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APPENDIX
INNLEDNING
If an individual already has a background of emotional instability , vulnerability or insecurity , or has a mental illness , and does not receive support from family or the community , the reaction to new traumatic events can be very serious .
However , pre-existing factors do not predict the development of PTSD . In most cases , those suffering from it will get better and stabilise ; but the condition can also become chronic . In the worst cases , it can lead to lasting changes in personality .
Complex PTSD
Many consider that the above description of PTSD does not fully describe the experience of survivors of very serious trauma . They consider that a distinct diagnostic category should describe the reactions of survivors of long-term , complex traumas . However , such a diagnosis has not yet been included officially in the diagnostic catalogue ICD-10 .
“ Complex PTSD ” can develop after chronic , persistent , long-term trauma situations , including persistent violence , prolonged neglect , mental and physical abuse over time ( not least in childhood ), or abusive situations that include multiple rapes . Exposure to combat or captivity over a long period of time can also cause the condition .
In such cases , the emotions of survivors are out of balance . They may alternate between states of intense emotion , depression and hypersensitivity . However , they may not be aware of their emotions or states . They may switch from one state to another without control , and their milieu often does not understand the background to these changes .
Their concentration and ability to focus may be impaired . They often respond in a narrow , limited way to threats . They are impulsive and do not consider consequences . In many cases , their ability to function socially and emotionally is impaired . They do not trust themselves or others , and constantly expect and prepare for rejection . They generally have low self-esteem , to the extent of “ hating themselves ”. This often leads to self-harming behaviour , and can lead to chronic thoughts of suicide . All the “ common ” symptoms of trauma disorders may appear , but they may be less pronounced and distinct than in ( for example ) PTSD .
Persistent personality changes after catastrophic events
The effects of violent trauma can last for years and can lead to changes in personality . ICD-10 has a separate category for such changes : “ persistent personality changes after catastrophic events ” ( F-62 ). Acute stress symptoms may no longer be obvious ( but may be present to a significant degree ), but the survivor is permanently in a state of desperation and depression . The survivor feels he has changed and will often appear to others to have changed . According to the WHO , a person with this disorder may be characterised by “ a hostile or suspicious attitude towards the world , social withdrawal , feelings of emptiness or hopelessness . The survivor experiences a chronic feeling of being on the edge , as if he is constantly threatened and alienated . Posttraumatic stress disorder can precede this type of personality change and PTSD symptoms may still be visible .”