複雜性創傷後壓力症候群
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）[1]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。[2]C-PTSD與精神障礙的創傷模型有關，也和長期持續的性、心理與自戀型（兒童）虐待和身體虐待或忽視、長期親密伴侶暴力、長期的職場或校園霸凌的受害者[3][4]、綁架和人質情況的受害者、契約奴隸、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、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。[5] 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，無助感以及個人的自我認同和自我感受的變形。[6]
C-PTSD也被稱為DESNOS或其他未指定的極端壓力障礙。[7]
一些研究人員認為，C-PTSD與PTSD、身體化症、解離性身份疾患和邊緣性人格障礙不同但相似。[6] 其主要差異是個人核心自我認同的扭曲和嚴重的情緒失調。[8] 美國精神病學家和學者朱迪思·赫爾曼（Judith Herman）於1992年在她的《創傷與復原》一書以及隨附的文章中首次描述了這種疾病。[6][9][10] 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），澳大利亞衛生直轄區（HDA）和國家衛生局（NHS）認可。
症狀
兒童與青少年
PTSD的診斷最初是為遭受單一事件創傷（例如性侵）或戰爭中經歷過創傷的成年人開發的。[11] 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、家庭失能（英語：dysfunction），和可能包括和主要照顧者的依戀中斷。[12] 大部分情況是孩子的照顧者造成創傷。[11] 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。[11] 發育創傷障礙（英語：developmental trauma disorder，縮寫為DTD）一詞被提議視為兒童期的C-PTSD。[12] 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。[12] 貝索·馮·德·克洛博士將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：遺棄，背叛，失敗或羞恥造成。[13] 在兒童時期反覆遭受創傷將導致不同於PTSD的症狀。[13] 庫克等人在七個方面描述了其症狀和行為特徵：[14][1]
- 依戀－「存在關係界線的問題、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、身體化症和醫療問題增加」
- 情感或情緒調節－「情緒調節不良、難以識別、表達情緒與內在狀態、難以溝通需求、欲望和願望」
- 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、侵略性問題、病理性自慰問題和睡眠疾患」
- 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、自我監控；難以處理新訊息；難以集中精力和完成任務；物體恆定感差；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」
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。[9][15] 這可能成為成人生活中與他人交往的普遍方式，稱為不安全依戀。在當前的DSM-5（2013）中，這種症狀既沒有包括在解離性障礙（英語：dissociative disorder）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，同時有顯著的再次受害風險。[16]
診斷
鑑別診斷
創傷後壓力症候群
創傷性悲傷
與邊緣性人格障礙的差異和相似之處
治療
兒童
成人
爭議
另請參閱
參考
- ^ 1.0 1.1 Cook, A.; Blaustein, M.; Spinazzola, J.; Van Der Kolk, B. Complex trauma in children and adolescents. Psychiatric Annals. 2005, 35 (5): 390–398 [2008-03-29]. doi:10.3928/00485713-20050501-05.
- ^ Cortman C, Walden J. Keep pain in the past : getting over trauma, grief and the worst that's ever happened to you. Coral Gables, FL. 2018-10-15. ISBN 978-1-63353-810-8. OCLC 1056250299.
- ^ Hyland P, Murphy J, Shevlin M, Vallières F, McElroy E, Elklit A, et al. Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms (PDF). Social Psychiatry and Psychiatric Epidemiology. June 2017, 52 (6): 727–736. PMID 28194504. doi:10.1007/s00127-017-1350-8.
- ^ Ho GW, Karatzias T, Cloitre M, Chan AC, Bressington D, Chien WT, et al. Translation and validation of the Chinese ICD-11 International Trauma Questionnaire (ITQ) for the Assessment of Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). European Journal of Psychotraumatology. 2019-12-31, 10 (1): 1608718. PMC 6522970
. PMID 31143410. doi:10.1080/20008198.2019.1608718.
- ^ Stein JY, Wilmot DV, Solomon Z. Does one size fit all? Nosological, clinical, and scientific implications of variations in PTSD Criterion A. Journal of Anxiety Disorders. October 2016, 43: 106–117. PMID 27449856. doi:10.1016/j.janxdis.2016.07.001.
