COMPLEX TRAUMA EN COMPLEXE PTSS
review of Dutch Journal
A Complex-Trauma and a Complex-PTSD is not the same
Lots of people suffer a Complex Trauma (traumatic experiences),
but not all of them meet also the criteria (symptoms) of a Complex PTSD (clinical diagnose)
* * *
Psych-traumatology handles three terms to define and indicate a Psychologically-trauma.
- PTSD, Post-traumatic stress syndrome
- Complex Trauma (multiple and divers traumatic experiences)
- C-PTSD or CPTSD, a clinical condition: a Complex-Trauma with typical PTSD symptoms which is indicated for Complex-PTSD treatment
Although the upcoming ICD-11 will also carry a category to classify CPTSD, the DSM-5 carries no record to the classification of a Complex – Post Traumatic Stress Disorder (CPTSD or C-PTSD). As results one is bound to the diagnose of PTSD to diagnose a CPTSD. However, the guidelines for the treatment of a PTSD and a CPTSD vary enormously.
If we talk about a ‘Complex Trauma’
we talk about multiple traumatic experiences, in other words; the traumatic experiences are complex
If we talk about a Complex-PTSD
we talk about a clinical (diagnostically) PTSD condition, in other words; the symptoms of the PTSD are complex.
And here the misunderstanding starts, because a Complex-Trauma does not automatically mean one is suffering a Complex Post Traumatic Stress Disorder; many patient groups this is not examined or are the prevalence’s relatively low. So it is very important to understand and use these terms proper. And it is also very important to specify both, a complex-trauma and complex-PTSD, in a descriptive diagnosis.
To do so we need to know ‘What do we define as complex’ ?
- The traumatic experience (Single Trauma or Complex Trauma – multiple traumatic experiences)
- The consequences of the Trauma (the symptoms mild, complex or multiple complex (comorbidity disorders).
- And which treatment policy is needed
In order of this line you can define:
- PTSD treatment is indicated if a client suffers PTSD symptoms (often caused by a single Traumatic-experience)
- A Complex Trauma:
Is characterized by long duration, repetition, interpersonal context and the disruption of development phases. But… if one suffered a Complex Trauma, this means not automatically one also suffers a CPTSD. And here misunderstandings often arise !
- CPTSD is classified if one suffers complex-PTSD symptoms
Lots of times these terms get confused with each other because one know no distinction between a Complex Trauma ‘and’ a Complex PTSD and that brings consequences for treatment. The most characteristic difference between the treatment of a PTSD and a CPTSD is in the can or cannot lift avoidance and in the confrontation with traumatic memories.
To the treatment of a PTSD confrontation with traumatic memories is standard treatment policy (van Balkom e.a., 2013), but at the core of a CPTSD treatment we need to focus on psychosocial stabilization – the phase I of the treatment guidelines of CPTSD (Cloitre e.a.,2012) because one first needs to explore if the client is stable enough to enter a phase II of the treatment (confrontation with traumatic memories). The assessment of whether or not to directly start a phase II and skip the stabilization phase, needs much more research. Therefore Jackie June ter Heid, Rolf Kleber en Trudy Mooren (2014) call for a better understanding and use of terms.
Situations and causes which lead to symptoms:
Until this moment there is still no agreement on which elements are typical to define a Complex Trauma. In view of the lack of agreement on what complex trauma involves, it seems wise for treating physicians in communication about their patients (such as treatment plans including reference letters) to specify characteristics of the complex trauma history, either to speak of prolonged or repeated or interpersonal or early trauma.
Translated Review of the Dutch Journal:
11 Oct 2014
Auteur(s) :Jackie June ter Heide, Rolf Kleber, Trudy Mooren
Review by Nique EU Disja
* Ross CA (2014) 33,3 pg 285 – question 1
* Nijenhuis ERS, TRTC Assen-Drenthe the Netherland (2014) Ten Reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder. Psichiatria e Psicoterapia 33, 1, 74-106.
* The Haunted Self (Nijenhuis, vd Hart, Steele, 2005, 2006)
* And Nique EU Disja 2014 ANP EP daily life handlingsystem
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