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Friday, June 13, 2025

Nativism (politics)

From Wikipedia, the free encyclopedia

Definition

According to Cas Mudde, a University of Georgia professor, nativism is a largely American notion that is rarely debated in Western Europe or Canada; the word originated with mid-19th-century political parties in the United States, most notably the Know Nothing party, which saw Catholic immigration from nations such as Germany and Ireland as a serious threat to native-born Protestant Americans.[4] In the United States, nativism does not refer to a movement led by Native Americans, also referred to as American Indians.

Causes

According to Joel S. Fetzer, opposition to immigration commonly arises in many countries because of issues of national, cultural, and religious identity. The phenomenon has especially been studied in Australia, Canada, New Zealand, the United Kingdom, and the United States, as well as in continental Europe. Thus, nativism has become a general term for opposition to immigration which is based on fears that immigrants will "distort or spoil" existing cultural values. In situations where immigrants greatly outnumber the original inhabitants, nativists seek to prevent cultural change.

Beliefs that contribute to anti-immigration sentiment include:

  • Economic
    • Employment: The belief that immigrants acquire jobs that would have otherwise been available to native citizens, limiting native employment, and the belief that immigrants also create a surplus of labor that results in lowered wages.
    • Government expense: The belief that immigrants do not pay enough taxes to cover the cost of the services they require.
    • Welfare: The belief that immigrants make heavy use of the social welfare systems.
    • Housing: The belief that immigrants reduce vacancies, causing rent increases.
  • Cultural
    • Language: The belief that immigrants isolate themselves in their own communities and refuse to learn the local language.
    • Culture: The belief that immigrants will outnumber the native population and replace its culture with theirs.
    • Crime: The belief that immigrants are more prone to crime than the native population.
    • Patriotism: The belief that immigrants damage a nation's sense of community based on ethnicity and nationality.
  • Environmental
    • Environment: The belief that immigrants increase the consumption of limited resources.
    • Overpopulation: The belief that immigration contributes to overpopulation.
  • Decolonization: The belief immigrants are colonizing those considered native or indigenous people.

Hans-Georg Betz examines three facets of nativism: economic, welfare, and symbolic. Economic nativism preaches that good jobs ought to be reserved for native citizens. Welfare nativism insists that native citizens should have absolute priority in access to governmental benefits. Symbolic nativism calls on the society and government to defend and promote the nation's cultural heritage. Betz argues that economic and welfare themes were historically dominant, but that since the 1990s symbolic nativism has become the focus of radical right-wing populist mobilization.

By country and region

Asia-Pacific

Australia

Many Australians opposed the influx of Chinese immigrants at time of the nineteenth-century gold rushes. When the separate Australian colonies formed the Commonwealth of Australia in 1901, the new nation adopted "White Australia" as one of its founding principles. Under the White Australia policy, entry of Chinese and other Asians remained controversial until well after World War II, although the country remained home to many long-established Chinese families dating from before the adoption of White Australia. By contrast, most Pacific Islanders were deported soon after the policy was adopted, while the remainder were forced out of the canefields where they had worked for decades.

Antipathy of native-born white Australians toward British and Irish immigrants in the late 19th century was manifested in a new party, the Australian Natives' Association.

Since early 2000, opposition has mounted to asylum seekers arriving in boats from Indonesia.

South Korea

The Democratic Party of Korea has been described as nativist by scholars due to its support for Korean nationalism and opposition to immigration.

Pakistan

The Pakistani province of Sindh has seen nativist movements, promoting control for the Sindhi people over their homeland. After the 1947 Partition of India, large numbers of Muhajir people migrating from India entered the province, becoming a majority in the provincial capital city of Karachi, which formerly had an ethnically Sindhi majority. Sindhis have also voiced opposition to the promotion of Urdu, as opposed to their native tongue, Sindhi.

These nativist movements are expressed through Sindhi nationalism and the Sindhudesh separatist movement. Nativist and nationalist sentiments increased greatly after the independence of Bangladesh from Pakistan in 1971.

Taiwan

Taiwan nativist literature (鄉土文學) is a genre of Taiwanese literature that was born in the 1920s, the Taiwan under Japanese rule. Taiwan nativist literature was suppressed by the rise of Japanese fascism in 1937, and after the surrender of Japan, it was suppressed by the White Terror of the Chinese Nationalist Party (Kuomintang) and began to gain attention again in the 1970s.

After the Chinese Civil War, Taiwan became a sanctuary for Chinese nationalists who followed a Western ideology, fleeing from communists. The new arrivals governed through the Kuomintang until the 1970s. Taiwanese identity constructed through literature in the post-civil war period led to the gradual acceptance of Taiwan's unique political destiny. This led to a peaceful transition of power from the Kuomintang to the Democratic Progressive Party in the 2000s. A-chin Hsiau (Author of Politics and Cultural Nativism) claims the origins of Taiwanese national identity to the 1970s, when youth activism transformed society, politics and culture which some are still present.

Americas

Brazil

The Brazilian elite desired the racial whitening of the country, similarly to Argentina and Uruguay. The country encouraged European immigration, but non-white immigration always faced considerable backlash. On 28 July 1921, representatives Andrade Bezerra and Cincinato Braga proposed a law whose Article 1 provided: "The immigration of individuals from the black race to Brazil is prohibited." On 22 October 1923, representative Fidélis Reis produced another bill on the entry of immigrants, whose fifth article was as follows: "The entry of settlers from the black race into Brazil is prohibited. For Asian [immigrants] there will be allowed each year a number equal to 5% of those residing in the country.(...)".

In the 19th and 20th centuries, there were negative feelings toward the communities of German, Italian, Japanese, and Jewish immigrants, who conserved their languages and cultures instead of adopting Portuguese and Brazilian habits (so that nowadays, Brazil has the most communities in the Americas of Venetian speakers, and the second-most of German), and were seen as particularly likely to form ghettos and to have high rates of endogamy (in Brazil, it is regarded as usual for people of different backgrounds to marry), among other concerns.

It affected the Japanese more harshly, because they were Asian, and thus seen as an obstacle to the whitening of Brazil. Oliveira Viana, a Brazilian jurist, historian and sociologist described the Japanese immigrants as follows: "They (Japanese) are like sulfur: insoluble". The Brazilian magazine O Malho in its edition of December 5, 1908 issued criticised the Japanese immigrants in the following quote: "The government of São Paulo is stubborn. After the failure of the first Japanese immigration, it contracted 3,000 yellow people. It insists on giving Brazil a race diametrically opposite to ours". In 1941 the Brazilian minister of justice, Francisco Campos, defended the ban on the admission of 400 Japanese immigrants into São Paulo writing: "their despicable standard of living is a brutal competition with the country's worker; their selfishness, their bad faith, their refractory character, make them a huge ethnic and cultural cyst located in the richest regions of Brazil".

