ADULT SURVIVORS OF CHILDHOOD TRAUMA CLINICAL

Exposure therapy Distress regulation

Avoidance Hypervigilance
(persistent perceptions of
(of thoughts, memories or heightened current threat;
Psychological reminders of triggers) enhanced startle reflex)
awareness of the link
between symptoms
and situation Distress regulation

Somatic symptoms Re-experiencing

(strong physical sensations;
(nightmares, flashbacks,
strong, overwhelming
vivid intrusive memories)
emotions: fear/horror)
Complex
post-traumatic
stress disorder
Belief systems affected symptoms Altered attention
(as diminished, defeated or and consciousness;
worthless, with feelings of
shame, guilt or failure)
memory
Re-establishment Distress regulation
of values and
appropriate Emotional
expectations Interpersonal dysregulation
instability (problems in affect
(difficulty in sustaining regulation)
relationships and feeling
close to others)

Modelling of Distress regulation

appropriate attachment

Figure 1. A model of complex post-traumatic stress disorder with potential general practice interventions18,19
Adapted from the International Society for Traumatic Stress Studies guidelines and the World Health Organization’s International
Classification of Diseases, 11th Revision

© The Royal Australian College of General Practitioners 2020 REPRINTED FROM AJGP VOL. 49, NO. 7, JULY 2020