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Understanding Complex Trauma (C-PTSD) and Maladaptive Protective Ego Construct Strategies (PECS)

Updated: Aug 7

Complex Trauma (C-PTSD) in youth isn’t just a pop culture buzzword, it’s a profound condition that shapes lives in ways standard trauma models often miss. Unlike single-event traumas, C-PTSD stems from repeated interpersonal threats during development, creating unique challenges. This article explores what C-PTSD is, how it differs from simpler traumas, the role of Protective Ego Construct Strategies (PECS), why Cognitive Behavioral Therapy (CBT) falls short, and how Integrative Self-Analysis (ISA) offers a transformative path to healing. Let’s dive in.


Key Terms Included: Complex Trauma (C-PTSD), Protective Ego Construct Strategies (PECS), Integrative Self-Analysis (ISA), Emotional Dysregulation, Dream Mapping.

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What is Complex Trauma (C-PTSD)?

Quick Answer: Complex Trauma (C-PTSD) results from repeated interpersonal threats during youth, leading to symptoms like Emotional Dysregulation and distorted self-perception. It’s deeper and more pervasive than simpler traumas.


Why It Matters: Imagine growing up in an environment where trust is shattered over and over with abuse, neglect, or betrayal. That’s the root of C-PTSD. Unlike a car accident (a one-time trauma), C-PTSD builds over time, wiring the brain and body differently. Studies show it’s tied to worse mental health outcomes, like anxiety or depression, compared to single-event PTSD (Schaefer et al., 2018).


Symptoms to Know:

  • Emotional Dysregulation: Mood swings or overwhelming feelings.

  • Hypervigilance: Always on edge, expecting danger.

  • Distorted Self-Image: Feeling broken or unworthy.


C-PTSD’s developmental impact makes it trickier to spot and treat, often mistaken for standard PTSD in tools like the DSM-5 (American Psychiatric Association, 2013).


How Does C-PTSD Differ from Single Event Traumas?

Quick Answer: C-PTSD arises from prolonged, interpersonal trauma during youth, unlike simpler traumas from one-off events, affecting cognition and relationships more deeply.


The Difference: Single event traumas, like a natural disaster, hit once and fade with support. C-PTSD, though, comes from ongoing threats (Think a child facing years of emotional abuse). It creates Protective Ego Construct Strategies (PECS), defenses that twist how youth think and feel (Herman, 1992).


Comparison Table:

Aspect

Single Trauma Event (PTSD)

Complex Trauma (C-PTSD)

Cause

Single event (e.g., accident)

Repeated interpersonal threats

Symptoms

Flashbacks, avoidance

Emotional Dysregulation, PECS

Impact

Acute, often resolves

Pervasive, developmental

Diagnosis

Clear in DSM-5-TR

Often mismeasured & isn't in the DSM-5-TR

This distinction matters because treating C-PTSD like PTSD can miss the mark, or worse.

 

What are Protective Ego Construct Strategies (PECS)?

Quick Answer: PECS are defense mechanisms that interfere with a healthy feedback between the Instinctual Consciousness (emotional insight) and the self-aware ego, like Splitting or Hypervigilance. Youth with C-PTSD develop PECS to cope, distorting cognition while simultaneously trapping the emotional vitality of The Instinctual Consciousness.


Youth with C-PTSD develop PECS to cope, distorting cognition while simultaneously trapping the emotional vitality of The Instinctual Consciousness.

Why I Developed the C-PTSD Subcategory of PECS: To heal my Complex Post-Traumatic Stress Disorder (C-PTSD), I had to create the Integrative Self-Analysis principles independently. This was necessary because the DSM-5 lacks a comprehensive diagnosis for C-PTSD, particularly one that addresses emotions as Instinctual Consciousness. Additionally, I faced the challenge of identifying ego-related cognitive deficits scattered across various diagnoses. This fragmentation often leads to comorbidity confusion, dual diagnoses, ineffective treatments, unfounded etiologies, and harmful stigmas. By conceptualizing these cognitive deficits a a subcategory originating from C-PTSD, I was able to effectively address them and develop a more holistic approach to healing.


How They Work: PECS are the mind’s way of saying, “I’ll protect you,” but they come at a cost. A child might split people into “all good” or “all bad” (Splitting) to simplify a chaotic world. Or they might scan every room for threats (Hypervigilance). These strategies signal a deeper issue in The Instinctual Consciousness, think basic drives like FEAR or CARE being stuck and screaming for release (Panksepp, 1998).


Examples of PECS:

  • Emotional Fragmentation: Unconsciously shutting off feelings to survive.

  • Neurotic Alibis: Excuses to avoid engaging with life.

  • Psychogenic Transduction: Stress turning into real physical issues, like asthma.


These distortions can lead to chronic struggles, from poor focus to broken relationships (Schore, 2003).


Protective Ego Constructs (PECs) are a diagnostic subcategory within the category of Integrative Self-Analysis’ (ISA) idea of Complex Trauma (C-PTSD) (which include various groupings and subgroupings). PECs are maladaptive, semi-autonomous ego structures fabricated from Malignant Complexes. Malignant Complexes are underlying maladaptive psychogenic formations that siphon energy through unconscious narratives. These constructs (PEC) develop as a defensive response to pervasive developmental trauma and act as an artificial ego, masking themselves as the authentic Dominant Ego Personality (DEP), presenting a false or simplified facade that distorts the individual’s true self-concept.


Table: ISA Conceptual Framework for C-PTSD

Diagnostic Category

Instinct-Ego Defense Subcategory

Instinct-Ego Distortion Groups and Strategies

Complex Post-Traumatic Stress Disorder (C-PTSD)

Protective Ego Constructs (PEC): These constructs disrupt instinct-ego harmony by blocking the integration of The Instinctual Consciousness and the self-aware DEP.

Cognitive Distortions Group (CDG): Cognitive Dissonance, Idealizing, Incontiguous Time Gaps, Neurotic Alibis, Regressive Intelligence, Splitting



Dissociative Defense Group (DDG): Amnesia, Derealization, Depersonalization of the Self-Image, Ego Drifting, Numbness, Paracosmic Escapism



Drive-State Signals Group (DSG): Anxious Reassurance Seeking, Empathetic Control, Excessive Concern, Hypervigilance



Egoic Intrusion Group (EIGS): Ego Haunting, Apparition of the Emergent Dominant Ego, Emergent Dominant Ego Integrity Issues, Relational Integrity Distortion, Emergent Dominant Ego Hyper-Position, Emergent Dominant Ego Hypo-Position



Emotional Conflict & Control Group (ECCG): Depressive Resistant, Euphoric Escapism & Control, Emotional Cynicism, Undermining



Emotional Dysregulation Group (EDG): Coercive Emotions, Diversional Diagnosis, Emotional Fragmentation, Functional Intrusion, Leveraging Immaturity, Mood Liability, Overreactive Emotions, Overwhelming Emotions



Emotional Hyporegulation Group (EHG): Dismissiveness, Emotional Amputation, Inauthentic Manipulation, Masochistic Soothing, Sadistic Soothing, Vengeful Style



Emotional Somatization Group (ESG): Psychogenic Transduction



Introjected Possession Group (IPG): Neurotic Identification, Emotional Contagion (Entrainment),



Mental Looping Group (MLG): Catastrophic Thinking, Naval-Gazing (Hyper-Reflexivity), Perseverating



Projection Defense Group (PDG): Complex Displacement (Countertransference), Complex Projection (Transference), Distorted Social Engagement, Egoic Shadow Projection, Misattribution



Social Adaptations Group (SAG): Externalized Emotional Coping (Social Exogeneous Regulation), Over-Attachment (Enmeshment), Reaction Formation, Vicarious Enmeshment

PECs manifest through their associated groups and subgroupings of strategies, disrupting the feedback between the Instinctual Consciousness (emotional insight and wisdom) and the self-aware DEP (intelligence and contiguous effectiveness), thereby hindering emotional and cognitive integration. While PECs serve as a protective barrier against pervasive developmental traumas, they perpetuate cycles of emotional dysregulation, relational dysfunction, cognitive distortions, and dissociation by channeling libidinal energy into maladaptive narratives, thus obstructing the healthy development of the Dominant Ego Personality (DEP). Nevertheless, PECs hold transformative potential, as these same mechanisms can be repurposed for healing, resilience, and personal growth when effectively integrated.


