複雜性創傷後壓力症候群：修订间差异
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{{NoteTA |G1=ME|G2=Psychology}}
{{Translating|[[:en:complex post-traumatic stress disorder]]||time=2020-08-02T01:07:53+00:00}}
{{medical}}
C-PTSD也被稱為DESNOS或其他未指定的極端壓力障礙。<ref>{{Cite journal |last1=Luxenberg |first1=Toni |last2=Spinazzola |first2=Joseph |last3=Van der Kolk |first3=Bessel |name-list-format=vanc |date=November 2001 |title=Complex trauma and disorders of extreme stress (DESNOS) diagnosis, part one: Assessment |journal=Directions in Psychiatry |volume=21 |pages=22 |url=https://complextrauma.org/wp-content/uploads/2019/01/CPTSD-1-Joseph-Spinazzola.pdf |access-date=2020-08-02 |archive-date=2020-01-11 |archive-url=https://web.archive.org/web/20200111170850/https://complextrauma.org/wp-content/uploads/2019/01/CPTSD-1-Joseph-Spinazzola.pdf |dead-url=no }}</ref>
一些研究人員認為，C-PTSD與[[創傷後壓力症候群|PTSD]]、{{link-en|身體化症|somatization disorder}}、[[解離性身份疾患]]和[[邊緣性人格障礙]]不同但相似。<ref name="TAR">{{cite book| first = Judith L. | last = Herman | name-list-format = vanc |title=Trauma and Recovery: The Aftermath of Violence--From Domestic Abuse to Political Terror|url=https://archive.org/details/traumarecovery00herm_0| url-access = registration |access-date=29 October 2012|date=30 May 1997|publisher=Basic Books|isbn=978-0-465-08730-3}}</ref> 其主要差異是個人核心[[自我概念|自我認同]]的扭曲和嚴重的{{link-en|情緒失調|emotional dysregulation}}。<ref name = "Brewin_2017">{{cite journal | vauthors = Brewin CR, Cloitre M, Hyland P, Shevlin M, Maercker A, Bryant RA, Humayun A, Jones LM, Kagee A, Rousseau C, Somasundaram D, Suzuki Y, Wessely S, van Ommeren M, Reed GM | display-authors = 6 | title = A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD | journal = Clinical Psychology Review | volume = 58 | pages = 1–15 | date = December 2017 | pmid = 29029837 | doi = 10.1016/j.cpr.2017.09.001 | url = http://mural.maynoothuniversity.ie/11577/1/Hyland_Review_2017.pdf | access-date = 2020-08-02 | archive-date = 2020-03-05 | archive-url = https://web.archive.org/web/20200305151304/http://mural.maynoothuniversity.ie/11577/1/Hyland_Review_2017.pdf | dead-url = no }}</ref> 美國精神病學家和學者{{link-en|朱迪思·赫爾曼（Judith Herman）|Judith Herman}}於1992年在她的《創傷與復
在世界衛生組織（WHO）[[國際疾病與相關健康問題統計分類]]的第11版（[[ICD-11]]）中收錄了該疾病。將C-PTSD標準納入[[精神疾病診斷與統計手冊]]（DSM）之提案尚未通過[[美國精神病學協會]]（APA）的私人批准委員會批准。複雜性創傷後壓力症候群也獲得[[美國退伍軍人事務部]]（VA），{{link-en|澳大利亞衛生直轄區|Healthdirect Australia}}（HDA）和[[國民保健署|國家衛生局]]（NHS）認可。
==症狀==
===兒童與青少年===
PTSD的診斷最初是為遭受單一創傷事件（例如[[性侵]]）或[[戰爭]]中經歷過創傷的成年人開發的。<ref name = traumacenter>{{cite web | url=http://www.wmich.edu/traumacenter/pdf/Complex%20Trauma%20and%20Developmental%20Trauma%20Disorder1%5D.pdf | title=Complex Trauma And Developmental Trauma Disorder | publisher=National Child Traumatic Stress Network | access-date=14 November 2013 | archive-url=https://web.archive.org/web/20131205105733/http://www.wmich.edu/traumacenter/pdf/Complex%20Trauma%20and%20Developmental%20Trauma%20Disorder1%5D.pdf | archive-date=2013-12-05
