Differences between the effects of short-term
trauma and the effects of chronic trauma?
The diagnosis of PTSD accurately describes the symptoms that
result when a person experiences a short-lived trauma. For example,
car accidents, natural disasters, and rape are considered traumatic
events of time-limited duration. However,
chronic traumas continue or repeat for months or years at a time.
Clinicians and researchers have found that the current PTSD
diagnosis often does not capture the severe psychological harm that
occurs with such prolonged, repeated trauma. For example, ordinary,
healthy people who experience chronic trauma can experience changes
in their self-concept and the way they adapt to stressful events.
Dr. Judith Herman of Harvard University suggests that a new
diagnosis, called Complex PTSD, is needed to describe the symptoms of
long-term trauma. Another name sometimes used to describe this cluster of symptoms is: Disorders of Extreme Stress Not Otherwise Specified (DESNOS).
Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met criteria for PTSD, Complex PTSD was not added as a separate diagnosis. Complex PTSD may indicate a need for special treatment considerations.
What are examples of types of captivity that are associated with chronic
trauma?
Judith Herman notes that during long-term traumas, the victim is
generally held in a state of captivity, physically or emotionally. In these situations the
victim is under the control of the perpetrator and unable to
flee.
Examples of captivity include:
Concentration camps
Prisoner of War camps
Prostitution brothels
Long-term domestic violence
Long-term, severe physical abuse
Child sexual abuse
Organized child exploitation rings
What are the symptoms of Complex PTSD?
The first requirement for the diagnosis is that the individual
experienced a prolonged period (months to years) of total control by
another. The other criteria are symptoms that tend to result
from chronic victimization. Those symptoms include:
Alterations in emotional regulation
This may include
symptoms such as persistent sadness, suicidal thoughts, explosive
anger, or inhibited anger
Alterations in consciousness
This includes things such as as forgetting traumatic
events, reliving traumatic events, or having episodes in which one
feels detached from one's mental processes or body
Changes in self-perception
This may include a sense of
helplessness, shame, guilt, stigma, and a sense of being completely
different than other human beings
Alterations in the perception of the perpetrator
For example;
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
Variations in personal relations including isolation,
distrust, or a repeated search for a rescuer
Changes in one's system of meanings
This may include a
loss of sustaining faith or a sense of hopelessness and despair
What other difficulties do those with Complex PTSD tend to
experience?
Survivors may avoid thinking and talking about trauma-related
topics because the feelings associated with the trauma are often
overwhelming.
Survivors may use alcohol and substance abuse as a way to avoid
and numb feelings and thoughts related to the trauma.
Survivors may also engage in self-mutilation and other forms of
self-harm.
There is a tendency to blame the victim.
A person who has been abused repeatedly is sometimes mistaken as
someone who has a "weak character."
Because of their chronic victimization, in the past, survivors
have been misdiagnosed by mental-health providers as having
Borderline, Dependent, or Masochistic Personality Disorder. When
survivors are faulted for the symptoms they experience as a result
of victimization, they are being unjustly blamed.
Researchers hope that a new diagnosis will prevent clinicians,
the public, and those who suffer from trauma from mistakenly
blaming survivors for their symptoms.
Summary
The current PTSD diagnosis often does not capture the severe
psychological harm that occurs with prolonged, repeated trauma. For
example, long-term trauma may impact a healthy person's
self-concept and adaptation. The symptoms of such prolonged trauma
have been mistaken for character weakness. Research is currently
underway to determine if the Complex PTSD diagnosis is the best way
to categorize the symptoms of patients who have suffered prolonged
trauma.
Recommended Reading
Trauma and Recovery: The Aftermath of Violence from Domestic
Abuse to Political Terror, by Judith Herman, M.D. (1997). Basic
Books; ISBN 0465087302
References
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.
Herman, J. (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.