Here is more information on this diagnosis for those that are unfamiliar.
Complex Post Traumatic Stress Disorder (C-PTSD)
Definition:
Complex Post-Traumatic Stress Disorder (C-PTSD) - Complex Post-Traumatic Stress Disorder is a psychological injury that results from prolonged exposure to social or interpersonal trauma, disempowerment, captivity or entrapment, with lack or loss of a viable escape route for the victim.
C-PTSD Introduction
Complex Post Traumatic Stress Disorder (C-PTSD) is a condition that results from chronic or long-term exposure to emotional trauma over which a victim has little or no control and from which there is little or no hope of escape, such as in cases of:
•domestic emotional, physical or sexual abuse
•childhood emotional, physical or sexual abuse
• entrapment or kidnapping.
•slavery or enforced labor.
•long term imprisonment and torture
• repeated violations of personal boundaries.
•long-term objectification.
•exposure to gaslighting & false accusations
•long-term exposure to inconsistent, push-pull, splitting or alternating raging & hoovering behaviors.
• long-term taking care of mentally ill or chronically sick family members.
•long term exposure to crisis conditions.
When people have been trapped in a situation over which they had little or no control at the beginning, middle or end, they can carry an intense sense of dread even after that situation is removed. This is because they know how bad things can possibly be. And they know that it could possibly happen again. And they know that if it ever does happen again, it might be worse than before.
The degree of C-PTSD trauma cannot be defined purely in terms of the trauma that a person has experienced. It is important to understand that each person is different and has a different tolerance level to trauma. Therefore, what one person may be able to shake off, another person may not. Therefore more or less exposure to trauma does not necessarily make the C-PTSD any more or less severe.
C-PTSD sufferers may "stuff" or suppress their emotional reaction to traumatic events without resolution either because they believe each event by itself doesn't seem like such a big deal or because they see no satisfactory resolution opportunity available to them. This suppression of "emotional baggage" can continue for a long time either until a "last straw" event occurs, or a safer emotional environment emerges and the damn begins to break.
The "Complex" in Complex Post Traumatic Disorder describes how one layer after another of trauma can interact with one another. Sometimes, it is mistakenly assumed that the most recent traumatic event in a person's life is the one that brought them to their knees. However, just addressing that single most-recent event may possibly be an invalidating experience for the C-PTSD sufferer. Therefore, it is important to recognize that those who suffer from C-PTSD may be experiencing feelings from all their traumatic exposure, even as they try to address the most recent traumatic event.
This is what differentiates C-PTSD from the classic PTSD diagnosis - which typically describes an emotional response to a single or to a discrete number of traumatic events.
Difference between C-PTSD & PTSD
Although similar, Complex Post Traumatic Stress Disorder (C-PTSD) differs slightly from the more commonly understood & diagnosed condition Post Traumatic Stress Disorder (PTSD) in causes and symptoms.
C-PTSD results more from chronic repetitive stress from which there is little chance of escape. PTSD can result from single events, or short term exposure to extreme stress or trauma.
Therefore a soldier returning from intense battle may be likely to show PTSD symptoms, but a kidnapped prisoner of war who was held for several years may show additional symptoms of C-PTSD.
Similarly, a child who witnesses a friend's death in an accident may exhibit some symptoms of PTSD but a child who grows up in an abusive home may exhibit the additional C-PTSD characteristics shown below:
C-PTSD - What it Feels Like:
People who suffer from C-PTSD may feel un-centered and shaky, as if they are likely to have an embarrassing emotional breakdown or burst into tears at any moment. They may feel unloved - or that nothing they can accomplish is ever going to be "good enough" for others.
People who suffer from C-PTSD may feel compelled to get away from others and be by themselves, so that no-one will witness what may come next. They may feel afraid to form close friendships to prevent possible loss should another catastrophe strike.
People who suffer from C-PTSD may feel that everything is just about to go "out the window" and that they will not be able to handle even the simplest task. They may be too distracted by what is going on at home to focus on being successful at school or in the workplace.