Years before World War II, the government of President Getúlio Vargas initiated a process of forced assimilation of people of immigrant origin in Brazil. In 1933, a constitutional amendment was approved by a large majority and established immigration quotas without mentioning race or nationality and prohibited the population concentration of immigrants. According to the text, Brazil could not receive more than 2% of the total number of entrants of each nationality that had been received in the last 50 years. Only the Portuguese were excluded. The measures did not affect the immigration of Europeans such as Italians and Spaniards, who had already entered in large numbers and whose migratory flow was downward. However, immigration quotas, which remained in force until the 1980s, restricted Japanese immigration, as well as Korean and Chinese immigration.

During World War II they were seen as more loyal to their countries of origin than to Brazil. In fact, there were violent revolts in the Japanese community of the states of São Paulo and Paraná when Emperor Hirohito declared the Japanese surrender and stated that he was not really a deity, which news was seen as a conspiracy perpetrated in order to hurt Japanese honour and strength. Nevertheless, it followed hostility from the government. The Japanese Brazilian community was strongly marked by restrictive measures when Brazil declared war against Japan in August 1942. Japanese Brazilians could not travel the country without safe conduct issued by the police; over 200 Japanese schools were closed and radio equipment was seized to prevent transmissions on short wave from Japan. The goods of Japanese companies were confiscated and several companies of Japanese origin suffered restrictions, including the use of the newly founded Banco América do Sul. Japanese Brazilians were prohibited from driving motor vehicles (even if they were taxi drivers), buses or trucks on their property. The drivers employed by Japanese had to have permission from the police. Thousands of Japanese immigrants were arrested or expelled from Brazil on suspicion of espionage. There were many anonymous denunciations because of "activities against national security" arising from disagreements between neighbours, recovery of debts and even fights between children. Japanese Brazilians were arrested for "suspicious activity" when they were in artistic meetings or picnics. On July 10, 1943, approximately 10,000 Japanese and German immigrants who lived in Santos had 24 hours to close their homes and businesses and move away from the Brazilian coast. The police acted without any notice. About 90% of people displaced were Japanese. To reside in Baixada Santista, the Japanese had to have a safe conduct. In 1942, the Japanese community who introduced the cultivation of pepper in Tomé-Açu, in Pará, was virtually turned into a "concentration camp" (expression of the time) from which no Japanese could leave. This time, the Brazilian ambassador in Washington, D.C., Carlos Martins Pereira e Sousa, encouraged the government of Brazil to transfer all the Japanese Brazilians to "internment camps" without the need for legal support, in the same manner as was done with the Japanese residents in the United States. No single suspicion of activities of Japanese against "national security" was confirmed.

Nowadays, nativism in Brazil affects primarily migrants from elsewhere in the Third World, such as the new wave of Levantine Arabs (this time, mostly Muslims from Palestine instead of overwhelmingly Christian from Syria and Lebanon), South and East Asians (primarily Mainland Chinese), Spanish-speakers and Amerindians from neighbouring South American countries and, especially, West Africans and Haitians. Following the 2010 Haiti earthquake and considerable illegal immigration to northern Brazil and São Paulo, a subsequent debate in the population was concerned with the reasons why Brazil has such lax laws and enforcement concerning illegal immigration.

According to the 1988's Brazilian Constitution, it is an unbailable crime to address someone in an offensive racist way, and it is illegal to discriminate against someone on the basis of his or her race, skin colour, national or regional origin or nationality; thus, nativism and opposition to multiculturalism would be too much of a polemic and delicate topic to be openly discussed as a basic ideology for even the most right-leaning modern political parties.

Canada

Throughout the 19th century, well into the 20th, the Orange Order in Canada attacked and tried to politically defeat the Irish Catholics. In the British Empire, traditions of anti-Catholicism in Britain led to fears that Catholics were a threat to the national (British) values. In Canada, the Orange Order campaigned vigorously against the Catholics throughout the 19th century, often with violent confrontations. Both sides were immigrants from Ireland and neither side claimed loyalty to Canada.

The Ku Klux Klan spread in the mid-1920s from the U.S. to parts of Canada, especially Saskatchewan, where it helped topple the Liberal government. The Klan creed was, historian Martin Robin argues, in the mainstream of Protestant Canadian sentiment, for it was based on "Protestantism, separation of Church and State, pure patriotism, restrictive and selective immigration, one national public school, one flag and one language—English."

In World War I, Canadian naturalized citizens of German or Austrian origins were stripped of their right to vote, and tens of thousands of Ukrainians (who were born in the Austro-Hungarian Empire) were rounded up and put in internment camps.

Hostility to the Chinese and other Asians was intense, and involved provincial laws that hindered immigration of Chinese and Japanese and blocked their economic mobility. In 1942 Japanese Canadians were forced into detention camps in response to Japanese aggression in World War II.

Hostility of native-born Canadians to competition from English immigrants in the early 20th century was expressed in signs that read, "No English Need Apply!" The resentment came because the immigrants identified more with England than with Canada.

Cartoon from Puck, August 9, 1899, by J. S. Pughe. Angry Uncle Sam sees hyphenated voters (including an Irish-American, a German-American, a French-American, an Italian-American, and a Hungarian-American) and demands, "Why should I let these freaks cast whole votes when they are only half Americans?"

United States

According to the American historian John Higham, nativism is:

an intense opposition to an internal minority on the grounds of its foreign (i.e., "un-American") connections. Specific nativist antagonisms may and do, vary widely in response to the changing character of minority irritants and the shifting conditions of the day; but through each separate hostility runs the connecting, energizing force of modern nationalism. While drawing on much broader cultural antipathies and ethnocentric judgments, nativism translates them into zeal to destroy the enemies of a distinctively American way of life.

Colonial era

There was nativism in the colonial era shown by English colonists against the Palatine German immigrants in the Pennsylvania ColonyBenjamin Franklin questioned about allowing Palatine refugees to settle in Pennsylvania. He was concerned about the potential consequences of their arrival, particularly regarding the preservation of Pennsylvania's English identity and heritage. He questioned whether it was prudent for a colony established by English settlers to be overwhelmed by newcomers who might not integrate into English culture and language.

