Complex post-traumatic stress disorder

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The complex of post-traumatic stress disorder ( C-PTSD , also known as complex trauma disorder ) is a psychological disorder suspected to occur as a result of recurrence, prolonged trauma involving persistent persecution or abandonment by caregivers or other interpersonal relationships with uneven power dynamics. C-PTSD deals with mental trauma disorder models and is associated with sexual, emotional or physical abuse or neglect in childhood, intimate partner violence, abductee and hostage situations, contract workers, slave victims, sweatshop workers, prisoners of war, bullying victims , survivors from concentration camps, school survivors, and cult defectors or sectarian organizations. Situations involving breeding/trapping (situations that do not have a proper flight route for victims or such perceptions) can cause symptoms similar to C-PTSD, which include prolonged fears of fear, disaffection, helplessness, and the deformation of one's identity and feelings. self.

Some researchers argue that C-PTSD is different from, but similar to PTSD, somatization disorder, dissociative identity disorder, and borderline personality disorder, with the main difference being that it distorts a person's core identity, especially when prolonged trauma occurs during childhood development. It was first described in 1992 by Judith Herman in his book Trauma & amp; Recovery and the accompanying article. Although peer-reviewed journals have published papers on C-PTSD, this category has not been adopted by the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorder , 5th Edition (DSM-5), or at World Health Organization (WHO) Classification of International Statistics of Diseases and Health Related Issues , Issue 10 (ICD-10). However, it is proposed for ICD-11, which will be completed by 2018.

Video Complex post-traumatic stress disorder

Symptoms

Children and teenagers

The diagnosis of PTSD was originally developed for adults suffering from single-event traumas, such as rape, or traumatic experiences during the war. However, the situation for many children is very different. Children can suffer chronic trauma such as abuse, family violence, and disruption in attachment to their primary caregiver. In many cases, it is the nanny that causes the trauma. The diagnosis of PTSD does not take into account how the stage of development of children can affect their symptoms and how trauma can affect a child's development.

The term developmental trauma disorder (DTD) has also been suggested. This growing form of trauma puts children at risk for developing psychiatric and medical disorders. Bessel van der Kolk describes DTD as many encounters with interpersonal trauma such as physical attacks, sexual violence, violence or death. It can also be characterized by subjective events such as betrayal, defeat or shame.

Recurrent trauma during childhood causes symptoms that are different from those described for PTSD. Cook and others describe the symptoms and behavioral characteristics in seven domains:

• Appendix - "issues with relationship restrictions, lack of trust, social isolation, difficulty understanding and responding to the emotional state of others"
• Biology - "sensory motor development dysfunction, sensory integration difficulties, somatization, and increased medical problems"
• Influence or emotional regulation - "badly affects regulation, difficulties identifying and expressing emotions and internal circumstances, and difficulty communicating needs, wants and expectations"
• Dissociation - "amnesia, depersonalization, discrete states of awareness with separate memories, affect, and function, and memory impairments for state-based events"
• Behavioral control - "problems with impulse control, aggression, pathological calming, and sleep problems"
• Cognition - "difficulty managing attention, problems with various 'executive functions' such as planning, assessment, initiation, material use and self-monitoring, difficulty processing new information, focusing difficulties and completing tasks, bad things, problems with cause-and-effect thinking, and language development issues such as the gap between receptive and expressive communication skills. "
• Self-concept - "broken and discontinuous autobiographical narrations, impaired body image, low self-esteem, excessive shyness, and internal negative self-working model".

Adult

Adults with C-PTSD sometimes experience prolonged interpersonal trauma as children as well as prolonged trauma as adults. This initial injury disrupts the development of a strong sense of self and others. Because physical or emotional pain or neglect is often caused by attachment figures such as older caregivers or siblings, these individuals can develop feelings that they are fundamentally flawed and others unreliable.

This can be a broad way to connect with others in adult life that is described as an insecure attachment. The diagnosis of dissociative disorder and PTSD in the current DSM-5 (2013) does not include unsafe attachment as a symptom. Individuals with PTSD Complex also exhibit a lasting personality disorder with significant revictimization risk.

Six groups of symptoms have been suggested for the diagnosis of C-PTSD:

• changes in regulatory and impulse settings;
• changes in attention or awareness;
• changes in self perception;
• changes in relationships with others;
• somatization;
• changes in system meaning.

Experience in this field may include:

• Difficulty managing emotions, including symptoms such as persistent dysphoria, chronic suicide preoccupation, self-injury, explosion or anger that is severely inhibited (perhaps alternately), or compulsive or highly stunted (compulsory) sexuality.
• Variations in consciousness, including forgetting traumatic events (ie, psychogenic amnesia), revitalizing experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation), or having dissociation episodes.
• Changes in self-perception, such as chronic and pervasive sense of helplessness, initiative paralysis, shame, guilt, self-blame, pollution or stigma, and feelings are completely different from other humans.
Variations in the perception of the perpetrator, such as attributing total power to the perpetrator, become preoccupied with the relationship with the offender, including preoccupation with revenge, idealization or paradoxical gratitude, seeking approval from the offender, a sense of special relationship with the perpetrator or acceptance of a belief system or rationalization of the offender.
• Changes in relationships with others, including isolation and withdrawal, persistent distrust, anger and hostility, recurring searches for rescuers, intercourse disorders and repeated failures of self-protection.
• Loss, or change in, a person's meaning system, which may include loss of defending beliefs or despair and despair.
• Termination from the environment is accompanied by feelings of terror and confusion.

Maps Complex post-traumatic stress disorder

Diagnostics

C-PTSD is being considered for inclusion in DSM-IV but not included when DSM-IV was published in 1994. Not included in DSM-5. PTSD will continue to be listed as a nuisance.

Differential diagnosis

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is included in DSM-III (1980), mainly due to the relatively large number of American war veterans from the Vietnam War seeking treatment for the effects of existing combat stress. In the 1980s, various researchers and doctors suggested that PTSD might also accurately depict trauma-related symptoms such as child sexual abuse and domestic abuse. However, it was soon suggested that PTSD fails to explain a group of symptoms that are often observed in cases of prolonged violence, especially those done to children by caregivers during the developmental stage of childhood and adolescence. Such patients are often very difficult to treat with existing methods.

The PTSD description fails to capture some of the core characteristics of C-PTSD. These elements include breeding, psychological fragmentation, loss of security, trust, and self-esteem, and a tendency to be revived. Most importantly, there is a loss of a coherent sense of self: this loss, and the next symptom profile, most clearly distinguishes C-PTSD from PTSD.

C-PTSD is also characterized by a disruption of attachment, particularly pervasive insecurity, or an unorganized type of attachment. DSM-IV (1994) dissociative disorders and PTSD do not include unsafe attachments in their criteria. As a consequence of this C-PTSD aspect, when some adults with C-PTSD become parents and face their own attachment needs, they may have particular difficulties responding sensitively especially to the distress of their children and babies they - like during a routine breakup, regardless of the intentions and best efforts of these two parents. Although most survivors do not abuse others, the difficulty in parenting these children can adversely affect the social and emotional development of their children if parents with this condition and their children are not receiving proper care.

Thus, the differences between the C-PTSD and PTSD diagnostic categories have been suggested. C-PTSD better describes the negative impact of recurrent chronic traumatic pervasive than PTSD alone.

C-PTSD also differs from sustained traumatic stress disorder (CTSD), which is introduced into the trauma literature by Gill Straker (1987). It was originally used by South African doctors to describe the effects of exposure to frequent, high-level violence commonly associated with civil conflict and political repression. The term also applies to the effects of exposure to contexts where gang and crime violence are endemic as well as the impact of persistent exposure to life threats in high-risk jobs such as police, fire, and emergency services.

Traumatic sadness

Traumatic sadness or elaborate sadness is a condition in which trauma and sadness coincide. There is a conceptual link between trauma and loss due to the loss of a loved one inherently traumatic. If a traumatic event is life-threatening, but does not result in death, then most likely the victim will experience post-traumatic stress symptoms. If a person dies, and a survivor is close to the person who died, then most likely symptoms of sadness will also develop. When death is a loved one, and sudden or violent, then both symptoms often coincide. This may be in children exposed to community violence.

In order for C-PTSD to materialize, violence will occur under conditions of detention, loss of control and helplessness, coinciding with the death of a friend or loved one in a life-threatening situation. This is again most likely for children and stepchildren who are subjected to prolonged domestic or chronic violence that ultimately results in the deaths of friends and loved ones. The phenomenon of increased risk of child abuse and death is referred to as the Cinderella effect.

Attachment theory and personality threshold disorder

C-PTSD may share some symptoms with PTSD and borderline personality disorder. It may be helpful to understand the intersection of attachment theory with C-PTSD and BPD if one reads the following opinion of Bessel A. van der Kolk along with an understanding taken from the description of BPD:

Uncontrolled disorder or binding distortion precedes the development of post-traumatic stress syndrome. People seek increased attachment in the face of danger. Adults, as well as children, can develop strong emotional ties with people who intermittently interfere with, hit, and, threaten them. This bonding persistence causes confusion of pain and love. Trauma can be repeated at the level of behavior, emotional, physiological, and neuroendocrinologic. Repetition at different levels causes a wide range of individual and social suffering.

However, C-PTSD and BPD have been found by researchers to be completely different disorders with very different features - notably, C-PTSD is not a personality disorder - those who suffer are not afraid to be left out, do not have an unstable relationship pattern - instead they retreat and they do not struggle with lack of empathy. There is a clear and very big difference between Borderline and C-PTSD and while there are some similarities - especially in terms of problems with attachments (although these play in a completely different way) and difficulty regulating powerful emotional effects (often feeling pain clearly) , the disorder is completely different in nature - especially given that C-PTSD is always a response to trauma rather than a personality disorder. In addition, C-PTSD is not a personality disorder - it is often a survival reaction to trauma that is a fundamental aspect of personality, in response to life with individuals with personality disorders.

