Complex Post Traumatic Stress Disorder (C-PTSD) is a condition that results from chronic or long-term exposure to emotional trauma over which a victim has little or no control and from which there is little or no hope of escape, such as in cases of:
- domestic emotional, physical or sexual abuse
- childhood emotional, physical or sexual abuse
- entrapment or kidnapping.
- slavery or enforced labor.
- long term imprisonment and torture
- repeated violations of personal boundaries.
- long-term objectification.
- exposure to gaslighting & false accusations
- long-term exposure to inconsistent, push-pull,splitting or alternating raging & hooveringbehaviors.
- long-term taking care of mentally ill or chronically sick family members.
- long term exposure to crisis conditions.
When people have been trapped in a situation over which they had little or no control at the beginning, middle or end, they can carry an intense sense of dread even after that situation is removed. This is because they know how bad things can possibly be. And they know that it could possibly happen again. And they know that if it ever does happen again, it might be worse than before.
The degree of C-PTSD trauma cannot be defined purely in terms of the trauma that a person has experienced. It is important to understand that each person is different and has a different tolerance level to trauma. Therefore, what one person may be able to shake off, another person may not. Therefore more or less exposure to trauma does not necessarily make the C-PTSD any more or less severe.
C-PTSD sufferers may "stuff" or suppress their emotional reaction to traumatic events without resolution either because they believe each event by itself doesn't seem like such a big deal or because they see no satisfactory resolution opportunity available to them. This suppression of "emotional baggage" can continue for a long time either until a "last straw" event occurs, or a safer emotional environment emerges and the damn begins to break.
The "Complex" in Complex Post Traumatic Disorder describes how one layer after another of trauma can interact with one another. Sometimes, it is mistakenly assumed that the most recent traumatic event in a person's life is the one that brought them to their knees. However, just addressing that single most-recent event may possibly be an invalidating experience for the C-PTSD sufferer. Therefore, it is important to recognize that those who suffer from C-PTSD may be experiencing feelings from all their traumatic exposure, even as they try to address the most recent traumatic event.
This is what differentiates C-PTSD from the classic PTSD diagnosis - which typically describes an emotional response to a single or to a discrete number of traumatic events.
Difference between C-PTSD & PTSD
Although similar, Complex Post Traumatic Stress Disorder (C-PTSD) differs slightly from the more commonly understood & diagnosed condition Post Traumatic Stress Disorder (PTSD) in causes and symptoms.
C-PTSD results more from chronic repetitive stress from which there is little chance of escape. PTSD can result from single events, or short term exposure to extreme stress or trauma.
Therefore a soldier returning from intense battle may be likely to show PTSD symptoms, but a kidnapped prisoner of war who was held for several years may show additional symptoms of C-PTSD.
Similarly, a child who witnesses a friend's death in an accident may exhibit some symptoms of PTSD but a child who grows up in an abusive home may exhibit the additional C-PTSD characteristics shown below:
C-PTSD - What it Feels Like:
People who suffer from C-PTSD may feel un-centered and shaky, as if they are likely to have an embarrassing emotional breakdown or burst into tears at any moment. They may feel unloved - or that nothing they can accomplish is ever going to be "good enough" for others.
People who suffer from C-PTSD may feel compelled to get away from others and be by themselves, so that no-one will witness what may come next. They may feel afraid to form close friendships to prevent possible loss should another catastrophe strike.
People who suffer from C-PTSD may feel that everything is just about to go "out the window" and that they will not be able to handle even the simplest task. They may be too distracted by what is going on at home to focus on being successful at school or in the workplace.
How it can manifest in the victim(s) over time:
Rage turned inward: Eating disorders. Depression. Substance Abuse / Alcoholism. Truancy. Dropping out. Promiscuity. Co-dependence. Doormat syndrome (choosing poor partners, trying to please someone who can never be pleased, trying to resolve the primal relationship)
Rage turned outward: Theft. Destruction of property. Violence. Becoming a control freak.
Other: Learned hyper vigilance. Clouded perception or blinders about others (especially romantic partners) Seeks positions of power and / or control: choosing occupations or recreational outlets which may put oneself in physical danger. Or choosing to become a "fixer" - Therapist, Mediator, etc.
Avoidance - The practice of withdrawing from relationships with other people as a defensive measure to reduce the risk of rejection, accountability, criticism or exposure.
Blaming - The practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.
Catastrophizing - The habit of automatically assuming a "worst case scenario" and inappropriately characterizing minor or moderate problems or issues as catastrophic events.
"Control-Me" Syndrome - This describes a tendency which some people have to foster relationships with people who have a controlling narcissistic, antisocial or "acting-out" nature.
Denial - Believing or imagining that some painful or traumatic circumstance, event or memory does not exist or did not happen.
Dependency - An inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.
Depression (Non-PD) -Depression is when you feel sadder than your circumstances dictate, for longer than your circumstances last, but still can't seem to break out of it.
Escape To Fantasy - Taking an imaginary excursion to a happier, more hopeful place.
Fear of Abandonment - An irrational belief that one is imminent danger of being personally rejected, discarded or replaced.
Relationship Hyper Vigilance - Maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.
Identity Disturbance - A psychological term used to describe a distorted or inconsistent self-view
Learned Helplessness- Learned helplessness is when a person begins to believe that they have no control over a situation, even when they do.
Low Self-Esteem - A common name for a negatively-distorted self-view which is inconsistent with reality.
Panic Attacks - Short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as hyperventilating, shaking, sweating and chills.
Perfectionism - The maladaptive practice of holding oneself or others to an unrealistic, unattainable or unsustainable standard of organization, order, or accomplishment in one particular area of living, while sometimes neglecting common standards of organization, order or accomplishment in other areas of living.
Selective Memory and Selective Amnesia - The use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.
Self-Loathing - An extreme hatred of one's own self, actions or one's ethnic or demographic background.
Tunnel Vision - The habit or tendency to only see or focus on a single priority while neglecting or ignoring other important priorities.
C-PTSD is caused by a prolonged or sustained exposure to emotional trauma or abuse from which no short-term means of escape is available or apparent to the victim.
The precise neurological damage that exists in C-PTSD victims is not well understood.
Little has been done in clinical studies of treatment of C-PTSD. However, in general the following is recommended:
- Removal of and protection from the source of the trauma and/or abuse.
- Acknowledgement of the trauma as real, important and undeserved.
- Acknowledge that the trauma came from something that was stronger than the victim and therefore could not be avoided.
- Acknowledgement of the "complex" nature of C-PTSD - that responses to earlier traumas may have led to decisions that brought on additional, undeserved trauma.
- Acknowledgement that recovery from the trauma is not trivial and will require significant time and effort.
- Separation of residual problems into those that the victim can resolve (such as personal improvement goals) and those that the victim cannot resolve (such as the behavior of a disordered family member)
- Mourning for what has been lost and cannot be recovered.
- Identification of what has been lost and can be recovered.
- Program of recovery with focus on what can be improved in an individual's life that is under their own control.
- Placement in a supportive environment where the victim can discover they are not alone and can receive validation for their successes and support through their struggles.
- As necessary, personal therapy to promote self-discovery.
- As required, prescription of antidepressant medications.
What to do about C-PTSD if you've got it:
Remove yourself from the primary or situation or secondary situations stemming from the primary abuse. Seek therapy. Talk about it. Write about it. Meditation. Medication if needed. Physical Exercise. Rewrite the script of your life.
What not to do about it:
- Stay. Hold it in. Bottle it up. Act out. Isolate. Self-abuse. Perpetuate the cycle.
- What to do about it if you know somebody else who has C-PTSD:
- Offer sympathy, support, a shoulder to cry on, lend an ear. Speak from experience. Assist with practical resolution when appropriate (guidance towards escape, therapy, etc.) Be patient.
- What not to do about it if you know somebody else who has it:
- Do not push your own agenda: proselytize, moralize, speak in absolutes, tell them to "get over it", or try to force reconciliation with the perpetrator or offer "sure fire" cures.
C-PTSD Support Groups & Links:
- Out of the Storm - Support Group for people who suffer from C-PTSD.
- Out of the FOG Support Forum - The Support Forum here at Out of the FOG.
- PTSD Forum Contains a Wiki page and Active Support Forum.
- Psych Forums PTSD Forum.
- http://healmyptsd.com/ - Resources & info about recovery from PTSD & C-PTSD
- C-PTSD Page - by Author Sarah Tate
- Trauma: Complex PTSD MentalHelp.net C-PTSD Article by Dr. Allan Schwartz