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Abstract
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For much of the 20th century, the male arena of war was the focus for understanding traumatic experiences. Late-19th-century psychiatry had included the sphere of the family and childhood sexual abuse, but they were largely left aside until the 1980s. Since post-traumatic stress disorder (PTSD) was introduced as a DSM diagnosis in 1980, what counts as traumatic events and symptoms has been continually contested and modified. Childhood maltreatment is now considered a form of interpersonal trauma involving physical, sexual, or emotional abuse, or neglect, but understandings are still shifting.
One way to address trauma is through diagnoses. With roots in Judith Herman's 1990s work on prolonged exposure and complex trauma, and Bessel van der Kolk's early 2000s argument on developmental trauma, the new ICD-11 diagnosis of complex PTSD recognises that chronic or repeated trauma can have pervasive effects. In addition to the three PTSD symptom clusters (re-experiencing the event, avoiding traumatic reminders, and heightened sense of threat), complex PTSD involves three clusters related to self-organisation, including affect dysregulation, extremely negative self-concept, and difficulties in forming and maintaining relationships. This diagnosis is particularly relevant for people who experienced childhood maltreatment, and it helps to focus trauma-informed responses.
But diagnoses are challenging. Children with trauma can be misdiagnosed with bipolar disorder, psychotic disorders, or disruptive mood dysregulation disorder, and the new complex PTSD clusters overlap somewhat with those of borderline personality disorder. Traumatic disorders are also not the only relevant diagnoses. In one study, nearly one in three children who experienced trauma had a major depressive episode and one in four had self-harmed by age 18 years. Complicating the picture, a 2021 study found that experience of complex trauma with multiple interpersonal threats was associated with more severe psychopathology at age 18 than non-complex trauma. The effects are also physical; people with a history of childhood trauma are twice as likely to experience chronic pain in adulthood, and associations have been found with abdominal and lower back pain, irritable bowel syndrome, and migraine.
Language: en |