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Understanding and Treating C-PTSD

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Abstract

Complex posttraumatic stress disorder (C-PTSD) can result from ongoing and repeated exposure to trauma, particularly in childhood. The trauma is frequently in the form of physical, emotional, or sexual abuse perpetrated by those in a position of trust such as a parent or other relative, teacher, caregiver, or clergyman. Treating those with C-PTSD is centered on the formation of a strong therapeutic alliance. This article examines how to diagnose C-PTSD and how the therapeutic alliance can be built with patients who have had their trust betrayed by the very people who should have protected them. It also covers a three-part approach to therapy that focuses on (1) coping in the here and now, (2) addressing the root cause of trauma, and (3) moving forward.

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References

  • Al-Shawi, A.F., & Lafta, R.K. (2015). Effect of adverse childhood experiences on physical health in adulthood: Results of a study conducted in Baghdad city. J Family Community Med. 22(2): 78-84. https://doi.org/10.4103/2230-8229.155374

    Article  PubMed  PubMed Central  Google Scholar 

  • Annan, J., Brier, M., & Aryemo, F. (2009). From “rebel” to “returnee”: Daily life and reintegration for young soldiers in Northern Uganda. Journal of Adolescent Research, 24(6), 639-667. https://doi.org/10.1177/0743558409350499

    Article  Google Scholar 

  • Bellis, M.A., Lowey, H., Leckenby, N., Hughes, K. & Harrison, D. (2014). Adverse childhood experiences: Retrospective study to determine their impact on adult health behavior and health outcomes in a UK population. J of Public Health, 36(1), 81-91. https://doi.org/10.1093/pubmed/fdt038

    Article  Google Scholar 

  • Briere, J. (2011). Trauma Symptoms Inventory - 2 (TSI-2). Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J of Consult and Clin Psychol., 68(5), 748-766. https://doi.org/10.1037//0022-006x.68.5.748

    Article  CAS  Google Scholar 

  • Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R.A., Humayun, A., Jones, L. M., Kagee, A., Rousseau, C., Somasundaram, D., Suzuki, Y., Wessely, S., van Ommeren, M., & Reed, G.M. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev. 58, 1-15. https://doi.org/10.1016/j.cpr.2017.09.001

    Article  PubMed  Google Scholar 

  • Children’s Bureau, Administration on Children, Youth and Families, Administration for Children and Families, US Department of Health and Human Services (2004). National Child Abuse and Neglect Data System (NCANDS) Child File, 2001. National Data Archive on Child Abuse and Neglect. 10.34681/DBM1-B519

  • Cloitre M., Courtois C.A., Charuvastra A., Carapezza R., Stolbach B.C., & Green B.L. (2011) Treatment of Complex PTSD: Results of the ISTSS expert clinician survey on best practices. Journal of Traumatic Stress. 24(6), 615-627. https://doi.org/10.1002/jts.20697

    Article  PubMed  Google Scholar 

  • Cloitre, M., Hyland, P., Bisson, J.I., Brewin, C.T., Roberts, N.P., Karatzias, T., & Shevlin, M. (2019). ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder in the United States: A population-based study. J of Trauma Stress. 32(6), 833-842. https://doi.org/10.1002/jts.22454

    Article  Google Scholar 

  • Cloitre, M., Koenen, K.C., Cohen, L.R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. J of Consult and Clin Psychol, 70(5), 1067–1074. https://doi.org/10.1037//0022-006x.70.5.1067

    Article  Google Scholar 

  • Cloitre, M., Stovall-McClough, K. C., Nooner, K., Zorbas, P., Cherry, S., Jackson, C. L., Gan, W., & Petkova, E. (2010). Treatment for PTSD related to childhood abuse: A randomized controlled trial. Am J Psychiatry, 167(8), 915–924. https://doi.org/10.1176/appi.ajp.2010.09081247

    Article  PubMed  Google Scholar 

  • Courtois C.A. (2010). Healing the Incest Wound: Adult Survivors in Therapy Second Edition. W.W. Norton & Company.

  • Courtois, C. A., Ford, J. D., Cloitre, M., & Schnyder, U. (2020) Best Practices in Psychotherapy for Adults. In J. D. Ford and C. A. Courtois (Eds.) Treating Complex Traumatic Stress Disorders, Second Edition. The Guilford Press.

    Google Scholar 

  • Danieli, Y. (1998) International Handbook of Multigenerational Legacies of Trauma. Springer US.

