Complex post-traumatic stress disorder (CPTSD) is closely related to post-traumatic stress disorder (PTSD). However, it usually develops due to repeated trauma over months or years rather than a single event.
Most people are familiar with PTSD, an anxiety disorder that results from a traumatic event, such as a natural disaster or car accident.
However, a similar condition called CPTSD is becoming more widely recognized by doctors in recent years. Read on to earn more about the symptoms, causes, differences from PTSD, diagnosis, treatment, and more.
What are the symptoms?
The symptoms of CPTSD usually include those of PTSD, plus an additional set of symptoms.
Symptoms of PTSD
Reliving the traumatic experience
This can include having nightmares or flashbacks.
Avoiding certain situations
You might avoid situations or activities, such as large crowds or driving, that remind you of the traumatic event. This also includes keeping yourself preoccupied to avoid thinking about the event.
Changes in beliefs and feelings about yourself and others
This can include avoiding relationships with other people, not being able to trust others, or believing the world is very dangerous.
Hyperarousal
Hyperarousal refers to constantly being on-alert or jittery. For example, you might have a hard time sleeping or concentrating. You might also be unusually startled by loud or unexpected noises.
Somatic symptoms
These refer to physical symptoms that don’t have any underlying medical cause. For example, when something reminds you of the traumatic event, you might feel dizzy or nauseated.
Symptoms of CPTSD
People with CPTSD typically have the above PTSD symptoms along with additional symptoms, including:
Lack of emotional regulation
This refers to having uncontrollable feelings, such as explosive anger or ongoing sadness.
Changes in consciousness
This can include forgetting the traumatic event or feeling detached from your emotions or body, which is also called dissociation.
Negative self-perception
You may feel guilt or shame, to the point that you feel completely different from other people.
Difficulty with relationships
You might find yourself avoiding relationships with other people out of mistrust or a feeling of not knowing how to interact with others. On the other hand, some might seek relationships with people who harm them because it feels familiar.
Distorted perception of abuser
This includes becoming preoccupied with the relationship between you and your abuser. It can also include preoccupation with revenge or giving your abuser complete power over your life.
Loss of systems of meanings
Systems of meaning refer to your religion or beliefs about the world. For example, you might lose faith in some long-held beliefs you had or develop a strong sense of despair or hopelessness about the world.
It’s important to note that symptoms of both PTSD and CPTSD can vary widely between people, and even within one person over time. For example, you might find yourself avoiding social situations for a period of time, only to start seeking potentially dangerous situations months or years later.
If you’re close to someone with CPTSD, it’s also important to remember that their thoughts and beliefs might not always match up with their emotions. They might know that, logically, they should avoid their abuser. However, they might also hold onto a sense of affection toward them.
What causes CPTSD?
Researchers are still trying to figure out exactly how traumatic stress affects the brain and leads to conditions like CPTSD. However, studies on animals suggest that trauma can have lasting effects on the amygdala, hippocampus, and prefrontal cortex. These areas play a big role in both our memory function and how we respond to stressful situations.
Any type of long-term trauma, over several months or years, can lead to CPTSD. However, it seems to appear frequently in people who’ve been abused by someone who was supposed to be their caregiver or protector. Examples include survivors of human trafficking or ongoing childhood sexual abuse by a relative.
Other examples of long-term trauma include:
- ongoing physical, emotional, or sexual abuse
- being a prisoner of war
- living in an area of war for long periods of time
- ongoing childhood neglect
Are there any risk factors?
While anyone can develop CPTSD, some people may be more likely to develop it than others. Aside from having past traumatic experiences, risk factors include:
- underlying mental illness, such as anxiety or depression, or a family history of it
- inherited personality traits, which is often referred to as temperament
- how your brain regulates hormones and neurochemicals, especially in response to stress
- lifestyle factors, such as not having a strong support system or having a dangerous job
How is it diagnosed?
