Complex post-traumatic stress disorder (C-PTSD) is a psychological disorder that was first recognised as a diagnosable condition in the 11th edition of the International Classification of Diseases in 2018 (ICD-11)*
It is a condition that is brought about by prolonged, repeated experiences of interpersonal trauma in which the sufferer has little or no chance of escape. In the context of early life adversity it is associated with chronic sexual, psychological, and physical abuse or neglect, or chronic school bullying. This new diagnostic category is most often directed at children and emotionally vulnerable adults.
It was first described in 1992 by an American psychiatrist and scholar, Judith Herman in her book ‘Trauma & Recovery’. It is the only current recognised diagnosable mental illness that makes reference to developmental adverse experiences or events as being directly causal in the condition.
The diagnosis of PTSD was originally developed for adults who had suffered from a single-event trauma, such as rape, or a traumatic experience during a war. However, the situation for many children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, dysfunction, and or a disruption in attachment to their primary caregiver. In many cases, it may be the child's caregiver who causes the trauma. The diagnosis of PTSD does not take into account how the developmental stages of children may affect their symptoms and how trauma can affect a child's development.
Repeated traumatisation during childhood leads to symptoms that differ from those described for PTSD. C-PTSD demonstrates symptoms and behavioural characteristics in seven domains:
Attachment – "problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to others' emotional states"
Biology – "sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems"
Affect or emotional regulation – "poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes"
Dissociation – "amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events"
Behavioural control – "problems with impulse control, aggression, pathological self-soothing, and sleep problems"
Cognition – "difficulty regulating attention; problems with a variety of 'executive functions' such as planning, judgement, initiation, use of materials, and self-monitoring; difficulty processing new information; difficulty focusing and completing tasks; poor object constancy; problems with 'cause-effect' thinking; and language developmental problems such as a gap between receptive and expressive communication abilities."
Self-concept – "fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self".
*(reference made to en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder)
