By Dr. C. Courtois -
http://giftfromwithin.org/html/cptsd-understanding-treatment.htmlComplex traumatic events and experiences can be defined as stressors that are:
(1)
repetitive, prolonged, or cumulative (2 )
most often interpersonal, involving direct harm, exploitation, and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults, and
(3)
often occur at developmentally vulnerable times in the victim's life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/ disempowerment/dependency/age /infirmity, and so on.
Child abuse of all types (physical, sexual, emotional, and neglect) within the family is the most common form of chronic interpersonal victimization. Such abuse is often founded on problematic and insecure attachment relationships (between parent and child or others who have primary caretaking responsibilities). Parents and other caregivers who abuse exploit a child's physical and emotional immaturity and dependent status to meet their own needs or do so in response to their own inadequacies or distress, quite often their own history of unresolved trauma and/or loss.
Rather than creating conditions of protection and security within the relationship, abuse by primary attachment figures instead becomes the cause of great distress and creates conditions of gross insecurity and instability for the child including misgivings about the trustworthiness of others....
Rather than having a secure and relatively carefree childhood, abused children are worried and hypervigilant. The psychological energy that would normally go to learning and development instead goes to coping and survival.....
Child abuse, occurring in the context of essential relationships, involves significant betrayal of the responsibilities of those relationships ....
The seven categories of additional aftereffects [to PTSD] include the following:
1.
Alterations in the regulation of affective impulses, including difficulty with modulation of anger and of tendencies towards self-destructivenesss. This category has come to include all methods used for emotional regulation and self-soothing, even those that are paradoxical such as addictions and self-harming behaviors;
2.
Alterations in attention and consciousness leading to amnesias and dissociative episodes and depersonalization. This category includes emphasis on dissociative responses different than those found in the DSM criteria for PTSD. Its inclusion in the CPTSD conceptualization incorporates findings that dissociation tends to be related to prolonged and severe interpersonal abuse occurring during childhood and, secondarily, that children are more prone to dissociation than are adults;
3.
Alterations in self perception, predominantly negative and involving a chronic sense of guilt and responsibility, and ongoing feelings of intense shame. Chronically abused individuals (especially children) incorporate abuse messages and posttraumatic responses into their developing sense of self and self-worth;
4.
Alterations in perception of the perpetrator, including incorporation of his or her belief system. This criterion addresses the complex relational attachment systems that ensue following repetitive and premeditated abuse and lack of appropriate response at the hands of primary caretakers or others in positions of responsibility;
5.
Alterations in relationship to others, such as not being able to trust the motives of others and not being able to feel intimate with them. Another "lesson of abuse" internalized by victim/ survivors is that other people are venal and self-serving, out to get what they can by whatever means including using/abusing others. Abuse survivors may be unaware that other people can be benign, caregiving, and not dangerous;
6.
Somatization and/or medical problems. These somatic reactions and medical conditions may relate directly to the type of abuse suffered and any physical damage that was caused or they may be more diffuse. They have been found to involve all major body systems and to include many pain syndromes, medical illnesses and somatic conditions;
7.
Alterations in systems of meaning. Chronically abused and traumatized individuals often feel hopeless about finding anyone to understand them or their suffering. They despair of being able to recover from their psychic anguish.
