“As PTSD evolved into its current format as the valid construct for ongoing psychological distress following an acute trauma, studies of victims of chronic interpersonal abuse demonstrate a variety of trauma-generated difficulties not included in PTSD.
This issue is addressed in a review article by Van der Kolk and colleagues: “The inclusion in ICD-10 of the diagnosis ‘enduring personality changes after catastrophic stress’ reflects the growing understanding that prolonged or severe trauma is more frequently associated with ‘complex characterological changes’ such as disturbances of affect regulation, impaired capacity for cognitive integration, somatisation, and self-destructive behaviors” (American Journal of Psychiatry, July 1996).
While classic PTSD is dominated by symptoms of “reliving the trauma” (referring to symptoms such as flashbacks, fear arousal, and avoidance behaviors), victims of prolonged interpersonal abuse present with an entirely different spectrum of impairments in personality structure and functioning.
These include difficulties with emotional regulation, attention, and perceptions of oneself and the world, as well as a reduced sense of autonomy and personal agency.
Another area of self-function that becomes derailed as a result of prolonged abuse pertains to the formation of distorted cognitive schemas responsible for negotiating interpersonal relationships.
To this extent, there is a predilection for such victims to reenact their childhood traumas over and over again, particularly, but not limited to, those involving authority and intimacy.
Even in work and marriage these victims seem unconsciously compelled to return to abusive relationships in which they reenact their inner trauma-generated schemas.
As such, they appear to almost invite themselves into relationships where they perpetuate the role of victim.
When faced with predatory threat, these victims lack a sense of personal efficacy, and cannot mobilize either internal or even external rescue functions.
Instead of seeking mutuality and power-sharing, such victims appear paradoxically compelled to return to the more familiar abuse dynamic.
The syndrome of “complex trauma” was described by Judith Herman in her landmark book Trauma and Recovery – The Aftermath of Violence (Basic Books, 1992). This evolved after years of collaborative research at the Victims of Violence Program at Cambridge Hospital and the Boston Area Rape Crises Center.”