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.hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">For post-traumatic stress disorder (PTSD), see <a href="/wiki/Post-traumatic_stress_disorder" title="Post-traumatic stress disorder">Post-traumatic stress disorder</a>.</div> <style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style>Complex post-traumatic stress disorder (CPTSD, sometimes hyphenated C-PTSD) is a <a href="/wiki/Stress-related_mental_disorder" class="mw-redirect" title="Stress-related mental disorder">stress-related mental disorder</a> generally occurring in response to complex traumas,<a href="#cite_note-Cook2005-1">[1]</a> i.e., commonly prolonged or repetitive exposures to a series of <a href="/wiki/Psychological_trauma" title="Psychological trauma">traumatic events</a>, within which individuals perceive little or no chance to escape.<a href="#cite_note-Brewin_(2020)-2">[2]</a><a href="#cite_note-ICD11-3">[3]</a><a href="#cite_note-TAR-4">[4]</a> <table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Complex post-traumatic stress disorder (CPTSD)</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Disorders of extreme stress not otherwise specified (DESNOS), enduring personality change after catastrophic experience (EPCACE)</td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><a href="/wiki/File:Causes_of_Complex_PTSD_1.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/68/Causes_of_Complex_PTSD_1.png/220px-Causes_of_Complex_PTSD_1.png" decoding="async" width="220" height="124" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/68/Causes_of_Complex_PTSD_1.png/330px-Causes_of_Complex_PTSD_1.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/68/Causes_of_Complex_PTSD_1.png/440px-Causes_of_Complex_PTSD_1.png 2x" data-file-width="1453" data-file-height="818"></a></td></tr><tr><td colspan="2" class="infobox-full-data">Potential causes of complex post-traumatic stress disorder</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a>, <a href="/wiki/Clinical_psychology" title="Clinical psychology">clinical psychology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Hyperarousal" class="mw-redirect" title="Hyperarousal">Hyperarousal</a>, emotional over-stress, <a href="/wiki/Intrusive_thought" title="Intrusive thought">intrusive thoughts</a>, <a href="/wiki/Emotional_dysregulation" title="Emotional dysregulation">emotional dysregulation</a>, <a href="/wiki/Hypervigilance" title="Hypervigilance">hypervigilance</a>, negative self-beliefs, interpersonal difficulties, and also often <a href="/wiki/Inattention" class="mw-redirect" title="Inattention">attention difficulties</a>, <a href="/wiki/Anxiety" title="Anxiety">anxiety</a>, <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a>, <a href="/wiki/Somatization" title="Somatization">somatization</a>, <a href="/wiki/Dissociation_(psychology)" title="Dissociation (psychology)">dissociation</a></td></tr></tbody></table> In the <a href="/wiki/ICD-11" title="ICD-11">ICD-11</a> classification, C-PTSD is a category of <a href="/wiki/Post-traumatic_stress_disorder" title="Post-traumatic stress disorder">post-traumatic stress disorder</a> (PTSD) with three additional clusters of significant symptoms: <a href="/wiki/Emotional_dysregulation" title="Emotional dysregulation">emotional dysregulation</a>, negative self-beliefs (e.g., feelings of shame, guilt, failure for wrong reasons), and interpersonal difficulties.<a href="#cite_note-Brewin_et_al._(2017)-5">[5]</a><a href="#cite_note-Cloitre_(2020)-6">[6]</a><a href="#cite_note-ICD11-3">[3]</a> Examples of C-PTSD's symptoms are prolonged feelings of terror, worthlessness, helplessness, distortions in identity or <a href="/wiki/Sense_of_self" class="mw-redirect" title="Sense of self">sense of self</a>, and <a href="/wiki/Hypervigilance" title="Hypervigilance">hypervigilance</a>.<a href="#cite_note-Brewin_et_al._(2017)-5">[5]</a><a href="#cite_note-Cloitre_(2020)-6">[6]</a><a href="#cite_note-ICD11-3">[3]</a> C-PTSD's symptoms share some similarities with the observed symptoms in <a href="/wiki/Borderline_personality_disorder" title="Borderline personality disorder">borderline personality disorder</a>, <a href="/wiki/Dissociative_identity_disorder" title="Dissociative identity disorder">dissociative identity disorder</a>, and <a href="/wiki/Somatization_disorder" class="mw-redirect" title="Somatization disorder">somatization disorder</a>.<a href="#cite_note-TAR-4">[4]</a><a href="#cite_note-Cloitre_(2020)-6">[6]</a> <div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"><input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none"><div class="toctitle" lang="en" dir="ltr"><h2 id="mw-toc-heading">Contents</h2><label class="toctogglelabel" for="toctogglecheckbox"></label></div> <ul> <li class="toclevel-1 tocsection-1"><a href="#History">1 History</a></li> <li class="toclevel-1 tocsection-2"><a href="#Classifications">2 Classifications</a></li> <li class="toclevel-1 tocsection-3"><a href="#Symptoms">3 Symptoms</a> <ul> <li class="toclevel-2 tocsection-4"><a href="#Children_and_adolescents">3.1 Children and adolescents</a></li> <li class="toclevel-2 tocsection-5"><a href="#Adults">3.2 Adults</a></li> </ul> </li> <li class="toclevel-1 tocsection-6"><a href="#Diagnosis">4 Diagnosis</a> <ul> <li class="toclevel-2 tocsection-7"><a href="#Differential_diagnosis">4.1 Differential diagnosis</a> <ul> <li class="toclevel-3 tocsection-8"><a href="#Post-traumatic_stress_disorder">4.1.1 Post-traumatic stress disorder</a></li> <li class="toclevel-3 tocsection-9"><a href="#Traumatic_grief">4.1.2 Traumatic grief</a></li> <li class="toclevel-3 tocsection-10"><a href="#Borderline_personality_disorder">4.1.3 Borderline personality disorder</a></li> </ul> </li> </ul> </li> <li class="toclevel-1 tocsection-11"><a href="#Treatment">5 Treatment</a> <ul> <li class="toclevel-2 tocsection-12"><a href="#Children">5.1 Children</a></li> <li class="toclevel-2 tocsection-13"><a href="#Adults_2">5.2 Adults</a> <ul> <li class="toclevel-3 tocsection-14"><a href="#Trauma_recovery_model">5.2.1 Trauma recovery model</a></li> <li class="toclevel-3 tocsection-15"><a href="#Neuroscientific_and_trauma_informed_interventions">5.2.2 Neuroscientific and trauma informed interventions</a></li> <li class="toclevel-3 tocsection-16"><a href="#Use_of_evidence-based_treatment_and_its_limitations">5.2.3 Use of evidence-based treatment and its limitations</a></li> <li class="toclevel-3 tocsection-17"><a href="#Treatment_challenges">5.2.4 Treatment challenges</a></li> <li class="toclevel-3 tocsection-18"><a href="#Recommended_treatment_modalities_and_interventions">5.2.5 Recommended treatment modalities and interventions</a></li> </ul> </li> </ul> </li> <li class="toclevel-1 tocsection-19"><a href="#Criticism_of_disorder_and_diagnosis">6 Criticism of disorder and diagnosis</a></li> <li class="toclevel-1 tocsection-20"><a href="#See_also">7 See also</a></li> <li class="toclevel-1 tocsection-21"><a href="#References">8 References</a></li> <li class="toclevel-1 tocsection-22"><a href="#Further_reading">9 Further reading</a></li> <li class="toclevel-1 tocsection-23"><a href="#External_links">10 External links</a></li> </ul> </div> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(1)"><h2 id="History">History</h2> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=1" title="Edit section: History" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-1 collapsible-block" id="mf-section-1"> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Expand_section plainlinks metadata ambox mbox-small-left ambox-content" role="presentation"><tbody><tr><td class="mbox-text"><div class="mbox-text-span">This section needs expansion. You can help by <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=">adding to it</a>. (February 2024)</div></td></tr></tbody></table> <a href="/wiki/Judith_Lewis_Herman" title="Judith Lewis Herman">Judith Lewis Herman</a> of Harvard University was the first psychiatrist and scholar to conceptualise Complex Post-Traumatic Stress Disorder (CPTSD) as a (new) mental health condition in 1992, within her book Trauma & Recovery and an accompanying article.<a href="#cite_note-TAR-4">[4]</a><a href="#cite_note-Herman1992-7">[7]</a> In 1988, Herman suggested that a new diagnosis of Complex Post-Traumatic Stress Disorder (CPTSD) was needed to describe the symptoms and psychological and emotional effects of long-term trauma. </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(2)"><h2 id="Classifications">Classifications</h2> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=2" title="Edit section: Classifications" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-2 collapsible-block" id="mf-section-2"> The <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> (WHO)'s <a href="/wiki/International_Statistical_Classification_of_Diseases" class="mw-redirect" title="International Statistical Classification of Diseases">International Statistical Classification of Diseases</a> has included CPTSD since its eleventh revision that was published in 2018 and came into effect in 2022 (<a href="/wiki/ICD-11" title="ICD-11">ICD-11</a>). The previous edition (<a href="/wiki/ICD-10" title="ICD-10">ICD-10</a>) proposed a diagnosis of Enduring Personality Change after Catastrophic Event (EPCACE), which was an ancestor of CPTSD.<a href="#cite_note-ICD11-3">[3]</a><a href="#cite_note-Brewin_(2020)-2">[2]</a><a href="#cite_note-8">[8]</a> <a href="/wiki/Healthdirect_Australia" title="Healthdirect Australia">Healthdirect Australia</a> (HDA) and the British <a href="/wiki/National_Health_Service" title="National Health Service">National Health Service</a> (NHS) have also acknowledged CPTSD as mental disorder.<a href="#cite_note-9">[9]</a><a href="#cite_note-10">[10]</a> However, the <a href="/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a> (APA) has not included CPTSD in the <a href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders" title="Diagnostic and Statistical Manual of Mental Disorders">Diagnostic and Statistical Manual of Mental Disorders</a>. It has nonetheless proposed: Disorders of Extreme Stress – not otherwise specified (DESNOS) since the <a href="/wiki/DSM-IV" class="mw-redirect" title="DSM-IV">DSM-IV</a>, which is a mental disorder close to CPTSD.<a href="#cite_note-11">[11]</a><a href="#cite_note-Brewin_(2020)-2">[2]</a> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(3)"><h2 id="Symptoms">Symptoms</h2> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=3" title="Edit section: Symptoms" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-3 collapsible-block" id="mf-section-3"> <div class="mw-heading mw-heading3"><h3 id="Children_and_adolescents">Children and adolescents</h3> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=4" title="Edit section: Children and adolescents" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> The diagnosis of <a href="/wiki/PTSD" class="mw-redirect" title="PTSD">PTSD</a> was originally given to adults who had suffered because of a single-event trauma (e.g., during a <a href="/wiki/War" title="War">war</a>, <a href="/wiki/Rape" title="Rape">rape</a>).<a href="#cite_note-traumacenter-12">[12]</a> However, the situation for many children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, dysfunction, or a disruption in attachment to their primary caregiver.<a href="#cite_note-Ford-13">[13]</a> In many cases, it is the child's caregiver who causes the trauma.<a href="#cite_note-traumacenter-12">[12]</a> The diagnosis of PTSD does not take into account how the <a href="/wiki/Early_childhood_development" title="Early childhood development">developmental stages</a> of children may affect their symptoms and how trauma can affect a child's development.<a href="#cite_note-traumacenter-12">[12]</a><a href="#cite_note-:2-14">[14]</a> The term developmental trauma disorder (DTD) has been proposed as the childhood equivalent of CPTSD.<a href="#cite_note-Ford-13">[13]</a> This developmental form of trauma places children at risk for developing psychiatric and medical disorders.<a href="#cite_note-Ford-13">[13]</a><a href="#cite_note-:2-14">[14]</a> <a href="/wiki/Bessel_van_der_Kolk" title="Bessel van der Kolk">Bessel van der Kolk</a> explains DTD as numerous encounters with interpersonal trauma such as physical assault, sexual assault, violence or death. It can also be brought on by subjective events such as abandonment, betrayal, defeat or shame.<a href="#cite_note-:0-15">[15]</a> Repeated traumatization during childhood leads to symptoms that differ from those described for PTSD.<a href="#cite_note-:0-15">[15]</a> Cook and others describe symptoms and behavioral characteristics in seven domains:<a href="#cite_note-NCTSNWhitePaper-16">[16]</a><a href="#cite_note-Cook2005-1">[1]</a> <ul><li>Attachment – problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to others' emotional states</li> <li>Biomedical symptoms – sensory-motor developmental dysfunction, sensory-integration difficulties; increased medical problems or even <a href="/wiki/Somatization" title="Somatization">somatization</a></li> <li>Affect or <a href="/wiki/Emotional_regulation" class="mw-redirect" title="Emotional regulation">emotional regulation</a> – poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes</li> <li>Elements of dissociation – amnesia, <a href="/wiki/Depersonalization" title="Depersonalization">depersonalization</a>, discrete <a href="/wiki/Dissociative_identity_disorder" title="Dissociative identity disorder">states of consciousness</a> with discrete memories, affect, and functioning, and impaired memory for state-based events</li> <li>Behavioral control – problems with <a href="/wiki/Impulse_control" class="mw-redirect" title="Impulse control">impulse control</a>, <a href="/wiki/Aggression" title="Aggression">aggression</a>, pathological self-soothing, and <a href="/wiki/Sleep_disorder" title="Sleep disorder">sleep problems</a></li> <li>Cognition – difficulty regulating <a href="/wiki/Attention" title="Attention">attention</a>; problems with a variety of <a href="/wiki/Executive_functions" title="Executive functions">executive functions</a> such as planning, judgment, initiation, use of materials, and self-monitoring; difficulty <a href="/wiki/Information_processing_(psychology)" title="Information processing (psychology)">processing new information</a>; difficulty focusing and completing tasks; poor <a href="/wiki/Object_constancy" class="mw-redirect" title="Object constancy">object constancy</a>; problems with cause-effect thinking; and language developmental problems such as a gap between receptive and expressive communication abilities.</li> <li>Self-concept – fragmented and/or disconnected autobiographical narrative, disturbed <a href="/wiki/Body_image" title="Body image">body image</a>, low <a href="/wiki/Self-esteem" title="Self-esteem">self-esteem</a>, excessive <a href="/wiki/Shame" title="Shame">shame</a>, and negative internal working models of self.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Adults">Adults</h3> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=5" title="Edit section: Adults" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> Adults with CPTSD have sometimes experienced prolonged interpersonal traumatization beginning in childhood, rather than, or as well as, in adulthood. These early injuries interrupt 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 other siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon.<a href="#cite_note-Herman1992-7">[7]</a><a href="#cite_note-Zlotnick1996-17">[17]</a> This can become a pervasive way of relating to others in adult life, described as <a href="/wiki/Insecure_attachment" class="mw-redirect" title="Insecure attachment">insecure attachment</a>. This symptom is neither included in the diagnosis of dissociative disorder nor in that of PTSD in the current <a href="/wiki/DSM-5" title="DSM-5">DSM-5</a> (2013). Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant risk of <a href="/wiki/Revictimization" class="mw-redirect" title="Revictimization">revictimization</a>.<a href="#cite_note-Ide2000-18">[18]</a> Six clusters of symptoms have been suggested for diagnosis of CPTSD:<a href="#cite_note-Roth_1997-19">[19]</a><a href="#cite_note-Pelcovitz1997-20">[20]</a> <ul><li>Alterations in regulation of affect and impulses</li> <li>Alterations in attention or consciousness</li> <li>Alterations in self-perception</li> <li>Alterations in relations with others</li> <li><a href="/wiki/Somatization" title="Somatization">Somatization</a><a href="#cite_note-Brewin_(2020)-2">[2]</a><a href="#cite_note-ICD11-3">[3]</a></li> <li>Alterations in systems of meaning<a href="#cite_note-Pelcovitz1997-20">[20]</a></li></ul> Experiences in these areas may include:<a href="#cite_note-TAR-4">[4]</a>: 199–122 <ul><li>Changes in emotional regulation, including experiences such as persistent <a href="/wiki/Dysphoria" title="Dysphoria">dysphoria</a>, chronic suicidal preoccupation, <a href="/wiki/Self-injury" class="mw-redirect" title="Self-injury">self-injury</a>, explosive or extremely <a href="/wiki/Cognitive_inhibition" title="Cognitive inhibition">inhibited anger</a> (may alternate), and compulsive or extremely inhibited sexuality (may alternate).</li> <li>Variations in consciousness, such as <a href="/wiki/Psychogenic_amnesia" class="mw-redirect" title="Psychogenic amnesia">amnesia</a> or <a href="/wiki/Hypermnesia" class="mw-redirect" title="Hypermnesia">improved recall</a> for traumatic events, episodes of <a href="/wiki/Dissociation_(psychology)" title="Dissociation (psychology)">dissociation</a>, <a href="/wiki/Depersonalization" title="Depersonalization">depersonalization</a>/<a href="/wiki/Derealization" title="Derealization">derealization</a>, and reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation).<a href="#cite_note-21">[21]</a></li> <li>Changes in self-perception, such as a sense of <a href="/wiki/Helplessness,_learned" class="mw-redirect" title="Helplessness, learned">helplessness</a> or paralysis of initiative, shame, guilt and self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings (may include a sense of specialness, utter aloneness, a belief that no other person can understand, or a feeling of nonhuman identity).</li> <li>Varied changes in perception of the perpetrators, such as a preoccupation with the relationship with a perpetrator (including a preoccupation with revenge), an unrealistic attribution of total power to a perpetrator (though the individual's assessment may be more realistic than the clinician's), <a href="/wiki/Idealization_and_devaluation" title="Idealization and devaluation">idealization</a> or paradoxical gratitude, a sense of a special or supernatural relationship with a perpetrator, and acceptance of a perpetrator's belief system or rationalizations.</li> <li>Alterations in relations with others, such as isolation and withdrawal, disruption in intimate relationships, a repeated search for a rescuer (may alternate with isolation and withdrawal), persistent distrust, and repeated failures of self-protection.</li> <li>Changes in systems of meaning, such as a loss of sustaining faith and a sense of hopelessness and despair.</li></ul> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(4)"><h2 id="Diagnosis">Diagnosis</h2> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=6" title="Edit section: Diagnosis" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-4 collapsible-block" id="mf-section-4"> CPTSD was considered for inclusion in the <a href="/wiki/DSM-IV" class="mw-redirect" title="DSM-IV">DSM-IV</a> but was excluded from the 1994 publication.<a href="#cite_note-TAR-4">[4]</a> It was also excluded from the <a href="/wiki/DSM-5" title="DSM-5">DSM-5</a>, which lists post-traumatic stress disorder.<a href="#cite_note-22">[22]</a> The <a href="/wiki/ICD-11" title="ICD-11">ICD-11</a> has included CPTSD since its initial publication in 2018 and an official psychometrics exists for assessing the ICD-11 CPTSD,<a href="#cite_note-Brewin_(2020)-2">[2]</a> which is the International Trauma Questionnaire (ITQ).