Korean journal of psychology:General (한국심리학회지ㆍ일반)

Korean Health Psychological Association (한국건강심리학회)
권호 표지

An Empirical Review of Complex Trauma

복합외상(complex trauma)의 개념과 경험적 근거

Ahn, Hyun-Nie
안현의

  • Published : 20070600
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Abstract

Posttraumatic Stress Disorder (PTSD) is the most common diagnosis given after a traumatic incident. However, there has been a broad consensus that PTSD does not explain all types of traumatic reponses, which led to the proposition of the notion of Complex PTSD or DESNOS. Complex PTSD or DESNOS is caused by complex trauma, a type of trauma that commonly involves repeated, interpersonal violence. Childhood abuse, family violence, war participation are some examples of the complex trauma. Complex PTSD or DESNOS is known to differ in its symptom manifestation, and therefore different treatment approaches are suggested. This study is a review of the current concepts and empirical evidence of complex PTSD, and its related issues. A few suggestions are given regarding the importance of understanding complext PTSD in Korean society.

외상후 스트레스 장애(Posttraumatic Stress Disorder; PTSD)는 정신적으로 큰 충격을 준 사건을 겪은 이후 지속적으로 심리적 후유증을 나타내는 이들에게 내려지는 대표적인 진단이다. 하지만 PTSD가 다양한 종류의 외상경험자의 증상과 반응양상을 모두 반영하지 못한다는 비판을 받으면서 복합 PTSD 또는 DESNOS 의 개념이 등장하였다. 외상 유형 가운데 대인간 폭력이 주가 되면서 반복적이거나 장기적으로 지속된 외상 유형의 경우(예, 아동폭력, 가정폭력, 난민 경험) 현재 DSM-IV에 수록된 PTSD 증상들과는 다른 증상 특징들을 나타내기에 기존의 PTSD 진단에 한계가 있을 뿐만 아니라 치료적 접근 또한 달라져야 한다고 보는 입장이 있다. 이 연구는 복합 외상에 대하여 기존의 PTSD 진단이 가지고 있는 제한점이 무엇인지, 복합 PTSD(complex PTSD)라는 새로운 진단의 개념과 치료에 관하여 최근까지 발표된 경험적 연구결과들이 무엇인지를 개관하여 소개하고자 한다.

