Welcome to Out of the Storm
Out of the Storm is a discussion group and resource site for those whose lives have been affected by Complex Post Traumatic Disorder (CPTSD). As a community of peers, we share information about our understanding of CPTSD and our experiences of living with CPTSD, and support one another as we move forward in learning, healing and recovering.
Out the Storm was launched in August 2014 as a sister site to Out of the FOG (OOTF), a support and information site for those dealing with someone who has a personality disorder.
This site is moderated and administered by volunteers who are dealing with CPTSD in their lives. Please note that we are not medical or mental health professionals, and the discussion board is not intended to be a substitute or replacement for professional therapy or mental health services.
Definition of Complex Post Traumatic Stress Disorder (CPTSD)
Complex Post Traumatic Stress Disorder can be defined as a psychological injury which results from ongoing or repeated trauma over which the victim has little or no control, and from which there is no real or perceived hope of escape. This accumulation of trauma distinguishes CPTSD from the better known Post Traumatic Stress Order (PTSD) in which trauma typically involves a single event or a group of events of limited duration (e.g., witnessing a tragedy, being the victim of a violent act, short term military combat exposure).
What Causes CPTSD?
Although there are many causes of CPTSD, childhood abuse (emotional, physical, sexual) and neglect are the most common. Examples of other situations in which CPTSD may develop include, but are not limited to, long term exposure to combat, emergency services work, homelessness, and prostitution.
According to Dr. Christine Courtois, CPTSD can develop when traumatic events/experiences:
- are repetitive, prolonged, or cumulative;
- are most often interpersonal, involving direct harm, exploitation, and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults; and
- occur at developmentally vulnerable times in the victim's life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/ disempowerment/dependency/age/infirmity, and so on.
Symptoms of CPTSD
There are a number of clinical descriptions of the symptoms of CPTSD (see below), but many victims of CPTSD relate easily to these, as described by Pete Walker in his book CPTSD: From Surviving to Thriving:
- emotional flashbacks – unlike the flashbacks associated with PTSD, these do not typically have a visual component (although they may), but instead involve overwhelmingly negative feelings such as anger, shame, humiliation, abandonment, and of being small and powerless much like a child would feel when abused
- toxic shame – a pervasive feeling of being worthless, defective and useless
- self-abandonment – a sense of not being worthy or deserving of care and protection from others or self; dissociating from situations which feel overwhelming or threatening
- inner critic - an ongoing inner dialogue which is contemptuous, disdainful and humiliating towards oneself
- social anxiety – a feeling of being different from everyone else; fear and anxiety when around other people; wanting to isolate and avoid social situations.
Differences between PTSD and CPTSD
In addition to the symptoms of CPTSD noted above, other symptoms may also include those associated with PTSD:
- Re-experiencing the traumatic event – visual flashbacks in which the sufferer feels as though the traumatic events were happening again; frequent upsetting thoughts or memories about the traumatic event; recurrent nightmares; strong feelings of distress when reminded of the traumatic event
- Avoidance - avoiding thoughts, feelings, or conversations about the traumatic event; avoiding places or people that are reminders of the traumatic event; difficulty remembering important parts of the traumatic event; loss of interest in important, once positive, activities; feeling distant from others; difficulties having positive feelings such as happiness or love.
- Hyperarousal - having a difficult time falling or staying asleep; feeling more irritable or having outbursts of anger; having difficulty concentrating; feeling constantly on guard or like danger is lurking around every corner; being jumpy or easily startled.
Treatment of CPTSD
The literature on the treatment of CPTSD identifies three or four basic stages of treatment for CPTSD which involve both cognitive and relational approaches, including:
- Assessment, stabilization and development of self-care and protection skills – this may include: identification of other disorders/issues such as substance addiction; education about the causes and effects of trauma; development of skills such as setting healthy boundaries and managing flashbacks/toxic shame/self-criticism; and, medication for physical and/or emotional symptoms
- Processing of trauma – this stage involves bringing the trauma to the surface and working through it cognitively (how the sufferer perceives or thinks about the trauma), and affectively (how the sufferer deals emotionally with the trauma), with an emphasis on the self-care and self-protection skills the sufferer can now use to manage pain, grief, abandonment fears, and anger
- Integration of trauma and adjusting to one’s new sense of self - emphasis in this stage is on openly acknowledging trauma and letting it blend into one’s sense of who one is, and of learning to be more comfortable with what this integration can bring to one’s life (e.g., more intimacy with others, joy, increased energy, ability to deal with pain and stress in a healthier way)
A Note about Terminology
It should be noted that the term Complex Post Traumatic Stress Disorder (CPTSD) has yet to be recognized as a separate diagnosis by the American Psychological Association in the current edition of the Diagnostic & Statistical Manual of Mental Disorders. It was, instead, included as a subsection under the more well-known Post Traumatic Stress Disorder (PTSD). CPTSD is also known as Complex Trauma, Developmental Trauma Disorder (when the sufferer is a child), and Disorder of Extreme Stress Not Otherwise Specified (DESNOS).
Given the fact that the term CPTSD has been (and continues to be) used extensively by both professionals (i.e., traumatologists, researchers, therapists) and the public, it has been adopted here so that those of us who are dealing with it -- by whatever name -- can begin our journey “out of the storm” that is CPTSD, to share our knowledge and experiences and support and encourage one another along the way.
(For a discussion of the various terms/diagnoses used in relation to this disorder see Vedat Sar’s article:
Developmental trauma, complex PTSD, and the current proposal of DSM-5.
More Information & Support...
If you have CPTSD or are in a relationship with someone who has this disorder, we encourage you to check out our Support Forum. Read about the experiences of others, ask questions, and receive support and encouragement from our online community.
Further Information about CPTSD
- Understanding Complex Trauma, Complex Reactions, and Treatment Approaches, Dr. Christine Courtois.
- CPTSD: From Surviving to Thriving, Pete Walker.
- Survivor to Thriver: Manual and workbook for adult survivors of child abuse who want to move-on with life. (2007). The Morris Centre for Healing from Child Abuse (Chapter Four).
- Complex PTSD: Response to Prolonged Trauma. Zawn Villines.
- A Developmental Approach to Understanding Complex PTSD. Dr. M. Cloitre.
- Developmental trauma, complex PTSD, and the current proposal of DSM-5 Vedar Sar.