Perhaps you are already familiar with post-traumatic stress disorder (PTSD), a psychological disorder associated with trauma exposure.  But have you heard of complex post-traumatic stress disorder (C-PTSD)?  This is a mental health condition that develops in individuals exposed to chronic maltreatment and abuse.  The present article discusses the symptoms and treatment of Complex PTSD.

When trauma becomes chronic

Let us begin with PTSD.  The development of PTSD is conditional on exposure to trauma, such as witnessing a murder, surviving a house fire, or learning of a friend’s rape.

However, not everyone who has been traumatized meets the criteria for PTSD.  Indeed, many survivors of prolonged trauma (e.g., chronic abuse) do not.  Yet, these individuals—be they ill-treated children, bullied students, or battered women—experience significant trauma-related distress and impairment in daily functioning.

A more appropriate diagnosis for these trauma survivors may be Complex PTSD, a diagnosis proposed by psychiatrist Judith Herman in the early 1990s.

Symptoms of Complex PTSD

Complex post-traumatic stress disorder is associated with psychological, bodily, and social symptoms; in particular, emotional dysregulation, behavioral problems, somatization, dissociation, and relationship disturbances.  These symptoms are described below.

Emotional dysregulation: Having difficulties controlling and regulating emotional states, particularly negative emotions, such as depression, guilt, rage, and helplessness.

Behavioral problems: Some examples are impulsiveness, aggression, self-harm, and alcohol and drug misuse.

Somatization: Unexplained bodily symptoms, such as sleep disturbances, stomach problems, and chronic pain.

Dissociation: Ranges from mild (e.g., performing a task mindlessly) to severe (e.g., developing multiple personalities).

Relationship difficulties: Dysfunctional patterns of relating (see below).

To understand the nature of relationship disturbances in Complex PTSD, we must remember victimized individuals are more likely to see themselves, others, and new relationships through the lens of the old, abusive relationship.  For instance, regardless of how their current romantic partner behaves, people who have experienced chronic trauma may feel the same instability, powerlessness, emotional exhaustion, and desperate need for affection that they did in the abusive relationship.  And, as a result, they may react in destructive or dysfunctional ways (e.g., becoming abusive themselves) in their present relationship.

Treatment of Complex PTSD

The treatment of complex PTSD consists mainly of psychotherapy (e.g., cognitive behavioral therapy, prolonged exposure therapy).  In addition, anti-anxiety agents, antidepressants, and other types of medications are sometimes prescribed to help manage severe anxiety, irritability, impulsivity, sleep difficulties, and other symptoms.

A commonly accepted psychotherapy model for the treatment of C-PTSD consists of three phases—namely, preparation, trauma processing, and generalization of the effect:

During the preparation phase, the focus is typically on education, safety, skills training, improving emotional stability, and building a therapeutic alliance.  It may take patients some time to feel stable and to develop a strong working relationship with the therapist.  Once this is achieved, patients are ready to begin the more challenging work of processing the unpleasant memories and emotions associated with the trauma.

The second phase, trauma processing, focuses on reducing avoidance of the memories and the reminders of the trauma, plus dampening trauma-related hyperarousal (e.g., exaggerated startle response).  A major goal is to help patients make sense of their trauma in a way that facilitates the integration of trauma memories into a cohesive life narrative.

The last phase involves the generalization of the effect—integrating therapeutic gains into daily activities and future plans, such as going back to work or starting a new romantic relationship.

By the end of therapy, individuals with Complex PTSD  have a greater understanding of the complex effects of the trauma.  They are also more aware of their own resilience and strengths.  And, having worked through the trauma, they may feel ready to begin a new chapter in their lives.