What Is Complex PTSD (CPTSD) & How Could It Be Affecting Me?
Written by Tiffany Lepa, NCC, LPC-Associate
It is highly likely that most of us will experience a traumatic event at least once in our lives. While post-traumatic stress disorder is a commonly known mental health disorder, not everyone who experiences trauma will develop PTSD. Everyone reacts to trauma differently for a variety of reasons. There is no wrong or right way to respond. In addition to PTSD, some individuals may experience what is known as complex post-traumatic stress disorder, or C-PTSD, which is less known than PTSD. In this post, we will explore the differences and similarities between PTSD and C-PTSD as well as treatment options for trauma therapy.
What is post-traumatic stress disorder?
When talking about PTSD, it is often associated with combat situations. Symptoms of PTSD were often referred to as “shell shock” or “war neurosis” to explain what soldiers experienced coming back from combat. Although symptoms of PTSD have existed as far back as violence has existed, it was not until after the Vietnam War that professionals working with veterans rallied for an official post-combat stress diagnosis, which became known as Post-Traumatic Stress Disorder in 1980. Other mental health professionals began to point out similar experiences in survivors of sexual assault, genocide, and domestic violence.
In the present day, PTSD encompasses traumatic events like mass shootings, life-threatening accidents, natural disasters, sexual assault, and physical assault to name a few. The following criteria are used to diagnose an individual with PTSD:
Re-experiencing the event - This may include flashbacks, nightmares, unwanted and intrusive negative thoughts or memories, and both internal and external triggers.
Trying to avoid reminders of the event - Signs of this may include behavioral changes like avoiding people, places, or things that remind you of the event as well as emotional avoidance and a restricted range of emotions or avoiding intimacy. Individuals may withdraw from others in order to avoid being triggered.
Hyperarousal or hypervigilance - Signs of hyperarousal include irritability, chronic anxiety, somatic issues, anger outbursts, an increased startle response, difficulty falling asleep or staying asleep, continuously scanning for perceived threats, and overestimating potential threats.
What are the risk factors and protective factors for PTSD?
As mentioned before, even if two people experience the exact same trauma, they may respond differently. Some risk and protective factors can account for these differences. Risk factors for developing PTSD include a lack of social support, ongoing stress, previous traumatic experiences, family history of mental health disorders, limited access to resources, and personality traits. Protective factors include a strong social support system, having a strong self-concept and self-efficacy, spirituality, and reaching out for help.
What is complex post-traumatic stress disorder?
While PTSD focuses on singular traumatic events, complex PTSD generally describes ongoing and sustained trauma. Complex trauma often stems from relational trauma such as domestic violence, physical abuse, psychological abuse, sexual abuse, or childhood neglect. Many times, complex trauma is rooted in early childhood experiences. Complex trauma also includes race based trauma and trauma experienced by other marginalized communities who face macro- and microaggressions daily.
Though the symptoms of PTSD and C-PTSD are similar, in addition to the criteria mentioned above for a PTSD diagnosis, what distinguishes C-PTSD from PTSD is the presence of dysregulation, negative self-concept, and interpersonal difficulties.
Affect Dysregulation - Affect is just a fancier word for emotions, so affect dysregulation refers to the difficulty or inability to regulate emotions or self-soothe in a helpful way. Individuals may experience overregulation or underregulation of emotions. Signs of overregulation are ignoring or shutting down emotions, dissociation, depersonalization, derealization, or amnesia. Overregulation is the brain’s way of protecting an individual from trauma. Underregulation, on the other hand, may look like losing control over emotions, having difficulty letting go of arguments, expressing emotions in an intense manner, feeling too overwhelmed or emotionally flooded to think through a situation before acting, and acting impulsively when feeling out of control of emotions. For those who have experienced trauma, underregulation acts as a means of protection. Your brain still believes that you are in danger at all times, so even small things feel like a threat.
Additionally, since complex trauma is often relational, individuals experiencing C-PTSD may have never had a healthy model of emotional regulation. In order to cope with overwhelming emotions, individuals may turn to unhelpful self-soothing behaviors like alcohol or drug use, self-harm, restricting food intake, yo-yo dieting, overexercising, or overworking. These behaviors can result in co-occurring disorders such as eating disorders and substance use disorders. Luckily, working with a trauma therapist can help you with building emotional regulation!
When emotions are properly regulated, individuals are able to feel their emotions, sit with them, and self-soothe in a helpful way. Helpful self-soothing might include checking in with your five senses like listening to your favorite music (sound), drinking a hot cup of tea (taste), snuggling up under a weighted blanket (touch), going for a walk and looking at nature (sight), lighting a scented candle (smell), or squeezing a stress ball (touch).
