Written by Lynn Churchill, on behalf of the Anti-Human Trafficking Intelligence Initiative (ATII)

Almost everyone has heard of post-traumatic stress disorder, or PTSD, the mental condition that can be caused when someone witnesses or experiences a terrifying event. But not many people are familiar with its evil twin, complex post-traumatic stress disorder, or C-PTSD – even some therapists. Yet it’s so common, chances are, someone you know has C-PTSD. That someone may even be you.

PTSD and Single Trauma

As mentioned, PTSD arises from a single, horrific trauma. Most people automatically think of soldiers on the battlefield, witnessing the atrocities of war, and that is certainly one valid example. Other examples of things that could cause PTSD are experiences like assault (sexual or otherwise), a car accident, natural disaster, the death of a loved one, or any number of things. Sadly, the possibilities are endless.

Not so long ago, the status of PTSD was about where C-PTSD is now; very few people had heard of it and among those who did, there were a few who mocked the condition and its sufferers, saying PTSD was an “invented” condition by those who desired to live as “perpetual victims”.

Which is ironic, given that these same people, along with pretty much everyone else, have always known that PTSD has been around since time began; it just had different names. For example, during and after World War I, the condition was referred to as “shell-shocked,” while those in the World War II-era called it “battle fatigue”.

Yet, for all the mental images of male military personnel that pop up in many minds when the term, “PTSD” is heard (although military women suffer from it as well), women in general, are twice as likely to suffer from the disorder. Could the reason for this be, that women are more likely to experience traumatic events in the form of abuse?

What is C-PTSD, and What’s the Difference?

The word, “Complex,” in complex post-traumatic stress disorder is there for a reason. C-PTSD is indeed more complex, as it arises out of more complex circumstances. Which is not to say that PTSD isn’t just as serious – it is, but although the two disorders share some symptoms, they are different.

C-PTSD can happen when a person is in a traumatic situation for a period of time with no way out, or at least, no perceived way out. Children who suffer ongoing physical or emotional abuse at the hands of parents, caregivers, or siblings often have C-PTSD; or if they’re not abused at home, they may suffer ongoing abuse from teachers, clergy, group leaders, or others. Being continually bullied at school by other children can cause C-PTSD as well.

Other types of circumstances that can lead to C-PTSD are bullying in the workplace, being part of a cult, or being a victim of ongoing domestic violence. It doesn’t matter if the domestic violence is physical, emotional, or spiritual (one doesn’t have to be a cult member to experience spiritual abuse), as non-physical abuse terrorizes and wounds the soul as surely as fists and object terrorize and wound the body, leaving long-lasting scars.
And of course, let us not forget one of the most obvious forms of long-term trauma – that of being a prisoner.

Whether it is that of being a prisoner behind bars in an actual jail or prison, or being a victim of human trafficking, the person thus trapped is a prisoner. And trauma is as ever-present as the ubiquitous prison guards and pimps.

Symptoms of PTSD and C-PTSD

Some of the symptoms of PTSD are:

  • Nightmares
  • Flashbacks
  • Insomnia
  • Being easily startled
  • Angry outbursts
  • Being tense or on-edge
  • Avoidance of places, objects, etc. that remind of the trauma
  • Trouble remembering features of traumatic event
  • Guilt; blaming oneself
  • No longer enjoys activities that they once did

The person suffering from C-PTSD can experience all these symptoms too, but as if these weren’t enough, part of what puts the “complex” at the front of PTSD is the plethora of additional symptoms. Instead of trauma caused by a one-time event, the trauma of C-PTSD tends to exist in layers because the person was abused, neglected, or otherwise traumatized repeatedly over time.

Some of the additional symptoms that get piled onto the person with C-PTSD are:

  • Memory of trauma may cause dizziness or nausea
  • Hyperarousal (heightened state of anxiety when thinking about traumatic event)
  • Hypervigilance (extreme state of alertness; always looking out for hidden dangers)
  • May lose trust in self and/or others
  • Difficulty concentrating
  • Insomnia
  • Easily startled
  • A negative self-view
  • Difficulty regulating emotion; sudden rages, explodes in frustration, etc., often over little things
  • Chronic relationship problems
  • Thoughts or actions of suicide
  • Fixating on pleasing the abuser, or seeking revenge
  • Attributing power to the abuser
  • Difficulty remembering details of traumas
  • Reliving traumas/intrusive thoughts of traumas
  • Depression
  • Overwhelming feelings of despair and/or hopelessness
  • Mood swings
  • A feeling of being detached from self
  • Feeling different from the rest of the world
  • Feeling guilty and/or ashamed
  • Difficulty maintaining relationships
  • Seeking out a “rescuer” or becoming one
  • Feeling afraid for no obvious reason
  • Self-isolation
  • Feeling helpless

Unfortunately, that’s not all. Injuring the brain alone, as trauma does, would be bad enough. But trauma doesn’t stop there.