* ''依戀''－「存在關係{{link-en|界線|Personal boundaries}}的問題、缺乏信任、[[社會孤立]]、難以感知和回應他人的情緒狀態」
* ''生物學''－「感覺－運動發育障礙、[[感覺統合]]困難、{{link-en|身體化症|Somatization}}和醫療問題增加」
* ''情感或
* ''[[解離 (心理学)|解離]]''－「[[失憶]]、[[人格解體]]、分離獨立的[[意識]]與分離獨立的[[記憶]]、情緒、功能，以及基於情緒的事件記憶受損」
* ''行為控制''－「有[[衝動控制]]、[[侵略 (社會科學)|侵略性]]問題、病理性[[自慰]]等問題和[[睡眠疾患]]」
* ''認知''－「難以集中注意力；各種『[[執行功能]]』的問題，如：[[計畫]]、[[判斷]]、任務啟動力、使用物品、{{link-en|自我監控|self-monitoring}}；難以[[資訊處理|處理新訊息]]；難以集中精力和完成任務；{{link-en|物體恆定感|object constancy}}差；難以思考[[因果關係]]；以及語言發展問題，例如接受訊息與表達的溝通能力間的差距」
* ''自我概念''－「[[自傳]]體敘事斷斷續續，[[身體形象]]混亂，[[自尊]]心低落，羞恥感過強以及自我的負面內在運作模式」
===成人===
患有C-PTSD的成年人有時是在兒童時代開始經歷長時間的人際創傷，而不是在成年時期開始，或者同樣也於成人期遭遇人際創傷。這些早期傷害打斷了對自我和他人強烈的自我意識的發展。由於諸如照顧者或年長的兄弟姐妹之類的依戀對象經常造成身體和情感上的[[痛苦]]或忽視，因此這些人可能會感到自己從根本上存在缺陷，無法依靠他人。<ref name="Herman1992" /><ref name="Zlotnick1996">{{cite journal | vauthors = Zlotnick C, Zakriski AL, Shea MT, Costello E, Begin A, Pearlstein T, Simpson E | title = The long-term sequelae of sexual abuse: support for a complex posttraumatic stress disorder | url = https://archive.org/details/sim_journal-of-traumatic-stress_1996-04_9_2/page/195 | journal = Journal of Traumatic Stress | volume = 9 | issue = 2 | pages = 195–205 | date = April 1996 | pmid = 8731542 | pmc = | doi = 10.1007/BF02110655 }}</ref> 這可能成為成人生活中與他人交往的普遍方式，稱為[[依附理論|不安全依戀]]。在當前的[[DSM-5]]（2013）中，這種症狀既沒有包括在[[解离性障碍|解離性障礙]]的診斷中，也沒有包括在PTSD中。患有複雜性創傷後壓力症候群的人也會表現出持久的人格障礙，同時有顯著的{{link-en|再次受害|Victimisation}}風險。<ref name="Ide2000">{{cite journal | vauthors = Ide N, Paez A | title = Complex PTSD: a review of current issues | journal = International Journal of Emergency Mental Health | volume = 2 | issue = 1 | pages = 43–9 | year = 2000 | pmid = 11232103 }}</ref>
建議以以下六類症狀作為診斷C-PTSD的依據：<ref name="Roth_1997">{{cite journal | vauthors = Roth S, Newman E, Pelcovitz D, van der Kolk B, Mandel FS | title = Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder | url = https://archive.org/details/sim_journal-of-traumatic-stress_1997-10_10_4/page/539 | journal = Journal of Traumatic Stress | volume = 10 | issue = 4 | pages = 539–55 | date = October 1997 | pmid = 9391940 | doi = 10.1002/jts.2490100403 }}</ref><ref name="Pelcovitz1997">{{cite journal | vauthors = Pelcovitz D, van der Kolk B, Roth S, Mandel F, Kaplan S, Resick P | title = Development of a criteria set and a structured interview for disorders of extreme stress (SIDES) | url = https://archive.org/details/sim_journal-of-traumatic-stress_1997-01_10_1/page/3 | journal = Journal of Traumatic Stress | volume = 10 | issue = 1 | pages = 3–16 | date = January 1997 | pmid = 9018674 | doi = 10.1002/jts.2490100103 }}</ref>
