Disorders of Extreme Stress Not Otherwise Specified (DESNOS)


I recently scanned a book, Healing Trauma(published by Norton in 2003), and ran across a new name (for me) for the problem of complex PTSD–Disorders of Extreme Stress NOS or DESNOS.  Because many christian counselors are only marginally aware of the research on complex PTSD I’ve decided to give a brief summary here.

The following symptom presentation may be found in those with prolonged and severe personal abuse (and often starting at an early age): 

  1. alterations in the regulation of affective impulses, including difficulty with modulation of anger and being self-destructive,
  2. alterations in attention and consciousness, leading to amnesias and dissociative and depersonalization episodes,
  3. alterations in self perception, such as a chronic sense of guilt and responsibility, and chronically feeling ashamed,
  4. alterations in relationships with others, such as not being able to trust and not being able to feel intimate with people,
  5. somatizating the problem: feeling symptoms on a somatic level when medical explanations can’t be found, and
  6. alterations in systems of meaning (loss of meaning or distorted beliefs)

Some folks include a 7th characteristic: (alterations of perceptions of perpetrator(s).

Check out the this paper(44 pages long) written on the assessment and treatment of DESNOS.  Though written for psychiatrists, I found the language easy to understand. The authors do a nice job of helping counselors differentiate between Borderline Personality Disorder and DESNOS. While they recognize significant overlap between the two constellation of symptoms, DESNOS folks tend to experience less relational push/pull (less manipulative behavior) and more push behaviors coupled with more intense sadness and grief.

Counseling work falls (per this paper) into 3 categories: stabilization, trauma processing, and re-integration into their world.

4 Comments

Filed under Abuse, Anxiety, counseling, counseling science, counseling skills, Post-Traumatic Stress Disorder, Psychology

4 responses to “Disorders of Extreme Stress Not Otherwise Specified (DESNOS)

  1. How is DESNOS different or the same as RAD? I am an adoptive parent. My child has been in an EBD class since placement. My peers really are mom’s whose kids have behavioral disorders; we are adoptive parents. Most of our kids carry the diagnosis RAD. Perhaps it is just the way it is term is applied. I recently read the APSAC Task Force on Attachment Therapy. Perhaps all of our kids should have the diagnosis DESNOS instead. Among adoptive parents an unattached child is one who lacks a conscience, is self-centered, self-serving and poses a danger to other children. This description doesn’t really seem to fit the diagnostic criteria of indiscriminate attachment or reluctance to attach.

    I suppose I should admit my bias. I don’t use what would classically be called attachment parenting in my home. The classes I took prior to adoption featured videos by a well known expert on “therapeutic parenting” and frankly I found her view of the kids demeaning and certainly not in agreement with the scriptural idea that I am parenting a unique, eternal image-bearer.

  2. Your own response gives evidence of the difference between the two. While RAD is often found in children of abuse, there are children who seem not to attach without the abuse problems.

    What you point out is that we have sets of symptoms or common behavioral patterns that often resist our attempts to categorize…

  3. The link does not function to the 44 page document that you mention. Can you give the url to the page?

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