C-PTSD Characteristics
How it can manifest in the victim(s) over time:
Rage turned inward: Eating disorders. Depression. Substance Abuse / Alcoholism. Truancy. Dropping out. Promiscuity. Co-dependence. Doormat syndrome (choosing poor partners, trying to please someone who can never be pleased, trying to resolve the primal relationship)
Rage turned outward:
Other: Learned hyper vigilance. Clouded perception or blinders about others (especially romantic partners) Seeks positions of power and / or control: choosing occupations or recreational outlets which may put oneself in physical danger. Or choosing to become a "fixer" - Therapist, Mediator, etc.
Avoidance - Avoidance is the practice of withdrawing from relationships with other people as a defensive measure to reduce the risk of rejection, accountability, criticism or exposure.
Blaming - Blaming is the practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.
Catastrophizing - Catastrophizing is the habit of automatically assuming a "worst case scenario" and inappropriately characterizing minor or moderate problems or issues as catastrophic events.
"Control-Me" Syndrome - "Control-Me" Syndrome describes a tendency that some abuse victims and some people who suffer from personality disorders have to nurture relationships with people who have a controlling narcissistic, antisocial or "acting-out" nature.
Denial (PD) - Denial is believing or imagining that some factual reality, circumstance, feeling or memory does not exist or did not happen.
Dependency - Dependency is an inappropriate and chronic reliance by one adult individual on another for their health, subsistence, decision making or personal and emotional well- being.
Depression (Non-PD) -Depression is when you feel sadder than your circumstances dictate, for longer than your circumstances last - but still can't seem to break out of it.
Escape To Fantasy - Escape to Fantasy is sometimes practiced by people who routinely shun transparency with others and present a facade to friends, partners and family members. Their true identity and feelings are commonly expressed privately in an alternate fantasy world.
Fear of Abandonment - Fear of abandonment and irrational jealousy is a phobia, sometimes exhibited by people with personality disorders, that they are in imminent danger of being rejected, discarded or replaced at the whim of a person who is close to them.
Hyper Vigilance - Hyper Vigilance is the practice of maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.
Identity Disturbance - Identity disturbance is a psychological term used to describe a distorted or inconsistent self-view.
Learned Helplessness- Learned helplessness is when a person begins to believe they have no control over a situation, even when they actually do have the power to change their circumstances, leading them into an unnecessary state of depression, where initiative, action or investment is deemed futile.
Low Self-Esteem - Low Self-Esteem is a common name for a negatively-distorted self-view which is inconsistent with reality. People who have low self-esteem often see themselves as unworthy of being successful in personal and professional settings and in social relationships. They may view their successes and their strenghts in a negative light and believe that others see them in the same way. As a result, they may develop an avoidance strategy to protect themselves from criticism.
Panic Attacks - Panic Attacks are short intense episodes of fear or anxiety, often accompanied by physical symptoms.
Perfectionism - Perfectionism is the practice of holding oneself or others to an unrealistic, unsustainable or unattainable standard of organization, order or accomplishment in one particular area of living, while sometimes neglecting common standards of organization, order or accomplishment in others.
Selective Memory and Selective Amnesia - Selective Memory and Selective Amnesia is the use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.
Self-Loathing - Self Loathing is an extreme self-hatred of one's own self, actions or one's ethnic or demographic background.
Tunnel Vision - Tunnel Vision is the habit or tendency to only see or focus on a single priority while neglecting or ignoring other important priorities.
C-PTSD Causes
C-PTSD is caused by a prolonged or sustained exposure to emotional trauma or abuse from which no short-term means of escape is available or apparent to the victim.
The precise neurological damage that exists in C-PTSD victims is not well understood.
C-PTSD Treatment
Little has been done in clinical studies of treatment of C-PTSD. However, in general the following is recommended:
1.Removal of and protection from the source of the trauma and/or abuse.
2.Acknowledgement of the trauma as real, important and undeserved.
3.Acknowledge that the trauma came from something that was stronger than the victim and therefore could not be avoided.
4.Acknowledgement of the "complex" nature of C-PTSD - that responses to earlier traumas may have led to decisions that brought on additional, undeserved trauma.
5.Acknowledgement that recovery from the trauma is not trivial and will require significant time and effort.
