Complex PTSD

A Syndrome in Survivors of Prolonged and Repeated Trauma
  • Judith Lewis Herman
Part of the The Springer Series on Stress and Coping book series (SSSO)


The current diagnostic formulation of PTSD derives primarily from observations of survivors of relatively circumscribed traumatic events: combat, disaster, and rape. It has been suggested that this formulation fails to capture the protean sequelae of prolonged, repeated trauma. In contrast to the circumscribed traumatic event, prolonged, repeated trauma can occur only where the victim is in a state of captivity, unable to flee, and under the control of the perpetrator. Examples of such conditions include prisons, concentration camps, and slave labor camps. Such conditions also exist in some religious cults, in brothels and other institutions of organized sexual exploitation, and in some families.


Childhood Abuse Borderline Personality Disorder Personality Disorder Borderline Personality Disorder Battered Woman 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Allodi, F., et al. (1985). Physical and psychiatric effects of torture: Two medical studies. In E. Stover and E. Nightingale (Eds.), The breaking of bodies and minds: Torture, psychiatric abuse, and the health profession. New York: Freeman. (pp. 58–78 ).Google Scholar
  2. Amnesty International. (1973). Report on torture. New York: Farrar, Straus and Giroux.Google Scholar
  3. Biderman, A. D. (1957). Communist attempts to elicit false confessions from Air Force prisoners of war. Bull. New York Acad. Med., 33, 616–625.Google Scholar
  4. Biderman, A. D., and Zimmer, H. (1961). The manipulation of human behavior. New York: Wiley.Google Scholar
  5. Bliss, E. L. (1986). Multiple personality, allied disorders, and hypnosis. New York: Oxford University Press.Google Scholar
  6. Brett, E. A. (1991). Classification of PTSD in DSM-IV as an anxiety disorder, dissociative disorder, or stress disorder. In Davidson J. and E. Foa (Eds.), PTSD in review: Recent research and future directions. Washington, DC: American Psychiatric Press.Google Scholar
  7. Brett, E. A., and Ostroff, R. (1985). Imagery in post-traumatic stress disorder: An overview. American Journal of Psychiatry, 142, 417–424.PubMedGoogle Scholar
  8. Briere, J. (1988). Long-term clinical correlates of childhood sexual victimization. Annals of the New York Academy of Sciences, 528, 327–334.PubMedCrossRefGoogle Scholar
  9. Briere, J., and Runtz, M. (1987). Post sexual abuse trauma: Data and implications for clinical practice. J. Interpers. Viol., 2, 367–379.CrossRefGoogle Scholar
  10. Briere, J., and Zaidi, L. (1989). Sexual abuse histories and sequelae in female psychiatric emergency room patients. American Journal of Psychiatry, 146, 1602–1606.PubMedGoogle Scholar
  11. Brown, D. P., and Fromm, E. (1986). Hypnotherapy and hypnoanalysis. Hillsdale, NJ: Erlbaum.Google Scholar
  12. Browne, A., and Finkelhor, D. (1986). Impact of child sexual abuse: A review of the literature. Psychological Bulletin, 99, 55–77.CrossRefGoogle Scholar
  13. Bryer, J. B., Nelson, B. A., Miller, J. B., and Krol, P. A. (1987). Childhood sexual and physical abuse as factors in adult psychiatric illness. American Journal of Psychiatry, 144, 1426–1430.PubMedGoogle Scholar
  14. Burgess, A. W., Hartman, C. R., McCausland, M. P., et al. (1984). Response patterns in children and adolescents exploited through sex rings and pornography. American Journal of Psychiatry, 141, 656–662.PubMedGoogle Scholar
  15. Carmen, E. H., Rieker, P. P., and Mills, T. (1984). Victims of violence and psychiatric illness. American Journal of Psychiatry, 141, 378–383.Google Scholar