<a href="#cite_note-23">[23]</a> <div class="mw-heading mw-heading3"><h3 id="Differential_diagnosis">Differential diagnosis</h3> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=7" title="Edit section: Differential diagnosis" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> <div class="mw-heading mw-heading4"><h4 id="Post-traumatic_stress_disorder">Post-traumatic stress disorder</h4> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=8" title="Edit section: Post-traumatic stress disorder" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Post-traumatic_stress_disorder" title="Post-traumatic stress disorder">Post-traumatic stress disorder</a></div> Post-traumatic stress disorder (PTSD) was included in the <a href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders#DSM-III_(1980)" title="Diagnostic and Statistical Manual of Mental Disorders">DSM-III</a> (1980), mainly due to the relatively large numbers of American combat veterans of the <a href="/wiki/Vietnam_War" title="Vietnam War">Vietnam War</a> who were seeking treatment for the lingering effects of combat stress. In the 1980s, various researchers and clinicians suggested that PTSD might also accurately describe the <a href="/wiki/Sequelae" class="mw-redirect" title="Sequelae">sequelae</a> of such traumas as child sexual abuse and domestic abuse.<a href="#cite_note-Courtois2004-24">[24]</a> However, it was soon suggested that PTSD failed to account for the cluster of symptoms that were often observed in cases of prolonged abuse, particularly that which was perpetrated against <a href="/wiki/Children" class="mw-redirect" title="Children">children</a> by <a href="/wiki/Caregiver" title="Caregiver">caregivers</a> during multiple <a href="/wiki/Childhood_development" class="mw-redirect" title="Childhood development">childhood</a> and <a href="/wiki/Adolescent_development" class="mw-redirect" title="Adolescent development">adolescent developmental</a> stages. Such patients were often extremely difficult to treat with established methods.<a href="#cite_note-Courtois2004-24">[24]</a> PTSD descriptions fail to capture some of the core characteristics of CPTSD. These elements include captivity, psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be <a href="/wiki/Revictimized" class="mw-redirect" title="Revictimized">revictimized</a>. Most importantly, there is a loss of a coherent sense of self: this loss, and the ensuing symptom profile, most pointedly differentiates CPTSD from PTSD.<a href="#cite_note-TAR-4">[4]</a>: 199–122 CPTSD is also characterized by <a href="/wiki/Attachment_disorder" title="Attachment disorder">attachment disorder</a>, particularly the <a href="/wiki/Insecure_attachment" class="mw-redirect" title="Insecure attachment">pervasive insecure</a>, or <a href="/wiki/Disorganized_attachment" class="mw-redirect" title="Disorganized attachment">disorganized-type attachment</a>.<a href="#cite_note-vanderKolkRoth2005-25">[25]</a> <a href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders#DSM-IV_(1994)" title="Diagnostic and Statistical Manual of Mental Disorders">DSM-IV</a> (1994) <a href="/wiki/Dissociative_disorder" class="mw-redirect" title="Dissociative disorder">dissociative disorders</a> and PTSD do not include insecure attachment in their criteria. As a consequence of this aspect of CPTSD, when some adults with CPTSD become parents and confront their own children's <a href="/wiki/Attachment_theory" title="Attachment theory">attachment</a> 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.<a href="#cite_note-Schechter2008-26">[26]</a>: 123–149 Although the great majority of survivors do not abuse others,<a href="#cite_note-Kaufman1987-27">[27]</a> this difficulty in parenting may have adverse repercussions for their children's social and emotional development if parents with this condition and their children do not receive appropriate treatment.<a href="#cite_note-Schechter2009-28">[28]</a><a href="#cite_note-Schechter2007-29">[29]</a> Thus, a differentiation between the diagnostic category of CPTSD and that of PTSD has been suggested. PTSD can exist alongside CPTSD; however a sole diagnosis of PTSD often does not sufficiently encapsulate the breadth of symptoms experienced by those who have experienced prolonged traumatic experience, and therefore CPTSD extends beyond the PTSD parameters.<a href="#cite_note-Herman1992-7">[7]</a> Continuous traumatic stress disorder (CTSD), which was introduced into the trauma literature by Gill Straker in 1987,<a href="#cite_note-30">[30]</a> differs from CPTSD.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>][<a href="/wiki/Wikipedia:Please_clarify" title="Wikipedia:Please clarify">how?</a>] It was originally used by South African clinicians to describe the effects of exposure to frequent, high levels of violence usually associated with <a href="/wiki/Civil_war" title="Civil war">civil conflict</a> and <a href="/wiki/Political_repression" title="Political repression">political repression</a>. The term is applicable to the effects of exposure to contexts in which <a href="/wiki/Gang_violence" class="mw-redirect" title="Gang violence">gang violence</a> and <a href="/wiki/Crime" title="Crime">crime</a> are endemic as well as to the effects of ongoing exposure to life threats in <a href="/wiki/Occupational_safety_and_health" title="Occupational safety and health">high-risk occupations</a> such as <a href="/wiki/Emergency_service" title="Emergency service">police, fire and emergency services</a>. It has also been used to describe ongoing relationship trauma frequently experienced by people leaving relationships which involved intimate partner violence.<a href="#cite_note-31">[31]</a> <div class="mw-heading mw-heading4"><h4 id="Traumatic_grief">Traumatic grief</h4> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=9" title="Edit section: Traumatic grief" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main articles: <a href="/wiki/Grief" title="Grief">Grief</a> and <a href="/wiki/Grief_counseling" title="Grief counseling">Grief counseling</a></div> Traumatic grief<a href="#cite_note-32">[32]</a><a href="#cite_note-33">[33]</a><a href="#cite_note-Ambrose-34">[34]</a><a href="#cite_note-Figley1997-35">[35]</a> or complicated mourning<a href="#cite_note-Rando1993-36">[36]</a> are conditions<a href="#cite_note-Rando1994-37">[37]</a> where trauma and <a href="/wiki/Grief" title="Grief">grief</a> coincide. There are conceptual links between trauma and bereavement since loss of a loved one is inherently traumatic.<a href="#cite_note-Green2000-38">[38]</a> If a traumatic event was <a href="/wiki/Lethality" title="Lethality">life-threatening</a>, but did not result in a <a href="/wiki/Death" title="Death">death</a>, then it is more likely that the survivor will experience post-traumatic stress symptoms. If a person dies, and the survivor was close to the person who died, then it is more likely that symptoms of grief will also develop. When the death is of a loved one, and was sudden or violent, then both symptoms often coincide. This is likely in children exposed to community violence.<a href="#cite_note-PynoosNader1988-39">[39]</a><a href="#cite_note-NCTSNFirstAid-40">[40]</a> For CPTSD to manifest traumatic grief, 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 phenomenon of the increased risk of violence and death of <a href="/wiki/Stepchild" title="Stepchild">stepchildren</a> is referred to as the <a href="/wiki/Cinderella_effect" title="Cinderella effect">Cinderella effect</a>. <div class="mw-heading mw-heading4"><h4 id="Borderline_personality_disorder">Borderline personality disorder</h4> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=10" title="Edit section: Borderline personality disorder" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main articles: <a href="/wiki/Attachment_theory" title="Attachment theory">Attachment theory</a> and <a href="/wiki/Borderline_personality_disorder" title="Borderline personality disorder">Borderline personality disorder</a></div> CPTSD may share some symptoms with both PTSD and borderline personality disorder (BPD).<a href="#cite_note-vanderKolkCourtois2005-41">[41]</a> However, there is enough evidence to also differentiate CPTSD from borderline personality disorder. It may help to understand the intersection of attachment theory with CPTSD and BPD if one reads the following opinion of <a href="/wiki/Bessel_van_der_Kolk" title="Bessel van der Kolk">Bessel A. van der Kolk</a> together with an understanding drawn from a description of BPD: <style data-mw-deduplicate="TemplateStyles:r1244412712">.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 32px}.mw-parser-output .templatequotecite{line-height:1.5em;text-align:left;margin-top:0}@media(min-width:500px){.mw-parser-output .templatequotecite{padding-left:1.6em}}</style><blockquote class="templatequote"> Uncontrollable disruptions or distortions of attachment bonds precede the development of post-traumatic 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 <a href="/wiki/Harassment" title="Harassment">harass</a>, beat, and, threaten them. The persistence of these attachment bonds leads to confusion of pain and love. Trauma can be repeated on behavioural, emotional, <a href="/wiki/Physiology" title="Physiology">physiologic</a>, and <a href="/wiki/Neuroendocrinology" title="Neuroendocrinology">neuroendocrinologic</a> levels. Repetition on these different levels causes a large variety of individual and social suffering. </blockquote> 25% of those diagnosed with BPD have no known history of childhood neglect or abuse and individuals are six times as likely to develop BPD if they have a relative who was diagnosed so[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] 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."<a href="#cite_note-Distel2008-42">[42]</a> A 2014 study published in the European Journal of Psychotraumatology was able to compare and contrast CPTSD, PTSD, and borderline personality disorder and found that it could distinguish between individual cases of each and when it was co-morbid, arguing for a case of separate diagnoses for each.