複雜性創傷後壓力症候群：修订间差异
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{{Translating|[[:en:complex post-traumatic stress disorder]]||time=2020-08-02T01:07:53+00:00}}
'''複雜性創傷後壓力症候群'''（英語：complex post-traumatic stress disorder，縮寫為C-PTSD，也稱為複雜性創傷症候群）<ref name="Cook2005">{{cite journal | author = Cook, A. |author2=Blaustein, M. |author3=Spinazzola, J. |author4=Van Der Kolk, B. | year = 2005 | title = Complex trauma in children and adolescents | journal = Psychiatric Annals | volume = 35 | issue = 5 | pages = 390–398 | url = http://doi.apa.org/?uid=2005-05449-004 | accessdate = 2008-03-29|doi=10.3928/00485713-20050501-05 }}</ref>是一種心理疾病，可能在個人很少或沒有機會逃脫的情況下，因長期反复的人際[[創傷]]經歷而形成。<ref>{{Cite book|title=Keep pain in the past : getting over trauma, grief and the worst that's ever happened to you|last1 = Cortman | first1 = Christopher| last2 = Walden | first2 = Joseph | name-list-format = vanc |isbn=978-1-63353-810-8|location=Coral Gables, FL|oclc=1056250299|date = 2018-10-15}}</ref>C-PTSD與[[精神障礙]]的{{link-en|創傷模型|trauma model of mental disorders}}有關，也和長期持續的[[性]]、[[心理]]與{{link-en|自戀型（兒童）虐待|narcissistic (child) abuse}}和[[身體虐待]]或{{link-en|忽視|neglect}}、長期{{link-en|親密伴侶暴力|intimate partner violence}}、長期的職場或校園[[霸凌]]的受害者<ref>{{cite journal | vauthors = Hyland P, Murphy J, Shevlin M, Vallières F, McElroy E, Elklit A, Christoffersen M, Cloitre M | display-authors = 6 | title = Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms | journal = Social Psychiatry and Psychiatric Epidemiology | volume = 52 | issue = 6 | pages = 727–736 | date = June 2017 | pmid = 28194504 | doi = 10.1007/s00127-017-1350-8 | url = http://mural.maynoothuniversity.ie/11571/1/Hyland_Variation_2017.pdf | access-date = 2020-08-02 | archive-date = 2020-01-11 | archive-url = https://web.archive.org/web/20200111101303/http://mural.maynoothuniversity.ie/11571/1/Hyland_Variation_2017.pdf | dead-url = no }}</ref><ref>{{cite journal | vauthors = Ho GW, Karatzias T, Cloitre M, Chan AC, Bressington D, Chien WT, Hyland P, Shevlin M | display-authors = 6 | title = Translation and validation of the Chinese ICD-11 International Trauma Questionnaire (ITQ) for the Assessment of Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) | journal = European Journal of Psychotraumatology | volume = 10 | issue = 1 | pages = 1608718 | date = 2019-12-31 | pmid = 31143410 | pmc = 6522970 | doi = 10.1080/20008198.2019.1608718 }}</ref>、[[綁架]]和[[人質]]情況的受害者、{{link-en|契約奴隸|Indentured servitude}}、[[奴隸制]]和[[人口販運]]的受害者、[[血汗工廠]]工人、[[戰俘]]、[[集中營]]倖存者、[[寄宿學校|住宿學校]]倖存者、以及[[邪教]]組織或類似邪教組織的脫離者有關聯。<ref>{{cite journal | vauthors = Stein JY, Wilmot DV, Solomon Z | title = Does one size fit all? Nosological, clinical, and scientific implications of variations in PTSD Criterion A | journal = Journal of Anxiety Disorders | volume = 43 | pages = 106–117 | date = October 2016 | pmid = 27449856 | doi = 10.1016/j.janxdis.2016.07.001 }}</ref> 涉及被囚禁/誘騙的情況（缺乏為受害者提供可望成功的逃生路線或逃生感的一種情況）可能導致類似C-PTSD的症狀，其中包括長期的恐懼感，無價值感，[[習得性失助|無助感]]以及個人的自我認同和自我感受的變形。<ref name="TAR" />
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 |
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《創傷與復原》（英語：Trauma and Recovery）一書以及隨附的文章中首次描述了這種疾病。<ref name="TAR" /><ref name="Herman1992">{{Cite journal | vauthors = Herman JL | title = Complex PTSD: A syndrome in survivors of prolonged and repeated trauma | doi = 10.1007/BF00977235 | journal = Journal of Traumatic Stress | volume = 5 | issue = 3 | pages = 377–391 | year = 1992 | pmid = | pmc = | url = http://202.68.89.83/NR/rdonlyres/D4D172A3-372C-4EC9-B27C-16CC2FF079C7/119065/49SCJE_EVI_00DBHOH_BILL9236_1_A15599_CooperLegalBa.pdf }}{{Dead link|date=July 2019 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>{{cite journal | vauthors = van der Hart O, Nijenhuis ER, Steele K | title = Dissociation: An insufficiently recognized major feature of complex posttraumatic stress disorder | journal = Journal of Traumatic Stress | volume = 18 | issue = 5 | pages = 413–23 | date = October 2005 | pmid = 16281239 | doi = 10.1002/jts.20049 | url = http://www.onnovdhart.nl/wp-content/uploads/2008/09/jts_complex_%20ptsd.pdf }}</ref>
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。
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==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=
