Complex post-traumatic stress disorder

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F62.- Persistent personality change, not a result of brain damage or disease
F62.0 Continuous personality change after extreme stress
F62.8 Other ongoing personality changes
F62.9 Persistent personality change, unspecified
ICD-10 online (WHO version 2019)

As a complex post-traumatic stress disorder (complex PTSD, K-PTSD) a is mental disease referred to, which is a result of severe and prolonged and / or repeated trauma ( abuse , sexual child abuse , war experiences , torture , natural disasters , life-threatening life events, physical or emotional neglect in the Childhood, destructive adult relationships, etc.). In most cases, these are forms of interpersonal violence .

The traumatized person goes through situations of catastrophic proportions for which they - especially as a child - are not adequately prepared and which overstrain any coping skills . It can appear immediately after the trauma or with a considerable delay (months to decades).

In contrast to classic post-traumatic stress disorder (PTSD), complex PTSD is not caused by a single event and is characterized by a broad spectrum of cognitive , affective and psychosocial impairments, which usually persist over a longer period of time. The term complex PTSD ( Complex PTSD , C-PTSD) was only introduced for this clinical picture in 1992 by the American psychiatrist Judith Herman and has not yet been fully established in the German-speaking area.

The ICD-11 , which will come into force in 2022, includes an independent diagnosis of complex post-traumatic stress disorder (KPTBS) for the first time. In addition to the main symptoms of classic PTSD, those affected by complex PTSD also suffer from affect regulation disorders, negative self-perception and relationship disorders.

Concept history

The term goes back to a critical examination of the definition and diagnostic criteria of post-traumatic stress disorder (PTSD), which were published in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) of the American Psychiatric Association (APA). The diagnostic criteria of PTSD focused on symptoms that had been observed in war participants and were not suitable for describing the disorders that could be observed in abused children. In particular, the PTSD criteria were not suitable for diagnosing psychological problems that developed as late effects of child abuse in adolescence and adulthood.

Based on the field studies initiated by the APA's DSM working group, it was possible to identify a more complex clinical picture that arises as a result of particularly severe or repeated or long-lasting traumas such as psychological, physical or sexual experiences of violence, but also after experiences of war and torture or kidnappings as "interference by extreme stress, otherwise referred to as" ( "disorder of Extreme stress not otherwise Specified" (DESNOS) , Annex DSM IV was conceptualized). This category is expected to be redrafted and included in the next revision of the DSM as “Complex Post-Traumatic Stress Disorder”. (P. 48) A very similar clinical picture is described in the ICD diagnosis F62.0 "Persistent personality change after extreme stress" . According to the clinical descriptions and diagnostic guidelines of the ICD-10 , the “late chronic sequelae of devastating stress, ie. H. those that only develop decades after the stressful experience [...] are classified under F62.0 ” (translated from English).

Appearance, frequency and course

Symptoms

As part of a complex post-traumatic stress disorder, a variety of symptoms can occur over the course of the disease . Based on the diagnostic criteria with which the very similar DESNOS was described, the symptoms can be assigned to six overarching areas:

  1. Changes in the regulation of affects and impulses ( affect regulation , dealing with anger, autodestructive behavior, suicidality , sexual disorders, excessive risk behavior)
  2. Changes in attention and consciousness ( amnesias , temporary dissociative episodes and experiences of depersonalization )
  3. Changes in self-perception (ineffectiveness, stigmatization, feelings of guilt, shame, isolation and trivialization, loss of self-esteem)
  4. Changes in relationships with others (inability to trust other people, revictimization, victimization of other people)
  5. Somatization ( gastrointestinal symptoms, chronic pain, cardio- pulmonary symptoms, conversion symptoms, sexual symptoms)
  6. Changes in attitudes towards life (despair and hopelessness, loss of previous supportive beliefs)

For the diagnosis according to ICD-10 it is necessary that at least two of the following personality changes are described:

  • hostile or suspicious attitude
  • social withdrawal
  • persistent feelings of emptiness and hopelessness (which may be accompanied by increased dependence on others, inability to express negative or aggressive feelings, or persistent symptoms of depression)
  • persistent feeling of nervousness or of threat without an external cause (which may lead to irritation or substance abuse)
  • persistent feeling of alienation (of being different from the others), possibly combined with feelings of emotional numbness.

