Stepping Out of Line : Constructions of Trauma in The UK Military.

The concept of Complex Posttraumatic Stress Disorder (CPTSD) (Courtois & Ford, 2009) or Disorder of Extreme Stress Not Otherwise Specified (DESNOS) is one that has attracted debate and controversy. Is it a separate entity from Posttraumatic Stress Disorder (PTSD), already in DSM IV? (American Psychiatric Association, 2000; Courtois, 2008; Ford, Courtois, Steele, van der Hart & Nijenhuis, 2005; Korn & Leeds, 2002;). Perhaps as a result of this diagnostic difficulty, attempts to establish effective treatment approaches have been scant. This is surprising considering the amount of people with CPTSD-symptoms within psychiatric populations (Courtois, 2008). A consensus of research suggests that CPTSD exists as a separate diagnostic entity to PTSD and that treatment is best attempted through a transtheoretical approach which uses empirically-supported protocol-based treatments within the wider context of a three-phase meta-model. This involves a focus on the client achieving emotional self-regulation skills and a secure attachment within the therapeutic relationship before more specific trauma-focused work is attempted (Courtois, 2008; Korn & Leeds, 2002; Pearlman & Courtois, 2005; Resick, Pallavi & Griffin, 2003)