What is Complex PTSD?

What is Complex PTSD?
Posted March 8, 2010 - 10:10am
0

by: Arthur Schoenstadt, MD

What Is Complex PTSD?
The diagnosis of post-traumatic stress disorder (PTSD) accurately describes the symptoms that result when a person experiences a short-lived trauma. For example, car accidents, natural disasters, and rape are considered traumatic events of time-limited duration.

Complex PTSD, however, is the result of long-term trauma. These are chronic traumas that continue for months or even years at a time.

The reason complex PTSD is separated from PTSD is that doctors and researchers have found that the current PTSD diagnosis often does not capture the severe psychological harm that occurs with such prolonged, repeated trauma. For example, ordinary, healthy people who experience chronic (long-term) trauma can experience changes in their self-concept and the way they adapt to stressful events.

The Effect of Captivity
During long-term traumas, the victim is generally held in a state of 'captivity'.

In these situations, the victim is under the control of the perpetrator and unable to flee.

Examples of captivity include:

* Prostitution brothels
* Long-term domestic violence
* Long-term, severe physical/ emotional and-or mental abuse (such as abuse starting in childhood and continuing throughout the person's life; or long-term abusive marriages/partnerships)

Symptoms of Complex PTSD
The first requirement for a diagnosis of complex PTSD is a prolonged period (months to years) of total control by another. The other criteria include symptoms that tend to result from chronic victimization.

These symptoms of chronic PTSD include:

* Changes in the ability to control emotions, which may include symptoms such as persistent sadness, suicidal thoughts, explosive anger, or inhibited anger

* Changes in consciousness, such as forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes or body

* Changes in how the person views himself or herself, which may include a sense of helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings

* Changes in how the person views the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator

* Changes in relationships with others, including isolation, distrust, or a repeated search for a rescuer and learned helplessness

* Changes in one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.

Complications Associated With Complex PTSD
Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming. They may use alcohol and substance abuse as a way to avoid and numb feelings and thoughts related to the trauma. Survivors may also engage in self-mutilation and other forms of self-harm.

There is a tendency to blame the victim in these situations. A person who has been abused repeatedly is sometimes mistaken as someone who has a "weak character." Because of their chronic victimization, in the past, survivors have been misdiagnosed by mental health providers as having borderline, codependent, or masochistic personality disorder. When survivors are faulted for the symptoms they experience as a result of victimization, they are being unjustly blamed.

Researchers hope that a new diagnosis of complex PTSD will prevent clinicians, the public, and those who suffer from trauma from mistakenly blaming survivors for their symptoms.

Final Thoughts
The current PTSD diagnosis often does not capture the severe psychological harm that occurs with prolonged, repeated trauma. For example, long-term trauma may affect a healthy person's self-concept and adaptation. The symptoms of such prolonged trauma have been mistaken for character weakness, but this is an unfair characterization.

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Klarity Belle's picture

C-PTSD

March 8, 2010 - 5:03pm — Klarity Belle

The more I learn about C-ptsd the more I see I fit the criteria. For years, since childhood I have felt there is something 'off' in the way I think, feel and react to the world around me. Perhaps this is why I have gravitated towards relationships with undiagnosed PD's - because like me they fly under the radar - undetected. Now I feel like I have detected them and me - I needed to find myself on the radar screen:-

Complex Post Traumatic Stress Disorder (CPTSD) is a clinical formulation (which may be included in the proposed DSM-V expected out in 2011) that refers to the results or outcomes of four simultaneous factors:

Chronic
Early
Maltreatment
Within a care-giving relationship

Maltreatment refers to abuse or neglect. Early, meaning occurring in early childhood; within the first several years of life. Chronic meaning a pervasive pattern, not a single or discrete event. Very important is that all the above occurs within a care-giving relationship. It is this last factor that makes the chronic early maltreatment so insidious and that leads to such pervasive negative effects on later development and impairment in so many domains of functioning.

The domains of impairment include the following:

Attachment
Biology
Emotional regulation
Dissociation
Behavioral control
Cognition
Self-concept

Here are some useful tips to help manage emotional flashbacks as developed by Pete Walker M.A.

MANAGING FLASHBACKS

Say to yourself: "I am having a flashback". Flashbacks take us into a timeless part of the psyche that feels as helpless, hopeless and surrounded by danger as we were in childhood. The feelings and sensations you are experiencing are past memories that cannot hurt you now.
Remind yourself: "I feel afraid but I am not in danger! I am safe now, here in the present." Remember you are now in the safety of the present, far from the danger of the past.

Own your right/need to have boundaries. Remind yourself that you do not have to allow anyone to mistreat you; you are free to leave dangerous situations and protest unfair behavior.

Speak reassuringly to the Inner Child. The child needs to know that you love her unconditionally- that she can come to you for comfort and protection when she feels lost and scared.

Deconstruct eternity thinking: in childhood, fear and abandonment felt endless - a safer future was unimaginable. Remember the flashback will pass as it has many times before.

Remind yourself that you are in an adult body with allies, skills and resources to protect you that you never had as a child. (Feeling small and little is a sure sign of a flashback) Ease back into your body. Fear launches us into 'heady' worrying, or numbing and spacing out.

[a] Gently ask your body to Relax: feel each of your major muscle groups and softly encourage them to relax. (Tightened musculature sends unnecessary danger signals to the brain)
[b] Breathe deeply and slowly. (Holding the breath also signals danger).
[c] Slow down: rushing presses the psyche's panic button.
[d] Find a safe place to unwind and soothe yourself: wrap yourself in a blanket, hold a stuffed animal, lie down in a closet or a bath, take a nap.
[e] Feel the fear in your body without reacting to it. Fear is just an energy in your body that cannot hurt you if you do not run from it or react self-destructively to it.

Resist the Inner Critic's Drasticizing and Catastrophizing:
[a] Use thought-stopping to halt its endless exaggeration of danger and constant planning to control the uncontrollable. Refuse to shame, hate or abandon yourself. Channel the anger of self-attack into saying NO to unfair self-criticism.
[b] Use thought-substitution to replace negative thinking with a memorized list of your qualities and accomplishments
Allow yourself to grieve. Flashbacks are opportunities to release old, unexpressed feelings of fear, hurt, and abandonment, and to validate - and then soothe - the child's past experience of helplessness and hopelessness. Healthy grieving can turn our tears into self-compassion and our anger into self-protection.

Cultivate safe relationships and seek support. Take time alone when you need it, but don't let shame isolate you. Feeling shame doesn't mean you are shameful. Educate your intimates about flashbacks and ask them to help you talk and feel your way through them.

Learn to identify the types of triggers that lead to flashbacks. Avoid unsafe people, places, activities and triggering mental processes. Practice preventive maintenance with these steps when triggering situations are unavoidable.

Figure out what you are flashing back to. Flashbacks are opportunities to discover, validate and heal our wounds from past abuse and abandonment. They also point to our still unmet developmental needs and can provide motivation to get them met.

Be patient with a slow recovery process: it takes time in the present to become un-adrenalized, and considerable time in the future to gradually decrease the intensity, duration and frequency of flashbacks. Real recovery is a gradually progressive process (often two steps forward, one step back), not an attained salvation fantasy. Don't beat yourself up for having a flashback.

~~~~~~~~~~~~~~~~~
"The deeper that sadness carves into your being, the more joy you can contain." ~ Kahlil Gibran

http://www.storyofmylife.com/KLARITY4

narcnarcwhosthere's picture

been there........got that.....

March 8, 2010 - 2:43pm — narcnarcwhosthere (not verified)

it's a wound that never heals.........

My blog

ariacatherine's picture

PTSD

March 8, 2010 - 2:25pm — ariacatherine

aria-Icannot tell you enlightening it is to read more on this illness, as it described all thesymptoms I have been and was experiencing both in and out of the relationship. I wasso frustrated with myself andthose around me because I wanted so desperatelyfor others who cared about me to understand what I was going through. It is comforting to know that I was not abnormal, and I thank God for this site that assists in healing ones heart in the aftermath of loving a horrible person such as I did. I am finally done after strikingbackin my manic state of trauma, where the adultclearheaded woman in me screamed "no more"..no more lies, deception,betrayal,made to feel less than and likea complete fool.
It has been almost 6 weeks of amputation, and I still have "flashes" of every scene, lie, story thatis clear to me now as a lie, and theyjust come... That piece is hard for metotry to turn off...
Iwas so unwell inthis for 3years and 4 months. I was such a fool to betray myself.. Hewas textbook, and was a master at his game. The hard part is that hestill fools many many professional people, even after being involved with the law. I wantto scream to everyone including his wife (which I tried),but I was looked at asthe bad one..
I know there will be better days ahead, and I will find healthy blessed love...
thank you to everyone who helpseach other on this site. I have never used anything like this before.
Aria