Over the last few decades, some truly remarkable research publications on complex post-traumatic stress disorder (CPTSD) have been published.
In this article, we’ll start a series regarding complicated post-traumatic stress disorder and new study discoveries about this topic.
What Is CPTSD? Definition
We will look at a description of complicated post-traumatic stress disorder as well as some older research findings.
Complex post-traumatic stress disorder is a psychological disorder that is theorized to develop in response to exposure to a series of traumatic events in a context in which the individual perceives little or no chance of escape, and particularly where the exposure is prolonged or repetitive.
CPTSD develops in the minds of persons who have little or no possibility of escaping the traumatic experiences. Depending on when the traumatic experiences occurred, CPTSD can develop in childhood or adulthood.
According to Beauty After Bruises, an organization that helps people with complex PTSD with or without the presence of a dissociative disorder, have given a long definition of CPTSD as follows:
Complex PTSD comes in response to chronic traumatization over the course of months or, more often, years. This can include emotional, physical, and/or sexual abuses, domestic violence, living in a war zone, being held captive, human trafficking, and other organized rings of abuse, and more. While there are exceptional circumstances where adults develop C-PTSD, it is most often seen in those whose trauma occurred in childhood. For those who are older, being at the complete control of another person (often unable to meet their most basic needs without them), coupled with no foreseeable end in sight, can break down the psyche, the survivor’s sense of self, and affect them on this deeper level. For those who go through this as children, because the brain is still developing and they’re just beginning to learn who they are as an individual, understand the world around them, and build their first relationships – severe trauma interrupts the entire course of their psychological and neurological development.
What Does C-PTSD Look Like?
To begin defining some of these trademark issues mentioned in the proposed Complex PTSD criteria, we’ll start with the one that appears most frequently in daily life: emotion regulation.
Complex PTSD survivors struggle greatly with emotions, including feeling them, managing them, and frequently even just being able to understand or describe them correctly.
Many people suffer with mismanaged or deep and ongoing grief, explosive or inaccessible anger, and/or suicidal thoughts.
They may be chronically numb, lack the appropriate affect in certain situations, be unable to triage sudden changes in emotional content or struggle to level out after a great high/low.
It’s also normal for these survivors to have intrusive re-experiences of trauma feelings, especially when triggered.
These feelings are often disproportionate to the present situation, but are proportionate to the intensity of what was required of them at the time of the trauma – also known as an emotional flashback.
Another fundamental struggle for complex trauma survivors is difficulty with self-perception, especially if their identity development was either violently interrupted or manipulated by someone with ulterior motives.
In its most basic form, how they see themselves vs how the rest of the world sees them might be directly opposed.
Some may believe they are “bad” because they carry or embody nothing except guilt and shameful acts.
Others feel they are fundamentally helpless; they have been let down by so many people who could have prevented the abuse but did not, so it “must be them.”
Many people blame themselves for what occurred to them and believe they are unworthy of compassion and love since “they did this to themselves” or “they are the one guilty for everything.”
So many with CPTSD may feel defined by stigma, that they are nothing more than their trauma, that they are constantly in the way or a burden, or that they are just completely and utterly different from anybody or everything around them..
All of these feelings, and more, can exist within the person with CPTSD, that on the outside may seem to you the most intelligent, competent, strong, and compassionate human being you know.
Interruptions in consciousness are also common. Some people may forget catastrophic events (even if they were aware of them previously), then relive them intrusively, recall painful information in a different chronological order, or have other severe dissociative experiences.
Larger gaps in time are often observed only in DID, although persons suffering from CPTSD alone can still have ‘interruptions in consciousness’ that result in memory gaps, poor recall, traumatic material that is completely inaccessible, or, conversely, re-experiencing trauma against their will (e.g. flashbacks, intrusive images, body memories, etc.)
Dissociation is a symptom that varies from harmless daydreaming or temporarily “spacing out” to more disruptive episodes of feeling disconnected from one’s body or mental processes, not feeling real, or losing time; all the way to the most severe, which includes switching between self-states (or alters), as seen in Dissociative Identity Disorder.
Difficulty in relationships may appear to be a normal thing, but it is not in this case, because it affects the relationship itself and prevents it from growing.
This refers to a survivor’s potential to feel completely isolated from people (or not knowing how to engage with them), to the point of harboring an outright refusal to trust anyone (or just not knowing why they ever should), or to the other extreme of trusting people far too easily (including those who are dangerous and abusive/violent toward them), also perpetually searching for a rescuer foe every situation; and seeking out friends and partners who are hurtful or abusive because it’s the only thing that feels familiar; and even abruptly abandoning relationships that are going well for any number of reasons.
