Christine A. Courtois | University of Pennsylvania (original) (raw)
Papers: National Child Traumatic Stress Network by Christine A. Courtois
Full citation: Layne, C. M., Briggs-King, E., & Courtois, C. (2014). Introduction to the Spec... more Full citation:
Layne, C. M., Briggs-King, E., & Courtois, C. (2014). Introduction to the Special Section: Unpacking risk factor caravans across development: Findings from the NCTSN Core Data Set. Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), 2014, S1-S8. http://dx.doi.org/10.1037/a0037768
Abstract: In this overview, we discuss the utility of the concept of risk factor caravan (Layne et al., 2009) as a conceptual vehicle for depicting how constellations of various risk factors tend to co-occur, accumulate in number, accrue and cascade forward in their harmful effects, and “travel” with their host across development. We also propose the concept of risk factor caravan passageway as a tool for describing the disadvantaged, resource-poor, and often dangerous ecologies that give rise to and maintain risk factor caravans across the life course. These twin concepts build upon and complement the concepts of resource caravan and resource caravan passageway as advanced by conservation of resources theory (Hobfoll, 2011; 2012). Our aim is to promote the scientific study of the diverse ways through which youths’ physical and social ecologies may profoundly affect (for good or ill) their developmental trajectories, life experiences, and life attainments. We discuss ways in which the Trauma History Profile—a tool for assessing exposure to a broad variety of types of trauma and loss across childhood and adolescence (Pynoos et al., 2014), combined with the concepts of risk factor caravans and caravan passageways, add conceptual richness, balance, developmental perspective, and methodological rigor to the study of such complex phenomena as the ACE Pyramid (Felitti et al., 1998), complex trauma exposure, and complex traumatic stress disorder (Ford & Courtois, 2013). We conclude by discussing ways in which the five papers making up the special section illustrate key concepts and applications of these conceptual and assessment tools.
Keywords: childhood traumatic stress, adverse childhood experiences, complex trauma, developmental psychopathology, risk factor
Papers by Christine A. Courtois
APA handbook of trauma psychology: Foundations in knowledge (Vol. 1).
Sexual boundary violations in psychotherapy: Facing therapist indiscretions, transgressions, and misconduct., 2021
Child sexual abuse is a topic rarely discussed in our society. This can make it difficult for sur... more Child sexual abuse is a topic rarely discussed in our society. This can make it difficult for survivors of child sexual abuse to understand and overcome what has happened to them. It is estimated that 1 in 3 girls and 1 in 6 boys will be sexually abused by age 16. 1 Most offenders are known to the child. Understanding the definition, impact, and recovery process of childhood sexual abuse can be helpful for individuals as they move through the healing process. What is Child Sexual Abuse? Child sexual abuse is the improper exposure of a child to sexual contact, activity, or behavior, which can include exhibitionism, exposure to pornography, sexual touching, and/or penetration. According to the Criminal Code of Canada, a person under the age of 12 cannot consent to any kind of sexual activity with anyone at anytime. Youth aged 1213 cannot consent unless the person is less than two years older than them. Youth aged 1415 cannot consent unless the person is less than five years older than them. Up until 18 years of age, youth cannot consent if the other person is in a position of power, trust, or authority (e.g. teacher, family member, babysitter, coach). Sexual abuse may occur on a regular basis over many months or years by one or several abusers, or it may happen on one occasion only.
Sexual boundary violations in psychotherapy: Facing therapist indiscretions, transgressions, and misconduct., 2021
Sexual boundary violations in psychotherapy: Facing therapist indiscretions, transgressions, and misconduct., 2021
Borderline Personality Disorder and Emotion Dysregulation, 2021
Background This article builds on a previous review (Ford and Courtois, Borderline Personal Disor... more Background This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD. Main body The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity; (2) clinical phenomen...
