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Complex PTSD
Complex post-traumatic stress disorder (c-PTSD or cPTSD) describes a set of disruptive symptoms that emerge after experiencing inescapable traumatic life events, especially those of a horrific or threatening nature or which recur or accumulate over a period of time. Such events are typically interpersonal, often involving abusive relationships with parents, caregivers, or other responsible adults at a young age. It may also be sparked by torture, the experience of being a refugee or asylum seeker, being held in a concentration camp or as a slave, or living through a genocidal campaign or other organized campaigns of violence.
Someone experiencing complex PTSD may struggle to control their anger, may make self-destructive decisions, have low self-esteem, find it difficult to trust others or find intimacy in relationships, or generally feel guilt, hopelessness, worthlessness, or despair. Any or all of these symptoms can hamper their everyday functioning.
For more, see Post-Traumatic Stress Disorder.
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Complex PTSD is not a recognized diagnosis in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), partly due to its overlap with symptoms of PTSD. However, it is recognized in the World Health Organization’s International Classification of Diseases (ICD).
Post-traumatic stress disorder can emerge after surviving a powerfully disturbing experience of any kind, such as a physical attack, sexual assault, or car accident, or witnessing a death or surviving a natural disaster. Complex PTSD is understood as more likely to develop after a repeated or chronic series of abusive or hurtful incidents lasting months or even years, especially during childhood, and the symptoms of c-PTSD tend to be more severe, and longer-lasting, than for those living with PTSD.
People living with c-PTSD tend to experience greater intrapersonal strife: They have a more negative perception of themselves; they may feel shame and have a sense that they are different from everyone else. They may also experience more volatile or chaotic personal relationships and greater emotional dysfunction—for example, they can be more prone to rage. And they are more likely than those with PTSD to engage in impulsive, risky, or self-destructive behavior.
According to the ICD, complex PTSD may be present when someone experiences, for a period of at least several weeks, all three of the core elements of post-traumatic stress disorder:
* Re-experiencing the event through vivid intrusive memories, flashbacks, or repeated dreams or nightmares, accompanied by feelings of being overwhelmed or terrified, with strong physical sensations
* Avoidance of anything that might lead to re-experiencing aspects of the traumatic event, including people, places, or media. Someone might avoid conversations that remind them of the experience, or strain to avoid thoughts of it, or they may try to change their environment; for example, by moving or changing jobs.
* A heightened perception of threat leading to hypervigilance or making someone easily startled. A person experiencing c-PTSD may constantly feel under threat and may worry that those close them are as well.
Along with these core symptoms of PTSD, someone with c-PTSD may be highly reactive to minor stressors, have violent outbursts, or engage in reckless, self-destructive behavior. In some cases of c-PTSD, a person may be emotionally numb, unable to experience pleasure or other positive emotions. The person may come to believe that they are flawed or worthless and feel deep guilt or shame because they blame themselves for falling victim to their trauma or for failing to protect others who experienced it. People experiencing c-PTSD may also have suicidal thoughts.
No. Not every person who endures experiences that may lead to c-PTSD develop symptoms themselves. Most people will experience acute stress after a trauma, but for many the symptoms may pass in a period of weeks; typically, within three months. The presence of another mental health disorder, a lack of social or emotional support, intergenerational trauma, and chronic physical ailments could increase one’s risk of c-PTSD. Estimates suggest that between 1 and 8 percent of the population will experience complex PTSD.
Someone living with complex PTSD may avoid social connections or struggle to establish intimate relationships or to trust or fully commit to a romantic partner or close friend. If they experienced abuse or other forms of betrayal from intimate family members or other responsible adults as a child, their symptoms may be most triggered by others attempting to get close to them. Their hypervigilance, or reluctance to be vulnerable, can also jeopardize connection with others.
Women have higher rates of complex PTSD than men, research suggests, and in women, the condition tends to be accompanied by a wider range of severe symptoms.
Complex PTSD can emerge at any age, but it can also present differently at different ages. Still, children and adolescents are more vulnerable to the condition than others. In children, c-PTSD is more likely to involve cognitive challenges such as difficulty with attention or organization; emotional regression; and reckless and aggressive behavior including substance use, unsafe sex, unsafe driving, and self-harm.
It can be difficult, especially if a clinician does not know that an individual has experienced a specific trauma such as child abuse, as someone may resist discussion of it. In children, symptoms of c-PTSD may overlap with common symptoms of depression, eating disorders, sleep disorders, ADHD, oppositional defiant disorder, and separation anxiety. Also, other disorders, especially bipolar disorder, can develop after extreme traumatic experiences.
No, but the conditions may have similar symptoms: Both typically lead to difficulty with emotional regulation, impulsivity, and chaotic interpersonal relationships, and both may be influenced by experiences of trauma. According to some research, borderline personality disorder could actually be considered one of a set of conditions influenced by trauma, especially childhood abuse.
There are differences between c-PTSD and BPD that should enable a clinician to distinguish between the two. Borderline personality disorder is characterized by a strong fear of abandonment, which may not be part of c-PTSD. People living with BPD are also more likely to engage in self-harm and to experience suicidal ideation than those experiencing c-PTSD. Although it is not uncommon for c-PTSD and BPD to co-occur in an individual—research has shown that one in four people with PTSD also meet the criteria for BPD—the proper diagnosis of one, the other, or both is essential. A correct diagnosis can help someone get the right treatment, of course, but also, people experiencing symptoms of c-PTSD may be incorrectly thought of as "being borderline”—particularly women, research suggests—which is problematic because of the stigma that label can carry.
Complex PTSD is generally treated in the same way as post-traumatic stress syndrome, with a combination of talk therapy, medication, and family and social support. But as many as half of those living with either condition find that current therapies do not bring full relief from symptoms; to help them, experimental approaches are being explored.
Cognitive behavioral therapy—specifically, a type known as trauma-focused cognitive behavioral therapy—is most often the first choice of therapists helping people deal with c-PTSD. In sessions, a therapist will help an individual identify the thoughts and thought patterns that keep them stuck on their traumatic experiences and begin to replace them with more positive, more productive ones; recognize symptoms quickly and develop strategies to address them in the moment; and, gradually, work toward facing, rather than avoiding, things that remind them of their trauma, sometimes through what’s known as exposure therapy.
There are no medications formally approved by the U.S. Food and Drug Administration for the treatment of PTSD or c-PTSD, but clinicians may prescribe antidepressants, anti-anxiety medications, and sleep aids to individuals living with symptoms of the conditions.
Along with seeking treatment, clinicians suggest that people living with PTSD or c-PTSD try to remain active, including maintaining an exercise routine, along with consistent sleep habits. Social engagement with others, especially people with whom they have high levels of comfort and trust, is can also be valuable. Some people find benefits from taking part in support groups where they can meet others dealing with similar traumas. Some research suggests that writing their thoughts and experiences in a journal can help many people better understand their experiences and begin to move forward. And understanding that progress may be slow, but taking the time to recognize positive steps, can help people discover, and maintain, a more optimistic outlook.