Early republic

Nativism was a political factor in the 1790s and in the 1830s–1850s. Nativism became a major issue in the late 1790s, when the Federalist Party expressed its strong opposition to the French Revolution by trying to strictly limit immigration, and stretching the time to 14 years for citizenship. At the time of the Quasi-War with the French First Republic in 1798, the Federalists and Congress passed the Alien and Sedition Acts, including the Alien Act, the Naturalization Act and the Sedition Act. Thomas Jefferson and James Madison fought against the new laws by drafting the Virginia and Kentucky Resolutions. In 1800, Jefferson was elected president, and removed most of the anti-immigrant legislation.

1830–1860
Guardians of Liberty, an anti-Catholic caricature by the Ku Klux Klan-affiliate Alma White (1943), founder and bishop of the Pillar of Fire Church

The term "nativism" was first used by 1844: "Thousands were Naturalized expressly to oppose Nativism, and voted the Polk ticket mainly to that end." Nativism gained its name from the "Native American" parties of the 1840s and 1850s. In this context "Native" does not mean Indigenous Americans or American Indians but rather descendants of the inhabitants of the original Thirteen Colonies. It impacted politics in the mid-19th century because of the large inflows of immigrants after 1845 from cultures that were different from the existing American culture. Nativists objected primarily to Irish Roman Catholics because of their loyalty to the Pope and also because of their supposed rejection of republicanism as an American ideal.

Nativist movements included the Know Nothing or "American Party" of the 1850s, the Immigration Restriction League of the 1890s, the anti-Asian movements in the Western states, resulting in the Chinese Exclusion Act of 1882 and the "Gentlemen's Agreement of 1907", by which the government of Imperial Japan stopped emigration to the United States. Labor unions were strong supporters of Chinese exclusion and limits on immigration, because of fears that they would lower wages and make it harder for workers to organize unions.

Nativist outbursts occurred in the Northeast from the 1830s to the 1850s, primarily in response to a surge of Irish Catholic immigration. In 1836, Samuel Morse ran unsuccessfully for Mayor of New York City on a nativist ticket, receiving 1,496 votes. In New York City, an Order of United Americans was founded as a nativist fraternity, following the Philadelphia Nativist Riots of the preceding spring and summer, in December 1844. The American historian Eric Kaufmann has suggested that American nativism has been explained primarily in psychological and economic terms due to the neglect of a crucial cultural and ethnic dimension. Furthermore, Kauffman claims that American nativism cannot be understood without reference to an American ethnic group which took shape prior to the large-scale immigration of the mid-19th century.

The nativists went public in 1854 when they formed the "American Party", which was especially hostile to the immigration of Irish Catholics, and campaigned for laws to require longer wait time between immigration and naturalization; these laws never passed. It was at this time that the term "nativist" first appeared, as their opponents denounced them as "bigoted nativists". Former President Millard Fillmore ran on the American Party ticket for the presidency in 1856. Henry Winter Davis, an active Know-Nothing, was elected on the American Party ticket to Congress from Maryland. He told Congress the un-American Irish Catholic immigrants were to blame for the recent election of Democrat James Buchanan as president, stating:

The recent election has developed in an aggravated form every evil against which the American party protested. Foreign allies have decided the government of the country -- men naturalized in thousands on the eve of the election. Again in the fierce struggle for supremacy, men have forgotten the ban which the Republic puts on the intrusion of religious influence on the political arena. These influences have brought vast multitudes of foreign-born citizens to the polls, ignorant of American interests, without American feelings, influenced by foreign sympathies, to vote on American affairs; and those votes have, in point of fact, accomplished the present result.

The American Party also included many former Whigs who ignored nativism, and included (in the South) a few Roman Catholics whose families had long lived in North America. Conversely, much of the opposition to Roman Catholics came from Protestant Irish immigrants and German Lutheran immigrants, who were not native at all and can hardly be called "nativists."

This form of American nationalism is often identified with xenophobia and anti-Catholic sentiment. In Charlestown, Massachusetts, a nativist mob attacked and burned down a Roman Catholic convent in 1834 (no one was injured). In the 1840s, small scale riots between Roman Catholics and nativists took place in several American cities. In Philadelphia, Pennsylvania in 1844, for example, a series of nativist assaults on Roman Catholic churches and community centers resulted in the loss of lives and the professionalization of the police force. In Louisville, Kentucky, election-day rioters killed at least 22 people in attacks on German and Irish Catholics on 6 August 1855, in what became known as "Bloody Monday."

The new Republican Party kept its nativist element quiet during the 1860s, since immigrants were urgently needed for the Union Army. European immigrants from England, Scotland, and Scandinavia favored the Republicans during the Third Party System (1854–1896), while others especially Irish Catholics and Germans, were usually Democratic. Hostility toward Asians was very strong in the Western region from the 1860s to the 1940s. Anti-Catholicism experienced a revival in the 1890s in the American Protective Association. It was led by Protestant Irish immigrants hostile to the Irish Catholics.

Anti-German nativism

From the 1840s to the 1920s, German Americans were often distrusted because of their separatist social structure, their German-language schools, their attachment to their native tongue over English, and their neutrality during World War I.

The Bennett Law caused a political uproar in Wisconsin in 1890, as the state government passed a law that threatened to close down hundreds of German-language elementary schools. Catholic and Lutheran Germans rallied to defeat Governor William D. Hoard. Hoard attacked German American culture and religion:

"We must fight alienism and selfish ecclesiasticism.... The parents, the pastors and the church have entered into a conspiracy to darken the understanding of the children, who are denied by cupidity and bigotry the privilege of even the free schools of the state."

Hoard, a Republican, was defeated by the Democrats. A similar campaign in Illinois regarding the "Edwards Law" led to a Republican defeat there in 1890.

In 1917–1918, a wave of nativist sentiment due to American entry into World War I led to the suppression of German cultural activities in the United States, Canada, and Australia. There was little violence, but many places and streets had their names changed (The city of "Berlin" in Ontario was renamed "Kitchener" after a British hero), churches switched to English for their services, and German Americans were forced to buy war bonds to show their patriotism. In Australia thousands of Germans were put into internment camps.

Anti-Chinese nativism

In the 1870s and 1880s in the Western states, ethnic White immigrants, especially Irish Americans and German Americans, targeted violence against Chinese workers, driving them out of smaller towns. Denis Kearney, an immigrant from Ireland, led a mass movement in San Francisco in the 1870s that incited attacks on the Chinese there and threatened public officials and railroad owners. The Chinese Exclusion Act of 1882 was the first of many nativist acts of Congress which attempted to limit the flow of immigrants into the U.S.. The Chinese responded to it by filing false claims of American birth, enabling thousands of them to immigrate to California. The exclusion of the Chinese caused the western railroads to begin importing Mexican railroad workers in greater numbers ("traqueros").

