Understanding Complex PTSD: Causes, Symptoms, and Healing

Trauma can leave lasting scars. While most people think of PTSD (Post-Traumatic Stress Disorder) as the aftermath of a single, horrific event, there's a lesser-known condition called Complex PTSD (C-PTSD) that arises from repeated or prolonged exposure to trauma.

Often rooted in childhood experiences of abuse or neglect, C-PTSD goes beyond flashbacks and nightmares. It can manifest as a complex web of emotional, psychological, and behavioral issues that significantly impact a person's life. In this article, I explore the causes, symptoms, and treatment options for C-PTSD, offering hope and resources for healing.

Complex PTSD (C-PTSD)

Complex PTSD (C-PTSD) is a mental health condition that arises from repeated or prolonged exposure to trauma, often during childhood. Unlike PTSD, which focuses on a single traumatic event, C-PTSD develops due to experiencing ongoing or inescapable traumatic situations. This can disrupt a person's ability to form healthy attachments and lead to a complex interplay of emotional, psychological, and behavioral symptoms that significantly impact their daily life.

The symptoms of C-PTSD can be severe and debilitating, encompassing both emotional and behavioral aspects. Some common symptoms include:

• Emotional dysregulation: Difficulty managing emotions like anger, sadness, or fear.

• Negative self-concept: Feelings of shame, guilt, worthlessness, and self-blame.

• Dissociation: Detachment from oneself or reality, which can manifest as amnesia, feeling like an observer in one's own body, or even Dissociative Identity Disorder (DID).

• Flashbacks and nightmares related to the trauma.

• Difficulty with relationships: Challenges trusting others and maintaining healthy connections.

• Self-destructive behaviors: Substance abuse, self-harm, etc.

• Difficulty controlling anger and aggression.

• Social isolation and withdrawal.

• Eating disorders.

Complex PTSD occurs when an individual is exposed to severe trauma for an extended period and is unable to escape from it. Some of the earliest cases of this were identified during the Vietnam War when soldiers faced extended combat, captivity, or traumatic environments without means of escape.

Another instance of complex post-traumatic stress disorder is observed in children enduring prolonged domestic or physical abuse without any means of escape.

CPTSD is more prevalent in women (with over 90% of c-PTSD cases occurring in women) and is associated with both psychological and physical health issues (such as depression, substance use, self-injury, suicidal behaviors, anorexia, bulimia, and eating disorders).

Specific symptoms of complex PTSD include loss of self-identity, loss of a sense of safety, feelings of captivity, an inability to trust, low self-worth, and an increased likelihood of suffering further victimization.

It's evident that all of these symptoms directly stem from the prolonged and chronic trauma experienced by these individuals. The loss of self-identity is perhaps the most significant symptom associated with this particular subtype of the disorder. Detachment from oneself and reality gives rise to a plethora of additional symptoms that profoundly impact the sufferer.

Attachment disorder is also linked to chronic PTSD sufferers, resulting in difficulties relating to others, especially their children with whom they fail to establish proper emotional connections. They might struggle to interact appropriately with their children and other individuals.

The symptoms of complex PTSD are notably more severe than those of typical PTSD, encompassing severe behavioral challenges.

Individuals suffering from complex PTSD often resort to alcohol or drug abuse. They also often develop eating disorders and experience extreme aggression. They also find it very difficult to control intense emotions such as panic and anger. They may experience persistent sadness and depression. Suicidal thoughts also enter their minds. They also feel unsafe most of the time, if not all the time. Distrust eats up their thoughts and they become preoccupied with the idea of revenge.

Other mental difficulties and disorders also start to manifest. Some suffer from amnesia and dissociation. Because patients lose their coherent sense of self, some find themselves having Dissociative Identity Disorder, also known as Multiple Personality Disorder, a serious mental condition. Borderline Personality Disorder is also highly indicative of Complex PTSD.

  Read also → CPTSD vs. BPD: Understanding the Differences and Similarities

Regrettably, the majority of individuals who undergo C-PTSD do not receive treatment, and even among those who do, adequate and effective treatment is often lacking.