Table: Protective Ego Construct Strategies (PECS) in c-PTSD

Instinct-Ego Distortion Groups

Instinct-Ego Distortion Strategies

Strategy Description

Primary Function

Instinct-Ego Disharmony

Cognitive Distortions Group (CDG)

Cognitive Dissonance

Tension from conflicting beliefs/values; used to reveal dissociative splits for healing.

Signals internal conflict for exploration

Fragments DEP by misaligning conscious awareness; hinders integration of instinctual drives.


Idealizing

Perceiving others/situations as flawless to manage insecurity or distress.

Avoids emotional vulnerability

Distorts DEP reality-testing, blocking authentic instinctual alignment (e.g., CARE, SEEKING).


Incontiguous Time Gaps

Dissociative fragmentation of time, creating irregular temporal boundaries and confusion.

Protects from traumatic memory

Disrupts DEP continuity, misaligning instinctual coherence (e.g., FEAR, PANIC/GRIEF).


Neurotic Alibis

Rationalizations to avoid emotional challenges, rooted in helplessness and Repetition Compulsion.

Avoids painful engagement

Stunts DEP growth, diverting libidinal energy from instinctual integration (e.g., SEEKING, PLAY).


Regressive Intelligence

Regression to immature cognitive states to evade emotional responsibility.

Shields from maturity demands

Limits DEP development, suppressing adaptive instinctual responses (e.g., SEEKING).


Splitting

Polarized perception (all good/bad) to simplify overwhelming emotions.

Simplifies emotional complexity

Fragments DEP, dysregulating instinctual balance (e.g., RAGE, CARE).

Dissociative Defense Group (DDG)

Amnesia

Discontiguous memory gaps to shield from emotional turmoil or trauma.

Blocks the traumatic recall of "repetition compulsion"

Disrupts DEP narrative coherence, misaligning instinctual memory (e.g., PANIC/GRIEF).


Derealization

Detachment from reality, perceiving it as unreal or dreamlike.

Reduces environmental distress

Disconnects DEP from present, blocking instinctual grounding (e.g., FEAR).


Ego Drifting

Aimless detachment from reality/responsibilities due to executive dysfunction.

Avoids engagement with reality

Weakens DEP purpose, misaligning Genomic Teleology and instinctual drives (e.g., SEEKING).


Numbness

Emotional and physical detachment to blunt overwhelming stimuli.

Shields from sensory overload

Numbs DEP awareness, suppressing instinctual responses (e.g., FEAR, PLAY).


Paracosmic Escapism

Creating imaginary worlds to escape emotional pain or identity confusion.

Provides relief via fantasy

Disconnects DEP from reality, blocking instinctual engagement (e.g., SEEKING, PLAY).

 

Zombie Brain

Feeling detached from one’s body/thoughts, distorting self-concept. (depersonal-ization)

Protects from emotional and mental overwhelm

Fragments DEP identity, hindering instinctual integration (e.g., CARE, SEEKING).

Drive-State Signals Group (DSG)

Anxious Reassurance Seeking

Excessive need for validation to calm emotional insecurity.

Seeks external stability

Overloads DEP with dependency, dysregulating instinctual trust (e.g., CARE, FEAR).


Empathetic Control

Preoccupation with others’ needs to mask manipulative control and fear of rejection.

Ensures relational security

Distorts DEP autonomy, misaligning instinctual CARE with control dynamics.


Excessive Concern

Over-focus on others to manage anxiety via control, often unconscious.

Mitigates vulnerability

Overburdens DEP, skewing instinctual CARE into manipulation.


Hypervigilance

Constant monitoring of environment/symptoms due to fear of instability.

Detects threats

Hyperactivates DEP FEAR system, disrupting instinctual balance (e.g., PLAY, SEEKING).

Egoic Intrusion Group (EIG)

Ego Haunting

Blurred self entangled with others’ identities and PEC, causing boundary confusion.

Apparition of Emergent Dominant Ego demands self-definition

Undermines DEP differentiation, misaligning instinctual and egoic  coherence (e.g., CARE).


Emergent Dominant Ego Integrity Issues

Oscillation between depressive/manic states to regulate Malignant Complex influence.

Maintains temporary stability through ego-dystonia or ego-syntonia

Destabilizes DEP, blocking instinctual integration (e.g., SEEKING, RAGE).


