What is Complex PTSD and do You Have It?
by Andrea M. Darcy
Complex PTSD (CPTSD or c-PTSD) is a relatively new diagnosis.
It describes the experience of those who suffered ongoing and inescapable trauma that has left them with long—term emotional, mental, and physical side effects.
What is complex PTSD?
Psychological trauma and its treatment is a field of psychology that is really only starting to come into its own. There is still a lot to understand, and there is ongoing controversy.
Complex trauma is currently one of these controversies. It is not yet fully accepted by all medical communities that those who suffered ongoing trauma or traumas, usually in childhood, would have symptoms different than those who experienced a single trauma.
In the USA ‘complex PTSD’ is not an official diagnosis, although the latest version of their diagnostic manual, the DSM-V, does hint at a possible set of other symptoms. The closest diagnosis here is “disorders of extreme stress not otherwise specified (DESNOS)”.
Here in the UK there is also work to be done. The National Guideline for Health and Care Excellence (NICE) still refuses to recognise complex PTSD, even as the NHS itself has recently added a page about it to their website. You might instead be given a diagnosis from the World Health Organisation’s manual the ICD-10 called “enduring personality change after catastrophic experience (EPCACE)”.
Complex Trauma vs PTSD
So how exactly is complex trauma different than post-traumatic stress disorder (PTSD)?
- it is a product of ongoing, chronic trauma or traumas instead of one big trauma
- the victim could not escape the trauma (a child can’t go live on his or her own)
- often the trauma was in childhood
- the perpetrator is in many cases known to the victim or someone they were close to.
Symptoms of Complex Trauma
Complex trauma does share the same symptoms as PTSD (read about them in our Guide to PTSD).
The difference is that it also involves a set of other emotional symptoms that can include:
- emotional ‘dysregulation’ (you struggle to control your emotions)
- trust issues – you don’t trust the world, others, or even yourself
- relating difficulties – you find relationships so hard you might even avoid them entirely
- hopelessness – you don’t think you’ll ever change or that life will ever get better
- disconnection – nobody can understand you and you feel totally different than everyone else
- low self-esteem – you feel so worthless you might even often consider suicide.
- identity issues – uncertain who you really are
- “emotional’ flashbacks – instead of remembering images, you might be hit by states of emotion that don’t match what is going around you in the present but arise from the past.
Why You? The Causes of CPTSD
Again, c-PTSD develops after a trauma that is repetitive, lasts over time, and from which there is really no escape.
So the types of trauma that lead to complex PTSD are things like:
- child sexual abuse
- physical abuse and neglect
- ongoing psychological abuse
- having to witness ongoing abuse or violence of another
- relationships that involve chronic abuse and violence
- kidnappings, hostage taking, prisoner of war
- human trafficking and slavery
- being forced to be a sex worker
- cult membership.
Misdiagnosis of complex PTSD
The biggest issues here is a misdiagnosis of borderline personality disorder (BPD). The two share many symptoms such as low self-worth, suicidal thinking, and out of control emotional responses. And both can be linked to child sexual abuse.
It is possible to have both borderline personality disorder and c-PTSD. But if you feel the treatment for BPD, focussing on the ways you relate and regulate your emotions, is not working, and you know you experienced trauma? It’s worth looking into treatments for trauma as well.
What sorts of therapy can help with complex PTSD?
You are an individual, so the therapy that works for you might not be quite right for another person. But one thing to consider is whether a type of therapy will ‘re-traumatise’ you or not. Many people with complex PTSD find talk therapies that ask them about their past make their symptoms worse, not better.
The best advice here is to first use therapies that help you stabilise your emotions and triggers. Cognitive behavioural therapy (CBT) is evidence-based as a treatment for PTSD and can help with this. You might also have some success with another treatment for PTSD, eye movement desensitisation and reprogramming (EMDR), although its usually just suggested for singular, distinct traumas. Other things to look into are body psychotherapies and hypnotherapy.
Once you are more in control of your emotions and thoughts, you might want to try a talk therapy that goes deeper into your traumatic experiences, and helps you with the ways you relate to others. Schema therapy is recommended here if you experienced abuse from a family member. It focuses on creating a strong relationship of trust between you and your therapist.
What if my country won’t diagnose complex PTSD?
While any one who actually suffers complex PTSD will find it strange that someone would feel it was not a real experience, psychological terms are sadly often not accepted until they are ‘proven’ by research.
If you live in a country that does not recognise complex PTSD as a diagnosis, look for a therapist who is willing to treat you as an individual with your own unique set of issues, who has experience with trauma victims, and who is interested in the issue, ‘official’ diagnosis aside.
Need to talk to a therapist experienced with complex PTSD? We connect you with some of London’s top therapists in central locations. Outside London or even the UK? Find a therapist that suits your needs on our sister booking site.
Andrea M. Darcy is a mental health and wellbeing expert with training in person-centred counselling and coaching. She writes from experience about trauma, relationships, and ADHD, and works as a consultant helping people plan their perfect therapy journey. Find her on Instagram @am_darcy
Finally an answer, I knew I was not a Borderline as I never have had the 5 out of 9. I suffered sexual, physical, and emotional abuse throughout childhood I began self injuring at the age of 5. I inserted object’s into my privates causing mutilation injuries numerous times over 50years. I just celebrated 2years injury free with the help of a trusted therapist. I hope this is accepted by USA in my life time!
