What is Complex PTSD?

Complex PTSD is a disorder that may develop after prolonged relational trauma. It is complex in its symptomology and treatment. Some treatments work for people with Complex PTSD.

What is Complex PTSD?

Complex Post-Traumatic Stress Disorder (Complex PTSD) is a disorder that may develop following ongoing, inescapable, relational trauma. It usually involves being hurt by another person in a way that is ongoing or repeated. It often consists of a betrayal and loss of safety. Ultimately, it essentially is a more complex version of PTSD where all diagnostic criteria for PTSD are met, plus some additional criteria, such as problems in affect regulation and relationships.

Complex PTSD is not found as a diagnosis in the DSM-5, but it is found in the ICD-11.

What Causes Complex PTSD?

Complex PTSD can be caused by traumatic events that are highly threatening. These are often prolonged or repeated, and escape is impossible or dangerous.

Some situations that can cause Complex PTSD include:

• Prolonged domestic violence.
• Childhood abuse, neglect, or abandonment
• Torture, genocide, kidnapping, slavery, and being a prisoner of war
• Repeatedly witnessing violence or abuse
• Being forced or manipulated into prostitution (trading sex)

You are more likely to develop complex PTSD if:

• You experienced trauma at an early age
• The trauma lasted for a long time
• Escape or rescue was unlikely or impossible
• You have experienced multiple traumas
• You were harmed by someone close to you.    

What are the Diagnostic Requirements of Complex PTSD According to the ICD-11?

Here are the basics of the criteria for the Complex PTSD (6B41) in the ICD-11:

• Exposure to an event or series of extremely threatening or horrific events, most commonly prolonged or repetitive events from which escape is difficult or impossible.
• Following the traumatic event, the development of all three core elements of Post-Traumatic Stress Disorder, lasting for at least several weeks:
  • Re-experiencing the traumatic event after the traumatic event has occurred, in which the event(s) is not just remembered but is experienced as occurring again in the here and now.
  • Deliberate avoidance of reminders is likely to produce re-experiencing of the traumatic event(s).
  • Persistent perceptions of heightened current threat are indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises. In Complex Post-Traumatic Stress Disorder, unlike in Post-Traumatic Stress Disorder, the startle reaction may, in some cases, be diminished rather than enhanced.
• Severe and pervasive problems in affect regulation.
• Persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the stressor.
• Persistent difficulties in sustaining relationships and in feeling close to others.
• The disturbance results in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.

Additional Clinical Features:

• Suicidal ideation and behaviour, substance abuse, depressive symptoms, psychotic symptoms, and somatic complaints may be present.

What are the Symptoms of Complex PTSD?

• Flashbacks (re-experiencing the traumatic event) can include fragments of memories, thoughts, emotions, or body sensations.
• Avoidance and detachment from people, events and environmental triggers of the trauma.
• Difficulty controlling emotions (Emotion Regulation) and dealing with persistent negative emotions. It’s common for someone suffering from Complex PTSD to lose control over their emotions or have constant feelings of emptiness or hopelessness.
• Negative self-view. Complex PTSD can cause a person to view themselves in a negative light. You may feel helpless, guilty, or ashamed. You may have a sense of being utterly different from other people and feeling like no one can understand what happened to you. You may feel as if you are permanently damaged or worthless.
• Negative worldview. You may see the world as dangerous and pay excessive attention to the possibility of danger (hypervigilance).
• Difficulty with relationships. Your relationships may suffer because you have difficulty trusting others and a negative self-view. A person with Complex PTSD may avoid relationships or develop unhealthy relationships because that is what they knew in the past.
• Detachment from the trauma. People may disconnect from themselves (depersonalization) and the world around them (derealization). Some people might even forget their trauma (amnesia).
• Loss of a system of meanings. This can include losing one’s core beliefs, values, spiritual faith, personal identity, or hope in the world and other people.
• Physical symptoms, such as chronic pain, headaches, gut issues, dizziness, and chest pains.

These symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other vital areas of life.

On What Levels Is Complex PTSD More Complex Than Regular PTSD?

While PTSD is often associated with a one-time experience or a single-incident trauma, complex PTSD is associated with a prolonged or repeated experience. People with Complex PTSD have the symptoms of PTSD along with additional symptoms due to their prolonged or repeated traumatic experiences.

Why is Complex PTSD Harder to Treat?

Complex PTSD is often more complicated to treat because the trauma is much more complex. There are patterns that you used to survive that now interfere with the healing process. You may have multiple traumas, beliefs, and survival mechanisms that are interlinked and confusing to unweave. People suffering from Complex PTSD also often have low self-worth, struggles with shame and guilt, and low self-confidence, which can increase their distress and interfere with their healing.

Why is Complex PTSD So Damaging?

Complex PTSD is so damaging because many adult survivors of complex trauma have experienced a lack (or loss) of safety and no agency during critical times in brain development for extended periods of time. This stunted their development, prevented them from creating the life they wanted, and left them with a lack of a sense of worth or a sense of self.

Adult survivors of complex trauma end up living in a constant state of hypervigilance and suffering long after they have escaped the danger. This can leave them experiencing amnesia, alienation, chronic mistrust, chronic physical pain, re-victimization, debilitating flashbacks, nightmares, body memories, anxiety, dissociation, trouble with regulating volatile emotions, severe depression, toxic shame, auto-immune disease, along with other profoundly distressing and potentially life-altering symptoms.

Often, people with Complex PTSD isolate to deal with their feelings of unsafety. However, the isolation can lead them to further despair and suicidality. The chronic stress of Complex PTSD can change your brain’s chemistry and structure, including changes to your:

• Amygdala: Processes fear and other emotions.
• Hippocampus: Responsible for learning and memory.
• Prefrontal cortex: Involved in executive functions, such as planning, decision-making, personality expression and controlling social behaviour.

Treatment of Complex PTSD

Healing Complex PTSD requires creating some new daily habits that allow survivors to reclaim their sense of agency, a sense of self-worth, and a feeling of relative safety.

EMDR

Eye Movement Desensitisation Reprocessing (EMDR) can be very effective for treating Complex PTSD. Still, there are some additional considerations and elements of the treatment which are modified or changed from the treatment of single-event PTSD.

Some modifications need to be made for various types of dysregulation and dissociation. Treatment for Complex PTSD takes longer than PTSD because there are a lot more thoughts, memories, and experiences that need to be processed.

Flash Technique

The Flash technique enables complex PTSD clients to engage with the Standard (EMDR) Protocol sooner than they would have with traditional stabilization techniques, which focus exclusively on resourcing. Flash can also be used as a standalone treatment or combined with other methods.

A moving, engaging resource, like you find in Flash, is much better than a static, safe place. It is about engaging with something the client connects with positively, creating a more fulfilling experience for the client. Conversations and appropriate contextual humour between client and therapist enhance engagement in the Flash technique. Severe PTSD clients inherently have long-standing poor concentration due to traumatic memories frequently intruding in their present orientation; the interactive resourcing afforded by Flash seems better suited to this group of clients.

Strength and Growth Focused

Complex PTSD often needs more than just desensitizing because you didn’t learn certain things when you were younger, and the damage to your emotional self is frequently much more extensive. This may mean learning skills that instill self-belief, help you figure out who you are, and build self-confidence and interpersonal effectiveness.

Medication for Complex PTSD

There are currently no medications approved for Complex PTSD, and often, people with Complex PTSD have worse reactions to medications than PTSD. Medications can be used to reduce symptoms. Some of the commonly used medications include:

• Antidepressants: selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).
• Anti-anxiety medications.
• Sleep medications.

Conclusion

Complex PTSD is a disorder that reflects the struggles and symptoms of people who have experienced prolonged trauma. It is complex in its symptomology and its treatment. Some treatments work for Complex PTSD.