The National Child Traumatic Stress Network has formed a Complex Trauma Task Force that includes experts in childhood trauma, such as Bessel van der Kolk. The Task Force is hard at work defining a new category that may be included in the DSM-V, due to be published in 2010. The category: Complex Post Traumatic Stress Disorder.

The definition of C-PTSD, also known as “complex trauma”, sounds a great deal like many of the “combo platter” issues that are faced by adopted and foster children who come from backgrounds of abuse, neglect and deprivation. As wikipedia says:

C-PTSD is characterized by chronic difficulties in many areas of emotional and interpersonal functioning. Symptoms include:
• Difficulties regulating emotions, including symptoms such as persistent sadness, suicidal thoughts, explosive anger, or inhibited anger
• Variations in consciousness, such as forgetting traumatic events, reliving traumatic events, or having episodes of dissociation (during which one feels detached from one's mental processes or body)
• Changes in self-perception, such as a sense of helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings
• Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge
• Alterations in relations with others, including isolation, distrust, or a repeated search for a rescuer
• Loss of, or changes in, one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair [1]

It goes on to say:

Children exposed to complex trauma (chronic maltreatment, abuse, neglect, witnessing domestic violence, etc.) often evidence impairment in several domains. Cook et al. (2000, 2003) describe symptoms and behavioral characteristics in seven domains:
1. Attachment - Uncertainty about the reliability and predictability of the world, distrust and suspiciousness, social isolation, interpersonal difficulties, difficulty attuning to other people's emotional states and points of view
2. Biology - hypersensitivity to physical contact, analgesia, somatization, increased medical problems
3. Affect or emotional regulation - easily-aroused high-intensity emotions, difficulty deescalating, difficulty describing feelings and internal experience, chronic and pervasive depressed mood or sense of emptiness or deadness, chronic suicidal preoccupation, overinhibition or excessive expression of anger
4. Dissociation - distinct alterations in states of consciousness, amnesia, depersonalization and derealization
5. Behavioral control - poor modulation of impulses, self-destructive behavior, aggressive behavior, sleep disturbances, eating disorders, substance abuse, oppositional behavior, excessive compliance
6. Cognition - difficulties in attention regulation and executive functioning, problems focusing on and completing tasks, difficulty planning and anticipating, learning difficulties, problems with language development
7. Self-concept - lack of a continuous and predictable sense of self, low self-esteem, feelings of shame and guilt, generalized sense of being ineffective in dealing with one's environment, belief that one has been permanently damaged by the trauma

Wow. The way I read this is that C-PTSD has the potential of explaining the alphabet soup of labels many of our kids get. Let’s look again at these domains and the current diagnoses they might incorporate:

1. Attachment –RAD or attachment issues
2. Biology – Sensory Integration Dysfunction
3. Affect or emotional regulation – current diagnosis possibilities: Depression, Anxiety Disorders…or if the moods are swinging between depressed and anger, maybe even Bipolar Disorder
4. Dissociation – that’s self-explanatory.
5. Behavioral control – ODD, OCD, Anxiety Disorders, Anorexia/Bulimia, self-mutiliation.
6. Cognition – ADHD, Autism, PDD, Language Disorders
7. Self-Concept – BPD….components of RAD…

And as a complete aside: Is there anyone besides the English major in me that is bugged by the fact there's no hyphen is Post-Traumatic Stress Disorder???? Oh my, my own OCD is showing!
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