As noted by the authors, the syndrome of complex PTSD, described by Herman (7) and others may be another example where a dissociative subtype of PTSD is prominent. In addition to the DSM-IV symptoms of PTSD, complex PTSD includes other commonly observed changes in emotional regulation, consciousness, perceptions, relationships, and meaning. In fact, complex PTSD—particularly since its symptoms tend to be multiple, severe, and chronic—comprises the majority of cases encountered in acute care clinical settings. Since the symptoms of complex PTSD cross over into many domains (e.g., anxiety disorders, dissociative disorders, affective disorders, and personality disorders), it is understandably difficult to fit into the DSM-IV nosology. Clinicians often need to think beyond the limitations of the DSM-IV when treating PTSD. In many ways, DSM-IV and the proposed DSM-V does not (and perhaps cannot) deal with complexity found in real clinical settings. No list of symptoms can describe the multiple state changes (e.g., in affect regulation and perceptions and assumptions about the self and environment) that can occur in the wake of severe trauma.