Talk:Complex post-traumatic stress disorder/Archive 1

Archive 1

Trauma type-I and type-II

Anyone has knowledge about Lenore Terr's trauma types I and II's, trauma II corresponding to complex PTSD? Think this should be mentioned. Jalind 16:54, 10 November 2006 (UTC)

PTSD and C-PTSD vs. personality disorders, Borderline Personality Disorder

I've removed the comparison with Borderline Personality Disorder as it is one of the most dubious categories in all of Psychology. Few psychologists refer to it and there has been discussion of removing it from the DSM altogether.) 70.142.154.44 18:20, 3 July 2006 (UTC)

I really disagree. Firstly, borderline personality disorder (BPD) is the most researched personality disorder, and also it is the most common PD. Secondly, there is growing understanding on the relation between early traumatization and BPD. However I see your point, there is debate (which is quite normal in psychology) about the essence of BPD. I think BPD will in the future be conceptualized more presisely and its relation to C-PTSD will be more clarified (like in this study by Macleon and Gallop (2003) [1]). Also it is important to see that C-PTSD and PTSD are very different disorders, especially when C-PTSD has happened in childhood disrupting normal development. For more information about general connection between early traumatization (=C-PTSD) and BPD see Winston (2000) Recent developments in borderline personality disorder (figure 1 is very informative) [2]. Jalind 10:48, 3 November 2006 (UTC)

Actually, a better reason for eliminating the comparison is that Borderline Personality Disorder is a Personality Disorder, while PTSD is an axis-I disorder and C-PTSD, if it becomes a DSM diagnosis would also likely be an axis-I diagnosis. RalphLender 19:37, 3 August 2006 (UTC)

Where can we add trauma re-enactment, self-harming

Where can we add trauma re-enactment (TR)??? - for many survivors of childhood trauma, it feels impossible to stop self-harming patterns like drug/alcohol/sex abuse as they recreate the destruction from their past. Patterns of TR behaviour: alcoholic drinking, drugging, being in abusive relationships, sexual acting out — often become the survivors “best friend” because TR fools them into thinking that these ways of being are their best defence, their best chance at survival. Masiarek 02:50, 5 August 2006 (UTC)

What you are describing is a way in which suvivors of childhood trauma reduce stress and releave tension...not in a healthy growth enhancing manner. DPeterson 20:32, 5 August 2006 (UTC)

The victim may also be using these strategies as an unhealthy way of empowering themselves. If they are harming/punishing themselves, they are not somebody elses victim, as they are choosing this treatment. They are in control of their treatment.

It is a symptom of their difficulties...JohnsonRon 22:17, 15 October 2006 (UTC)

I don't think it is symptoms we are dealing here. Also I think trauma re-enactment is not necesarily self-regulation or defense, it is merely lack of self-regulation. Talking about re-enactment may produce needless guilty of survivors. It is the insufficient self-regulation (ie. lack of assertiveness, impulsiveness) that is causing the symptoms (ie. depression, anxiety, interpersonal problems) and also exposes to retraumatization. This viewpoint underlines empathy and acceptance, and is seen on central on new treatments of BPD, like Linehan's DBT. Jalind 21:01, 2 November 2006 (UTC)

Actually, trauma reenactment (or flashbacks) are often described in the professional literature as the mind's attempt at healing and integration (See J. Beiere's work, for example). the difficulty is that the individual lacks sufficient resources and/or the trauma is so overwhelming, that these normal processes are not effective, and so some formal treatment is necessary to resolve the trauma. In C-PTSD the trauma is of an chronic nature; it is early chronic trauma, which causes problems in a variety of domains (See National Trauma Center's White Paper). RalphLender^talk 21:38, 2 November 2006 (UTC)

Yes, I am familiar with this functional view (=restoration, healing) of flashbacks from work of Janoff Bullman. But Masiarek uses the term "re-enactment" and describes revictimization or unconsciously motivated behavioral repeating of the trauma event. Freud refers to this as repetition compulsion (did you by the way ment Breuer, Josef 1842-1925?). Flashbacks or intrusive symptoms of trauma are more mental phenomena, ie. repeatative memories, but not behavior. As van der Kolk (1989) - one of the leading authors on the field nowadays - says: "Freud thought that the aim of repetition was to gain mastery, but clinical experience has shown that this rarely happens; instead, repetition causes further suffering for the victims or for people in their surroundings." [3] To underline my point here is one example: It is known that women abused in childhood, are more often raped in adulthood. Is this because of their mental need for experience their trauma again (ie. to integrate traumatic experience into self), or might it be because of their general inability to protect theirselves (ie. lack of skills, accepting of maltreatment)? Jalind 10:35, 3 November 2006 (UTC)

