Complex Post-Traumatic Stress Disorder (C-PTSD)

What is Complex Post-Traumatic Stress Disorder (C-PTSD)

Complex post-traumatic stress disorder, also known as complex PTSD or C-PTSD, is a mental health disorder that people may develop after experiencing or witnessing a series of traumatic events. As with regular post-traumatic stress disorder (PTSD), complex post-traumatic disorder causes recurring nightmares, flashbacks, and disturbing memories about past trauma. However, C-PTSD develops from repeated trauma over a significant period of time, whereas PTSD often forms from a single incident (single-incident trauma). Complex PTSD typically involves relational and developmental trauma from an unsafe relationship or environment. For example, someone who has endured inescapable childhood abuse or neglect may be diagnosed with C-PTSD.

While mental health care professionals have diagnosed patients with C-PTSD, it is not an officially recognized condition in the DSM-5. C-PTSD may occur in people who have lived through persistent trauma, such as:

• Childhood abuse
• Domestic abuse
• Repeatedly witnessing abuse
• Torture or slavery
• Human trafficking
• Being a prisoner of war
• Being a refugee

People who are exposed to trauma and abuse at an early age or for prolonged periods of time are more likely to develop C-PTSD. C-PTSD symptoms typically appear three months to multiple years after trauma. People with C-PTSD often display all of the same symptoms of PTSD, which are separated into four main categories:

• Intrusive memories: Intrusive memories include unwanted memories, feelings of reliving the traumatic event, distressing nightmares, and emotional disturbances from triggers (signs that serve as reminders of the traumatic event). Intrusive memories can lead to elevated heart rate, anxiety, combativeness (fight), withdrawal (flight), and many other responses.
• Avoidance: Avoidance is an attempt to avoid speaking or thinking about an upsetting event. People with this response might also try to avoid certain people or locations that prompt memories of an event.
• Changes in physical and emotional reactions: These changes may include difficulty sleeping, hypervigilance, self-destructive behavior, and feelings of guilt and irritability.
• Alterations in cognition and mood: Alterations can cause negative self-beliefs, depression, shame, and detachment from others.

Symptoms more unique to C-PTSD include the inability to form stable and long-lasting attachments. Those with C-PTSD often have difficulty trusting others even years following their trauma. They may self-isolate and avoid socialization or deliberately seek out abusive relationships. People with C-PTSD are often unable to develop the relationships and support systems necessary to heal from their trauma. This lack of support makes C-PTSD recovery increasingly difficult.

The most common treatments for C-PTSD are psychotherapy and oral medications. Psychotherapy for C-PTSD can include cognitive therapy (therapy to change thought patterns), exposure therapy (therapy to confront memories of the traumatic incident) and eye movement desensitization and reprocessing therapy (EMDR). EMDR integrates exposure therapy with guided eye movements to help patients confront and process their trauma. Certain oral medications may help with C-PTSD, such as antidepressants and anti-anxiety medications. Self-care, support groups, and relaxation may also benefit those with C-PTSD.

The path to overcoming PTSD can be long and challenging and people with C-PTSD can benefit greatly by seeking professional treatment from a mental health care provider. Treatment can reduce PTSD symptoms, provide essential coping strategies, and improve one's quality of life.