<a href="#cite_note-Cloitre_2014-43">[43]</a> BPD may be confused with CPTSD by some without proper knowledge of the two conditions because those with BPD also tend to have PTSD or to have some history of trauma. In Trauma and Recovery, Herman expresses the additional concern that patients with CPTSD frequently risk being misunderstood as inherently '<a href="/wiki/Dependent_personality_disorder" title="Dependent personality disorder">dependent</a>', '<a href="/wiki/Sadomasochism" title="Sadomasochism">masochistic</a>', or '<a href="/wiki/Self-defeating_personality_disorder" title="Self-defeating personality disorder">self-defeating</a>', comparing this attitude to the historical misdiagnosis of <a href="/wiki/Female_hysteria" title="Female hysteria">female hysteria</a>.<a href="#cite_note-TAR-4">[4]</a> However, those who develop CPTSD do so as a result of the intensity of the <a href="/wiki/Traumatic_bonding" title="Traumatic bonding">traumatic bond</a> — in which someone becomes tightly biochemically bound to someone who abuses them and the responses they learned to survive, navigate and deal with the abuse they suffered then become automatic responses, embedded in their personality over the years of trauma — a normal reaction to an abnormal situation.<a href="#cite_note-44">[44]</a> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(5)"><h2 id="Treatment">Treatment</h2> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=11" title="Edit section: Treatment" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-5 collapsible-block" id="mf-section-5"> While standard evidence-based treatments may be effective for treating <a href="/wiki/Post-traumatic_stress_disorder" title="Post-traumatic stress disorder">post-traumatic stress disorder</a>, treating complex PTSD often involves addressing interpersonal relational difficulties and a different set of symptoms which make it more challenging to treat. <div class="mw-heading mw-heading3"><h3 id="Children">Children</h3> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=12" title="Edit section: Children" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> The utility of PTSD-derived psychotherapies for assisting children with CPTSD is uncertain. This area of diagnosis and treatment calls for caution in use of the category CPTSD. Julian Ford and <a href="/wiki/Bessel_van_der_Kolk" title="Bessel van der Kolk">Bessel van der Kolk</a> have suggested that CPTSD may not be as useful a category for diagnosis and treatment of children as a proposed category of <a href="/wiki/Developmental_trauma_disorder" class="mw-redirect" title="Developmental trauma disorder">developmental trauma disorder</a> (DTD).<a href="#cite_note-Ford_2009-45">[45]</a>: 60 According to Courtois and Ford, for DTD to be diagnosed it requires a <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1244412712"><blockquote class="templatequote"> history of exposure to early life developmentally adverse interpersonal trauma such as sexual abuse, physical abuse, violence, traumatic losses or 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.<a href="#cite_note-Ford_2009-45">[45]</a> </blockquote> Since CPTSD 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:<a href="#cite_note-Ford_2009-45">[45]</a>: 67 <ul><li>Identifying and addressing threats to the child's or family's safety and stability are the first priority.</li> <li>A relational bridge must be developed to engage, retain and maximize the benefit for the child and caregiver.</li> <li>Diagnosis, treatment planning and outcome monitoring are always relational (and) strengths based.</li> <li>All phases of treatment should aim to enhance self-regulation competencies.</li> <li>Determining with whom, when and how to address traumatic memories.</li> <li>Preventing and managing relational discontinuities and psychosocial crises.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Adults_2">Adults</h3> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=13" title="Edit section: Adults" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> <div class="mw-heading mw-heading4"><h4 id="Trauma_recovery_model">Trauma recovery model</h4> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=14" title="Edit section: Trauma recovery model" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> Judith Lewis Herman, in her book, Trauma and Recovery, proposed a complex trauma recovery model that occurs in three stages: <ol><li>Establishing safety</li> <li>Remembrance and mourning for what was lost</li> <li>Reconnecting with community and more broadly, society</li></ol> Herman believes recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship. This healing relationship need not be romantic or sexual in the colloquial sense of "relationship", however, and can also include relationships with friends, co-workers, one's relatives or children, and the <a href="/wiki/Therapeutic_relationship" title="Therapeutic relationship">therapeutic relationship</a>.<a href="#cite_note-TAR-4">[4]</a> However, the first stage of establishing safety must always include a thorough evaluation of the surroundings, which might include abusive relationships. This stage might involve the need for major life changes for some patients.<a href="#cite_note-onlinelibrary.wiley.com-46">[46]</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1244412712"><blockquote class="templatequote">Securing a safe environment requires strategic attention to the patient's economic and social ecosystem. The patient must become aware of her own resources for practical and emotional support as well as the realistic dangers and vulnerabilities in her social situation. Many patients are unable to move forward in their recovery because of their present involvement in unsafe or oppressive relationships. In order to gain their autonomy and their peace of mind, survivors may have to make difficult and painful life choices. Battered women may lose their homes, their friends, and their livelihood. Survivors of childhood abuse may lose their families. Political refugees may lose their homes and their homeland. The social obstacles to recovery are not generally recognized, but they must be identified and adequately addressed in order for recovery to proceed.<a href="#cite_note-onlinelibrary.wiley.com-46">[46]</a></blockquote> Complex trauma means complex reactions and this leads to complex treatments.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Hence, treatment for CPTSD requires a multi-modal approach.<a href="#cite_note-Cook2005-1">[1]</a> It has been suggested that treatment for complex 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, <a href="/wiki/Dissociation_(psychology)" title="Dissociation (psychology)">dissociation</a>, and interpersonal problems.<a href="#cite_note-vanderKolkRoth2005-25">[25]</a> Six suggested core components of complex trauma treatment include:<a href="#cite_note-Cook2005-1">[1]</a> <ul><li>Safety</li> <li>Self-regulation</li> <li>Self-reflective information processing</li> <li>Traumatic experiences integration</li> <li>Relational engagement</li> <li>Positive affect enhancement</li></ul> The above components can be conceptualized as a model with three phases. Not every case will be the same, but the first of phase will emphasize the acquisition and strengthening of adequate coping strategies as well as addressing safety issues and concerns. The next phase would focus on decreasing avoidance of traumatic stimuli and applying coping skills learned in phase one. The care provider may also begin challenging assumptions about the trauma and introducing alternative narratives about the trauma. The final phase would consist of solidifying what has previously been learned and transferring these strategies to future stressful events.<a href="#cite_note-47">[47]</a> <div class="mw-heading mw-heading4"><h4 id="Neuroscientific_and_trauma_informed_interventions">Neuroscientific and trauma informed interventions</h4> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=15" title="Edit section: Neuroscientific and trauma informed interventions" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> In practice, the forms of treatment and intervention varies from individual to individual since there is a wide spectrum of childhood experiences of developmental trauma and symptomatology and not all survivors respond positively, uniformly, to the same treatment. Therefore, treatment is generally tailored to the individual.<a href="#cite_note-48">[48]</a> Recent neuroscientific research has shed some light on the impact that severe childhood abuse and neglect (trauma) has on a child's developing brain, specifically as it relates to the development in brain structures, function and connectivity among children from infancy to adulthood. This understanding of the neurophysiological underpinning of complex trauma phenomena is what currently is referred to in the field of traumatology as 'trauma informed' which has become the rationale which has influenced the development of new treatments specifically targeting those with childhood developmental trauma.<a href="#cite_note-Anda_2006-49">[49]</a><a href="#cite_note-50">[50]</a> Martin Teicher, a Harvard psychiatrist and researcher, has suggested that the development of specific complex trauma related symptomatology (and in fact the development of many adult onset psychopathologies) may be connected to gender differences and at what stage of childhood development trauma, abuse or neglect occurred.