Talk:Complex post-traumatic stress disorder

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[edit] Trauma type-I and type-II

Anyone has knowledge about Lenore Terr's trauma types I and II's, trauma II corresponding to complex PTSD? Think this should be mentioned. Jalind 16:54, 10 November 2006 (UTC)

[edit] PTSD and C-PTSD vs. personality disorders, Borderline Personality Disorder

I've removed the comparison with Borderline Personality Disorder as it is one of the most dubious categories in all of Psychology. Few psychologists refer to it and there has been discussion of removing it from the DSM altogether.) 70.142.154.44 18:20, 3 July 2006 (UTC)

I really disagree. Firstly, borderline personality disorder (BPD) is the most researched personality disorder, and also it is the most common PD. Secondly, there is growing understanding on the relation between early traumatization and BPD. However I see your point, there is debate (which is quite normal in psychology) about the essence of BPD. I think BPD will in the future be conceptualized more presisely and its relation to C-PTSD will be more clarified (like in this study by Macleon and Gallop (2003) [1]). Also it is important to see that C-PTSD and PTSD are very different disorders, especially when C-PTSD has happened in childhood disrupting normal development. For more information about general connection between early traumatization (=C-PTSD) and BPD see Winston (2000) Recent developments in borderline personality disorder (figure 1 is very informative) [2]. Jalind 10:48, 3 November 2006 (UTC)

Actually, a better reason for eliminating the comparison is that Borderline Personality Disorder is a Personality Disorder, while PTSD is an axis-I disorder and C-PTSD, if it becomes a DSM diagnosis would also likely be an axis-I diagnosis. RalphLender 19:37, 3 August 2006 (UTC)

[edit] Where can we add trauma re-enactment, self-harming

Where can we add trauma re-enactment (TR)??? - for many survivors of childhood trauma, it feels impossible to stop self-harming patterns like drug/alcohol/sex abuse as they recreate the destruction from their past. Patterns of TR behaviour: alcoholic drinking, drugging, being in abusive relationships, sexual acting out — often become the survivors “best friend” because TR fools them into thinking that these ways of being are their best defence, their best chance at survival. Masiarek 02:50, 5 August 2006 (UTC)

What you are describing is a way in which suvivors of childhood trauma reduce stress and releave tension...not in a healthy growth enhancing manner. DPeterson 20:32, 5 August 2006 (UTC)

The victim may also be using these strategies as an unhealthy way of empowering themselves. If they are harming/punishing themselves, they are not somebody elses victim, as they are choosing this treatment. They are in control of their treatment.

