DESNOS: Complex Post-Traumatic Stress Disorder

A set of symptoms similar to PTSD. We analyze its characteristics.

Post-Traumatic Stress Disorder has been one of the most studied disorders in recent decades (especially in the aftermath of the devastating consequences of World War II), largely due to the awareness of the dysfunctionality it entails for the people who suffer from it and the people around them.

Anyone in the world may one day suffer from Post Traumatic Stress Disorder, even if they have been exposed to the experience or occurrence of a trauma only once..... But... what about people who have been exposed to very severe stressful conditions all their lives or over a long period of time? What about war veterans? What about children exposed to continuous physical, psychological and sexual abuse? What happens when the people who continuously assault you are your primary family relations?

In this article we are going to go deeper into the Complex Post-traumatic Stress Disorderonce called DESNOS.

What is DESNOS or Complex PTSD?

The DESNOS (for its acronym in English, Disorder of Extreme Stress Not Otherwise Specified(Disorder of Extreme Post-Traumatic Stress Not Otherwise Specified), now known as Complex PTSD, is defined by the presence of PTSD with added problems of self-regulation in the person. It usually occurs in people who have experienced multiple traumatic events, prolonged trauma, especially severe trauma (usually related to interpersonal victimization).

An example of complex PTSD, according to Luxenberg et al. (2001), would be a woman who as a child never received the necessary care and attention, was sexually abused by her alcoholic stepfather on numerous occasions, and saw (vicarious victimization) her stepfather rape her mother.

A new diagnostic category for complex PTSD has been proposed, and it appears that ICD-11 will distinguish between PTSD and complex PTSD (this has not been the case in DSM-5). The former will include three symptom clusters (reexperiencing, avoidance, and persistent sense of current threat manifested by arousal and hypervigilance), whereas complex PTSD will comprise three additional clusters: affective dysregulation, negative self-concept, and disturbance of relationships..

Symptoms and characteristics

As we have discussed, complex PTSD is characterized by the concurrence of PTSD with some self-regulation problems in the individual.. These problems are the following:

Disturbance of relational abilities

Disturbances in interpersonal relationships arise. The person with complex PTSD tends to isolate, to chronically distrust others, to live in anger or very spontaneous unjustified hostility towards others, to repeatedly look for a person to act as a "savior" (to re-establish lost security).

In general, they tend to be people who have few intimate relationships, due to the inability to trust and to open up towards others. In a way, it could be said that they are self-sabotaging, since in many occasions they do have social skills to establish intimate relationships but due to their learning behaviors and acquired beliefs they are not able to keep them.

Alterations in attention and consciousness

Dissociative symptoms frequently appear. People with complex PTSD may have alterations or fragmentations of consciousness, memory, identity, perception of self and/or environment.

• The dissociation is a difficult construct to define, and consists of several facets:
• Disconnection (emotional and cognitive separation from the immediate environment): they may attend social situations but appear to be absent.
• Depersonalization (altered perception of one's own body or self).
• Derealization (altered perception of the external world)
• Memory problems (loss of memory for personal events)
• Emotional constriction (decreased emotionality, reduced emotional responsiveness). As if they were emotionally anesthetized.
• Dissociation of the identity (would be the most severe and least frequent: perception or experience that more than one person exists within one's own mind).

Schemas or belief systems affected very unfavorably.

There are three types of persistent and exaggerated negative beliefs or expectations in cases of complex PTSD, which we must try to relax and modify in treatment:

• About oneself: "I am bad", "I am to blame for what happened", "I can never recover", "bad things only happen to bad people".
• About others: "you can't trust anyone", "you can't trust someone who hasn't been in the war".
• About the world: "the world is an unsafe and unfair place by default, something bad is going to happen", "the world is a very dangerous place", "I have no control over what can happen to me". In addition, feelings of shame, guilt, helplessness, invalidity, feeling that no one understands them are very frequent.

Difficulties in the regulation of emotions and somatic discomfort.

Drastic mood swings, dysphoric moods, irritable, intermittent anger (anger management difficulties) are common. ... They may show self-destructive and impulsive behaviors (including sexual). As for somatic discomfort, they may have frequent headaches, Gastrointestinal problems, chronic pain, nonspecific body aches ....

Treatment

Although treatment will depend largely on the type of trauma or traumas to which the subject has been exposed, the psychological model in which the clinician works and the time available, there are guidelines for the treatment of complex PTSD (Cloitre et al., 2012). Treatment can be divided into 3 phases:

• Phase 1: the aim is to ensure the safety of the person by managing self-regulation problems, improving emotional and social competences.
• Phase 2Phase 2: in this phase you will focus on the trauma as such, and on your processing of the memories.
• Phase 3At this stage the objective is to reintegrate and consolidate the achievements of the treatment and to help the person to adapt to the current life circumstances. A relapse prevention plan is recommended.

Finally, it is very important to work on beliefs about oneself, about others and about the world in a transversal way throughout the therapy, since it is a laborious and sometimes prolonged work, which is often the most difficult thing to modify.