20th century

In the 1890s–1920s era, nativists and labor unions campaigned for immigration restriction following the waves of workers and families from Southern and Eastern Europe, including the Kingdom of Italy, the Balkans, Congress Poland, Austria-Hungary, and the Russian Empire. A favorite plan was the literacy test to exclude workers who could not read or write their own foreign language. Congress passed literacy tests, but presidents—responding to business needs for workers—vetoed them. Senator Henry Cabot Lodge argued the need for literacy tests, and described its implication on the new immigrants:

It is found, in the first place, that the illiteracy test will bear most heavily upon the Italians, Russians, Poles, Hungarians, Greeks, and Asiatics, and lightly, or not at all, upon English-speaking emigrants, or Germans, Scandinavians, and French. In other words, the races most affected by the illiteracy test are those whose emigration to this country has begun within the last twenty years and swelled rapidly to enormous proportions, races with which the English speaking people have never hitherto assimilated, and who are most alien to the great body of the people of the United States.

Responding to these demands, opponents of the literacy test called for the establishment of an immigration commission to focus on immigration as a whole. The United States Immigration Commission, also known as the Dillingham Commission, was created and tasked with studying immigration and its effect on the United States. The findings of the commission further influenced immigration policy and upheld the concerns of the nativist movement. Following World War I, nativists in the 1920s focused their attention on Southern and Eastern Europeans due to their Roman Catholic and Jewish faith, and realigned their beliefs behind racial and religious nativism.

Three Klansmen talking to PI reporter Robert Berman in Seattle, Washington (circa 1923). Photograph currently preserved by the Museum of History & Industry.

Between the 1920s and the 1930s, the Ku Klux Klan developed an explicitly nativist, pro-Anglo-Saxon Protestant, anti-Catholic, anti-Irish, anti-Italian, and anti-Jewish stance in relation to the growing political, economic, and social uncertainty related to the arrival of European immigrants on the American soil, predominantly composed of Irish people, Italians, and Eastern European Jews. The racial concern of the anti-immigration movement was linked closely to the eugenics movement that was sweeping in the United States during the same period. Led by Madison Grant's book, The Passing of the Great Race nativists grew more concerned with the racial purity of the United States. In his book, Grant argued that the American racial stock was being diluted by the influx of new immigrants from the Mediterranean, Ireland, the Balkans, and the ghettos. The Passing of the Great Race reached wide popularity among Americans and influenced immigration policy in the 1920s. In the 1920s, a wide national consensus sharply restricted the overall inflow of immigrants from southern and eastern Europe. The Second Ku Klux Klan, which flourished in the United States during the 1920s, used strong nativist, anti-Catholic, and anti-Jewish rhetoric, but the Catholics led a counterattack, such as in Chicago in 1921, where ethnic Irish residents hanged a Klan member in front of 3,000 people.

After intense lobbying from the nativist movement, the United States Congress passed the Emergency Quota Act in 1921. This bill was the first to place numerical quotas on immigration. It capped the inflow of immigrations to 357,803 for those arriving outside of the western hemisphere. However, this bill was only temporary, as Congress began debating a more permanent bill. The Emergency Quota Act was followed with the Immigration Act of 1924, a more permanent resolution. This law reduced the number of immigrants able to arrive from 357,803, the number established in the Emergency Quota Act, to 164,687. Though this bill did not fully restrict immigration, it considerably curbed the flow of immigration into the United States, especially from Southern and Eastern Europe. During the late 1920s, an average of 270,000 immigrants were allowed to arrive, mainly because of the exemption of Canada and Latin American countries. Fear of low-skilled Southern and Eastern European immigrants flooding the labor market was an issue in the 1920s, the 1930s, and the first decade of the 21st century (focused on immigrants from Mexico and Central America).

An immigration reductionism movement formed in the 1970s and continues to the present day. Prominent members often press for massive, sometimes total, reductions in immigration levels. American nativist sentiment experienced a resurgence in the late 20th century, this time directed at undocumented workers, largely Mexican, resulting in the passage of new penalties against illegal immigration in 1996. Most immigration reductionists see illegal immigration, principally from across the United States–Mexico border, as the more pressing concern. Authors such as Samuel Huntington have also seen recent Hispanic immigration as creating a national identity crisis and presenting insurmountable problems for US social institutions.

Despite the fact that, Mexican people descend from actual natives to the region, when noting Mexican immigration in the Southwest, the European-American Cold-War diplomat George F. Kennan wrote in 2002 he saw "unmistakable evidences of a growing differentiation between the cultures, respectively, of large southern and southwestern regions of this country, on the one hand", and those of "some northern regions". In the former, he warned:

the very culture of the bulk of the population of these regions will tend to be primarily Latin-American in nature rather than what is inherited from earlier American traditions ... Could it really be that there was so little of merit [in America] that it deserves to be recklessly trashed in favor of a polyglot mix-mash?"

David Mayers argues that Kennan represented the "tradition of militant nativism" that resembled or even exceeded the Know Nothings of the 1850s.

21st century

By late 2014, the "Tea Party movement" had turned its focus away from economic issues, spending, and Obamacare, and towards President Barack Obama's immigration policies, which it saw as a threat to transform American society. It planned to defeat leading Republicans who supported immigration programs, such as Senator John McCain. A typical slogan appeared in the Tea Party Tribune: "Amnesty for Millions, Tyranny for All." The New York Times reported:

What started five years ago as a groundswell of conservatives committed to curtailing the reach of the federal government, cutting the deficit and countering the Wall Street wing of the Republican Party has become a movement largely against immigration overhaul. The politicians, intellectual leaders and activists who consider themselves part of the Tea Party have redirected their energy from fiscal austerity and small government to stopping any changes that would legitimize people who are here illegally, either through granting them citizenship or legal status.

Political scientist and pollster Darrell Bricker, CEO of Ipsos Public Affairs, argues nativism is the root cause of the early 21st century wave of populism.

[T]he jet fuel that’s really feeding the populist firestorm is nativism, the strong belief among an electorally important segment of the population that governments and other institutions should honour and protect the interests of their native-born citizens against the cultural changes being brought about by immigration. This, according to the populists, is about protecting the "Real America" (or "Real Britain" or "Real Poland" or "Real France" or "Real Hungary") from imported influences that are destroying the values and cultures that have made their countries great.
Importantly, it’s not just the nativists who are saying this is a battle over values and culture. Their strongest opponents believe this too, and they are not prepared to concede the high ground on what constitutes a "real citizen" to the populists. For them, this is a battle about the rule of law, inclusiveness, open borders, and global participation.

