What Is Complex PTSD?
By Sarah Fader
Updated December 10, 2018
Reviewer Tiffany Howard, LPC, LCADC
Complex post-traumatic stress disorder (Complex PTSD) is a mental condition that results from ongoing or repetitive exposure to traumatizing, highly stressful situations. Its signs and symptoms are varied and generally intense, and not unlike PTSD. However, there are some critical differences between the two, both in the origin of the disorder, and its impacts on the individual who lives with the condition.
Many people are familiar with PTSD, which is a trauma disorder that occurs after exposure to a traumatic event like war, assault, a natural disaster, or any event that threatens someone's life and safety. PTSD is typically the result of one specific incident. Complex PTSD, on the other hand, is onset after repeated exposure to traumatizing, abusive conditions. Generally, such conditions are ones that occurred and persisted through childhood, but it is possible to develop Complex PTSD as an adult.
Examples of situations that can cause Complex PTSD include long-term childhood abuse, surviving through time in a concentration or labor camp, being held captive, or exposure to repeated domestic violence. Living under any oppressive conditions long-term where you felt entirely powerless can cause Complex PTSD.
Symptoms Of Complex PTSD In Adults And Children
There is currently no definitive test you can take to determine if you have Complex PTSD. If the symptoms listed here sound like something you suffer from, it's important that you connect with a therapist. A therapist can evaluate you and determine if you meet criteria to be diagnosed with Complex PTSD. Complex PTSD can look like other conditions as well, so it's critical that you get evaluated by a professional.
Complex PTSD involves all of the symptoms of PTSD, but also include:
- The difficulty with regulating emotions and behavior. This can cause bouts of rage or anger, uncontrollable crying, or numbness. It can also manifest as risk-taking, self-injury or suicidal behavior, or sexual impulsivity.
- Dissociation or amnesia around traumatic events. Dissociation is the experience of being disconnected from one's self-experience. It looks like "zoning out" or the mind going blank when faced with stress, or trying to remember a traumatic experience.
- Disturbance in self-perception. This can include an inability to feel truly "at home" in oneself, which relates back to feelings of dissociation. It can also manifest as feelings of shame, guilt, and self-loathing.
- Fluctuating perception of the abuse perpetrator. This symptom involves cycling between idealizing the person who inflicted the trauma, and loathing them and/or wanting to seek revenge.
- Impaired ability to form relationships with others. Often those with Complex PTSD re-enact their traumatic relationship with others, either by re-victimizing oneself or by victimizing others. It can also look like seeking to be rescued, or seeking to rescue others. Trust in others is usually eroded by the traumatic experiences, stifling intimacy.
- Loss of meaning. Life often feels hopeless and meaningless for those with this condition. For example, someone who once felt deeply spiritual no longer does; they feel disconnected from their belief systems.
- Experiencing physical symptoms of traumatic stress. This is referred to as somatization, in which traumatic psychological pain is "converted" into physical pain-digestive issues, migraines, or otherwise unexplained physical symptoms.
Complex PTSD is generally considered to be more disabling than PTSD and requires careful treatment considerations. The condition frequently is comorbid with other disorders, including addiction and eating disorders.
Symptoms of Complex PTSD, as in the case of PTSD, can exhibit differences in children and are often mistaken for learning disabilities or ADHD.
What Are Tell-Tale Behaviors Of People With Complex PTSD?
If someone is living with untreated, undiagnosed Complex PTSD, there are a variety of common behaviors that result from the condition. Engaging in these behaviors are the result of trying to manage symptoms, but often cause more suffering-both to the person with Complex PTSD, and for loved ones.
Substance abuse is a common struggle for those who have Complex PTSD. In an attempt to cope with the immense stress of Complex PTSD, some turn to drugs or alcohol for relief. Often this attempt at management of distress can develop into a whole other problem: addiction.
If you believe you may suffer from addiction, you can get help.
Another common behavior of those with Complex PTSD is self-injury or self-harm. This is another behavior that is used as an attempt to manage the pain of living with unresolved traumatic stress.
Avoidance of distress or pain-especially of anything that is similar to the traumatic conditions that induced Complex PTSD-is another tell-tale sign. This can look like avoiding conflict altogether and becoming "people pleasing", or lashing out at someone for offering a minor criticism, deflecting the criticism onto the other person.