I meant to cite, Principles of Trauma Therapy by John Briere & Catherine Scott, 2006, Sage Publications. Again, much of the flash-back and re-enactments described in the trauma lit can be viewed as the mind's efforts to integrate the trauma and heal. In fact, current practice protocols on trama treatment call for the this very thing to occur in a controlled and supported therapeutic relationship when it does not occur "naturally." DPeterson^talk 11:29, 3 November 2006 (UTC)

Thank you for clarifying the source, it seems wery interesting and updated. I agree about the therapeutic value of reliving the trauma in therapeutic setting. I still doubt that revictimization and intrusive symptoms are functionally related. (Firstly: How much is their correlation, do they load on same factors in factor analysis, do they cause relief in any circumstances?). I have been thinking about scientific criterions to clarify the issue, and glanced a few empirical studies. In study by Noll, Horowitz, Bonnanno, Trickett and Putnam (2003) [4] they explored what factors explain revictimization. They explored the unique predictive value of several predictors (see table 4: ie. early sexual, physical and emotional maltreatment; experienced symptoms like PTSD symptoms, dissociation and sexual permissiveness). When taking into account the intercorrelations between these predictors, dissociation and sexual permissiveness but not PTSD-symptoms (including intrusive and avoidant symptoms) were predictive of physical revictimization. They concluded that "victims who adopt pathological dissociation as the primary defense strategy in adolescence or adulthood may be less able to engage in self-protection when physically threatened." Their results support my view that revictimization is caused by lack of skills, not by psychological need to experience again a traumatic event (I suggest that we accept intrusive and avoidant PTSD-symptoms as a measure of this psychological need to revictimization/re-experiencing). The supposition about revictimized patient's psychological need for retraumatization in vivo may in itself be destructive, untherapeutic and not scientificly based. It increases victims guilt and deteriorates self-esteem.

Very interesting study is also Gladstone, Mitchell, Malhi and Austin (2004) [5] . The study design demonstrates that this problem in hand is open to empirical solution. In their study there was both a mediated (and direct link) between physical abuse as a child TO personality dysfunction TO adult retraumatization (see fig 1). Jalind 10:47, 4 November 2006 (UTC)

This is a very useful discussion. I wonder if you would be willing to take what you've written above (in the section about Noll, Horowitz, et.al. and put that into the article itself? I think it is very relevant and clearly based on a verifiable source. It would help clarify this point. RalphLender^talk 14:09, 3 November 2006 (UTC)

Thank you for suggesting, I could do this (when have more time), meanwhile anyone else is also free to contribute. Any suggestions for subtopic, like: Some possible consequences of C-PTSD. This topic could contain Borderline personality disorder and Revictimization? Jalind 10:47, 4 November 2006 (UTC)

Clarification: is C-PTSD restricted to children?

I dont think that it is only relaited to children. If you read the article and pay attention, it says domestic violenc, tourchure, war, sexual abuse, etc. Any one can go threw a number of these things. including but not limited to adults. You dont have to have pre-exsposhure to child hood abuse. if you get into a abusive relationship that goes on for several year, spicifically sexual or physical, any number of combinations. I can be severly traumitizeing. At any age. Women, boys, girls, and even men, who are forsed into sex traid (human trafficking) are highly likely to suffer from more than just PTSD. Thats like war in its self, A struggle to keep your life, with repeated richual sexual abuse, rape, and assult. This is the same thing that a child goes threw. Not to down play what a child would go threw, im a survivor of molestaion myself, but children are very resilant. Sometimes they dont understan what had happened to them. But one day they might be abile to move on when there older and know truly they had no controle. For an adult thats a little harder. THAT'S where the C-PTSD somes in after PTSD.68.82.14.147 (talk) 19:12, 5 March 2008 (UTC)

The first paragraph implies there's no restriction. This seems especially true in the comparison with PTSD. The rest of the article is specific to children, though, and someone not already familiar with the diagnosis could be confused by this (I am).

Greybirds 09:32, 5 February 2007 (UTC)

Complex Post Traumatic Stress Disorder is caused by chronic 'early' trauma. The outcome of this is not limited to children, although it's impact on children is what most of the literature focuses on. DPeterson^talk 13:57, 5 February 2007 (UTC)

I was going to ask the same question. If it's true that it's only about early trauma, it should say so in the article. I personally doubt that's true. Certainly a lot of adults say they have this condition. As the introduction says, it's about any long-term exposure to severe stress.Merkinsmum 11:36, 16 April 2007 (UTC)

The literature on this (for example, the White Paper from the National Child Trauma Center on evaluating and treating CPTSD) pretty much describes the "cause" as having four primary elements: Early, Chronic, Maltreatment, in a Caregiving relationship. Early means in the first few years...However, the effects of CPTSD, if not treated, continue throughout life into adulthood. DPeterson^talk 12:35, 16 April 2007 (UTC)

I just noticed this thread. I'm the one who originally wrote this article, although I haven't looked at it in quite some time.