6.Separation of residual problems into those that the victim can resolve (such as personal improvement goals) and those that the victim cannot resolve (such as the behavior of a disordered family member)
7.Mourning for what has been lost and cannot be recovered.
8.Identification of what has been lost and can be recovered.
9.Program of recovery with focus on what can be improved in an individuals life that is under their own control.
10.Placement in a supportive environment where the victim can discover they are not alone and can receive validation for their successes and support through their struggles.
11.As necessary, personal therapy to promote self discovery.
12.As required, prescription of antidepressant medications.
What to do about C-PTSD if you've got it:
Remove yourself from the primary or situation or secondary situations stemming from the primary abuse. Seek therapy. Talk about it. Write about it. Meditation. Medication if needed. Physical Exercise. Rewrite the script of your life.
What not to do about it:
Stay. Hold it in. Bottle it up. Act out. Isolate. Self-abuse. Perpetuate the cycle.
What to do about it if you know somebody else who has C-PTSD:
Offer sympathy, support, a shoulder to cry on, lend an ear. Speak from experience. Assist with practical resolution when appropriate (guidance towards escape, therapy, etc.) Be patient.
What not to do about it if you know somebody else who has it:
Do not push your own agenda: proselytize, moralize, speak in absolutes, tell them to "get over it", or try to force reconciliation with the perpetrator or offer "sure fire" cures.
Treatment of Complex Post-Traumatic Stress Disorder
Herman (1992) divides recovery from CPTSD into three stages: establishing safety, remembrance and mourning for what was lost, and reconnecting to society. Before this work can begin, a healing relationship must be established; Herman believes recovery can come only within a relationship and only if the survivor is empowered.
Establishing safety
This stage is further subdivided into a series of tasks that must be accomplished in order for the client to feel safe in therapy. First, the therapist and client must name the problem. This involves not so much making a formal diagnosis as acknowledging the trauma and its past and present effects, both mental and physical. Next, one must restore a sense of control to the client. This begins with control of the body: controlling physical symptoms by balancing diet, exercise, and sleep and by getting the client appropriate medical care, including medication where it is indicated. Finally, control moves outward to establishing a safe environment: setting up support networks of caring people, helping the client to protect him/herself from any physical danger they may face (particularly from an abuser), and developing a plan for dealing with for future protection, one that takes into account any self-destructive behaviors the client engages in. This includes such things as setting up no-harm contracts (or procedures in case of harm), establishing sobriety, etc.
Herman cautions that there's not easy way to tell when this (or any) stage of recovery is complete. The first stage in particular is demanding; therapists and clients must be careful not to push on until safety is well established. Herman states that when the client has regained some trust in herself and her environment, when the therapeutic alliance is good, and when the most disturbing symptoms are controlled and the client knows which people can be relied on in times of crisis, it is reasonably safe to proceed.
Remembrance and mourning
The second stage is also divided into sub-stages. First, the client must reconstruct the story of the trauma. Many times, traumatized person have never been able to put it all together and make it into a narrative. During this stage, a sense of continuity with the past is reestablished. Herman stresses the importance of, in this stage, retrieving both the memories and the emotions attached to them; this corresponds to the view of some practitioners that free-floating anxiety can be "emotional memories" that have somehow gotten unstuck from the memories of the events during which they were experienced.
When the narrative reconstruction is complete, Herman says, the traumatic memories must be transformed using flooding/exposure (as in cognitive therapy) or testimony techniques. Finally, the losses that resulted from the trauma must be mourned fully. Only when all of this is accomplished is the second stage complete.
Re-connection
The final task for a trauma survivor in Herman's model is to "reclaim her world." The client must create a future by re-learning how to live. The first step is learning to defend him/herself, learning to fight for what is important and to protect her/himself. Reconciliation with the self, identifying and appreciating what is positive about oneself while recognizing and accepting the negatives, follows. Then comes reconnecting with others -- becoming part of a community. Herman also recommends finding a survivor mission -- some work to add meaning to life.
Herman notes that even after these steps are complete, the trauma may never be fully resolved; she considers recovery to be a lifelong process. However, at this point, it becomes on of many factors in a client's life and not the dominant one.