Symptoms of CPTSD
Complex post-traumatic stress disorder symptoms vary from person to person, but a basic list is provided below:
Reliving the trauma through flashbacks and nightmares
Avoiding situations that remind them of the trauma
Dizziness or nausea when remembering the trauma
Hyper-arousal, which means being in a continual state of high alert
The belief that the world is a dangerous place
A loss of trust in the self or others
Difficulty sleeping or concentrating
Loud noises might easily startle you
A negative self-view
Changes in beliefs and worldview
Difficulties in emotional control
Problems with relationships
Thoughts or actions of suicide
Fixating on the abuser or seeking revenge
Neuroimaging of PTSD and It’s relevance to CPTSD
Complex post-traumatic stress disorder and post-traumatic stress disorder (PTSD) are closely connected.
So, in order to better understand brain changes caused by trauma, let us analyze the results of neuroimaging performed on the brains of persons suffering from PTSD.
Because of the similarities, researchers in one study in 2013, were able to perform fMRI tests on persons suffering from PTSD and use the same data, concluding that the same damages existed in the brains of those suffering from CPTSD.
CPTSD and PTSD are not just for those who have experienced severe trauma such as rape or accidents.
These two life-altering disorders impact 50-70 percent of American citizen and cost the country more than $40 billion every year.
The suffering and impact on families and communities are enormous, leaving many individuals unable to cope with their life and losing the capacity to work productively (Brenner, 2018).
Interestingly, some traumatized individuals may not show symptoms for several years after the traumatic event.
In fact, a study published in the journal Neuroscience and Biobehavioral Review discovered that trauma-exposed people who did not have PTSD had considerably less hippocampus volume, amygdalae, and smaller cortical areas than healthy control participants.
Not only were those areas of the brain impacted, but so were the areas that influence intelligence, such as the corpus callosum (brain wiring) and a smaller-than-average frontal lobe volume (the seat of intelligence) (Karl, Schaefer, et. al. 2006).
The Findings from Neuroimaging Post-Traumatic Stress Disorder
Researchers have conducted many research projects using different modes of neuroimaging, including fMRI, PET, and newer forms of visualizing the brain come into existence every year (Bremner, Randall et. al. 1995).
Researchers discovered damage to the amygdalae and hippocampi in the brains of those who had experienced severe traumatic events, such as those returning from war.
In 1980, research using the then-new neuroimaging technology functional magnetic resonance imaging (fMRI) found smaller-than-normal volumes in both the hippocampi and amygdalae of people with PTSD.
This study demonstrates how severe stress damages two important areas of the brain related to emotional regulation and memory consolidation (The American journal of psychiatry, Bremner, J. D.).
Treatment of C-PTSD
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 disorder’s complexity and severity, C-PTSD may be treated using many of the same treatments as PTSD, including: psychotherapy and medications.
Psychotherapy
C-PTSD psychotherapy focuses on recognizing traumatic memories and negative thinking patterns, replacing them with more realistic and positive ones, and learning to cope with the impact of the trauma in a more adaptive manner.
Medications
Medications may help reduce symptoms of C-PTSD, such as anxiety or depression. They are especially helpful when used in combination with psychotherapy. Antidepressants are often used to treat complex PTSD, including Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline).
Note: You should consult a medical doctor before taking any antidepressants.
Coping With C-PTSD
Find support: Complex PTSD, like PTSD, often causes people to withdraw from friends and family. That’s why having a strong social support network, is crucial for mental health.
Reach out to a trusted friend or family member when you are feeling overwhelmed, angry, anxious, or afraid.
Self-Awareness: be more aware of what you are feeling in the moment and combat feelings of distress. This practice involves learning ways to focus on the present moment.
Write down your thoughts: Studies have shown that keeping a journal can help with PTSD symptoms such as flashbacks, intrusive thoughts, and nightmares.
In terms of treatment, keeping a journal might help you keep a note of symptoms that you can later address with your therapist.
A Word From Bloogit
If you or someone you care about has been exposed to repeated trauma and are struggling to cope, it’s important to seek help from a therapist who is familiar with PTSD. In addition to asking your primary care physician for a referral, there are many online resources that can help you find mental health providers in your area who treat PTSD.
If you or a loved one are struggling with PTSD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