C-PTSD is not restricted to children. As a diagnosis, it is PTSD that present with Borderline features. As the Borderline personality does not begin to manifest until age 10, it is impossible for the disorder to even appear in children. The precursors and antecedents may be present, and it is to this that the literature speaks. --DashaKat 22:22, 3 August 2007 (UTC)

DDP

I have removed Dyadic Developmental Psychotherapy from this page. This little known therapy has been extensively advertised on Wiki as evidence based, sometimes the only evidence based treatment for a variety of disorders affecting attachment. (Theraplay, also little known and not evidence based has also been advertised in this way.) A range of attachment articles including attachment therapy are currently before ArbCom. In the course of ArbCom it has transpired that of the 6 users promoting DDP and Theraplay and controlling these pages, User:DPeterson, User:RalphLender, User:JonesRD, User:SamDavidson, User:JohnsonRon, and User:MarkWood, the latter four are definitely socks and have been blocked, and the other two have been blocked for one year. The attachment related pages are in the course of being rewritten. Fainites ^barley 21:29, 3 August 2007 (UTC)

Update - all 5 are now indefinitely blocked as sockpuppets of DPeterson, and DPeterson has been banned for 1 year by ArbCom.[6] Fainites ^barley 19:41, 5 September 2007 (UTC)

Update 2 - User:AWeidman, AKA Dr. Becker-Weidman ^Talk and Dr Art has now also been indef. banned for breach of the ban on his sockpuppet DPeterson. Fainites ^barley 18:37, 4 November 2007 (UTC)

I am concerned that recent edits and undo's on this article are all related to DDP. I have put a lot of work into this article to get it up to wiki standards and don't want it to become another venue for DDP promotion and demotion battles. If the article remains evidence based then the categories of C-PTSD and DTD have a chance of being useful to a reader.--Ziji (talk email) 21:46, 1 April 2009 (UTC)

Article spin

Having a chance to look at this article, I'm having some difficulty reconciling the manner in which it is presented. It currently sounds as if this is a disturbance that is dependent upon childhood trauma, and nothing could be further from the truth.

The C-PTSD nomenclature was developed to help describe acute Borderline characteristics presented by trauma victims. Anything else is empirical gravy, as the trauma does not have to have a genesis in childhood.

To my way of thinking, the article widely misses the mark. --DashaKat 21:05, 4 August 2007 (UTC)

Thats probably because it was largely edited by the sock army mentioned in the section above for the apparent purpose of advertising a therapy for it. They're all gone for the moment so edit away! Fainites ^barley 19:50, 5 September 2007 (UT

Edit, Hitladynmore~ Yikes, that's alot of fancy talk. Last week A friend of mine was changing a lightbulb for me. It exploded and glass flew everywhere....I took off, had a major anxiety attack and have had a total of three nightmares about it. Spoke to a friend of mine from a PTSD group I took a few years back. She reminded me of my Dad swinging a Metal Texaco truck at my head and the truck busted the overhead light on his backswing. I was shocked, how did she remember? It didn't happen to her in the first place, but the thought of it scared her so bad for me. It was also decided that day that I shouldn't feel guilty for my Dads anger. As far as BPD, cop-out? Crap-out, Whatever. Apples and Oranges. The two may be related in that they are both psycological disorders. But C-PTSD is what I have been referring to as Chronic Traumatic Stress disorder. Meanwhile, ask anybody who married a guy "Just like dear old dad" and you will easily be able to make the connection that I have. I took my trauma into my adulthood and when the marriage (obviously) didn't work out....Never tried again. Body, heart, spirit, soul, mind, personality.. what, I should try again? (lol)

I'm the one who originally penned this article. It's current version is more than a modest distortion of the warp and woof of the subject matter. It is both biased and incomplete. I am planning a re-write that will include referenced information to correct both of these situations.