The symptoms described must not have existed before the traumatic event and not be caused by another psychological disorder (e.g. depression). The personality change described must have existed for at least two years. In the case of a previous post-traumatic stress disorder (PTSD), a persistent personality change should only be assumed if the PTSD had previously been fulfilled for at least two years (i.e. the diagnosis here requires at least two years of PTSD plus at least two years of personality change).

frequency

Among other things, because of the not conclusively clarified overlap with other mental illnesses, there is little knowledge about the prevalence of complex PTSD. According to current knowledge, the lifetime probability of “simple” PTSD in the general German population is between 2 and 7%; American studies speak of 5–10%. About two thirds of these people are at risk of becoming chronic.

Among the severely traumatized people in the western industrialized countries there are about twice as many women as men, which could be due to the significantly higher proportion of young girls and women among the victims of sexual abuse.

course

The complexity and individuality of the clinical picture is mainly reflected in the very variable course and the different forms. Often the effects of the trauma do not show for a long time or only with individual symptoms. With the milder forms of this clinical picture, those affected often manage to come to terms with it over a long period of time - provided they have psychological and social resources to cope with and compensate (so-called protective factors). Overall, however, there is a high tendency to become chronic. According to the results of the US “National Comorbidity Survey”, only about a third of the PTSD cases recorded in the study showed a significant reduction in symptoms after one year, while the other two thirds were still able to develop symptoms after ten years . In addition, about 80% of the cases had accompanying disorders that increased the psychological stress.

Due to the heterogeneity of the disorder, the diagnoses often differ from those affected, which are based only on individual symptoms, for example anxiety disorders or depression . A study with psychiatric patients showed that a greater number of them met the criteria for PTSD than the admitting doctors had originally recognized. Thus, trauma patients can get several different diagnoses over time by overlooking their complex problem. Untreated or incorrectly treated trauma damage does not go away on its own, however. It basically persists, even if the symptoms change or can be partially compensated for.

Another factor that intensifies the problem results from the unfavorable life situations that arise for those affected by their psychological problems. Since the behavior of those affected often triggers negative reactions from other people, social relationships (e.g. relationships with their own children) and professional life are not infrequently impaired, which intensifies their psychological problems as if in a vicious circle and leads to lasting social and professional ones Can cause problems. Especially with children who are victims of abuse or abuse, the school development can be endangered to a high degree.

In principle, the consequences of severe complex trauma almost never seem to recede completely without therapy (as early as possible), usually not even with treatment with the usual therapeutic therapy methods. In the meantime, special integrative psychotherapeutic approaches have been developed specifically for the treatment of complex PTSD, which can achieve better results for this. However, after-effects of the trauma can reappear, especially in new, stressful phases of life. Nonetheless, the psychological problems can in most cases be significantly alleviated by adequate psychotherapeutic procedures and, if necessary, drug treatment, so that those who are complexly traumatized can learn to deal better with recurring symptoms.

Connections with other clinical pictures

The symptoms of complex PTSD show great overlap with other clinical pictures (see comorbidity ) - in particular borderline personality disorder and dissociative disorders - which is why the question was raised early on whether these clinical pictures could not be predominantly based on complex PTSD. However, the empirical findings available so far are not clear in this regard: Dissociative disorders can be traced back to trauma in the vast majority of cases (they can be viewed as a "normal" mode of coping or protection). In addition, however, all severe cases of borderline disorders also have particularly pronounced dissociative symptoms. The trigger experiences that are always present can also only be explained through trauma. The general consensus among most psychologists is that in the case of borderline disorder, despite some efforts on the part of trauma research, no such close and clear connection with previous trauma has been demonstrated. Some trauma researchers (including Judith Herman, Michaela Huber), however, explicitly claim the opposite. It is said of them that the clear connection between trauma and the occurrence of a borderline disorder has already been proven several times. Not all those affected could remember the causal trauma, because the most severe traumas often occur in early childhood (the first two years of life are most sensitive to trauma), and in addition, in such events, a complete or partial failure of memory storage (the so-called . infantile amnesia often reaches far is about the second year of life beyond).