<a href="#cite_note-Anda_2006-49">[49]</a> For example, it is well established that the development of <a href="/wiki/Dissociative_identity_disorder" title="Dissociative identity disorder">dissociative identity disorder</a> among women is often associated with early childhood sexual abuse. <div class="mw-heading mw-heading4"><h4 id="Use_of_evidence-based_treatment_and_its_limitations">Use of evidence-based treatment and its limitations</h4> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=16" title="Edit section: Use of evidence-based treatment and its limitations" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> One of the current challenges faced by many survivors of complex trauma (or developmental trauma disorder) is support for treatment since many of the current therapies are relatively expensive and not all forms of <a href="/wiki/Therapy" title="Therapy">therapy</a> or <a href="/wiki/Psychological_intervention" title="Psychological intervention">intervention</a> are reimbursed by insurance companies who use <a href="/wiki/Evidence-based_practice" title="Evidence-based practice">evidence-based practice</a> as a criterion for reimbursement. <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a>, <a href="/wiki/Prolonged_exposure_therapy" title="Prolonged exposure therapy">prolonged exposure therapy</a> and <a href="/wiki/Dialectical_behavioral_therapy" class="mw-redirect" title="Dialectical behavioral therapy">dialectical behavioral therapy</a> are well established forms of evidence-based intervention. These treatments are approved and endorsed by the <a href="/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a>, the <a href="/wiki/American_Psychological_Association" title="American Psychological Association">American Psychological Association</a> and the Veteran's Administration. While standard evidence-based treatments may be effective for treating standard <a href="/wiki/Post-traumatic_stress_disorder" title="Post-traumatic stress disorder">post-traumatic stress disorder</a>, treating complex PTSD often involves addressing interpersonal relational difficulties and a different set of symptoms which make it more challenging to treat. For example, "Limited evidence suggests that predominantly cognitive behavioral therapy treatments are effective, but do not suffice to achieve satisfactory end states, especially in Complex PTSD populations."<a href="#cite_note-51">[51]</a> <div class="mw-heading mw-heading4"><h4 id="Treatment_challenges">Treatment challenges</h4> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=17" title="Edit section: Treatment challenges" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> It is widely acknowledged by those who work in the trauma field that there is no one single, standard, 'one size fits all' treatment for complex PTSD.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] There is also no clear consensus regarding the best treatment among the greater mental health professional community which included clinical psychologists, social workers, licensed therapists (MFTs) and psychiatrists. Although most trauma neuroscientifically informed practitioners understand the importance of utilizing a combination of both 'top down' and 'bottom up' interventions as well as including somatic interventions (sensorimotor psychotherapy or somatic experiencing or yoga) for the purposes of processing and integrating trauma memories. Survivors with complex trauma often struggle to find a mental health professional who is properly trained in trauma informed practices. They can also be challenging to receive adequate treatment and services to treat a mental health condition which is not universally recognized or well understood by general practitioners. Allistair and Hull echo the sentiment of many other trauma neuroscience researchers (including <a href="/wiki/Bessel_van_der_Kolk" title="Bessel van der Kolk">Bessel van der Kolk</a> and <a href="/wiki/Bruce_D._Perry" title="Bruce D. Perry">Bruce D. Perry</a>) who argue: <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1244412712"><blockquote class="templatequote"> Complex presentations are often excluded from studies because they do not fit neatly into the simple nosological categorisations required for research power. This means that the most severe disorders are not studied adequately and patients most affected by early trauma are often not recognised by services. Both historically and currently, at the individual as well as the societal level, "dissociation from the acknowledgement of the severe impact of childhood abuse on the developing brain leads to inadequate provision of services. Assimilation into treatment models of the emerging affective neuroscience of adverse experience could help to redress the balance by shifting the focus from top-down regulation to bottom-up, body-based processing."<a href="#cite_note-52">[52]</a> </blockquote> Complex post trauma stress disorder is a long term mental health condition which is often difficult and relatively expensive to treat and often requires several years of psychotherapy, modes of intervention and treatment by highly skilled, mental health professionals who specialize in trauma informed modalities designed to process and integrate childhood trauma memories for the purposes of mitigating symptoms and improving the survivor's quality of life. Delaying therapy for people with complex PTSD, whether intentionally or not, can exacerbate the condition.<a href="#cite_note-53">[53]</a> <div class="mw-heading mw-heading4"><h4 id="Recommended_treatment_modalities_and_interventions">Recommended treatment modalities and interventions</h4> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=18" title="Edit section: Recommended treatment modalities and interventions" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> There is no one treatment which has been designed specifically for use with the adult complex PTSD population (with the exception of component based psychotherapy<a href="#cite_note-54">[54]</a>) there are many therapeutic interventions used by mental health professionals to treat PTSD. As of February 2017<a class="external text" href="https://en.wikipedia.org/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit">[update]</a>, the American Psychological Association PTSD Guideline Development Panel (GDP) strongly recommends the following for the treatment of PTSD:<a href="#cite_note-55">[55]</a> <ol><li><a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a> (CBT) and trauma focused CBT</li> <li>Cognitive processing therapy (CPT)</li> <li>Cognitive therapy (CT)</li> <li><a href="/wiki/Prolonged_exposure_therapy" title="Prolonged exposure therapy">Prolonged exposure therapy</a> (PE)</li></ol> The American Psychological Association also conditionally recommends<a href="#cite_note-56">[56]</a> <ol><li><a href="/wiki/Eclectic_psychotherapy" title="Eclectic psychotherapy">Brief eclectic psychotherapy</a> (BEP)</li> <li><a href="/wiki/Eye_movement_desensitization_and_reprocessing" title="Eye movement desensitization and reprocessing">Eye movement desensitization and reprocessing</a> (EMDR)<a href="#cite_note-57">[57]</a><a href="#cite_note-58">[58]</a><a href="#cite_note-59">[59]</a><a href="#cite_note-60">[60]</a><a href="#cite_note-61">[61]</a></li> <li><a href="/wiki/Narrative_exposure_therapy" title="Narrative exposure therapy">Narrative exposure therapy</a> (NET)</li></ol> While these treatments have been recommended, there is still a lack of research on the best and most efficacious treatments for complex PTSD. Psychological therapies such as cognitive behavioural therapy, eye movement desensitisation and reprocessing therapy are effective in treating CPTSD symptoms like PTSD, depression and anxiety.<a href="#cite_note-:02-62">[62]</a><a href="#cite_note-:1-63">[63]</a> For example, in a 2016, meta-analysis, four out of eight EMDR studies resulted in statistical significance, indicating the potential effectiveness of EMDR in treating certain conditions. Additionally, subjects from two of the studies continued to benefit from the treatment months later. Seven of the studies that employed psychometric tests showed that EMDR led to a reduction in depression symptoms compared to those in the placebo group.<a href="#cite_note-64">[64]</a> Like EMDR, the other therapies are especially effective for complex trauma related to domestic violence and less effective when the condition is related to experiences of war or childhood sexual abuse. <a href="/wiki/Mindfulness" title="Mindfulness">Mindfulness</a> and <a href="/wiki/Relaxation_technique" title="Relaxation technique">relaxation</a> is effective for PTSD symptoms, emotion regulation and interpersonal problems for people whose complex trauma is related to sexual abuse.<a href="#cite_note-:02-62">[62]</a><a href="#cite_note-:1-63">[63]</a> Many commonly used treatments are considered complementary or alternative since there still is a lack of research to classify these approaches as evidence based. Some of these additional interventions and modalities include: <ul><li><a href="/wiki/Biofeedback" title="Biofeedback">biofeedback</a></li> <li>dyadic resourcing (used with EMDR)<a href="#cite_note-65">[65]</a></li> <li><a href="/wiki/Emotionally_focused_therapy" title="Emotionally focused therapy">emotionally focused therapy</a></li> <li>emotional freedom technique (EFT) or tapping<a href="#cite_note-66">[66]</a></li> <li><a href="/wiki/Equine-assisted_therapy" title="Equine-assisted therapy">equine-assisted therapy</a><a href="#cite_note-67">[67]</a></li> <li>expressive arts therapy</li> <li><a href="/wiki/Internal_Family_Systems_Model" title="Internal Family Systems Model">internal family systems therapy</a><a href="#cite_note-68">[68]</a></li> <li><a href="/wiki/Dialectical_behavior_therapy" title="Dialectical behavior therapy">dialectical behavior therapy</a> (DBT)</li> <li><a href="/wiki/Family_therapy" title="Family therapy">family systems therapy</a></li> <li><a href="/wiki/Group_psychotherapy" title="Group psychotherapy">group therapy</a><a href="#cite_note-Ford_2009-45">[45]</a></li> <li><a href="/wiki/Neurofeedback" title="Neurofeedback">neurofeedback</a><a href="#cite_note-69">[69]</a><a href="#cite_note-70">[70]</a><a href="#cite_note-71">[71]</a></li> <li><a href="/wiki/Psychodynamic_therapy" class="mw-redirect" title="Psychodynamic therapy">psychodynamic therapy</a></li> <li>sensorimotor psychotherapy<a href="#cite_note-72">[72]</a></li> <li><a href="/wiki/Somatic_experiencing" title="Somatic experiencing">somatic experiencing</a></li> <li><a href="/wiki/Yoga" title="Yoga">yoga</a>, specifically <a href="/wiki/Trauma-sensitive_yoga" title="Trauma-sensitive yoga">trauma-sensitive yoga</a><a href="#cite_note-73">[73]</a></li></ul> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(6)"><h2 id="Criticism_of_disorder_and_diagnosis">Criticism of disorder and diagnosis</h2> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=19" title="Edit section: Criticism of disorder and diagnosis" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-6 collapsible-block" id="mf-section-6"> Though acceptance of the idea of complex PTSD has increased with mental health professionals, the fundamental research required for the proper validation of a new disorder is insufficient as of 2013.