Complex post-traumatic stress disorder (C-PTSD) describes a specific type of PTSD. Also known as developmental trauma, C-PTSD develops in response to long-term trauma or repeated traumatic incidents. This trauma often, but not always, occurs during childhood. This distinguishes it from post-traumatic stress disorder, which can occur after a single traumatic event at any time in life.
Although the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has recognized PTSD as a diagnosis since its third edition, it still does not include C-PTSD as a subtype. However, other research supports C-PTSD as a separate presentation.
The World Health Organization is a group that supports the existence of C-PTSD. It is included as a diagnosis in its 2018 publication of the International Statistical Classification of Diseases and Related Health Problems (ICD-11).
The diagnostic criteria for C-PTSD, according to the WHO classification, include many of the same symptoms as general PTSD, including:
-Symptoms of intrusion: flashbacks and nightmares
-Avoidance symptoms: emotional numbness; dissociation; avoidance of possible triggers
-Symptoms of reactivity: hypervigilance, insomnia, etc.
However, a diagnosis of C-PTSD also involves three additional categories. These include:
-Problems regulating emotions.
-Develop a negative self-image
-Problems with interpersonal relationships.
C-PTSD symptoms can manifest in many different ways. Some of the most common signs of C-PTSD are:
-Periods of intense depression, suicidal thoughts, or both
-Difficulty managing emotional impulses.
-Tending to see yourself in a negative light
-Decreased self-esteem or self-pity.
-Persistent or recurring feelings of shame or guilt.
-Losing faith in one's personal belief system or moral code.
-Having difficulties trusting your intimate partner or people in general.
Research suggests that C-PTSD may also contribute to feelings of helplessness, vulnerability, and anger toward the source of the trauma, especially when the trauma was caused by an abuser. These feelings can contribute to the desire for revenge.
Any of the following experiences may contribute to the development of C-PTSD:
-Child abuse
-Child neglect/neglect
-Emotional abuse
-Intimate partner violence
-Repeated sexual abuse
-Living as a refugee or prisoner of war, or living in a concentration camp.
In short, both PTSD and C-PTSD are caused by trauma. But experts consider C-PTSD to be the specific result of long-term trauma. People who face traumatic experiences over and over again, or live in violent, abusive or traumatizing situations, may develop C-PTSD.
Experts believe that the severity of a person's symptoms may depend on several factors, including:
-If the trauma occurred in childhood.
-If a parent or caregiver was responsible for the trauma
-If the person had any support during the period of trauma
-How long the trauma lasts
Experiencing trauma, or a shorter period of abuse or neglect/neglect, can also cause trauma, but this type of trauma often results in symptoms that fit standard PTSD criteria.
Coping with the long-term effects of trauma can affect emotional well-being and quality of life. C-PTSD can also create challenges in relationships. Experiencing abuse, pain, or other long-term distress can make it difficult to relate to others. Changes in mood and self-perception can also make someone feel like they are no longer the person they used to be. They may lose their sense of self or personal identity.
These and other effects of trauma can lead someone to withdraw from the people they love and isolate themselves. People may do this intentionally or unintentionally, simply because they find it difficult to be around other people. They may feel that others cannot relate or understand what they have been through, and they may also not want to talk about the trauma with anyone who has not experienced it themselves.
People who work with C-PTSD may also have trust issues. Experiencing long-term trauma can make it difficult to feel safe enough to trust other people again. It is possible to overcome these difficulties and learn to trust again, but it may require a patient partner and the help of a trained, compassionate counselor.
Victimization and helplessness can also lead some people living with C-PTSD to unknowingly seek out unhealthy relationships. These may share elements of the original toxic relationship, such as jealousy or passive aggression. Some people may be unconsciously using the current relationship as a way to "redo" or "fix" the past. Other people might be desperate to find a “savior” and ignore the warning signs. Again, treatment for C-PTSD can help by allowing people to learn to recognize the signs of unhealthy relationships and work to avoid them.
While the primary person affected by C-PTSD is, of course, the person who experienced the trauma, the impact of trauma can extend to family, romantic partners, and other loved ones. A partner who wants to offer support may feel hurt when he or she is avoided or excluded. Angry outbursts can make friends, loved ones, or children feel scared or worried. Dissociative episodes and loss of sense of identity can also make partners feel alone or as if their partner has become someone else.
A person living with C-PTSD cannot avoid any of these effects, just as their partner is not to blame. A person with C-PTSD can address their symptoms in therapy and see improvement in all areas of life. Couples therapy or family therapy can also be very beneficial for all members of a family affected by C-PTSD.
Psychotherapist specialized in EMDR,
trauma therapy and psychobody therapy
