Complex Post Traumatic Stress Disorder (C-PTSD) vs PTSD

Previously, I discussed PTSD. However, his post will focus on a more severe cousin, Complex PTSD. Complex post-traumatic stress disorder, aka c-PTSD is an anxiety disorder that can be considered an overall more severe form of PTSD because, in addition to the standard PTSD symptoms, it features additional ones. Before continuing, it should be noted that, some mental health professionals make a distinction between PTSD and CPTSD in line with the 2018 decision of the World Health Organization (W.H.O) to include C-PTSD as its own separate diagnosis in the 11th revision of the "International Statistical Classification of Diseases and Related Health Problems" (ICD-11). However, as at 2022, CPTSD is still not recognized as a distinct disorder in the DSM-5 (the US diagnostic manual), forcing only the diagnosis of PTSD in the US, with  mild, moderate, severe and where patients may need to stress the additional criteria to emphasize the greater level of severity. 

The classification of the PTSD and c-PTSD under 'Trauma & Stressor-Related Disorders' indicates a coping response to trauma and stressors, usually intense trauma like rape and torture. 

Causes of C-PTSD

It is believed that C-PTSD is the result of severe, prolonged and repetitive abuse when the victim is vulnerable, disempowered and unable to escape, like childhood. In other words, it is the result of a series of ongoing traumatic events, commonly associated with the following list. Furthermore, the harmful effects of items on the list can be compounded within the context of oppression and racism, especially if the justice and other highly influential systems and institutions are involved or facilitating in this abuse.

• Child abuse, neglect, or abandonment
• Torture
• Slavery
• Domestic violence
• Genocide
• Childhood soldiering

Traumatic stress can have a number of effects on the brain. Research suggests that trauma is associated with lasting changes in key areas of the brain including the amygdala, hippocampus and prefrontal cortex.

C-PTSD versus PTSD

Here is a contrast between CPTSD and PTSD.

CPTSD

1. caused by repeated, inescapable, ongoing series of traumatic events over the long-term. The abuse may occur systematically (ie versus as a single, well defined event with a start, middle and end point). This is particularly the case with interpersonal relationships in which the sufferer feels disempowered and their sense of security is jeopardized. Offensive behavior is very personally directed against the sufferer. Needless to say, key terms include disempowerment, unsafety. 
• The events may collectively create a life with a pattern of trauma like a rape at age a and then at age b, witnessing a murder at age c, being in a life-threatening accident at age d and then experiencing continuous abuse at work. (Many people only experience 1 event and even if they experience multiple events, they are usually able to fully recover from the first before others occur).
• People with daily activities that are potentially life threatening or otherwise dangerous may not only experience their own suffering but even their children who fear for the safety and life of their loved one each time they leave home. The children may have panic attacks, especially if the loved one has already had a real event.
• People who have already had major health issues that involve numerous traumatic events scares that can recur can suffer. For instance, during the course of treating an illness; patients might have relapses, medications might provoke bad reactions, the patient and caregivers may make mistakes and so on.
2. typically occurs in childhood (a time of greatest vulnerability, especially if without a support system)
3. usually more intense than PTSD
4. often associated with oppression, racism, subsequent chronic mental and physical health issues like serious anxiety disorders, depression disorders, dissociative disorders, fibromyalgia, diabetes, heart disease, a compromised immune system, feeling intensely separate from others, digestive problems, perfectionism, limerence, addiction (to substances to numb and regulate negative emotions). There is greater functional impairment than in the case of PTSD. The brain structure begins to change because people suffering ongoing feelings of disempowerment lose hope.
   
   

PTSD

1. caused by one-off traumatic event like an accident, a terrorist attack, being raped as a one-off incident (ie versus repeated rape over several years, as by a primary caregiver)
2. can occur at any stage in life
3. usually milder than CPTSD

Effects of C-PTSD (vs PTSD or ASD)

C-PTSD is very isolating because others have trouble understanding the continued struggle. This lack of understanding is possible even among others who recovered from PTSD, thanks to the singular nature of their challenge and support, not only from family and friends but even from the wider community and justice system. Needless to say, the average person in the population (who has, at the worst already recovered from their acute stress disorder / ASD) is even less likely to understand. 

The intensity of the suffering of a vulnerable person without the wherewithal to overcome the circumstances, like a small child with long term abuse from primary caregivers and others in the community who exploit the child's obvious vulnerability is a greater burden to overcome. Consider the fundamental differences between people carrying complex trauma versus those who are not with the analogy offered by CTAD Clinic, Dr Mike Lloyd (Consultant Clinical Psychologist and Clinic Director) @02:30 in his following video. Dr Lloyd likens the average person without the ongoing burden of trauma to hardy dandelions. They survive harsh sunlight, heavy rain, transplantation to different environments and so on. Conversely, the orchid is fragile and needs a very special set of growing conditions in order to survive and even thrive. The case of the orchid is not lost, just a special one that requires special attention. CPTSD sufferers should therefore focus on learning what they need, usually safety is a key component.

