A history of subjection to totalitarian control over a prolonged period (months to years). Examples include:

• Hostages
• Prisoners of war
• Concentration-camp survivors
• Survivors of some religious cults
• Persons subjected to totalitarian systems in sexual and domestic life, including:
  • survivors of domestic battering
  • childhood physical or sexual abuse
  • organized sexual exploitation.

• Alterations in affect regulation, including:
  • persistent dysphoria
  • chronic suicidal preoccupation
  • self-injury
  • explosive or extremely inhibited anger (may alternate)
  • compulsive or extremely inhibited sexuality (may alternate)
• Alterations in consciousness, including:
  • amnesia or hyperamnesia for traumatic events
  • transient dissociative episodes
  • depersonalization/derealization
  • reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation
• Alterations in self-perception, including:
  • sense of helplessness or paralysis of initiative
  • shame, guilt, and self-blame
  • sense of defilement or stigma
  • sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)
• Alterations in perception of perpetrator, including:
  • preoccupation with relationship with perpetrator (includes preoccupation with revenge)
  • unrealistic attribution of total power to perpetrator (caution: victim’s assessment of power realities may be more realistic than clinician’s)
  • idealization or paradoxical gratitude
  • sense of special or supernatural relationship
  • acceptance of belief system or rationalizations of perpetrator

• Alterations in relations with others, including:
  • isolation and withdrawal
  • disruption in intimate relationships
  • repeated search for rescuer (may alternate with isolation and withdrawal)
  • persistent distrust
  • repeated failures of self-protection 

• Alterations in systems of meaning:
  • loss of sustaining faith
  • sense of hopelessness and despair