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 | dead-url=yes }}</ref> 但是，許多孩子的情況截然不同。兒童可能會遭受長期創傷，例如：[[虐待]]、[[家庭暴力]]、[[機能不全家庭|家庭失能]]（英語：dysfunction），和可能包括和主要照顧者的[[依附理論|依戀]]中斷。<ref name = Ford>{{cite journal | vauthors = Ford JD, Grasso D, Greene C, Levine J, Spinazzola J, van der Kolk B | title = Clinical significance of a proposed developmental trauma disorder diagnosis: results of an international survey of clinicians | url = https://archive.org/details/sim_journal-of-clinical-psychiatry_2013-08_74_8/page/841 | journal = The Journal of Clinical Psychiatry | volume = 74 | issue = 8 | pages = 841–9 | date = August 2013 | pmid = 24021504 | doi = 10.4088/JCP.12m08030 }}</ref> 大部分情況是孩子的照顧者造成創傷。<ref name = traumacenter/> PTSD診斷未考慮兒童發育階段如何影響其症狀以及創傷如何影響兒童的成長。<ref name = traumacenter/> '''發育創傷症候群'''（英語：developmental trauma disorder，縮寫為DTD）一詞被提議視為兒童期的C-PTSD。<ref name = Ford/> 這種創傷的發展方式使兒童處於患精神和醫學疾病的風險中。<ref name = Ford/> {{link-en|貝索·馮·德·克洛|Bessel van der Kolk}}博士將DTD解釋為遭遇許多[[人際]]創傷，例如：人身傷害、性傷害、[[暴力]]或[[死亡]]。也可以透過主觀事件，如：{{link-en|遺棄|Abandonment (emotional)}}，[[背叛]]，失敗或[[羞恥]]造成。<ref name=":0">{{cite web | url=http://www.traumacenter.org/products/Developmental_Trauma_Disorder.pdf | title=Developmental trauma disorder | publisher=Psychiatric Annals | year=2005 | access-date=14 November 2013 | vauthors=van der Kolk B | pages=401–408 | archive-date=2017-11-16 | archive-url=https://web.archive.org/web/20171116131957/http://www.traumacenter.org/products/Developmental_Trauma_Disorder.pdf | dead-url=no }}</ref> 在兒童時期反覆遭受創傷將導致不同於PTSD的症狀。<ref name=":0" /> 庫克等人在七個方面描述了其症狀和行為特徵：<ref name="NCTSNWhitePaper">{{Cite book | editor-last = Cook | editor-first = Alexandra | editor2-last = Blaustein | editor2-first = Margaret | editor3-last = Spinazzola | editor3-first = Joseph | editor4-last = van der Kolk | editor4-first = Bessel | name-list-format = vanc | date = 2003 | title = Complex Trauma in Children and Adolescents: White Paper from the National Child Traumatic Stress Network, Complex Trauma Task Force | publisher = National Child Traumatic Stress Network | url = http://nursebuddha.files.wordpress.com/2011/12/complex-trauma-in-children.pdf | access-date = 2013-11-14 | archive-date = 2014-07-14 | archive-url = https://web.archive.org/web/20140714235620/http://nursebuddha.files.wordpress.com/2011/12/complex-trauma-in-children.pdf | dead-url = no }}</ref><ref name="Cook2005" />
* ''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」
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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}}
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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 |dead-url=yes }}</ref>
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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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>
</blockquote>
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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]]
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