma: Supporting parents and caregivers in the treatment of children impacted by violence". Infant Mental Health Journal 24, 111-125.
• Bosquet, M. (2004). "How research informs clinical work with traumatized young children". In J.D. Osofsy (Ed.), Young children and trauma: Intervention and treatment, 301-325. New York: Guilford Press.
• Cohen, J.A., Deblinger, D., & Mannarino, A. (2004). Psychiatric Times. Vol. 21. http://psychiatrictimes.com/p040952.html
• Cook, A.; Blaustein, M.; Spinazzola, J.; and van der Kolk, B., (2003) Complex trauma in children and adolescents. White paper from the National Child Traumatic Stress Newtork Complex Trauma Task Force.
• Davidson, J.R.T. (1996). Davidson Trauma Scale. Toronto: Mental Health Systems.
• Davidson, J.R.T.; Tharwani, H.M. & Connor, K.M. (2002). "Davidson Trauma Scale (DTS): Normative scores in the general population and effect sizes in placebo-controlled SSRI trials". Depression and Anxiety 15, 75-78.
• Ghosh Ippen, C., Ford, J., Racusin, R., Acker, M., Bosquet, M., Rogers, K., Ellis, C. Schiffman, J., Ribbe, D., Cone, P., Lukovitz, M., Edwards, J., the Child Trauma Research Project of the Early Trauma Treatment Network, and the National Center for PTSD Dartmouth Child Trauma Research Group (2002). Traumatic Events Screening Inventory – Parent Report Revised. San Francisco: University of California, San Francisco Early Trauma Network.
• Kimerling, R., Calhoun, K.S., Forehand, R., Armistead, L., Morse, E., Morse, P., Clark, R., & Clark, L. (1999). Traumatic stress in HIV-infected women. AIDS Education and Prevention, 11, 321-330.
• Pynoos, R., Rodriguez, N., Steinberg, A., Stuber, M., & Frederick, C. (1998). The UCLA PTSD Index for DSM-IV. Los Angeles, UCLA Trauma Psychiatry Program.
• Ribbe, D. (1996). Psychometric review of the Traumatic Events Screening Instrument for Parents (TESI-P). In B.H. Stamm (Ed.), Measurement of stress, trauma, and adaptation, 386-387. Lutherville, MD: Sidran Press.
• van der Kolk, B.A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). "Disorders of extreme stress: the empirical foundation of a complex adaptation to trauma". Journal of Traumatic Stress 18, 389-399.
• Wolfe, J. & Levin, K. (1991). Life Stressor Checklist. Unpublished instrument, National Center for PTSD, Boston.

Footnoes

1. ^ van der Kolk, B.A. & Courtois, C.A. (2005). "Editorial comments: complex developmental trauma". Journal of Traumatic Stress 18, 385-388.
2. ^ ^{a b} 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. ^ ^{a b} Herman, Judith Lewis (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. Basic Books, p119-122. ISBN 0465087302.