This form of PTSD results from repeated, prolonged trauma. Experts often use a multipronged approach to treat it. C-PTSD may be familiar to many a surviving-victim of CSA!
BY MATTHEW TULL, PHD
MEDICALLY REVIEWED BY IVY KWONG, LMFT
Complex post-traumatic stress disorder (sometimes called complex PTSD or C-PTSD) is an anxiety condition that involves many of the same symptoms of PTSD, along with other symptoms.
First recognized as a condition that affects war veterans, post-traumatic stress disorder can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse.
When the underlying trauma is repeated and ongoing, though, some mental health professionals consider it C-PTSD.
The condition has gained attention in the years since it was first described in the late 1980s. However, it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the tool that mental health professionals use to diagnose mental health conditions.
PTSD vs. C-PTSD
PTSD and C-PTSD are a result of something deeply traumatic happening and can cause flashbacks, nightmares, and insomnia. Both conditions can also make you feel intensely afraid and unsafe even though the danger has passed. Despite these similarities, though, there are key differences, according to some experts.
The main difference is the frequency of the trauma. While PTSD is triggered by a single traumatic event, C-PTSD is caused by long-lasting trauma that continues or repeats for months, even years (commonly referred to as “complex trauma”). Another difference: C-PTSD is typically the result of childhood trauma.
The harmful effects of oppression and racism can add layers to the complex trauma—particularly if the justice system is involved.
The psychological and developmental impacts of complex trauma early in life are often more severe than a single traumatic experience—so different, in fact, that many experts believe that the PTSD diagnostic criteria don’t adequately describe the wide-ranging, long-lasting consequences of C-PTSD.
● Caused by long-term, repeated trauma
● Typically arises from childhood experiences
● Often occurs in those who have endured racism and oppression
● Usually more severe than PTSD
● Caused by a single event
● Can result from trauma experienced at any age
● Usually milder than C-PTSD
Symptoms of C-PTSD
In addition to all of the core symptoms of PTSD—reexperiencing, avoidance, and hyperarousal—C-PTSD symptoms generally also include:
DIFFICULTY CONTROLLING EMOTIONS. It’s common for someone suffering from C-PTSD to lose control over their emotions, which can manifest as explosive anger, persistent sadness, depression, and suicidal thoughts.
NEGATIVE SELF-VIEW. C-PTSD can cause a person to view themselves in a negative light. They may feel helpless, guilty, or ashamed. They often have a sense of being completely different from others.
TROUBLE WITH RELATIONSHIPS. People with C-PTSD may avoid relationships or develop unhealthy relationships because that is what they knew in the past.
DETACHMENT FROM THE TRAUMA. A person may disconnect from themselves (depersonalization) and the world around them (derealization). Some people might even forget their trauma.
LOSS OF BELIEFS AND FAITH. Another symptom can be losing core beliefs, values, religious faith, or hope in the world and other people.
All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of life.
Making a Diagnosis
Although C-PTSD comes with its own set of symptoms, some believe the condition is too similar to PTSD (and other trauma-related conditions) to warrant a separate diagnosis. As a result, the DSM-5 lumps symptoms of C-PTSD together with PTSD. Therefore it isn’t officially recognized by the American Psychiatric Association.
Many mental health professionals recognize C-PTSD as a separate condition, because the traditional symptoms of PTSD do not fully capture some of the unique characteristics shown in people who experienced repeat trauma.
In 2018, the World Health Organization made the decision to include C-PTSD as its own separate diagnosis in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems.
Because the condition is relatively new, doctors may make a diagnosis of PTSD instead of C-PTSD. Since there is not a specific test to determine the difference between PTSD and C-PTSD, you should keep track of the symptoms you have experienced so that you can describe them to your doctor.
Treatment for the two conditions is similar, but you may want to discuss some of your additional symptoms of complex trauma so your doctor or therapist can also address them.
C-PTSD can also share signs and symptoms with borderline personality disorder (BPD). Although BPD doesn’t always have its roots in trauma, this is often the case. In fact, some researchers and psychologists advocate for putting BPD under the umbrella of C-PTSD in future editions of the DSM to acknowledge the link to trauma, foster a better understanding of BPD, and help people with BPD face less stigma.
Identifying the Cause
C-PTSD is believed to be caused by severe, repetitive abuse over a long period of time. The abuse often occurs at vulnerable times in a person’s life—such as early childhood or adolescence—and can create lifelong challenges.
Traumatic stress can have a number of effects on the brain. Research suggests that trauma is associated with lasting changes in key areas of the brain including the amygdala, hippocampus, and prefrontal cortex.
The types of long-term traumatic events that can lead to C-PTSD include the following: child abuse, neglect, or abandonment; domestic violence; genocide; childhood soldiering; torture; and slavery.
In these types of trauma, a victim is under the control of another person and does not have the ability to easily escape.
The Latest Treatment
Because the DSM-5 does not currently provide specific diagnostic criteria for C-PTSD, it’s possible to be diagnosed with PTSD when C-PTSD may be a more accurate assessment of your symptoms. Despite the complexity and severity of the disorder, C-PTSD can be treated with many of the same strategies as PTSD, including:
Medications may help reduce symptoms of C-PTSD, such as anxiety or depression. They are especially helpful when used in combination with psychotherapy. Antidepressants including Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline) are often used to treat C-PTSD.
Psychotherapy for C-PTSD focuses on identifying traumatic memories and negative thought patterns, replacing them with more realistic and positive ones, and learning to cope more adaptively to the impact of your trauma.
One type of psychotherapy that may be used to treat both PTSD and complex PTSD is known as eye movement desensitization and reprocessing (EMDR). This approach uses eye movements guided by the therapist to process and reframe traumatic memories. Over time, this process is supposed to reduce the negative feelings associated with the traumatic memory.
Coping With C-PTSD
Treatments for complex PTSD can take time, so it is important to find ways to manage and cope with the symptoms of the condition. Some strategies that may help you manage your recovery:
FIND SUPPORT. Like PTSD, C-PTSD often leads people to withdraw from friends and family. However, having a strong social support network is important for mental well-being. When you are feeling overwhelmed, angry, anxious, or fearful, reach out to a trusted friend or family member.
Research has found that writing in a journal can be helpful in managing PTSD symptoms and decreases symptoms of flashbacks, intrusive thoughts, and nightmares.
PRACTICE MINDFULNESS: C-PTSD can lead to feelings of stress, anxiety, and depression. Mindfulness is a strategy that can help you become more aware of what you are feeling in the moment and combat feelings of distress. This practice involves learning different ways to tune into your body and focus on staying in the present moment.
WRITE DOWN YOUR THOUGHTS: Research has found that writing in a journal can be a useful tool for managing PTSD symptoms; it decreases symptoms including flashbacks, intrusive thoughts, and nightmares.
Keeping a journal can be a handy way to track symptoms so that you can later discuss them with your therapist.
Support groups and self-help books can also be helpful when dealing with complex PTSD. Two recommended books that address this topic are The Body Keeps the Score by Bessel van der Kolk, MD, and Complex PTSD: From Surviving to Thriving by Pete Walker.
It can feel overwhelming if you or someone you care about has been exposed to repeated trauma and is struggling to cope. But remember that it’s important to seek help from a therapist who is experienced treating PTSD.
You might also want to contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357; they can provide information on support and treatment facilities in your area.
In addition, you can do a search online to locate mental health providers in your area who specialize in PTSD. The bottom line? You don’t have to go it alone.
Tull, M. (2023). What is Complex PTSD? VeryWell Publishing. Retrieved http://apple.news/ADSJf7fEbSYSaDSpkxkqhaA.