Complex PTSD

Distinguishing Between PTSD and C-PTSD

Post-Traumatic Stress Disorder

Complex post traumatic stress disorder can closely resemble traditional post traumatic stress disorder (PTSD). PTSD is a psychological disorder affecting people who experience a traumatic event, especially an event associated with extreme stress, and deal with symptoms that persist months or even years after the event has occurred.

People with PTSD and Complex PTSD struggle to cope with traumatic memories that reoccur whether they want to think about them or not. The traumatic stress of the event or events in question is so severe that people are unable to move on from them in the way that they can from less difficult occurrences. A mental health professional may be able to help you determine whether the mental health issues you are experiencing PTSD symptoms.

PTSD Symptoms

PTSD symptoms include hyper-vigilance, irritability, anxiety, difficulty sleeping, flashbacks, uncontrollable thoughts about the event, loss of pleasure in activities (a condition known as anhedonia) and emotional detachment from loved ones and favored activities.

Mental health professionals can diagnose a person with post traumatic stress disorder based on their symptoms and the degree to which they impair their functioning. The PTSD diagnostic criteria focus on the person’s symptoms and their ability to get by despite them. In general, post traumatic stress disorder is understood as occurring in response to a single traumatic event.

Complex Post Traumatic Stress Disorder

Complex PTSD or C-PTSD is a specific form of PTSD. If a patient continues to suffer repeated traumas after the initial traumatic experience, one trauma compounds another, and the person may develop Complex PTSD. A person battling this illness can also suffer from many other conditions including depression, anxiety, and eating disorders, and many sufferers of Complex PTSD have also been subject to childhood abuse or sexual abuse.

The Diagnostic and Statistical Manual on Mental Disorders, 5th Edition is a book commonly used by psychiatrists and psychologists, published by the American Psychiatric Association. Complex PTSD has not been designated as a separate disease in the DSM yet, but there are diagnostic criteria that recognize its unique impacts on individuals.

C-PTSD overlaps with PTSD and shares many of the same diagnostic criteria, and for this reason diagnosing Complex PTSD can be difficult. People may not attribute their negative self concept to the traumatic events they experienced. They may not recognize how their experiences as children can create negative thought patterns and influence their behavioral health later on in life. C-PTSD is also not a separate diagnosis from PTSD, meaning that it can be difficult to differentiate one from another for clinicians.

How C-PTSD Occurs

Trauma Builds on Trauma

Traumatic events build on each other in a catastrophic way. A childhood trauma may leave a person vulnerable in the future, so that another painful event, like a car crash or difficult breakup, has much more impact than it would have otherwise. People who have experienced traumatic events suffer blows to their mental health that compromise their resilience and make them less capable of responding to pain. Complex PTSD occurs when multiple events of trauma occur and compound one another.

Learning The Wrong Lessons

Think of a childhood abuse victim who internalizes the incorrect lesson that they are deserving of pain. This person will be more likely to interpret future interpersonal trauma (like the dissolution of a friendship or a relationship) as an indication of their own lack of worth or inherent brokenness, rather than as a one-off clash of personalities. In this way, an event that could be difficult, but manageable for one person, can be devastating for a victim of chronic trauma.

Intersecting Struggles

People with Complex PTSD vary in their ability to cope, but a common trait across sufferers of the disorder is the interaction between their traumatic experiences. Complex trauma is characterized by the intersection of past, present, and future pain, as people who have been cut open by one event struggle to heal in the face of repeated trauma.

Treating complex post traumatic stress disorder is complicated by the multiple instances of complex trauma that the clinician needs to overcome and uncover. Mental health professionals say that C-PTSD is treatable but can require more intensive intervention than a typical case of posttraumatic stress disorder.

Childhood Abuse

One factor in many cases of C-PTSD is abuse of the patient in early childhood. People who are subject to sexual and physical abuse are subject to myriad risk factors as adults, including increased likelihood of alcoholism, drug addiction, and mental illness. The severe psychological harm inflicted by abuse at such a vulnerable age is a major predisposing factor for posttraumatic stress disorder later in life. Some children, particularly those with complex trauma histories, begin displaying C-PTSD symptoms from a very young age.

Unhealthy relationships between parents and children lead people to develop unhealthy relationships as adults, thus leading to further trauma as they recreate the difficult dynamics of their childhood in the boundaries of an adult relationship. A parent who suffers from explosive anger may imprint on a child, who then associates such extreme emotions with love, as the caregiver relationship is foundational in shaping the way we view affection towards ourselves and others. This is one reason why childhood abuse is also a risk factor for borderline personality disorder.