CPTSD is still a relatively new condition, so some doctors aren’t aware of it. This can make it hard to get an official diagnosis, and you might be diagnosed with PTSD instead of CPTSD. There’s no specific test for determining whether you have CPTSD, but keeping a detailed log of your symptoms can help your doctor make a more accurate diagnosis. Try to keep track of when your symptoms started as well as any changes in them over time.
Once you find a doctor, they’ll start by asking about your symptoms, as well as any traumatic events in your past. For the initial diagnosis, you likely won’t need to go into too much detail if it makes you uncomfortable.
Next, they may ask about any family history of mental illness or other risk factors. Make sure to tell them about any medications or supplements you take, as well as any recreational drugs you use. Try to be as honest as you can with them so they can make the best recommendations for you.
If you’ve had symptoms of post-traumatic stress for at least a month and they interfere with your daily life, your doctor will likely start with a diagnosis of PTSD. Depending on the traumatic event and whether you have additional symptoms, such as ongoing relationship problems or trouble controlling your emotions, they may diagnose you with CPTSD.
Keep in mind that you may need to see a few doctors before you find someone you feel comfortable with. This is very normal, especially for people dealing with post-traumatic stress.
How is it treated?
There are several treatment options for CPTSD that can both reduce your symptoms and help you better manage them.
Psychotherapy
Psychotherapy involves talking with a therapist either alone or in a group. It also includes the use of cognitive behavioral therapy (CBT). This type of treatment helps you identify negative thought patterns and gives you tools to replace them with more healthy, positive thoughts.
Your doctor might also recommend dialectical behavioral therapy, a type of CBT that helps you better respond to stress and build stronger relationships with others.
Eye movement desensitization and reprocessing (EMDR)
EMDR is commonly used to treat PTSD, and it can be helpful for CPTSD as well. You’ll be asked to briefly think about a traumatic moment while moving your eyes from side to side. Other techniques include having someone tap on your hands instead of moving your eyes. Over time, this process may help to desensitize you to traumatic memories and thoughts.
While there’s some debate within the medical community over its use, the American Psychological Association conditionally recommends it for PTSD. This means that they recommend it but additional information is still needed due to insufficient evidence.
Medication
Medications traditionally used to treat depression can also help with symptoms of CPTSD. They tend to work best when combined with another form of treatment, such as CBT. Common antidepressants used for CPTSD may include:
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
While some people benefit from using these medications long term, you may only need to take them for a short period of time while you learn new coping strategies.
Living with CPTSD
CPTSD is a serious mental health condition that can take some time to treat, and for many people, it’s a lifelong condition. However, a combination of therapy and medication can help you manage your symptoms and significantly improve your quality of life.
If starting treatment sounds overwhelming, consider joining a support group — either in person or online, first. Sharing your experience with people in similar situations is often the first step toward recovery.
Treatment for Posttraumatic Stress Disorder
PTSD Treatment guidelines have been produced by the International Society of Traumatic Stress Studies, with separate guidelines for both adults and adolescents/children. The information below applies to adults only.
Therapy for PTSD
The extensive PTSD guidelines cover different types of talking therapy, including
Cognitive-Behavioral Therapy
,
Eye Movement Desensitization and Reprocessing
,
Psychodynamic Therapy
,
Psychosocial Rehabilitation
, hypnosis (used alongside other therapies but not a therapy on itself),
Couple and Family Therapy
and
Creative Therapies
.
Psychological Debriefing (also known as Critical Incident Stress Debriefing) is not recommended
, and clinicians are advised to be cautious with patients who want to use hypnosis to access “unremembered” episodes of past abuse. [7]
Medication for PTSD
The only drugs that are currently FDA-approved for
PTSD
(in the United States) are
two
SSRI
s:
Paroxetine (
Paxil
)
and
Sertraline (
Zoloft
),
although other drugs may be prescribed for “off-label” use.[10] The strongest evidence for
medication
involves two classes of anti-depressant; SSRIs and
SNRI
s (e.g,
Venlafaxine).
