Desnos: complex post-traumatic stress disorder

Post-traumatic stress disorder has been one of the most studied disorders in recent decades (especially due to the devastating consequences of World War II), largely due to the awareness of the dysfunction that ‘it leads to people who suffer from it. the people around him.

Anyone in the world can one day suffer from post-traumatic stress disorder, even if they have only been exposed to the experience or occurrence of trauma once.. But … what about people who have been exposed to very severe stressful conditions all of their lives or for a long time? What about veterans? What about minors exposed to continued physical, psychological and sexual abuse? What happens when the people who continually assault you are your primary family relationships?

In this article, we will dive into the Complex post-traumatic stress disorder, In his time called DESNOS.

What is the Desnos or PTSD complex?

The disorder (extreme stress not elsewhere specified), currently known as complex PTSD, is defined as the presence of PTSD with additional self-regulatory issues in the person. It usually occurs in people who have experienced multiple traumatic events, prolonged trauma, especially severe trauma (usually related to interpersonal victimization).

An example of a PTSD complex, according to Luxenberg et al. (2001), is believed to be a woman who as a child never received the necessary care and attention, was sexually abused by her alcoholic stepfather on numerous occasions and saw (vicarious victimization) her stepfather rape his mother.

A new diagnostic category has been proposed for complex PTSD, and it appears that ICD-11 will distinguish between PTSD and complex PTSD (this was not the case in DSM-5). The first will include three groups of symptoms (re-experimentation, avoidance, and a persistent sense of current threat manifested by activation and hypervigilance), while complex PTSD will include three additional groups: emotional deregulation, negative self-conception and disruption of relationships.

Symptoms and characteristics

As we mentioned, complex PTSD is characterized by the concomitance of PTSD with certain self-regulatory problems in the individual. These problems are:

Disruption of interpersonal skills

Alterations in interpersonal relationships occur. The person suffering from a complex PTSD would tend to isolate himself, to distrust others in a chronic way, to live in anger or unjustified and unjustified hostility very spontaneously towards others, to repeatedly seek someone to act as a “savior”. .

In general, these are usually people who have few intimate relationships, due to the inability to trust and open up to others. Either way, you could say that they are sabotaging themselves, as in many cases they have social skills to build intimate relationships, but due to their learning and learning behaviors. their acquired beliefs, they are not able to preserve them.

Alterations in attention and consciousness

Dissociative symptoms appear frequently. People with a PTSD complex may have alterations or fragmentations in consciousness, memory, identity, self-perception and / or the environment.

  • the dissociation is a difficult construction to define and consists of several facets:
  • disconnect (Emotional and cognitive separation from the immediate environment): They may resort to social situations but appear absent.
  • depersonalization (Altered perception of own body or self)
  • unrealization (Altered perception of the outside world)
  • Memory problems (Memory loss due to personal events)
  • emotional constriction (Decreased emotionality, reduced ability to respond emotionally). As if they were emotionally numbed.
  • Identity dissociation (This would be the most serious and the least common: the perception or experience that there is more than one person in his mind).

Schemes or belief systems were severely affected

There are three types of persistent and exaggerated negative beliefs or expectations in complex PTSD, which should be tried to be flexible and changed in treatment:

  • About yourself: “I am bad”, “I am responsible for what happened”, “I can never get over it”, “Bad things only happen to bad people”.
  • About others: “you can’t trust anyone”, “you can’t trust someone who hasn’t made a war”.
  • About the world: “the world is an insecure and unfair place by default, something bad is going to happen”, “the world is a very dangerous place”, “I have no control over what can happen-” . In addition, feelings of shame, guilt, helplessness, handicap, the feeling that no one understands them are very common.

Difficulties regulating emotions and somatic discomfort

Drastic mood swings, dysphoric, irritable moods, intermittent anger are common (difficulty managing anger) … They can exhibit self-destructive and impulsive behaviors (including those of a sexual nature). As for somatic discomfort, they can often have headaches, gastrointestinal problems, chronic pain, non-specific aches …

treatment

Although treatment will largely depend on the type of trauma or trauma to which the subject has been exposed, the psychological model in which the clinician works and the time available, there are guidelines for the treatment of complex PTSD (Cloitre et al. ., 2012). The treatment can be divided into 3 phases:

  • Phase 1: The objective is to ensure the safety of the person by managing the problems of self-regulation, by improving his emotional and social skills.
  • Phase 2: In this phase, you will focus on the trauma itself and its processing of memories.
  • Phase 3: At this stage, the goal is to reintegrate and consolidate the successes of the treatment and to help the person adjust to current life circumstances. It is advisable to have a relapse prevention plan in place.

Finally, it should be noted that it is very important that beliefs about oneself, others and the world are worked on transversally throughout the therapy, because it is laborious and sometimes prolonged work. , which involves several sometimes the most difficult to modify. .

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