Keywords

References

  1. 김선아, 김소야자, 남경아, 박정화, 이현화 (2003) 가정폭력으로 쉼터에 입소한 여성의 피해실태와 정신건강. 대한간호학회지, 33, 981-989
  2. 김재엽, 양혜원 (1998). 자녀학대 피해 청소년의 정신건강 연구. 연세사회복지연구, 5, 37-62
  3. 김재엽, 최지현 (2005). 여대생의 아동학대경험이 정신건강 및 사회생활에 미치는 영향에 관한 연구. 한국가족복지학, 10, 27-47
  4. 김재엽, 김희수 (2003). 여성노인의 가정폭력피해 실태와 정신건강. 한국노년학, 23, 51-65
  5. 안현의 (2005). 청소년의 심리적 외상에 관한 탐색적 연구: 외상후 스트레스 증상과 성격특성을 중심으로. 한국심리학회지: 상담 및 심리치료, 17, 217-231
  6. 이수정 (2006). 가정폭력에 기인하여 배우자를 살해한 여성 재소자의 심리특성에 관한 연구. 한국심리학회지: 사회 및 성격, 20, 35-55
  7. Allen, J. (2001). Traumatic relationships and serious mental disorders. Chichester, UK: Wiley
  8. Allen, J. G., Huntoon, J., & Evans, R. B. (1999). Complexities in complex posttraumatic stress disorder in inpatient women: evidence from cluster analysis of MCMI-III personality disorder scale. Journal of Personality Assessment, 73, 449-471 https://doi.org/10.1207/S15327752JPA7303_10
  9. Andreasen, N. C. (2001). The validation of psychiatric diagnosis: New models and approaches(editorial). American Journal of Psychiatry, 152, 161-162
  10. Ashead, G. (1994). Damage: Trauma and violence in a sample of women referred to a forensic service. Behavioral Sciences and the Law, 12, 235-249 https://doi.org/10.1002/bsl.2370120304
  11. Bremner, J. D., Southwick, S., Brett, E., Fontana, A., Rosenheck, R., & Charney, D. S. (1992). Dissociation and posttraumatic stress disorder in Vietnam combat veterans. American Journal of Psychiatry, 149, 328-332 https://doi.org/10.1176/ajp.149.3.328
  12. Burgess, A. W., & Holmstrom, L. L. (1974). Rape trauma syndrome. American Journal of Psychiatry, 131, 981-986 https://doi.org/10.1176/ajp.131.9.981
  13. Chu, J. A. (1998). Rebuilding shattered lives: The responsible treatment of complex post-traumatic and dissociative disorders. New York: Wiley
  14. Courtois, C. A. (2004). Complex trauma, complex reactions: Assessment and treatment. Psychotherapy: Theory, Research, Practice, Training, 41, 412-425 https://doi.org/10.1037/0033-3204.41.4.412
  15. Creamer, M., Burgess, P. M., & McFarlane, A. C. (2001). Posttraumatic stress disorder: Findings from the Australian National Survey of Mental Health and Well-Being. Psychological Medicine, 31, 1237-1247
  16. Davidson, J. R. T., & Foa, E. B. (1991). Diagnostic issues in posttraumatic stress disorder: Considerations for the DSM-IV. Journal of Abnormal Psychology, 100, 346-355 https://doi.org/10.1037/0021-843X.100.3.346
  17. de Jong, J. T. V. M., Komproe, I. H., Spinazzola, J., van der Kolk, B. A., & Van Ommeren, M. H. (2005). DESNOS in three postconflict settings: Assessing cross-cultural construct equivalence. Journal of Traumatic Stress, 18, 13-21 https://doi.org/10.1002/jts.20005
  18. deVries, M. W. (1996). Trauma in cultural perspective. In Bessel A. van der Kolk, Alexander C. McFarlane, & Lars Weisaeth (Eds.) Traumatic stress. New York: The Guilford Press
  19. Friedman, M. J., & Rosenheck, R. (1996). PTSD as a chronic disorder. In S. Soreff (Ed.) The seriously and persistently mentally ill (pp.369-389). Seattle: Hogrefe & Huber
  20. Ford, J. D., Courtois, C. A., Steele, K., van der Hart, O., & Nijenhuis, E. R. S. (2005). Treatment of complex posttraumatic self-dysregulation. Journal of Traumatic Stress, 18, 437-447 https://doi.org/10.1002/jts.20051
  21. Ford, J. D., & Kidd, P. (1998). Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic PTSD. Journal of Traumatic Stress, 11, 743-761 https://doi.org/10.1023/A:1024497400891
  22. Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377-391 https://doi.org/10.1002/jts.2490050305
  23. Herman, J. L. (1992). Trauma and recovery. New York: Basic Books
  24. Ide, N., & Paez, A. (2000). Complex PTSD: a review of current issues. International Journal of Emergency Mental Health, 2, 43-49
  25. Kendall-Tackett, K. (2002). The health effects of childhood abuse: Four pathways by which abuse can influence health. Child Abuse and Neglect, 26, 715-729 https://doi.org/10.1016/S0145-2134(02)00343-5
  26. Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. American Journal of Psychiatry, 160, 4-12 https://doi.org/10.1176/appi.ajp.160.1.4
  27. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060 https://doi.org/10.1001/archpsyc.1995.03950240066012
  28. Kilpatrick, D. G. (2005). A special section on complex trauma and a few thoughts about the need for more rigorous research on treatment efficacy, effectiveness, and safety. Journal of Traumatic Stress, 18, 379-384 https://doi.org/10.1002/jts.20045
  29. Kilpatrick, D. G., & Resnick, H. S. (1992). A description of theposttraumatic stress disorder field trial. In J.R.T. Davidson & E. B. Foa (Eds.) Posttraumatic stress disorder: DSM-IV and beyond (pp.243-250). Washington, D.C: American Psychiatric Press
  30. Lebowitz, L., & Newman, E. (1996). The role of cognitive-affective themes in the assessment and treatment of trauma reaction. Clinical Psychology and Psychotherapy: An International Journal of Theory and Practice, 3, 196-207 https://doi.org/10.1002/(SICI)1099-0879(199609)3:3<196::AID-CPP102>3.0.CO;2-U
  31. Marshall, R. D., Schneier, F. R., Lin, S. H., Simpson, H. B., Vermes, D., & Liebowitz, M. R. (2000). Childhood trauma and dissociative symptoms in panic disorder. American Journal of Psychiatry, 157, 451-453 https://doi.org/10.1176/appi.ajp.157.3.451
