Harvard University’s Dr. Judith Herman has proposed that a new diagnosis of Complex Post Traumatic Stress Disorder (C-PTSD) is needed to describe symptoms of long-term trauma which may also be classified as Disorders of Extreme Stress Not Otherwise Specified (DESNOS).
Results from the DSM-IV Field Trials indicated that 92% of individuals with C-PTSD/DESNOS also met criteria for PTSD, so C-PTSD wasn’t added as a separate diagnosis in the DSM IV TR. She is the pioneer in C-PTSD and coined the term.
What is C-PTSD?
Complex Post Traumatic Stress Disorder is a psychological injury resulting from long-term exposure to trauma. In this traumatic situation, a person has lost control or he/she was never allowed to have control over the situation. In addition, the victim has no viable way to escape the trauma. It can involve psychological, physical and/or sexual abuse or careers involving continual contact with natural or human made disasters.
C-PTSD and the Diagnostic and Statistical Manual of Mental Disorders
The DSM IV, published by the American Psychiatric Association, provides criteria for mental disorders used by mental health professionals to diagnose disorders. There have been five revisions since it was published in 1952, including adding more disorders and removing some no longer considered as such. It was developed from systems used for collecting census, psychiatric institution’s statistics and a manual developed by the US Army.
The DSM V is currently being planned and will be published in May 2012. C-PTSD may indicate a need for different treatment and it's believed it will be included in the newest revision of the DSM.
How C-PTSD Differs from PTSD
PTSD descriptions don’t account for some of the characteristics of C-PTSD. These include the loss of feelings of safety, trust, and self-worth, the tendency to be re-victimized and the loss of a sound sense of self.
C-PTSD is characterized by pervasive insecure attachment, not feeling self-confident and a tendency not to trust others. The DSM IV doesn’t include insecure attachment in PTSD criteria. Attachment is the process of emotional bonding with significant people.
Types of Captivity Associated with C-PTSD
Victims are usually held in a state of captivity, psychologically or physically. They are under control of the perpetrator and unable to escape. Examples of captivity include:
- Being traumatized by continual psychological, physical and/or sexual child abuse;
- Being victimized by significant others’ psychological, physical and/or sexual abuse, and;
- Surviving concentration camps, POW camps, “white” slavery brothels and child exploitation rings.
Problems Faced by Victims of C-PTSD
When PTSD was proposed as a diagnostic category for the DSM-III in 1980, it was controversial because the influence of outside stressors was deemed the cause of this disorder. Psychiatry had emphasized deficiencies of individuals as the source of mental problems. There was a tendency to blame the victim. A continually abused person was and, still is, by some, mistaken as a person who has a weak personality.
C-PTSD survivors have been misdiagnosed by some mental health professionals as having Borderline, Dependent, or Masochistic Personality Disorder because of their chronic past and/or present victimization. When targets are blamed for the symptoms they experience as a result of chronic trauma, they often feel angry which compounds their problems.
Why C-PTSD Should Be Included in DSM V
The DSM IV diagnosis of PTSD does not address the severe psychological injury that occurs with prolonged continual trauma. Childhood abuse and/or long-term adult trauma can impact a healthy person's self-concept.
Symptoms of prolonged trauma were and, in some cases, are still are thought to be a character weakness. Research is currently being done to determine if the C-PTSD diagnosis is the best way to categorize symptoms of people who have suffered and still are subject to prolonged trauma. Researchers hope that this diagnosis will prevent some mental health professionals, the general public, and those suffering from trauma from mistakenly being blamed for the symptoms that they experience.
Articles Related to C-PTSD
People who found this article interesting might want to read What is the Proposed Criteria for Adult C-PTSD? and What Is Post-Traumatic Stress Disorder?
Sources:
- Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, American Psychiatric Association, (American Psychiatric Association, 2000).
- BullyOnline.org
- NCPTSD.va.gov
Jill Stefko - I'd rather deal with the paranormal than human abnormal - having dealt extensively with both.
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