Recovered Memories and False Memories, 1997
Posttraumatic Stress Disorder, 2015
Social, cultural, and other diversity issues in the traumatic stress field This chapter describes... more Social, cultural, and other diversity issues in the traumatic stress field This chapter describes how the impact of psychological trauma and posttraumatic stress disorder (PTSD) differ, depending on individual differences and the social and cultural context and culture-specific teachings and resources available to individuals, families, and communities. We use the framework (Kira et al., 2011) formulated to differentiate the impact on the individual's or group's (i) personal, unique physical characteristics, including skin color, racial background, gender, and sexual orientation; and (ii) family, ethnocultural, and community membership, including majority or minority group status, religious beliefs and practices, socioeconomic resources, and political and civic affiliations. While personal and social factors can be a positive resource contributing to safety and well-being, they also can be a basis for placing the person or group in harm's way. Disadvantaged persons and communities-such as those in poverty or who face stigma and discrimination, disabilities, homelessness, political repression, communal/ societal violence (including paramilitary, military, and gang warfare), forced immigration (refugees and asylum seekers), interrogation and torture, terrorism, genocide, and catastrophic disasters-are particularly vulnerable both to being exposed to traumatic stressors and to developing PTSD and associated psychiatric disorders and psychosocial problems (
Contemporary Psychoanalysis, 2001
Perhaps Eigen's greatest strength is his ability to search out ways for some kind of dialogue... more Perhaps Eigen's greatest strength is his ability to search out ways for some kind of dialogue to remain possible. He is deeply committed to remaining open to himself, his patients, and the larger world. This is especially revealed in his case presentations. Although at times they are very evocative and vivid examples of his use of theory, his case presentations can sometimes blur meaning rather than expand it. Eigen is so committed to staying open to the experience of his patients that his major concern, the analysis of states of deadness, can get lost in a maze of observations lacking sufficient coherence and precision. Eigen is aware of this limitation in his work. About himself, he can speak of his own difficulties and vulnerability in trying to understand some of his patients. He could not have written this book without a powerful awareness of the chaotic, potentially enlivening, potentially deadening nature of his own and others' inner experience.
Posttraumatic Stress Disorder, 2015
There are many ways to gather information and make a clinical or research determination that psyc... more There are many ways to gather information and make a clinical or research determination that psychological trauma and posttraumatic stress disorder (PTSD) have or have not occurred. This is understandable in light of the complexity of traumatic stressors, the risk and protective factors that influence the likelihood of developing traumatic stress disorders, and the several types of traumatic stress disorders in addition to PTSD and comorbid disorders and problems. Psychological trauma and PTSD, as defined in the American Psychiatric Association’s (2013) Diagnostic and Statistical Manual (5th edition), require the presence of events that are objectively “traumatic” and a menu of symptoms that include ones closely tied to memories of those events, reactions to and avoidance of those memories or reminders of those or similar events, persistent negative alterations in emotions, beliefs, and mental acuity, and problems with excessive or insufficient physical arousal affecting sleep, ability to manage impulses and anger, and observational measures that address each of these components in order to accurately determine if traumatic events have occurred and symptoms are sufficiently impairing to constitute a serious problem for the individual.
