Imagine growing up in a household marked by constant financial instability, where food was often scarce, utilities were cut off, and frequent moves were the norm. Or maybe you lived in a home where addiction created chaos, with parents exhibiting erratic behavior, neglect, and even dangerous situations. Perhaps your daily reality included emotional and physical abuse, making every day a challenge of navigating fear and pain. Or maybe you had a parent struggling with untreated mental illness, leading to an unpredictable and unstable environment. In some homes, severe family conflict made you a silent witness to aggression and terror, learning to remain invisible to avoid becoming a target. Neglectful environments left you without basic emotional and physical support, leading to feelings of worthlessness and abandonment.

Imagine being a “kid” living in a home where things were always uncertain. Every other day, if not every day, felt tense, as if you were always on edge, never knowing when something bad might happen. To manage, you got really good at watching for danger and reading people’s feelings, trying hard to avoid arguments, and suppressing your emotions and feelings. At that dear age, you began to live in constant fight-or-flight mode, unknowingly unaware of the detriments related to always “living on the edge.” As time passed, these distorted coping mechanisms you thought of as “staying safe” became daily habits and a part of your daily norm, even when you weren’t in danger anymore.

If you found yourself resonating and connecting with this narrative, then I am here to tell you that you may be experiencing Complex Post-Traumatic Stress Disorder (C-PTSD).

What is Complex PTSD?

Complex Post Traumatic Stress Disorder (C-PTSD) arises from prolonged exposure to trauma, such as childhood abuse, neglect, or chronic instability. Dr. Judith Herman, a renowned psychiatrist and trauma expert, introduced the concept of Complex Post-Traumatic Stress Disorder (C-PTSD) in her influential book “Trauma and Recovery” published in 1992. She expanded on the understanding of PTSD to include the prolonged and repetitive nature of trauma, particularly in cases of childhood abuse and long-term interpersonal trauma. Unlike PTSD, which can result from a single traumatic event, C-PTSD is characterized by long-term trauma and its pervasive impact on an individual’s emotional and psychological state (Herman, 1997).

Although Complex Post-Traumatic Stress Disorder (C-PTSD) is not widely recognized and is relatively new, it is quite common among individuals who have experienced prolonged trauma. As Complex Post-Traumatic Stress Disorder (CPTSD) is a relatively recent diagnosis, there is limited research on its prevalence. However, experts estimate that it may affect 1% to 8% of the global population (Cleveland Clinic, n.d.). Although its inclusion was reconsidered for DSM-5, complex PTSD was again excluded because there was too little empirical evidence supporting Herman’s original proposal that this was a separate diagnosis.

What is the Difference between C-PTSD and PTSD?

Complex PTSD (C-PTSD) and Post-Traumatic Stress Disorder (PTSD) differ significantly in their origins and manifestations. PTSD typically arises from a single, isolated traumatic incident, such as a car accident or assault, leading to symptoms like flashbacks, hypervigilance, and avoidance behaviors (American Psychiatric Association, 2013). In contrast, C-PTSD develops from prolonged and repeated exposure to trauma, often within environments lacking safety and stability, such as ongoing abuse or living in war zones (Herman, 1997). Individuals with C-PTSD not only experience PTSD symptoms but also struggle with emotional dysregulation, disrupted relationships, and a diminished sense of self-worth (Herman, 1997). While PTSD is formally recognized as a distinct diagnosis in the DSM-5, C-PTSD is not yet classified separately but is acknowledged for its unique symptom profile and treatment considerations by many clinicians (American Psychiatric Association, 2013; Herman, 1997). Treatment for both conditions typically involves trauma-focused therapies and supportive interventions tailored to address their specific symptomatology and underlying trauma history.

What Causes C-PTSD?

Complex Post-Traumatic Stress Disorder (CPTSD) can be caused by prolonged exposure to traumatic events or situations where safety and security are severely compromised. Here are some common causes:

1. Childhood Abuse and Neglect: Persistent physical, emotional, or sexual abuse during childhood.
2. Household Dysfunction: Growing up in a home affected by substance abuse, mental illness, or domestic violence.
3. Chronic Stress: Long-term exposure to stressful environments such as poverty, instability, or community violence.
4. Traumatic Events: Experiencing or witnessing prolonged traumatic events like war, captivity (e.g., prisoner of war camps), or trafficking situations.
5. Repetitive Trauma: Enduring ongoing experiences of violence, exploitation, or discrimination (e.g., racism, sexism, human trafficking, emotional abuse, physical abuse, etc.)

These factors can lead to adaptive responses in the brain and nervous system aimed at immediate survival, which can manifest in symptoms characteristic of CPTSD, such as hypervigilance, emotional dysregulation, dissociation, and impaired self-concept.

Signs of C-PTSD

Complex PTSD (C-PTSD) manifests through a variety of signs and symptoms that reflect its prolonged and pervasive impact on an individual’s emotional, psychological, and social functioning (American Psychiatric Association, 2013; Herman, 1997). Common signs of C-PTSD include:

Emotional Dysregulation: Intense and fluctuating emotions, including periods of extreme anger, sadness, or emotional numbness.

Negative Self-Concept: Persistent feelings of worthlessness, shame, guilt, or inadequacy, often stemming from prolonged experiences of abuse or trauma.