Emergent Dominant Ego Hyper-Position

Egodystonic opposition to Malignant Complex, causing guilt/shame.

Resists maladaptive control

Conflicts DEP, misaligning instinctual drives with true self (e.g., SEEKING).


Emergent Dominant Ego Hypo-Position

Egosyntonic alignment with Malignant Complex, reinforcing maladaptive patterns.

Maintains comfort in dysfunction

Stagnates DEP, suppressing instinctual growth (e.g., PLAY, SEEKING).

 

Relational Integrity Distortion

Dysfunctional relational patterns projecting unresolved trauma (e.g., traumatic limerence).

Manages emotional energy

Distorts DEP relational function, dysregulating instinctual drives like CARE and LUST, etc.

Emotional Conflict & Control Group (ECCG)

Depressive Resistant

Using depressive states to manipulate others via withdrawal and helplessness.

Controls relational dynamics

Inhibits DEP processing, dysregulating instinctual PANIC/GRIEF.


Euphoric Escapism & Control

Over-engagement with positive emotions to reject negative ones.

Avoids negative affect

Skews DEP balance, suppressing instinctual FEAR, RAGE, and PANIC/GRIEF.


Emotional Cynicism

Over-engagement with negative emotions, rejecting positivity as mistrust.

Protects from disillusionment

Hardens DEP through the PANIC/GRIEF endogenous opioid system, blocking instinctual PLAY and CARE.


Undermining

Subconscious sabotage of self/others to manage emotional conflict.

Avoids vulnerability, relating, and engagement with the world

Fragments DEP, dysregulating instinctual coherence (e.g., SEEKING).

Emotional Dysregulation Group (EDG)

Coercive Emotions

Manipulative emotional displays (e.g., guilt, anger) to control others.

Influences outcomes

Overloads DEP with strategy, misaligning instinctual RAGE and CARE.


Diversional Diagnosis

Exaggerated self-diagnosis to deflect from deeper trauma.

Malignant Complex overwhelms ego with drive-states and fear through a false positive bias

Fragments DEP narrative, blocking instinctual integration (e.g., FEAR, CARE, RAGE, PLAY, PANIC/GRIEF, etc.).


Emotional Fragmentation

Inconsistent, contradictory emotional states causing chaos.

Shields from relating and DEP coherence

Disrupts DEP stability, dysregulating all instinctual systems.


Functional Intrusion

Compulsive overthinking disrupts appropriate emotional responses.

Overanalyzes instead of connects

Overburdens DEP, misaligning instinctual clarity (e.g., SEEKING, etc.).


Leveraging Immaturity

Regression to infantile states for attention/protection.

Elicit care, avoids pain

Stunts DEP maturity, suppressing instinctual growth (e.g., CARE, FEAR, RAGE, SEEKING, etc.).


Mood Liability

Rapid, unpredictable mood shifts without clear triggers.

Reflects instability

Destabilizes DEP, dysregulating instinctual balance (e.g., PLAY, RAGE, etc.).


Overreactive Emotions

Destructive emotional outbursts harming self/others.

Releases excess energy

Harms DEP regulation, amplifying instinctual RAGE and FEAR, etc.


Overwhelming Emotions

Excessive emotional outpouring leading to impulsivity.

Vents unmanageable affect

Overwhelms DEP, dysregulating instinctual control (e.g., PANIC/GRIEF, etc.).

Emotional Hyporegulation Group (EHG)

Dismissiveness

Minimizing others’ feelings to avoid vulnerability.

Avoids emotional depth

Hardens DEP, blocking instinctual CARE and empathy (RAGE, etc.).


Emotional Amputation

Disconnecting from emotions to cope with distress.

Shields from overwhelm

Numbs DEP, suppressing instinctual responses (e.g., FEAR, CARE, etc.).


Inauthentic Manipulation

Deceptive tactics to influence others, masking true intent.

Good faith gestures to gain control

Distorts DEP authenticity, misaligning instinctual CARE with deceit (RAGE, etc.).


Masochistic Soothing

Self-punishment for emotional relief, tied to unworthiness.

Emotional regulation via pain

Damages DEP resilience, dysregulating instinctual PANIC/GRIEF, etc.


Sadistic Soothing

Aggression/control over others for emotional relief.

