Complex traumatization and complex PTSD are concepts that are far from unambiguous and have given rise to confusion, both nationally and internationally, both in the literature and in clinical practice.
A number of organizations in the Arq Psychotrauma Expert Group provide specialist care in the field of psychotrauma. Thus, ARQ Centrum’45 presents itself as the national treatment and expertise centre for people suffering from complex psychotrauma, Equator Foundation extends this care through its work on human bonding while the Psycho-diagnostic Centre conducts specialist research into the psychological consequences of traumatic events. From their own specific angle, each of these care institutions has acquired considerable expertise in the field of ‘complex traumatization’.
Over the past years, attempts have been made to reach a diagnostic definition yet the concept remains a subject of discussion. Recently, a taskforce of the International Society for Traumatic Stress Studies has devised a treatment guideline for complex PTSD. This expert consensus guideline defines complex PTSD thus:
The ISTSS task force definition of Complex PTSD included the core symptoms of PTSD (re-experiencing, avoidance/numbing, and hyper-arousal) in conjunction with a range of disturbances in self-regulatory capacities. The latter were grouped into five broad domains:
(a) emotion regulation difficulties,(b) disturbances in relational capacities,(c) alterations in attention and consciousness (e.g., dissociation), (d) adversely affected belief systems, and (e) somatic distress or disorganization (Cloitre et al., 2012).
An often-heard criticism is that a definition of complex PTSD as given in the treatment guideline is based overmuch on survivors of persistent, interpersonal childhood traumas, in other words, women who have been sexually abused. For this reason, a broader model has been advocated that also comprises the psychiatric consequences of, for instance, ethnic cleansing, torture or human trafficking. Such a model might also fit in better with the actual treatments provided by the care institutions within the Arq group.
To the present day, definitions of complex PTSD have offered very little guidance for actual treatments. Therefore, hardly any evidence-based treatments in the field of complex PTSD have been developed.
The development area ‘complex trauma’ seeks to bring about an enhanced understanding, both internally and externally, of the problems and evidence-based treatment of complex PTSD. We hope to achieve this internally by mapping complex PTSD among different target groups, which involves diagnosing and describing symptoms. Further, we also hope to effect a standard diagnostics that provides tools to benefit treatment. Why does a client improve, or if not, why not? Do specific factors such as childhood traumas, attachment problems or posttraumatic mourning play a role? And if we give close attention to these factors, in addition to the traumatization, will we then make more progress?
Finally, we wish to develop standardized, measurable treatment methods.
Cloitre, M., Courtois, C.A., Ford, J.D., Green, B.L., Alexander, P., Briere, J., Herman, J.L., Lanius, R., Stolbach, B.C., Spinazzola, J., Van der Kolk, B.A., Van der Hart, O. (2012). The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults. Retrieved from http://www.istss.org