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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
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:
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
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.
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.
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.
Trauma and Recovery: The Aftermath of Violence from
Domestic Abuse to Political Terror, by
Judith Herman, M.D. (1997). Basic Books; ISBN 0465087302
