Ela was happily married — or so people thought — until the day her husband came home with a DVD he had bought. Not a common practice for him. The name of the movie was Sleeping with the Enemy with Julia Roberts. Ela loved movies and made some popcorn to watch it with her husband. “Who recommended it?” she asked.
“Myself,” he responded. “I think it’s time for you to wake up.”
That day marked the beginning of Ela’s understanding of her dissociation, her depression, her submissiveness, her lack of enjoyment, and many other symptoms that she had developed through several years of emotional abuse and neglect, manipulation, gaslighting, and objectification at the hands of her husband.
Complex Trauma Diagnosis
Complex Trauma was first described in 1992 by Judith Herman in her book Trauma & Recovery. Immediately after that, Van Der Kolk (2000) and others began promoting the concept of “Complex PTSD” (C-PTSD), also referred to as “Disorder of Extreme Stress Not Otherwise Specified” (DESNOS).
According to Herman, complex trauma occurs after repetitive, prolonged trauma involving sustained abuse or abandonment by a caregiver or other interpersonal relationships with an uneven power dynamic; it distorts a person’s core identity, especially when prolonged trauma occurs during childhood.
DESNOS (1998) was formulated as a diagnosis with all the criteria and proposed in 2001 to be added to the DSM-5 as an option for complex trauma focused on children. It stated that childhood abuse and other developmentally adverse interpersonal trauma produce impairments in affective, cognitive, biological, and relational self-regulation. The proposal was rejected.
Christine A. Courtois and Julian Ford expanded on the concepts of PTSD and DESNOS arguing that complex trauma generally refers to traumatic stressors that are interpersonal — they are premeditated, planned, and caused by other humans, such as violating and/or exploitation of another person; repetitive, prolonged, or cumulative, most often interpersonal, involving direct harm, exploitation, and maltreatment of the sort; neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults, and often occurring at developmentally vulnerable times in the victim’s life, especially in early childhood or adolescence. Complex trauma can also occur later in life and in conditions of vulnerability associated with disability, disempowerment, dependency, age, infirmity, captivity, confinement, bondage, and so on.
After all the argumentation, Complex Posttraumatic Stress Disorder (C-PTSD) has been recently proposed as a distinct clinical entity in the WHO (World Health Organization) International Classification of Diseases, 11th version (ICD-11), due to be published soon, two decades after it was first proposed. It has been said that it will be an enhanced version of the current definition of PTSD, plus three additional clusters of symptoms: emotional dysregulation, negative self-cognition, and interpersonal hardship.