Understanding Complex Trauma, Complex Reactions, and Treatment Approaches, Part 3
Posted Nov 12 2010 4:19am
I hope you have been enjoying our series “Understanding Complex Trauma, Complex Reactions and Treatment Approaches”. We started this series two months ago with Understanding Complex Trauma Part 1 and Part 2 . Today in Part 3 of our series Dr. Christine Courtois moves on to Complex Reactions.
It is now understood that ongoing abuse or adversity over any developmental epoch but especially over the course of childhood can have major impact on the individual’s development in a variety of ways and involve all life domains. In fact, recent studies have documented that abuse and other trauma result in changes in the child’s neurophysiological development that, in turn, result in changes in learning patterns, behavior, beliefs and cognitions, identity development, self-worth, and relations with others, to name the most common.
Although some individuals who were traumatized as children manage to escape relatively unscathed at the time or later (often due to personal resilience or to having had a restorative and secure attachment relationship with a primary caregiver that countered the abuse effects), the majority developed a host of aftereffects, some of which were posttraumatic and met criteria for Posttraumatic Stress Disorder (PTSD). But the PTSD diagnosis as currently defined in the Diagnostic and Statistical Manual IV-TR of the American Psychiatric Association (American Psychiatric Association, 2000) (the mental health “Bible” that therapists and others use to make diagnoses) does not account for many of the aftereffects seen in children and later in adults abused as children, and is not, in fact, a diagnosis for childhood PTSD. As of yet, no such diagnosis has been included in the DSM, although a proposal for a Developmental Trauma Disorder (DTD) has been proposed submitted for its inclusion in the next edition (van der Kolk, 2005).
In recognition of this omission and the misfit encountered in applying many of the complex trauma reactions to the criteria of “standard” PTSD, a review of the most common aftereffects of chronic childhood abuse resulted in their organization into seven criteria sets that were included in a new diagnostic conceptualization labeled Complex PTSD or DESNOS (Disorders of Extreme Stress Not Otherwise Specified) (Herman, 1992 a & b). Complex PTSD was suggested as a means of organizing and understanding the often perplexing array of aftereffects that had been identified into one comprehensive and overarching diagnosis. Moreover, the diagnosis was a way to de-stigmatize aftereffects and symptoms by acknowledging their origin as outside the individual and not due to the character (or character defect) of the individual.
Unfortunately, these negative points of view have been held by many mental health practitioners over the years that impacted their compassion for and treatment of traumatized individuals. Sadly, Complex PTSD was not included as a freestanding mental health diagnosis in the DSM IV and was instead considered as an associated feature form of PTSD, although this might change in the future revisions with additional research findings. In the meantime, many therapists who treat children and adults with complex trauma histories and complex trauma reactions use this conceptualization because it matches what they see in their clients’ presentations and helps them to explain and organize the symptoms and to further organize their treatment. In fact, Complex PTSD/DESNOS was immediately accepted and used by a wide variety of clinicians treating patients with complex trauma histories because it had face validity in that it matched the varied presentations made by their clients and was a more parsimonious and less stigmatizing way to understand and diagnose the symptom constellation they presented.
Join us next month as we continue Complex Reactions with ‘Categories of Aftereffects’.
Christine A Courtois, PhD & Associates, PLCis a private practice that specializes in the treatment of adults experiencing the effects of childhood incest/sexual abuse and other types of trauma. Dr. Courtois has worked with these issues for 30 years and has developed treatment approaches for complex posttraumatic and dissociative conditions for which she has received international recognition.