* 情緒和衝動調節的改變；
* 注意力或意識的改變；
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==診斷==
{{main|創傷後壓力症候群}}
C-PTSD曾被考慮收錄進DSM-IV，但1994年發布DSM-IV時未將其包括在內。<ref name="TAR" /> 它也沒有收錄在[[DSM-5]]中。[[創傷後壓力症候群]]仍被列為一種疾病。<ref name=dsm5>{{cite web |last=American Psychiatric Association |title=American Psychiatric Association Board of Trustees Approves DSM-5 |url=http://dsmfacts.org/materials/american-psychiatric-association-board-of-trustees-approves-dsm-5/ |publisher=American Psychiatric Association |access-date=30 April 2013
===鑑別診斷===
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====創傷後壓力症候群====
{{main|創傷後壓力症候群}}
創傷後壓力症候群（PTSD）被收錄於[[DSM-III]]（1980）中，這主要是由於[[越南戰爭]]中相對多數的美國前線退伍軍人當時正在尋求對戰鬥壓力的持久影響的療法。在1980年代，各種研究人員和臨床醫生提出，創傷後壓力症候群也可能準確地描述兒童[[性虐待]]和家庭[[虐待]]等創傷的[[後遺症]]。<ref name="Courtois2004">{{Cite journal | vauthors = Courtois DA | title = Complex Trauma, Complex Reactions: Assessment and Treatment | doi = 10.1037/0033-3204.41.4.412 | journal = Psychotherapy: Theory, Research, Practice, Training | volume = 41 | issue = 4 | pages = 412–425 | year = 2004 | pmid = | pmc = | url = http://www.dhss.delaware.gov/dhss/DSAMH/files/si10_1396_article1.pdf | citeseerx = 10.1.1.600.157 | access-date = 2020-08-21 | archive-date = 2020-08-01 | archive-url = https://web.archive.org/web/20200801033827/https://www.dhss.delaware.gov/dhss/DSAMH/files/si10_1396_article1.pdf | dead-url = no }}</ref> 然而，創傷後壓力症候群無法解釋長期虐待情況下經常觀察到的症狀，尤其是
對PTSD的描寫無法描繪C-PTSD的某些核心特徵。包括囚禁感、心理上的破碎狀態、喪失安全感、信任感和自我價值感，以及重覆{{link-en|再次受害|revictimized}}的傾向。最明顯地區別C-PTSD與PTSD的最重要特徵是失去連貫的自我意識以及隨之而來的症狀。<ref name="TAR" />{{rp|199–122}}
C-PTSD的特徵還在於{{link-en|依戀障礙|attachment disorder}}，尤其是強烈蔓延的[[依附理論|不安全感]]或[[依附理論|無組織依戀]]。<ref name="vanderKolkRoth2005">{{cite journal | vauthors = van der Kolk BA, Roth S, Pelcovitz D, Sunday S, Spinazzola J | title = Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma | journal = Journal of Traumatic Stress | volume = 18 | issue = 5 | pages = 389–99 | date = October 2005 | pmid = 16281237 | pmc = | doi = 10.1002/jts.20047 | url = http://www.traumacenter.org/products/pdf_files/specialissuecomplextraumaoct2006jts3.pdf | access-date = 2020-08-21 | archive-date = 2018-06-19 | archive-url = https://web.archive.org/web/20180619095332/http://www.traumacenter.org/products/pdf_files/specialissuecomplextraumaoct2006jts3.pdf | dead-url = no }}</ref> DSM-IV（1994）標準中的[[解离性障碍|解離性障礙]]和PTSD未包括[[依附理論|不安全依戀]]。因此，當一些患有C-PTSD的成人成為家長面對自己的孩子的[[依附理論|依戀需求]]時，儘管這些家長有強烈的意願和盡了最大的努力，他們可能仍難以特別敏感地做出回應，尤其是對他們的嬰幼兒的日常焦慮，例如：日常的[[分離焦慮症|分離焦慮]]。