Complex Post-Traumatic Stress Disorder (CPTSD)

What is CPTSD?

Complex post-traumatic stress disorder (CPTSD) is a term that relates to individuals who have undergone repeated or ongoing traumatic events.

Those with CPTSD also have symptoms that are associated with poor self-esteem, unhealthy emotion regulation, and difficulty with relationships, as well as physical symptoms such as headaches, gastrointestinal symptoms, and chest pain.

The scars left by repeated trauma, especially in childhood, are not something a person can quickly grow out of, as these deep trauma wounds can have a lasting impact on how a person interacts with the world around them and how they view themselves as a person.

CPTSD is often challenging to diagnose because it is frequently confused with PTSD, as well as anxiety disorders and borderline personality disorders.

Causes of CPTSD

CPTSD is rooted in the recurrence of traumatic events such as childhood abuse or domestic violence. The person experiences sustained trauma or multiple occurrences, commonly known as “complex trauma.” Other examples could be living in refugee camps or prisons. Other causes of CPTSD include the following:

• Slavery
• Genocide
• Torture

Symptoms of CPTSD

Symptoms of CPTSD are similar to PTSD symptoms with the addition of difficulty with relationships, physical fatigue or illness, and severe compromise to your self-esteem.

An individual with CPTSD will experience shame and feel permanently damaged, which can take a toll on their mental health.

Common overlapping symptoms of PTSD and CPTSD include the following, which often manifest in the following ways:

• Intrusive thoughts: Re-experiencing reminders of the trauma in the form of nightmares or flashbacks. Certain smells, places, and people can also be reminders of the traumatic event. Experiencing physical sensations, such as pain, sweating, trembling, or feeling sick.
• Avoidance: Unhealthy actions to avoid anything that reminds you of the trauma, such as avoiding places or certain people, which can lead to isolation or emotional numbness.
• Dissociation: Having an out-of-body experience, an altered sense of reality, or the inability to remember important details about the traumatic event (dissociative amnesia).
• Hypervigilance: Always having your guard up, being on edge, or easily startled.
• Sleep problems: Experiencing sleep problems like difficulty falling or staying asleep.
• Difficulty concentrating: Making it challenging to complete everyday tasks.
• Angry outbursts: Experiencing overblown and inappropriate emotional responses.

Specific symptoms of CPTSD (not found in PTSD)

• Negative self-image (including feelings of shame, worthlessness, and guilt)
• Social isolation
• Difficulty managing emotions (impatient, cries often without any reason, and can experience feelings of anxiety and depression)
• Difficulty with interpersonal relationships can manifest as difficulty communicating, mistrust of others, or seeking out unhealthy relationships
• Compulsive or inhibited sexual behaviors
• Poor memory of your own experiences
• Constantly searching and feeling the need for someone to “rescue” you
• Poor or fragmented memory of one’s history
• Somatization: Psychological symptoms are so stressful that they manifest in physical ailments such as headaches, stomach pains, digestive problems, and back pain.
• Seeking help from a medical professional for somatization symptoms in moments of distress. This can often cause a negative stigma as the individual may be falsely perceived as “doctor shopping” or faking symptoms.

What’s the Difference Between CPTSD and PTSD?

The two main differences between CPTSD and PTSD are:

1. The symptoms: CPTSD shares many of the same symptoms as PTSD, but it also includes its own unique symptoms that are classified as difficulty with interpersonal relationships, negative self-image and beliefs, and emotional dysregulation.
2. A repeated traumatic event vs. one isolated event: The cause of CPTSD has to do with exposure to repeated trauma (complex trauma), especially in childhood or adolescence. In contrast, PTSD occurs after one isolated traumatic event.

How Common is CPTSD?

Not everyone who experiences complex trauma will develop CPTSD, but it is quite prevalent and mainly depends on risk factors associated with the type of recurring traumatic events.

Studies show that CPTSD occurs in 3-18% of the population in community settings and between 16-38% in treatment-seeking samples (individuals who are seeking professional treatment for CPTSD after establishing a diagnosis). CPTSD has been shown to be most common among victims of childhood sexual abuse and refugees.

