Complex PTSD: A syndrome in survivors of prolonged and repeated trauma
- Judith Lewis Herman
- … show all 1 hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95 *
* Final gross prices may vary according to local VAT.
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.
Related Content
Supplementary Material (0)
References (84)
- Allodi, F.,et al., (1985). Physical and psychiatric effects of torture: Two medical studies. In Stover, E., and Nightingale, E. (eds.),The Breaking of Bodies and Minds: Torture, Psychiatric Abuse, and the Health Professions Freeman, New York, pp. 58–78.
- Amnesty International (1973).Report on Torture Farrar, Straus and Giroux, New York.
- Biderman, A. D. (1957). Communist attempts to elicit false confessions from Air Force prisoners of war.Bull. New York Acad. Med. 33: 616–625.
- Biderman, A. D., and Zimmer, H. (1961).The Manipulation of Human Behavior Wiley, New York (Introduction), pp. 1–18.
- Bliss, E. L. (1986).Multiple Personality, Allied Disorders, and Hypnosis Oxford University Press, New York.
- Brett, E. A. (1992). Classification of PTSD in DSM-IV as an anxiety disorder, dissociative disorder, or stress disorder. In Davidson, J., and Foa, E. (eds.),PTSD in Review: Recent Research and Future Directions American Psychiatric Press, Washington, D.C.
- Brett, E. A., and Ostroff, R. (1985). Imagery in post-traumatic stress disorder: An overview.Am. J. Psychiatry 142: 417–424.
- Briere, J. (1988). Long-term clinical correlates of childhood sexual victimization.Annal. New York Acad. Sci. 528: 327–334.
- Briere, J., and Runtz, M. (1987). Post sexual abuse trauma: Data and implications for clinical practice.J. Interpers. Viol. 2: 367–379.
- Briere, J., and Zaidi, L. (1989). Sexual abuse histories and sequelae in female psychiatric emergency room patients.Am. J. Psychiatry 146: 1602–1606.
- Brown, D. P., and Fromm, E. (1986).Hypnotherapy and Hypnoanalysis Laurence Erlbaum, Hillsdale, N.J.
- Browne, A., and Finkelhor, D. (1986). Impact of child sexual abuse: A review of the literature.Psychological Bull. 99: 55–77.
- Bryer, J. B., Nelson, B. A., Miller, J. B., and Krol, P. A. (1987). Childhood sexual and physical abuse as factors in adult psychiatric illness.Am. J. Psychiatry 144: 1426–1430.
- Burgess, A. W., Hartman, C. R., McCausland, M. P.,et al. (1984). Response patterns in children and adolescents exploited through sex rings and pornography.Am. J. Psychiatry 141: 656–662.
- Carmen, E. H., Rieker, P. P., and Mills, T. (1984). Victims of violence and psychiatric illness.Am. J. Psychiatry 141: 378–383.
- Coons, P. M. (1985). Children of parents with multiple personality disorder. In Kluft, R. P. (ed.),childhood Antecedents of Multiple Personality Disorder American Psychiatric Press, Washington, D.C., pp. 151–166.
- Dawidowicz, L. (1975).The War Against the Jews Weidenfeld and Nicolson, London.
- De Loos, W. (1990). Psychosomatic manifestations of chronic PTSD. In Wolf, M. E., and Mosnaim, A. D. (eds.),Posttraumatic Stress Disorder: Etiology, Phenomenology, and Treatment American Psychiatric Press, Washington, DC, pp. 94–105.
- Dobash, R. E., and Dobash, R. (1979).Violence Against Wives: A Case Against the Patriarchy Free Press, New York.
- Dutton, D., and Painter, S. L. (1981). Traumatic bonding: The development of emotional attachments in battered women and other relationships of intermittent abuse.Victimology 6: 139–155.
- Farber, I. E., Harlow, H. F., and West, L. J. (1957). Brainwashing, conditioning, and DDD (debility, dependency, and dread).Sociometry 23: 120–147.
- Favazza, A. R., and Conterio, K. (1988). The plight of chronic self-mutilators.Community Mental Health Journal 24: 22–30.
- Ferenczi, S. (1932/1955). Confusion of tongues between adults and the child: The language of tenderness and of passion. InFinal Contributions to the Problems and Methods of Psychoanalysis Basic Books, New York.
- Gayford, J. J. (1975). Wife-battering: A preliminary survey of 100 cases.Brit. Med. J. 1: 194–197.
- Gelinas, D. (1983). The persistent negative effects of incest.Psychiatry 46: 312–332.
- Goldstein, G., van Kammen, V., Shelley, C.,et al., (1987). Survivors of imprisonment in the Pacific theater during World War II.Am. J. Psychiatry 144: 1210–1213.