- ^ 6.0 6.1 6.2 6.3 Herman JL. Trauma and Recovery: The Aftermath of Violence--From Domestic Abuse to Political Terror
. Basic Books. 30 May 1997 [29 October 2012]. ISBN 978-0-465-08730-3.
- ^ Luxenberg T, Spinazzola J, Van der Kolk B. Complex trauma and disorders of extreme stress (DESNOS) diagnosis, part one: Assessment (PDF). Directions in Psychiatry. November 2001, 21: 22.
- ^ Brewin CR, Cloitre M, Hyland P, Shevlin M, Maercker A, Bryant RA, et al. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD (PDF). Clinical Psychology Review. December 2017, 58: 1–15. PMID 29029837. doi:10.1016/j.cpr.2017.09.001.
- ^ 9.0 9.1 Herman JL. Complex PTSD: A syndrome in survivors of prolonged and repeated trauma (PDF). Journal of Traumatic Stress. 1992, 5 (3): 377–391. doi:10.1007/BF00977235.[永久失效連結]
- ^ van der Hart O, Nijenhuis ER, Steele K. Dissociation: An insufficiently recognized major feature of complex posttraumatic stress disorder (PDF). Journal of Traumatic Stress. October 2005, 18 (5): 413–23. PMID 16281239. doi:10.1002/jts.20049.
- ^ 11.0 11.1 11.2 Complex Trauma And Developmental Trauma Disorder (PDF). National Child Traumatic Stress Network. [14 November 2013]. （原始内容 (PDF)存档于5 December 2013）.
- ^ 12.0 12.1 12.2 Ford JD, Grasso D, Greene C, Levine J, Spinazzola J, van der Kolk B. Clinical significance of a proposed developmental trauma disorder diagnosis: results of an international survey of clinicians. The Journal of Clinical Psychiatry. August 2013, 74 (8): 841–9. PMID 24021504. doi:10.4088/JCP.12m08030.
- ^ 13.0 13.1 van der Kolk B. Developmental trauma disorder (PDF). Psychiatric Annals: 401–408. 2005 [14 November 2013].
- ^ Cook A, Blaustein M, Spinazzola J, van der Kolk B (编). Complex Trauma in Children and Adolescents: White Paper from the National Child Traumatic Stress Network, Complex Trauma Task Force (PDF). National Child Traumatic Stress Network. 2003 [2013-11-14].
- ^ Zlotnick C, Zakriski AL, Shea MT, Costello E, Begin A, Pearlstein T, Simpson E. The long-term sequelae of sexual abuse: support for a complex posttraumatic stress disorder. Journal of Traumatic Stress. April 1996, 9 (2): 195–205. PMID 8731542. doi:10.1007/BF02110655.
- ^ Ide N, Paez A. Complex PTSD: a review of current issues. International Journal of Emergency Mental Health. 2000, 2 (1): 43–9. PMID 11232103.
- ^ Roth S, Newman E, Pelcovitz D, van der Kolk B, Mandel FS. Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder. Journal of Traumatic Stress. October 1997, 10 (4): 539–55. PMID 9391940. doi:10.1002/jts.2490100403.
- ^ 18.0 18.1 Pelcovitz D, van der Kolk B, Roth S, Mandel F, Kaplan S, Resick P. Development of a criteria set and a structured interview for disorders of extreme stress (SIDES). Journal of Traumatic Stress. January 1997, 10 (1): 3–16. PMID 9018674. doi:10.1002/jts.2490100103.
- ^ Complex PTSD. www.ptsd.va.gov (National Center for PTSD). United States Department of Veterans Affairs. 2007.
延伸閱讀
- Anderson F, Schwartz R, Sweezy M. Internal Family Systems Skills Training Manual: Trauma-Informed Treatment for Anxiety, Depression, PTSD & Substance Abuse. PESI Publishing and Media. 2017. ISBN 978-1-68373-087-3.
- Appleyard K, Osofsky JD. Parenting after trauma: Supporting parents and caregivers in the treatment of children impacted by violence. Infant Mental Health Journal. 2003, 24 (2): 111–125. doi:10.1002/imhj.10050.