  16. Coons, P. M. (1985). Children of parents with multiple personality disorder. In R. P. Kluft (ed.), Childhood antecedents of multiple personality disorder (pp. 151–166 ). Washington, DC: American Psychiatric Press.Google Scholar
  17. Dawidowicz, L. (1975). The war against the Jews. London: Weidenfeld and Nicolson.Google Scholar
  18. De Loos, W. (1990). Psychosomatic manifestations of chronic PTSD. In M. E. Wolf and A. D.Google Scholar
  19. Mosnaim (Eds.), Posttraumatic stress disorder: Etiology, phenomenology, and treatment (pp. 94–105). Washington, DC: American Psychiatric Press.Google Scholar
  20. Dobash, R. E., and Dobash, R. (1979). Violence against wives: A case against the patriarchy. New York: Free Press.Google Scholar
  21. Dutton, D., and Painter, S. L. (1981). Traumatic bonding: The development of emotional attachments in battered women and other relationships of intermittent abuse. Victimology, 6, 139–155.Google Scholar
  22. Farber, I. E., Harlow, H. F., and West, L. J. (1957). Brainwashing, conditioning, and DDD (debility, dependency, and dread). Sociometry, 23, 120–147.Google Scholar
  23. Favazza, A. R., and Conterio, K. (1988). The plight of chronic self-mutilators. Community Mental Health Journal, 24, 22–30.Google Scholar
  24. Ferenczi, S. (1932/1955). Confusion of tongues between adults and the child: The language of tenderness and of passion. In Final contributions to the problems and methods of psychoanalysis. New York: Basic Books.Google Scholar
  25. Gayford, J. J. (1975). Wife-battering: A preliminary survey of 100 cases. British Medical Journal, 1, 194–197.PubMedCrossRefGoogle Scholar
  26. Gelinas, D. (1983). The persistent negative effects of incest. Psychiatry, 46, 312–332.PubMedGoogle Scholar
  27. Goldstein, G., van Kammen, V., Shelley, C., et al. (1987). Survivors of imprisonment in the Pacific theater during World War H. American Journal of Psychiatry, 144, 1210–1213.PubMedGoogle Scholar
  28. Goodwin, J., McMarty, T., and DiVasto, P. (1982). Physical and sexual abuse of the children of adult incest victims. In J. Goodwin (Ed.), Sexual abuse: Incest victims and their families. Boston: John Wright. (pp. 139–154 ).Google Scholar
  29. Goodwin, J. (1988). Evaluation and treatment of incest victims and their families: A problem oriented approach. In J. G. Howells (Ed.), Modern perspectives in psycho-social pathology, New York: Brunner/Mazel.Google Scholar
  30. Graham, D. L., Rawlings, E., and Rimini, N. (1988). Survivors of terror: Battered women, hostages, and the Stockholm syndrome. In K. Yllo and M. Bograd (eds.), Feminist perspectives on wife abuse (pp. 217–233 ). Beverly Hills, CA: Sage.Google Scholar
  31. Halperin, D. A. (1983). Group processes in cult affiliation and recruitment. In Psycho-dynamic perspectives on religion, sect, and cult. Boston: John Wright.Google Scholar
  32. Hearst, P. C., and Moscow, A. (1982). Every secret thing. New York: Doubleday.Google Scholar
  33. Herman, J. L. (1981). Father-daughter incest. Cambridge, MA: Harvard University Press.Google Scholar
  34. Herman, J. L. (1988). Considering sex offenders: A model of addiction. Signs: Journal of Women in Culture and Society, 13, 695–724.CrossRefGoogle Scholar
  35. Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.Google Scholar
  36. Herman, J. L., Perry, J. C., and van der Kolk, B. A. (1989). Childhood trauma in borderline personality disorder. American Journal of Psychiatry, 146, 490–495.PubMedGoogle Scholar
  37. Hilberman, E. (1980). The “wife-beater’s wife” reconsidered. American journal of Psychiatry, 137, 1336–1347.PubMedGoogle Scholar
  38. Hoppe, K. D. (1968). Resomatization of affects in survivors of persecution. International Journal of Psychoanalysis, 49, 324–326.PubMedGoogle Scholar
  39. Horowitz, M. (1986). Stress response syndromes. Northvale, NJ: Aronson.Google Scholar
