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複雜性創傷後壓力症候群：修订间差异

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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。
 
 
==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 | 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>{{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=5 December 2013 | url-status=dead }}</ref> 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」
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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{{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}}
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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" />
 
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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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====
检索自“https://zh.wikipedia.org/wiki/複雜性創傷後壓力症候群”