Emotional regulation by projecting pain outward

Harms DEP empathy, amplifying instinctual RAGE (PLAY, CARE, etc.).


Vengeful Style

Vindictive reactions to minor slights, fueled by trauma-based dichotomies.

Enacts justice

Distorts DEP perception, hyperactivating instinctual RAGE (CARE, etc.).

Emotional Somatization Group (ESG)

Psychogenic Transduction

Converting unresolved emotions into physical symptoms (e.g., fibromyalgia, psoriasis, arthritis, diabetes, certain cancers, etc.).

Expresses via body

Burdens DEP with somatic load, misaligning instinctual FEAR and PANIC/GRIEF.

Introjected Possession Group (IPG)

Neurotic Identification

Internalizing maladaptive traits/beliefs from others, distorting self.

Preserves false identity

Fragments DEP, blocking instinctual alignment with Genomic Teleology (e.g., SEEKING).

 

Emotional Contagion (Entrainment)

Unconsciously aligning emotions/behaviors with others to maintain dynamics

Reinforces relational status quo through interpersonal bugs, social outbreaks, or cultural epidemics

Blurs DEP boundaries, misaligning instinctual PLAY and CARE.

Mental Looping Group (MLG)

Catastrophic Thinking

Excessive awareness of negative possibilities by overthinking and rumination.

Avoids both external and internal positive emotional engagement

Overloads DEP, misaligning instinctual clarity (e.g., FEAR, PANIC/GRIEF).

 

Navel-Gazing (Hyper-Reflexivity)

Excessive self-awareness of self-improvement and personal faults by overthinking and rumination.

Converts shame and guilt to false conscientiousness by denying “repetition compulsion”

Overloads DEP, misaligning instinctual clarity (e.g., SEEKING, FEAR, PLAY, PANIC/GRIEF).

 

Spooling

 

Perseverating on intrusive thoughts

Avoids both external and internal emotional engagement

 

Projection Defense Group (PDG)

Complex Displacement (Countertransference)

Adopting others’ projected complexes, distorting relational dynamics.

Mirrors external Complex Projections to re-enact similar “state dependent memories” without self-awareness

Confuses DEP boundaries, dysregulating instinctual CARE and RAGE, etc.


Complex Projection (Transference)

Projecting unresolved conflicts onto current relationships.

Re-enacts past wounds without self-awareness

Distorts DEP reality, misaligning instinctual responses (e.g., FEAR, PANIC/GRIEF, etc.).


Distorted Social Engagement

Misinterpreting relationships via projected trauma, creating false intimacy/hostility.

Avoids authentic connection

Disrupts DEP relating, dysregulating instinctual CARE, PLAY, RAGE, etc.


Egoic Shadow Projection

Projecting repressed egoic  “shadow” traits onto others, avoiding self-awareness.

Denies internal conflict with current ego position

Fragments DEP, blocking instinctual integration (e.g., RAGE, SEEKING).


Misattribution

Inaccurately assigning motives/emotions based on past, not present.

Simplifies perception for “repetition compulsion”

Skews DEP reality-testing, misaligning instinctual clarity (e.g., FEAR).

Social Adaptations Group (SAG)

Externalized Emotional Coping

Relying on others and systems for emotional regulation, fearing abandonment.

Seeks emotional regulation through external stability

Weakens DEP autonomy, dysregulating instinctual CARE and SEEKING, etc.


Over-Attachment (Enmeshment)

Excessive intertwining of identity/emotions with others, fostering dependency.

Ensures connection

Undermines DEP independence, dysregulating instinctual CARE and LUST, etc.


Reaction Formation

Expressing opposite of true emotions to mask unacceptable impulses.

Conceals conflict

Distorts DEP authenticity, misaligning instinctual RAGE or FEAR, etc.


Vicarious Enmeshment

Absorption in others’ issues and systems to avoid internal suffering.

Distracts from self

Disconnects DEP from core, blocking instinctual SEEKING, CARE, etc.

Why is CBT Ineffective for C-PTSD?

Quick Answer: CBT focuses on rational thought to manage symptoms, but it overlooks C-PTSD’s instinctual roots and repressed memories, sometimes worsening Emotional Dysregulation.


