Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma. This only occurs in a context in which the individual has little or no chance of escape. C-PTSD relates to the trauma model of mental disorders and is associated with chronic sexual, psychological, and physical abuse or neglect. This is the best way to understand complex PTSD post traumatic stress disorder.
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C-PTSD is also associated with chronic intimate partner violence, victims of prolonged workplace or school bullying, victims of kidnapping, and hostage situations. Those who have dealt with indentured servants, been victims of slavery and human trafficking sweatshop workers, and prisoners of war may also suffer from this disorder. People who have been concentration camp survivors or residential school survivors can struggle with this. Prisoners kept in solitary confinement for a long period of time, and defectors from authoritarian religions are vulnerable as well.
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It is most often directed at children and emotionally vulnerable adults, and whilst motivations behind such abuse vary, though mostly being predominantly malicious, it has also been shown that the motivations behind such abuse can be well-intentioned. Situations involving captivity/entrapment (a situation lacking a viable escape route for the victim or a perception of such) can lead to C-PTSD-like symptoms, which can include prolonged feelings of terror, worthlessness, helplessness, and deformation of one’s identity and sense of self.
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C-PTSD has been referred to as DESNOS or Disorders of Extreme Stress Not Otherwise Specified. Some researchers also believe that C-PTSD is distinct from, but similar to, PTSD, somatization disorder, dissociative identity disorder, and borderline personality disorder. Its main distinctions are a distortion of the person’s core identity and significant emotional dysregulation.
The Best Ways to Understand Complex PTSD
Recognition
It was first described in 1992 by an American psychiatrist and scholar, Judith Herman in her book Trauma & Recovery and in an accompanying article. The disorder is included in the World Health Organization’s (WHO) eleventh revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). The C-PTSD criteria has not yet gone through the private approval board of the American Psychiatric Association (APA) for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Complex PTSD is also recognized by the United States Department of Veterans Affairs (VA), Healthdirect Australia (HDA), and the British National Health Service (NHS).
The Best Ways to Understand Complex PTSD
Symptoms
The diagnosis of PTSD was originally developed for adults who had suffered from a single-event trauma, such as rape, or a traumatic experience during a war. However, the situation for many children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, dysfunction, and 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. It also does not consider how trauma can affect a child’s development.
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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. Dr. 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.
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The seven domains include attachment, biology, affect/emotional dysregulation, dissociation, behavioral control, cognition, self-concept, and difficulty focusing and finishing tasks. 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. The effects of PTSD on the brain can include various interruptions in a person’s wellbeing. These include alterations of regulations in affect, impulse, attention, consciousness, self-perception, relations, somatization, and systems of meaning.
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Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or older siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon. This can become a pervasive way of relating to others in adult life, described as insecure attachment. This symptom is neither included in the diagnosis of dissociative disorder nor in that of PTSD in the current DSM-5. Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant risk of revictimization.
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An inability to control emotions is prevalent, meaning that a person’s emotional regulation is lacking to the point of dysregulation. Various feelings, including dysphoria and extreme anger are common along with changes in consciousness that include amnesia. Improved recall related to the events that lead to their disorder are very common through flashbacks and intrusive memories. Dissociation is also very prevalent, along with feelings of helplessness and victimization. This ends up making the person feel damaged and incapable of producing feelings of competence. Obsessive preoccupations with the perpetrator, along with feelings of deep shame and guilt are often associated with C-PTSD, too.
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A person with complex PTSD will also fluctuate between devaluation and idealization in themselves and other. This splitting in perception of others and self can lead to feelings of emptiness and lack of self. Feelings of negativity that come from C-PTSD can lead to those struggling to self-isolate from others. Even family members that are close to them can be pushed away if a person experiences an episode. Intimate relationships are especially impacted because of the closeness often relating to a perpetrator being reminded of. Many of these confused feelings and thoughts can lead to feelings of grief and loss of meaning.
The Best Ways to Understand Complex PTSD
Therapy
While standard evidence-based treatments may be effective for treating post traumatic stress disorder, the process is often more difficult. Treating complex PTSD often involves addressing interpersonal relational difficulties and a different set of symptoms which make it more challenging to treat. According to the United States Department of Veteran Affairs: The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms. Things such as changes in their self-concept and the way they adapt to stressful events are affected.
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Some of the treatment options that are recommended for C-PTSD are those that involve turning negative associations into positive ones. This may be through exposure response therapy, which changes the fear reactions someone has to a situation. This means to repeatedly expose someone to what they fear while learning new ways to respond to the stressful event in more positive ways. Even treatments like DBT (dialectical behavioral therapy) are useful, depending on the stress response. One of the most pronounced solutions for PTSD in general is cognitive behavioral therapy. This kind of therapy allows, through talk, ways of seeing a traumatic experience in a new light. This occurs by making positive or neutral associations to a once very negative event.
Final Thoughts: The Best Way to Understand Complex PTSD
C-PTSD and PTSD have many similarities, but there are some significant differences in their exposure and symptoms. It’s extremely important to understand the differences for making a proper diagnosis and attaining the respective treatment plan. If you or someone else is struggling with any symptoms related to C-PTSD, be sure to get help by seeing a doctor immediately. The symptoms are considered worse than regular PTSD and can often lead to suicide if untreated.
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