The atypical
anti-depressant
Mirtazapine (
Remeron
)
has also been shown to be effective, although there is some evidence for other anti-depressants. For people who have only a limited response to SSRIs,
atypical anti-psychotics
may be used in addition, for example
Risperidone
/
Olanzapine (
Zyprexa
)
or
Quetiapine (
Seroquel
)
. [7]:563-564,566, [10] Atypical antipsychotics can be helpful in PTSD for people with extreme
hypervigilance
/
paranoia
, physical
aggression
and trauma-related psychosis; conventional antipsychotics are not recommended. [7]:566
Antiadrenergic drugs
can reduce arousal (e.g., hypervigilance), reexperiencing and possibly dissociative symptoms caused by PTSD
.
Prazosin (
minipress
), a medication licensed for high blood pressure and other physical conditions, is
known to reduce trauma-related nightmares, sleep problems, and overall PTSD symptoms
.
Benzodiazepines (e.g.,
Alprazolam
and
Clonazepam
) are not recommended
, especially if used as the only medication. They can increase
depression
, slow physical movements, and do not reduce re-experiencing (e.g.,
flashbacks
). They are known to be problematic for people with a history of alcohol or drug abuse/dependence.[7]:566
Although some medication is recognized as a “Level A” treatment, meaning there is good evidence that it works,
medication is generally considered less effective than some Cognitive-Behavioral Therapies, both in United States and British treatment guidelines
.[7], [9] All medications can cause side effects, and symptoms may return after medication is discontinued. [7]:567
Disclaimer: The information above should not be considered advice. It is a summary of existing treatment guidelines which does not take into account a person’s current symptoms or medical history. Make sure you speak to a clinician for advice before making any medication or treatment decisions, or discontinuing existing medication.
Recovery without treatment
A recent review of 42
evidence-based
studies into long-term and spontaneous recovery in PTSD found that
44% of people in studies no longer had PTSD after an average of 3 years and 3 months without treatment
.
Recovery rates vary with the type of trauma
;
PTSD caused by a natural disaster had the highest recovery (remission) rates when untreated, at 60%. PTSD from physical disease had the lowest rates (31.4%) when untreated.
[8]
Treatment for Complex PTSD
Complex PTSD is harder to treat/recover from than ‘simple’ PTSD; not only are there multiple traumas but the interpersonal and long term nature of the traumas lead to
International Society of Traumatic Stress Studies
publishes
Complex Posttraumatic Stress Disorder
treatment guidelines which are based on
psychotherapy using a three-phase approach
.[11]
- Phase 1 focuses on improving the individual’s safety, reducing symptoms and skills training, which increases the person’s emotional, social and psychological competencies. This often involves medication. Improving safety refers to reducing unsafe behaviors, e.g. self harm, and risk taking, and if possible establishing a safe enviroment.
- Phase 2 focuses on processing and reappraisal of the unresolved trauma memories. This results in memories being integrated into an “adaptive representation of self, relationships and the world” and should be done using individual rather than group therapy.
- Phase 3 involves consolidating treatment gains, including using these gains to engage more in interpersonal relationships, work/education, and the community/life in general [11]:5-9
Complex PTSD is harder to treat/recover from than ‘simple’ PTSD; not only are there multiple traumas but the interpersonal and long term nature of the traumas lead to additional symptoms . Repeated child abuse is the most common cause of Complex PSTD. Thepublishestreatment guidelines which are based on
Treatments for Dissociative Disorders
Dissociative Identity Disorder and similar forms of Other Specified Dissociative Disorder
/
DDNOS
share the same Adult Treatment Guidelines, these are produced by the
International Society for the Study of Trauma and Dissociation
(ISST-D) and are based on expert consensus.[1] The main treatment involves
psychotherapy (talking therapy)
and uses a
three-phase treatment model very similar to that recommended for Complex PTSD
.[1]
Separate Child and Adolescent Treatment Guidelines also exist
References
PTSD Treatment guidelines have been produced by the International Society of Traumatic Stress Studies, with separate guidelines for both adults and adolescents/children. The information below applies to adults only.