<a href="#cite_note-74">[74]</a> The disorder was proposed under the name DES-NOS (Disorder of Extreme Stress Not Otherwise Specified) for inclusion in the <a href="/wiki/DSM-IV" class="mw-redirect" title="DSM-IV">DSM-IV</a> but was rejected by members of the <a href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders" title="Diagnostic and Statistical Manual of Mental Disorders">Diagnostic and Statistical Manual of Mental Disorders</a> (DSM) committee of the <a href="/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a> for lack of sufficient diagnostic validity research. Chief among the stated limitations was a study which showed that 95% of individuals who could be diagnosed with the proposed DES-NOS were also diagnosable with PTSD, raising questions about the added usefulness of an additional disorder.<a href="#cite_note-Roth_1997-19">[19]</a> Following the failure of DES-NOS to gain formal recognition in the DSM-IV, the concept was re-packaged for children and adolescents and given a new name, developmental trauma disorder.<a href="#cite_note-vanderKolk2005-75">[75]</a> Supporters of DTD appealed to the developers of the DSM-5 to recognize DTD as a new disorder. Just as the developers of DSM-IV refused to included DES-NOS, the developers of <a href="/wiki/DSM-5" title="DSM-5">DSM-5</a> refused to include DTD due to a perceived lack of sufficient research. One of the main justifications offered for this proposed disorder has been that the current system of diagnosing PTSD plus comorbid disorders does not capture the wide array of symptoms in one diagnosis.<a href="#cite_note-Herman1992-7">[7]</a> Because individuals who suffered repeated and prolonged traumas often show PTSD plus other concurrent psychiatric disorders, some researchers have argued that a single broad disorder such as CPTSD provides a better and more parsimonious diagnosis than the current system of PTSD plus concurrent disorders.<a href="#cite_note-76">[76]</a> Conversely, an article published in <a href="/wiki/BioMed_Central" title="BioMed Central">BioMed Central</a> has posited there is no evidence that being labeled with a single disorder leads to better treatment than being labeled with PTSD plus concurrent disorders.<a href="#cite_note-Schmid2013-77">[77]</a> Complex PTSD embraces a wider range of symptoms relative to PTSD, specifically emphasizing problems of emotional regulation, negative self-concept, and interpersonal problems. Diagnosing complex PTSD can imply that this wider range of symptoms is caused by traumatic experiences, rather than acknowledging any pre-existing experiences of trauma which could lead to a higher risk of experiencing future traumas. It also asserts that this wider range of symptoms and higher risk of traumatization are related by hidden confounder variables and there is no causal relationship between symptoms and trauma experiences.<a href="#cite_note-Schmid2013-77">[77]</a> In the diagnosis of PTSD, the definition of the stressor event is narrowly limited to life-threatening events, with the implication that these are typically sudden and unexpected events. Complex PTSD vastly widened the definition of potential stressor events by calling them adverse events, and deliberating dropping reference to life-threatening, so that experiences can be included such as neglect, emotional abuse, or living in a war zone without having specifically experienced life-threatening events.<a href="#cite_note-Brewin_et_al._(2017)-5">[5]</a> By broadening the stressor criterion, an article published by the <a href="/w/index.php?title=Child_and_Youth_Care_Forum&action=edit&redlink=1" class="new" title="Child and Youth Care Forum (page does not exist)">Child and Youth Care Forum</a> claims this has led to confusing differences between competing definitions of complex PTSD, undercutting the clear operationalization of symptoms seen as one of the successes of the DSM.<a href="#cite_note-78">[78]</a> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(7)"><h2 id="See_also">See also</h2> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=20" title="Edit section: See also" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-7 collapsible-block" id="mf-section-7"> <style data-mw-deduplicate="TemplateStyles:r1239009302">.mw-parser-output .portalbox{padding:0;margin:0.5em 0;display:table;box-sizing:border-box;max-width:175px;list-style:none}.mw-parser-output .portalborder{border:1px solid var(--border-color-base,#a2a9b1);padding:0.1em;background:var(--background-color-neutral-subtle,#f8f9fa)}.mw-parser-output .portalbox-entry{display:table-row;font-size:85%;line-height:110%;height:1.9em;font-style:italic;font-weight:bold}.mw-parser-output .portalbox-image{display:table-cell;padding:0.2em;vertical-align:middle;text-align:center}.mw-parser-output .portalbox-link{display:table-cell;padding:0.2em 0.2em 0.2em 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Retrieved 31 December 2019.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Psychiatry&rft.atitle=Yoga+as+an+adjunctive+treatment+for+posttraumatic+stress+disorder%3A+a+randomized+controlled+trial&rft.volume=75&rft.issue=6&rft.pages=e559-565&rft.date=2014-06&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A2382770%23id-name%3DS2CID&rft_id=info%3Apmid%2F25004196&rft_id=info%3Adoi%2F10.4088%2FJCP.13m08561&rft.aulast=van+der+Kolk&rft.aufirst=BA&rft.au=Stone%2C+L&rft.au=West%2C+J&rft.au=Rhodes%2C+A&rft.au=Emerson%2C+D&rft.au=Suvak%2C+M&rft.au=Spinazzola%2C+J&rft_id=https%3A%2F%2Fbesselvanderkolk.net%2Fuploads%2F3%2F4%2F9%2F8%2F34980287%2Fyoga_f_j_clin_psychiat___1_.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"> </li> <li id="cite_note-74"><a href="#cite_ref-74">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKeane2013" class="citation journal cs1">Keane TM (May 2013). 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The American Journal of Orthopsychiatry. 82 (2): 187–200. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1939-0025.2012.01154.x">10.1111/j.1939-0025.2012.01154.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/22506521">22506521</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Journal+of+Orthopsychiatry&rft.atitle=Understanding+interpersonal+trauma+in+children%3A+why+we+need+a+developmentally+appropriate+trauma+diagnosis&rft.volume=82&rft.issue=2&rft.pages=187-200&rft.date=2012-04&rft_id=info%3Adoi%2F10.1111%2Fj.1939-0025.2012.01154.x&rft_id=info%3Apmid%2F22506521&rft.aulast=D%27Andrea&rft.aufirst=W&rft.au=Ford%2C+J&rft.au=Stolbach%2C+B&rft.au=Spinazzola%2C+J&rft.au=van+der+Kolk%2C+BA&rft_id=http%3A%2F%2Fwww.traumacenter.org%2Fresearch%2FAJOP_why_we_need_a_complex_trauma_dx.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"> </li> <li id="cite_note-Schmid2013-77">^ <a href="#cite_ref-Schmid2013_77-0">a</a> <a href="#cite_ref-Schmid2013_77-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSchmidPetermannFegert2013" class="citation journal cs1">Schmid M, Petermann F, Fegert JM (January 2013). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3541245">"Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems"</a>. <a href="/wiki/BMC_Psychiatry" class="mw-redirect" title="BMC Psychiatry">BMC Psychiatry</a>. 13: 3. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1186%2F1471-244X-13-3">10.1186/1471-244X-13-3</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3541245">3541245</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23286319">23286319</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Psychiatry&rft.atitle=Developmental+trauma+disorder%3A+pros+and+cons+of+including+formal+criteria+in+the+psychiatric+diagnostic+systems&rft.volume=13&rft.pages=3&rft.date=2013-01&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3541245%23id-name%3DPMC&rft_id=info%3Apmid%2F23286319&rft_id=info%3Adoi%2F10.1186%2F1471-244X-13-3&rft.aulast=Schmid&rft.aufirst=M&rft.au=Petermann%2C+F&rft.au=Fegert%2C+JM&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3541245&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"> </li> <li id="cite_note-78"><a href="#cite_ref-78">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFScheeringa2015" class="citation journal cs1">Scheeringa MS (August 2015). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511493">"Untangling Psychiatric Comorbidity in Young Children Who Experienced Single, Repeated, or Hurricane Katrina Traumatic Events"</a>. <a href="/w/index.php?title=Child_%26_Youth_Care_Forum&action=edit&redlink=1" class="new" title="Child & Youth Care Forum (page does not exist)">Child & Youth Care Forum</a>. 44 (4): 475–492. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs10566-014-9293-7">10.1007/s10566-014-9293-7</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511493">4511493</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26213455">26213455</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Child+%26+Youth+Care+Forum&rft.atitle=Untangling+Psychiatric+Comorbidity+in+Young+Children+Who+Experienced+Single%2C+Repeated%2C+or+Hurricane+Katrina+Traumatic+Events&rft.volume=44&rft.issue=4&rft.pages=475-492&rft.date=2015-08&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4511493%23id-name%3DPMC&rft_id=info%3Apmid%2F26213455&rft_id=info%3Adoi%2F10.1007%2Fs10566-014-9293-7&rft.aulast=Scheeringa&rft.aufirst=MS&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4511493&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"> </li> </ol></div></div> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(9)"><h2 id="Further_reading">Further reading</h2> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=22" title="Edit section: Further reading" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-9 collapsible-block" id="mf-section-9"> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin refbegin-columns references-column-width" style="column-width: 32em"> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFAppleyardOsofsky2003" class="citation journal cs1">Appleyard K, Osofsky JD (2003). <a rel="nofollow" class="external text" href="http://www.futureunlimited.org/pdf/imh_.3_03.">"Parenting after trauma: Supporting parents and caregivers in the treatment of children impacted by violence"</a>. <a href="/wiki/Infant_Mental_Health_Journal" title="Infant Mental Health Journal">Infant Mental Health Journal</a>. 