It is a symptom of their difficulties...JohnsonRon 22:17, 15 October 2006 (UTC)
I don't think it is symptoms we are dealing here. Also I think trauma re-enactment is not necesarily self-regulation or defense, it is merely lack of self-regulation. Talking about re-enactment may produce needless guilty of survivors. It is the insufficient self-regulation (ie. lack of assertiveness, impulsiveness) that is causing the symptoms (ie. depression, anxiety, interpersonal problems) and also exposes to retraumatization. This viewpoint underlines empathy and acceptance, and is seen on central on new treatments of BPD, like Linehan's DBT. Jalind 21:01, 2 November 2006 (UTC)
Actually, trauma reenactment (or flashbacks) are often described in the professional literature as the mind's attempt at healing and integration (See J. Beiere's work, for example). the difficulty is that the individual lacks sufficient resources and/or the trauma is so overwhelming, that these normal processes are not effective, and so some formal treatment is necessary to resolve the trauma. In C-PTSD the trauma is of an chronic nature; it is early chronic trauma, which causes problems in a variety of domains (See National Trauma Center's White Paper). RalphLendertalk 21:38, 2 November 2006 (UTC)
Yes, I am familiar with this functional view (=restoration, healing) of flashbacks from work of Janoff Bullman. But Masiarek uses the term "re-enactment" and describes revictimization or unconsciously motivated behavioral repeating of the trauma event. Freud refers to this as repetition compulsion (did you by the way ment Breuer, Josef 1842-1925?). Flashbacks or intrusive symptoms of trauma are more mental phenomena, ie. repeatative memories, but not behavior. As van der Kolk (1989) - one of the leading authors on the field nowadays - says: "Freud thought that the aim of repetition was to gain mastery, but clinical experience has shown that this rarely happens; instead, repetition causes further suffering for the victims or for people in their surroundings." [3] To underline my point here is one example: It is known that women abused in childhood, are more often raped in adulthood. Is this because of their mental need for experience their trauma again (ie. to integrate traumatic experience into self), or might it be because of their general inability to protect theirselves (ie. lack of skills, accepting of maltreatment)? Jalind 10:35, 3 November 2006 (UTC)
I meant to cite, Principles of Trauma Therapy by John Briere & Catherine Scott, 2006, Sage Publications. Again, much of the flash-back and re-enactments described in the trauma lit can be viewed as the mind's efforts to integrate the trauma and heal. In fact, current practice protocols on trama treatment call for the this very thing to occur in a controlled and supported therapeutic relationship when it does not occur "naturally." DPetersontalk 11:29, 3 November 2006 (UTC)
Thank you for clarifying the source, it seems wery interesting and updated. I agree about the therapeutic value of reliving the trauma in therapeutic setting. I still doubt that revictimization and intrusive symptoms are functionally related. (Firstly: How much is their correlation, do they load on same factors in factor analysis, do they cause relief in any circumstances?). I have been thinking about scientific criterions to clarify the issue, and glanced a few empirical studies. In study by Noll, Horowitz, Bonnanno, Trickett and Putnam (2003) [4] they explored what factors explain revictimization. They explored the unique predictive value of several predictors (see table 4: ie. early sexual, physical and emotional maltreatment; experienced symptoms like PTSD symptoms, dissociation and sexual permissiveness). When taking into account the intercorrelations between these predictors, dissociation and sexual permissiveness but not PTSD-symptoms (including intrusive and avoidant symptoms) were predictive of physical revictimization. They concluded that "victims who adopt pathological dissociation as the primary defense strategy in adolescence or adulthood may be less able to engage in self-protection when physically threatened." Their results support my view that revictimization is caused by lack of skills, not by psychological need to experience again a traumatic event (I suggest that we accept intrusive and avoidant PTSD-symptoms as a measure of this psychological need to revictimization/re-experiencing). The supposition about revictimized patient's psychological need for retraumatization in vivo may in itself be destructive, untherapeutic and not scientificly based. It increases victims guilt and deteriorates self-esteem.
Very interesting study is also Gladstone, Mitchell, Malhi and Austin (2004) [5] . The study design demonstrates that this problem in hand is open to empirical solution. In their study there was both a mediated (and direct link) between physical abuse as a child TO personality dysfunction TO adult retraumatization (see fig 1). Jalind 10:47, 4 November 2006 (UTC)
This is a very useful discussion. I wonder if you would be willing to take what you've written above (in the section about Noll, Horowitz, et.al. and put that into the article itself? I think it is very relevant and clearly based on a verifiable source. It would help clarify this point. RalphLendertalk 14:09, 3 November 2006 (UTC)
Thank you for suggesting, I could do this (when have more time), meanwhile anyone else is also free to contribute. Any suggestions for subtopic, like: Some possible consequences of C-PTSD. This topic could contain Borderline personality disorder and Revictimization? Jalind 10:47, 4 November 2006 (UTC)

[edit] Clarification: is C-PTSD restricted to children?