<ref name="Schechter2008">{{cite journal | vauthors = Schechter DS, Coates SW, Kaminer T, Coots T, Zeanah CH, Davies M, Schonfeld IS, Marshall RD, Liebowitz MR, Trabka KA, McCaw JE, Myers MM | display-authors = 6 | title = Distorted maternal mental representations and atypical behavior in a clinical sample of violence-exposed mothers and their toddlers | journal = Journal of Trauma & Dissociation | volume = 9 | issue = 2 | pages = 123–47 | year = 2008 | pmid = 18985165 | pmc = 2577290 | doi = 10.1080/15299730802045666 }}, pp. 123-149</ref> 儘管絕大多數倖存者不會虐待他人<ref name="Kaufman1987">{{cite journal | vauthors = Kaufman J, Zigler E | title = Do abused children become abusive parents? | url = https://archive.org/details/sim_american-journal-of-orthopsychiatry_1987-04_57_2/page/186 | journal = The American Journal of Orthopsychiatry | volume = 57 | issue = 2 | pages = 186–192 | date = April 1987 | pmid = 3296775 | doi = 10.1111/j.1939-0025.1987.tb03528.x }}</ref>，如果患有這種情況的父母及其子女沒有得到適當的治療，這種養育子女的困難可能會對子女的社交和情感發展產生不利影響。<ref name="Schechter2009">{{cite journal | vauthors = Schechter DS, Willheim E | title = Disturbances of attachment and parental psychopathology in early childhood | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 18 | issue = 3 | pages = 665–86 | date = July 2009 | pmid = 19486844 | pmc = 2690512 | doi = 10.1016/j.chc.2009.03.001 }}</ref><ref name="Schechter2007">{{cite journal | vauthors = Schechter DS, Zygmunt A, Coates SW, Davies M, Trabka K, McCaw J, Kolodji A, Robinson J | display-authors = 6 | title = Caregiver traumatization adversely impacts young children's mental representations on the MacArthur Story Stem Battery | journal = Attachment & Human Development | volume = 9 | issue = 3 | pages = 187–205 | date = September 2007 | pmid = 18007959 | pmc = 2078523 | doi = 10.1080/14616730701453762 }}</ref>
因此提出C-PTSD和PTSD的診斷類別的區別。C-PTSD比PTSD更好地描述了長期重複創傷的廣泛負面影響。<ref name="NCPTSD"
C-PTSD也不同於由Gill Straker（1987）引入創傷文獻的連續創傷壓力症候群（英語：Continuous Traumatic Stress Disorder）。<ref>{{cite journal|last=Straker|first=Gillian| name-list-format = vanc |title=The Continuous Traumatic Stress Syndrome. The Single Therapeutic Interview|journal=Psychology in Society|year=1987|issue=8 |pages=46–79}}</ref> 它最初是南非臨床醫生用來描述暴露於常與[[內戰]]和[[政治鎮壓]]相關的頻繁、高度暴力的後果。該術語也適用暴露於[[幫派]][[暴力]]和[[犯罪]]流行的環境中的影響，以及持續暴露於[[警察]]、[[消防]]和緊急服務等高風險職業的生命威脅中的影響。
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====創傷性喪慟====
{{main|喪慟|悲傷輔導}}
創傷性喪慟<ref>{{Cite journal | vauthors = Bonanno GA | title = Is Complicated Grief a Valid Construct? | doi = 10.1111/j.1468-2850.2006.00014.x | journal = Clinical Psychology: Science and Practice | volume = 13 | issue = 2 | pages = 129–134 | year = 2006 | pmid = | pmc = }}</ref><ref>{{cite journal | vauthors = Jacobs S, Mazure C, Prigerson H | title = Diagnostic criteria for traumatic grief | journal = Death Studies | volume = 24 | issue = 3 | pages = 185–99 | year = 2000 | pmid = 11010626 | pmc = | doi = 10.1080/074811800200531 }}</ref><ref