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Complex post-traumatic stress disorder 

From Wikipedia, the free encyclopedia 

Complex post-traumatic stress disorder (C-PTSD) is a psychological injury that results from protracted 

exposure to prolonged social and/or interpersonal trauma with lack or loss of control, disempowerment, and in 

the context of either captivity or entrapment, i.e. the lack of a viable escape route for the victim. C-PTSD is 

distinct from, but similar to, posttraumatic stress disorder (PTSD). Though mainstream journals have published 

papers on C-PTSD, the category is not formally recognized in diagnostic systems such as DSM or ICD. [1] 

C-PTSD involves complex and reciprocal interactions between multiple biopsychosocial systems. It was first 

referred to by Judith Herman in her book Trauma & Recovery and an accompanying article. [2][3] Forms of 

trauma include sexual abuse (especially child sexual abuse), physical abuse, emotional abuse, domestic violence 

or torture. [4][5] 

Contents 

1 Differentiating PTSD from C-PTSD 

2 Differentiating Traumatic grief from C-PTSD 

3 Attachment theory, BPD and C-PTSD 

4 Child and adolescent symptom cluster 

5 Adult symptom cluster 

6 Treatment for adults 

7 Treatment for children 

8 See also 

9 References 

10 Further reading 

11 External links 

Differentiating PTSD from C-PTSD 

Main article: Posttraumatic stress disorder 

A differentiation between the diagnostic category of C-PTSD and that of posttraumatic stress disorder (PTSD) 

has been suggested. C-PTSD better describes the pervasive negative impact of chronic repetitive trauma than 

does PTSD alone. [6][7] 

PTSD descriptions fail to capture some of the core characteristics of C-PTSD. These elements include captivity, 

psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be 

revictimized, and, most importantly, the loss of a coherent sense of self. It is this loss of a coherent sense of self, 

and the ensuing symptom profile, that most pointedly differentiates C-PTSD from PTSD. [8] 

C-PTSD is characterized by pervasive insecure, often disorganized-type attachment. [9] DSM-IV dissociative 

disorders and PTSD do not include insecure attachment in their criteria. As a consequence of this aspect of C- 

PTSD, when some adults with C-PTSD become parents and confront their own children's attachment needs, 

they may have particular difficulty in responding sensitively especially to their infants' and young children's routine 

distress—such as during routine separations, despite these parents' best intentions and efforts. [10] And this 

difficulty in parenting may have adverse repercussions for their children's social and emotional development if 

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parents with this condition and their children do not receive appropriate treatment. [11][12] 

Differentiating Traumatic grief from C-PTSD 

Main articles: Grief and Grief counseling 

Traumatic grief [13][14][15][16] or complicated mourning [17] are conditions [18] where both trauma and grief 

coincide. If a traumatic event was only life threatening then more likely the survivor will experience posttraumatic 

stress symptoms. If the survivor was close to the person who died, then more likely symptoms of grief 

will also develop. When the death is of a loved one and was sudden or violent then both symptoms coincide. 

This is likely in children exposed to community violence. [19] 

For C-PTSD to manifest the violence would occur under conditions of captivity, loss of control and 

disempowerment, coinciding with the death of a friend or loved one in life threatening circumstances. This again 

is most likely for children and stepchildren who experience prolonged domestic or chronic community violence 

that ultimately results in the death of friends and loved ones. The phenomena of the increased risk of violence 

and death of stepchildren is referred to as the Cinderella effect. 

There are conceptual links between trauma and bereavement since loss of a loved one is inherently traumatic. [20] 

Attachment theory, BPD and C-PTSD 

Main articles: Attachment theory and Borderline personality disorder 

See also: Attachment in adults, Attachment in children, Attachment disorder, Attachment-based 

psychotherapy, Cinderella effect, Self-injury, and Emotionally focused therapy 

This controversial area [21] underlines the fragility of C-PTSD as an empirical diagnostic category separate from 

PTSD. [22][23] 