* ''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」
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* 意義系統的改變。<ref name="Pelcovitz1997" />
這些領域的經歷可能包括：<ref name="TAR" />{{rp|199–122}}<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) |accessdate=2020-08-17 |archive-date=2020-08-01 |archive-url=https://web.archive.org/web/20200801004705/https://www.ptsd.va.gov/professional/PTSD-overview/complex-ptsd.asp |dead-url=no }}</ref>
* {{link-en|情緒調節|Emotional dysregulation}}的變化，包括：持續的[[煩躁|煩躁不安]]，長期的[[自殺]]念頭，[[自殘]]，爆炸性或極度壓抑的憤怒（可能交替出現）以及強迫性或極度壓抑的性行為（可能交替出現）等經歷。
* 意識變化，例如：[[失憶症]]或對創傷事件增強的回憶、一系列[[解離_(心理学)|解離]]症狀、[[人格解體]]／[[失實症]]，和暫時性的回到過往經歷（可能為侵入性的PTSD症狀或反芻性的意念）。
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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 |url-status=dead |archive-url=https://web.archive.org/web/20130504075409/http://dsmfacts.org/materials/american-psychiatric-association-board-of-trustees-approves-dsm-5/ |archive-date=
===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{{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 | 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{{link-en|照顧者|caregivers}}對[[兒童]]在多個[[童年|童年]]和[[青少年]]發育階段所施行的虐待。這類患者通常極難以當時已知的方法治療。<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>
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? | 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">{{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" />
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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|
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]]」。
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====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]]（英語：borderline personality disorder，縮寫為BPD）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 | access-date = 2020-08-31 | archive-date = 2016-03-04 | archive-url = https://web.archive.org/web/20160304035458/http://afosterdissertation.wikispaces.com/file/view/van+der+Kolk_Editorial+Comments_2005.pdf | dead-url = no }}</ref> 但是，有充足的證據區別C-PTSD與邊緣性人格障礙。
閱讀{{link-en|貝索·馮·德·克洛博士|Bessel van der Kolk}}的觀點和了解邊緣性人格障礙，可能對了解[[依附理論]]、C-PTSD和[[邊緣性人格障礙]]的交集性有所幫助：
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</blockquote>
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{{link-en|女性歇斯底里症|female hysteria}}的誤診做比較。然而，C-PTSD患者之所以如此，是由於創傷性連結－－個人在生物化學方面與某個虐待他們的人的緊密連結的強烈影響，以及他們在遭受多年創傷後所習得用以生存、指引、應付他們所遭遇的虐待的反應之後成為自動反應，深埋入他們的人格－－對異常情況的正常反應。<ref>{{cite web|url=http://www.healing-arts.org/healing_trauma_therapy/traumabonding-traumaticbonds.htm#abuse_and_traumatic_bonds|title=Trauma Therapy Articles: Descilo: Understanding and Treating Traumatic Bonds|website=www.healing-arts.org|accessdate=2020-11-11|archive-date=2020-11-11|archive-url=https://web.archive.org/web/20201111231132/http://www.healing-arts.org/healing_trauma_therapy/traumabonding-traumaticbonds.htm#abuse_and_traumatic_bonds|dead-url=no}}</ref>
==治療==
雖然標準的[[循证医学|實證療法]]可能有效地治療創傷後壓力症候群，但是治療複雜性PTSD通常涉及解決人際關係困難和一系列不同的症狀，這使得治療更具挑戰性。根據[[美國退伍軍人事務部]]的說法：
<blockquote>
目前的PTSD診斷通常不能完全反映長期、反復的創傷所造成的嚴重心理傷害。遭受長期創傷的人經常除了正式的PTSD症狀外還有報告其他症狀，例如：[[自我概念]]以及他們適應壓力事件方式的改變。<ref>{{cite web |title=Complex PTSD - PTSD: National Center for PTSD |url=https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp |website=www.ptsd.va.gov |publisher=US Department of Veteran Affairs |access-date=1 January 2020 |language=en |archive-date=2020-11-12 |archive-url=https://web.archive.org/web/20201112034255/https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp |dead-url=no }} {{PD-notice}}</ref>
</blockquote>
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雖然標準的[[循证医学|實證療法]]可能有效地治療創傷後壓力症候群，但是治療複雜性PTSD通常涉及解決人際關係困難和一系列不同的症狀，這使得治療更具挑戰性。根據[[美國退伍軍人事務部]]的說法：
<blockquote>
目前的PTSD診斷通常不能完全反映長期、反復的創傷所造成的嚴重心理傷害。遭受長期創傷的人經常除了正式的PTSD症狀外還有報告其他症狀，例如：[[自我概念]]以及他們適應壓力事件方式的改變。<ref>{{cite news|url=https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp|title=Complex PTSD
</blockquote>
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==延伸閱讀==
{{refbegin|32em}}
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{{refend}}
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*[https://freeryou.com/2126/cptsd/ CPTSD介紹與創傷反應類型4F]
*{{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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