Journal of Traumatic Stress

, Volume 5, Issue 3, pp 377–391 | Cite as

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

  • Judith Lewis Herman
Article

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.

Key words

complex PTSD 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 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.Google Scholar
  2. Amnesty International (1973).Report on Torture Farrar, Straus and Giroux, New York.Google Scholar
  3. Biderman, A. D. (1957). Communist attempts to elicit false confessions from Air Force prisoners of war.Bull. New York Acad. Med. 33: 616–625.Google Scholar
  4. Biderman, A. D., and Zimmer, H. (1961).The Manipulation of Human Behavior Wiley, New York (Introduction), pp. 1–18.Google Scholar
  5. Bliss, E. L. (1986).Multiple Personality, Allied Disorders, and Hypnosis Oxford University Press, New York.Google Scholar
  6. 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.Google Scholar
  7. Brett, E. A., and Ostroff, R. (1985). Imagery in post-traumatic stress disorder: An overview.Am. J. Psychiatry 142: 417–424.Google Scholar
  8. Briere, J. (1988). Long-term clinical correlates of childhood sexual victimization.Annal. New York Acad. Sci. 528: 327–334.Google Scholar
  9. Briere, J., and Runtz, M. (1987). Post sexual abuse trauma: Data and implications for clinical practice.J. Interpers. Viol. 2: 367–379.Google Scholar
  10. Briere, J., and Zaidi, L. (1989). Sexual abuse histories and sequelae in female psychiatric emergency room patients.Am. J. Psychiatry 146: 1602–1606.Google Scholar
  11. Brown, D. P., and Fromm, E. (1986).Hypnotherapy and Hypnoanalysis Laurence Erlbaum, Hillsdale, N.J.Google Scholar
  12. Browne, A., and Finkelhor, D. (1986). Impact of child sexual abuse: A review of the literature.Psychological Bull. 99: 55–77.Google Scholar
  13. 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.Google Scholar
  14. 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.Google Scholar
  15. Carmen, E. H., Rieker, P. P., and Mills, T. (1984). Victims of violence and psychiatric illness.Am. J. Psychiatry 141: 378–383.Google Scholar
  16. 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.Google Scholar
  17. Dawidowicz, L. (1975).The War Against the Jews Weidenfeld and Nicolson, London.Google Scholar
  18. 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.Google Scholar
  19. Dobash, R. E., and Dobash, R. (1979).Violence Against Wives: A Case Against the Patriarchy Free Press, New York.Google Scholar
  20. 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.Google Scholar
  21. Farber, I. E., Harlow, H. F., and West, L. J. (1957). Brainwashing, conditioning, and DDD (debility, dependency, and dread).Sociometry 23: 120–147.Google Scholar
  22. Favazza, A. R., and Conterio, K. (1988). The plight of chronic self-mutilators.Community Mental Health Journal 24: 22–30.Google Scholar
  23. 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.Google Scholar
  24. Gayford, J. J. (1975). Wife-battering: A preliminary survey of 100 cases.Brit. Med. J. 1: 194–197.Google Scholar
  25. Gelinas, D. (1983). The persistent negative effects of incest.Psychiatry 46: 312–332.Google Scholar
  26. 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.Google Scholar
  27. 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.Google Scholar
  28. 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.Google Scholar
  29. 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.Google Scholar
  30. Halperin, D. A. (1983). Group processes in cult affiliation and recruitment. InPsychodynamic Perspectives on Religion, Sect, and Cult John Wright, Boston.Google Scholar
  31. Hearst, P. C., and Moscow, A. (1982).Every Secret Thing Doubleday, New York.Google Scholar
  32. Herman, J. L. (1981).Father-Daughter Incest Harvard University Press, Cambridge, Mass.Google Scholar
  33. Herman, J. L. (1988). Considering sex offenders: A model of addiction.Signs J. Women Culture Soc. 13: 695–724.Google Scholar
  34. Herman, J. L. (1992).Trauma and Recovery Basic Books, New York.Google Scholar
  35. 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.Google Scholar
  36. Hilberman, E. (1980). The “wife-beater's wife” reconsidered.Am. J. Psychiatry 137: 1336–1347.Google Scholar
  37. Hoppe, K. D. (1968). Resomatization of affects in survivors of persecution.Int. J. Psychoanal. 49: 324–326.Google Scholar
  38. Horowitz, M. (1986).Stress Response Syndromes Jason Aronson, Northvale, N.J., quote on p. 49.Google Scholar
  39. 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.Google Scholar
  40. 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.Google Scholar
  41. Jaffe, R. (1968). Dissociative phenomena in former concentration camp inmates.Int. J. Psychoanal. 49: 310–312.Google Scholar
