복합외상(complex trauma)의 개념과 경험적 근거 = An Empirical Review of Complex Trauma

다국어 초록 (Multilingual Abstract)

Posttraumatic Stress Disorder (PTSD) is the most common diagnosis given after a traumatic incident. However, there has been a broad consensus that PTSD does not explain all types of traumatic reponses, which led to the proposition of the notion of Complex PTSD or DESNOS. Complex PTSD or DESNOS is caused by complex trauma, a type of trauma that commonly involves repeated, interpersonal violence. Childhood abuse, family violence, war participation are some examples of the complex trauma. Complex PTSD or DESNOS is known to differ in its symptom manifestation, and therefore different treatment approaches are suggested. This study is a review of the current concepts and empirical evidence of complex PTSD, and its related issues. A few suggestions are given regarding the importance of understanding complext PTSD in Korean society.

국문 초록 (Abstract)

외상후 스트레스 장애(Posttraumatic Stress Disorder; PTSD)는 정신적으로 큰 충격을 준 사건을 겪은 이후 지속적으로 심리적 후유증을 나타내는 이들에게 내려지는 대표적인 진단이다. 하지만 PTSD가 다양한 종류의 외상경험자의 증상과 반응양상을 모두 반영하지 못한다는 비판을 받으면서 복합 PTSD 또는 DESNOS 의 개념이 등장하였다. 외상 유형 가운데 대인간 폭력이 주가 되면서 반복적이거나 장기적으로 지속된 외상 유형의 경우(예, 아동폭력, 가정폭력, 난민 경험) 현재 DSM－IV에 수록된 PTSD 증상들과는 다른 증상 특징들을 나타내기에 기존의 PTSD 진단에 한계가 있을 뿐만 아니라 치료적 접근 또한 달라져야 한다고 보는 입장이 있다. 이 연구는 복합 외상에 대하여 기존의 PTSD 진단이 가지고 있는 제한점이 무엇인지, 복합 PTSD(complex PTSD)라는 새로운 진단의 개념과 치료에 관하여 최근까지 발표된 경험적 연구결과들이 무엇인지를 개관하여 소개하고자 한다.

참고문헌 (Reference)

