CPTSD Syndrome Analysis

The etiology of CPTSD has evolved over time. When Herman (1992) initially introduced the concept of the syndrome, the idea of repeated trauma was linked to an ongoing element of captivity where escape from harm was inhibited, which included the possibility of developing the syndrome in adulthood via experiences associated with war torture, sex slavery, refugee status, and survivors of genocide campaigns. However a large body of research has focused on associations with childhood abuse and CPTSD (Amariglio, 2014; Boroske-Leiner, Hofmann, & Sack, 2008; Marylene Cloitre et al., 2009; Dorahy et al., 2009; Leahy, 2008; Mahoney, 2006; Mayfield-Schwarz, 2007; McLean & Gallop, 2003; Pelaprat, 2010; Petchkovsky & San Roque, 2002; Rosenkranz, Muller,

& Henderson, 2014; B. van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005; Vielhauer, 1996; Winnett, 2014).
The timing of trauma in childhood is considered to be a factor in developing CPTSD with earlier onset (Boroske-Leiner et al., 2008; Mahoney, 2006; Mayfield-Schwarz, 2007; McLean & Gallop, 2003; McTeague et al., 2010), and the duration of childhood abuse resulting in greater symptom distress in adulthood (Mayfield-Schwarz, 2007; Pelaprat, 2010; B.

van der Kolk et al., 2005). The type of trauma has also been considered with multiple findings supporting childhood sexual abuse as an etiological factor (Amariglio, 2014; Dorahy et al., 2009; Mahoney, 2006; McLean & Gallop, 2003; Vielhauer, 1996), but also emotional neglect (Dorahy et al., 2009), and perceived betrayal by the perpetrator and perceived failure to protect by the non-offending caregiver (Winnett, 2014). In addition to timing and type of trauma, repeated or cumulative trauma has been found associated with the development of CPTSD (Boroske-Leiner et al., 2008; Castelda, 2006; Marylene Cloitre et al., 2009; Hall, 1999; Mayfield-Schwarz, 2007; McTeague et al., 2010; Pelaprat, 2010; B. van der Kolk et al., 2005). Some literature has identified the severity or perceived severity of the abuse in childhood to be a contributing factor (Dorahy et al., 2009; Mayfield-Schwarz, 2007). Other researchers have looked at mediators and moderators such as the parent-child relationship moderating the development of CPTSD (Bruns, 2002), kinship and spirituality buffering exposure to violence in the etiology of CPTSD for

African-American youths (Jones, 2007), and childhood abuse found to mediate the relationship between domestic violence in adulthood and CPTSD, increasing the severity of symptoms (Leahy, 2008).
Although multiple studies have examined childhood abuse from varying perspectives, a recent literature review examined the body of research on adults without a history of childhood abuse. McDonnell, Robjant, and Katona (2013) reviewed 33 articles looking for evidence that victims of human rights violations had developed CPTSD without a history of childhood abuse. The overall findings suggest that survivors of torture and war can develop CPTSD without histories of child abuse (McDonnell et al., 2013). This evidence supports the idea originally postulated by Herman (1992) which suggested that it is not necessarily the timing of the abuse (in childhood) that results in CPTSD, but the captive element of the trauma in which a victim can not easily escape and therefore endures repeated abuse. Another study found that CPTSD can develop in victims of repeated domestic violence in adulthood without a history of child abuse although if child abuse was present it exacerbated the symptoms (Leahy, 2008).