I dont think that it is only relaited to children. If you read the article and pay attention, it says domestic violenc, tourchure, war, sexual abuse, etc. Any one can go threw a number of these things. including but not limited to adults. You dont have to have pre-exsposhure to child hood abuse. if you get into a abusive relationship that goes on for several year, spicifically sexual or physical, any number of combinations. I can be severly traumitizeing. At any age. Women, boys, girls, and even men, who are forsed into sex traid (human trafficking) are highly likely to suffer from more than just PTSD. Thats like war in its self, A struggle to keep your life, with repeated richual sexual abuse, rape, and assult. This is the same thing that a child goes threw. Not to down play what a child would go threw, im a survivor of molestaion myself, but children are very resilant. Sometimes they dont understan what had happened to them. But one day they might be abile to move on when there older and know truly they had no controle. For an adult thats a little harder. THAT'S where the C-PTSD somes in after PTSD.68.82.14.147 (talk) 19:12, 5 March 2008 (UTC)


The first paragraph implies there's no restriction. This seems especially true in the comparison with PTSD. The rest of the article is specific to children, though, and someone not already familiar with the diagnosis could be confused by this (I am).

Greybirds 09:32, 5 February 2007 (UTC)

Complex Post Traumatic Stress Disorder is caused by chronic 'early' trauma. The outcome of this is not limited to children, although it's impact on children is what most of the literature focuses on. DPetersontalk 13:57, 5 February 2007 (UTC)
I was going to ask the same question. If it's true that it's only about early trauma, it should say so in the article. I personally doubt that's true. Certainly a lot of adults say they have this condition. As the introduction says, it's about any long-term exposure to severe stress.Merkinsmum 11:36, 16 April 2007 (UTC)
The literature on this (for example, the White Paper from the National Child Trauma Center on evaluating and treating CPTSD) pretty much describes the "cause" as having four primary elements: Early, Chronic, Maltreatment, in a Caregiving relationship. Early means in the first few years...However, the effects of CPTSD, if not treated, continue throughout life into adulthood. DPetersontalk 12:35, 16 April 2007 (UTC)
I just noticed this thread. I'm the one who originally wrote this article, although I haven't looked at it in quite some time.
C-PTSD is not restricted to children. As a diagnosis, it is PTSD that present with Borderline features. As the Borderline personality does not begin to manifest until age 10, it is impossible for the disorder to even appear in children. The precursors and antecedents may be present, and it is to this that the literature speaks. --DashaKat 22:22, 3 August 2007 (UTC)

[edit] DDP

I have removed Dyadic Developmental Psychotherapy from this page. This little known therapy has been extensively advertised on Wiki as evidence based, sometimes the only evidence based treatment for a variety of disorders affecting attachment. (Theraplay, also little known and not evidence based has also been advertised in this way.) A range of attachment articles including attachment therapy are currently before ArbCom. In the course of ArbCom it has transpired that of the 6 users promoting DDP and Theraplay and controlling these pages, User:DPeterson, User:RalphLender, User:JonesRD, User:SamDavidson, User:JohnsonRon, and User:MarkWood, the latter four are definitely socks and have been blocked, and the other two have been blocked for one year. The attachment related pages are in the course of being rewritten. Fainites barley 21:29, 3 August 2007 (UTC)

Update - all 5 are now indefinitely blocked as sockpuppets of DPeterson, and DPeterson has been banned for 1 year by ArbCom.[6] Fainites barley 19:41, 5 September 2007 (UTC)

Update 2 - User:AWeidman, AKA Dr. Becker-Weidman Talk and Dr Art has now also been indef. banned for breach of the ban on his sockpuppet DPeterson. Fainites barley 18:37, 4 November 2007 (UTC)

[edit] Article spin

Having a chance to look at this article, I'm having some difficulty reconciling the manner in which it is presented. It currently sounds as if this is a disturbance that is dependent upon childhood trauma, and nothing could be further from the truth.

The C-PTSD nomenclature was developed to help describe acute Borderline characteristics presented by trauma victims. Anything else is empirical gravy, as the trauma does not have to have a genesis in childhood.