- Bannit SP. The Trauma Tool Kit: Healing PTSD from the Inside Out. Quest Books. 2012. ISBN 978-0-8356-0896-1.
- Briere J, Scott C. Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment. SAGE Publications. 30 August 2012 [29 October 2012]. ISBN 978-1-4129-8143-9.
- Courtois C. It's Not You, It's What Happened to You: Complex Trauma and Treatment. Elements Behavioral Health. October 12, 2014. ISBN 978-1-941536-55-1.
- Fisher, Janina. Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation. Routledge. 2017. ISBN 978-0-415-70823-4.
- Fisher S. Arousal and Identity: Thoughts on Neurofeedback in the Treatment of Developmental Trauma (PDF). Association for Applied Psychophysiology and Biofeedback. 2010, 38 (1): 6–8.
- Fisher S. Neurofeedback in the Treatment of Developmental Trauma: Calming the Fear-Driven Brain. W.W. Norton and Company. 2014. ISBN 978-0-393-70786-1.
- Ford JD. Disorders of extreme stress following war-zone military trauma: associated features of posttraumatic stress disorder or comorbid but distinct syndromes?. Journal of Consulting and Clinical Psychology. February 1999, 67 (1): 3–12. PMID 10028203. doi:10.1037/0022-006X.67.1.3.
- Frewen P, Lanius R. Healing the Traumatized Self: Consciousness, Neuroscience, Treatment. Norton Series on Interpersonal Neurobiology. W.W. Norton and Company. 2015. ISBN 978-0-393-70849-3.
- International Society For The Study. Guidelines for treating dissociative identity disorder in adults, third revision (PDF). Journal of Trauma & Dissociation. 2011, 12 (2): 115–87. PMID 21391103. doi:10.1080/15299732.2011.537247.
- Odgen P, Minton K, Pain C. Sensorimotor Psychotherapy: Interventions for Trauma and Attachment. W.W. Norton and Company. 2015. ISBN 978-0-393-70613-0.
- Teicher MH, Samson JA, Anderson CM, Ohashi K. The effects of childhood maltreatment on brain structure, function and connectivity. Nature Reviews. Neuroscience. September 2016, 17 (10): 652–66. PMID 27640984. doi:10.1038/nrn.2016.111.
- van der Hart O, Mosquera D, Gonzales A. Borderline Personality Disorder, Developmental Trauma and Structural Dissociation of the Personality (PDF). Persona. 2008, 2: 44–73.
- van der Hart O, Nijenhuis ER, Steele K. The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. W.W. Norton. 2006. ISBN 978-0-393-70401-3.
- van der Hart O, Boon S, Steele K. Treating Trauma-Related Dissociation: A Practical, Integrative Approach. Norton Series on Interpersonal Neurobiology. Norton Publishing. 2016. ISBN 978-0-393-70759-5.
- van der Kolk B. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin. 2015. ISBN 978-0-14-312774-1.
- van der Kolk BA. Clinical implications of neuroscience research in PTSD. Annals of the New York Academy of Sciences. July 2006, 1071 (1): 277–93. Bibcode:2006NYASA1071..277V. PMID 16891578. S2CID 28935850. doi:10.1196/annals.1364.022.
- van der Kolk B. Developmental trauma disorder (PDF). Psychiatric Annals. 2005: 401–408.
- van der Kolk BA, Stone L, West J, Rhodes A, Emerson D, Suvak M, Spinazzola J. Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial (PDF). The Journal of Clinical Psychiatry. June 2014, 75 (6): e559–65. PMID 25004196. doi:10.4088/JCP.13m08561.
- Walker P. Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma. CreateSpace Independent Publishing Platform. December 2013. ISBN 978-1-4928-7184-2.
外部連結
- CPTSD介紹與創傷反應類型4F（《第一本複雜性創傷後壓力症候群療癒聖經》譯者陳思含的blog）
- 开放目录项目中的“創傷後症候群”
- APA practice parameters for assessment and treatment for PTSD (Updated 2017)