  40. Hotaling, G., and Sugarman, D. (1986). An analysis of risk markers in husband to wife violence: The current state of knowledge. Viol. Vict., 1, 101–124.Google Scholar
  41. Jacobson, A., Richardson, B. (1987). Assault experiences of 100 psychiatric inpatients:Google Scholar
  42. Evidence of the need for routine inquiry. American Journal of Psychiatry, 144,908–913. Jaffe, R. (1968). Dissociative phenomena in former concentration camp inmates. Int. J. Psychoanal., 49,310–312.Google Scholar
  43. Kaufman, J., Zigler, E. (1987). Do abused children become abusive parents? American Journal of Orthopsychology, 57, 186–192.CrossRefGoogle Scholar
  44. Kernberg, O. (1967). Borderline personality organization. Journal of the American Psychoanalytic Association, 15, 641–685.PubMedCrossRefGoogle Scholar
  45. Kinzie, J. D., Boehnlein, J. K., Leung, P. K., et al. (1990). The prevalence of posttraumatic stress disorder and its clinical significance among Southeast Asian refugees. American Journal of Psychiatry, 147, 913–917.PubMedGoogle Scholar
  46. Kinzie, J. D., Fredrickson, R. H., Ben, R. et al. (1984). PTSD among survivors of Cambodian concentration camps. American Journal of Psychiatry, 141, 645–650.PubMedGoogle Scholar
  47. Kluft, R. P. (1990). Incest and subsequent revictimization: The case of therapist-patient sexual exploitation, with a description of the sitting duck syndrome. In Incest-related syndromes of adult psychopathology (pp. 263–289 ). Washington, DC: American Psychiatric Press.Google Scholar
  48. Kolb, L. C. (1989). Letter to the editor. American Journal of Psychiatry, 146, 811–812.PubMedGoogle Scholar
  49. Kroll, J., Habenicht, M., Mackenzie, T. et al. (1989). Depression and posttraumatic stress disorder in Southeast Asian refugees. American Journal of Psychiatry, 146, 1592–1597.PubMedGoogle Scholar
  50. Krystal, H. (Ed.) (1968). Massive psychic trauma. New York: International Universities Press. Krystal, H., and Niederland, W. (1968). Clinical observations on the survivor syndrome. In H. Krystal (Ed.), Massive Psychic Trauma (pp. 327–348). New York: International Universities Press.Google Scholar
  51. Levi, P. (1961). Survival in Auschwitz: The Nazi Assault on Humanity (S. Woolf, Trans. New York: Collier. (Original work published 1958 ).Google Scholar
  52. Lifton, R. J. (1987). Cults: Religious totalism and civil liberties. In The future of immortality and other essays for a nuclear age. New York: Basic Books.Google Scholar
  53. Lovelace, L., and McGrady, M. (1980). Ordeal. Secaucus, NJ: Citadel.Google Scholar
  54. Mai, F. M., Sc Merskey, H. (1980). Briquet’s treatise on hysteria: Synopsis and commentary. Archives of General Psychiatry, 37, 1401–1405.PubMedCrossRefGoogle Scholar
  55. Melges, F. T., ScSwartz, M. S. (1989). Oscillations of attachment in borderline personality disorder. American Journal of Psychiatry, 146, 1115–1120.PubMedGoogle Scholar
  56. Morrison, J. (1989). Childhood sexual histories of women with somatization disorder. American Journal of Psychiatry, 146, 239–241.PubMedGoogle Scholar
  57. NiCarthy, G. (1982). Getting free: A handbook for women in abusive relationships. Seattle: Seal.Google Scholar
  58. Niederland, W. G. (1968). Clinical observations on the “survivor syndrome.” International Journal of Psychoanalysis, 49, 313–315.PubMedGoogle Scholar
  59. Partnoy, A. (1986). The little school: Tales of disappearance and survival in Argentina. San Francisco: Cleis.Google Scholar
  60. Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. New York: Guilford.Google Scholar
  61. Putnam, F. W., Guroff, J. J., Silberman, E. K. et al. (1986). The clinical phenomenology of multiple personality disorder: Review of 100 recent cases. Journal of Clinical Psychiatry, 47, 285–293.PubMedGoogle Scholar