Posttraumatic Stress Disorder, 2015
Although most people will encounter a traumatic stressor at least once, and often several times, ... more Although most people will encounter a traumatic stressor at least once, and often several times, in their lives, most people who experience a traumatic stressor do not develop PTSD (Breslau, 2002; Kessler et al., 2005; Kessler, Sonnega, Bromet, & Hughes, 1995). Therefore, the question of what causes PTSD cannot simply be answered by referring to its definition: a disorder whose symptoms occur following exposure to a traumatic stressor. In fact, there is controversy as to whether PTSD symptoms really are caused by exposure to traumatic stressors, because all of the symptoms, except for memories, flashbacks, and nightmares of traumatic events, could occur regardless of whether a person has experienced a traumatic stressor. The PTSD symptoms that are not by definition tied to a traumatic stressor-even the two symptoms that are defined as psychological or physical distress due to reminders of past stressful events-actually are also symptoms of other psychiatric disorders as well as of PTSD. Thus, it is important to scientifically examine the assumption that PTSD is caused by exposure to traumatic stressors (Box 3.1). Scientific evidence indicating that PTSD is most likely to occur not just when a traumatic stressor has occurred-but when the objective severity of exposure to traumatic danger or harm is more extreme-provides important (albeit not definitive) support for the view that exposure to a traumatic stressor plays a key role in PTSD, as is discussed later in this chapter (see section on the Impact of Stressor Exposure). In this chapter, a more nuanced view of the causes of PTSD is presented than the commonsense version that PTSD is "caused" simply by exposure to a traumatic stressor. Research demonstrates that PTSD is a "multicausal" phenomenon, meaning that it is the product of a combination of a number of potential causes. Rather than describing the factors that contribute to the development of PTSD as "causes," it is clearer and more factual to describe them as "risk factors" and "protective factors"that is, things that increase a person's risk of developing PTSD and things that reduce (or protect against) the risk of developing PTSD. As you will see, risk factors include not only exposure to a traumatic stressor but also biological, psychological, and social factors that influence whether PTSD will occur and that can protect against (but not necessarily prevent) the development of PTSD (Box 3.2).
Posttraumatic Stress Disorder, 2015
Exposure to traumatic stressors can happen at any time in a person’s life. Although some age grou... more Exposure to traumatic stressors can happen at any time in a person’s life. Although some age groups are more susceptible to exposure to certain types of traumatic stressors (e.g., young adults are more likely to encounter war-related traumatic stressors than younger or older people because that is the developmental period in which military service most often occurs), all traumatic stressors can occur at any point in the life span. Therefore, with each passing year of life, the probability of having been exposed to a traumatic stressor increases, until in midlife or older adulthood it is rare to find a person who has not ever been exposed to a traumatic stressor. Epidemiology studies demonstrate that the likelihood of experiencing psychological trauma and of developing PTSD differs depending upon a variety of factors including age, gender, ethnocultural background, socioeconomic resources, and the extent of violence and poverty in the community or nation. However, anyone from any background in any part of the world can experience psychological trauma.
Encyclopedia of Trauma: An Interdisciplinary Guide
Full citation: Layne, C. M., Briggs-King, E., & Courtois, C. (2014). Introduction to the Spec... more Full citation:
Layne, C. M., Briggs-King, E., & Courtois, C. (2014). Introduction to the Special Section: Unpacking risk factor caravans across development: Findings from the NCTSN Core Data Set. Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), 2014, S1-S8. http://dx.doi.org/10.1037/a0037768
Abstract: In this overview, we discuss the utility of the concept of risk factor caravan (Layne et al., 2009) as a conceptual vehicle for depicting how constellations of various risk factors tend to co-occur, accumulate in number, accrue and cascade forward in their harmful effects, and “travel” with their host across development. We also propose the concept of risk factor caravan passageway as a tool for describing the disadvantaged, resource-poor, and often dangerous ecologies that give rise to and maintain risk factor caravans across the life course. These twin concepts build upon and complement the concepts of resource caravan and resource caravan passageway as advanced by conservation of resources theory (Hobfoll, 2011; 2012). Our aim is to promote the scientific study of the diverse ways through which youths’ physical and social ecologies may profoundly affect (for good or ill) their developmental trajectories, life experiences, and life attainments. We discuss ways in which the Trauma History Profile—a tool for assessing exposure to a broad variety of types of trauma and loss across childhood and adolescence (Pynoos et al., 2014), combined with the concepts of risk factor caravans and caravan passageways, add conceptual richness, balance, developmental perspective, and methodological rigor to the study of such complex phenomena as the ACE Pyramid (Felitti et al., 1998), complex trauma exposure, and complex traumatic stress disorder (Ford & Courtois, 2013). We conclude by discussing ways in which the five papers making up the special section illustrate key concepts and applications of these conceptual and assessment tools.
Keywords: childhood traumatic stress, adverse childhood experiences, complex trauma, developmental psychopathology, risk factor
APA handbook of trauma psychology: Foundations in knowledge (Vol. 1).
