複雜性創傷後壓力症候群：修订间差异

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>

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>

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>

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。