While standard evidence-based treatments may be effective for treating post traumatic stress disorder, treating<unk>  PTSD often involves addressing interpersonal relational difficulties and a different set of symptoms which make it more challenging to treat. According to the United States Department of Veteran Affairs: The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms, such as changes in their self-concept and the way they adapt to stressful events. The utility of PTSD-derived psychotherapies for assisting children with C-PTSD is uncertain. This area of diagnosis and treatment calls for caution in use of the category C-PTSD. Dr. Julian Ford and Dr. Bessel van der Kolk have suggested that C-PTSD may not be as useful a category for diagnosis and treatment of children as a proposed category of developmental trauma disorder (DTD). According to Courtois & Ford, for DTD to be diagnosed it requires a history of exposure to early life developmentally adverse interpersonal trauma such as sexual abuse, physical abuse, violence, traumatic losses or other significant disruption or betrayal of the child's relationships with primary caregivers, which has been postulated as an etiological basis for<unk>  traumatic stress disorders. Diagnosis, treatment planning and outcome are always relational. Since C-PTSD or DTD in children is often caused by chronic maltreatment, neglect or abuse in a care-giving relationship the first element of the biopsychosocial system to address is that relationship. This invariably involves some sort of child protection agency. This both widens the range of support that can be given to the child but also the<unk> ity of the situation, since the agency's statutory legal obligations may then need to be enforced. A number of practical, therapeutic and ethical principles for assessment and intervention have been developed and explored in the field: * Identifying and addressing threats to the child's or family's safety and stability are the first priority. * A relational bridge must be developed to engage, retain and maximize the benefit for the child and caregiver. * Diagnosis, treatment planning and outcome monitoring are always relational (and) strengths based. * All phases of treatment should aim to enhance self-regulation competencies. * Determining with whom, when and how to address traumatic memories. * Preventing and managing relational discontinuities and psychosocial crises. Adults Trauma recovery model Dr. Judith Lewis Herman, in her book, Trauma and Recovery, proposed a<unk>  trauma recovery model that occurs in three stages: # Establishing safety # Remembrance and mourning for what was lost # Reconnecting with community and more broadly, society Herman believes recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship. This healing relationship need not be romantic or sexual in the colloquial sense of "relationship", however, and can also include relationships with friends, co-workers, one's relatives or children, and the therapeutic relationship.<unk>  trauma means<unk>  reactions and this leads to<unk>  treatments. Hence, treatment for C-PTSD requires a multi-modal approach. It has been suggested that treatment for<unk>  PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems. Six suggested core components of<unk>  trauma treatment include: # Safety # Self-regulation # Self-reflective information processing # Traumatic experiences integration # Relational engagement # Positive affect enhancement The above components can be conceptualized as a model with three phases. Every case will not be the same, but one can expect the first phase to consist of teaching adequate coping strategies and addressing safety concerns. The next phase would focus on decreasing avoidance of traumatic stimuli and applying coping skills learned in phase one. The care provider may also begin challenging assumptions about the trauma and introducing alternative narratives about the trauma. The final phase would consist of solidifying what has previously been learned and transferring these strategies to future stressful events. Neuroscientific and trauma informed interventions In practice, the forms of treatment and intervention varies from individual to individual since there is a wide spectrum of childhood experiences of developmental trauma and symptomatology and not all survivors respond positively, uniformly, to the same treatment. Therefore, treatment is generally tailored to the individual. Recent neuroscientific research has shed some light on the impact that severe childhood abuse and neglect (trauma) has on a child's developing brain, specifically as it relates to the development in brain structures, function and connectivity among children from infancy to adulthood. This understanding of the neurophysiological underpinning of<unk>  trauma phenomena is what currently is referred to in the field of traumatology as 'trauma informed' which has become the rationale which has influenced the development of new treatments specifically targeting those with childhood developmental trauma. Dr. Martin Teicher, a Harvard psychiatrist and researcher, has suggested that the development of specific<unk>  trauma related symptomatology (and in fact the development of many adult onset psychopathologies) may be connected to gender differences and at what stage of childhood development trauma, abuse or neglect occurred. For example, it is well established that the development of dissociative identity disorder among women is often associated with early childhood sexual abuse. Use of evidence-based treatment and its limitations One of the current challenges faced by many survivors of<unk>  trauma (or developmental trauma disorder) is support for treatment since many of the current therapies are relatively expensive and not all forms of therapy or intervention are reimbursed by insurance companies who use evidence-based practice as a criteria for reimbursement. Cognitive behavioral therapy, prolonged exposure therapy and dialectical behavioral therapy are well established forms of evidence-based intervention. These treatments are approved and endorsed by the American Psychiatric Association, the American Psychological Association and the Veteran's Administration. While standard evidence-based treatments may be effective for treating standard post-traumatic stress disorder, treating<unk>  PTSD often involves addressing interpersonal relational difficulties and a different set of symptoms which make it more challenging to treat. The United States Department of Veterans Affairs acknowledges, the current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms, such as changes in their self-concept and the way they adapt to stressful events. For example, "Limited evidence suggests that predominantly Cognitive behavioral therapy CBT evidence-based treatments are effective, but do not suffice to achieve satisfactory end states, especially in<unk>  PTSD populations." Treatment challenges It is widely acknowledged by those who work in the trauma field that there is no one single, standard, 'one size fits all' treatment for<unk>  PTSD. There is also no clear consensus regarding the best treatment among the greater mental health professional community which included clinical psychologists, social workers, licensed therapists MFTs) and psychiatrists. Although most trauma neuroscientifically informed practitioners understand the importance of utilizing a combination of both 'top down' and 'bottom up' interventions as well as including somatic interventions (sensorimotor psychotherapy or somatic experiencing or yoga) for the purposes of processing and integrating trauma memories. Survivors with<unk>  trauma often struggle to find a mental health professional who is properly trained in trauma informed practices. They can also be challenging to receive adequate treatment and services to treat a mental health condition which is not universally recognized or well understood by general practitioners. Dr. Allistair and Dr. Hull echo the sentiment of many other trauma neuroscience researchers (including Dr. Bessel van der Kolk and Dr. Bruce D. Perry) who argue:<unk>  presentations are often excluded from studies because they do not fit neatly into the simple nosological categorisations required for research power. This means that the most severe disorders are not studied adequately and patients most affected by early trauma are often not recognised by services. Both historically and currently, at the individual as well as the societal level, "dissociation from the acknowledgement of the severe impact of childhood abuse on the developing brain leads to inadequate provision of services. Assimilation into treatment models of the emerging affective neuroscience of adverse experience could help to redress the balance by shifting the focus from top-down regulation to bottom-up, body-based processing."<unk>  post trauma stress disorder is a long term mental health condition which is often difficult and relatively expensive to treat and often requires several years of psychotherapy, modes of intervention and treatment by highly skilled, mental health professionals who specialize in trauma informed modalities designed to process and integrate childhood trauma memories for the purposes of mitigating symptoms and improving the survivor's quality of life. Delaying therapy for people with<unk>  PTSD, whether intentionally or not, can exacerbate the condition. Recommended treatment modalities and interventions There is no one treatment which has been designed specifically for use with the adult<unk>  PTSD population (with the exception of component based psychotherapy ) there are many therapeutic interventions used by mental health professionals to treat PTSD. As of February 2017, the American Psychological
Complex post-traumatic stress disorder
Acute stress disorder
Malingering of post-traumatic stress disorder
Post-traumatic stress disorder
Prolonged grief disorder
Childbirth-related post-traumatic stress disorder
Complicated grief disorder
Adjustment disorder