name="Ambrose">{{cite web | url = http://www.restoringconnections.ca/assets/pdf/ambrose_traumatic_grief.pdf | title = Traumatic Grief: What We Need to Know as Trauma Responders | last = Ambrose | first = Jeannette | name-list-format = vanc | accessdate = 2020-08-31 | archive-date = 2017-07-28 | archive-url = https://web.archive.org/web/20170728120222/http://www.restoringconnections.ca/assets/pdf/ambrose_traumatic_grief.pdf | dead-url = no }}</ref><ref name="Figley1997">{{cite book|first=Charles|last=Figley|name-list-format=vanc|title=Death And Trauma: The Traumatology Of Grieving|url=https://books.google.com/books?id=oxwdm5tA59EC|access-date=28 October 2012|date=1 April 1997|publisher=Taylor & Francis|isbn=978-1-56032-525-3|archive-date=2020-07-29|archive-url=https://web.archive.org/web/20200729152703/https://books.google.com/books?id=oxwdm5tA59EC|dead-url=no}}</ref>或複雜性哀悼<ref name="Rando1993">{{cite book|first=Therese A.|last=Rando|name-list-format=vanc|title=Treatment of complicated mourning|url=https://books.google.com/books?id=wXBHAAAAMAAJ|access-date=28 October 2012|date=February 1993|publisher=Research Press|isbn=978-0-87822-329-9|archive-date=2020-07-29|archive-url=https://web.archive.org/web/20200729153108/https://books.google.com/books?id=wXBHAAAAMAAJ|dead-url=no}}</ref>為[[創傷]]和[[喪慟]]同時發生的狀況。<ref name="Rando1994">{{Cite book|last=Rando|first=Therese A.|name-list-format=vanc|title=Dying, death, and bereavement: theoretical perspectives and other ways of knowing|url=https://books.google.com/books?id=6Q3XAAAAMAAJ|access-date=28 October 2012|date=1 January 1994|publisher=Jones and Bartlett|isbn=978-0-86720-631-9|pages=253–271|contribution=Complications in Mourning Traumatic Death.|editor-last=Corless|editor-first=Inge B.|editor2-last=Germino|editor2-first=Barbara B.|editor3-last=Pittman|editor3-first=Mary|archive-date=2020-07-29|archive-url=https://web.archive.org/web/20200729150946/https://books.google.com/books?id=6Q3XAAAAMAAJ|dead-url=no}}</ref> 創傷與喪親之間存在概念上的聯繫，因為失去親人本身就是創傷。<ref name="Green2000">{{Cite journal | vauthors = Green BL | doi = 10.1080/10811440008407845 | title = Traumatic Loss: Conceptual and Empirical Links Between Trauma and Bereavement | journal = Journal of Personal and Interpersonal Loss | volume = 5 | pages = 1–17| year = 2000 | pmid = | pmc = }}</ref> 如果創傷事件{{link-en|危及生命|lethality}}，但沒有導致[[死亡]]，倖存者更可能經歷[[創傷後壓力症候群|創傷後壓力症狀]]。若有人死亡，且倖存者與其關係親近，也可能同時形成[[喪慟]]的症狀。當親人突然死亡或因暴力而死亡，兩種症狀將同時出現。這可能發生在遭受社區暴力的兒童身上。