C-PTSD may have originated from observations of acute breakthrough of borderline personality (BPD) 

symptoms in trauma victims. [citation needed] This could be diagnosed as PTSD with borderline features, where 

the symptoms of BPD were not sufficient to sustain a (hypothetical) dual diagnosis of BPD and PTSD. C-PTSD 

may share some symptoms with both PTSD and BPD. [24] Judith Herman has suggested that C-PTSD be used 

in place of borderline. [25] 

It may help to understand the intersection of attachment theory with C-PTSD and BPD if one reads the 

following opinion of Bessel A. van der Kolk together with an understanding drawn from a description of BPD: 

Uncontrollable disruptions or distortions of attachment bonds precede the development of posttraumatic 

stress syndromes. People seek increased attachment in the face of danger. Adults, as 

well as children, may develop strong emotional ties with people who intermittently harass, beat, 

and, threaten them. The persistence of these attachment bonds leads to confusion of pain and love. 

Trauma can be repeated on behavioural, emotional, physiologic, and neuroendocrinologic levels. 

Repetition on these different levels causes a large variety of individual and social suffering. Anger 

directed against the self or others is always a central problem in the lives of people who have been 

violated and this is itself a repetitive re-enactment of real events from the past. Compulsive 

repetition of the trauma usually is an unconscious process that, although it may provide a temporary 

sense of mastery or even pleasure, ultimately perpetuates chronic feelings of helplessness and a 

subjective sense of being bad and out of control. Gaining control over one's current life, rather than 

repeating trauma in action, mood, or somatic states, is the goal of healing. [26][27] 



Seeking increased attachment to people, especially to care-givers who inflict pain, confuses love and pain and 

increases the likelihood of a captivity like that of betrayal bonding, [28] and of disempowerment and lack of 

control. If the situation is perceived as life threatening then traumatic stress responses will likely arise and C- 

PTSD more likely diagnosed in a situation of insecure attachment than PTSD. At what point do the complex, 

reciprocal biopsychosocial responses to prolonged and extreme abuse evolve into BPD? This may depend on 

the timing, intensity and duration of the abuse and an as yet unidentified predisposition to BPD that results in a 

reset of the neuroendocrinologic levels of the body [citation needed] in a self-reinforcing pattern recognisable as 

the symptom cluster of BPD. 

However, 25% of those diagnosed with BPD have no history of childhood neglect or abuse and individuals are 

six times as likely to develop BPD if they have a relative who was so diagnosed [citation needed] compared to 

those who do not. One conclusion is that there is a genetic predisposition to BPD unrelated to trauma. 

Researchers conducting a longitudinal investigation of identical twins found that "genetic factors play a major role 

in individual differences of borderline personality disorder features in Western society." [29][30] 

Child and adolescent symptom cluster 

Cook and others [31][32] describe symptoms and behavioural characteristics in seven domains: 

1. Attachment - "problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving 

and responding to other’s emotional states, and lack of empathy" 

2. Biology - "sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and 

increased medical problems" 

3. Affect or emotional regulation - "poor affect regulation, difficulty identifying and expressing emotions 

and internal states, and difficulties communicating needs, wants, and wishes" 

4. Dissociation - "amnesia, depersonalization, discrete states of consciousness with discrete memories, 

affect, and functioning, and impaired memory for state-based events" 

5. Behavioural control - "problems with impulse control, aggression, pathological self-soothing, and sleep 

problems" 

6. Cognition - "difficulty regulating attention, problems with a variety of "executive functions" such as 

planning, judgement, initiation, use of materials, and self- monitoring, difficulty processing new 

information, difficulty focusing and completing tasks, poor object constancy, problems with "cause-effect" 

thinking, and language developmental problems such as a gap between receptive and expressive 

communication abilities." 

7. Self-concept -"fragmented and disconnected autobiographical narrative, disturbed body image, low selfesteem, 

excessive shame, and negative internal working models of self". 

Source of quotes [33] 

Adult symptom cluster 

Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization as children as well as 

prolonged trauma as adults. This early injury interrupts the development of a robust sense of self and of others. 

Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or 

older siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot 

be relied upon. [34][35] 

This can become a pervasive way of relating to others in adult life described as insecure attachment. The 

diagnosis of dissociative disorder and PTSD in the current DSM-IV TR do not include insecure attachment as a 



symptom. Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant 

risk of revictimization. [36] 

Six clusters of symptom have been suggested for diagnosis of C-PTSD. [37][38] These are (1) alterations in 

regulation of affect and impulses; (2) alterations in attention or consciousness; (3) alterations in self-perception; 

(4) alterations in relations with others; (5) somatization, and (6) alterations in systems of meaning. [37] 

Experiences in these areas may include: [7][8] 

Difficulties regulating emotions, including symptoms such as persistent sadness, suicidal thoughts, 

explosive anger, or covert anger. 

Variations in consciousness, such as forgetting traumatic events, reliving traumatic events, or having 

episodes of dissociation (during which one feels detached from one's mental processes or body). 

Changes in self-perception, such as a sense of helplessness, shame, guilt, stigma, and a sense of 

being completely different from other human beings. 

Varied changes in the perception of the perpetrator, such as attributing total power to the 

perpetrator or becoming preoccupied with the relationship to the perpetrator, including a 

preoccupation with revenge. 

Alterations in relations with others, including isolation, distrust, or a repeated search for a rescuer. 

Loss of, or changes in, one's system of meanings, which may include a loss of sustaining faith or a 

sense of hopelessness and despair. 

Treatment for adults 

Herman [39] believes recovery from C-PTSD occurs in three stages. These are: establishing safety, remembrance 

and mourning for what was lost, and reconnecting with community and more broadly, society. Herman believes 

recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship. 

Complex trauma means complex reactions and this leads to complex treatments. Hence treatment for C-PTSD 

requires a multi-modal approach. [40] It has been suggested that treatment for C-PTSD should differ from 

treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. 

These problems include emotional dysregulation, dissociation, and interpersonal problems. [41] Six suggested 

core components of complex trauma treatment include: [40] 

1. Safety 

2. Self-regulation 

3. Self-reflective information processing 

4. Traumatic experiences integration 

5. Relational engagement 

6. Positive affect enhancement 

Multiple treatments have been suggested for C-PTSD. Among these treatments are experiential and emotionally 

focused therapy, internal family systems therapy, sensorimotor psychotherapy, cognitive behavioral therapy, 

family systems therapy and group therapy. [42] 



Treatment for children 

The utility of PTSD derived psychotherapies for assisting children with C-PTSD is uncertain. This area of 

diagnosis and treatment calls for caution in use of the category C-PTSD. Ford and van der Kolk [43] have 

suggested that C-PTSD may not be as useful a category for diagnosis and treatment of children as a proposed 

category of DTD (developmental trauma disorder). For DTD to be diagnosed it requires a 

'history of exposure to early life developmentally adverse interpersonal trauma such as sexual 

abuse, physical abuse, violence, traumatic losses of other significant disruption or betrayal of the 

child's relationships with primary caregivers, which has been postulated as an etiological basis for 

complex traumatic stress disorders. Diagnosis, treatment planning and outcome are always 

relational.' [44] 

Since C-PTSD or DTD in children is often caused by chronic maltreatment, neglect or abuse in a care-giving 

relationship the first element of the biopsychosocial system to address is that relationship. This invariably involves 

some sort of child protection agency. This both widens the range of support that can be given to the child but 

also the complexity of the situation, since the agency's statutory legal obligations may then need to be enforced. 

A number of practical, therapeutic and ethical principles for assessment and intervention have been developed 

and explored in the field: 

Identifying and addressing threats to the child's or family's safety and stability are the first priority. 

A relational bridge must be developed to engage, retain and maximize the benefit for the child and 

caregiver. 

Diagnosis, treatment planning and outcome monitoring are always relational (and) strengths based. 

All phases of treatment should aim to enhance self-regulation competencies. 

Determining with whom, when and how to address traumatic memories. 