- Goodwin, J., McMarty, T., and DiVasto, P. (1982). Physical and sexual abuse of the children of adult incest victims. In Goodwin, J. (ed.),Sexual Abuse: Incest Victims and their Families John Wright, Boston, pp. 139–154.
- Goodwin, J. (1988). Evaluation and treatment of incest victims and their families: A problem oriented approach. In Howells, J. G. (ed.),Modern Perspectives in Psycho-Social Pathology Brunner/Mazel, New York.
- Graham, D. L., Rawlings, E., and Rimini, N. (1988). Survivors of terror: Battered women, hostages, and the Stockholm syndrome. In Yllo, K., and Bograd, M. (eds.),Feminist Perspectives on Wife Abuse Sage, Beverly Hills, pp. 217–233.
- Halperin, D. A. (1983). Group processes in cult affiliation and recruitment. InPsychodynamic Perspectives on Religion, Sect, and Cult John Wright, Boston.
- Hearst, P. C., and Moscow, A. (1982).Every Secret Thing Doubleday, New York.
- Herman, J. L. (1981).Father-Daughter Incest Harvard University Press, Cambridge, Mass.
- Herman, J. L. (1988). Considering sex offenders: A model of addiction.Signs J. Women Culture Soc. 13: 695–724.
- Herman, J. L. (1992).Trauma and Recovery Basic Books, New York.
- Herman, J. L., Perry, J. C., and van der Kolk, B. A. (1989). Childhood trauma in borderline personality disorder.Am. J. Psychiatry 146: 490–495.
- Hilberman, E. (1980). The “wife-beater's wife” reconsidered.Am. J. Psychiatry 137: 1336–1347.
- Hoppe, K. D. (1968). Resomatization of affects in survivors of persecution.Int. J. Psychoanal. 49: 324–326.
- Horowitz, M. (1986).Stress Response Syndromes Jason Aronson, Northvale, N.J., quote on p. 49.
- Hotaling, G., and Sugarman, D. (1986). An analysis of risk markers in husband to wife violence: The current state of knowledge.Viol. Vict. 1: 101–124.
- Jacobson, A., and Richardson, B. (1987). Assault experiences of 100 psychiatric inpatients: Evidence of the need for routine inquiry.Am. J. Psychiatry 144: 908–913.
- Jaffe, R. (1968). Dissociative phenomena in former concentration camp inmates.Int. J. Psychoanal. 49: 310–312.
- Kaufman, J., and Zigler, E. (1987). Do abused children become abusive parents?Am. J. Orthopsych. 57: 186–192.
- Kernberg, O. (1967). Borderline personality organization.J. Am. Psychoanal. Assoc. 15: 641–685.
- Kinzie, J. D., Boehnlein, J. K., Leung, P. K.,et al., (1990). The prevalence of posttraumatic stress disorder and its clinical significance among Southeast Asian refugees.Am. J. Psychiatry 147: 913–917.
- Kinzie, J. D., Fredrickson, R. H., Ben, R.et al. (1984). PTSD among survivors of Cambodian concentration camps.Am. J. Psychiatry 141: 645–650.
- Kluft, R. P. (1990). Incest and subsequent revictimization: The case of therapist-patient sexual exploitation, with a description of the sitting duck syndrome. InIncest-Related Syndromes of Adult Psychopathology American Psychiatric Press, Washington, D.C., pp. 263–289.
- Kolb, L. C. (1989). Letter to the editor.Am. J. Psychiatry 146: 811–812.
- Kroll, J., Habenicht, M., Mackenzie, T.et al. (1989). Depression and posttraumatic stress disorder in Southeast Asian refugees.Am. J. Psychiatry 146: 1592–1597, quote on p. 1596.
- Krystal, E. (ed.) (1968).Massive Psychic Trauma International Universities Press, New York.
- Krystal, H., and Niederland, W. (1968). Clinical observations on the survivor syndrome. In Krystal, H. (ed.),Massive Psychic Trauma International Universities Press, New York, pp. 327–348.
- Levi, P. (1958/1961).Survival in Auschwitz: The Nazi Assault on Humanity Trans. Woolf, S., Collier, New York.
- Lifton, R. J. (1987). Cults: Religious totalism and civil liberties. InThe Future of Immortality and Other Essays for a Nuclear Age Basic Books, New York.
- Lovelace, L., and McGrady, M. (1980).Ordeal Citadel, Secaucus, N.J.
- Mai, F. M., and Merskey, H. (1980). Briquet's treatise on hysteria: Synopsis and commentary.Arch. Gen. Psychiatry 37: 1401–1405, quote on p. 1402.
- Melges, F. T., and Swartz, M. S. (1989). Oscillations of attachment in borderline personality disorder.Am. J. Psychiatry 146: 1115–1120.
- Morrison, J. (1989). Childhood sexual histories of women with somatization disorder.Am. J. Psychiatry 146: 239–241.