[Brackets mine]
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OTHER DEFINITION/DESCRIPTIONSA]
Description from Out of the FOG-http://c-ptsd.org/ - This is easy to read and understand, and gives some insight as to why personality disordered behaviour can result in the development of CPTSD
B]
Pete Walker's Description of CPTSD - From the book "CPTSD: From Surviving to Thriving" (2013)
"CPTSD is a more severe form of Post-traumatic stress disorder. It is delineated from this better known trauma syndrome by five of its most common and troublesome features:"
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Emotional flashbacks "...are sudden and often prolonged regressions to the overwhelming feelings states of being an abused/abandoned child" and involve "shame, alienation, rage, grief and depression." These are unlike flashbacks experienced with PTSD in that EFs do not typically have a visual component. (p. 3)
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Toxic shame - "can obliterate your self-esteem in the blink of an eye. In an emotional flashback you can regress instantly into feeling and thinking that you are as worthless and contemptible as your family perceived you .... toxic shame also inhibits us from seeking emotional comfort and support. In a reenactment of the childhood abandonment we are flashing back to, we often isolate ourselves and helplessly surrender to an overwhelming feeling of humiliation" (pp. 5-6)
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Self-abandonment - "As the quest for perfectionism fails over and over, and as parental acceptance and nurturing remain elusive, imperfectionism becomes synonymous with shame and fear. Perceived imperfection triggers fear of abandonment, which triggers self-hate for imperfection which expands abandonment into self-abandonment" (p. 177).
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Vicious inner critic - "The inner critic blames you incessantly for shortcomings that it imagines to be the cause of your parents' rejection. It is incapable of understanding that the real cause lies in your parents' shortcomings" (p. 168). ".... most survivors spend tremendous amounts of time barely conscious of how incessantly self-critical they are" (p. 172).
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Social anxiety - "Many therapists see CPTSD as an attachment disorder. This means that as a child the survivor grew up without a safe adult to healthily bond with..... When the developmental need to practice healthy relating with a caretaker is unmet, survivors typically struggle to find and maintain healthy relationships. ........childhood abuse installs a powerful people-are-dangerous program (pp. 50-51)
See various CPTSD related articles by Walker here -
http://www.pete-walker.com/C]
Clinical DescriptionCPTSD was first proposed as a diagnosis by Judith Herman is her 1992 book “Trauma and Recovery” to describe a cluster of symptoms which results from ongoing or repeated trauma over which the victim has little or no control, and from which there is no real or perceived hope of escape (e.g., children who are subjected to abuse and/or neglect by their parents). It is in this respect that CPTSD differs from the more well-known diagnosis Post Traumatic Stress Disorder (PTSD) which typically involves a single instance of acute trauma such as witnessing a tragedy or being the victim of an act of violence. That is, CPTSD is a layering of repeated trauma which results in additional symptoms to those of PTSD. In addition to the recurring flashbacks, avoidance or numbing of memories of the traumatic event, and hypervigilance experienced in PTSD, CPTSD involves five additional symptoms which include alterations in:
• regulation of emotions (e.g., anger, hair trigger flight/flight responses, suicide ideation);
• consciousness (e.g., dissociation);
• self-perception (e.g., fragile sense of self; pervasive sense of shame, guilt, self-blame, of being completely different from other human beings)
• perception of the perpetrator(s) (e.g., preoccupation with relationship with perpetrator);
• relations with others (e.g., isolation and withdrawal, distrust of others, relationship difficulties, loneliness and feelings of abandonment/rejection);
• systems of meaning (e.g., sense of hopelessness and despair, depression).
For further information see "Judith Herman and the Formulation of C-PTSD" at
http://traumainform.wordpress.com/2012/07/07/judith-herman-and-the-formulation-of-c-ptsd/. (Includes a video of an interview with Judith Herman)
It should be noted that the term CPTSD has yet to be recognized as an official diagnosis, but has been and continues to be used extensively by both professionals (i.e., traumatologists, researchers, therapists) and the public. The disorder is also known as Complex Trauma, Developmental Trauma Disorder (when the sufferer is a child), and a Disorder of Extreme Stress Not Otherwise Specified (DESNOS). However, given that CPTSD
is widely used, it has been adopted so that those of us who are dealing with it -- by whatever name -- can begin our journey out of the storm that is CPTSD, to share our knowledge of and experiences, and to support and encourage one another on our journey.
Note: For a discussion of the various terms/diagnoses used for CPTSD see
Developmental trauma, complex PTSD, and the current proposal of DSM-5 by Vedat Sar Mar 2011 at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402152/
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