The Problem: CBT works great for one-off traumas, think reframing a fear of driving after a crash (Ehlers & Clark, 2000). But C-PTSD isn’t just about thoughts; it’s about buried emotions and instincts. Forcing logic on a child with Emotional Amputation (numbness) can backfire, amplifying their disconnection (Ford, 2013).


Real-World Impact: Research and personal studies show CBT can intensify PECS like Ego Drifting, where the self feels unmoored, leaving youth more lost (Courtois & Ford, 2009). It’s like treating a broken leg with a Band-Aid. It doesn’t dig deep enough.


How Does ISA Help in Healing C-PTSD?

Quick Answer: Integrative Self-Analysis (ISA) heals C-PTSD by integrating dreams and repressed memories, dismantling PECS, and restoring instinctual balance with techniques like Dream Mapping.


A Better Way: You might be wondering, “If CBT doesn’t work, what does?” Enter ISA. Rooted in affective neuroscience (van der Kolk, 2005) and Jungian insights, ISA taps into what CBT misses: the unconscious as the Soul's Instinctual Consciousness. It uses Dream Mapping to uncover hidden pain and Instinctual Rescripting to reframe it.


How It Works:

  • Dream Mapping: Charts dreams to reveal PECS like Complex Projection.

  • Memory Integration: Brings repressed emotions to light, safely.

  • Somatic Focus: Uses body awareness (think Polyvagal Theory) to calm the nervous system (Porges, 2011).


Benefits:

  • Reduces Emotional Dysregulation.

  • Rebuilds trust in relationships.

  • Heals physical symptoms tied to Psychogenic Transduction.


Unlike CBT, ISA meets C-PTSD where it lives, which is deep in the psyche and body (Walker, personal research).


CBT vs. ISA: A Side-by-Side Look

Here’s a table to see the difference clearly:

Aspect

Cognitive Behavioral Therapy (CBT)

Integrative Self-Analysis (ISA)

Focus

Rational thought, symptom control

Instinctual integration, emergent healing

Approach to PECS

Targets behaviors like Hypervigilance with a top-down approach

Dismantles Emotional Repetition Compulsion with a bottom-up approach

Implicit Emotional Memory

Skims over repressed Implicit memory

Integrates explicit (cognitive) and implicit (emotional) memory

Effectiveness

Limited for C-PTSD; may worsen symptoms

Tailored to C-PTSD, restores balance between the instincts and ego cognition

Alternative therapies are built for the complexity of C-PTSD (Fisher, 2017).


Conclusion

C-PTSD in youth isn’t just trauma. It’s a life-altering web of repeated wounds, spawning Protective Ego Construct Strategies that twist cognition and trap instinctual wisdom. Current tools mislabel it, and CBT can make it worse. But Integrative Self-Analysis offers hope, blending dreams, emotions, and memories to heal what’s broken.


ISA is a bridge between science and soul.


About the Author

Michael C Walker, a chaplain at Jaguar Marigold Chapel, combines Christian Mysticism, Depth Psychology, Affective Neuroscience, Classical Studies, and Dream Mapping to delve into the human psyche. With 20+ years of experience, he pioneers the fusion of spiritual wisdom and scientific exploration. His innovative approach to Complex Trauma (C-PTSD) provides insights for Self-Analysis, divine purpose, and authenticity.


Why This Matters for You

This isn’t just theory—it’s about understanding youth who’ve faced too much, too soon. By spotlighting C-PTSD and ISA, we’re equipping you with knowledge to recognize, support, or even heal these effects. Questions? Dive into the references or ask away—I’m here to help.


References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

  2. Andreasen, N. C. (2004). Acute and delayed posttraumatic stress disorders: A history and some issues. American Journal of Psychiatry, 161(8), 1321-1323. https://doi.org/10.1176/appi.ajp.161.8.1321

  3. Bremner, J. D. (2006). Traumatic stress: Effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445-461.

  4. Briere, J., & Scott, C. (2014). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (2nd ed.). SAGE Publications.

  5. Caspi, A., Houts, R. M., Belsky, D. W., Goldman-Mellor, S. J., Harrington, H., Israel, S., et al. (2014). The p factor: One general psychopathology factor in the structure of psychiatric disorders? Clinical Psychological Science, 2(2), 119-137. https://doi.org/10.1177/2167702613497473

  6. Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70(5), 1067-1074. https://doi.org/10.1037//0022-006x.70.5.1067

  7. Cohen, J. A., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012). Trauma-focused CBT for youth with complex trauma. Child Abuse & Neglect, 36(7-8), 528-541. https://doi.org/10.1016/j.chiabu.2012.03.007

  8. Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B. (Eds.). (2003). Complex trauma in children and adolescents: White paper from the National Child Traumatic Stress Network Complex Trauma Task Force. https://www.nctsn.org/resources/complex-trauma-children-and-adolescents

  9. Courtois, C. A., & Ford, J. D. (Eds.). (2009). Treating complex traumatic stress disorders: An evidence-based guide. Guilford Press.

