Complex Post-Traumatic Stress Disorder (CPTSD)
Post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) are both neurobiological disorders that occur when someone experiences or witnesses a traumatic event. Examples include, but are not limited to, war or combat, natural disasters, physical or sexual assaults, and life-threatening accidents.
Almost all of us associate PTSD with veterans. We understand combat is gruesome on the body and devastating to the psyche. If only we look at the faces of our veterans when they return, it is clear that war is hell. We know, even without words, that they went through something far beyond the scope of normal human experience. In fact, generations before the term “post-traumatic stress disorder” became known, PTSD was known by other names: war neurosis, shell shock, soldier’s heart, or combat fatigue. Furthermore, much of the research, advocacy, awareness, and treatment options for PTSD have been through means such as the U.S. Department of Veterans Affairs. Thus, it makes sense we as a collective society to visualize a soldier in battle when we think of PTSD.
However, many times PTSD is most prevalent in people who have experienced dangerous, life-altering events. It seems to be most frequent in survivors of sexual assault or those who went through or witnessed violent car accidents, both which involve powerlessness, danger, and terror. Furthermore, PTSD can occur in populations that often are forgotten to be traumatic, such as ICU stays.
It is believed most people will experience at least one traumatic event in their lives, and a fourth will develop PTSD. It is not known how many people live with complex post-traumatic stress disorder (CPTSD).
Symptoms of PTSD:
People who suffer from trauma may feel its impact for days; this is called acute trauma. If the symptoms continue for weeks or longer, and disrupt daily living, that is suggestive of Post-Traumatic Stress Disorder, PTSD.
There are three types of PTSD symptoms:
Hyperarousal symptoms. People with PTSD may have sense-of-threat symptoms, as if they are on edge and hypervigilant of their environment. They can have a startled response such as jumpiness.
Re-experiencing symptoms. Nightmares and flashbacks are the hallmark symptoms of PTSD. The individual may “go through” the trauma again via memories, via sensory experiences and emotions. The individual may feel the same smells, sights, sounds of the trauma.
Avoidance symptoms. Those living with PTSD will participate in avoidance symptoms, as in avoiding triggers associated with the trauma. This is broad, and can include places, situations, people, or events (i.e., holidays). They may also attempt to drown the symptoms through self-medicating with alcohol or other substances.
What is Complex Post-Traumatic Stress Disorder?
CPTSD is a multilayered version of PTSD involving prolonged or chronic attacks on an individual’s sense of safety, self-worth, and integrity. This is dissimilar to PTSD, which is the result of one traumatic event. The ongoing maltreatment causes a multitude of additional symptoms, which shape neuropsychological development such as personality.
CPTSD results from situations of chronic powerlessness and a lack of control. This can be from long-standing domestic violence (whether experienced or witnessed), sex trafficking, or child maltreatment. However, it is most common in those who were subjected to child abuse or neglect at a very early age, especially if harm is by a caregiver or other significant adult. Also, multiple traumas increase the risk of developing CPTSD.
Symptoms of C-PTSD:
People with CPTSD have compounded symptoms of both PTSD and those from other mental health disorders. These may include the following:
Psychosomatic issues: Psychosomatic issues are physical issues without a medical explanation. This can be caused or worsened by a psychological reason such as stress. It is common for people with CPTSD to have vague physical symptoms such as dizziness, chest pains, abdominal aches, and headaches.
Emotional flashbacks: A flashback is a vivid, intense experience in which a person will relive some parts of a trauma. Some people feel as if it is happening in the present. Stereotypically, people tend to think of the war veteran who is having a “movie-like” flashback in which the event unfolds again in its entirety. However, a flashback does not need to be so extreme – and usually they are not.
People with C-PTSD are likelier to experience what is called an emotional flashback – that is, the emotions experienced during the trauma, such as shame or fear. Such individuals may react to these events in the present, unaware they are having a flashback.
Difficulty regulating emotions: Those with CPTSD may experience sharp, vivid emotions which can be inappropriate for the situation. These rapid shifts in mood can be misdiagnosed as bipolar disorder or borderline personality disorder, which can have similar features but are not the same.
Flat affect: People with CPTSD may also have a flat affect, meaning they appear numb, somber, or emotionless to others. This body language can be misinterpreted by others, making people think the individual is feeling a certain way or is aloof. In truth, the person may have a rich, sophisticated inner world of their emotions and be feeling very differently than how they are expressing themselves.