Symptoms of C-PTSD (that exist in addition to PTSD)

In addition to all of the core symptoms of PTSD (re-experiencing, avoidance, and hyperarousal), C-PTSD symptoms generally also include the following to a life-altering extent. (See video below about re-experiencing)

• Negative self-view, aka cognitive distortions, maladaptive thoughts, errors in thinking or irrational thoughts refer to very unpleasant thoughts that are extreme and arguably inconsistent with reality. As a result, such negative thoughts can negatively influence mood and lead to unhealthy behaviors (like isolation and other forms of avoidance because solitude is attractive over having to deal the dangers inherent in dealing with others). When child abuse CPTSD sufferers experienced such complete defenselessness and powerlessness, it is no wonder they feel like this. 
• When one views him or herself negatively, their thoughts might be of helpless, hopelessness, guilt, or shame, feeling unlovable, feeling alien from others
• Constantly feels unsafe or a heightened preoccupation with safety. This is coupled with fears of the potential occurrence of absolute catastrophes. Tendency to create a routine that is planned to manage every detail with multiple backup plans to safeguard against adversity. 
• Dissociative disorders and detachment from one's own experiences (emotions, health, etc). While these phenomena occur with PTSD, the incidence is much greater among those with c-PTSD. Consider the fact the PTSD symptom re-experiencing (aka intrusions) involves the instantaneous 'fronting' of a fragmented part of one's past self wanting to protect the main person. Consequently, complex trauma provides far more opportunities of this type of fragmentation to occur. Triggers can make a person disconnect from themselves (depersonalization) and the world around them (derealization) or some other form of dissociation. Triggers can make a person even forget their trauma (dissociative amnesia).
• A child who was repeatedly raped by primary caregivers and community members recognizing that child's vulnerability over extended periods is more likely to dissociate in order to survive daily life (ie in comparison with someone who was raped once by strangers or acquaintance but had support from family, friends and the justice system).
• numbness, ignoring or denial of illness which imitates lacking concern of authority figures during the abuse and their corresponding response to survive.

        

• Nervous system dysregulation. While a healthy nervous system is able to calm down shortly after some stress-inducing trigger, an unhealthy nervous system has a very delayed recovery period. See video on nervous system dysregulation.
• Two people are startled by something. Both experience abnormal breathing in the moment. While the one with a healthy nervous recovers normal breathing and reverts to an overall state of calm within seconds or minutes at most, the person with an unhealth nervous system continues to demonstrate signs of anxiety for hours or even days.
• Difficulty controlling emotions. Triggers can commonly provoke sufferers to lose control over their emotions in one of several ways, like explosive anger, persistent sadness, depression, and suicidal thoughts.
• Having been blamed in an overly harsh way for extended periods, always fearful of being targeted for ill treatment, left to fend for oneself as a child and so on, C-PTSD sufferers may handle conflict with inappropriate emotions and levels of emotion. The reactions may appear excessively aggressive to others.
• Long term concentration camp survivors may have excessively loud, anxious  reactions if someone hits them unexpectedly from behind many years afterwards.
• Difficulty with trust in relationships. Relationships may suffer due to difficulties trusting others and a negative self-view. A sufferer may avoid relationships or develop unhealthy relationships because that is what they knew in the past.
• Major change in world view, aka 'loss of a system of meanings'. This can include losing one's core beliefs, values, religious faith, or hope in the world and other people. One's world view may become negative.
• The impression of how the world works and the lack of understanding of the sufferer's circumstances can lead sufferers to feel that there is no place in the world for them, that they do not fit in anywhere.
• You may no longer feel capable of overcoming obstacles but as if your hands are tied behind your back by external forces, like a racist judicial system, a corrupt authority figures and so on.
• Sufferers are more observant and aware of the potentially threatening stimuli in the world than the average person.

 

Treatment

The key elements for recovery is to restore a sense of safety and empowerment, reintegration of fragmented parts of self, including the parts stuck in the fight or flight mode of the brain's amygdala and relational security.

In addition to the treatments sought for PTSD, the following are used for c-PTSD.

• EMDR is used for the reintegration specifically.

Common mis-diagnosis

Beware, C-PTSD is most commonly misdiagnosed as borderline personality disorder. However, keys ways in which CPTSD and borderline personality disorder (BPD) differ are that the following.

• C-PTSD sufferers tend to be avoidant of relationships while borderline personality disordered persons are more concerned with abandonment issues.
• C-PTSD sufferers tend to have a distorted sense of self while BPD sufferers have trouble with a sense of identity, something different.
• C-PTSD sufferers are less likely to be suicidal while suicide has a stronger likelihood.
• C-PTSD sufferers have an extremely strong likelihood of significant childhood trauma while this is hardly the case with BPD sufferers.

CONTENT RELATED TO COMPLEX POST TRAUMATIC DISORDER (c-PTSD)

• Post Traumatic Stress Disorder (PTSD) and its key symptoms (re-experiencing, avoidance, and hyperarousal)
• Extreme empaths can inadvertently retraumatize themselves and cause C-PTSD
• Re-experiencing video: 'When Dissociation Gets Physical' by CTAD Clinic (Dr Mike Lloyd)
• Complex Post Traumatic Stress Disorder (C-PTSD)
• Social psychology
• Food for thought

 

Challenges with mental health and fatigue from masking neurodivergence are clues that helps in recognizing neurodivergence, especially for boomers and generation Xers.