C-PTSD Symptoms and Behaviors

The symptoms that constitute CPTSD are those that are characteristic of PTSD. These include: 

• intrusive, unwanted thoughts, images, or memories of the trauma or trauma-related experiences; 
• flashbacks, nightmares, or reliving the traumatic event(s);
• emotional numbing or detachment; avoidance of trauma-related emotions; and
• hyper-arousal; negative self-concept; and negative self-image.

The symptoms of C-PTSD are similar to those of PTSD, with individuals with C-PTSD often experiencing additional symptoms such as depression, anxiety, substance abuse, dissociative symptoms, and a history of suicide attempts. These symptoms also tend to persist, and C-PTSD is characterized by difficulties in emotional regulation, affect regulation, and relational and attachment problems.

Furthermore, people with C-PTSD struggle with self-image, potentially resulting in poor self-esteem, low self-efficacy, and a sense of hopelessness. They might have low self-worth and employ inadequate coping strategies, leading to challenges in maintaining relationships. These symptoms are frequently chronic and can be triggered or exacerbated by specific events, places, or people.

The 17 Symptoms of Complex PTSD

Understanding the symptoms of C-PTSD is crucial for recognizing and addressing the condition. Here are the 17 key symptoms:

1. Emotional Dysregulation: People with C-PTSD often struggle to manage their emotions. They may experience extreme mood swings and overwhelming feelings of anger, sadness, or anxiety that can be difficult to control.

2. Distorted Self-Perception: A pervasive sense of helplessness, guilt, or shame is common. Individuals might believe they are worthless or that they are permanently damaged due to their traumatic experiences.

3. Difficulty with Relationships: C-PTSD can severely impact personal relationships. Trust issues, fear of intimacy, and challenges in forming healthy attachments often arise.

4. Dissociation: Dissociation involves feeling disconnected from oneself or one’s surroundings. This can manifest as feeling detached from one’s body or experiencing gaps in memory.

5. Persistent Sadness: Chronic feelings of sadness or depression that do not seem to have an obvious cause are prevalent in those with C-PTSD.

6. Hypervigilance: A constant state of alertness and being on edge, always anticipating danger, even in safe environments.

7. Nightmares and Flashbacks: Re-experiencing the traumatic events through distressing dreams or vivid flashbacks can be a daily struggle for individuals with C-PTSD.

8. Avoidance: Avoiding places, people, or activities that remind them of the trauma, which can significantly limit their daily functioning and enjoyment of life.

9. Feelings of Hopelessness: A pervasive sense of hopelessness and despair about the future makes it difficult to envision positive outcomes.

10. Memory Issues: Problems with memory, including difficulty recalling certain parts of the traumatic events or general forgetfulness.

11. Physical Symptoms: Chronic pain, headaches, and gastrointestinal issues can occur without a clear medical explanation, linked to the body's response to long-term stress.

12. Loss of Interest: A significant loss of interest in activities that were once enjoyable, often overlapping with feelings of depression.

13. Self-Destructive Behavior: Engaging in risky or harmful behaviors, such as substance abuse, self-harm, or reckless activities, as a coping mechanism.

14. Feeling Different from Others: A sense of being fundamentally different or separated from other people, often feeling that no one else can understand their experiences.

15. Difficulty Concentrating: Problems with focus and concentration can interfere with work, school, and daily tasks.

16. Emotional Numbness: An inability to feel emotions fully, leading to a sense of numbness or detachment from feelings.

17. Overwhelming Guilt and Shame: Persistent feelings of guilt and shame, often irrational, about the traumatic events or their perceived inadequacies.

Reference:

National Center for PTSD. (2023, July). Complex PTSD: Posttraumatic stress disorder. Veterans Affairs Department.

PTSD vs CPTSD

CPTSD is different from PTSD in several ways. CPTSD is an umbrella term that refers to a form of PTSD that has many other features and symptoms that are not present in PTSD. For example, C-PTSD is characterized by the presence of complex trauma, a long duration of injury, and multiple life traumas, as well as an inability to process trauma-related memories.