In his 2016 bid for the presidency, Republican presidential candidate Donald Trump was accused of introducing nativist themes via his controversial stances on temporarily banning foreign Muslims from six specific countries entering the United States, and erecting a substantial wall between the US-Mexico border to halt illegal immigration. Journalist John Cassidy wrote in The New Yorker that Trump was transforming the GOP into a populist, nativist party:

Trump has been drawing on a base of alienated white working-class and middle-class voters, seeking to remake the G.O.P. into a more populist, nativist, avowedly protectionist, and semi-isolationist party that is skeptical of immigration, free trade, and military interventionism.

Donald Brand, a professor of political science, argues:

Donald Trump's nativism is a fundamental corruption of the founding principles of the Republican Party. Nativists champion the purported interests of American citizens over those of immigrants, justifying their hostility to immigrants by the use of derogatory stereotypes: Mexicans are rapists; Muslims are terrorists.
Language
Sticker sold in Colorado

American nativists have promoted English and deprecated the use of German and Spanish. English Only proponents in the late 20th century proposed an English Language Amendment (ELA), a Constitutional Amendment making English the official language of the United States, but it received limited political support.

Europe

In recent decades distrust of immigrating populations and populism have become major themes in considering political tensions in Europe. Many observers see the post-1950s wave of immigration in Europe as fundamentally different to the pre-1914 patterns. They debate the role of cultural differences, ghettos, race, Muslim fundamentalism, poor education and poverty play in creating nativism among the hosts and a caste-type underclass, more similar to white-black tensions in the US. Sociologists Josip Kešić and Jan Willem Duyvendak define nativism as an intense opposition to an internal minority that is portrayed as a threat to the nation because of its different values and priorities. There are three subtypes: secularist nativism; racial nativism; and populist nativism that seeks to restore the historic power and prestige of indigenous elites.

France

Since the 1990s France experienced rising levels of Islamic antisemitism and acts. By 2006, rising levels of antisemitism were recorded in French schools. Reports related to the tensions between the children of North African Muslim immigrants and North African Jewish children. In the first half of 2009, an estimated 631 recorded acts of antisemitism took place in France, more than the whole of 2008. Speaking to the World Jewish Congress in December 2009, the French Interior Minister Hortefeux described the acts of antisemitism as "a poison to our republic". He also announced that he would appoint a special coordinator for fighting racism and antisemitism.

Germany

For the Poles in the mining districts of western Germany before 1914, nationalism (on both the German and the Polish sides) kept Polish workers, who had established an associational structure approaching institutional completeness (churches, voluntary associations, press, even unions), separate from the host German society. Lucassen found that religiosity and nationalism were more fundamental in generating nativism and inter-group hostility than the labor antagonism.

Nativism grew rapidly in the 1990s and since.

United Kingdom

The city of London became notorious for the prevalence of nativist viewpoints in the 16th century, and conditions worsened in the 1580s. Many European immigrants became disillusioned by routine threats of assault, numerous attempts at passing legislation calling for the expulsion of foreigners, and the great difficulty in acquiring English citizenship. Cities in the Dutch Republic often proved more hospitable, and many immigrants left London permanently. Nativism emerged in opposition to Irish and Jewish arrivals in the early 20th century. Irish immigrants in Great Britain during the 20th century became estranged from British society, something which Lucassen (2005) attributes to the deep religious divide between Irish Protestants and Catholics.

Complex post-traumatic stress disorder

Complex post-traumatic stress disorder
Other namesFormerly: Enduring personality change after catastrophic experience (EPCACE)
Potential causes of complex post-traumatic stress disorder
SpecialtyPsychiatry, clinical psychology
SymptomsHyperarousal, emotional over-stress, intrusive thoughts, emotional dysregulation, hypervigilance, negative self-beliefs, interpersonal difficulties, attention difficulties, anxiety, depression, somatization, dissociation
Duration> 1 month
CausesProlonged (or repetitive) exposure to a traumatic event or traumatic events
Differential diagnosisPost-traumatic stress disorder, borderline personality disorder, grief

Complex post-traumatic stress disorder (CPTSD, cPTSD, or hyphenated C-PTSD) is a stress-related mental disorder generally occurring in response to complex traumas[1] (i.e., commonly prolonged (or repetitive) exposure to a traumatic event (or traumatic events), from which one sees little or no chance to escape).

In the ICD-11 classification, C-PTSD is a category of post-traumatic stress disorder (PTSD) with three additional clusters of significant symptoms: emotional dysregulation, negative self-beliefs (e.g., shame, guilt, failure for wrong reasons), and interpersonal difficulties. C-PTSD's symptoms include prolonged feelings of terror, worthlessness, helplessness, distortions in identity or sense of self, and hypervigilance. Although early descriptions of C-PTSD specified the type of trauma (i.e., prolonged, repetitive), in the ICD-11 there is no requirement of a specific trauma type.

Classifications

The World Health Organization (WHO)'s International Statistical Classification of Diseases has included C-PTSD since its eleventh revision that was published in 2018 and came into effect in 2022 (ICD-11). The previous edition (ICD-10) proposed a diagnosis of Enduring Personality Change after Catastrophic Event (EPCACE), which was an ancestor of C-PTSD. Healthdirect Australia (HDA) and the British National Health Service (NHS) have also acknowledged C-PTSD as mental disorder. The American Psychiatric Association (APA) has not included C-PTSD in the Diagnostic and Statistical Manual of Mental Disorders. The related disorder, Disorders of Extreme Stress – not otherwise specified (DESNOS) was studied for inclusion in the DSM-IV, but not ultimately included. Instead, the symptoms of PTSD were expanded in the DSM-IV and then DSM-5 to better capture the range of symptoms that can follow from all types of trauma.

Signs and symptoms

Children and adolescents

The diagnosis of PTSD was originally given to adults who had suffered because of a trauma (e.g., during a war, rape). However, the situation for many children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, school bullying, dysfunction, or a disruption in attachment to their primary caregiver. In many cases, it is the child's caregiver who causes the trauma. The diagnosis of PTSD does not take into account how the developmental stages of children may affect their symptoms and how trauma can affect a child's development.

The term developmental trauma disorder (DTD) has been proposed as the childhood equivalent of C-PTSD. This developmental form of trauma places children at risk for developing psychiatric and medical disorders. Bessel van der Kolk explains DTD as numerous encounters with interpersonal trauma such as physical assault, sexual assault, violence or death. It can also be brought on by subjective events such as abandonment, betrayal, defeat or shame.

