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Cited by 1,284Posttraumatic Stress Disorder ResearchChild Abuse and TraumaPsychoanalysis and Psychopathology Research

Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma

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van der Kolk, Bessel A., Roth, Susan, Pelcovitz, David, Sunday, Susanne, Spinazzola, Joseph·2005·Journal of Traumatic Stress
DOI 10.1002/jts.20047
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Abstract

Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis. The DSM-IV (American Psychiatric Association, 1994) Field Trial studied 400 treatment-seeking traumatized individuals and 128 community residents and found that victims of prolonged interpersonal trauma, particularly trauma early in the life cycle, had a high incidence of problems with (a) regulation of affect and impulses, (b) memory and attention, (c) self-perception, (d) interpersonal relations, (e) somatization, and (f) systems of meaning. This raises important issues about the categorical versus the dimensional nature of posttraumatic stress, as well as the issue of comorbidity in PTSD. These data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology.

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  • Partners of sex addicts seeking counseling/therapy services may have presenting concerns that do not fall within the current framework of PTSD, and therefore their symptoms may be attributed to comorbid conditions, suggesting that the symptoms occurred independently from PTSD symptoms.

    “As partners of sex addicts seek counseling/therapy services, their presenting concerns may not fall within the current framework of PTSD, and therefore their symptoms may be attributed to comorbid conditions, suggesting that the symptoms occurred independently from PTSD symptoms (van der Kolk et al., 2005).”

    From Assessing the Validity of the Trauma Inventory for Partners of Sex Addicts (TIPSA) (2020) · cites this paper as van der Kolk et al., 2005

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • These impairments can lead to difficulty negotiating relationships with parents and caregivers, peers, and marital partners.

    “These impairments, in turn, can lead to difficulty negotiating relationships with parents and caregivers, peers, and marital partners (van der Kolk et al., 2005).”

    From Assessing the Validity of the Trauma Inventory for Partners of Sex Addicts (TIPSA) (2020) · cites this paper as van der Kolk et al., 2005

    The Developmental and Relational Issues section reports that studies of traumatized children find both psychological impairments and difficulty negotiating relationships with caregivers, peers, and later marital partners. It lists these as problems found in the same population, but does not say that the impairments cause the relationship difficulties. (LLM, conf=0.82)

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  • The DSM-IV field trial for PTSD indicated that individuals who had experienced early and chronic interpersonal trauma reported a greater number and severity of DESNOS symptoms particularly related to emotion regulation difficulties, negative self-concept, and relational disturbances, in comparison to those without such a history.

    “The DSM-IV field trial for PTSD 26,27 indicated that individuals who had experienced early and chronic interpersonal trauma reported a greater number and severity of DESNOS symptoms particularly related to emotion regulation difficulties, negative self-concept, and relational disturbances, in comparison to those without such a history.”

    From Emerging experience with selected new categories in the <scp>ICD</scp>‐11: complex <scp>PTSD</scp>, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [26]

    The Nature of Trauma section and Table 3 report greater endorsement of DESNOS items after early-onset interpersonal trauma than after later-onset trauma, including items concerning affect regulation, self-perception, and relationships. The Discussion also links earlier onset and longer exposure to greater likelihood of DESNOS. The reported comparisons concern endorsement and prevalence, however; they do not establish greater symptom severity or single out those three domains as particularly affected. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Children exposed to childhood trauma may develop PTSD, but potential outcomes are not limited to PTSD.

    “In diagnosis, children exposed to childhood trauma may develop PTSD, but the potential outcomes are not limited to PTSD (235).”

    From Epigenetic Modifications in Stress Response Genes Associated With Childhood Trauma (2019) · cites this paper as [235]

  • Relegating symptoms to seemingly unrelated comorbid conditions may cause fundamental trauma-related disturbances to be lost to scientific investigation, and clinicians may run the risk of applying treatment approaches that are not helpful.

