Trauma: Complex PTSD

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Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

One of the factors of PTSD is that some people seem to have severe cases while others do not. In fact, whether in Iraq or Afghanistan, some soldiers were more vulnerable to extreme trauma and stress than others. As an explanation for some of these complications it has been suggested and researched that there is a form of PTSD that is called DESNOS. DESNOS stands for Disorders of Extreme Stress Not Otherwise Specified. Another and similar term is C-PTSD or Complex-PTSD.

There is a wide difference between PTSD and DESNOS. PTSD results from and extreme trauma such as what happens in a hurricane, earthquake, trauma experienced in war. PTSD is bad enough but DESNOS is even worse than that. DESNOS results from repeated and long term trauma. In other words, the  negative experiences are prolonged and repeated. The victim is at the mercy of a perpetrator and cannot get away from the situation. The perpetrator can be a parent or parents, criminal or any variety of other people.


Some of the types of trauma that contribute to DESNOS are:

1. Concentration Camps

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2. Prisoner of War Camps

3. Prostitution and Living in Brothels

4. Long Term Domestic Violence

5. Long Term Child Physical Abuse

6. Long Term Sexual Abuse

7. Organized Exploitation of Children

It’s important to understand that the effects of Complex PTSD fall into the three main categories of the Bio-Psycho-Social sphere. In other words the impact is so complete the it affects every aspect of life. Some of the symptoms of this disorder are:

*Substance abuse

*Enduring change in Personality

*Difficulty regulating and controlling emotions: depression, sadness, suicidal thoughts, explosive anger.

*Social isolation, distrust of others, repeated search for a rescuer and more.

*Being preoccupied with thoughts about the perpetrator, fantasies of revenge and other distortions.

*Feelings of shame, guilt helplessness and a sense of being different from other people.

*Feeling detached or dissociated from life and from other people. Also, reliving traumatic events.

*Self mutilation and other forms of self harm.

*Multiple physical symptoms including vulnerability to all types of illnesses.

There are treatments for DESNOS and they are similar as those for PTSD. However, symptoms are more persistent and difficult to treat. One of the goals of treatment is to help the patient to gain a sense of control over their lives and over their emotions.

There is debate over whether DESNOS is a separate category of diagnosis or comes under that for PTSD. Therefore, it is not as yet listed in the DSM IV, the manual used by psychiatrists and other mental health professionals to diagnose patients.

Do you know someone with DESNOS or with PTSD? Your comments, questions and observations are welcome.

Allan N. Schwartz, PhD

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