Unlike PTSD which sometimes develops from exposure to a single traumatic event (e.g., rape, witnessing a dangerous, terrifying incident), C-PTSD, on the other hand, develops from chronic, repetitive trauma where there is generally no possibility of escape from the perpetrator and oftentimes when the victim is kept under the control of the abuser.

Examples include those subjected to captivity, torture, concentration camps, victims/refugees of human trafficking, organized child exploitation rings, or victims of long-term domestic violence or child abuse – most notably physical and sexual abuse.

C-PTSD is also associated with a negative self-concept and a negative self-image.

In addition, C-PTSD is characterized by the presence of dissociative symptoms, which can be intense and distressing.

The diagnostic criteria for C-PTSD are based on the presence of trauma in the past, unlike PTSD, which is the result of past trauma.

The mental health professional who diagnoses a patient with C-PTSD will typically also evaluate the patient for the presence of PTSD using one of the established screening tools, as well as assess for other trauma-related problems, such as personality disorders, substance abuse, and mood disorders.

C-PTSD Triggers

C-PTSD Triggers can be anything that reminds you of your trauma. It can be a person, place, thing, or even a smell. These triggers can even be anything from a loud noise to a certain smell. Anything that brings back memories of your trauma can be a trigger.

For some, one of her triggers is her home. She says,

"I grew up in a very abusive home. Anytime I go back, it triggers all of my PTSD symptoms. I have to be very careful when I'm around my trigger. I have to make sure that I'm in a safe place, and that I have people with me who can support me if I start to have a panic attack or flashbacks..."

If you have triggers, it's important to identify them and to have a plan for what to do when you're around them. It can be helpful to keep a journal and to track when your symptoms occur. Once you start to see a pattern, you can begin to work on identifying your triggers. If you're not sure what your triggers are, it's a good idea to talk to a therapist who can help you figure them out.

What can cause C-PTSD?

Complex PTSD (C-PTSD) develops from repeated or prolonged exposure to traumatic events. These events can last for months or even years and overwhelm a person's ability to cope. Here are some examples:

• Chronic abuse or neglect: This can include physical, emotional, or sexual abuse, or neglect of a child's basic needs.

• Intimate partner violence: Witnessing or experiencing violence or threats from a romantic partner can be highly damaging.

• Bullying: Repeated physical or emotional bullying, both in person and online, can lead to C-PTSD.

• Disasters and violence: Witnessing or surviving natural disasters, wars, accidents, or other violent events can be traumatic.

• Repeated exposure to traumatic news: People in professions like healthcare workers who frequently deliver difficult news may be at risk.

• Captivity or human trafficking: Being held captive or forced into sex trafficking can be a terrifying and isolating ordeal.

Increased Vulnerability

While anyone can develop C-PTSD from trauma, some people are more vulnerable. These include:

• Those who experience trauma during childhood: A developing child's sense of safety and self-worth is highly dependent on their caregivers. Trauma from a trusted adult can be particularly damaging.

• Individuals with a family history of mental health issues: Certain mental health conditions may increase susceptibility to C-PTSD.

• Those who lack social support: A strong support system can be a crucial buffer against the effects of trauma.

Long-Term Impact

In individuals with C-PTSD, the trauma can have a profound impact on their nervous system, particularly regarding attachment and relationships. This can make it difficult to form healthy and trusting bonds with others.

    You may read also: Understanding Trauma Bonding: 7 Stages and 10 Signs

Why does C-PTSD happen?

Traumatic events can have long-term effects on the brain, particularly the amygdala, hippocampus, and prefrontal cortex, which are responsible for memory and response to stress. In a traumatic situation, the mind suspends normal operations, such as digestion, and instead prepares to fight, flee, or freeze. Trauma can cause memories to be stored randomly, in pieces, throughout the brain, and when triggered, these memories may be presented as real-time information.

C-PTSD is caused by prolonged, extreme, or repetitive trauma, which physiologically changes the brain. This causes hypervigilance, inappropriate fear responses, and impaired regulation of fear responses.

Symptoms of C-PTSD include emotional and physical reactions, such as shortness of breath, tight muscles, racing heart, hypervigilance, and avoidance of trauma reminders. The symptoms can lead to a vicious cycle of avoidance, hyper-arousal, and emotional numbing, perpetuating the symptoms clusters.

