Complex post traumatic stress disorder

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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.

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.

Symptom profile

C-PTSD is characterized by chronic difficulties in many areas of emotional and interpersonal functioning. Symptoms may include:

• 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. 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. Six suggested core components of complex trauma treatment include:

1. Safety
2. Self-regulation
3. Self-reflective information processing
4. Traumatic experiences integration
5. Relational engagement
6. 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.

As C-PTSD shares symptoms with both PTSD and borderline personality disorder, 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.

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.
• 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.CS1 maint: Multiple names: authors list (link)
• 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.CS1 maint: Multiple names: authors list (link)