What
are the 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 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.
What
are examples 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. 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, which may include symptoms
such as persistent sadness, suicidal thoughts, explosive
anger, or inhibited anger
* Alterations in
consciousness, such as forgetting traumatic events,
reliving traumatic events, or having episodes in which
one feels detached from one's mental processes or body
* Alterations in
self-perception, which 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, 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
* Alterations in one's
system of meanings, which 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
Selected 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. |