24 (2): 111–125. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1002%2Fimhj.10050">10.1002/imhj.10050</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Infant+Mental+Health+Journal&rft.atitle=Parenting+after+trauma%3A+Supporting+parents+and+caregivers+in+the+treatment+of+children+impacted+by+violence&rft.volume=24&rft.issue=2&rft.pages=111-125&rft.date=2003&rft_id=info%3Adoi%2F10.1002%2Fimhj.10050&rft.aulast=Appleyard&rft.aufirst=K&rft.au=Osofsky%2C+JD&rft_id=http%3A%2F%2Fwww.futureunlimited.org%2Fpdf%2Fimh_.3_03.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBannit2012" class="citation book cs1">Bannit SP (2012). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=6Yrv2ugNUnEC">The Trauma Tool Kit: Healing PTSD from the Inside Out</a>. Quest Books. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-8356-0896-1" title="Special:BookSources/978-0-8356-0896-1"><bdi>978-0-8356-0896-1</bdi></a> – via <a href="/wiki/Google_Books" title="Google Books">Google Books</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Trauma+Tool+Kit%3A+Healing+PTSD+from+the+Inside+Out&rft.pub=Quest+Books&rft.date=2012&rft.isbn=978-0-8356-0896-1&rft.aulast=Bannit&rft.aufirst=Susan+Pease&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D6Yrv2ugNUnEC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBriereScott2012" class="citation book cs1">Briere J, Scott C (30 August 2012). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=W_G0ygAACAAJ">Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment</a>. <a href="/wiki/SAGE_Publications" class="mw-redirect" title="SAGE Publications">SAGE Publications</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4129-8143-9" title="Special:BookSources/978-1-4129-8143-9"><bdi>978-1-4129-8143-9</bdi></a>. Retrieved 29 October 2012 – via <a href="/wiki/Google_Books" title="Google Books">Google Books</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Principles+of+Trauma+Therapy%3A+A+Guide+to+Symptoms%2C+Evaluation%2C+and+Treatment&rft.pub=SAGE+Publications&rft.date=2012-08-30&rft.isbn=978-1-4129-8143-9&rft.aulast=Briere&rft.aufirst=John&rft.au=Scott%2C+Catherine&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DW_G0ygAACAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCourtois2014" class="citation book cs1">Courtois C (12 October 2014). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=ZycVogEACAAJ&q=Courtois+christine+its+not+what">It's Not You, It's What Happened to You: Complex Trauma and Treatment</a>. Elements Behavioral Health. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-941536-55-1" title="Special:BookSources/978-1-941536-55-1"><bdi>978-1-941536-55-1</bdi></a> – via <a href="/wiki/Google_Books" title="Google Books">Google Books</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=It%27s+Not+You%2C+It%27s+What+Happened+to+You%3A+Complex+Trauma+and+Treatment&rft.pub=Elements+Behavioral+Health&rft.date=2014-10-12&rft.isbn=978-1-941536-55-1&rft.aulast=Courtois&rft.aufirst=Christine&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DZycVogEACAAJ%26q%3DCourtois%2Bchristine%2Bits%2Bnot%2Bwhat&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFisher2017" class="citation book cs1">Fisher, Janina (2017). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=NJ40DgAAQBAJ&q=Healing+the+fragmented+selves">Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation</a>. <a href="/wiki/Routledge" title="Routledge">Routledge</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-415-70823-4" title="Special:BookSources/978-0-415-70823-4"><bdi>978-0-415-70823-4</bdi></a> – via <a href="/wiki/Google_Books" title="Google Books">Google Books</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Healing+the+Fragmented+Selves+of+Trauma+Survivors%3A+Overcoming+Internal+Self-Alienation&rft.pub=Routledge&rft.date=2017&rft.isbn=978-0-415-70823-4&rft.aulast=Fisher&rft.aufirst=Janina&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DNJ40DgAAQBAJ%26q%3DHealing%2Bthe%2Bfragmented%2Bselves&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFisher2010" class="citation journal cs1">Fisher S (2010). <a rel="nofollow" class="external text" href="https://www.aapb.org/files/publications/biofeedback/2010/biof-38-01-6-8.pdf">"Arousal and Identity: Thoughts on Neurofeedback in the Treatment of Developmental Trauma"</a> (PDF). Biofeedback. 38 (1): 6–8. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.5298%2F1081-5937-38.1.6">10.5298/1081-5937-38.1.6</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biofeedback&rft.atitle=Arousal+and+Identity%3A+Thoughts+on+Neurofeedback+in+the+Treatment+of+Developmental+Trauma&rft.volume=38&rft.issue=1&rft.pages=6-8&rft.date=2010&rft_id=info%3Adoi%2F10.5298%2F1081-5937-38.1.6&rft.aulast=Fisher&rft.aufirst=Sebern&rft_id=https%3A%2F%2Fwww.aapb.org%2Ffiles%2Fpublications%2Fbiofeedback%2F2010%2Fbiof-38-01-6-8.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFord1999" class="citation journal cs1">Ford JD (February 1999). <a rel="nofollow" class="external text" href="http://www.trauma-pages.com/a/ford99.php">"Disorders of extreme stress following war-zone military trauma: associated features of posttraumatic stress disorder or comorbid but distinct syndromes?"</a>. <a href="/wiki/Journal_of_Consulting_and_Clinical_Psychology" title="Journal of Consulting and Clinical Psychology">Journal of Consulting and Clinical Psychology</a>. 67 (1): 3–12. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1037%2F0022-006X.67.1.3">10.1037/0022-006X.67.1.3</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10028203">10028203</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Consulting+and+Clinical+Psychology&rft.atitle=Disorders+of+extreme+stress+following+war-zone+military+trauma%3A+associated+features+of+posttraumatic+stress+disorder+or+comorbid+but+distinct+syndromes%3F&rft.volume=67&rft.issue=1&rft.pages=3-12&rft.date=1999-02&rft_id=info%3Adoi%2F10.1037%2F0022-006X.67.1.3&rft_id=info%3Apmid%2F10028203&rft.aulast=Ford&rft.aufirst=JD&rft_id=http%3A%2F%2Fwww.trauma-pages.com%2Fa%2Fford99.php&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFrewenLanius2015" class="citation book cs1">Frewen P, Lanius R (2015). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=zRN0AwAAQBAJ">Healing the Traumatized Self: Consciousness, Neuroscience, Treatment</a>. Norton Series on Interpersonal Neurobiology. <a href="/wiki/W.W._Norton_and_Company" class="mw-redirect" title="W.W. Norton and Company">W.W. Norton and Company</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-393-70849-3" title="Special:BookSources/978-0-393-70849-3"><bdi>978-0-393-70849-3</bdi></a> – via <a href="/wiki/Google_Books" title="Google Books">Google Books</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Healing+the+Traumatized+Self%3A+Consciousness%2C+Neuroscience%2C+Treatment&rft.series=Norton+Series+on+Interpersonal+Neurobiology&rft.pub=W.W.+Norton+and+Company&rft.date=2015&rft.isbn=978-0-393-70849-3&rft.aulast=Frewen&rft.aufirst=Paul&rft.au=Lanius%2C+Ruth&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DzRN0AwAAQBAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFInternational_Society_For_The_Study2011" class="citation journal cs1">International Society For The Study (2011). <a rel="nofollow" class="external text" href="https://www.isst-d.org/wp-content/uploads/2019/02/GUIDELINES_REVISED2011.pdf">"Guidelines for treating dissociative identity disorder in adults, third revision"</a> (PDF). <a href="/wiki/Journal_of_Trauma_%26_Dissociation" class="mw-redirect" title="Journal of Trauma & Dissociation">Journal of Trauma & Dissociation</a>. 12 (2): 115–87. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1080%2F15299732.2011.537247">10.1080/15299732.2011.537247</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/21391103">21391103</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Trauma+%26+Dissociation&rft.atitle=Guidelines+for+treating+dissociative+identity+disorder+in+adults%2C+third+revision&rft.volume=12&rft.issue=2&rft.pages=115-87&rft.date=2011&rft_id=info%3Adoi%2F10.1080%2F15299732.2011.537247&rft_id=info%3Apmid%2F21391103&rft.au=International+Society+For+The+Study&rft_id=https%3A%2F%2Fwww.isst-d.org%2Fwp-content%2Fuploads%2F2019%2F02%2FGUIDELINES_REVISED2011.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFvan_der_HartMosqueraGonzales2008" class="citation journal cs1">van der Hart O, Mosquera D, Gonzales A (2008). <a rel="nofollow" class="external text" href="http://www.onnovdhart.nl/wp-content/uploads/2008/09/persona2.pdf">"Borderline Personality Disorder, Developmental Trauma and Structural Dissociation of the Personality"</a> (PDF). Persona. 2: 44–73.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Persona&rft.atitle=Borderline+Personality+Disorder%2C+Developmental+Trauma+and+Structural+Dissociation+of+the+Personality&rft.volume=2&rft.pages=44-73&rft.date=2008&rft.aulast=van+der+Hart&rft.aufirst=Onno&rft.au=Mosquera%2C+Delores&rft.au=Gonzales%2C+Anabel&rft_id=http%3A%2F%2Fwww.onnovdhart.nl%2Fwp-content%2Fuploads%2F2008%2F09%2Fpersona2.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFvan_der_HartNijenhuisSteele2006" class="citation book cs1">van der Hart O, Nijenhuis ER, Steele K (2006). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=PPpxN70YLQEC">The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization</a>. <a href="/wiki/W.W._Norton_and_Company" class="mw-redirect" title="W.W. Norton and Company">W.W. Norton and Company</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-393-70401-3" title="Special:BookSources/978-0-393-70401-3"><bdi>978-0-393-70401-3</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Haunted+Self%3A+Structural+Dissociation+and+the+Treatment+of+Chronic+Traumatization&rft.pub=W.W.+Norton+and+Company&rft.date=2006&rft.isbn=978-0-393-70401-3&rft.aulast=van+der+Hart&rft.aufirst=Onno&rft.au=Nijenhuis%2C+Ellert+R.S.