To start, how it is that a diagnostic category initially introduced to explain acute BPD symptom breakthrough in trauma vicitims no longer contains any information on that subject is simply beyond me. --Sadhaka 00:39, 29 October 2007 (UTC)

Sadhaka, do you want to come back and differentiate BPD from C-PTSD in separate sub section?--Ziji (talk email) 09:50, 6 March 2009 (UTC)

If you look above you'll see it was edited by a sock army pushing a particular definition (as an alternative to a discredited version of reactive attachment disorder) and a therapy to cure it. Six are already banned and the 7th is in the process of being indef. banned so you are unlikely to be troubled by them if you start rewriting it. Fainites ^barley 15:36, 31 October 2007 (UTC)

Adding to above statement......(as a concerned parent) Let's stay on the constructive path. My daughters were molested for 3 years from the age of 6 to 9 including torture, I immediately got them into therapy and there are such differnces in the two. My older one never spoke about it while the other couldn't stop talking about it. They are 13 months apart in age. My older one who is now 23 and has been in and out of treatment since (with an ongoing drug/alcohol abuse history). I/We have yet to find anyone who can help her, now that she wants it. Seems to me alot more awareness has to reach other facets of our communities other than doctors. She has had much difficulty finding HELP, most just want to lock her up and be done with it!! This child had/has so much potential, 4 presidential awards, 3 citizenship awards, spelling bees, honor roll student until the 9th grade, softball all star player, basketball trophies, peer mediation plaques, an overachiever? Oh and absolutely beautiful. Why? How? And is there anyone out there that can/will go completely out of they're way for these kids? I can be reached at pllblondee@msn.com. There is so much more to tell if anyone wants to assist!!!! The only reason why she has these problems is because of what happened to her other than that she has had a very stable and nurturing upbringing.

Thank Goodness. —Preceding unsigned comment added by 65.7.176.200 (talk • contribs)

Page additions should be added based on reliable sources, not personal experience. Please post new comments at the bottom of talk pages WLU (talk) 19:51, 8 April 2008 (UTC)

Regardless if that is true or not, I think everyone with PTSD and C-PTSD would very much prefer anyone giving orders here to have PTSD or C-PTSD, or be a caregiver, or doctor. I do not appreciate all the nonsense on this discussion forum because it gives me headaches to read it, and when you post disrespectful crap like that, it really ticks me off and makes me want to throw you through my tiny little window repeatedly until you fit. Show respect, and for gods sake everyone else STOP RAMBLING and making all these posts and categories about the same damn thing. Im not signing this because im pretty sure I speak for all of us. —Preceding unsigned comment added by 76.180.55.81 (talk) 06:27, 1 June 2008 (UTC)

Complex Trauma in Children

I think that children do suffer from C-PTSD. If a child is molested froma young age, and remembers this abuse or any form of abuse for that matter, it could manifest its self into C-PTSD. After being abused a certain way for so long then a child begins to exibit these behavours to. Sexualy acting out, inapropreate relationships. Just because they're under the age of 18 doesnt mean that they dont suffer. Nightmares, even flashbacks, re-accurent bed wettings, abussive behaviour twards animals. I had read somewhere that a little girl had dumped her gold fish out of it's tank. She knew that if the fish was out of water it would die. I vegley remember the girl was about 8. When her mother had asked her why she dumped her fish out, she had replied: "I wanted to see what it was like to die." Thierefor leading the mother to suspect that her 8 year old wanted to die. In my opinion and from persional experience with C-PTSD myself, only a child who has been severly abused in some way would want to die. I think thought that it would be harder to tell if a child is traumatized or not. Children are very easily conned for more of a better word. If you tell them not to say something or to keep a secret and they don's, something bad will happen. Then they will keep that secret. NO matter how bad it hurts, or how horrible of a secret it is. CHildren dont really know or understand whats right from wrong, or fact from fiction. Sometimes its harder to tell if a child has been traumatised. Thats why parents should watch for any change in behavour. One little inconsistancy can tell a whole story and possibly save your child a life time of pain and hurt68.82.14.147 (talk) 19:18, 5 March 2008 (UTC)

Dude, you deleted my original statement, which is really not cool. Here's what I wrote before the above author deleted it.

This section reads as an ad. I just deleted it- if you disagree with me please tell me why here and revert it and I'll leave it alone. I would suggest writing a section about CPTSD in childhood if anyone can come up with one. CelticLabyrinth 17:28, 4 December 2007 (UTC)

Anyway, this isn't a debate forum- and I was talking about someone advertising a specific therapy. If you want to research and create a section based on clinical evidence that CPTSD is a valid diagnosis in childhood then please- do so. If not then that's fine too. But please, do not delete a valid entry on a talk page! CelticLabyrinth (talk) 08:51, 14 April 2008 (UTC)

Why were other potential treatments removed?

I appreciate the cleanup of the section I edited and reinserted. However, I am curious why this line was removed:

"Those who have experienced complex trauma caused by chronic maltreatment can be treated with Cognitive Behavioral Therapy interventions, education, EMDR and other approaches."

