Post-traumatic stress disorder (PTSD) is a well-known and well-researched clinical condition. It arises as the result of serious traumas. Such traumas can include military incidents, such as witnessing or being involved in heavy fire resulting in death or serious injury. In the case of personal injury litigation it most commonly arises as the result of a serious road traffic accident.

There is significant evidence that survivors of prolonged, repeated trauma such as survivors of repeated abuse as children tend to suffer from an associated but more extensive range of symptoms as adults. It is known as Complex PTSD (C-PTSD).

The type and severity of these symptoms is more debilitating and has a stronger tendency to chronicity than does PTSD and this should be taken into consideration when assessing both treatment options and quantum in personal injury cases.

Symptoms associated with C-PTSD resemble those of PTSD (see DSM-IV) but can also resemble Borderline Personality Disorder, involving issues of subordinate control, captivity, victimisation and helplessness. Many adult survivors lose any sense of safety, trust and self-worth. They also tend to be “re-victimised” by even minor traumas and it is common for them to “act out” their psychological distress in physical acts such as self-harm or promiscuity while appearing to be emotionally well-controlled. This is via an unconscious process known as dissociation.

Given the complexity and likely chronicity of the symptoms it is unsurprising that the treatment of C-PTSD is considerably more complex than the treatment of PTSD. There is a recognised three-stage pattern of treatment including a. stabilisation, b. resolution of traumatic memory (reprocessing) and c. personality re-integration and rehabilitation. “Normal” models of brief CBT are unlikely to lead to therapeutic gains in themselves although they would constitute a central part of the wider therapeutic process.

Professor Hugh Koch regularly holds clinics in London.

Mr David Bird regularly holds clinics in Leeds, Nottingham, Sheffield and Wakefield.