Borderline personality disorder

Sufferers of borderline personality disorder vacillate rapidly between extreme affection and extreme hatred, in part because their childhood traumatic events lead them to view the two emotions as inextricable from one another. Victims of childhood sexual abuse may struggle to have healthy relationships with others as adults if they come to associate intimacy with pain and secrecy.

Being abused as a child may cause an enduring personality change that persists into adulthood, and as a result many sufferers of complex trauma have co-occurring complex PTSD and borderline personality disorder and may have additional symptoms from other domains of mental illness.

Mental health professionals can help victims of abuse identify the reasons for their current impairment and act to reconcile their current PTSD diagnosis with the events of their past. Borderline personality disorder and C-PTSD are but a few of the many mental health conditions that are associated with abuse suffered as a child.

Battlefield Trauma

Another group that is at increased risk of C-PTSD is veterans. Posttraumatic stress disorder was originally coined as a diagnosis to replace shell shock, a term used to describe American veterans of World War I who came back with their emotional regulation shattered by the extreme stress of trench warfare. GIs who dealt with the chronic trauma of seeing their close friends gunned down inches away from them were a stark indication of a truth that doctors and healers had understood for centuries: war changes a man. C-PTSD symptoms are just one way that this manifests.

The traumatic event of the Normandy Landing at D-Day in World War II undoubtedly left thousands of men scarred forever at the sight of their comrades; Stephen Spielberg’s film “Saving Private Ryan” illustrates this in grim detail. In years to follow, “shell shock” was replaced by “combat fatigue” and “hysterical neurosis,” terms that similarly failed to capture the root of the issue: the traumatic memory of war. Although the term C-PTSD did not yet exist, the distinct clinical syndrome that it constitutes did, and our current understanding of complex trauma helps explain the symptoms these veterans of the World Wars displayed when they returned from combat.

Vietnam and the Origin of PTSD

However, clinical inquiry into their problems only started in earnest when men began returning from the Vietnam War, decades later. The Department of Veterans Affairs estimates that 30 out of 100 American veterans of the Vietnam War suffered from PTSD at one point in their lifetime.

With our current understanding of Complex PTSD, we may assert that many, if not most, of these men were suffering from C-PTSD. Veterans of these brutal wars suffered trauma after trauma, with prolonged exposure to violence, horrific environmental conditions, and fear of their own death combining and compounding one another.

Naming PTSD

The term post traumatic stress disorder came into use in the 1970s as a diagnosis for Vietnam veterans. These men were returning in a theretofore unique situation, not as glorious victors, but as pariahs in a country where public opinion had largely turned against the war.

The social isolation these veterans, who were never “welcomed home” in the way that WWII and WWI vets had been, contributed to their distorted perceptions of themselves and others, as many internalized the idea that they personally bore responsibility for the failure of the war and the atrocities that had become public knowledge in the aftermath. The limited mental health resources at the time made the situation worse.

An Epidemic Among Veterans

Thus, coming home from war became its own traumatic experience. These compounding and repeated traumas are the type of thing we now recognize as causative of complex PTSD. Mortality and morbidity statistics for veterans painted a grim picture. Seeing these men lose faith in their country, and in themselves, mental health professionals began working to determine how they could help.

The Department of Veterans Affairs began working to develop psychological interventions to treat the men they were tasked with healing, many of whom had long term trauma and psychiatric disorders from their experiences in Vietnam. They began diagnosing PTSD among veterans who had suffered from prolonged trauma. Their work led the American Psychiatric Association to add PTSD to the Diagnostic and Statistical Manual 3rd Edition.

Widespread Recognition

Years later, PTSD is now recognized by the World Health Organization and other medical governing bodies as a severe mental health condition worthy of further study and has been written about extensively in Clinical Psychology Review, a peer-reviewed journal for the mental health professional community.

Complex PTSD is a more recent discovery, but there is a growing body of literature in the field of clinical psychiatry dealing with complex post traumatic stress and its effects. Complex PTSD is gaining recognition as a distinct mental illness with its own unique challenges and accompanying best practices.

Treating Complex Posttraumatic Stress Disorder

If you are dealing with PTSD symptoms and believe you may have PTSD or complex PTSD, your first step is to consult with a mental health professional. Search for a mental health provider in your area and ask if they have staff who can treat PTSD and complex PTSD.

Once you have found a mental health provider, they will assess your trauma symptoms and risk factors and may ask questions about your early childhood. They may find that your PTSD symptoms are occurring because of another psychiatric disorder, in which case they may give you a separate diagnosis. But if your symptoms align with the diagnostic criteria, they will diagnose you with complex PTSD.

