I found this to be interesting.
http://en.wikipedia.org/wiki/Complex_po ... s_disorder
Complex post-traumatic stress disorder (C-PTSD) is a psychological injury that results from protracted exposure to prolonged social and/or interpersonal trauma with lack or loss of control, disempowerment, and in the context of either captivity or entrapment, i.e. the lack of a viable escape route for the victim. C-PTSD is distinct from, but similar to, posttraumatic stress disorder (PTSD). Though mainstream journals have published papers on C-PTSD, the category is not formally recognized in diagnostic systems such as DSM or ICD.[1]
C-PTSD involves complex and reciprocal interactions between multiple biopsychosocial systems. It was first referred to by Judith Herman in her book Trauma & Recovery and an accompanying article.[2][3] Forms of trauma include sexual abuse (especially child sexual abuse), physical abuse, emotional abuse, domestic violence or torture.[4][5]
A differentiation between the diagnostic category of C-PTSD and that of posttraumatic stress disorder (PTSD) has been suggested. C-PTSD better describes the pervasive negative impact of chronic repetitive trauma than does PTSD alone.[6][7]
PTSD descriptions fail to capture some of the core characteristics of C-PTSD. These elements include captivity, psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be revictimized, and, most importantly, the loss of a coherent sense of self. It is this loss of a coherent sense of self, and the ensuing symptom profile, that most pointedly differentiates C-PTSD from PTSD.[8]
C-PTSD is characterized by pervasive insecure, often disorganized-type attachment.[9] DSM-IV dissociative disorders and PTSD do not include insecure attachment in their criteria. As a consequence of this aspect of C-PTSD, when some adults with C-PTSD become parents and confront their own children's attachment needs, they may have particular difficulty in responding sensitively especially to their infants' and young children's routine distress—such as during routine separations, despite these parents' best intentions and efforts.[10] And this difficulty in parenting may have adverse repercussions for their children's social and emotional development if parents with this condition and their children do not receive appropriate treatment.[11][12]
C-PTSD may have originated from observations of acute breakthrough of borderline personality (BPD) symptoms in trauma victims.[citation needed] This could be diagnosed as PTSD with borderline features, where the symptoms of BPD were not sufficient to sustain a (hypothetical) dual diagnosis of BPD and PTSD. C-PTSD may share some symptoms with both PTSD and BPD.[24] Judith Herman has suggested that C-PTSD be used in place of borderline.[25]
It may help to understand the intersection of attachment theory with C-PTSD and BPD if one reads the following opinion of Bessel A. van der Kolk together with an understanding drawn from a description of 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 neuroendocrinologic 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.[26][27]
Seeking increased attachment to people, especially to care-givers who inflict pain, confuses love and pain and increases the likelihood of a captivity like that of betrayal bonding,[28] and of disempowerment and lack of control. If the situation is perceived as life threatening then traumatic stress responses will likely arise and C-PTSD more likely diagnosed in a situation of insecure attachment than PTSD. At what point do the complex, reciprocal biopsychosocial responses to prolonged and extreme abuse evolve into BPD? This may depend on the timing, intensity and duration of the abuse and an as yet unidentified predisposition to BPD that results in a reset of the neuroendocrinologic levels of the body[citation needed] in a self-reinforcing pattern recognisable as the symptom cluster of BPD.
However, 25% of those diagnosed with BPD have no history of childhood neglect or abuse and individuals are six times as likely to develop BPD if they have a relative who was so diagnosed[citation needed] compared to those who do not. One conclusion is that there is a genetic predisposition to BPD unrelated to trauma. Researchers conducting a longitudinal investigation of identical twins found that "genetic factors play a major role in individual differences of borderline personality disorder features in Western society."[29][30]
Herman[39] believes recovery from C-PTSD occurs in three stages. These are: establishing safety, remembrance and mourning for what was lost, and reconnecting with community and more broadly, society. Herman believes recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship.
Complex trauma means complex reactions and this leads to complex treatments. Hence treatment for C-PTSD requires a multi-modal approach.[40] It has been suggested that treatment for C-PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems.