Understanding Complex PTSD (CPTSD)

Trauma comes in many forms, and one of them is called Complex Post Traumatic Stress Disorder, or Complex PTSD.

If you have experienced trauma in your life, especially in your childhood, and you find yourself still struggling with it, know that there is nothing wrong with you. Trauma has a profound impact on our sense of safety, and when it occurs, it can fundamentally change how we experience the world.

What is Complex PTSD (CPTSD)?

Complex PTSD develops after a person experiences trauma over a long period of time. This can happen when a person has experienced abuse, neglect, sexual violence, or extended trauma due to war or other community violence. In many cases, CPTSD develops from experiences that people have in childhood or at an early age, although it can develop from experiences at any age.

Some situations that may lead to the development of complex PTSD include:

• Growing up in an abusive home

• Being neglected or abandoned as a child

• Growing up or living in an unsafe or violent area

• Being in an abusive or violent relationship

• Experiencing human trafficking or other sexual violence

• Living in a war zone

• Living through a genocide

• Being kidnapped, held captive, tortured, or imprisoned

Experiencing trauma not only has an impact on mental health, it can physically change the structure of parts of the brain, including the amygdala, which processes emotions including fear, the hippocampus, which controls learning and memory, and the prefrontal cortex, which is involved in executive function and decision making. These changes, along with the psychological impact of trauma, can help explain why trauma has such a lasting impact on people who experience it. 

What is the difference between CPTSD and PTSD?

While complex PTSD and PTSD are both responses to trauma, CPTSD develops as a result of trauma that occurs more frequently, over months or years. Post Traumatic Stress Disorder, on the other hand, is typically thought to develop after a time-limited incident, like a natural disaster, or an accident. 

CPTSD has many of the same symptoms of PTSD, but people with complex PTSD have additional symptoms that cause them distress in other areas of their life that people with PTSD don’t typically deal with. 

What are the symptoms of CPTSD?

Some of the symptoms of complex PTSD are similar to PTSD, such as being re-triggered by situations that are similar to the traumatic experience, or trying to avoid memories of the trauma. 

The symptoms of CPTSD that are similar to PTSD include: 

• Avoiding situations, places, or even memories of the traumatic events

• Intrusive thoughts like memories, flashbacks, nightmares

• Intense physical or emotional reactions to trauma triggers

• Hypervigilance

• Problems sleeping, like insomnia

• Increased anger or irritability

• Intense anxiety and/or depression

• Problems with concentration 
  

• Dissociation 
  

In addition to these symptoms, however, people with CPTSD experience symptoms that impact their everyday life in other ways. 

The symptoms of complex PTSD that are distinct from PTSD include: 

• A negative view of the self, such as feeling guilty or ashamed, or like there is something fundamentally wrong with them because of what happened to them

• Difficulty regulating emotions, whether it’s anger, fear, paranoia, sadness, depression, or even suicidality

• Feeling detached or distant from the trauma, feeling disconnected from the world around them, feeling disconnected from themselves, feeling like the trauma happened to someone else or like they watched it outside of themselves, or sometimes even forgetting the trauma itself

• Struggling in relationships with others, whether friendships, family, or romantic relationships, because of difficulty trusting others, viewing themselves negatively, and difficulty regulating emotions 
  

• Physical manifestations of trauma, like chronic pain and illness, including autoimmune disorders later in life

• Fundamental changes in worldview or belief systems, losing faith in humanity or in meaning in general, feeling extremely hopeless about the world

As you can imagine, these symptoms make it extremely difficult to function in everyday life. It’s hard to get through the day, hold a job, build relationships, and find meaning when you’re constantly trying to cope with the trauma of the past. 

People who experience CPTSD often find themselves trying to cope in different ways. Some people may self-medicate with substances like drugs and alcohol to deal with the pain of the trauma and its aftermath. Others may isolate themselves out of fear of getting close to others and being hurt or abused again. 

How is CPSTD diagnosed?

Complex PTSD is diagnosed by a healthcare provider, like a physician, psychiatrist, or therapist. 

The official organizations that publish diagnostic manuals have differing opinions on CPTSD, which does not mean that it’s not a valid diagnosis. The World Health Organization, which publishes the International Classification of Diseases, has recognized CPTSD in the most recent edition of the ICD-11. However, the American Psychological Association, which publishes the Diagnostic and Statistical Manual of Mental Health Disorder (or the DSM, the most recent being the DSM-5), does not separate complex PTSD as a distinct diagnosis from PTSD. 

Because CPTSD is a newer diagnosis that’s not recognized everywhere, it can sometimes be misdiagnosed as PTSD. There’s no test to take that can say specifically if you have PTSD or complex PTSD, so your provider will ask questions about your history and the symptoms you’re experiencing to determine your diagnosis.

When seeking diagnosis or treatment, it’s helpful to find a practice that’s experienced in treating complex PTSD so they will recognize your symptoms and get you started with appropriate treatment right away, so you can experience relief. 

How is CPTSD treated?

Like many other mental health disorders, a combination of treatment options is typically used to treat C-PTSD. Therapy and medication are often two of the main recommendations, but it’s important to work with a professional to determine what the best course of treatment is for you. 

Trauma-informed therapy such as EMDR can have a profound effect on healing trauma. Other helpful treatments for trauma include Cognitive Processing Therapy and Trauma Focused Cognitive Behavioral Therapy. Trauma is treatable, and it may take time to find the right treatment for you, but don’t give up hope. Help is out there, and you are worthy of care, no matter what happened to you. 

At Hope+Wellness, we provide trauma-informed care for trauma, PTSD, and CPTSD. We serve Falls Church, McLean, and Arlington, as well as Tysons Corner, Vienna, Reston, Great Falls, Fairfax, Merrifield, and Alexandria, as well as Washington DC and Maryland. Telehealth is available across 20+ other states. Contact us today for more information or to request an initial consultation.