Negative Self-Concept - Individuals with a negative self-concept may consider themselves inherently bad, shameful, worthless, unlovable, or powerless. Our self-concept is influenced by how others react to us and treat us, so it makes sense that individuals who have experienced ongoing relational trauma may have a negative self-concept. Additionally, when the traumatized brain is continually stressed and just fighting to survive, developing an identity outside of that becomes difficult. One of the protective factors for PTSD and C-PTSD is a strong self-efficacy, but if you are unable to escape traumatic situations and your life is controlled by others, you may be reluctant to believe in yourself and your abilities, to problem-solve, or to take risks. You may believe that the trauma happened to you because there was something wrong with you or that you deserved it. Our therapists can work with you to challenge your negative self-concept and build self-esteem. We know that you are not your trauma and believe you are absolutely worthy of acceptance and love.
Interpersonal Difficulties - When you haven’t seen positive examples of secure relationships, being vulnerable with others and trusting others can be very difficult and uncomfortable. Remember, trauma keeps us in a fight, flight, fawn, or freeze response and constantly on alert for any perceived threat. This makes it difficult to connect with others. When constantly exposed to traumatic situations, there is no time to recover either through self-soothing or co-regulation, and thus the brain remains highly activated which impacts how you interact with others. For example, a person with a fawn response may have difficulty voicing their needs in relationships leading to loose boundaries or codependency. On the other hand, a person with a flight response may avoid intimacy and conflict at all costs.
As an important note, please remember that none of these responses are your fault or a “bad” thing. They are simply your brain and body doing the best they can to protect you when faced with potential threats.
What are the risk factors and protective factors for C-PTSD?
One of the greatest risk factors for developing C-PTSD are adverse childhood experiences. Adverse Childhood Experiences (ACES) include but are not limited to physical, sexual, or psychological abuse; witnessing violence; neglect; having a loved one with mental health issues or substance use issues; loss of a caretaker; separation from caretaker(s); or chronic poverty. According to the CDC, it is estimated that at least two thirds of the U.S. population have experienced at least one ACE, that over a quarter of the population has experienced two or more, and that 1 in 6 adults have experienced four or more. Additional risk factors include a lack of social support, ongoing stress, previous traumatic experiences, family history of mental health disorders, limited access to resources, and personality traits.
Protective factors include a secure attachment in childhood, social support systems, access to resources (community, financial, and health-related), having a strong self-concept and self-efficacy, having a stable and supportive home environment, or having at least one caring person outside of the household to act as a mentor.
What are the effects of PTSD + C-PTSD?
PTSD and C-PTSD not only affect mental health but can also affect physical health and interpersonal relationships. Some of the physical impacts of trauma include chronic pain, digestive issues, increased blood pressure, elevated heart rate, muscle tension, insomnia, memory issues, or fatigue. Other mental health issues often co-occur with PTSD including eating disorders, depression, anxiety, substance misuse, and obsessive compulsive disorder. Co-occurring disorders are common, with about 80% of individuals with PTSD also struggling with another mental health disorder. PTSD and C-PTSD can also contribute to low self-esteem and issues in intimate relationships. Survivors of trauma may have difficulty trusting others, experience social anxiety, feel misunderstood by others, or feel alienated and alone.
What are the treatment options for PTSD and C-PTSD? There has been less research on specific treatment options for C-PTSD since it is a fairly new concept. Due to the multi-dimensional nature of complex trauma, treatment includes a variety of components including self-esteem work to build self efficacy, interpersonal healing and relational work to foster secure attachments, emotional regulation and coping tools, empowerment through reconstructing a narrative around the trauma, and somatic body-centered therapies to establish a strong mind-body connection.
Somatic Therapies
Mind-body connection is crucial in trauma recovery, because our bodies hold onto trauma. As you have probably heard it, the body keeps the score. We remain activated and on high alert even if we logically understand that we are not in danger. For this reason, treatments that go beyond talk therapy and incorporate movement, meditation, visualization, body awareness, breath-work, and grounding are useful. These are referred to as somatic therapy. Some somatic therapies include Eye Movement Desensitization and Reprocessing (EMDR), Somatic Experiencing, and mindfulness.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
This modality is used with children and adolescents who have experienced trauma. TF-CBT involves five core components: psychoeducation, coping skills, gradual exposure, cognitive processing, and caretaker involvement. TF-CBT helps children and their caregivers alike develop tools for managing stress, challenging negative thoughts such as guilt or shame around the trauma, and developing better communication skills.
Group Therapy
As mentioned before, social support is crucial in trauma recovery. There is power in knowing you are not alone. Connecting with others who have experienced trauma as well and seeing others’ journeys and perspectives can foster feelings of hope and acceptance.
Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT)
CBT and DBT are two forms of talk therapy used in trauma treatment. Therapists who use CBT help clients to identify and challenge negative thoughts and beliefs and replace them with ones that are more accurate.
DBT is helpful for clients who have difficulty regulating their emotions. Therapists who practice DBT aim to help clients accept where they are and also recognize and change unhelpful behaviors. DBT includes the four components of building skills around mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.
Our trauma-informed team members offer a variety of approaches to trauma therapy personalized to your needs. When you are ready to process your trauma safely, contact us for a free 15-minute consultation.
