Developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity

Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 10/2009; 22(5):399-408. DOI: 10.1002/jts.20444
Source: PubMed


Exposure to multiple traumas, particularly in childhood, has been proposed to result in a complex of symptoms that includes posttraumatic stress disorder (PTSD) as well as a constrained, but variable group of symptoms that highlight self-regulatory disturbances. The relationship between accumulated exposure to different types of traumatic events and total number of different types of symptoms (symptom complexity) was assessed in an adult clinical sample (N = 582) and a child clinical sample (N = 152). Childhood cumulative trauma but not adulthood trauma predicted increasing symptom complexity in adults. Cumulative trauma predicted increasing symptom complexity in the child sample. Results suggest that Complex PTSD symptoms occur in both adult and child samples in a principled, rule-governed way and that childhood experiences significantly influenced adult symptoms.

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    • "Severe and early interpersonal traumatization, for example, childhood sexual abuse or maltreatment, tends to result in a chronic inability to modulate emotions and a more complex pattern of symptoms concerning broader areas of psychological functioning (Cloitre et al., 2009). Thus, particularly after traumatization early in life, the development of a generalized guilt-and shame-prone self-concept seems likely. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) and interpersonal traumatization are frequently associated with trauma-related guilt and shame. However, research on generalized guilt and shame in PTSD is lacking. The aim of this study was to investigate generalized explicit and implicit guilt and shame in interpersonal traumatization and PTSD. Interpersonally traumatized women either with PTSD (n = 28) or without PTSD (n = 32) and 32 nontraumatized women completed the Test of Self-Conscious Affect-3 and the Implicit Association Test to measure explicit and implicit guilt and shame. Explicit guilt and shame were significantly higher in women with PTSD than in traumatized women without PTSD. Traumatized women without PTSD showed significantly higher levels of explicit guilt and shame than nontraumatized women did. PTSD was associated with implicit guilt but not implicit shame. In addition to trauma-related guilt and shame, generalized explicit guilt and shame and implicit guilt seem to play a crucial role in PTSD.
    Journal of Nervous & Mental Disease 11/2015; DOI:10.1097/NMD.0000000000000428 · 1.69 Impact Factor
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    • "However measured, extreme CT is often seen as an indicator of complex trauma, defined as exposure to multiple traumas over time, frequently including early childhood abuse and/or neglect (Briere & Scott, in press; Courtois & Ford, 2013). Cumulative/complex trauma has been linked to a wide range of simultaneously-presenting but separate psychological difficulties, described in the research literature as symptom complexity (Briere, Kaltman, & Green, 2008; Cloitre et al., 2009) and in the clinical literature, including the International Classification of Diseases -11 (Friedman, 2014) as complex PTSD (Herman, 1992). These wide-ranging symptoms are also sometimes seen as evidence of borderline personality disorder, although recent research suggests that complex PTSD is a phenomenologically and statistically distinct entity (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014). "
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    ABSTRACT: Objective: This research was undertaken to examine the role between cumulative exposure to different types of traumatic events and PTSD status in general population and prison samples. Methods: Two archival datasets were examined: the standardization sample for the Detailed Assessment of Posttraumatic States (DAPS; Briere, 2001), and data from a study on trauma and posttraumatic sequelae among inmates and others. Results: PTSD was found in 4% of the general population sample, and 48% of the prison sample. Trauma exposure was very common among prisoners, including a 70% rate of childhood sexual abuse for women and a 50% rate for men. Lifetime number of different types of trauma was associated with PTSD in both the general population and prison samples, even when controlling for the effects of sexual trauma. Cumulative interpersonal trauma predicted PTSD whereas cumulative noninterpersonal trauma did not. In the general population sample, participants who had only one type of trauma exposure had a 0% likelihood of current PTSD, whereas those with six or more other trauma types had a 12% likelihood. In the prison sample, those with only one type of trauma exposure had a 17% percent likelihood of current PTSD, whereas those exposed to six or more other trauma types had a 64% chance of PTSD. Conclusion: Cumulative trauma predicts current PTSD in both general population and prison samples, even after controlling for sexual trauma. PTSD appears to develop generally as a function of exposure to multiple types of interpersonal trauma, as opposed to a single traumatic event.
    Psychological Trauma Theory Research Practice and Policy 11/2015; In press. · 2.31 Impact Factor
    • "Broadly speaking, trauma adversely impacts the development of socioemotional capacities that could promote resilience or effective adaptation to future trauma exposure. Exposure to repeated trauma in childhood produces disturbances in affective and interpersonal capacities, in addition to increasing risk for psychopathology (Cloitre et al. 2009; Kim and Cicchetti 2010). Emotion regulation difficulties, for example , are central to conceptualizations of chronic exposure to trauma (e.g., Herman 1997). "

    Journal of Child & Adolescent Trauma 10/2015; DOI:10.1007/s40653-015-0061-0
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