Why is TF-CBT the only one listed? That makes it seem almost like an endorsement for a particular method. Why were other potential treatments removed? Were there just no sources available to support those? If I was looking this up for me, I would want to know all the available treatments there are. 75.177.39.22 (talk) 04:40, 4 April 2008 (UTC)

It was deleted because it was unsourced, although I think the more appropriate action would have been to insert a citation needed thingy. If you can find a source that says those treatments then you can reinsert them. I know that all of those are cited in academic papers as treatment for PTSD and DID but I know of few sources for C-PTSD. CelticLabyrinth (talk) 08:55, 14 April 2008 (UTC)

heheh- I should actually look before I talk. I deleted some stuff by those people before, they are advertising a therapy. I have reposted on treatment and provide a cite so it shouldn't be deleted that easily. If anyone else mentions TF-CBT I would delete it- the cite is for sexually abused children, not for complex PTSD. CelticLabyrinth (talk) 18:18, 14 April 2008 (UTC)

Trauma Focused Cognitive Behavioral Therapy

Someone keeps editing this page to add something about trauma focused cognitive behavioral therapy, an obscure therapy being used with traumatized children. The citation links to an article about treating sexually abused children, not an article about complex PTSD. I would suggest that, if you see something on TF-CBT then check out the source- if it does not mention anything about C-PTSD (which, by all appearances is almost solely diagnosed in late adolescence and adulthood as it requires symptomatology of borderline personality disorder which is hardly every diagnosed in childhood, whereas TF-CBT is a treatment for children) then please delete it. CelticLabyrinth (talk) 18:26, 14 April 2008 (UTC)

Geodon

I removed the section on drug therapy (which looked like an ad) as it referred to treatment for [post-traumatic stress disorder] not C-PTSD. I also removed a part that mentioned car accidents- C-PTSD is a reaction to chronic trauma- car accidents cause PTSD, not C-PTSD. CelticLabyrinth (talk) 15:39, 12 August 2008 (UTC)

• I think you went way too far in this edit. The Geodon section was badly written, but it contains useful information. Your idea that some drugs that are effective for PTSD might not work for C-PTSD is unwarranted speculation on your part, and in violation of the Wikipedia guideline WP:OR. — Aetheling (talk) 18:05, 30 August 2008 (UTC).

Original research would be to say that the Geodone is effective for CPTSD, when providing refrences saying that Geodone is effect for PTSD. CPTSD does not equal PTSD. CelticLabyrinth (talk) 22:55, 6 September 2008 (UTC)

There is no need for you to be tendentious on this point. These are research questions on which there is as yet no consensus. The article itself cites Whealin & Slone, who say this: "Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met criteria for PTSD, Complex PTSD was not added as a separate diagnosis. Complex PTSD may indicate a need for special treatment considerations." I don't know how much clearer this can be. The two conditions are closely related, and there is a suggestion that special treatment considerations might needed. You — a 20-year-old college student — have absolutely no business speculating in a Wikipedia article on the suitability of any specific drugs for either condition. Leave that to research psychiatrists with decades of experience. When you write for Wikipedia you cannot substitute your own beliefs about psychiatric treatments, no matter how strongly held, for published scientific studies. Either find and quote a suitable study on the lack of effectiveness of Geodon for C-PTSD, or pipe down. —Aetheling (talk) 22:01, 27 September 2008 (UTC)

PTSD vs CPTSD

Complex post-traumatic stress disorder is a clinically distinct diagnosis, not a subdiagnosis of PTSD. Information relevent to the treatment of PTSD needs to be placed inside PTSD's main entry on wikipedia, not here. To this end, I have deleted the refrence for antipsychotic medications in the treatment to CPTSD as the refrence was for PTSD, and added a citation needed notation after the SSRI and atypical antipsychotic refrences. CelticLabyrinth (talk) 23:10, 6 September 2008 (UTC)

I have PMID'd ref no. 7. However, currently the treatment section lists not only SSRIs and atypical antipsychotics uncited, but also dialectic behavior therapy and exposure therapy. If these are in fact in the Taylor et al article then the ref could be moved to the end of the sentence. Fainites ^barley 20:50, 14 September 2008 (UTC)

C-PTSD and Alcoholism/Addiction: The Chicken or the Egg?

In the largest and most prominent Drug and Alcohol Addiction centers in the United States, being familiar (to put it lightly) with each updated DSM, are correct psychological diagnoses being not being made?
In consideration of the scope and depth that alcoholism/drug/sex addiction reaches, why is not an appropriate assessment of each patient's psychological well-being included as a catalyst for relaspe prevention?
This is a severe failure in our current modality of practice in that the symptoms, not the disease are being treated.
My quandry is this: Why, in a 12-step based program which claims to be strongly supported by CBT and evidence based research, are we still focused on the Egg, when it may be the Chicken? CollectiveWhole (talk) 07:19, 25 February 2009 (UTC)

Expert

I'm a clinical psychologist and expert in trauma treatment with 35 years experience. I have begun to work on this article, first by adding to the opening paragraph that it is a psychological injury from protracted and prolonged trauma in the presence of captivity or entrapment and disempowerment. It troubled me that these critical elements of the diagnosis were lacking in opening sentences of the article, despite the sometimes erudite discussion on this talk page. Was that an oversight by editors or am I way off the mark in thinking that was a glaring omission? I don't think so.