The Scorekeeping Body

Dr. Bessel Van Der Kolk is a Boston psychiatrist and trauma specialist who has had great success in treating trauma patients. According to his 2014 book, “The Body Keeps the Score”, trauma wreaks havoc on the bodies and health of its victims. Which is why Dr. Van Der Kolk insists that the way to treat the traumatized is by treating the whole person – body, mind, and brain.

Dr. Van Der Kolk says in his book that after someone is severely traumatized, the nervous system is changed, and now the survivor works hard to maintain control as they use their energy to suppress their inner chaos.

This, in turn, can cause numerous and seemingly mysterious physical symptoms, as on the surface there seems to be no obvious cause for them. Some of the symptoms mentioned by Dr. Van Der Kolk are:

  • Chronic neck and back pain
  • Migraines
  • Fibromyalgia
  • Chronic fatigue
  • Spastic colon/irritable bowel syndrome
  • Some forms of asthma
  • Digestive problems

Other symptoms noted by many other doctors include:

  • Heart disease
  • Hypertension
  • Weakened immune system
  • Chronic pain
  • High cholesterol
  • Obesity
  • Endocrine system breakdown
  • Visions problems

Many Trauma Survivors Left Out

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the go-to book in the U.S. for those in the mental health field. First published in 1952, it has been revised roughly every 10-25 years, not including reprints. The latest revision is the DSM-5, which was published in 2013; an edition that was not received with great enthusiasm. One of many reasons given for this lukewarm acceptance is that C-PTSD was not included.

Meanwhile, in the rest of the developed world, the International Classification of Diseases (ICD) does list C-PTSD as a separate condition.
But C-PTSD is harder to treat. When dealing with PTSD, the therapist only has to focus the treatment on memories from one or at most, a very few events of the past. This lends itself to a more targeted approach.

But C-PTSD patients have been experiencing many different types of ongoing trauma for months or years – perhaps even a lifetime. This makes an exclusively trauma-focused treatment a real challenge. Which trauma should be focused on first? Second? Third? When the traumas seem to be innumerable, can you even address them all?

One thing for certain is that treatment for C-PTSD doesn’t – or shouldn’t – be one-size-fits-all. Treatment must be individualized because each person, trauma, and situation is different, including the mysterious ways that an individual’s body deals with it.

There Is Always Hope!

Despite the DSM’s unfortunate omission, many mental health professionals recognize and treat C-PTSD. And, despite the seriousness and severity of the psychological injury that is C-PTSD, patients can and do get better. A few of the approaches used by therapists are:

  • Eye movement desensitization and reprocessing (EMDR) --
  • Various types of Cognitive Behavioral Therapy (CBT)
  • Cognitive Restructuring Therapy (CRT)
  • Standard Behavioral Therapies (SBT)
  • Dialectical Behavioral Therapy (DBT)
  • Biofeedback

In addition to these and other types of treatment, such as medication, many C-PTSD survivors have found group therapy to be invaluable. After all, no one understands what you’re going through like those who have gone through similar situations. Some of these groups are even free, such as the many Facebook groups for survivors of human trafficking, and there are online professional resources that have their own Facebook groups as well.

Trauma-Informed Care

Whether someone is suffering from PTSD or C-PTSD, trauma-informed care (TIC) is needed. It’s often said that TIC shifts the question in the therapist’s approach from, “What’s wrong with you?” to “What happened to you?”
Trauma-informed therapists receive special training and are guided in part by what is known as the “4 R’s”:

  • Realizing the widespread impact of trauma and paths for recovery
  • Recognizing the signs and symptoms of trauma in patients, families, and their own staff
  • Responding by assimilating knowledge of trauma into policies, procedures, and practices
  • Resisting re-traumatizing the patient

A well-trained TIC therapist understands and knows how best to respond to the many issues and special needs of a trauma survivor, and has a deep understanding of both the psychological and physical affects that trauma can cause.

Below are links to a few references to help you get started on your path to healing.

Websites

https://cptsdfoundation.org/ – An excellent resource. Sign up for their emails and get even more – these are emails that are actually helpful. The website has a very informative blog, they have workshops, their own Facebook groups (depending on what type of group you want), and much more.

https://www.betterhelp.com/about/ – Another great resource, this is a great place to go to find affordable counseling from therapists who are trauma-trained, even in treating C-PTSD. But the site itself is also a wealth of information, although the downside is, their search function doesn’t work well. These two blog posts, https://www.betterhelp.com/advice/ptsd/what-is-complex-ptsd/, and https://www.betterhelp.com/advice/ptsd/complex-ptsd-symptoms-and-treatment/, turned up during a basic Google search, but not when searching their site.

https://www.beautyafterbruises.org/ – Another excellent resource, this foundation even has grants available for those who can’t afford treatment, in addition to a blog and other tools.

Books

https://www.besselvanderkolk.com/resources/the-body-keeps-the-score – Dr. Van Der Kolk’s site, which, in addition to his book, you’ll find a blog and other helpful resources.

http://www.pete-walker.com/complex_ptsd_book.html – Dr. Pete Walker not only treats patients suffering from C-PTSD, but he is also a C-PTSD survivor himself. His website is another wealth of information.

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