    Book  Google Scholar 

  • Farber, B.A., Suzuki, J.A., & Lynch, D.A. (2018). Positive regard and psychotherapy outcome: A meta-analytic review. Psychotherapy, 55(4), 411-423. https://doi.org/10.1037/pst0000171

    Article  PubMed  Google Scholar 

  • Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med., 14(4), 245-58. https://doi.org/10.1016/s0749-3797(98)00017-8

    Article  CAS  PubMed  Google Scholar 

  • Fillol, C.F., Serrano-Ibanez, E.R., Ruiz-Parraga, G.T., Maestre, C.R., Zarazaga, R.E., & Martinez A.E.L. (2018). Effective therapies for the treatment of complex posttraumatic stress disorder: A qualitative systematic review. Salud Mental. 41(2), 81-90. 10.17711/SM.0185-3325.2018.013

  • Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2015). Prevalence of childhood exposure to violence, crime, and abuse: Results from the National Survey of Children’s Exposure to Violence. JAMA Pediatr, 169(8), 746-754. https://doi.org/10.1001/jamapediatrics.2015.0676

    Article  PubMed  Google Scholar 

  • First, M., William, J., Karg, R., & Spitzer, R. (2016). Structured Clinical Interview for DSM-5 Disorders, Clinician Version (SCID-5-CV). Arlington, VA: American Psychiatric Association.

    Google Scholar 

  • Fisher J. (2021) Transforming the Living Legacy of Trauma: A Workbook for Survivors and Therapists. Pesi Publishing & Media.

  • Ford, J.D. & Courtois, C.A. (2014). Complex PTSD, affect dysregulation, and borderline personality disorder. Bord Personal Disord Emot Dysregul 1, 9. https://doi.org/10.1186/2051-6673-1-9

    Article  Google Scholar 

  • Ford, J.D., Courtois, C.A., Steele ,K., van der Hart, O., & Nijenhuis, E.R.S. (2005). Treatment of complex posttraumatic self-dysregulation. J of Traumatic Stress, 18(5), 437-447. https://doi.org/10.1002/jts.20051

  • Forward S. (2002). Toxic Parents: Overcoming Their Hurtful Legacy and Reclaiming Your Life. Bantam.

    Google Scholar 

  • Franco, F. (2020). Broadening Perspectives on Trauma: Considering the Role of Social Affects and Shame in Complex PTSD. Complex Trauma Perspectives: ISTSS Complex Trauma Special Interest Group Newsletter. 1, 15-17.

    Google Scholar 

  • Frewen, P., Zhu, J., & Lanius, R. (2019). Lifetime traumatic stressors and adverse childhood experiences uniquely predict concurrent PTSD, complex PTSD, and dissociative subtype of PTSD symptoms whereas recent non-traumatic stressors do not: results from an online survey study. Eur J Psychotraumatol. 10(1), 1606625. https://doi.org/10.1080/20008198.2019.1606625

    Article  PubMed  PubMed Central  Google Scholar 

  • Harvey, M. R. (1996) An ecological view of psychological trauma and trauma recovery. J of Trauma Stress, 9(1), 3-23.

    Article  CAS  Google Scholar 

  • Haselgruber A., Solva K., & Lueger-Schuster B. (2020) Validation of ICD-11 PTSD and complex PTSD in foster children using the International Trauma Questionnaire. Acta Psychiatr Scand. 141(1), 60-73. https://doi.org/10.1111/acps.13100

    Article  CAS  PubMed  Google Scholar 

  • Horvath, A.O., & Luborsky, L (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61(2), 561-573. https://doi.org/10.1037/0022-006X.61.4.561

    Article  CAS  PubMed  Google Scholar 

  • Jobes D. A. (2020). Commonsense recommendations for standard care of suicidal risk. Journal of Health Service Psychology, 46(4), 141-148. https://doi.org/10.1007/s42843-020-00020-3

    Article  Google Scholar 

  • Karatzias, T., Hyland, P., Bradley, A., Cloitre, M., Roberts, N.P., Bisson, J. I., & Shevlin, M. (2019). Risk factors and comorbidity of ICD-11 PTSD and complex PTSD: Findings from a trauma-exposed population based sample of adults in the United Kingdom. Depression & Anxiety, 36(9), 887-894. https://doi.org/10.1002/da.22934

    Article  PubMed  Google Scholar 

  • Karatzias, T., Shevlin, M., Fyvie, C., Hyland, P., Efthymiadou, E., Wilson, D., Roberts, N., Bisson, J.I. Brewin, C.R. & Cloitre, M. (2017). Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the new ICD-11 trauma questionnaire (ICD-TQ). J of Affect Disord., 207, 181-187. https://doi.org/10.1016/j.jad.2016.09.032

    Article  Google Scholar 

  • Krug E.G., Mercy, J.A., Dahlberg, L.L. & Zwi, A.B. eds. (2002), World Report on Violence and Health Geneva, World Health Organization. https://doi.org/10.1016/S0140-6736(02)11133-0

  • Maercker, A., Forstmeier, S., Wagner, B., Glaesmer, H. & Brähler, E. (2008). Post-traumatic stress disorder in Germany. Results of a nationwide epidemiological study. Nervenarzt. 79(5), 577-86. https://doi.org/10.1007/s00115-008-2467-5

