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Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma
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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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“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
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“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
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“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 ICD‐11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [26]
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“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]
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“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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“The work of van der Kolk and others addresses non-life-threatening trauma, asserting that, 'women who are exposed to prolonged interpersonal violence consistently report a range of psychological sequelae that are not captured in the PTSD diagnostic criteria' (van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005, p. 390).”
From Assessing the Validity of the Trauma Inventory for Partners of Sex Addicts (TIPSA) (2020) · cites this paper as van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005
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“The selection of specific symptoms and symptom clus ters reflecting difficulties in these domains was guided by the DESNOS formulation in the DSM-IV field trials 26 as well as by an expert consensus survey on complex PTSD 19 .”
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“This decision was supported by the observation in the DSM-IV field trial that nearly all individuals whose symptoms met criteria for DESNOS also met criteria for these three symptoms of PTSD 26 .”
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“Fragmentation of the trauma memory is a phenomenon that is often clinically observed, and continues to be an important area of focus for those treating PTSD (e.g., Becker, Zayfert, & Anderson, 2004, van der Kolk et al., 2005).”
From Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis (2012) · cites this paper as van der Kolk et al., 2005
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Cited by
Sorted by citations
Cloitre, M., Stolbach, B. C., Herman, J. L., Kolk, B. V. D., Pynoos, R., Wang, J., & Petkova, E. (2009) · Journal of Traumatic Stress · doi:10.1002/jts.20444 · Cited by 1,473
Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., Karatzias, T., & Hyland, P. (2018) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12956 · Cited by 1,314
Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-s1-s1 · Cited by 1,090
“Many RCTs have excluded patients with complex clinical profiles including childhood abuse histories, current SUDs, personality disorders, suicidality or self-injurious behavior, homelessness, refugees, intimate partner violence, and significant dissociative symptoms among others [926,927].”
BackgroundTeicher, M. H., & Samson, J. A. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.12070957 · Cited by 1,050
Smith, C. P., & Freyd, J. J. (2014) · American Psychologist · doi:10.1037/a0037564 · Cited by 849
Metadata
- 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
- 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
- bronze
- doi.org
- 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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