These behaviors are developed as a response to the original traumatic conditions, and often were the only possible way to survive the trauma at the time. However, once out of the traumatic conditions, these behaviors can be understandably self-destructive, and hurtful to loved ones who witness them-or if they are directly impacted, such as in the case of being yelled at in response to bringing up a conflict, or as the result of substance abuse.
However, it is important to remember if you or a loved one are exhibiting these behaviors as a result of Complex PTSD-it is not because you or that person is inherently bad. It is because you or they are suffering from very severe psychological trauma. Identifying the reason for the destructive behavior is a crucial step in recovery and healing.
What Distinguishes Complex PTSD From PTSD And Borderline Personality Disorder?
Symptoms of Complex PTSD overlap a great deal with symptoms of PTSD, as well as symptoms of Borderline Personality Disorder (BPD). However, the three conditions are distinct. Though symptoms are shared across all three conditions, the symptoms that are most impactful depend on which condition someone has.
A 2014 study identified distinguishing features of Complex PTSD. Compared to BPD, those who have Complex PTSD report a consistent self-concept, it just happens to be one that is "consistently negative". Those with BPD have an unstable self-concept.
Additionally, while those who have BPD have difficulty with relationships, it is generally attributed to the tendency to fluctuate between idealizing and devaluing others and avoid abandonment at all costs. Those with Complex PTSD also struggle with relationships, but this is a result of avoidant behavior and a feeling of disconnection or alienation from others.
Because of the strong overlap in Complex PTSD between PTSD and BPD, it is especially important to meet with a professional who can arrive at the correct diagnosis. The different diagnoses require different treatment, and it is critical to find which treatment will be most effective for you if you think you have Complex PTSD. Start a conversation with a professional today.
Complex PTSD Treatment & Recovery
Because Complex PTSD and BPD share many of the same symptoms, the treatment developed for BPD is effective in treating Complex PTSD. This treatment is Dialectical Behavioral Therapy (DBT). DBT can support you in developing the ability to regulate your emotions, tolerating distress and pain instead of avoiding it or dissociating, and developing mindfulness skills (referred to as wise mind).
But because Complex PTSD is caused by traumatic stress-which BPD generally is not-it is important that any therapy you engage in is trauma-informed. In order to heal from the effects of trauma and Complex PTSD, it is important to do the work of trauma processing. DBT will help build coping skills, but trauma processing is critical in order to return your body and mind to a stable baseline. Generally, trauma-informed DBT is referred to as DBT-PTSD.
Before the work of trauma processing is started, it is important to develop the healthy coping skills and emotional tools that DBT teaches. Otherwise, trying to engage in processing can be re-traumatizing, causing continued and possibly heightened suffering, perpetuating the condition. This approach is usually referred to as the phase-oriented treatment.
The three stages of phase-oriented treatment involve 1) stabilization by building emotional regulation and distress tolerance skills, 2) processing trauma under the care of a trauma-informed, trained mental health professional, and 3) reconnecting with yourself and rebuilding a sense of self-esteem and security. By undergoing phase-oriented trauma therapy, it is possible to recover from Complex PTSD.
Another emerging treatment for Complex PTSD is phase-oriented EMDR, Eye Motion Desensitization, and Reprocessing. This treatment is a mind-body intervention that mimics the effects of REM sleep to process traumatic material. Research continues on this treatment method for Complex PTSD, but is used for PTSD-it is even used by the Department of Defense and Veteran's Affairs, and the World Health Organization.
Healing Is Possible
Complex PTSD is a serious condition, but those who suffer from it can get help. Its effects are severe, sometimes disabling, but it does respond to appropriate treatments. Treatment of Complex PTSD is continuing to be researched. Luckily, it is responsive to many of the treatments that PTSD is responsive to. It is possible to heal from Complex PTSD, but it is only possible when done under the treatment of a mental health professional.
If you suspect you have Complex PTSD or any type of traumatic stress, get in touch with a therapist today-you don't have to go through this alone. There are online counselors who are professionally trained to help you heal from Complex PTSD and you deserve to get the help you need.