What is complex posttraumatic stress disorder (PTSD) (disorder of extreme stress not otherwise specified [DESNOS])?

Updated: Nov 14, 2018
  • Author: T Allen Gore, MD, MBA, CMCM, DFAPA; Chief Editor: David Bienenfeld, MD  more...
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In the 1990s, Van Der Kolk and others began promoting the concept of “Complex PTSD.” It is also referred to as Disorder of Extreme Stress Not Otherwise Specified (DESNOS). DESNOS arises from severe, protracted abuse, most notably childhood sexual abuse, victims of torture, and living in a war zone. This type of trauma often leads to the use of primitive defense mechanisms (splitting and dissociation), which causes significant interpersonal problems and emotional struggles in addition to the standard symptoms of PTSD. Complex PTSD often leads to poor resilience, increased risk of depressive and anxiety disorders, and somatization. Numerous situations will trigger these individuals and lead to very strong adverse emotional reactions. The great majority of individuals who develop Borderline Personality Disorder or Dissociative Identity Disorder suffered complex trauma during childhood. Although many clinicians find this to be a useful conceptualization, it does not appear in the DSM-5. [13]

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