A Look at Complex PTSD
There has been growing awareness in recent years of an insidious and nebulous condition, a state of enduring psychological injury referred to as Complex Post-Traumatic Stress Disorder, or, more commonly, Complex PTSD, CPTSD or C-PTSD. There are some who call it Childhood PTSD, which is technically incorrect, but does underscore the tendency for this condition to arise from experiences in childhood (though it can also have its origin later in life, in some cases).
In this blog post, I'll write a little about what Complex PTSD is, some of its more prevalent symptoms, its status as a diagnosis, and the most effective treatments. This is a particular area of interest for me, as it describes much of my own personal experience, and by extension, it is where I am most passionate focusing my energy as a counsellor. I believe that this condition is vastly more common and devastating than most realize (and most outside of the mental health field have never heard of it) so I do whatever I can do to spread awareness and support for people struggling beneath the weight of CPTSD.
What is CPTSD? What sets it apart from PTSD?
We've all heard of Post-Traumatic Stress Disorder (PTSD), a state of prolonged activation and dysregulation stemming from a specific, overwhelming traumatic incident such as a car accident, a violent attack, a natural disaster or acute medical crisis. Complex PTSD shares many of the same symptoms as "regular" PTSD, with some key differences in its development, symptomology and treatment. It must also be noted that both can be present in the same individual.
The most fundamental difference between the two is that Complex PTSD develops from prolonged or repeated exposure to traumatic circumstances, rather than an isolated incident. This can look like extreme situations such as living in a war zone or being a victim of sex trafficking, and it can also look like childhood abuse or emotional neglect, schoolyard bullying, economic instability or chronic illness and invasive medical interventions. The most common source of Complex PTSD is one's family of origin. There are so many among us who are tragically afflicted by the consequences of growing up with substance-addicted or narcissistic parents, or simply parents who were well-intentioned but emotionally unavailable because of their own baggage or immaturity.
Throughout our lives, but particularly when we are young, our nervous systems adapt to our environments and experiences. An individual who experiences life as mostly being safe and stable will develop a nervous system which defaults to a state of flexibility, relaxation and regulation, whereas someone who is chronically exposed to intensely stressful circumstances will typically develop a nervous system which defaults to a state of hyper-activation, constant fight-or-flight response, and a high anxiety baseline. Furthermore, those who have grown up in traumatic environments experience alterations in brain development, with the limbic system (the so-called reptilian brain, which manages threat response and base emotions) growing larger and more sensitive, and the prefrontal cortex (which governs critical thinking, executive functioning, decision-making and language skills, among other things) shrinking and becoming less active. Because of these changes, sufferers of trauma - and especially complex trauma - tend to be more impulsive, more sensitive to emotional stimuli, and less able to manage their state through cognitive means. The effects of trauma cannot be fully undone, but with sustained effort over months and years, the nervous system can be retrained, and the traumatized person’s experience of life can become significantly more comfortable and regulated.
It is important to note that the Diagnostic and Statistical Manual of mental illnesses (the DSM-V) makes no mention of CPTSD, and does not consider it a distinct, diagnosable condition, rather considering it a subcategory of PTSD. However, the World Health Organization (WHO) does list CPTSD as an official diagnosis, and because of this, the condition exists in a grey area in terms of one's ability to seek diagnosis, recognition and effective treatment for it. That said, when one who suffers from this condition begins to discover resources explaining it, and finds others with similar experiences, this can be deeply validating, and can shine a light on the path forward, where previously there was little hope.
What are common features of CPTSD?
For those who have experienced ongoing traumatic experiences, especially during their developmental years, the effects of CPTSD can endure for decades, or even for the rest of their lives, if it is not treated with care and intention. It can present in a variety of ways, depending on many factors, but the most prevalent effects people experience are:
Chronic emotional dysregulation. This can look like being stuck in fight, flight or freeze, in a shut-down state, or being easily triggered.
Intensely negative self-concept and thought patterns, as well as overwhelming feelings of guilt and shame.
Intense difficulty forming and maintaining healthy relationships. Belief in being unworthy and deep fear of abandonment. Insecure attachment styles, and tendency towards loneliness and isolation.
General instability, which can manifest in difficulty holding onto jobs or having a grounded sense of home or belonging.
High rates of depression, anxiety and addictive behaviours.
Hypervigilance, or feeling constantly on high alert.
Insomnia and nightmares.
The experience of flashbacks and re-living traumatic experiences.
Somatic manifestations of disease, such as gastrointestinal and autoimmune disorders.
Cognitive difficulties - trouble concentrating, and brain fog.
A pervasive sense that the world is unsafe and people untrustworthy.
A tendency towards suicidal ideation and attempted suicide.
What treatments are effective for C-PTSD?
Because Complex PTSD is not universally recognized as a formally diagnosable condition, and because its character can vary from person to person, there has been some ambiguity in the mental health field about how to treat it. However, clear trends have been emerging in recent years, as it's become increasingly acknowledged both among practitioners and the general public. It is worth noting that, as with all treatment of mental health disorders, no one treatment or combination of treatments will be appropriate for every case of CPTSD, but there are a handful of methods that can be very effective.
As with conventional PTSD, there are three broad stages of treatment. The first is creating an environment of safety and stabilization, without which no meaningful healing can occur. The second is the actual processing of trauma, which can be done in a number of ways. And finally there is integration, meaning-making, and reconnecting with the self, with society and the world at large.
Some specific treatments which tend to be more helpful than others (especially in combination) are as follows:
Somatic Experiencing and other somatic processing methods
Dialectical Behavioural Therapy (DBT)
Cognitive Behaviour Therapy (CBT) - This is debated, as it focuses on cognition, whereas trauma resides primarily in the body, and effective treatment must address this.
Eye Movement Desensitization and Reprocessing (EMDR) - This too is debated. It is very effective in some cases, but is more appropriate for recovery from specific-incident trauma than chronic and complex manifestations.
Prolonged Exposure (PE) Therapy
Internal Family Systems (IFS) Therapy
Alternative therapies such as Narrative Therapy, Expressive Arts Therapy, psychedelic-assisted therapy and ecotherapy.
Antidepressant medications may be used to manage symptoms, but as with their use for all conditions, they merely numb symptoms, and do not address the underlying causes of the condition.
Additional resources such as support groups, journalling and mindfulness practices can be helpful in recovery.
Recovery from a chronic and debilitating condition such as Complex PTSD is a very gradual, and often non-linear process, and attempting to rush through it - especially if safety and stabilization are not prioritized - can be retraumatizing. One should expect healing to take years, and to be a perpetually on-going journey. It is debated whether one can ever completely heal from trauma, to the extent that it might as well have never happened. In reality, our experiences leave permanent imprints on us, and healing from trauma means using these challenging experiences to help us grow, and live ever more fulfilling and meaningful lives. Healing doesn't mean erasing the past; it means rewriting our stories and taking back control of our lives.
I know from my own experience, and the experiences of many whose stories I've had the privilege to hear, that healing absolutely is possible, and with the support of a skilled and compassionate therapist, there is abundant ground for hope.
