Complex PTSD (C-PTSD): Symptoms, Behaviors and Treatment

Complex PTSD

Complex PTSD (cPTSD or C-PTSD) is a chronic, relapsing, and comorbid psychiatric disorder, characterized by the presence of childhood abuse and neglect, prolonged exposure to traumatic events, and significant disruptions in the formation of healthy, secure attachments in the first years of life. The term “complex” in the name reflects the fact that c-PTSD is not a unitary disorder, but involves the presence of several types of post traumatic symptoms and problems with the treatment of these symptoms.

What is CPTSD

Complex PTSD (c-PTSD) is a form of PTSD that presents with symptoms of both PTSD and dissociation. This form of PTSD is characterized by flashbacks and/or recurrent reenactments of trauma.

CPTSD is characterized by the following:

• multiple and persistent traumatic events or trauma-related experiences,
• chronic and persistent trauma-related symptoms (e.g. flashbacks and nightmares),
• negative self-concept (e.g. blame, worthlessness), and
• chronic and persistent avoidance of trauma-related emotional states.

Complex PTSD occurs when a person is exposed to some severe trauma for a long period of time, and they are unable to escape from it. Some of the first cases of this came to light in the Vietnam War, after soldiers were fighting, or held in captivity for long periods of time or were held in a traumatic environment with no means of escape.

Another example of complex post-traumatic stress disorder is of children suffering domestic or physical abuse for a long period of time and again having no means to escape.

CPTSD is most prevalent in women (more than 90% of people with c-PTSD are women), and is associated with both psychological and physical health problems (e.g. depression, substance use, self-injurious and suicidal behaviors, anorexia, bulimia, and eating disorders).

The symptoms specific to complex PTSD are the loss of a sense of self, the loss of a sense of safety, feeling of captivity, inability to trust, low self-worth, and increased likelihood of suffering further victimization.

It is clear how all of these are directly attributable to the longer and more chronic form of the trauma experienced by these sufferers. The loss of a sense of self is perhaps the most significant symptom associated with this particular variety of the disorder. Detachment from oneself and reality bring with them a whole host of other symptoms which have huge impacts on the sufferer.

Attachment disorder is also associated with chronic PTSD sufferers, which results in them having difficulty relating to others; particularly their children who they fail to develop a proper emotional connection with. They may not be able to relate to and deal appropriately with their child, or other people.

The symptoms of complex PTSD are much more severe than the usual PTSD. These symptoms include severe behavioral difficulties.

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. (See also: Personality Disorders).

Unfortunately, most people who experience C-PTSD do not receive treatment, and those who do often do not receive adequate and effective treatment.

CPTSD Symptoms & 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;
• hyper-arousal; negative self-concept; and negative self-image.

The symptoms of c-PTSD are similar to those of PTSD, except that people with c-PTSD tend to have many other symptoms that include: depression, anxiety, substance abuse, dissociative symptoms, and a history of suicide attempts. These symptoms also tend to be persistent, and c-PTSD is marked by difficulties in emotional regulation, affect regulation, and relational and attachment problems.

In addition, people with c-PTSD have difficulty with self-image, and may have poor self-esteem, poor self-efficacy, and a sense of hopelessness. They may have low self-worth and poor coping strategies, and may find it difficult to maintain relationships. The symptoms are often chronic and may be triggered, or worsened, by certain events, places, or people.

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 someone, 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.

PTSD vs CPTSD

cPTSD is different from PTSD in a number of 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.

C-PTSD is also associated with 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.

It is important to note that the diagnostic criteria for C-PTSD are based on the presence of trauma in the past, unlike PTSD, which is the result of a 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.

Complex PTSD Causes

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, a victim/refugee of human trafficking, organized child exploitation rings, or victims of long-term domestic violence or child abuse – most notably that of physical and sexual abuse.

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 are able to 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 always struggle with some symptoms, particularly if they experienced very severe trauma. But even for those people, there is hope that things can get better. With time, healing is possible.

CPTSD 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 in order for 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 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 usual treatments for PTSD but requires its own treatments as well. Complex PTSD sufferers must regain their sense of trust and safety, usually before they can undergo other therapies. Therapists must make the sufferer feel safe and recognize the distinction between the present and the traumatic past. The therapist must also help the sufferer rebuild their sense of emotional engagement with others, and to 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.

Anti-depressant 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 pro's, con's 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.

Support groups can be another extremely useful form of therapy in the sense you are able to meet and talk with others facing the same issues you are. Being able to relate to others facing the same problems you are 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 PTSD or cPTSD.

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

Complex post-traumatic stress disorder is not recognized as a separate disorder by all medical organizations; however it is argued by many to be significantly different enough in terms of the chronic and repetitive nature of the trauma and its effects that it warrants its own classification.

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:

1. 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.
2. 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 big help.
3. 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 help with childcare, grocery shopping, or running errands.
4. Help them to avoid triggers. There are certain things that can trigger c-PTSD symptoms. Help your friend or loved one to avoid these triggers. It's important for someone with complex PTSD to feel safe and supported in their environment. This may mean creating boundaries with certain people or situations, or providing emotional support when needed.
5. 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.
6. Help them to create a support network. This can include friends, family, therapist, or a support group for people with complex PTSD.
7. Help them find professional help. Your friend or family member may need professional help. Offer to help them find a therapist or other mental health professional.
8. If you are struggling to support them, it’s important to 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.
9. 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.
10. Take care of yourself, too. It's important to take care of yourself while you're supporting someone else. Make sure to schedule time for your own self-care so you don't get too overwhelmed.

If you’re struggling with c-PTSD, know that you’re not alone. Seek out help from a therapist or other professional, and reach out to your friends and family for support.