This quote from Bessel A. van der Kolk, MD* is central to differentiating C-PTSD from both PTSD and BPD: "Uncontrollable disruptions or distortions of attachment bonds precede the development of post-traumatic stress syndromes. People seek increased attachment in the face of danger. Adults, as well as children, may develop strong emotional ties with people who intermittently harass, beat, and, threaten them. The persistence of these attachment bonds leads to confusion of pain and love. Trauma can be repeated on behavioural, emotional, physiologic, and neuroendocriniologic levels. Repetition on these different levels causes a large variety of individual and social suffering.

Anger directed against the self or others is always a central problem in the lives of people who have been violated and this is itself a repetitive re-enactment of real events from the past. Compulsive repetition of the trauma usually is an unconscious process that, although it may provide a temporary sense of mastery or even pleasure, ultimately perpetuates chronic feelings of helplessness and a subjective sense of being bad and out of control. Gaining control over one's current life, rather than repeating trauma in action, mood, or somatic states, is the goal of healing." | Vanderkolk and

These thoughts from Emotion Focussed Couples Therapy with Trauma Survivors will also indicate my bias for developing this article: "Trauma is a violation of human connection. Attachment theory is a theory of trauma - a secure attachment is the ultimate antidote for healing. Trauma survivors are often trying to fight two battles at the same time - they are fighting the cycle of distress in their relationships and are also fighting the echoes of traumatic events that are constantly evoked in an intimate relationship." Associating C-PTSD with Borderline Personality Disorder (BPD) just doesn't cut it with me since in my view BPD is better understood as Dyslymbic brain function rather than an attachment disorder.

For the article to claim without citation, that C-PTSD shares symptoms of both PTSD and BPD strikes me as careless language. I propose to wipe most of the claims lacking citations from the Treatment sub-section and leave it somewhat empty until we come up with something clearer and more authoritative.

So can any of you help by citing research and treatment papers that substantiate the claims that I will now partially delete: "Current medical care includes the use of SSRIs[citation needed], and sometimes the atypical antipsychotics[citation needed].

Since C-PTSD shares symptoms with both PTSD and borderline personality disorder,[7] it is likely that a combination of treatments utilized for these conditions would be helpful for an individual with C-PTSD, such as dialectic behavior therapy and exposure therapy.[citation needed]"--Ziji (talk email) 10:32, 25 February 2009 (UTC)

• I have begun to add to the symptom profile material from ISST_D--Ziji (talk email) 11:01, 25 February 2009 (UTC)

• • Now created new subsection differentiating C-PTSD from PTSD added to the intro, vicarious traumatisation conditions that could lead to C-PTSD. That subject starts to reach a bit beyond the literature but is not an uncommon observation in clinical practice. Just think of the carers/survivors following 9/11 to understand the meaning of protracted social trauma--Ziji (talk email) 22:25, 25 February 2009 (UTC)

• • • Begun new section differentiating C-PTSD from Traumatic Grief. This article by Ambrose on traumatic grief will help editors get a grip on this twister. Please help.--Ziji (talk email) 04:55, 5 March 2009 (UTC)

What does this sentence mean?

"Trauma sources include repeated and denied intimate betrayals"? Is this phrase supposed to mean repeated betrayals by people who then deny they did it, i.e. 'gaslighting'? Because the way the sentence is written, the meaning is unclear. MarmadukePercy (talk) 04:49, 6 March 2009 (UTC)

gaslighting is the one. Go ahead and change the sentence.--Ziji (talk email) 07:02, 6 March 2009 (UTC)

Okay, thanks much for clarifying. I'll do a rewrite tomorrow. Regards, MarmadukePercy (talk) 07:05, 6 March 2009 (UTC)

Thank you and I had the time and did it adding reference to DARVO ie deny, attack reverse victim offender.--Ziji (talk email) 07:15, 6 March 2009 (UTC)

I tweaked the punctuation just a bit, but I think that between your adds and mine, the sentence works just fine now. Best, MarmadukePercy (talk) 07:27, 6 March 2009 (UTC)

Your adds freed me to put in 'traumatic violation of power' with citation (at last) and now with mind clear I have gone on to complicated mourning. Do I dare enter the lions den and attempt a sub section to differentiate BPD from C-PTSD? Best to you.--Ziji (talk email) 09:48, 6 March 2009 (UTC)

