title: Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma.
abstract: Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis. The DSM-IV (American Psychiatric Association, 1994) Field Trial studied 400 treatment-seeking traumatized individuals and 128 community residents and found that victims of prolonged interpersonal trauma, particularly trauma early in the life cycle, had a high incidence of problems with (a) regulation of affect and impulses, (b) memory and attention, (c) self-perception, (d) interpersonal relations, (e) somatization, and (f) systems of meaning. This raises important issues about the categorical versus the dimensional nature of posttraumatic stress, as well as the issue of comorbidity in PTSD. These data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology.
authors.affiliation: The Trauma Center and Boston University School of Medicine, Boston, Massachusetts, USA. bvanderk@aol.com
authors.forename: Bessel A
authors.initials: BA
authors.lastname: van der Kolk
authors.forename: Susan
authors.initials: S
authors.lastname: Roth
authors.forename: David
authors.initials: D
authors.lastname: Pelcovitz
authors.forename: Susanne
authors.initials: S
authors.lastname: Sunday
authors.forename: Joseph
authors.initials: J
authors.lastname: Spinazzola
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007406:Interview, Psychological; D008016:Life Change Events; D008297:Male; D010554:Personality Disorders / Q000453:epidemiology; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires