Complex post-traumatic stress disorder (C-PTSD) is surprisingly common. Recent research found this specific condition, caused by chronic trauma, affects 3.8% of the population, with 3.4% of people suffering from standard PTSD.
In the latest version of the International Classification for Diseases (ICD-11), C-PTSD is listed as its own condition. In previous ICD systems, there was no distinction between it and standard PTSD.
As many as 70% of adults experience some form of trauma during their lifetime, so the estimates may actually be low. Also, diagnosis may be difficult, with some people unable to link their symptoms to traumatic events and others confusing them for a different mental illness, such as clinical depression, anxiety, or substance abuse.
A wide range of treatment options are available, including cognitive behavioral and exposure therapies and medications. With support from mental health specialists, people with C-PTSD can overcome their symptoms.
What is C-PTSD?
Complex post-traumatic stress disorder is a relatively new designation. Mental health researchers found that people who experience repetitive trauma, such as ongoing abuse or torture, suffer from additional symptoms not experienced with standard PTSD.
C-PTSD often comes from childhood trauma. Symptoms can be similar to other dissociative or personality disorders, sometimes making diagnosis difficult. Also, because the patient may be years removed from trauma, defining the cause of C-PTSD can be a challenge.
Because of the different causes and symptoms, C-PTSD requires unique treatment approaches. However, with proper assistance, a C-PTSD patient can deal with the symptoms and address the underlying causes of their condition.
Symptoms of C-PTSD
Though there is an overlap between PTSD and C-PTSD symptoms, the latter also has distinct features associated with emotional development and exposure to long-term trauma.
Here are the symptoms common to both PTSD and C-PTSD.
- Both conditions can cause flashbacks to traumatic memories. A patient will relive the trauma repeatedly because of these episodes.
- Trauma sufferers may have physical and emotional reactions caused by a trigger that reminds them of past violence or abuse. According to the ICD-11 listing, this “re-experiencing” can be as intense and traumatic as the original event.
- Those with PTSD often try to avoid situations, events, or places that remind them of the trauma.
- Patients often relive the trauma through repeated nightmares about the events or about experiencing similar traumas.
- Both PTSD and C-PTSD can cause angry or aggressive outbursts or lead to emotional numbness and the inability to experience joy or fun.
C-PTSD has additional symptoms that make it a unique condition requiring specific treatments.
- C-PTSD patients have difficulty regulating emotions. They may be excessively sad or depressed, violently angry, or extremely apathetic. They may be unable to define emotions or describe how they are feeling, adding additional challenges to diagnosis and treatment.
- Some people with this condition may develop dissociative disorders causing them to block out large portions of their memories, making defining the trauma more challenging.
- Repeated trauma can cause relationship and trust issues. Patients may avoid close friendships or romances or engage in extremely short but intense relationships that they cannot sustain. They may also mistrust kindness, thinking that a helpful person has an ulterior motive.
The ICD-11 listing also warns of an increased risk for suicide and self-medication with drugs or alcohol.
Causes of C-PTSD
C-PTSD is possible in people who experience repeated trauma or were immersed in traumatic situations over months or years.
Here are some specific examples of such traumas.
- Undergoing physical or sexual abuse by a caregiver or authority figure during childhood;
- Experiencing or witnessing domestic violence at home;
- Being tortured repeatedly or held against your will for an extended time;
- Living in a war zone or being in multiple combat situations while in the military;
- Being a victim of sex trafficking or forced labor/slavery.
Childhood neglect can lead to C-PTSD even without direct abuse. Other traumas, such as grief after losing a loved one, may cause PTSD symptoms, but won’t lead to C-PTSD without additional factors.
Long-term effects of C-PTSD
C-PTSD can have long-term effects on mental and emotional health and can impact physical health by causing illnesses or worsening existing conditions. The issues can extend to education, professional development, family life, and socialization.
- The Department of Veterans Affairs (VA) points to various studies linking PTSD with higher risks of gastrointestinal and cardiovascular illnesses.
- These studies also point to increases in respiratory illnesses and cancers after trauma.
- People with C-PTSD may be isolated because they avoid specific situations and struggle to maintain relationships.
- The extra stress hormones produced by re-experiencing trauma or ongoing anxiety can impact your immune system, increasing the risk of illnesses like immune disorders or cancers.
These effects can be compounded by substance abuse issues often associated with PTSD.
How is C-PTSD diagnosed?
The avoidance and dissociative aspects of C-PTSD can make diagnosis difficult, as can the fact that the abuse or repeated trauma took place during childhood long before the patient sought help.
Mental health and medical professionals look for primary PTSD symptoms and then assess the patient further to detect behaviors and reactions that might indicate C-PTSD.
PTSD indicators include avoiding trigger situations, hypervigilance, and reliving the trauma. A C-PTSD diagnosis requires additional signs, including relationship difficulties, isolation, and the inability to regulate emotions or responses to trigger situations.
Some people who experience traumatic events do not develop C-PTSD. Therefore, psychologists and therapists will start with the presence of symptoms instead of investigating the patient’s past trauma first.
What is the treatment for C-PTSD?
Treatments can vary for C-PTSD patients. Evidence-based options include talk therapy, visualization, oral and intravenous medications, and other techniques. In addition, patients can focus on their overall health, wellness, and relaxation.
- Cognitive processing therapy (CPT) and prolonged exposure (PE) are usually the first treatment options for PTSD and C-PTSD. They focus on getting the patient to confront the trauma, reprocess it, or respond differently.
- Depending on the patient, psychologists may try other evidence-based approaches, such as cognitive behavioral therapy. These could be used to address specific symptoms or as the main approach to treatment.
- Eye movement desensitization and reprocessing (EMDR) uses a technique called bilateral stimulation to change the way the brain processes the event. The patient will still recall the trauma, but it won’t feel as vivid or elicit an intense emotional response.
- Transcranial magnetic stimulation uses magnets to change the electrical patterns in the brain. It works for a variety of mental illnesses, including PTSD and clinical depression.
- Cortisone injections may alleviate the symptoms of PTSD or keep trauma sufferers from developing it in the first place.
- Visualization, guided meditation, or massage therapy can C-PTSD sufferers relax and deal with the muscle pain and stiffness, and excessive hormone production that usually accompanies the condition.
People with healthy lifestyle habits respond better to PTSD and C-PTSD treatments than those who do not adopt these changes.
Healthy coping strategies for C-PTSD
Most C-PTSD patients need extensive therapy and regular meetings with mental health professionals. However, self-care practices can speed recovery and limit symptoms.
Psychological self-care involves adopting coping mechanisms to deal with C-PTSD symptoms, practicing techniques learned in therapy, and solidifying cognitive changes.
- You can be aware of situations and events that trigger memories or reactions and practice techniques to deal with these responses before they happen.
- With the help of a therapist, you can develop calming techniques that focus your mind and lessen the severity of your response.
- You can develop a support system by letting trusted family and friends know about your triggers and planned responses. They can provide support when needed or give you time and space to perform calming exercises.
You can work with a therapist to create coping strategies and select and test techniques for dealing with C-PTSD effects.
Community support for C-PTSD
Support groups are available online and in person. For example, the C-PTSD Foundation offers an online support group. Psychology Today offers resources for finding in-person groups. The National Alliance on Mental Illness (NAMI) offers access to a nationwide support network.
People with C-PTSD will likely coordinate their treatment through a psychologist or a treatment center with a staff of mental health professionals and treatment specialists.