  32. Nemeroff, C. B., Heim, C. M., Thase, M. E., Klein, D. N., Rush, A. J., Schatzberg, A. F., Nina, P. T., McCullough, J. P., Weiss, P. M., Dunner, D. L., Rothbaum, B. A., Kornstein, S., Keitner, G., & Keller, M. B. (2003). Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proceedings of the National Academy of Sciences of the United States of America, 100, 14293-14296
  33. Newman, E., Riggs, D. S., & Roth, S. (1997). Thematic resolution, PTSD, and complex PTSD: The relationship between meaning and trauma-related diagnoses. Journal of Traumatic Stress, 10, 197-213
  34. Norriss, F. H., & Kaniasty, K. (1994). Psychological distress following criminal victimization in the general population: Cross-section, longitudinal, and prospective analyses. Journal of Consulting and Clinical Psychology, 62, 111-123 https://doi.org/10.1037/0022-006X.62.1.111
  35. Parson, E. R. (1994). Post-traumatic ethnotherapy: Processes in assessment and intervention in aspects of global psychic trauma. In M. B. Williams, & J. F. Sommer (Eds). Handbook of posttraumatic therapy. CT: Greenwood Press
  36. Resick, P. A., Pallavi, N., & Griffin, M. G. (2003). How well does cognitive-behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial. CNS Spectrums, 8, 351-355
  37. Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., & Best, C. L. (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of Consulting and Clinical Psychology, 61, 984-991 https://doi.org/10.1037/0022-006X.61.6.984
  38. Romano, E., & DeLuca, R. V. (1997). Exploring the relationship between childhood sexual abuse and adult sexual perpetration. Journal of Family Violence, 12, 85-98 https://doi.org/10.1023/A:1021950017920
  39. Roth, S., & Newman, E. (1991). The process of coping with trauma. Journal of Traumatic Stress, 4, 279-297 https://doi.org/10.1002/jts.2490040209
  40. Roth, S., & Newman, E. (1993). The process of coping with incest for adult survivors. Journal of Interpersonal Violence, 8, 363-377 https://doi.org/10.1177/088626093008003005
  41. Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Journal of Traumatic Stress, 10, 539-555
  42. Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5, 455-475 https://doi.org/10.1002/jts.2490050309
  43. Schiraldi, G. (2000). Posttraumatic stress disorder sourcebook. Illinois: McGraw-Hill
  44. Spitzer, R., Kaplan, S., & Pelcovitz, D. (1989). Victimization disorder. New York: New York Psychiatric Institute
  45. Taylor, S., Asmundson, G. J. G., & Carleton, R. N. (2006). Simple versus complex PTSD: A cluster analytic investigation. Journal of Anxiety Disorders, 20, 459-472 https://doi.org/10.1016/j.janxdis.2005.04.003
  46. Terr, L. C. (1992). Childhood traumas: An outline and overview. In M. E. Hertzig & E. A. Farber (Eds). Annuals progress in child psychiatry and child development (pp.165-186). New York. Brunner/Mazel
  47. Turner, S. W., McFarlane, A. C., & van der Kolk, B. A., (1996). The therapeutic environment and new explorations in the treatment of posttraumatic stress disorder. In Bessel A. van der Kolk, Alexander C. McFarlane, & Lars Weisaeth (Eds.) Traumatic stress. New York: The Guilford Press
  48. van der Kolk, B. (2005). Developmental trauma disorder. Psychiatric Annals, 35, 401-408 https://doi.org/10.3928/00485713-20050501-06
  49. van der Kolk, B., & Courtois, C. A. (2005). Editorial comments: complex developmental trauma. Journal of Traumatic Stress, 18, 385-388 https://doi.org/10.1002/jts.20046
  50. van der Kolk, B., Pelcovitz, D., Roth, S., Mandel, F., McFarlane, A., & Herman, J. L. (1996). Dissociation, affect dysregulation, and somatization: The complexity of adaptation to trauma. American Journal of Psychiatry, 153, 83-93 https://doi.org/10.1176/ajp.153.1.83
  51. van der Kolk, B., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005).Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18, 389-399 https://doi.org/10.1002/jts.20047
  52. Walker, L. E. (1984). The battered woman syndrome. New York: Springer
  53. Weine, S. M., Becker, D. F., Vojvoda, D., Hodzic, E., Sawyer, M., Hyman, L. (1998). Individual change after genocide in Bosnian survivors of 'ethnic cleansing': Assessing personality dysfunction. Journal of Traumatic Stress, 11, 147-153 https://doi.org/10.1023/A:1024469418811
  54. World Health Organization. (1992). The ICD-10 classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization
  55. Yen, S., Shea, M. T., Pagano, M. E., Sanislow, C. A., Grilo, C. M., McGlashan, T. H. (2003). Axis I and Axis II disorders as predictors of prospective suicide attempts: Findings from the Collaborative Longitudinal Personality Disorders Study. Journal of Abnormal Psychology, 112, 375-381 https://doi.org/10.1037/0021-843X.112.3.375
  56. Zanarini, M. C., Ruser, T. F., Frankenburg, F. R., Henne, J., & Gunderson, J. G. (2000). Risk factors associated with the dissociative experiences of borderline patients. Journal of Nervous and Mental Disease, 188, 26-30 https://doi.org/10.1097/00005053-200001000-00005
  57. Zlotnick, C. (1999). Antisocial personality disorder, affect dysregulation and childhood abuse among incarcerated women. Journal of Personality Disorders, 13, 90-95 https://doi.org/10.1521/pedi.1999.13.1.90