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Complex PTSD (CPTSD), also known as complex trauma disorder, is a more severe form of post-traumatic stress disorder. It can occur when a person suffers repeated traumas, especially if these stressful events occur in childhood and involve despicable acts by others such as sexual assault or torture by a close family member. Some of the most common causes of complex PTSD include:
- Witnessing repeated acts of violence (e.g., living in a war zone)
- Extreme neglect or abandonment during childhood
- Sexual or physical abuse
- Chronic abuse from a partner or spouse
- Slavery, forced labor, and human trafficking
The International Classification of Diseases (ICD) recognizes complex PTSD as a separate medical condition, describing it as a “disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible.” Although people with CPTSD also present with common PTSD symptoms, they also manifest with additional troublesome features such as emotional regulation problems and distortion of core identity.
Complex PTSD: Misunderstood and Misdiagnosed
Diagnosing CPTSD is particularly challenging because of the limited number of studies evaluating complex PTSD in children and adolescents. It has been commonly misdiagnosed as somatization disorder, borderline personality disorder, and multiple personality disorder. In her seminal book Trauma and Recovery, Judith Herman proposed the term complex posttraumatic disorder for survivors of prolonged repeated trauma. Complex PTSD patients are often misdiagnosed and inappropriately treated because of the following reasons:
- CPTSD is not part of the DSM-5 – the condition has been subjected to various deliberations since the fourth edition of the diagnostic manual, but the American Psychiatric Association still decided against its inclusion in the DSM-5.
- Comorbid disorders can mask CPTSD – multiple disorders can exist simultaneously. Prolonged trauma in childhood can also cause anxiety disorders, depression, and learning disabilities.
- The symptoms of CPTSD are similar to other disorders – 90% of PTSD and complex PTSD symptoms are the same. CPTSD symptoms also mimic other diagnoses such as anxiety disorder, bipolar disorder, and major depressive disorder (MDD).
People with CPTSD may have some or all of these personality problems:
- Inability to regulate emotions, especially anger.
- Find it hard to live in the moment without being forgetful, dissociative, or preoccupied with trauma.
- Inability to separate themselves from their abuser or perpetrator without either being preoccupied with revenge, being thankful or accepting of their abuser’s maligned views.
- Blaming oneself and feeling guilty, shameful, or stigmatized.
- Inability to have positive, healthy relationships with others without being distrustful, isolated, or constantly searching for someone to save them.
- Constant feeling of despair and hopelessness.
The Impact of CPTSD in the Mind and Body
It is important for caregivers to provide predictable help to a developing child. Consistency is the key here; children who were given consistent and predictable care develop clear expectations about themselves and the world. On the other hand, growing up in a household of neglect and abuse has ramifications on the cognitive, emotional, and physical aspects of development. Individuals with CPTSD often experience any of the following issues:
- Physical health problems that remain until adulthood.
- Hypervigilance or the state of heightened alertness–a behavior that resembles paranoia.
- Changes in brain structures associated with deficits in social skills and career success
- Poor interpersonal relationship strategies, including blaming others, withdrawing or pushing someone away, being overly critical of friends and loved ones.
- Avoiding trauma reminders (memories, emotions, sensations) maintained by defenses such as denial, dissociation, or addictive behaviors.
- Loss of distinction between the past and the present (disorientation)
- Psychological distress that manifests as physical symptoms (racing heartbeat, dizziness, diarrhea).
- Emotional vexations or frequent feelings of despair, sadness, anxiety, hopelessness, depression, and suicidal ideation.
Other Symptoms of CPTSD
- Irritability, outbursts of anger
- Social anxiety or paranoia
- Emotional eating
- Cutting one’s skin or pulling hair out
- Substance or alcohol addiction
- Recklessness, excessive risk-taking, impulsivity
- Relationship and intimacy problems
- Oversensitivity to pressuring situations
- Low self-esteem
- Engaging in distracting activities (video games, binge-watching)
The Silver Lining
The diagnosis of CPTSD is not the end of the road. Pete Walker, a psychotherapist and former CPTSD sufferer, explains how recovering from CPTSD is challenging but doable. He said the CPTSD is a learned set of responses, and what is learned can be unlearned. Unlike other mental health disorders, genetics has no role in its development. It is neither inborn nor trait-based. What your parents failed to give you (e.g., love, attention, motivation) can now be provided by yourself and others. Healing from CPTSD has two important aspects: self-help and relational component. Relational healing can come from friends, partners, counselors, teachers, therapists, and therapy groups. However, survivors of childhood trauma are often plagued with extreme distrust of other people from years of being betrayed by their parents and families. In this case, other therapeutic options can be considered such as workbooks, self-help websites, and pets.