There are several reasons for a flat affect. One powerful reason is because the individual may not have witnessed emotional expression in their formative years, thus in turn they have been shapened to be “flat” as an adult. To explain it plainly, imagine a mother not smiling at her baby. The baby mimics and responds to its mother by also not smiling. At the neurological level, this is influencing the baby to respond such a way going forward.
Alexithymia (lack of emotional vocabulary): Individuals with CPTSD may have difficulty with articulating their emotions or they may not understand what they feel; that is, there is an absence of an emotional vocabulary. They may struggle in therapy when asked “what are you feeling?” and respond with “I don’t know” or they may describe a physiological feeling instead (i.e., tiredness, nausea). This is because in the context of prolonged trauma they had to adapt to shutting down their emotions to survive. For example, they may have been programmed in their earliest years to think “emotions are bad” because they were consistently invalidated or punished for emotional expression by their caregivers.
Dissociation: Dissociation happens to everyone. Dissociation is a sensation of feeling disconnected from oneself and the world through a sensory experience, thought, sense of self, or time. A person who dissociates may feel depersonalization (detached from their body) or derealization (feeling as if their surroundings are unreal). And at one time or another, all of us have dissociated. Getting lost in a daydream, forgetting the details of a car drive, or spacing out during a boring class lecture are all examples of dissociation.
When applied to trauma, dissociation is an innate coping mechanism. It is a protective action taken by the mind to let an individual survive a traumatic experience. At the time of the event, dissociation is beneficial, especially for children as they often lack insight and more sophisticated coping skills. However, the downside of dissociation is that when someone has dissociation and is at risk of developing CPTSD or another trauma-related disorder, the dissociation does not resolve the trauma. In adulthood, the effects of dissociation can negate the ability to trust, form and maintain healthy relationships, and prioritize self-care. Through the phenomenon of mind-body separation, individuals may develop self-destructive behaviors such as ones that keep them dissociated (“I can’t tell when I’m feeling hungry, so I eat less than I should”) or ones to make them dissociate (“I drink alcohol to numb myself so I don’t have to feel my despair”).
Negative core beliefs: Individuals with CPTSD may have the core belief “I am not safe” or “the world is unsafe.” Alternatively, they may have other core beliefs (“I am unlovable” or “I am not worthy of respect”, for example). These core beliefs are deeply ingrained, at the pool of their identities, which can mean the individual is unaware they even carry such beliefs until they develop more insight.
Relationship difficulties: Individuals with CPTSD can struggle with developing and maintaining healthy relationships. Such individuals struggle with feeling able to trust others due to their traumatic histories; thus, they may isolate themselves or feel intensely uncomfortable with “opening up” to others. Or they may respond inappropriately in a social situation. Unfortunately, these factors only enhance their risk of disapproval or misunderstanding by others, which makes them more susceptible to social isolation or ridicule.
Additionally, people with CPTSD are more susceptible to entering and remaining in abusive relationships – especially those who already experienced abuse.
Treatments for CPTSD:
CPTSD can be effectively treated, but finding the right therapist is crucial. Not every therapist is equipped to handle complex trauma, so it important to thoroughly vet potential therapists. During your initial consultation, inquire about their experience and expertise in treating CPTSD, much like you would when choosing a medical doctor.
Additionally, ask about their treatment approaches and intervention styles. Common treatments for CPTSD include:
- Eye Movement Desensitization and Reprocessing (EMDR): Involves processing trauma while following a bilateral stimulus, leading to eye movements.
- Trauma Processing Therapies.
- Exposure Therapy: Involves safely re-experiencing trauma in a controlled setting.
- Cognitive Behavioral Therapy (CBT): Focuses on changing the relationship between thoughts, emotions, and behaviors.
- Dialectical Behavior Therapy (DBT): A CBT variant that includes skills for interpersonal effectiveness, emotional regulation, distress tolerance, and mindfulness.
- Cognitive Processing Therapy (CPT): Aims to change unhelpful beliefs related to traumatic events.
I specialize in complex trauma, having worked with clients who experienced child maltreatment, domestic violence, complicated bereavement, and so on.
Contact me today to schedule an appointment and start living in the present.
