Everything you need to know about complex PTSD
“Hypervigilance and startle reaction are big issues for me. I constantly scan to make sure everything is safe. I can’t sit with my back to a door, and if I do, I think ‘there could be danger,” Kate G. The Mighty said in 2019 of the experience of living with C-PTSD. “Loud noises startle me easily…Last year, [the Fourth of July celebration] was so bad that I came home, turned the music up as high as I could and started screaming and sobbing. I couldn’t stand it,” G. added.
C-PTSD, or complex post-traumatic stress disorder – also called complex traumatic disorder – is the result of prolonged exposure to trauma. While PTSD usually follows a single traumatic event, C-PTSD is often the result of repeated trauma – particularly, if one saw no way out of the traumatic situation. Experiencing constant bullying or ostracism as a child, experiencing neglect or abandonment, witnessing repeated domestic violence or abuse, experiencing domestic violence, or having lived experiences repeatedly invalidated are things that can put people at a higher likelihood of developing C-PTSD.
While anyone can develop C-PTSD, experts note that people with underlying mental health conditions, or a family history, may be more vulnerable. Similarly, how individual brains regulate “hormones and neurochemicals, particularly in response to stress,” may also determine the propensity to contract C-PTSD, as may the lack of a strong support system. .
Research suggests that 7.3% of all humans could develop PTSD and C-PTSD in their lifetime – between the two, the prevalence rate of PTSD was estimated at 4% and that of C-PTSD was 3.3%.
Yet the DSM-5, or the fifth (and final) edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association in 2013, does not yet include C-PTSD as an official diagnosis. Unlike DSM-5, however, ICD-11, or the eleventh revision of the International Classification of Diseases published by the World Health Organization in 2018, recognizes C-PTSD as a “disorder”. The neurodiversity movement – which is urging society to view autism, ADHD and OCD, among others, as a departure from neurotypy, rather than a “health condition” – also recognizes C-PTSD as a neurodivergence; although acquired.
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C-PTSD manifests in much the same way as PTSD – except it has additional symptoms. Traits it shares with PTSD include reliving traumatic events as flashbacks or nightmares; avoid reminders of trauma – whether it’s certain sounds, settings, or people; and be hyper–responsive to stimuli, or being hyper–vigilant due to a constant perception of threat.
Additional symptoms induced by C-PTSD range from emotional dysregulation, such as “feelings of anger [for instance] appear[ing] overwhelming and difficult for the person to manage,” as David Berle, a clinical psychologist and associate professor at the University of Technology Sydney, wrote in The Conversation. A negative sense of self dominated by notions of shame, guilt or worthlessness; feeling disconnected from others; or having trouble communicating thoughts and emotions effectively are a few other ways C-PTSD manifests. Additionally, symptoms of C-PTSD may also include somatic symptoms such as headache, chest pain, or dizziness. According to the NHS, C-PTSD can also manifest as “destructive or risky behavior” such as self-harm or substance abuse – and even thoughts of suicide.
Manifestations of C-PTSD can also vary across ages – experiencing it in childhood, for example, can cause individuals to develop disorganized attachment styles. According to the ICD-11, C-PTSD can also present differently in different cultures, and even be exacerbated depending on social identity. “For migrant communities, especially refugees or asylum seekers, [C-PTSD] may be exacerbated by acculturative stressors and the social environment in the host country,” the manual states.
It may also be relevant to note that according to ICD-11, women are more vulnerable to C-PTSD than their male counterparts. Not only that, but the first set also has a higher likelihood of exhibiting “a higher level of psychological distress and functional impairment.” Large-scale data on gender diversity—capturing C-PTSD vulnerability across the gender spectrum—remains unsurprisingly lacking.
Unfortunately, however, many mental health professionals continue to ignore C-PTSD, which not only makes diagnosis more difficult, but also makes people who have it feel misunderstood. “The first psychotherapist I saw said he was trauma informed, so I thought it would be a good choice. I confided in him and reported my symptoms…I was told that I needed mood stabilizing medication and it looked like I had [Borderline Personality Disorder (BPD)]. I stood in that office very frustrated, feeling like he wasn’t really listening to me and trying to figure out what I was dealing with, but instead jumped on a diagnosis,” wrote Traci Powell, who lives with C-PTSD, in 2019. Unfortunately, Powell’s experience, while heartbreaking, is not unique. Many, like Powell, are misdiagnosed with borderline personality disorder, resulting in unwarranted medication and the prolonged misery of not receiving treatment for their condition, while continuing to feel isolated in their experience.
“After trying the meds and feeling much worse, a friend convinced me to try another therapist… She took her time getting to know me for weeks before suggesting a diagnosis, and when she did finally did, it was complex PTSD. As she explained to me what it was, I sobbed. Finally, someone understood me and, even more so, I finally understood myself,” Powell continued.
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C-PTSD may warrant intensive long-term support – perhaps even longer than traditional PTSD – but it is treatable. “Sometimes I felt like nothing was going to end the distress, experiencing more than 10 flashbacks a day…It was a long recovery process, with lots of bumps along the way, but the right medication and therapy to long term with someone I came to trust, changed my life,” a person living with C-PTSD told Mind, a mental health charity in England and Wales, last January.
Treatment for C-PTSD may involve a combination of approaches, including psychotherapy and medication. According to Mind, one may also need support for other existing conditions like depression and dissociation.
But when it comes to treating C-PTSD in itself, often the treatments recommended for traditional PTSD are employed. This includes trauma-focused therapy, which “involves[s] a systematic recall of traumatic memory in a safe and controlled way,” says Berle. Mental health professionals may engage in trauma-focused CBT (cognitive-behavioral therapy) or DBT (dialectical behavior therapy) to treat people living with C-PTSD.
Taruna Jamalamadaka, DClinPsy, a clinical psychologist from the UK who practices trauma-focused CBT, told The Swaddle last year that when we experience trauma, her memories are not stored in the same way as ordinary memories. In general, memories are classified in the hippocampus of the human brain – sorted by context, i.e. by date, time and place of occurrence. Traumatic experiences, on the other hand, are stored in the amygdala, mostly in the form of fragmented sensory memories in the amygdala, which can be triggered by sights, smells, and sounds. Trauma-focused therapy works by helping a person process those traumatic memories—that cause them dissociation, flashbacks, or nightmares—in such a way that they are contextually filed in the hippocampus as regular memories.
While professionals have developed different approaches to treating people with C-PTSD, there is still debate about whether treatments for traditional PTSD can necessarily help people with C-PTSD. As Berle noted, “Discussions of diagnoses can seem far removed from the lived experience of people who have suffered trauma. Diagnostic systems are research-based, but they are the product of committees of stakeholders with a wide range of views.
Perhaps with the growing awareness of C-PTSD, there will be more research into treatment options for individuals. Until then, petitions to have it recognized in the DSM will likely continue to circulate – perhaps, in hopes of greater awareness of the condition among mental health professionals, if not just for options. better documented treatment.