  62. Rhodes, R. (1990). A hole in the world. New York: Simon and Schuster.Google Scholar
  63. Rieker, P. P., and Carmen, E. (1986). The victim-to-patient process: The disconfirmation and transformation of abuse. American Journal of Orthopsychiatry, 56, 360–370.PubMedCrossRefGoogle Scholar
  64. Ross, C. A., Miller, S. D., Reagor, P. et al. (1990). Structured interview data on 102 cases of multiple personality disorder from four centers. American Journal of Psychiatry, 147, 596–601.PubMedGoogle Scholar
  65. Russell, D. (1986). The secret trauma. New York: Basic Books.Google Scholar
  66. Russell, D. (1989). Lives of courage: Women for a new South Africa. New York: Basic Books.Google Scholar
  67. Sanders, B., McRoberts, G., and Tollefson, C. (1989). Childhood stress and dissociation in a college population. Dissociation, 2, 17–23.Google Scholar
  68. Segal, J., Hunter, E. J., and Segal, Z. (1976). Universal consequences of captivity: Stress reactions among divergent populations of prisoners of war and their families. International Journal of Social Science, 28, 593–609.Google Scholar
  69. Sharansky, N. (1988). Fear no evil (S. Hoffman, Trans.). New York: Random House.Google Scholar
  70. Shengold, L. (1989). Soul Murder: The Effects of Childhood Abuse and Deprivation. New Haven, CT: Yale University Press.Google Scholar
  71. Stremz, T. (1982). The Stockholm syndrome: Law enforcement policy and hostage behavior. In F. M. Ochberg and D. A. Soskis (Eds.), Victims of terrorism (pp. 149–163 ). Boulder, CO: Westview.Google Scholar
  72. Symonds, M. (1982). Victim responses to terror: Understanding and treatment. In F. M. Ochberg and D. A. Soskis (Eds.), Victims of terrorism (pp. 95–103 ). Boulder, CO: West-view.Google Scholar
  73. Tennant, C. C., Gouston, K. J., and Dent, O. F. (1986). The psychological effects of being a prisoner of war: Forty years after release. American Journal of Psychiatry, 143, 618–622.Google Scholar
  74. Terr, L. C. (1983). Chowchilla revisited: The effects of psychic trauma four years after a school-bus kidnapping. American Journal of Psychiatry, 140, 1543–1550.PubMedGoogle Scholar
  75. Timerman, J. (1981). Prisoner without a name, cell without a number (T. Talbot, Trans.). New York: Vintage.Google Scholar
  76. Kolk, B. A. (1987). Psychological trauma. Washington, DC: American Psychiatric Press.Google Scholar
  77. Kolk, B. A. (1989). Compulsion to repeat the trauma: Reenactment, revictimization, and masochism. Psychiatr. Clin. North Am, 12, 389–411.PubMedGoogle Scholar
  78. Kolk, B. A., Perry, J. C., and Herman, J. L. (1991). Childhood origins of self-destructive behavior. American Journal of Psychiatry, 148, 1665–1671.PubMedGoogle Scholar
  79. Ploerd, H. M. (1989). Being held hostage in the Netherlands: A study of long-term aftereffects. Journal of Traumatic Stress, 2, 153–170.Google Scholar
  80. Walker, L. (1979). The battered woman. New York: Harper and Row.Google Scholar
  81. Wardell, L., Gillespie, D., and Leffler, A. (1983). Science and violence against wives. In Finkelhor, D., Gelles, R., Hotaling, G., et al. (eds.), The dark side of families: Current family violence research (pp. 69–84 ). Beverly Hills, CA: Sage.Google Scholar
  82. Weschler, L. (1989, April 3). The great exception: I. Liberty, New Yorker.Google Scholar
  83. Wiesel, E. (1960). Night (S. Rodway, Trans.), New York: Hill and Wang.Google Scholar
  84. Zanarini, M., Gunderson, J., Frankenburg, F., et al. (1990). Discriminating borderline personality disorder from other Axis II disorders. American Journal of Psychiatry, 147, 161–167.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Judith Lewis Herman
    • 1
  1. 1.SomervilleUSA

Personalised recommendations