To my way of thinking, the article widely misses the mark. --DashaKat 21:05, 4 August 2007 (UTC)

Thats probably because it was largely edited by the sock army mentioned in the section above for the apparent purpose of advertising a therapy for it. They're all gone for the moment so edit away! Fainites barley 19:50, 5 September 2007 (UT

Edit, Hitladynmore~ Yikes, that's alot of fancy talk. Last week A friend of mine was changing a lightbulb for me. It exploded and glass flew everywhere....I took off, had a major anxiety attack and have had a total of three nightmares about it. Spoke to a friend of mine from a PTSD group I took a few years back. She reminded me of my Dad swinging a Metal Texaco truck at my head and the truck busted the overhead light on his backswing. I was shocked, how did she remember? It didn't happen to her in the first place, but the thought of it scared her so bad for me. It was also decided that day that I shouldn't feel guilty for my Dads anger. As far as BPD, cop-out? Crap-out, Whatever. Apples and Oranges. The two may be related in that they are both psycological disorders. But C-PTSD is what I have been referring to as Chronic Traumatic Stress disorder. Meanwhile, ask anybody who married a guy "Just like dear old dad" and you will easily be able to make the connection that I have. I took my trauma into my adulthood and when the marriage (obviously) didn't work out....Never tried again. Body, heart, spirit, soul, mind, personality.. what, I should try again? (lol)

I'm the one who originally penned this article. It's current version is more than a modest distortion of the warp and woof of the subject matter. It is both biased and incomplete. I am planning a re-write that will include referenced information to correct both of these situations.
To start, how it is that a diagnostic category initially introduced to explain acute BPD symptom breakthrough in trauma vicitims no longer contains any information on that subject is simply beyond me. --Sadhaka 00:39, 29 October 2007 (UTC)

If you look above you'll see it was edited by a sock army pushing a particular definition (as an alternative to a discredited version of reactive attachment disorder) and a therapy to cure it. Six are already banned and the 7th is in the process of being indef. banned so you are unlikely to be troubled by them if you start rewriting it. Fainites barley 15:36, 31 October 2007 (UTC)

Adding to above statement......(as a concerned parent) Let's stay on the constructive path. My daughters were molested for 3 years from the age of 6 to 9 including torture, I immediately got them into therapy and there are such differnces in the two. My older one never spoke about it while the other couldn't stop talking about it. They are 13 months apart in age. My older one who is now 23 and has been in and out of treatment since (with an ongoing drug/alcohol abuse history). I/We have yet to find anyone who can help her, now that she wants it. Seems to me alot more awareness has to reach other facets of our communities other than doctors. She has had much difficulty finding HELP, most just want to lock her up and be done with it!! This child had/has so much potential, 4 presidential awards, 3 citizenship awards, spelling bees, honor roll student until the 9th grade, softball all star player, basketball trophies, peer mediation plaques, an overachiever? Oh and absolutely beautiful. Why? How? And is there anyone out there that can/will go completely out of they're way for these kids? I can be reached at pllblondee@msn.com. There is so much more to tell if anyone wants to assist!!!! The only reason why she has these problems is because of what happened to her other than that she has had a very stable and nurturing upbringing.
Thank Goodness. —Preceding unsigned comment added by 65.7.176.200 (talk • contribs)
Page additions should be added based on reliable sources, not personal experience. Please post new comments at the bottom of talk pages WLU (talk) 19:51, 8 April 2008 (UTC)
Regardless if that is true or not, I think everyone with PTSD and C-PTSD would very much prefer anyone giving orders here to have PTSD or C-PTSD, or be a caregiver, or doctor. I do not appreciate all the nonsense on this discussion forum because it gives me headaches to read it, and when you post disrespectful crap like that, it really ticks me off and makes me want to throw you through my tiny little window repeatedly until you fit. Show respect, and for gods sake everyone else STOP RAMBLING and making all these posts and categories about the same damn thing. Im not signing this because im pretty sure I speak for all of us. —Preceding unsigned comment added by 76.180.55.81 (talk) 06:27, 1 June 2008 (UTC)

