Complex post-traumatic stress

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Complex post-traumatic stress (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, domestic violence, torture, and chronic early maltreatment in a caregiving relationship. It has been suggested that a differentiation be made between the diagnostic categorizations of C-PTSD and Post traumatic stress disorder (PTSD), as C-PTSD better describes the pervasive negative impact of chronic trauma than does PTSD.[1]

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.

Diagnostic criteria

Note: The American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders, forbids the unauthorized reproduction of their diagnostic criteria. A narrative of the DSM-IV-TR criteria follows.

Symptom profile

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

  • 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 [1]

C-PTSD and Borderline personality disorder

Complex post-traumatic stress (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 psychosocial 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 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 social and psychosocial 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.

References

  1. van der Kolk BA & Courtois CA (2005) Editorial comments: complex developmental trauma. Journal of Traumatic Stress 18:385-8