It should be noted, however, that despite the clear overlap in terms of symptoms and the often difficult differential diagnosis between borderline disorders and complex PTSD, the spectrum of symptoms with ideal-typical manifestation shows considerable differences (especially in the areas of social behavior, emotionality, fear of rejection, self-harm - according to. DSM-5, the borderline disorder is characterized by ... "a profound pattern of instability in interpersonal relationships, in self-image and in the affects as well as clear impulsiveness " , which can be missing in complex PTSD, see → diagnostic criteria for complex PTSD and borderline Personality disorder according to ICD-10 and DSM-5), which is why most psychiatrists consider it useful to differentiate between the two disorders. The forms of trauma associated with complex PTSD and also found in the majority of borderline disorders represent a massive risk for further psychosocial development - regardless of which disorders arise in their wake.

See also

literature

Technical article

  • C. Courtois: Complex Trauma, Complex Reactions: Assessment and Treatment. (PDF) In: Psychotherapy: Theory, Research, Practice, Training. 2004, 41, pp. 412-425 doi: 10.1037 / 0033-3204.41.4.412
  • M. Driessen, T. Beblo, L. Reddemann : Is Borderline Personality Disorder a Complex Post-Traumatic Disorder? In: Neurologist. 2002, 73, pp. 820-829.
  • D. Korn, A. Leeds: Preliminary evidence of efficacy for EMDR Resource Development and Installation in the stabilization phase of treatment of complex posttraumatic stress disorder. In: Journal of Clinical Psychology. 2002, 58, pp. 1465-1487.
  • D. Kunzke, F. Güls: Diagnosis of simple and complex post-traumatic disorders in adulthood. In: Psychotherapist. 2003, 48, pp. 50-70.
  • M. Sack: Diagnostic and clinical aspects of the complex post-traumatic stress disorder. In: Neurologist. 2004, 75, pp. 451-459.
  • A. Streeck-Fischer: “Trauma and Development” Consequences of traumatization in childhood and adolescence. In: Psychiatria Danubina , 2004, 16 (4), pp. 269-278; psychiat-danub.com (PDF; 225 kB)

Books

  • G. Fischer, P. Riedesser: Textbook of Psychotraumatology. Ernst-Reinhardt-Verlag (UTB), 1998, ISBN 3-8252-8165-5 .
  • Judith Lewis Herman : Trauma and Recovery: The Aftermath of Violence. Basic Books, New York 1992, ISBN 0-465-08765-5 .
  • Michaela Huber : Ways of trauma treatment (2). Junfermann, Paderborn 2003, ISBN 3-87387-550-0 .
  • B. Hudnall Stamm: Secondary trauma disorders. Junfermann, Paderborn 2002, ISBN 3-87387-489-X .
  • O. Kernberg , B. Dulz, U. Sachsse et al. a .: Handbook of Borderline Personality Disorders. Schattauer, Stuttgart 2000, ISBN 3-7945-1850-0 .
  • A. Matsakis: How can I get over it. Junfermann, Paderborn 2004, ISBN 3-87387-592-6 .
  • I. Özkan, A. Streeck-Fischer, U. Sachsse: Trauma and society. Vandenhoeck & Ruprecht, Göttingen 2002, ISBN 3-525-45893-2 .
  • B. van der Kolk, A. Mc Farlane, L. Weisaeth: Traumatic Stress. Junfermann, Paderborn 2000, ISBN 3-87387-384-2 .
  • M. Sack, U. Sachsse, J. Schellong: Complex trauma-related disorders. Diagnosing and treating the consequences of severe violence and neglect. Schattauer, Stuttgart 2013, ISBN 978-3-7945-2878-3

