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What is Complex PTSD?


Graphic reads 'Understanding Complex PTSD: Symptoms, Causes and Treatments'

What is Complex PTSD?

In very simple terms, Complex PTSD (sometimes called CPTSD) is Post-Traumatic Stress Disorder (PTSD) with an additional set of symptoms.


Symptoms of PTSD and CPTSD

PTSD can occur after experiencing a single traumatic event or a series of traumatic events. Symptoms fall into four main groups:


  1. Hypervigilance

Hypervigilance is a bit like being on high alert, so you might notice you feel jumpy or more anxious than usual. You may also be more irritable or easily agitated. Some people experience an increased startle response. Others describe feeling really on edge all the time as if something bad is about to happen.


2. Intrusions

There are typically two main types of intrusions. You may experience nightmares or distressing dreams when you sleep. This can lead to a fear of sleeping, disrupted sleep and tiredness.


The other kind of intrusion, sometimes called flashbacks, happens while you’re awake. You might experience a series of still images in your mind or thoughts that feel like a video of the traumatic event. Sometimes flashbacks are more subtle. They can feel like a thought or an emotion that reminds us of the traumatic event.

Intrusions can be triggered by things we see, hear or smell. A trigger might be something somebody says or does, or it might be experiencing an emotion similar to one we felt at the time of the trauma.


For many people, intrusions are very distressing. It can be difficult to differentiate between what happened then and what is happening now. Intrusions can lead to lots of fear, high levels of distress, and anxiety, fuelling the sense that something bad is happening in the present.


3. Avoidance

To manage intrusions and hypervigilant feelings, people often avoid things that remind them of the traumatic event.  At first, this may be a handful of things that are exact replicas of the trauma, but over time people often begin to avoid more and more things. This can lead to them becoming increasingly isolated and less likely to do things they would normally enjoy.


Some people use specific things to avoid their symptoms and dampen down the thoughts and images in their mind. For example, people might use alcohol, substances or medications to dull their psychological experiences. Some people use self-harm as a way of coping with their emotions. Others develop certain behaviours designed to keep them safe, such as not going to places, not driving on certain roads, or only visiting certain places in the company of others. All these behaviours mean their life becomes more and more restricted.


4. Negative Beliefs

Often, when people have experienced a traumatic event, they are left with unhelpful beliefs that begin to form part of how they see the world. These beliefs can also reinforce negative emotional states such as fear, guilt, anxiety and low self-esteem.


Sometimes people misplace responsibility for a traumatic event, blaming themselves for something that isn’t their fault. Some people overestimate the likelihood of something terrible happening again or they underestimate their ability to cope in future difficult situations.


You can learn more about PTSD here. With Complex PTSD, there are additional symptoms to look out for:


  1. Difficulties with Emotional Regulation

You can think about emotional regulation like a volume control for your feelings. When you use the volume control on a device, you can prevent it from being too loud. With CPTSD, the volume control for your feelings doesn’t work as it should, making your emotions ‘louder’ and harder to manage.


Emotional dysregulation can present as mood swings, impulsive behaviour, being prone to losing your temper, or becoming easily frustrated by small inconveniences or annoyances. More severe effects can include verbal outbursts (shouting, yelling, screaming or crying), aggressive or even violent behaviour (towards objects, animals or people) and trouble maintaining friendships, relationships or other forms of social connection.  


2. Interpersonal Difficulties

CPTSD can lead to significant problems with interpersonal relationships. These difficulties may stem from feelings, thoughts, and behaviours that interfere with your ability to bond with others in general or in particular types of relationships. This can have a huge impact on family relationships, romantic relationships, friendships, and even your ability to succeed at work.


3. Pervasive Negative View of Self

Pervasive negative beliefs are deeply held core ideas that influence thinking patterns, interpretations of events, and behavioral responses. Sadly, with CPTSD, it is very common to view yourself in a highly critical way in relation to many different aspects of your life.  


What Causes Complex PTSD?

Our brain and nervous system respond in a particular way to traumatic events. When the moment of trauma has passed, normal functioning resumes. However, when someone repeatedly experiences trauma for an extended period, the brain becomes continuously stuck in this trauma response state.


Think of your brain and body like a car engine. You can only run an engine at full throttle for a short amount of time. If you repeatedly and persistently do so, eventually it’s going to impact the overall functioning of the engine. This is what happens with Complex PTSD.


Usually, Complex PTSD occurs when somebody has experienced repeated or chronic exposure to multiple traumatic events. These types of events include things like child abuse, domestic violence, occupational trauma, torture, trafficking, and other forms of systemic long-term abuse. It also tends to occur when somebody has been in a situation they can’t escape. For example, a child in an abusive situation is unable to leave because they cannot fend for themselves. If the perpetrator of the abuse is somebody important in their life like a caregiver, the nature of the attachment adds another layer of difficultly that can lead to the individual developing Complex PTSD.


Who Is at Risk?

For the reasons outlined above, some people are more at risk of developing Complex PTSD.  

·       Police, firefighters or those in the military

·       People exposed to repeated abuse in childhood

·       People who have been in conflict situations

·       People who have been held captive

·       Survivors of human trafficking

·       People who have been in domestic abuse situations they were unable to leave

·       People who have experienced long-term exposure to bullying


Treatment for CPTSD

The treatment options for Complex PTSD are the same as for PTSD, so Trauma Focused CBT and/or EMDR. However, treatment may take longer. As well as having more memories to process, forming a safe therapeutic relationship can take time. We might prioritise working on the traumatic events which are most significant or are having the most impact in the here and now. There might also be additional work to do around learning to regulate your emotions and helping you view yourself in a more compassionate way.


Find Out More

Although treatment can take time, you can heal and recover from Complex PTSD. If you’re struggling with any of the things described in this article, please get in touch. I also share lots of tips and advice via Instagram.  

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