複雜性創傷後壓力症候群：修订间差异
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完成成人章節譯文 增加診斷一章譯文、部分創傷後壓力症候群小節譯文 修飾語句 維護清理 标签：新用户加入疑似宣传性内容 |
維基化 維護清理 修飾語句 完成創傷後壓力症候群和創傷性喪慟小節 增加與邊緣性人格障礙的差異和相似之處一節部分翻譯 |
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===成人===
患有C-PTSD的成年人有時會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，或者也同樣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 | 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
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 | 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) | journal = Journal of Traumatic Stress | volume = 10 | issue = 1 | pages = 3–16 | date = January 1997 | pmid = 9018674 | doi = 10.1002/jts.2490100103 }}</ref>
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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{{link-en|後遺症|sequela}}。<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 }}</ref> 然而
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 }}</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? | 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>
====創傷性悲傷====▼
====與邊緣性人格障礙的差異和相似之處====▼
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">{{cite web |url=http://www.ptsd.va.gov/professional/PTSD-overview/complex-ptsd.asp |title=Complex PTSD |year=2007 |publisher=[[United States Department of Veterans Affairs]] |work=www.ptsd.va.gov (National Center for PTSD)}}</ref> PTSD可以與C-PTSD並存，但是，僅對PTSD進行診斷通常不能充分囊括那些經歷了長期創傷經歷的人所經歷的症狀廣度，因此C-PTSD拓展了PTSD的診斷範圍。<ref name="Herman1992" />
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。
{{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 }}</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}}</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}}</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 }}</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 | 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 |url-status=dead }}</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將表現出創傷性的悲痛。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====
{{main|依附理論|邊緣性人格障礙}}
C-PTSD可能與創傷後壓力症候群和[[邊緣性人格障礙]]有共同的症狀。<ref name="vanderKolkCourtois2005">{{cite journal | vauthors = van der Kolk BA, Courtois CA | title = Editorial comments: Complex developmental trauma | journal = Journal of Traumatic Stress | volume = 18 | issue = 5 | pages = 385–8 | date = October 2005 | pmid = 16281236 | pmc = | doi = 10.1002/jts.20046 | url = http://afosterdissertation.wikispaces.com/file/view/van+der+Kolk_Editorial+Comments_2005.pdf }}</ref> 但是，有充足的證據區別C-PTSD與邊緣性人格障礙。
==治療==
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==外部連結==
*[https://freeryou.com/2126/cptsd/ CPTSD介紹與創傷反應類型
*{{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)]
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