  10. Dalgleish, T., Black, M., Johnston, D., & Bevan, A. (2020). Transdiagnostic approaches to mental health problems: Current status and future directions. Journal of Consulting and Clinical Psychology, 88(3), 179-195. https://doi.org/10.1037/ccp0000482

  11. Danese, A., Moffitt, T. E., Arseneault, L., Bleiberg, B. A., Dinardo, P. B., Gandelman, S. B., et al. (2017). The origins of cognitive deficits in victimized children: Implications for neuroscientists and clinicians. American Journal of Psychiatry, 174(4), 349-361. https://doi.org/10.1176/appi.ajp.2016.16030333

  12. Danese, A., & Lewis, S. J. (2017). Psychoneuroimmunology of early-life stress: The hidden wounds of childhood trauma? Neuropsychopharmacology, 42(1), 99-114. https://doi.org/10.1038/npp.2016.198

  13. Danese, A. (2020). Annual research review: Rethinking childhood trauma—new research directions for measurement, study design and analytical strategies. Journal of Child Psychology and Psychiatry, 61(3), 236-250. https://doi.org/10.1111/jcpp.13160

  14. Deary, I. J., Pattie, A., & Starr, J. M. (2013). The stability of intelligence from age 11 to age 90 years: The Lothian birth cohort of 1921. Psychological Science, 24(12), 2361-2368. https://doi.org/10.1177/0956797613486487

  15. Dinkler, L., Lundström, S., Gajwani, R., Lichtenstein, P., Gillberg, C., & Minnis, H. (2017). Maltreatment-associated neurodevelopmental disorders: A co-twin control analysis. Journal of Child Psychology and Psychiatry, 58(6), 691-701. https://doi.org/10.1111/jcpp.12682

  16. Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345. https://doi.org/10.1016/s0005-7967(99)00123-0

  17. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245-258.

  18. Fisher, H. L., Caspi, A., Moffitt, T. E., Wertz, J., Gray, R., Newbury, J., et al. (2015). Measuring adolescents’ exposure to victimization: The environmental risk (E-Risk) longitudinal twin study. Development and Psychopathology, 27(4pt1), 1399-1416. https://doi.org/10.1017/S0954579415000838

  19. Fisher, J. (2017). Healing the fragmented selves of trauma survivors: Overcoming internal self-alienation. Routledge.

  20. Ford, J. D. (2013). Treatment of complex trauma: A sequenced, relationship-based approach. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: An evidence-based guide (pp. 3-27). Guilford Press.

  21. Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377-391.

  22. Koenen, K. C., Moffitt, T. E., Poulton, R., Martin, J., & Caspi, A. (2007). Early childhood factors associated with the development of post-traumatic stress disorder: Results from a longitudinal birth cohort. Psychological Medicine, 37(2), 181-192. https://doi.org/10.1017/S0033291706009019

  23. Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., et al. (2010). Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. American Journal of Psychiatry, 167(6), 640-647.

  24. Levine, P. A. (1997). Waking the tiger: Healing trauma. North Atlantic Books.

  25. Lewis, S. J., Arseneault, L., Caspi, A., Fisher, H. L., Matthews, T., Moffitt, T. E., et al. (2019). The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales. The Lancet Psychiatry, 6(3), 247-256. https://doi.org/10.1016/S2215-0366(19)30031-8

  26. Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., van Ommeren, M., Jones, L. M., et al. (2013). Diagnosis and classification of disorders specifically associated with stress: Proposals for ICD-11. World Psychiatry, 12(3), 198-206. https://doi.org/10.1002/wps.20057

  27. McFarlane, A. C. (2010). The long-term costs of traumatic stress: Intertwined physical and psychological consequences. World Psychiatry, 9(1), 3-10.

