CPTSD
Complex Post Traumatic Stress Disorder

Recommended DSM diagnostic criteria, per Trauma and Recovery by Judith Herman, ©1992 by Basic Books.

A history of subjection to totalitarian control over a prolonged period (months to years). Examples include:

  • Hostages
  • Prisoners of war
  • Concentration-camp survivors
  • Survivors of some religious cults
  • Persons subjected to totalitarian systems in sexual and domestic life, including:
    • survivors of domestic battering
    • childhood physical or sexual abuse
    • organized sexual exploitation.

 

  • Alterations in affect regulation, including:
    • persistent dysphoria
    • chronic suicidal preoccupation
    • self-injury
    • explosive or extremely inhibited anger (may alternate)
    • compulsive or extremely inhibited sexuality (may alternate)

     

  • Alterations in consciousness, including:
    • amnesia or hyperamnesia for traumatic events
    • transient dissociative episodes
    • depersonalization/derealization
    • reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

     

  • Alterations in self-perception, including:
    • sense of helplessness or paralysis of initiative
    • shame, guilt, and self-blame
    • sense of defilement or stigma
    • sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

     

  • Alterations in perception of perpetrator, including:
    • preoccupation with relationship with perpetrator (includes preoccupation with revenge)
    • unrealistic attribution of total power to perpetrator (caution: victim's assessment of power realities may be more realistic than clinician's)
    • idealization or paradoxical gratitude
    • sense of special or supernatural relationship
    • acceptance of belief system or rationalizations of perpetrator

     

  • Alterations in relations with others, including:
    • isolation and withdrawal
    • disruption in intimate relationships
    • repeated search for rescuer (may alternate with isolation and withdrawal)
    • persistent distrust
    • repeated failures of self-protection

     

  • Alterations in systems of meaning:
    • loss of sustaining faith
    • sense of hopelessness and despair
 

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