Distorted Perception of Perpetrators: Difficulty trusting others, persistent feelings of betrayal, or viewing oneself as fundamentally different or damaged compared to others.

Difficulties in Relationships: Struggles with forming and maintaining stable relationships, whether due to mistrust, fear of intimacy, or patterns of conflict.

Avoidance: Avoidance of reminders of the trauma or situations that trigger distressing memories, which can lead to isolation or withdrawal from social activities.

Hypervigilance: Constantly being on guard, easily startled, or having an exaggerated response to potential threats, even in non-threatening situations.

Dissociation: Episodes of dissociation, where individuals feel disconnected from their thoughts, emotions, or surroundings, as a way to cope with overwhelming stress or trauma triggers.

Difficulty Regulating Emotions: Problems with controlling emotions, leading to outbursts, emotional shutdowns, or self-destructive behaviors.

Somatic Symptoms: Physical symptoms such as headaches, gastrointestinal issues, or chronic pain, often without clear medical cause but linked to unresolved trauma.

Negative Outlook on the Future: Pessimism about the future, feelings of hopelessness, or a belief that one’s life will always be marked by suffering.

These signs may vary in intensity and presentation among individuals with C-PTSD, reflecting the complex and individual nature of trauma’s impact. Treatment typically involves trauma-focused therapy, cognitive-behavioral interventions, and support to address these symptoms and promote healing and recovery (American Psychiatric Association, 2013; Herman, 1997).

The Long-Term Impact of C-PTSD

Complex PTSD (C-PTSD) can have profound and enduring effects on various aspects of an individual’s life, often persisting long after the traumatic experiences have ended. Some of the long-term impacts of C-PTSD include:

1. Chronic Physical Health Issues: Individuals with C-PTSD may experience ongoing physical health problems such as chronic pain, gastrointestinal issues, cardiovascular problems, and autoimmune disorders. These issues can arise from the prolonged activation of the body’s stress response system.
2. Emotional and Psychological Challenges: Persistent emotional dysregulation, including intense mood swings, feelings of shame, guilt, and worthlessness, as well as ongoing struggles with anxiety, depression, and suicidal thoughts.
3. Impaired Self-Concept and Identity: Negative self-perceptions, distorted self-concept, and challenges in developing a coherent sense of identity due to early and prolonged exposure to trauma and invalidation.
4. Interpersonal Difficulties: Difficulties in forming and maintaining healthy relationships, characterized by mistrust, fear of intimacy, and challenges with boundaries. Individuals may struggle with social isolation or engage in tumultuous relationships.
5. Cognitive Impairments: Cognitive impairments such as difficulties with attention, concentration, and memory, which can impact daily functioning and academic or occupational performance.
6. Somatic Symptoms: Persistent physical symptoms and somatic complaints, such as headaches, muscle tension, and gastrointestinal problems, often without clear medical explanations.
7. Re-Victimization: Increased vulnerability to re-traumatization or entering into abusive relationships due to patterns of relating shaped by early traumatic experiences.
8. Maladaptive Coping Strategies: Continued reliance on maladaptive coping mechanisms, such as substance abuse, self-harm, or disordered eating, as ways to manage distress and emotional pain.
9. Impact on Parenting and Family Life: Difficulties in parenting, including challenges in forming secure attachments with children, as well as disruptions in family dynamics and functioning.
10. Reduced Quality of Life: Overall diminished quality of life due to ongoing psychological distress, impaired social functioning, and limitations in personal and professional pursuits.

Addressing Your C-PTSD

After reading this, you may feel hopeless or even shocked, but I am here to tell you there is hope! You have the power to change the narrative. Addressing the long-term impacts of C-PTSD often requires comprehensive and trauma-informed treatment approaches, including psychotherapy tailored to address trauma-related symptoms, medication when appropriate, and supportive interventions to enhance coping skills and resilience.Here are a few ways you can begin to heal from C-PTSD:

• Awareness and Recognition: Understanding that you have C-PTSD is the first step. Recognize the patterns and behaviors that stem from your trauma
• Talking with Your PCP/Therapy Options: Working with a therapist, especially one trained in trauma-informed care, can help you process past trauma and develop healthier coping mechanisms. Additionally, consulting with your primary care physician (PCP) is crucial. They can provide comprehensive care by monitoring and addressing any physical health impacts of C-PTSD, such as chronic health issues exacerbated by stress responses, ensuring a holistic approach to recovery
• Self-Care and Mindfulness: Engaging in regular self-care practices and mindfulness can help reduce anxiety and promote a sense of safety
• Building Support Systems: Creating a network of supportive relationships can provide the stability and security needed for healing

While C-PTSD serves as a crucial coping mechanism during times of danger, remaining in this state can significantly impact mental health and overall well-being. Understanding and addressing the underlying causes of C-PTSD, through therapy and self-care, can lead to healing and a more fulfilling life.

Until next time, stay well and take care…

Zelina Chinwoh, MSW, LCSW

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Disclaimer: This article is intended for educational purposes only. The information provided is not a substitute for professional advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider or mental health professional with any questions you may have regarding your mental health or well-being.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.

Cleveland Clinic. (n.d.). Complex PTSD. Retrieved from [CPTSD (Complex PTSD): What It Is, Symptoms & Treatment (clevelandclinic.org) ]

Herman, J. L. (1997). Trauma and recovery: The aftermath of violence — from domestic abuse to political terror. Basic Books.