Most people have heard of post-traumatic stress disorder that afflicts many men and women returning from a war zone. It is characterized by flashbacks, unstable moods, and survivor’s remorse. However, many have never heard of a condition that often develops in childhood and changes the course of the child’s life forever, complex post-traumatic stress disorder (CPTSD).
For a good definition of CPTSD, we turned to Beauty After Bruises, an organization that offers outreach focused on adult survivors of childhood trauma who have complex PTSD with or without the presence of a dissociative disorder. Their definition of complex post-traumatic stress disorder as follows:
“Complex PTSD comes in response to chronic traumatization over the course of months or, more often, years. This can include emotional, physical, and/or sexual abuses, domestic violence, living in a war zone, being held captive, human trafficking, and other organized rings of abuse, and more. While there are exceptional circumstances where adults develop C-PTSD, it is most often seen in those whose trauma occurred in childhood. For those who are older, being at the complete control of another person (often unable to meet their most basic needs without them), coupled with no foreseeable end in sight, can break down the psyche, the survivor’s sense of self, and affect them on this deeper level. For those who go through this as children, because the brain is still developing and they’re just beginning to learn who they are as an individual, understand the world around them, and build their first relationships – severe trauma interrupts the entire course of their psychologic and neurologic development.”
CPTSD forms in response to repeated interpersonal violence that leaves the victim, a child or adult, feeling trapped with no hope of escape or of imminent death.
Complex post-traumatic stress disorder is a developmental trauma disorder (DTD) which is wildly different than post-traumatic stress disorder that normally, but not always, forms in adulthood.
The trauma model states that children who experience chronic sexual, psychological, physical abuse and neglect develop CPTSD. However, it also forms in kids who suffer slavery, human trafficking, working in sweatshops, war or survivors of concentration camp environments and cults. The trauma which causes this disorder may also include having experienced betrayal, defeat, and shame.
The reason children are vulnerable to forming CPTSD is that children do not have the cognitive or emotional skills to understand what is happening to them. Since the abuse and neglect, they are experiencing is normally perpetrated by people they know and trust, to admit to themselves that these same people want to hurt them is akin to emotional suicide so they use other means to manage the trauma.
The psychological implications are enormous leaving the child with a complex mess of their core beliefs about who they are what they are. This tangled mess becomes even more complicated by flashbacks, nightmares and other symptoms that are worse in adulthood.
Often, children experiencing interpersonal traumatic events experience a conundrum in their minds and some choose to dissociate the events away.
CPTSD and PTSD in the DMS-5
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), is the bible of the psychiatric world. However, CPTSD is not mentioned because the author’s believed it was sufficient to lump it together with other trauma-related disorders including post-traumatic stress disorder.
The tragedy of complex post-traumatic stress disorder not appearing in the DSM-V is that mental health providers cannot officially give their clients this diagnosis because it is not accepted by the American Psychiatric Association, the publishers of the DSM-5.
However, there is a growing movement among those living with CPTSD and others who are advocating to have this diagnosis receive its own listing in the next edition. The reason this is vital is that the symptoms of CPTSD are different in many important ways than PTSD.
Now you may be wondering, what’s the difference between complex and the other style of stress disorder, (sometimes referred to as “simple” or “classic” PTSD when being compared or contrasted with complex PTSD)
Post-traumatic stress disorder develops when a person experiences or witnesses something which is frightening, shocking, dangerous, or scary. Most people recover from such experiences, but some people develop short-term or ongoing symptoms including re-experiencing the event(s) through flashbacks or nightmares, avoiding places, events or objects which remind them of what they experienced, or arousal symptoms like being easily startled.
Complex post-traumatic stress disorder is different in two crucial ways, the trauma is longer-lasting or repeated, and the symptoms are more severe.
CPTSD can form in both children and adults, but in this series of articles, we are going to focus on children and how what they can face will affect them throughout their life span.
In short, any repetitive situation where the child cannot escape or believes themselves trapped with no hope of escape.
The symptoms of CPTSD can be life-altering and cause severe disabilities such as many different forms of mental health disorders, including borderline personality disorder, dissociative disorders, and somatization disorder. The emotional damage that precludes complex post-traumatic stress disorder can lead to prolonged feelings of terror, worthlessness, helplessness, and the warping of the identity and sense of self in children.
When these children become adults, they have wide-reaching symptoms with not having a solidified understanding of self and problems regulating their own emotions. However, while the emotional state of young children facing overwhelming life experiences is terrible enough, repeatedly being in a position of being in danger continually changes their brains as well.
The amygdalae of these highly traumatized youngsters, due to its constant bombardment from the stress hormones which make the body ready for fight or flight cannot form correctly. This part of the human brain responsible for emotional regulation has been found to be smaller than average by as much as 20% or more when they reach adulthood.
