In my previous blog posts, I have discussed what is PTSD. The signs and symptoms, how can you help someone who is suffering from the same, and finally, the self-help options for dealing with PTSD. In this blog post, I will discuss the symptoms of complex PTSD. Complex PTSD is not as widely known as PTSD. This is why I felt that there is a need to shed some light on this mental health disorder as well. Before I get into the symptoms of complex PTSD and how it differs from normal PTSD, let me give you an overview of complex PTSD.
In layman’s terms, complex PTSD can be described as an advanced version of PTSD. Complex PTSD occurs if a person has experienced multiple episodes of trauma over a long period.
This form of PTSD has not been entered into the diagnostic and statistical manual of mental disorders 5th edition (DSM-5) so far. The DSM-5 is a handbook used by psychologists and psychiatrists for the diagnosis of mental disorders. However, In the year 2018, it was proposed to be added as a clinical entity in the WHO international classification of diseases, version 11. The symptoms of complex PTSD show all of the signs of PTSD along with three additional symptoms. These three additional symptoms of complex PTSD are negative self-cognition, emotional dysregulation, and interpersonal hardship.
Symptoms of complex PTSD vs bipolar disorder
The three additional symptoms of complex PTSD like interpersonal hardships, dysfunctional emotional regulation, and negative self-cognition resembles symptoms that are observed in the case of borderline personality disorder [BPD]. However, complex PTSD is very different from BPD.
Borderline personality disorders are also caused by prolonged trauma like repetitive childhood experiences abuse, neglect, etc. These victims also suffer from difficulty in forming interpersonal relationships, unstable identity problems, etc. These symptoms are also observed in the case of complex PTSD. Therefore, research is being conducted to understand whether borderline personality disorder is also a part of the disorders related to a person’s past trauma or is borderline personality disorder a duplication of the complex PTSD itself.
How are the symptoms of complex PTSD different from those of PTSD?
The answer to this lies in the basis of the problem itself. PTSD can get triggered by one traumatic incident in the person’s life. Suppose a person lands in a car accident. The person may have PTSD of walking on the road, driving a car, or even watching movies involving car crashes. However, in the case of complex PTSD, the cause is the presence of multiple traumas. A single trauma is not enough for the disorder to be classified as complex PTSD.
For a person to get trapped in the cyclone of complex PTSD, the individual has to be exposed to either constant trauma or multiple forms of trauma over a long period. In other words, complex trauma is a summation of various precipitating traumatic events that have occurred over a long duration in the person’s life. These events feel threatening, deleterious, entrapping, horrific, and interpersonal. A few examples of such events could be:
- childhood physical or sexual abuse
- Genocide campaigns
- Prolonged domestic violence
- And various other factors.
These factors along with the inability of the victim to escape the situation due to the presence of multiple constraints contribute to complex PTSD. These constraints can be their psychological barriers, the physical abuse because of which the person is not able to get away, or the social conformities that prevented the person from taking a step. It can also be any other factor because of which the person could not escape the trauma in which they were trapped and the trauma continued.
Post-traumatic stress disorder vs complex PTSD
Post-traumatic stress disorder is a part of the anxiety disorder spectrum. It is the result of the person experiencing extremely distressing, scary, or stressful events. The memory of these events festers and eventually makes it hard for the person to perform their day-to-day activities and lead life in a normal manner. They face nightmares, flashbacks, night terrors, and the inability to lead a normal life, and are constantly haunted by their traumatic past.
Symptoms of PTSD
The most common symptoms of PTSD are insomnia, difficulty concentrating, and constant experiencing flashbacks and nightmares. The person may also show signs of excessive guilt, irritability, and isolation. These symptoms are most often so severe that they impede the person’s ability to lead a normal life.
PTSD turns into complex PTSD when the person starts to face difficulties in maintaining relationships and managing their own emotions. PTSD and complex PTSD share a few similarities. However, complex PTSD includes more symptoms than the number of symptoms listed under normal PTSD.
Symptoms of complex PTSD
In most cases, the symptoms of complex PTSD are pretty much similar to those of PTSD as I mentioned before. The symptoms that are primary in the case of PTSD like flashbacks (re-experiencing the trauma), disturbed emotions, feeling detached from others, avoiding people and social engagements, loud noises, presence of certain people as triggers, etc. are all parts of complex PTSD. However, along with this, it also shows symptoms of
- Constant feelings of guilt, shame, and worthlessness
- Difficulty in controlling one’s emotions
- Finding it impossible to connect to other people
- Facing constant relationship problems.
