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May 05, 2009, 06:51 PM
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crystalrose,
If you haven't already read it, I strongly suggest this book by Judith Herman. This chapter deals with prolonged trauma. She's been pushing for the C-PTSD dx for a long time now.
Trauma and Recovery
By Judith Lewis Herman, M.D.
Even the diagnosis of "post-traumatic stress disorder," as it is presently defined, does not fit accurately enough.
The existing diagnostic criteria for this disorder are derived mainly from survivors of circumscribed traumatic events. They are based on the prototypes of combat, disaster, and rape.
In survivors of prolonged, repeated trauma, the symptom picture is often far more complex. Survivors of prolonged abuse develop characteristic personality changes, including deformations of relatedness and identity.
Survivors of abuse in childhood develop similar problems with relationships and identity; in addition, they are particularly vulnerable to repeated harm, both self-inflicted and at the hands of others.
The current formulation of post-traumatic stress disorder fails to capture either the protean symptomatic manifestations of prolonged, repeated trauma or the profound deformations of personality that occur in captivity.
The syndrome that follows upon prolonged, repeated trauma needs its own name. I propose to call it "complex post-traumatic stress disorder." The responses to trauma are best understood as a spectrum of conditions rather than as a single disorder.
They range from a brief stress reaction that gets better by itself and never qualifies for a diagnosis, to classic or simple post-traumatic stress disorder, to the complex syndrome of prolonged, repeated trauma.
Although the complex traumatic syndrome has never before been outlined systematically, the concept of a spectrum of post-traumatic disorders has been noted, almost in passing, by many experts.
Clinicians who work with survivors of childhood abuse have also seen the need for an expanded diagnostic concept. Lenore Terr distinguishes the effect of a single traumatic blow, which she calls "Type I" trauma, from the effects of prolonged, repeated trauma, which she calls "Type II."
Her description of the Type II syndrome includes denial and psychic numbing, self-hypnosis and dissociation, and alternations between extreme passivity and outbursts of rage.
The psychiatrist Jean Goodwin has invented the acronyms FEARS for simple post-traumatic stress disorder and BAD FEARS for the severe post-traumatic stress disorder observed in survivors of childhood abuse.
http://www.amazon.com/s/ref=nb_ss_gw...very&x=13&y=23
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