Complex PTSD: A syndrome in survivors of prolonged and repeated trauma

TLDR

PTSD diagnostic criteria, based on single traumatic events, do not account for the complex sequelae of prolonged, repeated trauma that occurs under captivity and coercive control, a syndrome currently being considered for DSM‑IV as DESNOS. The paper reviews evidence for a complex form of PTSD in survivors of prolonged, repeated trauma. It examines literature on the syndrome’s characteristics and diagnostic criteria. The current PTSD formulation fails to capture the diverse sequelae of prolonged, repeated trauma.

Abstract

This paper reviews the evidence for the existence of a complex form of post-traumatic disorder in survivors of prolonged, repeated trauma. This syndrome is currently under consideration for inclusion in DSM-IV under the name of DESNOS (Disorders of Extreme Stress Not Otherwise Specified). The current diagnostic formulation of PTSD derives primarily from observations of survivors of relatively circumscribed traumatic events. This formulation fails to capture the protean sequelae of prolonged, repeated trauma. In contrast to a single traumatic event, prolonged, repeated trauma can occur only where the victim is in a state of captivity, under the control of the perpetrator. The psychological impact of subordination to coercive control has many common features, whether it occurs within the public sphere of politics or within the private sphere of sexual and domestic relations.