- Finding it difficult to maintain relationships with friends or family
- Constantly feeling isolated
Understanding the symptoms of PTSD and complex PTSD in detail
To gain a complete understanding of both of these mental health issues, we need to first tackle and understand the symptoms of PTSD in detail.
Symptoms of post-traumatic stress disorder
Let’s take an example. Suppose you have been through a traumatic event recently. You are facing the effects of the trauma like flashbacks, nightmares, insomnia, etc. if these symptoms are persistent and disrupt your ability to lead a functional life, you are suffering from PTSD. Under such conditions, you should seek help from a trained mental health professional to confirm the diagnosis and start the treatment.
Symptoms of PTSD usually fall under three categories
Reexperiencing the memories
The two primary symptoms of PTSD are flashbacks and nightmares. The individual feels stuck in a time loop and cannot escape their past. The memories of the past can trigger powerful emotions in the person. The traumatic memory is edged in the brain to such an extent that the person even starts to relive the sounds, smells, and sights from the event. Therefore, if the person comes across any of the triggers from the past trauma, they may have an anxiety attack, panic attack, or start to relive their traumatic event.
Sense of threat
Those who suffer from PTSD go into hyper-alert mode. Their brain always tells them that there is a threat nearby. To better understand this symptom, let’s take an example. Suppose a person was in a car crash. Their brain will tell them that walking on the road is dangerous. A vehicle may crash into the person. There may be another crash if they drive a car. The chances of these incidences occurring are very slim. However, the fear gripping the person is very real. This can lead to the person avoiding getting behind the steering wheel of the car or even walking on roads. Walking or traveling on the roads may give the person flashbacks about their car accident. Road traffic, buses, visuals of vehicular crashes in movies, etc. can act as a trigger for the person’s PTSD
Symptoms of avoidance
As I mentioned before, since the person has been in a car crash that took place on the road or the highway, the person’s brain may tell him to avoid those places. If the person’s past trauma was caused by another individual, certain people may also act as a trigger. The first thing that the brain does to protect the victim is to avoid any trigger that may bring back memories. Such people may also indulge in self-medication with alcohol or drugs to dull their senses.
Changes in the belief system
The person may start believing that the world is not a good place. This occurs if the individual was hurt by loved ones. Thus, t hey will try to avoid getting into relationships with others because trust is not something that comes easily to them. They may stop socializing, attending parties, or even going out where they will have to interact with people.
Somatic symptoms primarily refer to the physical signs and symptoms that do not display any underlying medical reason. For example, a person hugging you may remind you of a traumatic event. As a result, you may want to avoid hugs. You may even feel dizzy or nauseated. In certain cases, people avoid being touched for the same reason.
Symptoms of complex PTSD
As I mentioned before, those who suffer from complex PTSD have the symptoms of PTSD along with certain additional symptoms. These additional symptoms may include
Complete lack of emotional regulation
Such people experience uncontrollable feelings. If they are angry, their anger is explosive. They won’t be able to contain their anger or display a logical side when they are angry. If they are sad, they may not come out of their room for days. Sadness may seem like abysmal darkness. any emotion they experience is very heightened and out of their control.
Changes in consciousness level
Changes in consciousness level include completely forgetting that the traumatic event even occurred. The individual may even feel detached from their own emotions or body. This symptom is referred to as dissociation. This is one of the ways the mind protects the body from the harmful psychological effects of trauma.
The person may feel shame or guilt. This shame or guilt is overpowering and completely engulfs them. They may stop in indulge in their day-to-day activities because of the regretful feelings. It may also keep them up at night and prevent them from being their usual self.
Difficulty in relationships
The person may start to negatively react to their interpersonal relationships. Not form new relationships or find it very difficult to figure out how to interact with people. This may arise from a lack of trust. If the person was abused by a loved one, they may feel that everyone’s out to get them. Another common feeling is that they are only important to others when they are of use to them. Therefore, having relationships becomes very difficult for such people.
Distorted perception of the abuser
In some cases, the victim may become preoccupied with the abuser and the relationship they shared. The person may start to justify the behavior of the abuser, get preoccupied with revenge, or completely surrender and allow the abuser to have ultimate power over their life.
