Complex Post-Traumatic Stress Disorder

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Complex Post-Traumatic Stress Disorder
Recommended DSM diagnostic criteria, per Trauma and Recovery by Judith Herman, c1992 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, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and 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 hypermnesia 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