  28. Moffitt, T. E., & the E-Risk Study Team. (2002). Teen-aged mothers in contemporary Britain. Journal of Child Psychology and Psychiatry, 43(6), 727-742. https://doi.org/10.1111/1469-7610.00082

  29. Odgers, C. L., Caspi, A., Russell, M. A., Sampson, R. J., Arseneault, L., & Moffitt, T. E. (2012). Supportive parenting mediates neighborhood socioeconomic disparities in children’s antisocial behavior from ages 5 to 12. Development and Psychopathology, 24(3), 705-721. https://doi.org/10.1017/S0954579412000326

  30. Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. W. W. Norton & Company.

  31. op den Kelder, R., Ensink, J. B. M., Overbeek, G., Maric, M., & Lindauer, R. J. L. (2017). Executive function as a mediator in the link between single or complex trauma and posttraumatic stress in children and adolescents. Quality of Life Research, 26(6), 1687-1696. https://doi.org/10.1007/s11136-017-1535-3

  32. Panksepp, J. (1998). Affective neuroscience: The foundations of human and animal emotions. Oxford University Press.

  33. Pelcovitz, D., van der Kolk, B., Roth, S., Mandel, F., Kaplan, S., & Resick, P. (1997). Development of a criteria set and a structured interview for disorders of extreme stress (SIDES). Journal of Traumatic Stress, 10(1), 3-16. https://doi.org/10.1023/a:1024800212070

  34. Perry, B. D. (2006). The neurosequential model of therapeutics: Applying principles of neuroscience to clinical work with traumatized and maltreated children. In N. B. Webb (Ed.), Working with traumatized youth in child welfare (pp. 27-52). Guilford Press.

  35. Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.

  36. Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. W. W. Norton & Company.

  37. Schaefer, J. D., Moffitt, T. E., Arseneault, L., Danese, A., Fisher, H. L., Houts, R., et al. (2018). Adolescent victimization and early-adult psychopathology: Approaching causal inference using a longitudinal twin study to rule out noncausal explanations. Clinical Psychological Science, 6(3), 352-371. https://doi.org/10.1177/2167702617741381

  38. Schore, A. N. (2003). Affect dysregulation and disorders of the self. W. W. Norton & Company.

  39. Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are (2nd ed.). Guilford Press.

  40. Silberg, J. L., Copeland, W., Linker, J., Moore, A. A., Roberson-Nay, R., & York, T. P. (2016). Psychiatric outcomes of bullying victimization: A study of discordant monozygotic twins. Psychological Medicine, 46(9), 1875-1883. https://doi.org/10.1017/S0033291716000362

  41. Spinazzola, J., Ford, J. D., Zucker, M., van der Kolk, B. A., Silva, S., Smith, S. F., et al. (2005). Survey evaluates complex trauma exposure, outcome, and intervention among children and adolescents. Psychiatric Annals, 35(5), 433-439.

  42. Teicher, M. H., Andersen, S. L., Polcari, A., Anderson, C. M., Navalta, C. P., & Kim, D. M. (2003). The neurobiological consequences of early stress and childhood maltreatment. Neuroscience & Biobehavioral Reviews, 27(1-2), 33-44. https://doi.org/10.1016/S0149-7634(03)00007-1

  43. Terr, L. C. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148(1), 10-20. https://doi.org/10.1176/ajp.148.1.10

  44. Trouton, A., Spinath, F. M., & Plomin, R. (2002). Twins early development study (TEDS): A multivariate, longitudinal genetic investigation of language, cognition and behavior problems in childhood. Twin Research, 5(5), 444-448. https://doi.org/10.1375/136905202320906255

  45. van der Kolk, B. A. (2005). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35(5), 401-408.

  46. van der Kolk, B. A., 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(5), 389-399. https://doi.org/10.1002/jts.20047

  47. Wamser-Nanney, R., & Vandenberg, B. R. (2013). Empirical support for the definition of a complex trauma event in children and adolescents. Journal of Traumatic Stress, 26(6), 671-678. https://doi.org/10.1002/jts.21857

  48. Yehuda, R. (2002). Post-traumatic stress disorder. New England Journal of Medicine, 346(2), 108-114.

 

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