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Complex PTSD In Children And Its Misdiagnosis As Anger Disorders

When I got to about the age of 12 or 13 I became a very angry child (although my angry outbursts were mainly confined to the home). In my case, my anger almost certainly came about as a defensive reaction to my mother’s extreme psychological abuse. In hindsight, now, I can see that such behavior was, in fact, an early sign of complex PTSD. Unfortunately, this was not recognized so there was no early intervention in terms of therapy and, almost certainly as a result of this lack of intervention, I became extremely unwell as an adult

In fact, it is becoming increasingly articulated by those who study the effects of trauma on children that many children today who are suffering from the early stages of complex PTSD as a result of severe and protracted trauma and are, as a result, displaying anger control problems (including outbursts of extreme rage and physical violence) are being inappropriately diagnosed with conditions such as HIGH CONFLICT PERSONALITY (HCP) and INTERMITTENT EXPLOSIVE DISORDER. (IED).

This is unfortunate, to say the least, because although problems relating to poor anger control is indeed a frequent symptom of com[plex PTSD, complex PTSD also encompasses many other symptoms including impaired concentration, socially isolating oneself, problems getting on with others, risky behavior, self-harm, suicidal thoughts, distrust of the world, extreme sadness, dissociation (often this manifests itself as a feeling of ‘living in a dream world’.

So, if a child is diagnosed with HCP or IED when really they are suffering from complex PTSD there is the danger that many of the child’s symptoms (other than anger control problems) will be overlooked and go untreated. 

Furthermore, with a diagnosis of an anger-control disorder rather than a diagnosis of complex  PTSD, the treatment the child receives is less likely to be trauma-informed and, therefore, less effective or, even, counterproductive.


Individuals described as having High Conflict Personality (HCP) are often also diagnosed as having a personality disorder that falls into the CLUSTER B range (dramatic, emotional, and erratic). I have already written a short article about personality disorder clusters – if you would like to read it, please click here. It is quite possible, therefore, that the individual diagnosed with HCP may also be diagnosed with anti-social personality disorder, borderline personality disorder (BPD), or histrionic personality disorder. However, it should also be noted here that BPD and other personality disorders can be mistakenly diagnosed when a more accurate diagnosis would have been complex PTSD, and labeling people with BPD can adversely affect their treatment.

Sometimes, however, the person described as having High Conflict Personality (HCP) may not obviously fall into any of these specific categories, in which case he or she may, instead, be diagnosed with what has been technically termed: ‘personality disorder not otherwise specified.


These include :

– feeling easily threatened

– tendency to see things in ‘black and white’ (eg ‘good’ or ‘bad’)

– generally untrusting

– tends to view self as victim

– tends to be controlling

highly emotional

highly aggressive

– has marked difficulty accepting blame

– finds it hard to see things from others’ points of view/perspective

– reluctance to take responsibility

– frequently initiates/escalates conflict

– conflict tends to be a very prominent feature of their relationships

– marked tendency to blame others

Often, High Conflict Personality (HCP) is used as a descriptive term rather than as a formal diagnosis.

How Is High Conflict Personality (HCP) Currently Being Treated?

At present, the main treatments are :

– cognitive behavior therapy (CBT) ; click here to read my article on this

– dialectical behavior therapy (DBT) ; click here to read my article on this

– neurofeedback



This disorder, which is listed in DSM V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), a manual which is used by psychologists and psychiatrists to diagnose mental illness and provides the diagnostic criteria (i.e. relevant symptoms) by which diagnosis of the specific psychiatric condition is made, is, as the name implies, related to problems a person has with controlling his/her anger.


According to DSM V, the symptoms of intermittent explosive disorder (IED) are as follows :

1) Several episodes of being unable to suppress impulses of intense anger which leads to serious aggressive acts such as assault and destruction of property

2) The high intensity of the aggression displayed during these episodes is clearly out of proportion to the precipitating event (ie the event that triggered the aggression)

3) The episodes of aggression are not better explained by other mental conditions such as borderline personality disorder (BPD) or anti-social personality disorder.


Research into this area so far suggests that around 5% of the population may be considered to be suffering from IED during some period of their life-span. Not infrequently, the disorder first appears during adolescence.

Often, too, the disorder will exist co-morbidly (i.e. together with/alongside) other mental health conditions.



IED can very adversely affect many crucial areas of the sufferer’s life, which include: relationships with family, relationships with friends, reputation, career prospects and even freedom (if the uncontrolled aggression results in an incident that leads to being sent to jail). Clearly, then, a person who suffers from IED urgently requires treatment in order to prevent him/her from potentially ruining his/her own life. But in order to treat it, of course, it is first necessary to understand what causes it. In relation to this quest, research has focused on childhood trauma.


Research indicates that the experience of childhood trauma, particularly childhood trauma connected to problematic (i.e. dysfunctional) relationships with parents/carers is the strongest predictor of the diagnosis of IED in adulthood. It is thought that the reason for this is that, as a result of such trauma, the affected individual does not learn how to manage his/her emotions nor how to manage the intricacies of interpersonal relationships.

Neurological issues may also be related to IED; however, I should point out that such issues may themselves have been caused by childhood trauma – further research into this is necessary.


These include :

Dialectical Behavioural Therapy (DBT). .

Trauma Focused CBT.





My eBook entitled: CHILDHOOD TRAUMA AND ITS LINK TO COMPLEX PTSD now available for instant download from Amazon. Other titles are available. Click here.


David Hosier BSc Hons ; MSc; PGDE(FAHE).


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