DESNOS: Complex Post Traumatic Stress Disorder

He Post Traumatic Stress Disorder has been one of the most studied disorders in recent decades (especially as a result of the devastating consequences of World War II Worldwide), due in large part to the awareness of the dysfunctionality that it entails for the people who suffer from it and the people of their around.

Anyone in the world can 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 those people who have been exposed to very serious stressful conditions all their lives or over a long period of time? What about war veterans? And with minors exposed to continued physical, psychological and sexual abuse? What happens when the people who continually aggress you are your primary family relationships?

In this article we will delve into the Complex Post Traumatic Stress Disorder, in its day called DESIGNS.

What is DESNOS or complex PTSD?

The DESNOS (for its acronym in English, Disorder of Extreme Stress Not Otherwise Specified

; unspecified extreme post-traumatic stress disorder), now known as PTSD complex, 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 a complex PTSD, according to Luxenberg et al. (2001), it would be a woman who as a child never received the necessary care and attention, she was sexually abused by her alcoholic stepfather on numerous occasions, and she watched (vicarious victimization) her stepfather rape his 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 first will include three groups of symptoms (re-experiencing, avoidance, and persistent sense of current threat). manifested by arousal and hypervigilance), while complex PTSD will comprise three additional groups: affective dysregulation, negative self-concept, and relationship disruption.

Symptoms and characteristics

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

Disturbance of relational capacities

Alterations arise in interpersonal relationships. The person with complex PTSD would tend to isolate, to chronically distrust others, to live in anger or unjustified hostility very spontaneous towards others, to repeatedly look for a person who acts as a "savior" (to re-establish security loss).

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

Alterations in attention and consciousness

Dissociative symptoms frequently appear. People with complex PTSD may present with altered or fragmented consciousness, memory, identity, perception of oneself and/or the environment.

• The dissociation It is a difficult construct to define, and it consists of several facets:
• disconnection (emotional and cognitive detachment from the immediate environment): they can go to social situations but it seems that they are absent.
• depersonalization (alteration in the perception of one's own body or oneself)
• Derealization (altered perception of the external world)
• Memory problems (memory losses for personal events)
• emotional constriction (decreased emotionality, reduced emotional response capacity). As if they were emotionally numb.
• dissociation of identity (It would be the most serious and least frequent: perception or experience that there is more than one person 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 must be tried to be made more flexible and modified during treatment:

• About yourself: "I'm bad", "I'm 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 nobody understands them are very frequent.

Difficulties regulating emotions and somatic discomfort

Drastic mood swings, dysphoric, irritable moods, intermittent anger (anger management difficulties) are common. … They can show self-destructive and impulsive behaviors (including those of a sexual nature). Regarding somatic discomfort, they may frequently have headaches, gastrointestinal problems, chronic pain, non-specific body pain...

Treatment

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

• Phase 1: the objective is to guarantee the safety of the person by managing self-regulation problems, improving their emotional and social skills.
• Phase 2: in this phase you will focus on the trauma as such, and on your processing of memories.
• Phase 3: at this moment the objective is to reintegrate and consolidate the achievements of the treatment and help the person to adapt to the current vital circumstances. It is advisable to carry out a relapse prevention plan.

Lastly, it should be noted that it is very important that the beliefs about oneself, about others and about the world, since it is a laborious and sometimes prolonged job, which is often the most difficult thing to do. Modify.