Complex PTSD: Response to Prolonged Trauma

June 5, 2016
Contributed by Zawn Villines

Posttraumatic stress (PTSD) can severely interfere with functioning, resulting in intrusive memories, depression, disrupted sleep, anxiety, and avoidance of situations that bring back memories of the trauma. But the symptoms of some trauma survivors, particularly those who have experienced prolonged abuse or captivity, don’t neatly match traditional symptoms of PTSD. In the 1980s, some therapists and researchers began to advocate for recognition of a new variety of PTSD called complex posttraumatic stress disorder or C-PTSD. Although C-PTSD is not listed in the Diagnostic and Statistical Manual of Mental Disorders, therapists are increasingly recognizing the issue, which requires different treatment and produces different symptoms.

What Is Complex PTSD?

PTSD is a reaction to a threatening event, and the event is usually a single event that occurred for a brief duration. Traumatic events that might cause PTSD include watching a loved one die, witnessing a violent act, rape, assault, and military combat. C-PTSD, by contrast, is more likely to occur when a person experiences multiple or ongoing traumas or when a single trauma lasts for a long time and leads to feelings of captivity. Survivors of concentration camps, people who were regularly abused as children, domestic violence survivors, military personnel who are exposed to ongoing violence, people who have experienced repeated sexual assaults, and kidnapping victims may experience C-PTSD.

While PTSD typically causes disturbances—such as flashbacks, avoidance of locations or situations that remind a person of the event, or chronic fear and depression—to the traumatic event, C-PTSD is more likely to cause identity and personality disturbances in addition to the symptoms of traditional PTSD. This is because people exposed to prolonged trauma may begin to view the trauma as a core part of their identity or as something they caused, and sometimes they might question their own memories—believing, for example, that perhaps the trauma didn’t really happen.

Symptoms of Complex PTSD

C-PTSD has many of the same symptoms as PTSD, including intrusive memories or flashbacks, depression, anxiety, avoidance, and changes in personality. However, people with C-PTSD also experience symptoms that people with PTSD don’t normally have. These include:

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Chronic fear of abandonment. Many people with C-PTSD are diagnosed with an attachment disorder, and neediness, fear of abandonment, and even regression during times of stress are common in C-PTSD.
Difficulty controlling emotions or changes in personality.
Disturbances in self-perception and persistent feelings of shame.
Obsession with the perpetrator and frequently changing perceptions of the perpetrator. A sexual abuse survivor, for example, might go back and forth between viewing the abuser as evil and loving, and might continue an unhealthy entanglement with that person.
Emotional flashbacks: Rather than intrusively remembering the traumatic event, a person with C-PTSD might instead simply get emotionally overwhelmed and re-experience the emotions he or she felt during the traumatic event without ever actually recalling or thinking about the traumatic event. This is particularly common during periods of stress. A person might, for example, begin sobbing or feel terrified during a minor disagreement with his or her partner.

Treatment for Complex PTSD

Because C-PTSD is a relatively newly recognized condition, there’s still some debate about how it should be treated. Exposure therapy, which is highly effective with PTSD, is still being studied for its effectiveness in treating C-PTSD. As C-PTSD may mean dozens of traumatic memories or years of trauma, some clinicians have argued exposure therapy is impractical. C-PTSD researchers have generally recommended a stage-based treatment approach that includes the following phases:

Establishing safety and helping the client find ways to feel safe in his or her environment or eliminate dangers in the environment.
Teaching basic self-regulation skills.
Encouraging information processing that builds introspection.
Helping the client to integrate his or her traumatic experiences.
Encouraging healthy relationships and engagement.
Strategies designed to reduce distress and increase positive affect.

References:

Complex PTSD. (n.d.). National Center for PTSD. Retrieved from http://www.ptsd.va.gov/professional/pages/complex-ptsd.asp
ISTSS complex PTSD treatment guidelines. (n.d.). International Society for Traumatic Stress Studies. Retrieved from http://www.istss.org/AM/Template.cfm?Section=ISTSS_Complex_PTSD_Treatment_Guidelines
Walker, P. (n.d.). Emotional flashback management in the treatment of complex PTSD.Psychotherapy.net. Retrieved from http://www.psychotherapy.net/article/complex-ptsd

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