C-PTSD is a real physical injury that can last for years, and the symptoms can get worse over time.

Diagnosing Complex PTSD

Complex PTSD shares many symptoms with Post-Traumatic Stress Disorder (PTSD), but it also involves difficulties managing emotions, how you view yourself, and your relationships.

Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) doesn't have a separate category for C-PTSD. Instead, it recognizes a similar condition called "Complex PTSD: Disorder of Extreme Stress Not Otherwise Specified" (DESNOS). This includes additional symptoms related to struggles with self-organization.

Some mental health professionals use the International Classification of Diseases, 11th Revision (ICD-11), which includes a diagnosis of complex PTSD.

Getting diagnosed with C-PTSD involves a comprehensive assessment by a therapist. This typically includes:

• Clinical Interview: The therapist will ask you about your personal history, including any traumatic experiences and the symptoms you're experiencing.

• Symptom Assessment: They'll evaluate your symptoms and how they affect your emotions, relationships, and daily life.

• Psychological Testing: In some cases, tests may be used to gather more information about your symptoms and functioning, and to rule out other diagnoses.

Diagnosing C-PTSD can be complex, and therapists may have different approaches. While not all medical organizations recognize it as a separate disorder, many argue that the long-lasting, repeated nature of the trauma and its effects justify classifying it as a distinct diagnosis.

C-PTSD Treatment

CPTSD is treated in a similar way to PTSD, with several unique aspects. First and foremost, trauma-related memories need to be processed through one of the most effective ways of processing memories: EMDR (Eye Movement Desensitization and Reprocessing). Processing trauma-related memories through EMDR is probably the most effective empirically supported treatment for C-PTSD.

Next, because of the difficulty in processing trauma-related memories, cognitive behavioral therapy (CBT) is one of the most effective treatments for C-PTSD.

Lastly, there are additional considerations for treating CPTSD. For example, people with C-PTSD often have co-occurring conditions such as depression, substance use/abuse/addiction, or anxiety. These conditions must also be treated for the treatment to be effective.

Treatment for Complex PTSD is a little different from the usual PTSD in several important ways. Treatments for PTSD focus on the impact of specific events in the past and the processing of trauma memories. Treatments for Complex PTSD should also focus on problems that lead to more functional impairment. These problems are dissociation, interpersonal problems, and emotional dysregulation.

Some patients with Complex PTSD are treated with Cognitive Behavioral Therapy along with psychoeducation and other approaches. For some patients, especially children, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is used and is considered to be highly effective. This treatment focuses on post-traumatic, depressive, and anxiety symptoms. It also addresses trauma-associated cognitive distortions. TF-CBT includes several core components which include psychoeducation, cognitive processing, creation of a trauma narrative, and Affect Regulation skills.

EMDR (Eye movement desensitization and reprocessing) – a fairly new, nontraditional type of interactive psychotherapy technique – is effectively used to treat PTSD as well as complex PTSD.

EMDR was discovered in 1987 by Francine Shapiro. Originally, it focused on the healing effects of eye movements on disturbing thoughts and feelings. Later, it was discovered that a variety of stimulation that affects the left and right sides of the body can help process out of our system negative, even traumatic memories. It doesn't erase memories, but it does reduce, sometimes greatly, the upset about those memories.

Treatment for complex post-traumatic stress disorder involves the standard approaches used for PTSD, while also requiring its distinct treatments. Individuals with complex PTSD need to regain their sense of trust and safety, often before they can engage in other therapeutic interventions.

Therapists must make the person with C-PTSD feel safe and recognize the distinction between the present and the traumatic past. The therapist must also help the individual rebuild their sense of emotional engagement with others, and help deal with the sense of isolation and detachment they experience.

Cognitive behavior therapy can also be used to help deal with the problems presented by complex PTSD e.g. learning how to recognize and deal with irrational or negative thoughts.