    Article  CAS  PubMed  Google Scholar 

  • Levenson, J. (2017). Trauma Informed Social Work Practice. Social Work, 62(2), 105-113. https://doi.org/10.1093/sw/swx001

    Article  PubMed  Google Scholar 

  • Maercker, A., & Horn, A. B. (2013). A socio-interpersonal perspective on PTSD: The case for environments and interpersonal processes. Clin Psychol & Psychother, 20(6), 465-481. https://doi.org/10.1002/cpp.1805

    Article  Google Scholar 

  • Maercker, A., & Hecker, T. (2016). Broadening perspectives on trauma and recovery: A sociointerpersonal view of PTSD. Eur J Psychotraumatol, 7(1), 29303. https://doi.org/10.3402/ejpt.v7.29303

    Article  PubMed  Google Scholar 

  • Merrick, M.T., Ports, K. A., Ford, D. C., Afifi, T. O., Gershoff, E.T. & Grogan-Kaylor, A. (2017). Unpacking the impact of adverse childhood experiences on adult mental health. Child Abuse Negl. 69,10-19. https://doi.org/10.1016/j.chiabu.2017.03.016

    Article  PubMed  PubMed Central  Google Scholar 

  • Monnat, S. M. & Chandler, R. F. (2015). Long term physical health consequences of adverse childhood experiences. Sociol Q., 56(4), 723-752. https://doi.org/10.1111/tsq.12107

    Article  PubMed  PubMed Central  Google Scholar 

  • Mueller, J., Moergeli, H., & Maercker, A. (2008). Disclosure and social acknowledgement as predictors of recovery from posttraumatic stress: A longitudinal study in crime victims. Can J of Psychiatry, 53(3), 160-168. https://doi.org/10.1177/070674370805300306

    Article  Google Scholar 

  • Rothbaum, B. O., Meadows, E. A., Resick, P., & Foy, D. W. (2000). Cognitive-behavioral therapy. In E. B. Foa, T. M. Keane, & M. J. Friedman (Eds.), Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies pp. 320-325. Guilford Press.

  • Sadowski, L.S., Hunter, W.M., Bangdiwala, S.I. & Munoz, S.R. (2004). The world studies of abuse in the family environment (WorldSAFE): A model of a multi-national study of family violence. Inj Control and Safe Promot, 11(2), 81-90. https://doi.org/10.1080/15660970412331292306

    Article  Google Scholar 

  • Schauer M., Robjant K., Elbert T., & Neuner F. (2020) Narrative Exposure Therapy. In J.D. Ford and C. A. Courtois (Eds.) Treating Complex Traumatic Stress Disorders, Second Edition. The Guilford Press.

    Google Scholar 

  • Schore, A. N. (2003). Affect Dysregulation and Disorders of the Self. Norton & Company.

    Google Scholar 

  • Simon, N., Roberts, N. P., Lewis, C. E., van Gelderen, M. J., & Bisson, J. I. (2019). Associations between perceived social support, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD): implications for treatment. Euro J psychotraumatol, 10(1), 1573129. https://doi.org/10.1080/20008198.2019.1573129

    Article  Google Scholar 

  • Steil, R., Dyer, A., Priebe, K., Kleindienst, N., & Bohus, M. (2011). Dialectical behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: A pilot study of an intensive residential treatment program. J Trauma Stress, 24(1), 102–106. https://doi.org/10.1002/jts.20617

    Article  PubMed  Google Scholar 

  • Street, A. E., Gibson, L. E., & Holohan, D. R. (2005). Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence. J Trauma Stress, 18(3), 245-252. https://doi.org/10.1002/jts.20026

    Article  PubMed  Google Scholar 

  • van der Kolk B. A., Roth S., Pelcovitz D., Sunday S., Spinazzola J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. J Trauma Stress, 18(5), 389-399.

    Article  Google Scholar 

  • van der Kolk, B. (2015). The Body Keeps the Score. Penguin Random House.

    Google Scholar 

  • World Health Organization (2018). International Statistical Classification of Disease and Related Health Problems (11th ed.; ICD-11). Retrieved from https://icd.who.int/browse11/l-m/en

  • Yehuda, R., Daskalakis, N.P., Lehrner, A., Desarnaud, F., Bader, H.N., Makotkine, I., Flory, J.D., Bierer, L.M., & Meaney, M.J. (2014). Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring. Am J Psychiatry. 171(8), 872-880. https://doi.org/10.1176/appi.ajp.2014.13121571

    Article  PubMed  PubMed Central  Google Scholar 

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  1. New York, NY, USA

    Fabiana Franco

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  1. Fabiana Franco
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Franco, F. Understanding and Treating C-PTSD. J Health Serv Psychol 47, 85–93 (2021). https://doi.org/10.1007/s42843-021-00038-1

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