Repeated traumatization during childhood leads to symptoms that differ from those described for PTSD. Cook and others describe symptoms and behavioral characteristics in seven domains:

  • Attachment – problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to others' emotional states
  • Biomedical symptoms – sensory-motor developmental dysfunction, sensory-integration difficulties; increased medical problems or even somatization
  • Affect or emotional regulation – poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes
  • Elements of dissociation – amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events
  • Behavioral control – problems with impulse control, aggression, pathological self-soothing, and sleep problems
  • Cognition – difficulty regulating attention; problems with a variety of executive functions such as planning, judgment, initiation, use of materials, and self-monitoring; difficulty processing new information; difficulty focusing and completing tasks; poor object constancy; problems with cause-effect thinking; and language developmental problems such as a gap between receptive and expressive communication abilities.
  • Self-concept – fragmented and/or disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self.

Adults

Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization beginning in childhood, rather than, or as well as, in adulthood. These early injuries interrupt the development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or other siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon.

Earlier descriptions of CPTSD suggested six clusters of symptoms:

  • Alterations in regulation of affect and impulses
  • Alterations in attention or consciousness
  • Alterations in self-perception
  • Alterations in relations with others
  • Somatization
  • Alterations in systems of meaning

Experiences in these areas may include:

  • Changes in emotional regulation, including experiences such as persistent dysphoria, chronic suicidal preoccupation, self-injury, explosive or extremely inhibited anger (may alternate), and compulsive or extremely inhibited sexuality (may alternate).
  • Variations in consciousness, such as amnesia or improved recall for traumatic events, episodes of dissociation, depersonalization/derealization, and reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation).
  • Changes in self-perception, such as a sense of helplessness or paralysis of initiative, shame, guilt and self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings (may include a sense of specialness, utter aloneness, a belief that no other person can understand, or a feeling of nonhuman identity).
  • Varied changes in perception of the perpetrators, such as a preoccupation with the relationship with a perpetrator (including a preoccupation with revenge), an unrealistic attribution of total power to a perpetrator (though the individual's assessment may be more realistic than the clinician's), idealization or paradoxical gratitude, a sense of a special or supernatural relationship with a perpetrator, and acceptance of a perpetrator's belief system or rationalizations.
  • Alterations in relations with others, such as isolation and withdrawal, disruption in intimate relationships, a repeated search for a rescuer (may alternate with isolation and withdrawal), persistent distrust, and repeated failures of self-protection.
  • Changes in systems of meaning, such as a loss of sustaining faith and a sense of hopelessness and despair.

Diagnosis

C-PTSD was considered for inclusion in the DSM-IV but was excluded from the 1994 publication. It was also excluded from the DSM-5, which lists post-traumatic stress disorder. The ICD-11 has included C-PTSD since its initial publication in 2018 and a validated self-report measure exists for assessing the ICD-11 C-PTSD, which is the International Trauma Questionnaire (ITQ).

Differential diagnosis

Post-traumatic stress disorder

In the ICD-11, there are two paired diagnoses, PTSD and CPTSD. A person can only be diagnosed with one or the other. A diagnosis of PTSD is made if a person has experienced a trauma and also experiences 1) re-experiencing the event in the form of intrusive memories, nightmares, or flashbacks, 2) avoidance of memories of the event or of people, places, and situations that remind them of it, and 3) perceptions of heightened current threat (e.g., hypervigilance, enhanced startle reaction). These symptoms must cause impairment in important areas of functioning.

In contrast, a diagnosis of CPTSD is made if the person meets all of the above criteria in addition to 1) difficulties in regulating emotions, 2) changes in beliefs about oneself such as feeling worthless with significant shame, and 3) difficulties in maintaining close relationships with important people. Again, these symptoms must cause significant impairment to be considered CPTSD.

In the DSM-5, many of the symptoms of complex PTSD are now captured in the symptoms of PTSD, which are much broader than the PTSD symptoms in the ICD-11. Moreover, the DSM-5 also includes a dissociative symptom subtype.

Earlier descriptions of CPTSD were broader but may no longer apply clinically; for instance, CPTSD was described to include captivity, psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be revictimized. Most importantly, there is a loss of a coherent sense of self: this loss, and the ensuing symptom profile, most pointedly differentiates C-PTSD from PTSD. C-PTSD has also been characterized by attachment disorder, particularly the pervasive insecure, or disorganized-type attachment. Thus, a differentiation between the diagnostic category of C-PTSD and that of PTSD has been suggested.

Continuous traumatic stress disorder (CTSD), which was introduced into the trauma literature by Gill Straker in 1987, differs from C-PTSD. It was originally used by South African clinicians to describe the effects of exposure to frequent, high levels of violence usually associated with civil conflict and political repression. The term is applicable to the effects of exposure to contexts in which gang violence and crime are endemic as well as to the effects of ongoing exposure to life threats in high-risk occupations such as police, fire and emergency services. It has also been used to describe ongoing relationship trauma frequently experienced by people leaving relationships which involved intimate partner violence.

Traumatic grief

Traumatic grief or complicated mourning are conditions where trauma and grief coincide. There are conceptual links between trauma and bereavement since loss of a loved one is inherently traumatic. If a traumatic event was life-threatening, but did not result in a death, then it is more likely that the survivor will experience post-traumatic stress symptoms. If a person dies, and the survivor was close to the person who died, then it is more likely that symptoms of grief will also develop. When the death is of a loved one, and was sudden or violent, then both symptoms often coincide. This is likely in children exposed to community violence.

For C-PTSD to manifest traumatic grief, the violence would occur under conditions of captivity, loss of control and disempowerment, coinciding with the death of a friend or loved one in life-threatening circumstances. This again is most likely for children and stepchildren who experience prolonged domestic or chronic community violence that ultimately results in the death of friends and loved ones. The phenomenon of the increased risk of violence and death of stepchildren is referred to as the Cinderella effect.

Borderline personality disorder

C-PTSD may share some symptoms with both PTSD and borderline personality disorder (BPD). However, there is enough evidence to also differentiate C-PTSD from borderline personality disorder.

It may help to understand the intersection of attachment theory with C-PTSD and BPD if one reads the following opinion of Bessel A. van der Kolk together with an understanding drawn from a description of BPD:

Uncontrollable disruptions or distortions of attachment bonds precede the development of post-traumatic stress syndromes. People seek increased attachment in the face of danger. Adults, as well as children, may develop strong emotional ties with people who intermittently harass, beat, and, threaten them. The persistence of these attachment bonds leads to confusion of pain and love. Trauma can be repeated on behavioural, emotional, physiologic, and neuroendocrinologic levels. Repetition on these different levels causes a large variety of individual and social suffering.