Sexual boundary violations in psychotherapy: Facing therapist indiscretions, transgressions, and misconduct., 2021
Child sexual abuse is a topic rarely discussed in our society. This can make it difficult for sur... more Child sexual abuse is a topic rarely discussed in our society. This can make it difficult for survivors of child sexual abuse to understand and overcome what has happened to them. It is estimated that 1 in 3 girls and 1 in 6 boys will be sexually abused by age 16. 1 Most offenders are known to the child. Understanding the definition, impact, and recovery process of childhood sexual abuse can be helpful for individuals as they move through the healing process. What is Child Sexual Abuse? Child sexual abuse is the improper exposure of a child to sexual contact, activity, or behavior, which can include exhibitionism, exposure to pornography, sexual touching, and/or penetration. According to the Criminal Code of Canada, a person under the age of 12 cannot consent to any kind of sexual activity with anyone at anytime. Youth aged 1213 cannot consent unless the person is less than two years older than them. Youth aged 1415 cannot consent unless the person is less than five years older than them. Up until 18 years of age, youth cannot consent if the other person is in a position of power, trust, or authority (e.g. teacher, family member, babysitter, coach). Sexual abuse may occur on a regular basis over many months or years by one or several abusers, or it may happen on one occasion only.
Sexual boundary violations in psychotherapy: Facing therapist indiscretions, transgressions, and misconduct., 2021
Sexual boundary violations in psychotherapy: Facing therapist indiscretions, transgressions, and misconduct., 2021
Borderline Personality Disorder and Emotion Dysregulation, 2021
Background This article builds on a previous review (Ford and Courtois, Borderline Personal Disor... more Background This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD. Main body The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity; (2) clinical phenomen...
Recovered Memories and False Memories, 1997
Posttraumatic Stress Disorder, 2015
Social, cultural, and other diversity issues in the traumatic stress field This chapter describes... more Social, cultural, and other diversity issues in the traumatic stress field This chapter describes how the impact of psychological trauma and posttraumatic stress disorder (PTSD) differ, depending on individual differences and the social and cultural context and culture-specific teachings and resources available to individuals, families, and communities. We use the framework (Kira et al., 2011) formulated to differentiate the impact on the individual's or group's (i) personal, unique physical characteristics, including skin color, racial background, gender, and sexual orientation; and (ii) family, ethnocultural, and community membership, including majority or minority group status, religious beliefs and practices, socioeconomic resources, and political and civic affiliations. While personal and social factors can be a positive resource contributing to safety and well-being, they also can be a basis for placing the person or group in harm's way. Disadvantaged persons and communities-such as those in poverty or who face stigma and discrimination, disabilities, homelessness, political repression, communal/ societal violence (including paramilitary, military, and gang warfare), forced immigration (refugees and asylum seekers), interrogation and torture, terrorism, genocide, and catastrophic disasters-are particularly vulnerable both to being exposed to traumatic stressors and to developing PTSD and associated psychiatric disorders and psychosocial problems (
Contemporary Psychoanalysis, 2001
Perhaps Eigen's greatest strength is his ability to search out ways for some kind of dialogue... more Perhaps Eigen's greatest strength is his ability to search out ways for some kind of dialogue to remain possible. He is deeply committed to remaining open to himself, his patients, and the larger world. This is especially revealed in his case presentations. Although at times they are very evocative and vivid examples of his use of theory, his case presentations can sometimes blur meaning rather than expand it. Eigen is so committed to staying open to the experience of his patients that his major concern, the analysis of states of deadness, can get lost in a maze of observations lacking sufficient coherence and precision. Eigen is aware of this limitation in his work. About himself, he can speak of his own difficulties and vulnerability in trying to understand some of his patients. He could not have written this book without a powerful awareness of the chaotic, potentially enlivening, potentially deadening nature of his own and others' inner experience.