Other risk factors for developing CPTSD include the following:

• Younger age
• Emotional neglect in childhood
• Family instability in childhood
• Growing up in an urban environment

How is CPTSD Diagnosed?

CPTSD, like PTSD, is diagnosed based on the history of trauma and current presenting symptoms. Since CPTSD is a relatively new term in the mental health world and is very similar to PTSD, many mental health professionals will diagnose CPTSD as PTSD, as there are no specific tests to distinguish between the two. Although treatment may be very similar, it is important to differentiate the diagnosis between PTSD and CPTSD.

To diagnose CPTSD, one must meet the diagnostic criteria for PTSD in addition to three additional symptoms:

• Mood dysregulation
• Problems with interpersonal relationships
• Persistent feelings of self-blame and shame in relation to the trauma

CPTSD vs. Borderline Personality Disorder

Borderline personality disorder (BPD) shares a lot of symptom overlap with CPTSD, and as a result, people with CPTSD are commonly misdiagnosed with BPD. Some experts even argue that there is insufficient evidence to accurately differentiate between BPD and CPTSD. It is important to distinguish between CPTSD and BPD because the treatment differs drastically.

BPD is characterized by volatile and unstable relationships, an unstable sense of self, and impulsive emotional regulation that often results in self-harm and suicidal behaviors as an attempt to escape these intolerable inner emotions. BPD does not have to be rooted in trauma, although people with BPD often experience trauma; however, this is not a diagnostic criterion.

CPTSD is characterized by isolation, distant and avoidant relationships, and a persistent negative sense of self (self-blame and low self-esteem).

It is possible for CPTSD and BPD to co-occur.

How is CPTSD Treated?

CPTSD is treated similarly to PTSD, but treatment is usually longer. There are no specific or consistent guidelines for treating CPTSD, which is why it is important to seek care from a mental health professional who has a background and experience in trauma and trauma-informed care.

Medications are usually not given as there is not sufficient evidence showing their effectiveness, except in people who have symptoms of depression or anxiety (which are common in CPTSD as they relate to a negative sense of self and emotional dysregulation).

Treatment for CPTSD is rooted in psychotherapy with an emphasis on trauma-informed intervention. This approach focuses on identifying the source of the trauma, separating the person from the trauma, and offering tools for empowerment, self-care, autonomy, and trust-building. For children, this often involves family therapy and play therapy.

Treatment for CPTSD usually focuses on what caused the trauma rather than the symptoms associated with it. Like PTSD, CPTSD is often treated with the following types of psychotherapies:

• Prolonged exposure therapy (PET): PET gradually exposes people to triggers associated with their past trauma until they become desensitized (no emotional reaction to the associations with the trauma).
• Dialectical behavioral therapy (DBT): DBT focuses on developing healthy coping mechanisms to manage the emotions and thoughts associated with the trauma while also teaching how to build and manage healthy interpersonal relationships.
• Trauma focused cognitive behavioral therapy (TF-CBT): TF-CBT focuses on processing the traumatic memories.
• Eye movement desensitization (EMDR): EMDR is a multi-step approach where the therapist helps the client process the traumatic memories while engaging in bilateral eye movements to reduce the intensity of the traumatic memories.

Resources for People with CPTSD

Treatment for CPTSD can take a lot of time, so it is important to take care of yourself as you navigate the treatment plan. There are many ways you can educate yourself on your diagnosis, connect with others, and take care of yourself, which can have a huge positive impact on your life. Common self-support techniques for those with CPTSD include:

• Joining a trauma support group (virtual or in-person)
• Practicing self-care, which includes exercising, eating well, and doing things that bring you joy
• Spending time with people who care about and support you
• Journaling (writing down your thoughts and journaling can help manage symptoms associated with CPTSD, such as nightmares and flashbacks)
• Practicing mindfulness techniques
• Listening to podcasts or reading books about CPTSD to educate yourself on your diagnosis

If you have experienced repeated or prolonged trauma and are noticing symptoms that affect your daily life, speak to a mental health professional about a CPTSD assessment. They can help you better understand the underlying causes and develop coping techniques to lead you toward a more stable, fulfilling life. Remember: you are not alone, and healing is possible.