Post-Traumatic Stress Disorder has been one of the most studied disorders in recent decades (particularly in the wake of the devastating consequences of World War II), largely due to the awareness of the dysfunctionality it brings to those who suffer from it and those around them.

Any person in the world can one day suffer from a Post-Traumatic Stress Disorder, even if they have been exposed to the experience or occurrence of a trauma only once . But… what about those people who have been exposed to very serious stressful conditions all their lives or over a long period of time? What about war veterans? What about children who are exposed to ongoing physical, psychological and sexual abuse? What happens when the people who continually assault you are your primary family relationships?

In this article we are going to deepen on the Post-Traumatic Stress Disorder Complex , once called DESNOS .

What is DESNOS or complex PTSD?

DESNOS Disorder of Extreme Stress Not Otherwise Specified , now known as complex PTSD, is defined by the presence of PTSD with added self-regulatory problems in the person. It usually occurs in people who have experienced multiple traumatic events, prolonged trauma, or especially severe trauma (usually related to interpersonal victimization).

An example of a complex PTSD, according to Luxenberg et al. (2001), would be a woman who as a child never received the necessary care and attention, was sexually abused by her alcoholic stepfather on numerous occasions, and saw her stepfather rape her mother (vicarious victimization).

A new diagnostic category has been proposed for complex PTSD, and it appears that ICD-11 will distinguish between PTSD and complex PTSD (this has not been the case in DSM-5). The first will include three groups of symptoms (re-experimentation, avoidance, and a persistent sense of current threat manifested by activation and hypervigilance), while complex PTSD will include three additional groups: affective deregulation, negative self-concept and relationship disruption .

Symptoms and characteristics

As we have commented, complex PTSD is characterized by the concurrence of PTSD with some self-regulation problems in the individual . These problems are the following:

Disturbance of relational abilities

Alterations in interpersonal relationships arise. The person with complex PTSD would tend to isolate, chronically mistrust others, live in anger or unjustified hostility very spontaneously towards others, and repeatedly look for a person to act as a “savior” (to re-establish lost security).

In general, they tend to be people who have few intimate relationships, due to the inability to trust and open up to others. In a way, it could be said that they are self-sabotaging, since in many occasions they do have social skills to establish intimate relationships but because of their learning behaviors and acquired beliefs they are not able to keep them.

Alterations in attention and consciousness

Dissociative symptoms often appear. People with complex PTSD may have alterations or fragmentations of consciousness, memory, identity, perception of self and/or environment.

  • The dissociation is a difficult construct to define, and consists of several facets:
  • Disconnection (emotional and cognitive separation from the immediate environment): they may turn to social situations but seem to be absent.
  • Depersonalization (alteration in the perception of one’s body or self)
  • Unrealization (altered perception of the external world)
  • Memory problems (memory loss for personal events)
  • Emotional constriction (decreased emotional responsiveness, reduced emotional response capacity). As if they were emotionally numb.
  • Dissociation of identity (would be the most serious and least frequent: perception or experience that there is more than one person within one’s own mind)

Belief schemes or systems affected very unfavourably

There are three types of persistent and exaggerated negative beliefs or expectations in cases of complex PTSD, which must be tried to be flexible and modified in treatment:

  • About oneself: “I am bad”, “I am to blame for what happened”, “I can never recover”, “bad things only happen to bad people”.
  • About the others: “you can’t trust anyone”, “you can’t trust someone who hasn’t been in the war”.
  • About the world: “the world is an unsafe and unfair place by default, something bad is going to happen”, “the world is a very dangerous place”, “I have no control over what can happen to me”.
    Also, feelings of shame, guilt, helplessness, invalidity, feeling that no one understands them are very common

Difficulties in the regulation of emotions and somatic discomfort

Drastic mood swings, dysphoric, irritable, intermittent anger (difficulty in managing anger) are frequent … They may show self-destructive and impulsive behaviours (including sexual ones).
As for somatic discomfort, they may often have headaches, gastrointestinal problems, chronic pain, non-specific body aches

Treatment

Although treatment will depend largely on the type of trauma or traumas to which the subject has been exposed, the psychological model in which the clinician works, and the time available, there are guidelines for the treatment of complex PTSD (Cloitre et al., 2012). Treatment can be divided into 3 phases:

  • Phase 1 : the aim is to ensure the safety of the person by managing self-regulation problems, improving emotional and social skills.
  • Phase 2 : in this phase you will focus on the trauma as such, and on your processing of memories.
  • Phase 3 : at this stage the aim is to reintegrate and consolidate the achievements of the treatment and help the person to adapt to the current life circumstances. A relapse prevention plan is recommended.

Finally, it is very important that throughout the therapy, beliefs about oneself, about others and about the world are worked on, since it is a laborious and sometimes prolonged work, which is often the most difficult to modify.