Posttraumatic Stress Disorder, 2015
There are many ways to gather information and make a clinical or research determination that psyc... more There are many ways to gather information and make a clinical or research determination that psychological trauma and posttraumatic stress disorder (PTSD) have or have not occurred. This is understandable in light of the complexity of traumatic stressors, the risk and protective factors that influence the likelihood of developing traumatic stress disorders, and the several types of traumatic stress disorders in addition to PTSD and comorbid disorders and problems. Psychological trauma and PTSD, as defined in the American Psychiatric Association’s (2013) Diagnostic and Statistical Manual (5th edition), require the presence of events that are objectively “traumatic” and a menu of symptoms that include ones closely tied to memories of those events, reactions to and avoidance of those memories or reminders of those or similar events, persistent negative alterations in emotions, beliefs, and mental acuity, and problems with excessive or insufficient physical arousal affecting sleep, ability to manage impulses and anger, and observational measures that address each of these components in order to accurately determine if traumatic events have occurred and symptoms are sufficiently impairing to constitute a serious problem for the individual.
Posttraumatic Stress Disorder, 2015
Although most people will encounter a traumatic stressor at least once, and often several times, ... more Although most people will encounter a traumatic stressor at least once, and often several times, in their lives, most people who experience a traumatic stressor do not develop PTSD (Breslau, 2002; Kessler et al., 2005; Kessler, Sonnega, Bromet, & Hughes, 1995). Therefore, the question of what causes PTSD cannot simply be answered by referring to its definition: a disorder whose symptoms occur following exposure to a traumatic stressor. In fact, there is controversy as to whether PTSD symptoms really are caused by exposure to traumatic stressors, because all of the symptoms, except for memories, flashbacks, and nightmares of traumatic events, could occur regardless of whether a person has experienced a traumatic stressor. The PTSD symptoms that are not by definition tied to a traumatic stressor-even the two symptoms that are defined as psychological or physical distress due to reminders of past stressful events-actually are also symptoms of other psychiatric disorders as well as of PTSD. Thus, it is important to scientifically examine the assumption that PTSD is caused by exposure to traumatic stressors (Box 3.1). Scientific evidence indicating that PTSD is most likely to occur not just when a traumatic stressor has occurred-but when the objective severity of exposure to traumatic danger or harm is more extreme-provides important (albeit not definitive) support for the view that exposure to a traumatic stressor plays a key role in PTSD, as is discussed later in this chapter (see section on the Impact of Stressor Exposure). In this chapter, a more nuanced view of the causes of PTSD is presented than the commonsense version that PTSD is "caused" simply by exposure to a traumatic stressor. Research demonstrates that PTSD is a "multicausal" phenomenon, meaning that it is the product of a combination of a number of potential causes. Rather than describing the factors that contribute to the development of PTSD as "causes," it is clearer and more factual to describe them as "risk factors" and "protective factors"that is, things that increase a person's risk of developing PTSD and things that reduce (or protect against) the risk of developing PTSD. As you will see, risk factors include not only exposure to a traumatic stressor but also biological, psychological, and social factors that influence whether PTSD will occur and that can protect against (but not necessarily prevent) the development of PTSD (Box 3.2).
Posttraumatic Stress Disorder, 2015
Exposure to traumatic stressors can happen at any time in a person’s life. Although some age grou... more Exposure to traumatic stressors can happen at any time in a person’s life. Although some age groups are more susceptible to exposure to certain types of traumatic stressors (e.g., young adults are more likely to encounter war-related traumatic stressors than younger or older people because that is the developmental period in which military service most often occurs), all traumatic stressors can occur at any point in the life span. Therefore, with each passing year of life, the probability of having been exposed to a traumatic stressor increases, until in midlife or older adulthood it is rare to find a person who has not ever been exposed to a traumatic stressor. Epidemiology studies demonstrate that the likelihood of experiencing psychological trauma and of developing PTSD differs depending upon a variety of factors including age, gender, ethnocultural background, socioeconomic resources, and the extent of violence and poverty in the community or nation. However, anyone from any background in any part of the world can experience psychological trauma.
Encyclopedia of Trauma: An Interdisciplinary Guide