Treatment Options

If they find enough evidence to conclude that you have C-PTSD, they may recommend one form or another of cognitive therapy. This therapy works by challenging the negative thought patterns that sufferers of C-PTSD so often deal with.

People with C-PTSD have internalized negative ideas about themselves and the world around them, so these therapeutic methods can be effective for dealing with some aspects of complex PTSD. However, many C-PTSD sufferers deal with ongoing physical symptoms that are less easily treated via cognitive means.

Prolonged Exposure Therapy

Prolonged exposure therapy is one option for people with complex PTSD. This therapy works by gradually and carefully re-introducing the patient to things that provoke a fear response due to the trauma of the person’s past.

People with complex PTSD frequently attach a lot of significance to reminders of their trauma. They may do whatever they can to avoid things that are reminiscent of the circumstances of their trauma, which limits their ability to socialize, work, and otherwise live life.

Prolonged exposure therapy targets this issue by letting the person suffering from complex PTSD face their fear on their own terms, in the company of a clinician who can guide them through slowly and with attention to their reactions. This is important to avoid re-traumatizing the patient.

Imaginal Exposure

The clinician will start by reviewing the Complex PTSD patient’s past and identifying the feared stimulus or traumatic event, and teaching breathing techniques to manage anxiety. These techniques will be necessary for the next step of treatment.

Following this, the therapist begins guiding the Complex PTSD patient through imagining the traumatic event again, identifying emotions that arise and managing them as they occur. This process is recorded so that the patient can listen between sessions. This is known as imaginal exposure.

In Vivo Exposure

When the Complex PTSD patient is ready, the clinician will assign homework. The clinician and the Complex PTSD patient work together to identify stimuli and situations that are connected with the traumatic event and produce fear as a result.

The Complex PTSD patient then plans to confront one or more of these stimuli and to journal about how they are affected. Over time, the Complex PTSD patient becomes more confident in their ability to deal with these situations on their own.

Eye Movement Desensitization and Reprocessing

Another therapeutic technique that shows promise for treating Complex PTSD is eye movement desensitization and reprocessing therapy, also known as EMDR. EMDR is an evidence-based practice that has been recognized by the World Health Organization. This therapy makes use of research into memory and the processing of memories and is based on the theory that people suffering from PTSD and C-PTSD have not completely processed their traumatic memories. EMDR takes place in 8 phases.

Phase 1: History and Treatment Planning

The therapist reviews the Complex PTSD patient’s history and symptoms to understand what they are dealing with. They will briefly discuss the trauma and potential memories for reprocessing.

Phase 2: Preparation

Therapist will teach the patient techniques for managing stress that may arise during the treatment process, including deep breathing and mindfulness tactics.

Phase 3: Assessment

During this phase, the clinician assists the C-PTSD patient in selecting a painful memory to process, and identifying specific aspects, like physical sensations associated with the memory, intrusive images or thoughts that the memory brings to mind, and negative self-images tied to the memory.

Phase 4-7: Assessment

In phases 4-7, the clinician begins addressing the targeted memories in 4 stages:

Desensitization entails focusing on the negative memory, while being guided through bilateral stimulation. This involves making specific eye movements when instructed. After this, the Complex PTSD patient lets their mind go blank and takes note of any feelings that arise. The therapist may then ask the patient to refocus on that memory or to move on.

Installation pairs bilateral stimulation with a new, positive self-belief or image. The patient will focus on this new belief while making the eye movements as instructed.

In the Body scan stage, the C-PTSD patient will identify any uncomfortable physical sensations they are feeling and go through another repetition of bi-lateral stimulation to remove these sensations.

Finally, in the Closure stage, the clinician will review the progress the patient has made and suggest strategies for helping you maintain your progress.

Phase 8: Re-Evaluation

The therapist asks the Complex PTSD patient to review the feelings they discussed in the previous session. If they are still causing distress, they will repeat phase 4-7; if they are not, they will move on to new memories to target for re-processing.

Living with Complex PTSD

These therapeutic techniques show promise for treating people suffering from Complex PTSD. Many people who have this disorder are able to lead normal and happy lives once they understand their illness and seek help in dealing with it. They can rebuild relationships that may have been damaged by their symptoms and can regain their enjoyment of activities that lost their appeal when suffering from the anhedonia that accompanies PTSD and C-PTSD.

The biggest obstacle for many people is a lack of knowledge, which is why spreading the word and increasing awareness about PTSD is so important. The more people are aware of PTSD and C-PTSD, the easier it will be for sufferers and their loved ones to recognize it and to seek the help they need to live happy and functional lives.