"While people in BPD reported many symptoms of PTSD and CPTSD, the BPD class clearly differed in the unique attestation symptoms for BPD.RR ratio presented in Table 5 revealed that the following symptoms were highly indicative of placement in BPD rather than CPTSD classes: (1) avoiding tangible or imaginative neglect, (2) unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, (3) self-image or highly unstable and unstable senses, and (4) impulsiveness Given gravity suicidal behavior and self-injury, it is important to note that there are also marked differences in the presence of suicidal behaviors and self-harming with about 50% of individuals in BPD classes reporting these symptoms but far fewer and equivalent amounts do so in the CPSD class and PTSD (14.3 and 16.7% respectively).The only symptom of individual BPD in BPD class is no different from CPT class SD is a feeling of chronic emptiness, indicating that in this sample, these symptoms are not specific to either BPD or CPTSD and do not differentiate between them. "

"Overall, the findings indicate that there are several ways in which the PTSD and BPD Complex are different, consistent with the proposed diagnostic formulations of CPTSD.PBD is characterized by abandoned fears, self-instability, unstable relationships with others, and impulsivity and self-behavior - harming. In contrast, in CPTSD as in PTSD, there is little support for items that relate to instability in self-representation or relationships. The concept of self-concept tends to be consistently negative and relational difficulties mainly concerning avoidance of relationships and sense of alienation. "

In addition, 25% of those diagnosed with BPD have no history of childhood abuse or abuse and people who are six times more likely to develop BPD if they have a diagnosed relative than those who are not diagnosed. One conclusion is that there is a genetic predisposition for BPD not related to trauma. The researchers conducted a longitudinal investigation of identical twins found that "genetic factors play a major role in individual differences in features of borderline personality disorder in Western society." A 2014 study published in the European Journal of Psychotraumatology was able to compare and contrast C-PTSD, PTSD, Borderline Personality Disorder and found that it was able to distinguish between individual cases of each and then co-morbid, citing separate diagnostic cases. for each. BPD may be confused with C-PTSD by some people without the proper knowledge of the two conditions because those with BPD also tend to suffer from PTSD or have some history of trauma.

In Trauma and Recovery Herman expressed the additional concern that patients suffering from C-PTSD often risk being misunderstood as 'self-dependent', 'masochistic' or 'self-defeating', comparing this attitude with a historic misdiagnosis of hysteria women. However, those who develop C-PTSD do so as a result of the intensity of traumatic bonds - in which a person becomes chemically bonded closely to someone who abuses them and the responses they learn to survive, navigate and handle their miserable misery then become automatic responses, embedded in their personalities during years of trauma - normal reactions to abnormal situations.

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Treatment

Treatment is usually tailored to the individual.

Children

The PTSD utility derives psychotherapy to help children with C-PTSD uncertain. This field of diagnosis and care requires attention in the use of the C-PTSD category. Ford and van der Kolk have suggested that C-PTSD may not be useful as a category for diagnosis and treatment of children as a category of proposed developmental trauma disorder (DTD). For DTD to be diagnosed requires

'history of exposure to early life experiencing the development of adverse interpersonal trauma such as sexual harassment, physical violence, violence, traumatic loss from other significant disturbances or betrayal of childhood relationships with primary caregivers, who have been postulated as an etiological basis for complex traumatic stress disorder. Diagnosis, planning and treatment outcomes are always related. '

Because C-PTSD or DTD in children is often caused by chronic abuse, neglect or abuse in parenting relationships, the first element of the biopsychosocial system to be addressed is the relationship. It always involves some kind of child protection agent. This extends the range of support that can be provided to the child but also the complexity of the situation, since the legal obligations of the institution may need to be enforced.

A number of practical, therapeutic and ethical principles for assessment and intervention have been developed and explored in the field:

• Identifying and addressing threats to child and family safety and stability is the first priority.
• Relational bridges should be developed to engage, maintain, and maximize benefits for children and carers.
• Diagnosis, care planning and results monitoring are always relational (and) based on strength.
• All phases of care should aim to improve self-regulatory competence.
• Determine with whom, when, and how to overcome traumatic memories.
• Prevent and manage relational discontinuities and psychosocial crises.

Adult

Delaying therapy for people with complex PTSD (cPTSD), either intentionally or not, may aggravate the condition. Herman believes the recovery of C-PTSD takes place in three stages:

1. build security,
2. remember and grieve over what's missing,
3. reconnect with the community and more broadly, the community.

Herman believes that recovery can only occur in a healing relationship and only if the survivors are empowered by that relationship. This healing relationship does not need to be romantic or sexual in the sense of everyday "relationships", however, and can also include relationships with friends, co-workers, relatives or children, and therapeutic relationships.

Complex trauma means a complex reaction and this leads to complicated treatment. Therefore, treatment for C-PTSD requires a multi-modal approach. It has been suggested that treatment for C-PTSD should be different from treatment for PTSD by focusing on problems that cause functional impairment more than PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems. The six suggested core components of complex trauma care include:

1. Security
2. Self-help
3. Self-reflective information processing
4. Experience of traumatic integration
5. Link engagement
6. Positively affects the increase

Source of the article : Wikipedia