I did a little more tweaking. The only question I have about the first graf is whether the compulsory jury service belongs in there (not sure who added that). Although I don't question whether someone could be traumatized by things they hear, I (and I'm not an expert) wouldn't put it in the category of the other causes that are mentioned. I think mention of it could be moved lower down in the article. Best, MarmadukePercy (talk) 18:55, 6 March 2009 (UTC)

Totally agree. I put it in there and you can put it anywhere you think fit. It was primarily a way to get in vicarious traumatisation and that too can be ejected from the article or the section. Any thoughts about the difficult area of BPD and C-PTSD wouls be greatly appreciated. Cheers --Ziji (talk email) 20:40, 6 March 2009 (UTC)

Okay, thanks. I will move it a bit later today when I have some time. As far as the area concerning BPD and C-PTSD, that is really beyond the scope of my knowledge, although I have an opinion on the issue (that they are two entirely different things). In any case, I'll leave that one to people better-informed than I. Cheers, MarmadukePercy (talk) 21:18, 6 March 2009 (UTC)

Thank you for your clarity. I noticed you replaced violations 'of power' with 'of personal boundaries', which I think together with gaslighting makes the case - even though I miss violations of power :-). I have got the BPD section to a good enough spot to leave it to other editors who may want to shift the focus a bit. I might head on down to the next section. Best to you--Ziji (talk email) 10:37, 7 March 2009 (UTC)

Thanks ASCE. I have made significant increase in content with addition of child, adolescent cluster with numerous citations for that material--Ziji (talk email) 04:27, 8 March 2009 (UTC)

Vicarious traumatisation and C-PTSD

I have taken out the section I put into the intro and not sure where to put it so here it is:

As a result of compulsory jury service, some jurors develop vicarious traumatisation. In a prolonged trial concerning for example, multiple human rights violations or war crimes this vicarious trauma can develop into C-PTSD.

--Ziji (talk email) 10:12, 8 March 2009 (UTC)

Ziji I think if you look it up you may find number 32, 2006c was withdrawn. Also the studies you referenced utilised the RADQ and attachment parenting techniques. I have a copy of the original study and can obtain a copy of the follow up one if you wish.Fainites ^barleyscribs 17:16, 23 March 2009 (UTC)

Fainites - as ever you are a marvel. Still not sure what to do with it and with your offer as I want to move onto emotion focused therapy and leave C-PTSD for a month or so, so that others can contribute.--Ziji (talk email) 10:09, 24 March 2009 (UTC)

Coo! There's a compliment! Also, Becker-Weidman is not a psychologist. He's a LCSW. His doctorate in in Human Development. Nothing wrong in that of course but I don't think his website would count as an appropriate source for matters pertaining to a psychiatric diagnosis. Apart from that this page is infinitely improved. Fainites ^barleyscribs 18:34, 24 March 2009 (UTC)

Compliments all round, thank you. I was tempted to keep B-W at a distance but I thought better to include for balance rather than exclude because of past experience with RAD.--Ziji (talk email) 21:12, 24 March 2009 (UTC)

Hughes would be better than BW then. He's the Clin psych who developed DDP and has got into the trauma thing rather than ye olde RAD etc. Fainites ^barleyscribs 00:09, 25 March 2009 (UTC)

Perfect - have you got time to add?--Ziji (talk email) 07:28, 25 March 2009 (UTC)

OK Fainites ^barleyscribs 20:21, 25 March 2009 (UTC)

Treating Complex Traumatic Stress Disorders

I urge editors to consult the recent publication of the same name (subtitled 'an evidence based guide') edited by Christine A Courtois and Julian Ford, 2009 The Guilford Press. Chapter 3 titled 'Best Practices in Psychotherapy for Children and Adolescents' states the utility of PTSD psychotherapies for children with C-PTSD is uncertain. It may be better to proceed in the treatment section of this article with DTD (developmental trauma disorder) for children rather than C-PTSD and separate the child area from the adult. The chapter goes on to list provisional practice principles for treating children with c-ptsd, which I will attempt to include at a later stage. At the moment I am busy on emotion focused therapy article.--Ziji (talk email) 21:51, 29 March 2009 (UTC)

Looks like a useful source Ziji. Fainites ^barleyscribs 08:21, 31 March 2009 (UTC)

Useful and humbling.--Ziji (talk email) 09:38, 31 March 2009 (UTC)

Edit: clarifies and adds content. approach is evidence-based. book only discusses university based large scale studies, evidence-based is an area open for discussion. Edit to NPOV. Corkytig (talk) 20:03, 1 April 2009 (UTC)