Preventing and managing relational discontinuities and psychosocial crises. [45] 

See also 

Attachment theory 

Attachment in adults 

Attachment in children 

Child Welfare 

Dyadic developmental psychotherapy 

Trauma model 

Emotional self-regulation 

Stress (biological) 

Posttraumatic stress disorder 

Dissociation 

Bipolar Disorder 

Borderline personality disorder 

Reactive attachment disorder 

Psychoneuroimmunology 

Attachment-based therapy (children) 

Child psychotherapy 

Maladaptive daydreaming 

Play therapy 

Parent-Child Interaction Therapy (PCIT) 

Psychosomatic medicine 

Dyadic Developmental Psychotherapy 

The WAVE Trust 

References 

1. ^ Roth S, Newman E, Pelcovitz D, van der Kolk B, Mandel FS (1997). "Complex PTSD in victims exposed to 

sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder". J Trauma 



Stress 10 (4): 539–55. doi:10.1002/jts.2490100403 (http://dx.doi.org/10.1002%2Fjts.2490100403) . 

PMID 9391940 (http://www.ncbi.nlm.nih.gov/pubmed/9391940) . 

2. ^ Herman, J.L. (1992(a)). Trauma and recovery. New York: Basic Books. 

3. ^ Herman, J. L. (1992(b)). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. 

Journal of Traumatic Stress, 5, 377-391. 

4. ^ Freyd, J.J. (1997) Violations of power, adaptive blindness, and betrayal trauma theory. Feminism & 

Psychology, 7, 22-32 

5. ^ Veldhuis, C. B., & Freyd, J. J. (1999). Groomed for silence, groomed for betrayal. In M. Rivera (Ed.), 

Fragment by Fragment: Feminist Perspectives on Memory and Child Sexual Abuse (pp. 253-282). 

Charlottetown, PEI Canada: Gynergy Books 

6. ^ van der Kolk BA, Courtois CA (2005). "Editorial comments: Complex developmental trauma". J Trauma 

Stress 18 (5): 385–8. doi:10.1002/jts.20046 (http://dx.doi.org/10.1002%2Fjts.20046) . PMID 16281236 

(http://www.ncbi.nlm.nih.gov/pubmed/16281236) . 

7. ^ ab Julia M. Whealin, Ph.D. and Laurie Slone, Ph.D.. "Complex PTSD" 

(http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_complex_ptsd.html? 

opm=1&rr=rr89&srt=d&echorr=true) . National Center for Posttraumatic Stress Disorder. United States 

Department of Veteran Affairs. http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_complex_ptsd.html? 

opm=1&rr=rr89&srt=d&echorr=true. 

8. ^ ab Herman, Judith Lewis (1997). Trauma and recovery: The aftermath of violence from domestic abuse to 

political terror. Basic Books. pp. 119–122. ISBN 0465087302. 

9. ^ 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. Journal of Traumatic Stress, 18, 389-39 

10. ^ Schechter DS, Coates, SW, Kaminer T, Coots T, Zeanah CH, Davies M, Schonfield IS, Marshall RD, 

Liebowitz MR Trabka KA, McCaw J, Myers MM (2008). Distorted maternal mental representations and 

atypical behavior in a clinical sample of violence-exposed mothers and their toddlers. Journal of Trauma and 

Dissociation , 9(2), 123-149. 

11. ^ Schechter DS, Willheim E (2009). Disturbances of attachment and parental psychopathology in early 

childhood. Infant and Early Childhood Mental Health Issue. Child and Adolescent Psychiatry Clinics of North 

America, 18(3), 665-687. 

12. ^ Schechter DS, Zygmunt A, Coates SW, Davies M, Trabka KA, McCaw J, Kolodji A., Robinson JL (2007). 

Caregiver traumatization adversely impacts young children’s mental representations of self and others. 

Attachment & Human Development, 9(3), 187-205. 

