from
Trauma and Recovery by Judith Lewis Herman

Some researchers and therapists have made a distinction between simple PTSD and  (derived from a one-time or situational trauma) severe PTSD (derived from "prolonged, repeated trauma" as experienced by survivors of childhood abuse. Herman has defined the expanded concept of  PTSD.

1.  A history of subjection to totalitarian control over a prolonged period (months to years). Examples include hostages, prisoners of war, concentration camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical abuse, and other organized sexual exploitation.
 
2.  Alterations in affect regulation, including

• persistent dysphoria (inappropriate expression of feelings) 
• chronic suicidal preoccupation 
• self-injury
• explosive or extremely inhibited anger (may alternate)
• compulsive or extremely inhibited sexuality (may alternate)

3.  Alterations in consciousness, including

• amnesia or hyperamnesia for traumatic events
• transient dissociative epidodes
• depersonalization/derealization
• reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation (going over it again and again).

4.  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 entity).

5.  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 or perpetrator

6.  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 or self-protection

7.  Alterations in systems of meaning

• loss of sustaining faith
• sense of hopelessness and despair