Other parts of the body are affected as well as the body’s inflammatory response to the ongoing influx of stress hormones, harming the child’s systems. Illnesses in adulthood are directly attributable to trauma in childhood, such as problems with immune system disorders, diabetes, and heart disease.
The symptoms of complex post-traumatic stress order may include the following:
- Losing memories of trauma or reliving them
- Difficulty regulating emotions that often manifest as rage
- Suicidal thoughts or actions
- Sudden mood swings
- Feeling detached from oneself
- Feeling different from others
- Feeling ashamed
- Feeling guilty
- Difficulty maintaining relationships
- Difficulty trusting others
- Seeking our or becoming a rescuer
- Feeling afraid for no obvious reason
- Having a feeling of always on the alert
- Becoming obsessed with revenge on the perpetrator
- Feeling a loss of spiritual attachment and either ignoring or depending upon religion for self-worth
What Does Complex Post-Traumatic Stress Disorder Look Like?
There are several and various psychological aspects to CPTSD and we have tried to list as many as we could below with associated explanations.
Problems with Emotional Regulation. Survivors find they have a very difficult time experiencing, expressing, and controlling emotions. Not only are survivors unable to describe, comprehend and label them correctly, feeling emotions is terrifying and might express in a volatile manner.
Survivors may experience persistent sadness, suicidality, or either explosive anger or be incapable of expressing it. Survivors often feel numb and are incapable of leveling out their moods after they have experienced an extreme emotion such as elation or grief.
One common symptom any survivors encounter is the re-experiencing of their childhood trauma through flashbacks. These flashbacks are intrusive and often the triggers causing them are elusive. This symptom is known as an emotional flashback.
Difficulty with Relationships. One might think that when we talk about having difficulty with relationships, we are only speaking about having trouble forming and holding an intimate relationship but that’s not all there is to it.
Survivors often have feelings of isolation and haven’t the knowledge of HOW to form relationships. The fear involved in trusting another human being will not harm them leaves these survivors in a morass of harboring the intense need to hide away and refuse to try to trust others with also desperately wanting someone to love them.
However, some survivors swing the opposite direction and trust too much leaving them vulnerable to victimization to people who will repeat the pain and abandonment of the past.
Below are listed and described some of the difficulties people living with the diagnosis of complex post-traumatic stress disorder experience.
Difficulties with Self-Perception. Due to the messages given by their childhood abusers, survivors often have problems with perceiving themselves as worthwhile and worthy of dignity and respect. Unfortunately, due to the signals sent by caregivers, many believe they are fundamentally bad or damaged beyond repair. This leaves survivors feeling powerless, hopeless, and helpless. Many survivors take on the role of rescuer, sacrificing their own health and happiness to care for others; while others feel a sense of entitlement that blocks their healing.
There is also a permeating feeling of not belonging in the world that, somehow, they are a mistake and should never have been born. This brings a deep sense of loneliness that may result in isolating from other people.
However, these beliefs and feelings are far from the truth as survivors are compassionate, competent, strong, and intelligent human beings.
Attachment to the Perpetrator. Because survivors have such a low esteem of themselves, many find themselves believing that they are making up things about those who harm them, or worse, that they deserve maltreatment.
Many cannot break free from the influence of their abusers, especially if that person is someone they love like a father or mother. Even though they know the behavior they received as children or are receiving in the present, telling the truth about their loved one feels like a betrayal. These feelings can sometimes translate into suicidality as the survivor struggles with the impression left by their abuser that if they talk about what happened, then they are dirty, nasty, or will be disowned.
Some survivors feel guilt and sadness in leaving their abuser even knowing how badly they are treated by them. Perpetrators groom their victims by giving the impression that they love them and make statements relating to their victim that they will never be loved the way the perpetrator loves them.
Other survivors feel inadequate to manage life without their perpetrators in the picture, following up on messages from the abuser that they cannot live without them.
An Interruption of the Survivor’s System of Meanings. A person’s system of meanings involves their assessment of who they are based on the person’s abilities, weaknesses, feelings, and life. Childhood abuse interrupts a survivor’s sense of self which leads to a struggle to maintain faith or belief that justice, ethics, and morality are unreal. This leaves the survivor with an unfairly contorted outlook on the world.
This distorted vision of their environment often leads to doubt that there is any goodness or kindness that isn’t selfish and that they can never find forgiveness, although they did nothing wrong.
While many people exhibit most of the symptomology listed on this page, they may or may not experience all of them. This is important to understand as survivors are individuals first and have different life experiences. It is also vital to note that comparing one person’s experiences with childhood or other trauma with someone else’s is like comparing an apple to an orange. While they are both almost round and contain seeds, that is where the resemblance ends. One person’s trauma is not better or worse than that of someone else.
For more information on CPTSD, including resources and materials to help in healing and living with Complex PTSD symptoms, head over to CPTSDfoundation.org.