In addition to therapy, there are self-help strategies that individuals can incorporate into their healing journey. These strategies can help manage symptoms, improve emotional regulation, and promote overall well-being. Some examples include mindfulness practices, relaxation techniques such as deep breathing or progressive muscle relaxation, and journaling to process thoughts and emotions.

Antidepressants and anti-anxiety medications are often used to ease symptoms of C-PTSD so that therapy can go forward. This is the key... getting your symptoms under control enough so that you can deal with just the everyday stressors in a more normal and healthy way so that you can work on the bigger issues.

Medication has both its pros, cons, and risks, but when used 'properly' it can play a very useful role in treating and managing many PTSD symptoms especially if it is used in conjunction with other forms of therapy.

There is no one drug that will cure C-PTSD and nothing can replace therapy itself because without therapy the drugs are only Band-Aids for a wound that will not heal until it is properly treated and cared for. 'Re-training' your brain and body is what this whole process of healing is about.

Complex PTSD Support Groups

Support groups can be a valuable resource for people with CPTSD. They can be another extremely useful form of therapy in the sense you can meet and talk with others facing the same issues you are. Being able to relate to others facing the same problems as you eases that feeling that you are in this alone and having someone there for you when things get rough makes it so much easier to handle C-PTSD.

If you're looking for C-PTSD support groups, here are a few steps you can take:

Ask Your Therapist: If you're already seeing a therapist or counselor, ask them if they know of any C-PTSD support groups. They may have recommendations tailored to your needs.

Online Resources: Search for online C-PTSD support groups on platforms like Reddit, Facebook, or specialized mental health websites. Websites such as Psych Central, DailyStrength, and HealthUnlocked might host relevant communities.

Therapist or Mental Health Professional Recommendations: Reach out to mental health professionals, therapists, or counselors who specialize in trauma therapy. They often have information about local or online support groups that can be beneficial for C-PTSD.

Mental Health Organizations: Contact mental health organizations like the National Alliance on Mental Illness (NAMI) or the Anxiety and Depression Association of America (ADAA). They might provide resources or information about support groups focused on trauma-related conditions.

Local Mental Health Centers: Check with local mental health centers, community centers, or hospitals. They might offer support groups specifically designed for individuals dealing with trauma-related conditions.

Therapy Apps and Online Platforms: Explore therapy apps and platforms that offer virtual support groups. Some platforms connect you with therapists and peers who can provide guidance and understanding.

Finding the right support group is important. Look for groups led by trained facilitators that maintain a respectful and empathetic atmosphere, and prioritize the well-being of their members. It's also a good idea to attend a few sessions before deciding if a particular group is a good fit for you.

List of CPTSD Support Groups

The CPTSD Foundation: This organization offers a variety of support groups, both in-person and online. Their website has a search tool that allows you to find groups in your area or online. You can also sign up for their mailing list to receive updates about upcoming events and resources.

The CPTSD Foundation is a great resource for information on complex PTSD. Their website provides comprehensive information on the symptoms, behaviors, and treatment of C-PTSD. You can find more information at https://cptsdfoundation.org/.

The National Alliance on Mental Illness (NAMI): This organization has support groups for people with all types of mental health conditions, including CPTSD. Their website has a searchable database of support groups in your area. You can also call their helpline at 1-800-950-NAMI (6264) to get help finding a group.

The Rape, Abuse & Incest National Network (RAINN): This organization offers support groups for survivors of sexual violence, including CPTSD. Their website has a searchable database of support groups in your area. You can also call their helpline at 1-800-656-HOPE (4673) to get help finding a group.

The National Child Traumatic Stress Network (NCTSN): This organization has a directory of support groups for children and adults who have experienced trauma, including CPTSD. Their website allows you to search for groups by location, age, and type of trauma. You can also call their helpline at 1-800-422-4453 to get help finding a group.

The Complex PTSD Society: This organization offers a variety of resources for people with CPTSD, including support groups. Their website has a list of support groups in your area. You can also call their helpline at 1-800-273-TALK (8255) to get help finding a group.

  Read also: PTSD: Test, Tips, Treatment & Coping with Flashbacks

Complex PTSD prognosis

When it comes to the prognosis for people with Complex PTSD, the outlook is generally positive. While there is no “cure” for PTSD, with treatment and support, many people can manage their symptoms and live relatively normal lives.