[edit] Complex Trauma in Children

I think that children do suffer from C-PTSD. If a child is molested froma young age, and remembers this abuse or any form of abuse for that matter, it could manifest its self into C-PTSD. After being abused a certain way for so long then a child begins to exibit these behavours to. Sexualy acting out, inapropreate relationships. Just because they're under the age of 18 doesnt mean that they dont suffer. Nightmares, even flashbacks, re-accurent bed wettings, abussive behaviour twards animals. I had read somewhere that a little girl had dumped her gold fish out of it's tank. She knew that if the fish was out of water it would die. I vegley remember the girl was about 8. When her mother had asked her why she dumped her fish out, she had replied: "I wanted to see what it was like to die." Thierefor leading the mother to suspect that her 8 year old wanted to die. In my opinion and from persional experience with C-PTSD myself, only a child who has been severly abused in some way would want to die. I think thought that it would be harder to tell if a child is traumatized or not. Children are very easily conned for more of a better word. If you tell them not to say something or to keep a secret and they don's, something bad will happen. Then they will keep that secret. NO matter how bad it hurts, or how horrible of a secret it is. CHildren dont really know or understand whats right from wrong, or fact from fiction. Sometimes its harder to tell if a child has been traumatised. Thats why parents should watch for any change in behavour. One little inconsistancy can tell a whole story and possibly save your child a life time of pain and hurt68.82.14.147 (talk) 19:18, 5 March 2008 (UTC)

Dude, you deleted my original statement, which is really not cool. Here's what I wrote before the above author deleted it.
This section reads as an ad. I just deleted it- if you disagree with me please tell me why here and revert it and I'll leave it alone. I would suggest writing a section about CPTSD in childhood if anyone can come up with one. CelticLabyrinth 17:28, 4 December 2007 (UTC)
Anyway, this isn't a debate forum- and I was talking about someone advertising a specific therapy. If you want to research and create a section based on clinical evidence that CPTSD is a valid diagnosis in childhood then please- do so. If not then that's fine too. But please, do not delete a valid entry on a talk page! CelticLabyrinth (talk) 08:51, 14 April 2008 (UTC)

[edit] Why were other potential treatments removed?

I appreciate the cleanup of the section I edited and reinserted. However, I am curious why this line was removed:

"Those who have experienced complex trauma caused by chronic maltreatment can be treated with Cognitive Behavioral Therapy interventions, education, EMDR and other approaches."

Why is TF-CBT the only one listed? That makes it seem almost like an endorsement for a particular method. Why were other potential treatments removed? Were there just no sources available to support those? If I was looking this up for me, I would want to know all the available treatments there are. 75.177.39.22 (talk) 04:40, 4 April 2008 (UTC)

It was deleted because it was unsourced, although I think the more appropriate action would have been to insert a citation needed thingy. If you can find a source that says those treatments then you can reinsert them. I know that all of those are cited in academic papers as treatment for PTSD and DID but I know of few sources for C-PTSD. CelticLabyrinth (talk) 08:55, 14 April 2008 (UTC)
heheh- I should actually look before I talk. I deleted some stuff by those people before, they are advertising a therapy. I have reposted on treatment and provide a cite so it shouldn't be deleted that easily. If anyone else mentions TF-CBT I would delete it- the cite is for sexually abused children, not for complex PTSD. CelticLabyrinth (talk) 18:18, 14 April 2008 (UTC)

[edit] Trauma Focused Cognitive Behavioral Therapy

Someone keeps editing this page to add something about trauma focused cognitive behavioral therapy, an obscure therapy being used with traumatized children. The citation links to an article about treating sexually abused children, not an article about complex PTSD. I would suggest that, if you see something on TF-CBT then check out the source- if it does not mention anything about C-PTSD (which, by all appearances is almost solely diagnosed in late adolescence and adulthood as it requires symptomatology of borderline personality disorder which is hardly every diagnosed in childhood, whereas TF-CBT is a treatment for children) then please delete it. CelticLabyrinth (talk) 18:26, 14 April 2008 (UTC)