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Humans must identify others as enemies or allies to develop, protect, maintain, and refine their sense of self. This is a part of their normal psychological development. These phenomena operate on individual and large group levels and are pronounced under threat. In peril, they help create psychological boundaries between conflicting parties and bonds between allies. These boundaries and bonds are invested with strong emotions. The narcissism of minor differences concept is involved in identifying and delineating enemies at times of perceived danger. This article introduces the concept of the narcissism of minor resemblances. This concept is discussed from the psychodynamic perspective and illustrated with examples of socio-political developments from modern history. The narcissism of minor resemblances concept may help us understand the underlying dynamics of bonding with allies and identifying with others when undergoing threat and hardship. This concept connects the public arena of political action with individual psychological development. Awareness of this phenomenon can help mitigate the negative aspects of rigid enemy-ally distinctions and promote cooperation and peace. It may also help individuals impacted by psychological trauma to make meaning of psychological and societal processes experienced and contribute to their healing.

While treatment guidelines agree on the first-line interventions for the treatment of posttraumatic stress disorder (PTSD), there is an ongoing debate between experts regarding the treatment of complex posttraumatic stress disorder (C-PTSD). As scientific research is slowly emerging, different treatment approaches are used in clinical practice This article aims to provide a set of treatment options for C-PTSD in adult survivors of repeated exposure to severe violence and abuse, both in childhood and later on in life. The developmental-contextual perspective on mental health forms the basis of this approach. This perspective is elaborated using the tree metaphor. Then, several treatment strategies are suggested. The presented strategies are a combination of the existing evidence-based approaches for the treatment of PTSD and personality disorders. They target psychological damage in survivors while taking their developmental trajectories and ecological environments into consideration. The treatment model presented is based on longstanding clinical practice and it may be a promising framework for treating C-PTSD. However, it still needs to be scientifically examined for acceptability and effectiveness.

Nowadays, the PTSD diagnosis is often a prerequisite for the survivor’s access to specialized treatment services and for obtaining legal recognition or financial compensation when exposed to violence. However, some survivors do not meet all necessary criteria for the PTSD diagnosis, particularly not in the long term. Therefore, they run the risk of being misdiagnosed, inadequately helped or undertreated, and may remain legally unrecognized and unprotected. In this article the “hidden” long-term impacts of exposure to war and violence, beyond the PTSD diagnosis, are presented, discussed, and illustrated with case presentations. They include dissociative states, attachment problems, personality changes, guilt, shame, rage, identity issues, moral injury, substances abuse, damaged core beliefs, and bodily sensations linked to stress activation. These phenomena are not persistent, but fluctuate over the survivor’s life trajectories. Moreover, the “hidden” impacts are framed within theoretical models for understanding long-term impacts of exposure to violence. The models help us grasp the dynamics of interactions between resilience, psychological damage, context and time. These interactions are non linear, and contingently result in development of psychopathological phenomena when reaching a threshold during a process of accumulating potentially traumatic experiences over a survivors’ lifetime. Understanding psychological impacts of exposure to violence as a spectrum of interchangeable phenomena over a lifetime, and learning to recognize the “hidden” manifestations of psychological trauma will help to improve mental and legal assistance to the survivors both on a short and long term.

Background: Research shows that trauma-focused therapy and multimodal interventions are the two most often used strategies in treatment of refugees suffering from posttraumatic stress disorder (PTSD). While preliminary evidence suggests that trauma-focused approaches may have some efficacy, this could not be established for multimodal interventions. However, it may be that multimodal interventions have been studied in more treatment-resistant refugees with very high levels of psychopathology, disability, and chronicity. In the past decades, various models for understanding of the complex relationship between mental health problems and well-being have emerged. They aim at framing mental health problems in individualized, contextual, epigenetic, and culturally sensitive ways, and may be useful in tailoring content and timing of multimodal interventions. Objective: To draw clinicians’ attention to the possibility of using the Integrative Contextual Model for understanding and assessment of posttrauma mental health sequelae while tailoring multimodal interventions; to present a possible way of combining multimodal with evidence-based trauma-focused approaches; and to improve the understanding and treatment of PTSD and other mental health problems in refugee survivors of prolonged and repeated trauma. Method: Based on literature, clinical experience, and presentation of a fictional case, the use of the Integrative Contextual Model in tailoring the treatment of severe PTSD in a refugee patient is presented and discussed. Results: The Integrative Contextual Model for understanding and assessing factors, which may play a role in causing and maintaining of PTSD and comorbidity in refugees, may help tailoring of multimodal interventions. These interventions can be combined with evidence-based trauma-focused treatments. Conclusion: The field of refugee mental health intervention and clinical practice with traumatized refugees may be enriched with the use of contextual and developmental models for assessment and conceptualization of posttrauma sequelae. Multimodal and trauma-focused interventions may be applied sequentially in a course of the treatment trajectory.