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Complex Posttraumatic Stress Disorder/Disorders of Extreme Stress (CP/DES) in Sexually Abused Children: An Exploratory Study

NCJ Number
Journal of Child Sexual Abuse Volume: 8 Issue: 4 Dated: 1999 Pages: 51-71
Darlene K. Hall
Date Published
21 pages
The syndrome of "Complex" Posttraumatic Stress Disorder/Disorders of Extreme Stress (CP/DES) has been proposed to describe symptoms, inadequately characterized by posttraumatic stress disorder (PTSD), reported by adult survivors of repeated interpersonal trauma; this study explores whether CP/DES characterizes the responses of sexually abused children, some of whom have sustained multiple interpersonal trauma.
Herman (1992a, 1992b, 1993) and van der Kolk and colleagues have recommended the adoption of a new classification for chronic, early traumatic stress that emanates from interpersonal sources, i.e., Disorder of Extreme Stress (DES) or "Complex" PTSD(CP). Seven main categories of symptoms have been highlighted by van der Kolk (1996) and others as characteristics of victims of "extreme stress" who have sustained repeated and/or accumulated interpersonal trauma during childhood, such as sexual and physical abuse. The seven categories are alteration in regulation of affect/impulses; alteration in regulation of attention and consciousness; alteration in self-perception; alteration in perception of the perpetrator; alteration in relationships with others; somatization; and alteration in systems of meaning. In the current study, three groups of young sexually abused children (n=99) were compared on seven child CP/DES indexes. Children with PTSD exhibited more CP/DES symptoms within a greater number of CP/DES categories than Partial- or Non-PTSD groups. The relationship between cumulative trauma and total number of CP/DES symptoms revealed that as the cumulative number of types of trauma increased the number of CP/DES symptoms increased. These results suggest that CP/DES also characterizes sexually abused children, especially those who have been multiply maltreated, and offers a more developmentally appropriate framework for assessment and treatment than PTSD. 5 tables and 41 references