  42. Kaufman, J., and Zigler, E. (1987). Do abused children become abusive parents?Am. J. Orthopsych. 57: 186–192.Google Scholar
  43. Kernberg, O. (1967). Borderline personality organization.J. Am. Psychoanal. Assoc. 15: 641–685.Google Scholar
  44. 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.Google Scholar
  45. Kinzie, J. D., Fredrickson, R. H., Ben, R.et al. (1984). PTSD among survivors of Cambodian concentration camps.Am. J. Psychiatry 141: 645–650.Google Scholar
  46. 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.Google Scholar
  47. Kolb, L. C. (1989). Letter to the editor.Am. J. Psychiatry 146: 811–812.Google Scholar
  48. 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.Google Scholar
  49. Krystal, E. (ed.) (1968).Massive Psychic Trauma International Universities Press, New York.Google Scholar
  50. 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.Google Scholar
  51. Levi, P. (1958/1961).Survival in Auschwitz: The Nazi Assault on Humanity Trans. Woolf, S., Collier, New York.Google Scholar
  52. 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.Google Scholar
  53. Lovelace, L., and McGrady, M. (1980).Ordeal Citadel, Secaucus, N.J.Google Scholar
  54. 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.Google Scholar
  55. Melges, F. T., and Swartz, M. S. (1989). Oscillations of attachment in borderline personality disorder.Am. J. Psychiatry 146: 1115–1120.Google Scholar
  56. Morrison, J. (1989). Childhood sexual histories of women with somatization disorder.Am. J. Psychiatry 146: 239–241.Google Scholar
  57. NiCarthy, G. (1982).Getting Free: A Handbook for Women in Abusive Relationships Seal Press, Seattle.Google Scholar
  58. Niederland, W. G. (1968). Clinical observations on the ‘survivor syndrome.’Int. J. Psychoanal. 49: 313–315.Google Scholar
  59. Partnoy, A. (1986).The Little School: Tales of Disappearance and Survival in Argentina, Cleis Press, San Francisco.Google Scholar
  60. Putnam, F. W. (1989).Diagnosis and Treatment of Multiple Personality Disorder Guilford, New York.Google Scholar
  61. 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.Google Scholar
  62. Rhodes, R. (1990).A Hole in the World Simon and Schuster, New York.Google Scholar
  63. Rieker, P. P., and Carmen, E. (1986). The victim-to-patient process: The disconfirmation and transformation of abuse.Am. J. Orthopsychiat. 56: 360–370.Google Scholar
  64. 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.Google Scholar
  65. Russell, D. (1986).The Secret Trauma Basic Books, New York.Google Scholar
  66. Russell, D. (1989).Lives of Courage: Women for a New South Africa Basic Books, New York.Google Scholar
  67. Sanders, B., McRoberts, G., and Tollefson, C. (1989). Childhood stress and dissociation in a college population.Dissociation 2: 17–23.Google Scholar
  68. 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.Google Scholar
  69. Sharansky, N. (1988).Fear No Evil (Trans. Hoffman, S.), Random House, New York.Google Scholar
  70. Shengold, L. (1989).Soul Murder: The Effects of Childhood Abuse and Deprivation Yale University Press, New Haven, quote on p. 26.Google Scholar
  71. 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.Google Scholar
  72. 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.Google Scholar
  73. 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.Google Scholar
  74. Terr, L. C. (1983). Chowchilla revisited: The effects of psychic trauma four years after a school-bus kidnapping.Am. J. Psychiastry 140: 1543–1550.Google Scholar
  75. Timerman, J. (1981)Prisoner Without a Name, Cell Without a Number (Trans. Talbot, T.), Vintage, New York.Google Scholar
  76. van der Kolk, B. A. (1987).Psychological Trauma American Psychiatric Press, Wasington, D.C.Google Scholar
  77. van der Kolk, B. A. (1989). Compulsion to repeat the trauma: Reenactment, revictimization, and masochism.Psychiatr. Clin. North Am. 12: 389–411.Google Scholar
  78. 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.Google Scholar
  79. van der Ploerd, H. M. (1989). Being held hostage in the Netherlands: A study of long-term aftereffects.J. Traum. Stress 2: 153–170.Google Scholar
  80. Walker, L., (1979).The Battered Woman Harper and Row, New York.Google Scholar
  81. 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.Google Scholar
  82. Weschler, L. (1989). The great exception: I: Liberty,New Yorker, April 3.Google Scholar
  83. Wiesel, E. (1960).Night (Trans. Rodway, S.), Hill and Wang, New York.Google Scholar
  84. Zanarini, M., Gunderson, J., Frankenburg, F.,et al. (1990) Discriminating borderline personality disorder from other Axis II disorders.Am. J. Psychiatry 147: 161–167.Google Scholar

Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • Judith Lewis Herman
    • 1
  1. 1.Somerville

Personalised recommendations