You have most likely heard the term Post Traumatic Stress Disorder – also known as PTSD. It is used to describe the mental and emotional anguish suffered by those who have experienced sudden trauma. PTSD is often experienced by soldiers as well as those who have been victims of rape and other crimes, and even victims of house fires and car accidents. Symptoms of PTSD include:

Re-experiencing (eg flashbacks &/or nightmares)

Avoidance (of,thoughts, people, places, activities)

Arousal/Reactivity changes (e.g. hypervigilance &/or startling easily) 

Changes in cognition and mood (e.g. distorted feelings like guilt, distractibility) 

Complex Post Traumatic Stress Disorder (C-PTSD) describes a condition that very much presents like PTSD, but with additional features such as disruptions in relational capacities.

Diagnosing C-PTSD

Diagnosing C-PTSD is tricky because the symptoms do not always appear to be unique. That is to say, someone who is suffering from C-PTSD may be experiencing anxiety and lethargy, but these symptoms match other mental health issues. To help correctly identify C-PTSD, a therapist must uncover an accurate history to understand if:

The individual has experienced multiple prolonged traumas that have lasted for months (or even years)

The traumas were caused by someone the individual had a deep interpersonal relationship with and/or someone who was part of their primary care network (most commonly a parent or caregiver)

These traumas were experienced as permanent features of life, with the individual unable to see any end in sight

The individual had no control or power over the person traumatizing them

Symptoms of C-PTSD

As I just mentioned, the outward symptoms of C-PTSD may match other mental health disorders. C-PTSD is diagnosed when an individual experiences symptoms above and beyond of “classic” PTSD. Additional symptoms that may appear in cases of C-PTSD include:

Emotion regulation difficulties (e.g. emotional flashbacks/flooding prompting shame and guilt; intense anger; chronic suicidality)

Disturbances in relational capacities (often, fearing intimacy or feeling disconnected)

Alterations in attention and consciousness (e.g., dissociation; memory loss), 

Adversely affected belief systems (ie self-concept becomes “worthlessness”; negative view of the world) 

Somatic distress (e.g. chronic pain conditions).

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C-PTSD is thus much more than a stressor-response. It becomes the defining shape of one's personality and relationship to self, others, and the world. 

Treatment for C-PTSD

Generally, treatment for complex trauma involves 3 phases, outlined by The International Society for Traumatic Stress Studies (ISTSS) Expert Consensus Treatment Guidelines For Complex PTSD In Adults (2012)

Phase 1: Stabilization and Skills Strengthening focuses on ensuring the client's safety, reducing symptoms (e.g. substance abuse, cognitive distortions), and increasing important emotional, social and psychological competencies such as self-regulation. Here, a therapist is likely to employ strategies stemming from Dialectical Behavior Therapy (DBT) skills, as well as psychoeducation, and rapport building. Individual and group therapy are recommended for this phase. 

In Phase 2: review and reappraisal of trauma memories focuses on processing the unresolved aspects of the individual’s memories of traumatic experiences. This phase emphasizes the review and re-appraisal of traumatic memories so that they are integrated into an adaptive representation of self, relationships and the world. Here, interventions such as Internal Family Systems, EMDR, Narrative, and Art therapies are likely to be used.

Phase 3: consolidate the gains involves review of treatment gains to facilitate the transition from the end of the treatment to greater engagement in relationships, work or education, and community life. 

While this phase-approach is recommended for the processing of traumatic experiences, one, newer therapy, Brainspotting (BSP), holds particular promise for the resolution of C-PTSD. This therapy relies on the body’s natural resourcing and processing, allowing for accelerated progress towards healing. It is effective for trauma responses and memories, attachment wounds and even personality disorders. To learn more about this exciting development, stay tuned for next month’s post. 

If you believe you are suffering from C-PTSD and would like to explore treatment options, please be in touch. I’d be happy to discuss how I may be able to help.