13. ^ Bonanno, G.A. (2006). Is Complicated Grief a Valid Construct? Clinical Psychology: Science and Practice 13 

(2) , 129–134 

14. ^ Jacobs, Shelby, Carolyn Mazure, and Holly Prigerson. "Diagnostic Criteria for Traumatic Grief." Death 

Studies 24 (2000):185–199 

15. ^ Traumatic grief (http://www.ctsn-rcst.ca/Traumaticgrief.html) 

16. ^ Figley, C., Bride, B. & Mazza, N. (1997). Death and trauma: The traumatology of grieving. Philadelphia: 

Brunner/Mazel 

17. ^ Rando, T. (1993) Treatment of complicated mourning. Champaign, IL: Research Press 

18. ^ Rando, T. (1998). Complications in mourning traumatic death. In K. Doka (Ed.) Living with grief after 

sudden loss. Bristol, PA: Taylor & Francis 

19. ^ Pynoos, R. & Nader, K. (1988), Psychological first aid and treatment approach to children exposed to 

community violence: Research implications. Journal of Traumatic Stress, 1, 445-473. 

20. ^ Green, B. L. (2000) Traumatic loss: Conceptual and empirical links between trauma and bereavement. Journal 

of Personal and Interpersonal Loss, 5, 1-17 

21. ^ Clinical Psychology article on BPD/Dyslimbic brain function (http://www.peterfox.com.au/bpd.htm) 

22. ^ Luxenberg, T., Spinazzola, J., & van der Kolk, B. A. (2001). Complex trauma and disorders of extreme 

stress (DESNOS) diagnosis, part one: Assessment [Electronic version]. Directions in Psychiatry, 21(25), 373- 

392. 

23. ^ Luxenberg, T., Spinazzola, J., Hidalgo, J., Hunt, C., & van der Kolk, B. A. (2001). Complex trauma and 

disorders of extreme stress (DESNOS) part two: Treatment [Electronic version]. Directions in Psychiatry, 

21(26), 395-414 

24. ^ Taylor S, Asmundson GJ, Carleton RN (2006). "Simple versus complex PTSD: a cluster analytic 

investigation". J Anxiety Disord 20 (4): 459–72. doi:10.1016/j.janxdis.2005.04.003 

(http://dx.doi.org/10.1016%2Fj.janxdis.2005.04.003) . PMID 15979838 



(http://www.ncbi.nlm.nih.gov/pubmed/15979838) . 

25. ^ Johnson, S. Emotionally Focused Couple Therapy for Trauma Survivors' Guilford Press 2002 Chapter 4 page 

75 

26. ^ [1] (http://www.cirp.org/library/psych/vanderkolk/) 

27. ^ Bessel A. van der Kolk, MD* The Compulsion to Repeat the Trauma Re-enactment, Revictimization, and 

Masochism Psychiatric Clinics of North America, Volume 12, Number 2, Pages 389-411, June 1989 

28. ^ Patrick J. Carnes 'The Betrayal Bond: Breaking Free of Exploitive Relationships' ISBN 1558745262 ISBN 

978-1558745261 

29. ^ Distel et al. Chromosome 9: linkage for borderline personality disorder features. Psychiatric Genetics, 2008; 

18 (6): 302 DOI: 10.1097/YPG.0b013e3283118468 

30. ^ Distel et al. Heritability of borderline personality disorder features is similar across three countries. 

Psychological Medicine, 2008; 38 (9): DOI: 10.1017/S0033291707002024 

31. ^ Cook, A., Blaustein, M., Spinazolla, J., van der Kolk, B. (2003) Complex trauma in children and adolescents. 

White paper from the national child traumatic stress network complex trauma task force. Los Angeles, CA: 

National Center for Child Traumatic Stress 

32. ^ Cook, A., Spinazzola, J., Ford, J., Lanktree, C., et al. (2005) Complex trauma in children and adolescents. 

Psychiatric Annals, 35:5, 390-398. 

33. ^ Trends in Research into C-PTSD (http://www.center4familydevelop.com/Trends%20in%20Research.pdf) 

34. ^ Herman, J.L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of 

Traumatic Stress 5, 377-392. 

35. ^ Zlotnick, C., Zakriski, A.L., Shea, M.T., Costello, E., Begin, A., Pearlstein, T., & Simpson, E. (1996). The 

long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder. Journal of Traumatic 

Stress, 9, 195-20 

36. ^ Ide, N., & Paez, A. (2000). Complex PTSD: A review of current issues. International Journal of Emergency 

Mental Health, 2, 43-49 

37. ^ ab Pelcovitz, D., van der Kolk, B.A., Roth, S., Mandel, F., Kaplan, S., & Resick, P. (1997). Development of 

a criteria set and a structured interview for the disorders of extreme stress (SIDES). Journal of Traumatic 

Stress, 10, 3-16. 