- NiCarthy, G. (1982).Getting Free: A Handbook for Women in Abusive Relationships Seal Press, Seattle.
- Niederland, W. G. (1968). Clinical observations on the ‘survivor syndrome.’Int. J. Psychoanal. 49: 313–315.
- Partnoy, A. (1986).The Little School: Tales of Disappearance and Survival in Argentina, Cleis Press, San Francisco.
- Putnam, F. W. (1989).Diagnosis and Treatment of Multiple Personality Disorder Guilford, New York.
- Putnam, F. W., Guroff, J. J., Silberman, E. K.et al. (1986). The clinical phenomenology of multiple personality disorder: Review of 100 recent cases.J. Clin. Psychiatry 47: 285–293.
- Rhodes, R. (1990).A Hole in the World Simon and Schuster, New York.
- Rieker, P. P., and Carmen, E. (1986). The victim-to-patient process: The disconfirmation and transformation of abuse.Am. J. Orthopsychiat. 56: 360–370.
- Ross, C. A., Miller, S. D., Reagor, P.et al. (1990). Structured interview data on 102 cases of multiple personality disorder from four centers.Am. J. Psychiatry 147: 596–601.
- Russell, D. (1986).The Secret Trauma Basic Books, New York.
- Russell, D. (1989).Lives of Courage: Women for a New South Africa Basic Books, New York.
- Sanders, B., McRoberts, G., and Tollefson, C. (1989). Childhood stress and dissociation in a college population.Dissociation 2: 17–23.
- Segal, J., Hunter, E. J., and Segal, Z. (1976) Universal consequences of captivity: Stress reactions among divergent populations of prisoners of war and their families.Int. J. Social Sci. 28: 593–609.
- Sharansky, N. (1988).Fear No Evil (Trans. Hoffman, S.), Random House, New York.
- Shengold, L. (1989).Soul Murder: The Effects of Childhood Abuse and Deprivation Yale University Press, New Haven, quote on p. 26.
- Strentz, T. (1982). The Stockholm syndrome: Law enforcement policy and hostage behavior. In Ochberg, F. M., and Soskis, D. A. (eds.),Victims of Terrorism Westview, Boulder, Colo., pp. 149–163.
- Symonds, M. (1982). Victim responses to terror: Understanding and treatment. In Ochberg, F. M., and Soskis, D. A. (eds.),Victims of Terrorism Westview, Boulder, Colo., pp. 95–103, quote on p. 99.
- Tennant, C. C., Gouston, K. J., and Dent, O. F. (1986). The psychological effects of being a prisoner of war: Forty years after release.Am. J. Psychiatry 143: 618–622.
- Terr, L. C. (1983). Chowchilla revisited: The effects of psychic trauma four years after a school-bus kidnapping.Am. J. Psychiastry 140: 1543–1550.
- Timerman, J. (1981)Prisoner Without a Name, Cell Without a Number (Trans. Talbot, T.), Vintage, New York.
- van der Kolk, B. A. (1987).Psychological Trauma American Psychiatric Press, Wasington, D.C.
- van der Kolk, B. A. (1989). Compulsion to repeat the trauma: Reenactment, revictimization, and masochism.Psychiatr. Clin. North Am. 12: 389–411.
- van der Kolk, B. A., Perry, J. C., and Herman, J. L. (1991). Childhood origins of self-destructive behavior.Am. J. Psychiatry 148: 1665–1671.
- van der Ploerd, H. M. (1989). Being held hostage in the Netherlands: A study of long-term aftereffects.J. Traum. Stress 2: 153–170.
- Walker, L., (1979).The Battered Woman Harper and Row, New York.
- Wardell, L., Gillespie D., and Leffler, A. (1983). Science and violence against wives. In Finkelhor, D., Gelles, R., Hotaling, G.,et al. (eds.),The Dark Side of Families: Current Family Violence Research Sage, Beverly Hills, pp. 69–84.
- Weschler, L. (1989). The great exception: I: Liberty,New Yorker, April 3.
- Wiesel, E. (1960).Night (Trans. Rodway, S.), Hill and Wang, New York.
- Zanarini, M., Gunderson, J., Frankenburg, F.,et al. (1990) Discriminating borderline personality disorder from other Axis II disorders.Am. J. Psychiatry 147: 161–167.
About this Article
- Title
- Complex PTSD: A syndrome in survivors of prolonged and repeated trauma
- Journal
-
Journal of Traumatic Stress
Volume 5, Issue 3 , pp 377-391 - Cover Date
- 1992-07-01
- DOI
- 10.1007/BF00977235
- Print ISSN
- 0894-9867
- Online ISSN
- 1573-6598
- Publisher
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links
- Topics
- Keywords
-
- complex PTSD
- Authors
- Author Affiliations
-
- 1. 61 Roseland St., 02143, Somerville, Massachusetts