<ref name="PynoosNader1988">{{Cite journal | vauthors = Pynoos RS, Nader K | doi = 10.1002/jts.2490010406 | title = Psychological first aid and treatment approach to children exposed to community violence: Research implications | url = https://archive.org/details/sim_journal-of-traumatic-stress_1988-10_1_4/page/445 | journal = Journal of Traumatic Stress | volume = 1 | issue = 4 | pages = 445–473 | year = 1988 | pmid = | pmc = }}</ref><ref name = "NCTSNFirstAid">{{cite web |url=http://nctsnet.org/nctsn_assets/pdfs/edu_materials/psychological_1st_aid.pdf |title=Psychological First Aid |publisher=National Child Traumatic Stress Network |work=Adapted from Pynoos RS, Nader K (1988) |access-date=2012-10-29 |archive-url=https://web.archive.org/web/20160304033259/http://nctsnet.org/nctsn_assets/pdfs/edu_materials/psychological_1st_aid.pdf |archive-date=2016-03-04
於囚禁、失去控制和喪失權力的情況下遭受暴力，並同時在危及生命的情況下遭遇朋友或親人死亡時，C-PTSD將表現出創傷性喪慟。對於經歷長期[[家庭暴力]]或長期[[社區暴力]]並最終導致朋友和親人死亡的兒童和繼子女，這很可能再次發生。[[繼子女]]遭受暴力和死亡風險增加的現象稱為「[[灰姑娘效應]]」。
====與邊緣性人格障礙的差異和相似之處====
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</blockquote>
然而，研究人員發現C-PTSD和BPD是完全不同的疾病，具有不同的特徵。值得注意的是，C-PTSD不是人格障礙。那些患有C-PTSD的人不懼怕被遺棄或關係不穩定。相反地，他們退出關係了。他們不因缺乏同理心而掙扎。<ref>{{cite journal | vauthors = Golier JA, Yehuda R, Bierer LM, Mitropoulou V, New AS, Schmeidler J, Silverman JM, Siever LJ | s2cid = 29404130 | display-authors = 6 | title = The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events | url = https://archive.org/details/sim_american-journal-of-psychiatry_2003-11_160_11/page/2018 | journal = The American Journal of Psychiatry | volume = 160 | issue = 11 | pages = 2018–24 | date = November 2003 | pmid = 14594750 | doi = 10.1176/appi.ajp.160.11.2018 }}</ref> 邊緣性人格障礙與C-PTSD之間存在大量明顯差異，儘管兩者之間存在一些相似之處－－主要是依戀問題（儘管以完全不同的方式發揮作用），以及難以調節強烈的情感效果（通常會鮮明地感到痛苦），但這些疾病本質上是完全不同的－－特別是考慮到C-PTSD始終是對創傷的反應，而不是人格障礙。
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儘管BPD案例報告了許多PTSD和CPTSD的症狀，但BPD診斷類別對其特有症狀的認定方面顯然截然不同。表5中顯示的RR比率高度顯示以下症狀屬於BPD而不是CPTSD診斷類別：（1）瘋狂努力以避免真實或想像中的被遺棄，（2）不穩定而且緊張的人際模式，特徵為在過度理想化，以及否定其價值兩極端之間變換，（3）自我形象或自我感受持續明顯不穩定，（4）衝動。有自殺或自殘的嚴重性。請注意，自殺和自傷行為也存在顯著差異，BPD診斷類別中約有50％的人報告有該症狀，但CPTSD和PTSD診斷類別中這一現象要少得多且數量相當（分別為14.3％和16.7％）。BPD診斷類別中的案例和CPTSD診斷類別中的案例唯一沒有差異的症狀是長期的空虛感，這表明在此樣本中，該症狀並非BPD或CPTSD所特有，且不能區分它們。
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另外，被診斷出患有BPD的人中有25％沒有兒童期被忽視或虐待的病史，如果他們的親屬被診斷為BPD，則其患BPD的可能性是未患該病的人的六倍。一種結論是，BPD有遺傳傾向與創傷無關。對同卵雙胞胎進行縱向研究的研究人員發現「在西方社會中，決定邊緣性人格障礙特徵的個人差異的主要因素是遺傳」。<ref name ="Distel2008">{{cite journal | vauthors = Distel MA, Trull TJ, Derom CA, Thiery EW, Grimmer MA, Martin NG, Willemsen G, Boomsma DI | display-authors = 6 | title = Heritability of borderline personality disorder features is similar across three countries | journal = Psychological Medicine | volume = 38 | issue = 9 | pages = 1219–29 | date = September 2008 | pmid = 17988414 | pmc = | doi = 10.1017/S0033291707002024 | url = http://dare.ubvu.vu.nl/bitstream/handle/1871/17379/Distel_Psychological%20Medicine_38%289%29_2008_u.pdf | hdl = 1871/17379 | access-date = 2020-09-12 | archive-date = 2016-03-04 | archive-url = https://web.archive.org/web/20160304083847/http://dare.ubvu.vu.nl/bitstream/handle/1871/17379/Distel_Psychological%20Medicine_38(9)_2008_u.pdf | dead-url = no }}</ref> 一份2014年發表於《歐洲精神創傷學雜誌》的研究比較CPTSD、PTSD和邊緣性人格障礙的異同，並發現可辨別它們各自的個案，且主張當共病存在時對每種病症給出獨立的診斷。<ref name = "Cloitre_2014" /> 在沒有適當了解這兩種情況的情況下，某些人可能會混淆BPD與C-PTSD，因為患有BPD的人也多半同時患有PTSD或一定的創傷史。