• 1 Roth, S., 10 : 539-555, 1997
• 2 안현의, "청소년의 심리적 외상에 관한 탐색적 연구: 외상후 스트레스 증상과 성격 특성을 중심으로" 한국상담심리학회 17 (17): 217-231, 2005
• 3 김재엽, "자녀학대 피해 청소년의 정신건강 연구" 5 : 37-62, 1998
• 4 김재엽, "여성노인의 가정폭력 피해실태와 정신건강" 한국노년학회 23 (23): 51-65, 2003
• 5 김재엽, "여대생의 아동학대경험이 정신건강 및 사회생활에 미치는 영향에 관한 연구" 10 : 27-47, 2005
• 6 김선아, "가정폭력으로 쉼터에 입소한 여성의 피해실태와 정신건강" 한국간호과학회 33 (33): 981-989, 2003
• 7 이수정, "가정폭력에 기인하여 배우자를 살해한여성 재소자의 심리특성에 관한 연구" 한국사회및성격심리학회 20 (20): 35-55, 2006
• 8 Spitzer, R., "Victimization disorder" New York Psychiatric Institute 1989
• 9 Ford, J. D., "Treatment of complex posttraumatic self－dysregulation" 18 : 437-447, 2005
• 10 Allen, J., "Traumatic relationships and serious mental disorders" Wiley 2001
• 11 deVries, M. W., "Trauma in cultural perspective, In Traumatic stress" The Guilford Press 1996
• 12 Herman, J. L., "Trauma and recovery" Basic Books 1992
• 13 Newman, E., "Thematic resolution, PTSD, and complex PTSD: The relationship between meaning and trauma－related diagnoses" 10 : 197-213, 1997
• 14 Andreasen, N. C., "The validation of psychiatric diagnosis: New models and approaches (editorial)" 152 : 161-162, 2001
• 15 Turner, S. W., "The therapeutic environment and new explorations in the treatment of posttraumatic stress disorder, In Traumatic stress" The Guilford Press 1996
• 16 Lebowitz, L., "The role of cognitive－affective themes in the assessment and treatment of trauma reaction" 3 : 196-207, 1996
• 17 Roth, S., "The process of coping with trauma" 4 : 279-297, 1991
• 18 Roth, S., "The process of coping with incest for adult survivors" 8 : 363-377, 1993
• 19 Kendall－Tackett, K., "The health effects of childhood abuse: Four pathways by which abuse can influence health" 26 : 715-729, 2002
• 20 Walker, L. E., "The battered woman syndrome" Springer 1984
• 21 World Health Organization., "The ICD－10 classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines" World Health Organization 1992
• 22 Taylor, S., "Simple versus complex PTSD: A cluster analytic investigation" 20 : 459-472, 2006
• 23 Zanarini, M. C., "Risk factors associated with the dissociative experiences of borderline patients" 188 : 26-30, 2000
• 24 Chu, J. A., "Rebuilding shattered lives: The responsible treatment of complex post－traumatic and dissociative disorders" Wiley 1998
• 25 Burgess, A. W., "Rape trauma syndrome" 131 : 981-986, 1974
• 26 Norriss, F. H., "Psychological distress following criminal victimization in the general population: Cross－section, longitudinal, and prospective analyses" 62 : 111-123, 1994
• 27 Resnick, H. S., "Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women" 61 : 984-991, 1993
• 28 Parson, E. R., "Post－traumatic ethnotherapy: Processes in assessment and intervention in aspects of global psychic trauma, In Handbook of posttraumatic therapy" Greenwood Press 1994
• 29 Creamer, M., "Posttraumatic stress disorder: Findings from the Australian National Survey of Mental Health and Well－Being" 31 : 1237-1247, 2001
• 30 Schiraldi, G., "Posttraumatic stress disorder sourcebook" McGraw－Hill 2000
• 31 Kessler, R. C., "Posttraumatic stress disorder in the National Comorbidity Survey" 52 : 1048-1060, 1995
• 32 Friedman, M. J., "PTSD as a chronic disorder, In The seriously and persistently mentally ill" Hogrefe & Huber 369-389, 1996
• 33 Weine, S. M., "Individual change after genocide in Bosnian survivors of “ethnic cleansing”: Assessing personality dysfunction" 11 : 147-153, 1998
• 34 Resick, P. A., "How well does cognitive－behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial" 8 : 351-355, 2003
• 35 Romano, E., "Exploring the relationship between childhood sexual abuse and adult sexual perpetration" 12 : 85-98, 1997
• 36 van der Kolk, B., "Editorial comments: complex developmental trauma" 18 : 385-388, 2005
• 37 Ford, J. D., "Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic PTSD" 11 : 743-761, 1998
• 38 Kendell, R., "Distinguishing between the validity and utility of psychiatric diagnoses" 160 : 4-12, 2003
• 39 van der Kolk, B., "Dissociation, affect dysregulation, and somatization: The complexity of adaptation to trauma" 153 : 83-93, 1996
• 40 Bremner, J. D., "Dissociation and posttraumatic stress disorder in Vietnam combat veterans" 149 : 328-332, 1992
• 41 van der Kolk, B., "Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma" 18 : 389-399, 2005
• 42 Nemeroff, C. B., "Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma" 100 : 14293-14296, 2003
• 43 Davidson, J. R. T., "Diagnostic issues in posttraumatic stress disorder: Considerations for the DSM－IV" 100 : 346-355, 1991
• 44 van der Kolk, B., "Developmental trauma disorder" 35 : 401-408, 2005
• 45 Ashead, G., "Damage: Trauma and violence in a sample of women referred to a forensic service" 12 : 235-249, 1994
• 46 de Jong, J. T. V. M., "DESNOS in three postconflict settings: Assessing cross－cultural construct equivalence" 18 : 13-21, 2005
• 47 Allen, J. G., "Complexities in complex posttraumatic stress disorder in inpatient women: evidence from cluster analysis of MCMI－Ⅲ personality disorder scale" 73 : 449-471, 1999
• 48 Courtois, C. A., "Complex trauma, complex reactions: Assessment and treatment" 41 : 412-425, 2004
• 49 Ide, N., "Complex PTSD: a review of current issues" 2 : 43-49, 2000
• 50 Herman, J. L., "Complex PTSD: A syndrome in survivors of prolonged and repeated trauma" 5 : 377-391, 1992
• 51 Terr, L. C., "Childhood traumas: An outline and overview, In Annuals progress in child psychiatry and child development" Brunner/Mazel 165-186, 1992
• 52 Marshall, R. D., "Childhood trauma and dissociative symptoms in panic disorder" 157 : 451-453, 2000
• 53 Yen, S., "Axis I and Axis Ⅱ disorders as predictors of prospective suicide attempts: Findings from the Collaborative Longitudinal Personality Disorders Study" 112 : 375-381, 2003
• 54 Zlotnick, C., "Antisocial personality disorder, affect dysregulation and childhood abuse among incarcerated women" 13 : 90-95, 1999
• 55 Kilpatrick, D. G., "A special section on complex trauma and a few thoughts about the need for more rigorous research on treatment efficacy, effectiveness, and safety" 18 : 379-384, 2005
• 56 Rothbaum, B. O., "A prospective examination of post－traumatic stress disorder in rape victims" 5 : 455-475, 1992
• 57 Kilpatrick, D. G., "A description of theposttraumatic stress disorder field trial, In Posttraumatic stress disorder: DSM－IV and beyond" American Psychiatric Press 243-250, 1992