What is Complex-PTSD?
…and Why is it so Complex?
You have likely heard the term “trauma” before, especially over the past year when we’ve globally been living through the COVID-19 pandemic. The past year has been very traumatic for a lot of different people for a lot of different reasons.
You may have even heard the term Post-Traumatic Stress Disorder. It’s a term that is probably most closely associated with veterans, as evidenced by the fact that the first thing Google pulls up is an article by the Veterans Association. However, civilians can experience it too. Post-traumatic stress disorder is a constellation of symptoms that can occur after a person experiences a shocking, scary, or life-threatening event or an event that involves the threat of serious injury. PTSD can also develop after you have witnessed the event or even if you’ve heard about the event happing to someone close to you.
PTSD has a lesser-known, but very common, presentation known as “complex PTSD.” You won’t find this anywhere the “big book of mental health diagnoses” (known as the DSM-5) though. So what makes complex PTSD so complex? Let’s first take a look at the definition of trauma.
Definition of Trauma
Trauma occurs when a person experiences an event that overwhelms their ability to cope with the situation at hand. The event itself isn’t the trauma, it’s the response to the event. Lots of different events can set off a trauma response; some of them are more common than others and some occur on a much larger scale than others. Some traumatic events even happen fairly frequently during the course of many people’s lives. Examples include living through a natural disaster, being a victim of a physical or sexual assault, experiencing abuse or neglect in childhood, intimate partner violence, being separated from a parent as a child, growing up in poverty, living in a family struggling with addiction, having a car accident, and the list goes on… These events don’t always cause a person to experience a traumatic reaction, but it’s still normal and reasonable for others to experience a traumatic reaction to the same event depending on their level of social support, coping skills, perception of the event, and ability to work through their experience in a safe way.
It’s important to remember that the symptoms you experience after a traumatic event are normal reactions to an abnormal situation. Your brain is designed to protect you during traumatic events by activating primal, ingrained protective mechanisms that are managed by your brain’s autonomic nervous system. Your nervous system is responsible for regulating your bodily functions, such as breathing, digesting food, sleeping, heart rate, etc. It is also in charge of protecting you from danger with various defensive strategies, commonly known as fight, flight, freeze, and feign (more on these in a future post). Your body’s response to an actual dangerous event is automatic. You can’t control it. It happens in a split second when you sense danger. You may experience feelings of guilt and shame after such an event because you think they should have done something differently. You may also feel like you’re “going crazy” after you’ve experienced a traumatic event and have symptoms of nervous system energy that hasn’t been fully allowed to discharge. The symptoms can be confusing and overwhelming when you don’t understand why they’re happening or what to do about them.
So let’s talk about what it looks like when you do go on to develop a traumatic stress response that doesn’t seem to go away.
Post-Traumatic Stress Disorder
The symptoms of Post-Traumatic Stress Disorder include the following:
Criteria one was explained above. You have to have directly experienced, witnessed, or heard about a traumatic event happening to someone close to you to qualify for a diagnosis of PTSD.
Criteria two involves experiencing things like nightmares, vividly reliving the event (flashbacks), or memories that seem to haunt you despite your best efforts not to think about them. It can also involve experiencing extreme anxiety or distress when a memory is “triggered” by something in the environment. We call these symptoms “intrusions.”
Criteria three involves avoidance of external reminders of the trauma (people, places, or things) as well as internal representations of the trauma (thoughts, images, talking about it with others, etc).
Criteria four is about the impact on your emotions and thoughts. It includes negative changes in how you think about yourself, other people, and the world around you. You may feel more hopeless, guilty or ashamed, find it difficult to connect with others or maintain relationships, feel less interested in activities you’d usually enjoy, and have memory problems. You may also find that you seem to have trouble feeling positive emotions, feeling emotionally numb, or switch between the two.
Criteria five is all about what we call “nervous system arousal.” This refers to your body’s “fight or flight” response being stuck “on,” and can include things like being easily startled, always being on your guard and feeling like something bad is going to happen, difficulty sleeping or staying asleep, difficulty concentrating, angry outbursts and self-destructive or reckless behavior.
If a certain number of these symptoms occur right after the event, we call this “acute stress disorder.” If you continue experiencing these symptoms longer than a month after the event has passed, we call that “post-traumatic stress disorder.”
What about Complex-PTSD?
One of the main distinguishing factors of C-PTSD is that it involves prolonged (usually over months or years) traumatic events that are typically interpersonal in nature. The most common examples of this that I typically work with experiences of child abuse/neglect and intimate partner violence.
Complex PTSD is different in part because of the duration and the nature of the trauma, but also because of the symptoms. Individuals with complex PTSD may still experience all the symptoms of PTSD, but they have additional symptoms that contribute to difficulties in daily life with relationships and mood. These symptoms include:
Chronic difficulty controlling emotions and mood
Difficulty controlling and expressing anger in appropriate ways (or not being able to express anger at all)
Self-destructive behaviors or chronic suicidal thoughts/behaviors
Difficulty with intimate/sexual relationships
Impulsivity and risk-taking behavior
Amnesia for important parts of one’s life or day to day experience
Dissociative symptoms (not feeling in touch with one’s physical or emotional experience, feeling like you’re living in a dream or a fog, feeling like the world around you isn’t real)
Somatic complaints (digestive issues, chronic pain, headaches, pain that is not explained by a medical diagnosis, panic)
Chronic feelings of despair or hopelessness, loss of connection with a higher power/God/religious or spiritual beliefs
Chronic feelings of guilt, shame, self-blame, powerlessness, etc. that impact how you think and feel about yourself, others, and the world around you; or feeling that they have no sense of self (needs, wants, identity, etc) or a fragmented sense of self as in the case of Dissociative Identity Disorder.
Difficulty trusting others or connecting to people, feeling a “push/pull” between yourself and the people in your life, avoiding relationships, feeling distant or cut off from others
These symptoms feel overwhelming and can have a big impact on your relationships, your ability to work or go to school, and your ability to function in daily life. The good news is that healing is possible and therapy can help. If you’re finding yourself resonating with the experiences described above, please browse the resources section for more information.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Courtois C.A. and Ford J.D. (2013), Treatment of complex trauma: A sequenced, relationship-based approach. Guilford Press.
Herman, J. (2015). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. Basic Books.
Complex Post-traumatic Stress Disorder. (Apr 26, 2021). Traumadissociation.com. Retrieved Apr 26, 2021 from http://traumadissociation.com/complexptsd. Read more: http://traumadissociation.com/complexptsd