38. ^ Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F.S. (1997). Complex PTSD in victims 

exposed to sexual and physical abuse: Results from the DSM-IV Field Trial for Posttraumatic Stress Disorder. 

Journal of Traumatic Stress 10, 539-556 

39. ^ Herman, J.L. (1992(a)). Trauma and recovery. New York: Basic Books 

40. ^ ab Cook, A.; Blaustein, M.; Spinazzola, J.; Van Der Kolk, B. (2005). "Complex trauma in children and 

adolescents" (http://doi.apa.org/?uid=2005-05449-004) . Psychiatric Annals 35 (5): 390–398. 

http://doi.apa.org/?uid=2005-05449-004. Retrieved 2008-03-29. 

41. ^ van der Kolk BA, 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): 389–99. doi:10.1002/jts.20047 

(http://dx.doi.org/10.1002%2Fjts.20047) . PMID 16281237 (http://www.ncbi.nlm.nih.gov/pubmed/16281237) . 

42. ^ Courtois, C>A.and Ford, J>D 'Treating Complex Traumatic Stress Disorders - an evidence based guide. 

2009 the Guilford Press 

43. ^ page 60 Chapter 3 in Courtois, CA.and Ford, J.D eds 'Treating Complex Traumatic Stress Disorders - an 

evidence based guide. 2009 the Guilford Press 

44. ^ Chapter 3 in Courtois, CA.and Ford, J.D eds 'Treating Complex Traumatic Stress Disorders - an evidence 

based guide. 2009 the Guilford Press 

45. ^ page 67 Chapter 3 in Courtois, CA.and Ford, J.D eds 'Treating Complex Traumatic Stress Disorders - an 

evidence based guide. 2009 the Guilford Press 

Further reading 

Appleyard, K.; Osofsky, J.D. (2003). "Parenting after trauma: Supporting parents and caregivers in the 

treatment of children impacted by violence". Infant Mental Health Journal 24 (2): 111–125. 

doi:10.1002/imhj.10050 (http://dx.doi.org/10.1002%2Fimhj.10050) . 

Cook, A.; Blaustein, M.;Spinazzola, J.; and van der Kolk, B., (2003) Complex trauma in children and 

adolescents. White paper from the National Child Traumatic Stress Newtork Complex Trauma Task 



Force. 

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., et al., (2005) Complex trauma in children and 

adolescents. Psychiatric Annals, 35, 390-398. 

Courtois, Christine A. (Editor), Ford, Julian D. PhD (Editor) 'Treating Complex Traumatic Stress 

Disorders' The Guilford Press; 1 edition (February 5, 2009) ISBN 1606230395 ISBN 978- 

1606230398 

Herman, JL (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political 

terror. New York: Basic Books. 

Scott, Catherine V.; Briere, John (2006). Principles of Trauma Therapy : A Guide to Symptoms, 

Evaluation, and Treatment. Thousand Oaks: Sage Publications. ISBN 0-7619-2921-5. 

Ford JD (1999). "Disorders of extreme stress following war-zone military trauma: associated features of 

posttraumatic stress disorder or comorbid but distinct syndromes?". J Consult Clin Psychol 67 (1): 3– 

12. doi:10.1037/0022-006X.67.1.3 (http://dx.doi.org/10.1037%2F0022-006X.67.1.3) . 

PMID 10028203 (http://www.ncbi.nlm.nih.gov/pubmed/10028203) . 

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". Journal of Traumatic Stress 18, 

389-399. 

External links 

Post-traumatic stress (http://www.dmoz.org/Health/Mental_Health/Disorders/Anxiety/Posttraumatic_Stress//) 

at the Open Directory Project 

Recommended DSM criteria (http://www.sasian.org/papers/cptsd.htm) 

Retrieved from "http://en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder" 

Categories: Stress | Abuse | Bullying | Traumatology | Anxiety disorders | Mood disorders | Psychotherapy | 

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