&rft.au=Steele%2C+Kathy&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DPPpxN70YLQEC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFvan_der_HartBoonSteele2016" class="citation book cs1">van der Hart O, Boon S, Steele K (2016). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=l_B_DQAAQBAJ&q=Dissociation+boon">Treating Trauma-Related Dissociation: A Practical, Integrative Approach</a>. Norton Series on Interpersonal Neurobiology. <a href="/wiki/Norton_Publishing" class="mw-redirect" title="Norton Publishing">Norton Publishing</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-393-70759-5" title="Special:BookSources/978-0-393-70759-5"><bdi>978-0-393-70759-5</bdi></a> – via <a href="/wiki/Google_Books" title="Google Books">Google Books</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Treating+Trauma-Related+Dissociation%3A+A+Practical%2C+Integrative+Approach&rft.series=Norton+Series+on+Interpersonal+Neurobiology&rft.pub=Norton+Publishing&rft.date=2016&rft.isbn=978-0-393-70759-5&rft.aulast=van+der+Hart&rft.aufirst=Onno&rft.au=Boon%2C+Suzanne&rft.au=Steele%2C+Kathy&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dl_B_DQAAQBAJ%26q%3DDissociation%2Bboon&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFvan_der_Kolk2015" class="citation book cs1">van der Kolk B (2015). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=vHnZCwAAQBAJ">The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma</a>. <a href="/wiki/Penguin_Books" title="Penguin Books">Penguin</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-14-312774-1" title="Special:BookSources/978-0-14-312774-1"><bdi>978-0-14-312774-1</bdi></a> – via <a href="/wiki/Google_Books" title="Google Books">Google Books</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Body+Keeps+the+Score%3A+Brain%2C+Mind%2C+and+Body+in+the+Healing+of+Trauma&rft.pub=Penguin&rft.date=2015&rft.isbn=978-0-14-312774-1&rft.aulast=van+der+Kolk&rft.aufirst=Bessel&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DvHnZCwAAQBAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFvan_der_Kolk2006" class="citation journal cs1">van der Kolk BA (July 2006). "Clinical implications of neuroscience research in PTSD". Annals of the New York Academy of Sciences. 1071 (1): 277–93. <a href="/wiki/Bibcode_(identifier)" class="mw-redirect" title="Bibcode (identifier)">Bibcode</a>:<a rel="nofollow" class="external text" href="https://ui.adsabs.harvard.edu/abs/2006NYASA1071..277V">2006NYASA1071..277V</a>. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1196%2Fannals.1364.022">10.1196/annals.1364.022</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16891578">16891578</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:28935850">28935850</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+the+New+York+Academy+of+Sciences&rft.atitle=Clinical+implications+of+neuroscience+research+in+PTSD&rft.volume=1071&rft.issue=1&rft.pages=277-93&rft.date=2006-07&rft_id=info%3Adoi%2F10.1196%2Fannals.1364.022&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A28935850%23id-name%3DS2CID&rft_id=info%3Apmid%2F16891578&rft_id=info%3Abibcode%2F2006NYASA1071..277V&rft.aulast=van+der+Kolk&rft.aufirst=BA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWalker2013" class="citation book cs1">Walker P (December 2013). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=32AQnwEACAAJ">Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma</a>. CreateSpace Independent Publishing Platform. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4928-7184-2" title="Special:BookSources/978-1-4928-7184-2"><bdi>978-1-4928-7184-2</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Complex+PTSD%3A+From+Surviving+to+Thriving%3A+A+Guide+and+Map+for+Recovering+from+Childhood+Trauma&rft.pub=CreateSpace+Independent+Publishing+Platform&rft.date=2013-12&rft.isbn=978-1-4928-7184-2&rft.aulast=Walker&rft.aufirst=Pete&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D32AQnwEACAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComplex+post-traumatic+stress+disorder" class="Z3988"></li></ul> </div> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(10)"><h2 id="External_links">External links</h2> <a role="button" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=edit&section=23" title="Edit section: External links" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-10 collapsible-block" id="mf-section-10"> <ul><li><a rel="nofollow" class="external text" href="https://www.apa.org/ptsd-guideline/">APA practice parameters for assessment and treatment for PTSD (Updated 2017)</a></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl 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href="https://en.wikipedia.org/w/index.php?title=Complex_post-traumatic_stress_disorder&oldid=1254892100">https://en.wikipedia.org/w/index.php?title=Complex_post-traumatic_stress_disorder&oldid=1254892100</a>"</div></div> </div> <div class="post-content" id="page-secondary-actions"> </div> </main> <footer class="mw-footer minerva-footer" role="contentinfo"> <a class="last-modified-bar" href="/w/index.php?title=Complex_post-traumatic_stress_disorder&action=history"> <div class="post-content last-modified-bar__content"> Last edited on 2 November 2024, at 05:28 </div> </a> <div class="post-content footer-content"> <div id='mw-data-after-content'> <div class="read-more-container"></div> </div> <div id="p-lang"> <h4>Languages</h4> <section> <ul id="p-variants" class="minerva-languages"></ul> <ul class="minerva-languages"><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A7%D8%B6%D8%B7%D8%B1%D8%A7%D8%A8_%D8%A7%D9%84%D9%83%D8%B1%D8%A8_%D8%A7%D9%84%D8%AA%D8%A7%D9%84%D9%8A_%D9%84%D9%84%D8%B5%D8%AF%D9%85%D8%A9_%D8%A7%D9%84%D9%85%D8%B9%D9%82%D8%AF" title="اضطراب الكرب التالي للصدمة المعقد – Arabic" lang="ar" hreflang="ar" data-title="اضطراب الكرب التالي للصدمة المعقد" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Ekstrem_stressforstyrrelse" title="Ekstrem stressforstyrrelse – Danish" lang="da" hreflang="da" data-title="Ekstrem stressforstyrrelse" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target">Dansk</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Komplexe_posttraumatische_Belastungsst%C3%B6rung" title="Komplexe posttraumatische Belastungsstörung – German" lang="de" hreflang="de" data-title="Komplexe posttraumatische Belastungsstörung" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Trastorno_de_estr%C3%A9s_postraum%C3%A1tico_complejo" title="Trastorno de estrés postraumático complejo – Spanish" lang="es" hreflang="es" data-title="Trastorno de estrés postraumático complejo" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Trouble_de_stress_post-traumatique_complexe" title="Trouble de stress post-traumatique complexe – French" lang="fr" hreflang="fr" data-title="Trouble de stress post-traumatique complexe" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D4%B2%D5%A1%D6%80%D5%A4_%D5%B0%D5%A5%D5%BF%D5%BF%D6%80%D5%A1%D5%BE%D5%B4%D5%A1%D5%BF%D5%AB%D5%AF_%D5%BD%D5%A9%D6%80%D5%A5%D5%BD%D5%A1%D5%B5%D5%AB%D5%B6_%D5%AD%D5%A1%D5%B6%D5%A3%D5%A1%D6%80%D5%B8%D6%82%D5%B4" title="Բարդ հետտրավմատիկ սթրեսային խանգարում – Armenian" lang="hy" hreflang="hy" data-title="Բարդ հետտրավմատիկ սթրեսային խանգարում" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Gangguan_stres_pascatrauma_kompleks" title="Gangguan stres pascatrauma kompleks – Indonesian" lang="id" hreflang="id" data-title="Gangguan stres pascatrauma kompleks" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Disturbo_da_stress_post-traumatico_complesso" title="Disturbo da stress post-traumatico complesso – Italian" lang="it" hreflang="it" data-title="Disturbo da stress post-traumatico complesso" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%94%D7%A4%D7%A8%D7%A2%D7%94_%D7%A4%D7%95%D7%A1%D7%98-%D7%98%D7%A8%D7%90%D7%95%D7%9E%D7%98%D7%99%D7%AA_%D7%9E%D7%95%D7%A8%D7%9B%D7%91%D7%AA" title="הפרעה פוסט-טראומטית מורכבת – Hebrew" lang="he" hreflang="he" data-title="הפרעה פוסט-טראומטית מורכבת" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Complexe_posttraumatische_stressstoornis" title="Complexe posttraumatische stressstoornis – Dutch" lang="nl" hreflang="nl" data-title="Complexe posttraumatische stressstoornis" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E8%A4%87%E9%9B%91%E6%80%A7PTSD" title="複雑性PTSD – Japanese" lang="ja" hreflang="ja" data-title="複雑性PTSD" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Perturba%C3%A7%C3%A3o_de_estresse_p%C3%B3s-traum%C3%A1tico_complexo" title="Perturbação de estresse pós-traumático complexo – Portuguese" lang="pt" hreflang="pt" data-title="Perturbação de estresse pós-traumático complexo" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%BF%D0%BB%D0%B5%D0%BA%D1%81%D0%BD%D0%BE%D0%B5_%D0%BF%D0%BE%D1%81%D1%82%D1%82%D1%80%D0%B0%D0%B2%D0%BC%D0%B0%D1%82%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%BE%D0%B5_%D1%81%D1%82%D1%80%D0%B5%D1%81%D1%81%D0%BE%D0%B2%D0%BE%D0%B5_%D1%80%D0%B0%D1%81%D1%81%D1%82%D1%80%D0%BE%D0%B9%D1%81%D1%82%D0%B2%D0%BE" title="Комплексное посттравматическое стрессовое расстройство – Russian" lang="ru" hreflang="ru" data-title="Комплексное посттравматическое стрессовое расстройство" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Komplext_posttraumatiskt_stressyndrom" title="Komplext posttraumatiskt stressyndrom – Swedish" lang="sv" hreflang="sv" data-title="Komplext posttraumatiskt stressyndrom" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E8%A4%87%E9%9B%9C%E6%80%A7%E5%89%B5%E5%82%B7%E5%BE%8C%E5%A3%93%E5%8A%9B%E7%97%87%E5%80%99%E7%BE%A4" title="複雜性創傷後壓力症候群 – Chinese" lang="zh" hreflang="zh" data-title="複雜性創傷後壓力症候群" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target">中文</a></li></ul> </section> </div> <div class="minerva-footer-logo"><img src="/static/images/mobile/copyright/wikipedia-wordmark-en.svg" alt="Wikipedia" width="120" height="18" style="width: 7.5em; height: 1.125em;"/> </div> <ul id="footer-info" class="footer-info hlist hlist-separated"> <li id="footer-info-lastmod"> This page was last edited on 2 November 2024, at 05:28 (UTC).</li> <li id="footer-info-copyright">Content is available under <a 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