Wonderful to hear, Deanna, that you have a trusted therapist and are seeing real results! That is just the power of therapy when we find a therapist we click with. We do feel there is an overdiagnosis going on around BPD in America. And it’s so important to realise that any mental health diagnosis is not an illness you’ll see under a microscope. It’s a term created by mental health professionals to describe groups of people with similiar symptoms, and, sadly, particularly in the USA, to make it easier for them to quickly prescribe meds. We often wonder what diagnosis would be left standing if our societies actually took a stand against the endemic trauma going on within them, if they actually put in place real protocol to protect children, and educate all of us on recognising trauma.
My partner aged 78 has recently had an unthreatening ‘standard’ operation, and his normal quiet sensible, rather withdrawn behaviour changed – anxiety, full of fear and trepidation – shaking with fear and sleeplessness before going to the doctor or the hospital.
This meant I had to warn all the doctors, nurses, hospital workers etc we
were involved with – that ‘the patient’ was panicky and terrified, and telling him that everything
was going to be fine was not the way ….. Now the operation is over and he is recovered, he is having talks with the GP’s mental health adviser – who almost immediately proposed a diagnosis of complex-PTSD or EPCACE – which I had never heard of. So here I am trying to find out more, and where we can go from here. Would it be best to find an EMDR therapist before hoping to get cognitive behaviour therapy? We have been to a course on Mindfulness, but it was not good and the counsellors not well-trained.
We are sorry to hear that sounds like either old trauma was triggered or something in the hospital triggered a trauma response. Was he under anaesthetic? There are cases, albeit rare, where patients under anaesthetic have tiny bits of recall meaning the anaesthetic didn’t entirely work on them, and the end result is PTSD. There is no exact math to therapy, it depends on the individual, but yes, given that one experience has triggered it as opposed to a build up over time, EMDR or clinical hypnotherapy be better to try first. There is also a new modality in the UK called BWRT which might be useful. We hope this time you see some results!
I grew up in an emotionally abusive household with a mother with some narcissistic tendencies and an older sister who was perceived as the perfect child. I was called stupid, fat and much worse, despite having excellent grades and being good at sports. I was regularly given a silent treatment by my mother as a punishment for saying something wrong. She would also lock herself in a room leaving me outside crying for ignoring me. I couldn’t understand what was wrong with me to deserve her treatment. She would say I was responsible for my sister’s failed exam or when someone got sick, that I had such intense look it made her sick. My sister started calling me fat and ugly when I was 12 (I have always had a healthy BMI and I have never been overweight). I was told I was too sensitive and wasn’t allowed to cry in front of them when they abused me this way. The saddest thing is I really saw myself through their eyes, as if I was materialising their version of me. I used to cry in my room as a teenager asking myself why am I feeling so much pain and wishing it would stop. Later on I chose partners who also commented on my body negatively as if I was reliving my family trauma with them. I chose those partners not out of love but because I believed they would be nice to me and they seemed like a safe choice, and I was happy someone was interested in me at all. I never approached the person I was really interested in, because I got too scared or my family would tell me that person is too good looking/smart/successful and he would never be interested in someone like me. I never trusted myself enough to make a choice on my own. I would ask the people who emotionally abused me what was good for me. I know it was irrational. Now that I am in my 30s I am much better at understanding why I behave the way I behave but understanding doesn’t lessen the pain. I suffer from elements of an eating disorder, BDM, anxiety, PTSD, depression, death anxiety and social disorder. I have tried talking therapy, medication, exercise, relationships, well paid job, etc. but nothing makes me feel safe and loved. I think it is because I have not been able to express my true self and be my own version of me and had to become precoccupied with the way I looked and behaved because of the family trauma. I keep replaying the past over and over again and wishing for someone to save me/love me unconditionally. I feel the pain is stored in my body – while I am able to rationally face the trauma and even my own wrongdoings, I feel physical tension and discomfort no matter how objectively well I look after my body, even when I exercise or eat healthy, or look ‘attractive’ according to other people. How can I accept myself and stop being my worst enemy? How can I start living and not merely surviving? What therapy would you suggest for someone like me?
Hi there Ally.There is no ‘rational’ processing of trauma. We can’t think away the effects of trauma which changes the way the brain performs and is a very physical experience if we have c-PTSD. Notice how you recount in great detail your childhood. How did you feel after writing it? Heavy, unhappy? We are wondering what kind of talk therapy you tried. You see recounting the past again and again if we have PTSD can lead to feeling WORSE, not better. Which is why going straight into certain kinds of talk therapy can just leave you feeling hopeless. Before deep diving you need therapies that stablise you first, and calm down your trauma response, like EMDR, BWRT, and hypnotherapy. And then we’d suggest you look into body psychotherapy. It’s a form of therapy that focuses on how trauma is stored in the body and how the body also ‘talks’. And also somatic therapy, which is body-based trauma therapy. Finally, you can’t snap your fingers and go from survivor to thriver. It’s a process. And note that it is also possible to overidentify with being a survivor, to take too much of our personal power from our trauma story. Yes, you survived hard things, like, unfortunately, far too many of us. But you are also much more. Your life is not just this story. What are your success stories? What goes right each day? Do you actually WANT to thrive, or is merely surviving deep down your comfort zone? Thriving can be scary. It means we have to become like everyone else instead of someone whose only identity is suffering. In summary, you are on your journey, you are trying things, you are moving forward. Also try to cut yourself some slack. You might find our article about self compassion useful http://bit.ly/selfcompassionHT. Best, HT.
Iam 73 year old male who was beaten daily by his mother with a belt. It has caused me horribly difficult psychological problems. I suffer from intense panic attacks since 14, a binge eating disorder, sexual addictions, ocd bpd,ied, which I believe led to a fib. I was told by a psychiatrist that I had critical ptsd. I also had 2 stella ganglion block shots that did nothing. I’m in therapy but my anxiety is he’ll and I’m running out of time to ever be truly healed. I live in the USA