Absence of systems of meanings
System of meaning primarily refers to the belief or the religion that a person follows. For example, you may have a certain belief system. However, after the traumatic events, your belief system completely changes. You may have been brought up to believe that humanity exists. However, after your series of traumatic events, you start to develop a very strong sense of hopelessness and despair and believe that every person on this Earth is cruel.
Symptoms of complex PTSD may vary
One thing that you need to understand is that in the case of any mental health issue, the symptom can vary amongst different people. All of us process information differently, react to the same situation differently, and have different reactions when things go wrong in our lives. Sometimes, difficult situations make us stronger. Sometimes they break us down. However, every person has a different reaction to the same psychological stimulus. Therefore, one person may develop PTSD while the other person may develop c-PTSD after being exposed to the same traumatic situation.
If you have someone or if you know someone who is suffering from complex PTSD, you must understand that their belief system and thoughts may not always match what they are feeling. Their brain may be divided into 2 halves: one logical and one illogical. The logical brain may tell them that they should not react this way. However, the illogical brain may have complete control over their anger or their feelings of despair. What you may see might not be the illogical side of them even though they do have a logical side which is screaming at them to not behave this way.
Causes behind the symptoms of complex PTSD
Research is still under foot when it comes to complex PTSD. Psychologists and psychiatrists are trying to figure out how traumatic events affect the brain and cause complex PTSD. So far, the studies conducted on animals show that trauma tends to have very lasting effects on the person’s pre-frontal cortex, hippocampus, and amygdala. These are the sections that have a huge role to play in our memory retention and response to stressful stimulations.
Any trauma that has occurred over a long period like years or months can lead to complex PTSD. However, complex PTSD has a higher chance to occur in those people who have been abused by their caregiver or protector. Example: people who have survived human trafficking or sexual abuse in childhood by their loved ones. It also includes those who have suffered severe emotional trauma as a result of having a psychopathic mother or narcissistic parents. Other examples of long-term trauma include:
- Ongoing emotional sexual or physical abuse
- Being a war prisoner
- Living in a region affected by war
- Childhood neglect
Risk factors that predispose a person toward complex PTSD
Even though any person can develop complex PTSD, certain groups of people are more likely to develop this mental health condition than others. Apart from having faced traumatic experiences in their past, certain other risk factors include
- Their brain functionality in terms of regulation of the neurochemicals and hormones in response to stress
- Inherited personality traits i.e. their temperament
- Suffering from underlying mental illness like depression, anxiety, or having a family history of the same
- Lifestyle factors like the absence of a support system or having a dangerous job.
Triggers for complex PTSD
If you are a victim of complex PTSD, you may realize that certain situations or emotions can bring on extreme symptoms that relate to your trauma.
Triggers are different in different people. What may trigger you may not trigger somewhere else. This happens because a trauma trigger relates to the original trauma. The trigger will be something that your five senses picked up when the trauma was occurring. Here are some examples of common trauma triggers:
- Pain or specific sensations
- Intense emotions like anger, fear, or sadness
- Specific sounds, images, tastes, or smells
- A specific date, time, or month of the year
- Watching a movie or reading a book that reminds you of the trauma
- Specific places like churches, dental care clinics, etc
Diagnosis of complex PTSD
Since complex PTSD shares so many symptoms with PTSD and borderline personality disorder, diagnosing complex PTSD is not easy. It is possible that your mental health practitioner may not be aware of complex PTSD itself. This is because complex PTSD has still not made its name in the DSM 5 manual. However, one thing you can do is maintain a detailed log of your symptoms. What you are feeling when you are feeling it, what is triggering it, etc.
Once you find a good mental health practitioner, they will enquire about your symptoms, your past, and the situations in your past that possibly triggered such a reaction. They may also inquire about your history of mental health conditions and other risk factors. Ensure that you give them all the details about your life history, situation, and medical background. This will help them formulate the best treatment plan for you.
If the symptoms that you are facing are interfering with your day-to-day life, your therapist will probably start with a PTSD diagnosis itself. If you have faced multiple trauma and are showing additional symptoms like difficulty in relationships, explosive behavior, etc., your therapist may diagnose you with complex PTSD.
There is a high chance that you may have to go through a few therapists before you find one with whom you feel comfortable. This is fine and you should not feel guilty about changing therapists.