25% of those diagnosed with BPD have no known history of childhood neglect or abuse and individuals are six times as likely to develop BPD if they have a relative who was diagnosed as such compared to those who do not. One conclusion is that there is a genetic predisposition to BPD unrelated to trauma. Researchers conducting a longitudinal investigation of identical twins found that "genetic factors play a major role in individual differences of borderline personality disorder features in Western society." A 2014 study published in the European Journal of Psychotraumatology was able to compare and contrast C-PTSD, PTSD, and borderline personality disorder and found that it could distinguish between individual cases of each and when it was co-morbid, arguing for a case of separate diagnoses for each.

In Trauma and Recovery, Herman expresses the additional concern that patients with C-PTSD frequently risk being misunderstood as inherently 'dependent', 'masochistic', or 'self-defeating', comparing this attitude to the historical misdiagnosis of female hysteria. However, those who develop C-PTSD do so as a result of the intensity of the traumatic bond — in which someone becomes tightly biochemically bound to someone who abuses them and the responses they learned to survive, navigate and deal with the abuse they suffered then become automatic responses, embedded in their personality over the years of trauma — a normal reaction to an abnormal situation.

Treatment

While standard evidence-based treatments may be effective for treating post-traumatic stress disorder, treating complex PTSD often involves addressing interpersonal relational difficulties and a different set of symptoms which make it more challenging to treat.

Children

The utility of PTSD-derived psychotherapies for assisting children with C-PTSD is uncertain. This area of diagnosis and treatment calls for caution in use of the category C-PTSD. Julian Ford and Bessel van der Kolk have suggested that C-PTSD may not be as useful a category for diagnosis and treatment of children as a proposed category of developmental trauma disorder (DTD). According to Courtois and Ford, for DTD to be diagnosed it requires a

history of exposure to early life developmentally adverse interpersonal trauma such as sexual abuse, physical abuse, violence, traumatic losses or other significant disruption or betrayal of the child's relationships with primary caregivers, which has been postulated as an etiological basis for complex traumatic stress disorders. Diagnosis, treatment planning and outcome are always relational.

A number of practical, therapeutic and ethical principles for assessment and intervention have been developed and explored in the field:

  • Identifying and addressing threats to the child's or family's safety and stability are the first priority.
  • A relational bridge must be developed to engage, retain and maximize the benefit for the child and caregiver.
  • Diagnosis, treatment planning and outcome monitoring are always relational (and) strengths based.
  • All phases of treatment should aim to enhance self-regulation competencies.
  • Determining with whom, when and how to address traumatic memories.
  • Preventing and managing relational discontinuities and psychosocial crises.

Adults

Trauma recovery model

Judith Lewis Herman, in her book, Trauma and Recovery, proposed a complex trauma recovery model that occurs in three stages:

  1. Establishing safety
  2. Remembrance and mourning for what was lost
  3. Reconnecting with community and more broadly, society

Herman believes recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship. This healing relationship need not be romantic or sexual in the colloquial sense of "relationship", however, and can also include relationships with friends, co-workers, one's relatives or children, and the therapeutic relationship. However, the first stage of establishing safety must always include a thorough evaluation of the surroundings, which might include abusive relationships. This stage might involve the need for major life changes for some patients.

Securing a safe environment requires strategic attention to the patient's economic and social ecosystem. The patient must become aware of her own resources for practical and emotional support as well as the realistic dangers and vulnerabilities in her social situation. Many patients are unable to move forward in their recovery because of their present involvement in unsafe or oppressive relationships. In order to gain their autonomy and their peace of mind, survivors may have to make difficult and painful life choices. Battered women may lose their homes, their friends, and their livelihood. Survivors of childhood abuse may lose their families. Political refugees may lose their homes and their homeland. The social obstacles to recovery are not generally recognized, but they must be identified and adequately addressed in order for recovery to proceed.

It has been suggested that treatment for complex PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems. Six suggested core components of complex trauma treatment include:

  • Safety
  • Self-regulation
  • Self-reflective information processing
  • Traumatic experiences integration
  • Relational engagement
  • Positive affect enhancement

The above components can be conceptualized as a model with three phases. Not every case will be the same, but the first phase will emphasize the acquisition and strengthening of adequate coping strategies as well as addressing safety issues and concerns. The next phase would focus on decreasing avoidance of traumatic stimuli and applying coping skills learned in phase one. The care provider may also begin challenging assumptions about the trauma and introducing alternative narratives about the trauma. The final phase would consist of solidifying what has previously been learned and transferring these strategies to future stressful events.

Neuroscientific and trauma informed interventions

In practice, the forms of treatment and intervention varies from individual to individual since there is a wide spectrum of childhood experiences of developmental trauma and symptomatology and not all survivors respond positively, uniformly, to the same treatment. Therefore, treatment is generally tailored to the individual. Recent neuroscientific research has shed some light on the impact that severe childhood abuse and neglect (trauma) has on a child's developing brain, specifically as it relates to the development in brain structures, function and connectivity among children from infancy to adulthood. This understanding of the neurophysiological underpinning of complex trauma phenomena is what currently is referred to in the field of traumatology as 'trauma informed' which has become the rationale which has influenced the development of new treatments specifically targeting those with childhood developmental trauma. Martin Teicher, a Harvard psychiatrist and researcher, has suggested that the development of specific complex trauma related symptomatology (and in fact the development of many adult onset psychopathologies) may be connected to gender differences and at what stage of childhood development trauma, abuse or neglect occurred. For example, it is well established that the development of dissociative identity disorder among women is often associated with early childhood sexual abuse.

Use of evidence-based PTSD treatment

Cognitive behavioral therapy, prolonged exposure therapy and dialectical behavioral therapy are well established forms of evidence-based intervention. These treatments are approved and endorsed by the American Psychiatric Association, the American Psychological Association and the Veteran's Administration. There is a question as to whether these PTSD treatments can also treat CPTSD. Given that the ICD-11 CPTSD diagnosis is relatively young, it will be years before this is adequately studied. However, some preliminary studies have examined whether PTSD treatments work equally well in those with PTSD or CPTSD. Two different studies of phase-based PTSD treatment found that both standard PTSD treatment and phased treatment worked equally well whether participants had a diagnosis of PTSD or CPTSD (per the ITQ). Another study of an existing European intensive trauma treatment combining Prolonged Exposure and EMDR found that people with PTSD and CPTSD had comparable decreases in PTSD and CPTSD (though they had more severe PTSD at baseline).

One of the current challenges faced by many survivors of complex trauma (or developmental trauma disorder) is support for treatment since many of the current therapies are relatively expensive and not all forms of therapy or intervention are reimbursed by insurance companies who use evidence-based practice as a criterion for reimbursement.

