An Overview of Psychic Trauma
and Post Traumatic Stress Disorder (PSTD)
Step 10

10. What is CPTSD? (Complex PTSD)

Recommended DSM diagnostic criteria, per Trauma and Recovery
by Judith Herman, c1992 by Basic Books.

A history of subjection to totalitarian control over a prolonged
period (months to years). Examples include hostages, prisoners
of war, concentration-camp survivors, and survivors of some
religious cults. Examples also include those subjected to
totalitarian systems in sexual and domestic life, including
survivors of domestic battering, childhood physical or sexual
abuse, and organized sexual exploitation.

Alterations in affect regulation, including:

persistent dysphoria

chronic suicidal preoccupation


explosive or extremely inhibited anger (may alternate)

compulsive or extremely inhibited sexuality (may alternate)

Alterations in consciousness, including:

amnesia or hypermnesia for traumatic events

transient dissociative episodes


reliving experiences, either in the form of intrusive
post-traumatic stress disorder symptoms or in the form of
ruminative preoccupation

Alterations in self-perception, including:

sense of helplessness or paralysis of initiative

shame, guilt, and self-blame

sense of defilement or stigma

sense of complete difference from others (may include
sense of specialness, utter aloneness, belief no other person
can understand, or non-human identity)

Alterations in perception of perpetrator, including:

preoccupation with relationship with perpetrator (includes
preoccupation with revenge)

unrealistic attribution of total power to perpetrator
(caution: victim's assessment of power realities may be more
realistic than clinician's)

idealization or paradoxical gratitude

sense of special or supernatural relationship

acceptance of belief system or rationalizations of perpetrator

Alterations in relations with others, including:

isolation and withdrawal

disruption in intimate relationships

repeated search for rescuer (may alternate with isolation
and withdrawal)

persistent distrust

repeated failures of self-protection

Alterations in systems of meaning:

loss of sustaining faith

sense of hopelessness and despair

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