Treatment of complex PTSD
There are many treatment options available. These can help reduce your symptoms and allow you to manage them better.
Psychotherapy is primarily referred to as talk therapy. This treatment method includes using cognitive behavioral therapy (CBT). CBT helps identify negative thoughts and provides you with different tools that you can use to replace those negative thoughts with positive thoughts.
Some other options that your mental health practitioner may use to help you tackle and win the war against complex PTSD may be:
Prolonged exposure therapy
Prolonged exposure therapy is a part of CBT itself. It centers around the ideology that those who suffer from PTSD will try to unconsciously avoid everything that may remind them of the traumatic event. The primary goal of prolonged exposure therapy is to reduce this avoidance. The focus here is to help the person have a less severe reaction toward the triggers and memories of the trauma.
Prolonged exposure therapy primarily consists of two different parts. Imaginal exposure and the in vivo exposure. The imaginal exposure involves a discussion of the traumatic event. In this, the patient is encouraged to describe the event as if it is occurring in the present time. The patient and the therapist then work through the emotions that the event triggers in the patient.
In the case of in-vivo exposure, the patient generally confronts the stimuli that can cause or act as a trigger in the case of PTSD. This is a part of the plan that the patient has agreed on with the therapist itself.
Eye movement decentralization and reprocessing [EMDR] therapy
The EMDR is very common PTSD treatment. It has also been shown to work in cases of complex PTSD as well. You can find more details on how EMDR can be used to target PTSD in the blog post about the same.
- Zoloft (sertraline)
- Prozac (Fluoxetine)
- Paxil (paroxetine)
Are often used for PTSD treatment.
Medication is not the long-term solution for dealing with complex PTSD or any other form of mental health illness. However, they help in the short term, while you work on your coping strategies and incorporate them into your daily life.
Living with PTSD or complex PTSD is not easy. It can change how you perceive yourself, others, and life. You may feel intense emotions and wonder why this is happening to you. You may feel alone during this difficult time and feel that no one understands what you are going through. However, one thing that I want you to remember is that you are not alone. There are many forms of professional help and support networks available. If you do not have the option of getting professional help, you can always try out
- Relaxation techniques
- Self-help options
- Nutrition and movement
- Opting for online support groups
- Reconnecting with family and friends who can be a part of your vital support system
Learning more about the care plans available for complex PTSD can help you recover faster and heal yourself better.
Address your queries
If you have any queries about this blog post or any other on Guilt Free Mind, feel free to reach out to me on Twitch. I do coworking streams on Twitch every day from 11 AM to 7 PM Indian Standard Time. Furthermore, I also do mental health streams on Tuesdays and Fridays. You can get your mental health-related questions addressed directly in my live stream. If you want to stay updated with all the latest info from Guilt Free Mind, please subscribe to the blog. If you like watching videos, subscribe to the YouTube channel as well. Do not forget to ring the notification bell.
Are you a victim of PTSD or complex PTSD? How do you handle your PTSD in daily life? What strategies have you implemented to help you lead a normal functioning life? Please share your experiences in the comments section below. Your experience and anecdotes may encourage someone else to seek out the help that they deserve.
See you in my next blog post
Frequently asked Questions
Despite recent scientific evidence of the significant health and social burdens associated with complex PTSD, it is not currently listed in the DSM-5. This is because more research and consensus are needed before it can be added as an official diagnosis. Until then, clinicians may treat symptoms associated with complex PTSD on a case-by-case basis.
Common triggers for Complex PTSD include difficult memories and trauma reminders, such as triggers related to the aftermath of a traumatic event, flashbacks or reminders of the original trauma, people or situations that remind them of past traumatic events, feeling mistreated or misunderstood by others, feeling like they are in an unsafe environment and intrusive thoughts.
Yes, complex post-traumatic stress disorder (CPTSD) can be particularly dangerous because it can lead to long-term psychological difficulties such as low self-esteem, anxiety, and depression. It is important for anyone with CPTSD to seek treatment from a mental health professional in order to address the symptoms and prevent future complications.
Complex Post Traumatic Stress Disorder (PTSD) is usually caused by a longer exposure to repeated or prolonged trauma compared to single incident PTSD. It can be caused by multiple experiences of extreme distress resulting in emotions such as shame or guilt, persistent distorted beliefs about oneself or the world and changes in relationships with others due to distrust or withdrawal.