Treatment challenges

It is widely acknowledged by those who work in the trauma field that there is no one single, standard, 'one size fits all' treatment for complex PTSD. There is also no clear consensus regarding the best treatment among the greater mental health professional community which included clinical psychologists, social workers, licensed therapists (MFTs) and psychiatrists. Although most trauma neuroscientifically informed practitioners understand the importance of utilizing a combination of both 'top down' and 'bottom up' interventions as well as including somatic interventions (sensorimotor psychotherapy or somatic experiencing or yoga) for the purposes of processing and integrating trauma memories.

Allistair and Hull echo the sentiment of many other trauma neuroscience researchers (including Bessel van der Kolk and Bruce D. Perry) who argue:

Complex presentations are often excluded from studies because they do not fit neatly into the simple nosological categorisations required for research power. This means that the most severe disorders are not studied adequately and patients most affected by early trauma are often not recognised by services. Both historically and currently, at the individual as well as the societal level, "dissociation from the acknowledgement of the severe impact of childhood abuse on the developing brain leads to inadequate provision of services. Assimilation into treatment models of the emerging affective neuroscience of adverse experience could help to redress the balance by shifting the focus from top-down regulation to bottom-up, body-based processing."

Complex post-traumatic stress disorder is a long term mental health condition which often requires treatment by highly skilled mental health professionals who specialize in trauma informed modalities designed to process and integrate childhood trauma memories for the purposes of mitigating symptoms and improving the survivor's quality of life. Delaying therapy for people with complex PTSD, whether intentionally or not, can exacerbate the condition.

There is no one treatment which has been designed specifically for use with the adult complex PTSD population (with the exception of component based psychotherapy) there are many therapeutic interventions used by mental health professionals to treat PTSD. As of February 2017, the American Psychological Association PTSD Guideline Development Panel (GDP) strongly recommends the following for the treatment of PTSD:

  1. Cognitive behavioral therapy (CBT) and trauma-focused CBT
  2. Cognitive processing therapy (CPT)
  3. Cognitive therapy (CT)
  4. Prolonged exposure therapy (PE)

The American Psychological Association also conditionally recommends

  1. Brief eclectic psychotherapy (BEP)
  2. Eye movement desensitization and reprocessing (EMDR)
  3. Narrative exposure therapy (NET)

While these treatments have been recommended, there is still a lack of research on the best and most efficacious treatments for complex PTSD. Psychological therapies such as cognitive behavioural therapy, eye movement desensitisation and reprocessing therapy are effective in treating C-PTSD symptoms like PTSD, depression and anxiety. For example, in a 2016, meta-analysis, four out of eight EMDR studies resulted in statistical significance, indicating the potential effectiveness of EMDR in treating certain conditions. Additionally, subjects from two of the studies continued to benefit from the treatment months later. Seven of the studies that employed psychometric tests showed that EMDR led to a reduction in depression symptoms compared to those in the placebo group. Mindfulness and relaxation is effective for PTSD symptoms, emotion regulation and interpersonal problems for people whose complex trauma is related to sexual abuse.

Many commonly used treatments are considered complementary or alternative since there still is a lack of research to classify these approaches as evidence based. Some of these additional interventions and modalities include:

History

Judith Lewis Herman of Harvard University was the first psychiatrist and scholar to conceptualise complex post-traumatic stress disorder (C-PTSD) as a (new) mental health condition in 1992, within her book Trauma & Recovery and an accompanying article. In 1988, Herman suggested that a new diagnosis of complex post-traumatic stress disorder (C-PTSD) was needed to describe the symptoms and psychological and emotional effects of long-term trauma. Over the years, the definition of CPTSD has shifted (including a proposal for DESNOS in DSM-IV and a diagnosis of EPCACE in ICD-10), with a different definition in the ICD-11 than per Dr. Herman's initial conceptualization. The ICD-11 definition of CPTSD overlaps more with DSM-5 PTSD than earlier definitions of PTSD.

Criticism of disorder and diagnosis

Though acceptance of the idea of complex PTSD has increased with mental health professionals, the research required for the proper validation of a new disorder was considered insufficient to include CPTSD as a separate disorder in the DSM-IV and DSM-5. The disorder was proposed under the name DES-NOS (Disorder of Extreme Stress Not Otherwise Specified) for inclusion in the DSM-IV but was rejected by members of the Diagnostic and Statistical Manual of Mental Disorders (DSM) committee of the American Psychiatric Association for lack of sufficient diagnostic validity research. Chief among the stated limitations was a study which showed that 95% of individuals who could be diagnosed with the proposed DES-NOS were also diagnosable with PTSD, raising questions about the added usefulness of an additional disorder.

Following the failure of DES-NOS to gain formal recognition in the DSM-IV, the concept was re-packaged for children and adolescents and given a new name, developmental trauma disorder. Supporters of DTD appealed to the developers of the DSM-5 to recognize DTD as a new disorder. Just as the developers of DSM-IV refused to included DES-NOS, the developers of DSM-5 refused to include DTD due to a perceived lack of sufficient research.

One of the main justifications offered for this proposed disorder has been that the current system of diagnosing PTSD plus comorbid disorders does not capture the wide array of symptoms in one diagnosis. Because individuals who suffered repeated and prolonged traumas often show PTSD plus other concurrent psychiatric disorders, some researchers have argued that a single broad disorder such as C-PTSD provides a better and more parsimonious diagnosis than the current system of PTSD plus concurrent disorders. Conversely, an article published in BioMed Central has posited there is no evidence that being labeled with a single disorder leads to better treatment than being labeled with PTSD plus concurrent disorders.

Complex PTSD embraces a wider range of symptoms relative to PTSD, specifically emphasizing problems of emotional regulation, negative self-concept, and interpersonal problems. Diagnosing complex PTSD can imply that this wider range of symptoms is caused by traumatic experiences, rather than acknowledging any pre-existing experiences of trauma which could lead to a higher risk of experiencing future traumas. It also asserts that this wider range of symptoms and higher risk of traumatization are related by hidden confounder variables and there is no causal relationship between symptoms and trauma experiences. In the diagnosis of PTSD, the definition of the stressor event is limited to life-threatening or sexually violent events, with the implication that these are typically sudden and unexpected events. Complex PTSD vastly widened the definition of potential stressor events by calling them adverse events, and deliberating dropping reference to life-threatening, so that experiences can be included such as neglect, emotional abuse, or living in a war zone without having specifically experienced life-threatening events. By broadening the stressor criterion, an article published by the Child and Youth Care Forum claims this has led to confusing differences between competing definitions of complex PTSD, undercutting the clear operationalization of symptoms seen as one of the successes of the DSM.

Clinical trial

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