Web links

Individual evidence

  1. ↑ Complex Post Traumatic Stress Disorder. Klinik am Waldschlößchen GmbH, accessed on September 18, 2017 .
  2. ↑ a b J. Herman: Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. In: Journal of Traumatic Stress. 1992, 5 (3), pp. 377-391.
  3. ↑ 6B41 Complex post traumatic stress disorder. In: ICD-11. WHO, accessed May 17, 2019 .
  4. ↑ a b L. Reddemann, C. Dehner-Rau: Trauma - recognize consequences. 2nd corrected edition. Trias Verlag, Stuttgart 2006, ISBN 3-8304-3345-X .
  5. ↑ The ICD-10 - Classification of Mental and Behavioral Disorders - Clinical descriptions and diagnostic guidelines. (PDF; 1.3 MB) there under F43.1, subsection "Diagnostic Guidelines"
  6. ↑ M. Huber: Multiple personalities, women in society. Fischer Taschenbuch Verlag, 1995, ISBN 3-596-12160-4 .
  7. ↑ a b J. Herman: The scars of violence. Understand and overcome traumatic experiences. Junfermannsche, 2003, ISBN 3-87387-525-X .
  8. ^ Association of the Scientific Medical Societies in Germany awmf.org
  9. ↑ a b M. Huber: Trauma and the consequences. Volume 1, Junfermann, Paderborn 2003, ISBN 3-87387-510-1 .
  10. ^ DS Schechter, A. Zygmunt, SW Coates, M. Davies, KA Trabka, J. McCaw, A. Kolodji, JL Robinson: Caregiver traumatization adversely impacts young children's mental representations of self and others. In: Attachment & Human Development. 2007, 9 (3), pp. 187-120.
  11. ↑ DS Schechter, SW Coates, T. Kaminer, T. Coots, CH Zeanah, M. Davies, IS Schonfield, RD Marshall, MR Liebowitz, KA Trabka, J. McCaw, MM Myers: Distorted maternal mental representations and atypical behavior in a clinical sample of violence-exposed mothers and their toddlers. In: Journal of Trauma and Dissociation. 2008, 9 (2), pp. 123-149.
  12. ↑ Christiane Eichenberg, Luise Reddemann .: Complex post-traumatic stress disorder (practice of psychodynamic psychotherapy - analytical and depth psychology-based psychotherapy): Multidimensional psychodynamic trauma therapy (MPTT) and psychodynamic-imaginative trauma therapy (PITT) . Hogrefe, Göttingen [a. a.] 2010, ISBN 3-8017-2301-1 .
  13. ↑ Luise Reddemann .: Psychodynamic Imaginative Traumatherapy: PITT® - The Manual: A Resilience-Oriented Approach in Psychotraumatology. 9th edition. Klett-Cotta, Stuttgart, ISBN 3-608-89201-X .
  14. ↑ BL Brand, RJ Loewenstein, D. Spiegel: Dispelling myths about dissociative identity disorder treatment: an empirically based approach. In: Psychiatry. Volume 77, number 2, 2014, pp. 169-189, doi: 10.1521 / psyc.2014.77.2.169 , PMID 24865199 (review).
  15. ↑ Martin Sack , Ulrich Sachsse, Julia Schellong .: Complex trauma-related disorders: diagnosis and treatment of the consequences of severe violence and neglect. Schattauer, Stuttgart 2013, ISBN 3-7945-2878-6 .
  16. ^ U. Schäfer, E. Rüther, U. Sachsse: Borderline disorders. A guide for those affected and their families. Vandenhoeck and Ruprecht, 2006, ISBN 3-525-46249-2 .
  17. ↑ “Numerous studies found particularly high comorbidity rates between borderline disorders and complex early traumas. Some authors even go so far as to regard traumatization as almost constitutive for the borderline disorder (cf. Dulz and Jensen 2000). You see borderline personality disorder as a special form of chronic, complex post-traumatic stress disorder (Herman 1992; Reddemann and Sachsse 1998, 1999, 2000; van der Kolk 1999). Others, e.g. B. Kernberg (1995, 2000) contradict this view. Kernberg sees other developmental factors as specific, particularly chronic aggression by the primary caregivers. The author attaches great importance to differentiating chronic aggression from specifically traumatic experiences (2000). "- from: Dieter Kunzke, Frank Güls: Diagnosis of simple and complex post-traumatic disorders in adulthood - an overview for clinical practice In: Psychotherapeut , 2003, 48, Pp. 50-70.
  18. ↑ Ursula Gast, Frauke Rodewald, Arne Hofmann , Helga Mattheß, Ellert Nijenhuis, Luise Reddemann, Hinderk M. Emrich: The dissociative identity disorder - often misdiagnosed. Deutsches Ärzteblatt, vol. 103, issue 47 - November 24, 2006.
  19. ↑ Dieter Kunzke, Frank Güls: Diagnostics of simple and complex post-traumatic disorders in adulthood - an overview for clinical practice. Psychotherapeut (2003) 48: 50-70.