    “Additionally, van der Kolk et al. (2005) asserted that, 'By relegating [symptoms] to seemingly unrelated 'comorbid' conditions, fundamental trauma-related disturbances may be lost to scientific investigation, and clinicians may run the risk of applying treatment approaches that are not helpful' (p. 309).”

    From Assessing the Validity of the Trauma Inventory for Partners of Sex Addicts (TIPSA) (2020) · cites this paper as van der Kolk et al., 2005

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Research works printed but not linked: 7

  1. Brett, E., Spitzer, R., & Williams, J. (1988). DSMIII-R criteria for posttraumatic stress disorder. American Journal of Psychiatry, 144, 1232-1236.
  2. Finkelhor, D., & Kendall-Tackett, K. (1997). A developmental perspec- tive on the childhood impact of crime, abuse and violent victim- ization. In D. Cicchetti & S. Toth (Eds.), Rochester symposium on developmental psychopathology and developmental perspec- tives on trauma (pp. 1-32). Rochester, NY: University of Rochester Press.
  3. Ford, J.D., Fisher, P., & Larson, L. (1997). Object relations as predictors of treatment outcome with chronic PTSD. Journal of Consulting and Clinical Psychology, 64, 547-559.
  4. Herman, J.L., & Van der Kolk, B.A. (1987). Traumatic antecedents of borderline personality disorder. In B. Van der Kolk (Ed.), Psycho- logical trauma (pp. 111-126). Washington, DC: American Psychi- atric Press.
  5. Kilpatrick, D.G., Resnick, H.S., Freedy, J.R., Pelcovitz, D., Resick, P.A., Roth, S., et al. (1998). Posttraumatic stress disorder field trial: Evaluation of the PTSD construct-Criteria A through E. In T.A. Widiger, A.J. Frances, H.A. Pincus, R. Ross, M.B. First, W. David et al. (Eds.), DSM-IV sourcebook (Vol. 4, 4th ed., pp. 803-844). Washington, DC: American Psychiatric Association.
  6. Leeds, A.M., & Shapiro, F. (2000). EMDR and resource installation: Principles and procedures for enhancing current functioning and resolving traumatic experiences. In J. Carlson & L. Sperry (Eds.), Brief therapy with individuals & couples (pp. 469-534). Phoenix, AZ: Tucker & Theisen, Inc.
  7. Vielhauer, M.J. (1996). Complex post-traumatic stress disorder associ- ated with childhood sexual and physical abuse in male veterans with histories of substance abuse disorders. Unpublished doctoral dissertation, State University of New York at Buffalo.

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Authors
van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J.
Affiliations
  • Duke University (US)
  • Cornell University (US)
  • Boston University (US)
Venue
Journal of Traumatic Stress
Publisher
Wiley
Published
2005
Volume
18
Issue
5
Pages
389-399
ISSN
  • 0894-9867 (ISSN-L)
  • 1573-6598
DOI
10.1002/jts.20047
OpenAlex
W2145499550
Cited by
1,284
References
98
Citations by year
2026: 36 · 2025: 43 · 2024: 41 · 2023: 67 · 2022: 61 · 2021: 68 · 2020: 105 · 2019: 86 · 2018: 82 · 2017: 68 · 2016: 86 · 2015: 73 · 2014: 80 · 2013: 74 · 2012: 60
FWCI
33.23
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 3895 d)
Locations
  • Journal of Traumatic Stress (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5p01mh047200-03)
  • National Institute of Mental Health (1 P01 MH47200-01)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
post-traumatic stress disorder, trauma exposure, emotion regulation, impulse control, attention and memory, self-perception, interpersonal relationships, somatization, meaning systems, comorbidities, trauma treatment, children and adults
MeSH terms
Adolescent, Adult, Female, Humans, Interpersonal Relations, Interview, Psychological, Life Change Events, Male, Personality Disorders, Surveys and Questionnaires, Severity of Illness Index, Stress Disorders, Post-Traumatic, Stress, Psychological, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders

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