Please read the book before you attempt to represent its contents in argument about edits. You will notice the book is far more comprehensive and real world than 'university based large scale studies', with contributors who are clinical experts. A forword by Judith Herman and Afterword by Bessel van der Kolk with contributors like John Briere, Susan Johnson and Chrisitne Courtois this is not an academic treatise but a state of the art guide book to clinical practice. I notice Corkytig's recent edit is DDP related, please see 5. above.--Ziji (talk email) 21:54, 1 April 2009 (UTC)

Semi-protection of the article

Here is the rough guide to the purpose of protecting wikipedia articles.--Ziji (talk email) 22:40, 1 April 2009 (UTC)

You will no doubt be relieved to learn that both User:PAMom and User:Corkytig have been indef banned. Fainites ^barleyscribs 06:25, 2 April 2009 (UTC)

Thank you all - now it's safe to go back to editing the article without fear or favour - well at least until another sock puppet appears.--Ziji (talk email) 07:25, 2 April 2009 (UTC)

I have deleted the references to EFT, TF-CBT and DDP, for the sake of those interested parties, the deleted material below:

Emotionally focused therapy, Trauma focused cognitive behaviour therapy (TF-CBT) and Dyadic developmental psychotherapy are three of a number of approaches for treating paediatric PTSD.

Dyadic developmental psychotherapy does not appear in the latest guide to treating complex traumatic stress disorders by Courtois and Ford (2009) , which covers evidence based or promising evidence informed treatments. It is a method, not without controversy, originally developed by Hughes as an intervention for children whose emotional distress resulted from earlier separation from familiar caregivers and complex trauma. Hughes proposes that an attachment based treatment may be more effective for such foster and adoptive children than other treatments and parenting interventions. .

There seems to be an actual link here. Whether this is OK or not or some copyright breach I don't know.Fainites ^barleyscribs 13:24, 31 May 2009 (UTC)

Formal Recognition of C-PTSD

http://apps.who.int/classifications/apps/icd/icd10online/

Chapter V F62.0

The name might be different but the symptoms are nearly if not exactly identical. —Preceding unsigned comment added by 99.224.163.104 (talk) 08:09, 11 March 2010 (UTC)

Complex PTSD is not a formal diagnosis. It is not in the ICD-10 or the US DSM. This is important and very relevant information. My addition: Complex Trauma or Developmental Trauma Disorder are different that PTSD. Complex Post Traumatic Stress Disorder is not a diagnosis found in the DSM-IV-TR

Is quite relevant and important for the reader to know. To present as if complex ptsd has any broad recognition or clearly identified symptoms is misleading. I don't see why this Faainites keeps removing this without any clear discussion or explaining self. TuvolaPHD (talk) 19:26, 15 November 2010 (UTC)

Dr B-W, you have not read the article. If you had, you would see the "points" you are trying to add are addressed elsewhere in the article, more comprehensively and better sourced. Fainites ^barleyscribs 21:08, 15 November 2010 (UTC)

TuvolaPHD, please remember to assume good faith on the part of your fellow volunteers. As Fainites says, the point is already addressed by this article in a more appropriate way. If you think that the presentation or sourcing can be improved, please make a suggestion here so we can discuss it. - 2/0 (cont.) 21:44, 15 November 2010 (UTC)

I do disagree with Faaintes and think the distinction should be clearer and at the beginning. Regarding assuming good faith, is if good faith to call me a name that is not mine???TuvolaPHD (talk) 05:18, 16 November 2010 (UTC)

Again - the points you are trying to add are already addressed better elsewhere in the article. Please read the article. On the second part of your edit - there is already a discussion on DTD and Kolk in the bottom paragraph. Properly sourced. Your links to websites do not appear to support the claim you make. Fainites ^barleyscribs 17:30, 16 November 2010 (UTC)

The website citations or references (which is the proper term?) do show that complex trauma and not C-PTSD are the proper and commonly used terms. Furthermore I see no other notations pointing to the NCTSN! So, I think the material should remain. What is the harm? Why are you so ownerish about this and what did you mean by Dr. B-W???? I see no references in this article to that? TuvolaPHD (talk) 19:32, 16 November 2010 (UTC)

The article already makes it plain it is not in DSM IV. Secondly - where in the website does it claim that this is a more commonly used term for the same thing. There is already a discussion in the article about DTD and Kolk. Your additions are variously unhelpful, unsourced and inaccurate. Also I believe you to be a sock puppet of a prolific socker and permanently banned user, known as the DPeterson entity, one of who's manifestations was Dr B-W. I am not blocking you myself because I am "involved" in that I was involved in the arbitration case resulting in the exposure of all the socks and the banning.Fainites ^barleyscribs 19:36, 17 November 2010 (UTC)