赫爾曼在《創傷與復原》中表達了對C-PTSD時常被繼承性的誤認為[[依賴型人格障礙]]、[[受虐狂]]、[[自我挫敗人格障礙]]的憂慮，並將這種態度與歷史上對
==治療==
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由PTSD衍生的心理療法對幫助患有C-PTSD的兒童的實用性尚不確定。在診斷和治療領域，使用C-PTSD類別時需要注意。朱利安·福特（Julian Ford）和貝索·馮·德·克洛（Bessel van der Kolk）博士提出，C-PTSD對診斷和治療兒童可能不如特為兒童而設的發育創傷症候群（DTD）那樣有用<ref name= "Ford_2009" />{{rp|60}} 根據庫圖瓦（Courtois）和福特，要開出DTD診斷患者必須
<blockquote>
經歷過早期生命發展不良的人際交往創傷的歷史，例如：性虐待、肢體虐待、暴力、對個人而言重要、崩潰性的創傷性喪失或主要照顧者背叛與兒童的關係，這被認為是複雜性創傷後壓力症候群的病理基礎。診斷、治療計劃和結果永遠互相關聯。<ref name= "Ford_2009">{{cite book | first1 = Julian D. | last1 = Ford | first2 = Marylene | last2 = Cloitre | chapter = Chapter 3: Best Practices in Psychotherapy for Children and Adolescents |editor-last1=Courtois |editor-first1=Christine A. |editor-last2=Herman |editor-first2=Judith Lewis | name-list-format = vanc |title=Treating complex traumatic stress disorders : an evidence-based guide | url = https://archive.org/details/treatingcomplext0000unse_t4e3 |date=2009 |publisher=Guilford Press |isbn=978-1-60623-039-8 |page=[https://archive.org/details/treatingcomplext0000unse_t4e3/page/60 60] |edition=1st}}</ref>
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複雜的創傷表現往往被排除在研究之外，因為它們不符合研究力量所需的簡單疾病分類學分類。無論是目前還是在歷史上，在個人層面和社會面上，「不承認虐待兒童對大腦發育的嚴重影響，導致提供的治療服務不足。將新出現的關於逆境經驗的情感神經科學納入治療模式，可以將重點從自上而下的調節轉向自下而上的、基於身體的處置，從而有助於糾正這種平衡」。<ref>{{cite journal | vauthors = Corrigan FM, Hull AM | title = Neglect of the complex: why psychotherapy for post-traumatic clinical presentations is often ineffective | journal = BJPsych Bulletin | volume = 39 | issue = 2 | pages = 86–9 | date = April 2015 | pmid = 26191439 | pmc = 4478904 | doi = 10.1192/pb.bp.114.046995 }}</ref>
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====建議的治療方式和干預措施====
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==外部連結==
*[https://freeryou.com/2126/cptsd/ CPTSD介紹與創傷反應類型4F] {{Wayback|url=https://freeryou.com/2126/cptsd/ |date=20220707043114 }}
*{{dmoz|Health/Mental_Health/Disorders/Anxiety/Post-traumatic_Stress/|創傷後症候群}}
* [http://www.apa.org/ptsd-guideline/ APA practice parameters for assessment and treatment for PTSD (Updated 2017)]{{Wayback|url=http://www.apa.org/ptsd-guideline/ |date=20200801081936 }}
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{{Borderline personality disorder}}
{{abuse}}
{{ICD-11-06}}
{{DEFAULTSORT:複雜性創傷後壓力症候群}}
[[Category:創傷學]]
[[Category:
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