That said, everyone is different and recovery from Complex PTSD can be a lifelong process. Some people may struggle with some symptoms, particularly if they experience very severe trauma. But even for those people, there is hope that things can get better. With time, healing is possible.

How to Help and Support Someone with C-PTSD

If you know someone who is struggling with c-PTSD, there are ways you can help and support them. Here are some tips:

• Educate yourself about c-PTSD. The more you know about the condition, the better equipped you will be to help and support your friend or family member.

• Listen to them.  It can be helpful for someone with complex PTSD to talk about their experiences and to be heard. Let your friend or family member vent, cry, or just talk. You don’t need to have all the answers; just being a good listener – without judgment, criticism, or advice – can be a significant help.

• Offer practical support. If the person you care about is struggling with daily tasks, offer to help out where you can. This may include things like assisting with childcare, grocery shopping, or running errands.

• Help them to avoid triggers. Certain things can trigger c-PTSD symptoms. Assist your friend or loved one in avoiding these triggers. It's important for someone with complex PTSD to feel safe and supported in their environment. This may involve creating boundaries with certain people or situations, or providing emotional support when needed.

• Encourage healthy coping mechanisms. Help the person you care about find healthy ways to cope with their symptoms. This could involve exercise, relaxation techniques, or journaling.

• Help them to create a support network. This can include friends, family, a therapist, or a support group for people with complex PTSD.

• Help them find professional help. Your friend or family member may need professional assistance. Offer to help them find a therapist or other mental health professional.

• If you are struggling to support them, seek out help for yourself as well. This can be in the form of counseling, support groups, or simply talking to a trusted friend or family member.

• Be patient and support their recovery. Recovery from c-PTSD is possible. However, it can take a long time for someone with c-PTSD to heal and recover. Your friend or family member may have good days and bad days. It’s important to be patient and understand that this is part of the process. Support them as they work on recovery.

• Take care of yourself, too. Take care of yourself while you're supporting someone else. Make sure to schedule time for your self-care so you don't get too overwhelmed.

Conclusion

Complex PTSD is a challenging condition that stems from repeated and prolonged exposure to trauma. It can significantly impact an individual's emotional well-being, relationships, and overall quality of life. However, with the right support, treatment, and coping strategies, healing and recovery are possible.

If you or someone you know is affected by Complex PTSD, remember that you are not alone. Reach out to mental health professionals, support groups, and loved ones who can provide the understanding and support needed on the path to healing. With time, resilience, and appropriate interventions, it is possible to overcome the challenges posed by Complex PTSD and reclaim a fulfilling life.

FAQs about Complex PTSD

Q1. Is Complex PTSD a lifelong condition?

Ans: Complex PTSD can have long-lasting effects, but with appropriate treatment and support, individuals can experience significant healing and improve their quality of life.

Q2. Can Complex PTSD be cured?

Ans: While there is no definitive "cure" for Complex PTSD, recovery is possible with appropriate treatment and support. With therapy, coping skills development, and self-care practices, individuals can experience significant improvements in their quality of life and overall well-being.

Q3. Are there any medications specifically for Complex PTSD?

Ans: There are no medications specifically approved for Complex PTSD. However, certain medications may be prescribed to manage associated symptoms such as anxiety, depression, or sleep disturbances. Therapy is the primary treatment approach. It is crucial to consult with a psychiatrist to discuss the potential benefits and risks of medication options.

Q4. Is it possible to develop resilience after experiencing Complex PTSD?

Ans: Yes, resilience can be cultivated and developed after experiencing Complex PTSD. With proper support, therapy, and self-care practices, individuals can learn to navigate their trauma and build resilience, allowing them to lead fulfilling lives despite their past experiences.

Q5. How can I support a loved one with Complex PTSD?

Ans: Supporting a loved one with Complex PTSD requires empathy, patience, and understanding. Educate yourself about the condition, listen actively, and validate their experiences. Encourage them to seek professional help and provide support in their healing journey. Avoid judgment and be present to lend a compassionate ear when needed.