PTSD

Complex PTSD: What You Should Know About it and How it Can Be Treated

July 9, 2021

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Many people are familiar with Post Traumatic Stress Disorder, which is diagnosis of individuals who have lasting stress or fear in response to experiencing a shocking, dangerous, or scary event. What’s less discussed, however, is the sibling to PTSD, Complex PTSD.

Complex PTSD, first acknowledged in 1988 by Dr. Judith Herman at Harvard University, is a fairly recent diagnosis characterized by behavioral, cognitive, emotional, and interpersonal difficulties. 

While some doctors today will diagnose individuals with Complex PTSD, the disorder is not recognized in the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), a handbook that psychologists and psychiatrists use to diagnose patients with various mental conditions. 

Still, those who suffer from Complex PTSD have experienced continuous long-lasting trauma struggle, creating more symptoms than they would have from PTSD alone. In this article, we’ll explain how to differentiate Complex PTSD from PTSD and shed some light on how Complex PTSD can be treated. 

PTSD vs. Complex PTSD

Causes

Both PTSD and Complex PTSD arise from deeply traumatic events. However, while PTSD can stem from a singular traumatic experience, Complex PTSD results from a series of traumatic events that have occurred over a long period of time. 

PTSD can also be exacerbated into Complex PTSD if an individual was harmed by someone close to them, had limited or no ability to escape, or experienced trauma at an early age. The psychological impact that kinds of traumatic experiences can have on an individual when experienced early on in life or over the course of several years are often more severe than a single traumatic experience, which is why some psychologists and psychiatrists distinguish it from typical PTSD. 

A man with Complex PTSD rests his head in his hands
Complex PTSD is similar to normal PTSD in that it is caused by a dangerous or life threatening experience. However, while PTSD can result from only one instance of danger, Complex PTSD occurs from continuous long-term danger which often creates more severe symptoms than PTSD. Image courtesy of American Headache Society. 

Here is a more specific breakdown of different causes of PTSD and Complex PTSD:

PTSD

Not everyone who experiences a dangerous event suffers from PTSD afterward. In fact, according to the National Institute of Mental Health, most people will never experience PTSD. With that being said, there are several risk factors that can influence whether an individual does suffer from it, including:

  • Living through dangerous events and traumas
  • Getting hurt
  • Seeing another person get hurt, or seeing a dead body
  • Having a history of mental illness or substance abuse
  • Feeling horror, helplessness or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
  • A single traumatic experience like a car collision, earthquake, or sexual assault

Complex PTSD

Potential causes of Complex PTSD:

  • Experiencing childhood neglect, abuse, or abandonment
  • Experiencing human trafficking 
  • Experiencing domestic abuse
  • Being a prisoner of war
  • Living in a region affected by war
  • Torture, kidnapping, or slavery
  • Repeatedly witnessing violence or abuse

Symptoms

PTSD

While symptoms of PTSD usually occur within three months of experiencing a traumatic event, they can sometimes occur years later. To be diagnosed with PTSD, a person must experience the following for at least one month: 

  • One or more re-experiencing symptoms
  • One or more avoidance symptoms
  • Two or more arousal and reactivity symptoms
  • Two or more cognition and mood symptoms
A diagram outlining the symptoms of PTSD
Individuals who have experienced a dangerous event are prone to developing PTSD afterward. Symptoms commonly include flashbacks, bad dreams, negative thinking, and avoiding the trauma. Image courtesy of Heroes’ Mile.

Here is a more detailed breakdown of what each symptom entails:

Re-experiencing symptoms: inhibit a person’s every day routine. Symptoms may arise from a person’s thoughts and feelings and be triggered by words, objects, or situations that remind a person of a traumatic event they’ve experienced.

  • Flashbacks
  • Bad dreams
  • Frightening thoughts

Avoidance symptoms: Things that remind a person of a traumatic experience that cause them to change their personal routine

  • Staying away from places, events, or objects that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event

Arousal and reactivity symptoms: Make it difficult for an individual to do daily tasks like concentrating, eating, or sleeping. These symptoms are not triggered by a specific object or situation, but constant and often make a person feel stressed and angry.

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts

Cognition and mood symptoms: Make a person feel alienated or detached from friends or family members. These symptoms can begin or worsen after the traumatic event. While it’s normal for a person to have some of these symptoms a few weeks they’ve experienced a dangerous event, when they last longer than a month, seriously impact their ability to function, and are caused by nothing other than the event itself, they might be a sign of PTSD.

  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings like guilt or blame
  • Loss of interest in enjoyable activities

Complex PTSD

Symptoms of Complex PTSD usually include those of typical PTSD as well as new ones. These may include:

  • Difficulty controlling emotions: Often those with Complex PTSD will lose control of their emotions and act out in bursts of anger or experience persistent sadness or suicidal thoughts.
  • Negative self-view: People who suffer from Complex PTSD may have feelings of shame, helplessness, or guilt. This can create a negative self-view and the impression that they are different from everyone else.
  • Difficulty with relationships: A negative self-view combined with a difficulty to trust others can cause a person with Complex PTSD to avoid relationships entirely or fall into the habit of developing unhealthy ones.
  • Detachment from trauma: People with Complex PTSD might detach themselves from their trauma and the world around them. In some cases, they may even forget their trauma entirely. 
  • Loss of a system of meanings: Complex PTSD can cause a person to lose hope in the world and their core beliefs.

Treating Complex PTSD

While Complex PTSD manifests more severe symptoms than PTSD, it can be treated with the same tactics. Some of these include medication, psychotherapy, and TMS therapy. 

Medications

Medications like antidepressants can be used to mitigate some of the symptoms that come with Complex PTSD, like anxiety and depression.  Some medications that are often used to treat Complex PTSD include Prozac, Paxil, and Zoloft. This type of treatment often works best when paired with psychotherapy.

Psychotherapy

Psychotherapy for treating Complex PTSD often involves identifying traumatic experiences and learning how to replace negative thought patterns with more positive ones. 

Eye movement desensitization and reprocessing is a specific type of therapy used to treat both PTSD and Complex PTSD.  For this type of treatment, a therapist guides a patient’s eye movements to help them reframe the traumatic memories and negative feelings they associate with their traumatic memory. Eventually, a person who has undergone EMDR treatment will be able to recall a memory without having an adverse reaction to it. 

The use of EMDR treatment is considered controversial because scientists don’t exactly know what causes the therapy to work. Despite debate in the medical community, the American Psychological Association has recommended the use of EMDR therapy for those with PTSD under certain conditions. But the effectiveness of EMDR therapy in treating PTSD remains unclear and requires more research.

TMS therapy

A patient receives TMS therapy to help treat Complex PTSD.
TMS therapy is a non-invasive and proven method successful in treating patients who suffer from PTSD. For those who can’t find relief by taking medication or would just prefer to avoid it, TMS is both a helpful and practical option to consider. Image courtesy of Help Guide.

Transcranial Magnetic Stimulation therapy is the use of magnetic pulses to stimulate specific regions of the brain that are associated with mood. It is an innovative, safe, and proven method that has not only been successfully used to treat PTSD, but has also been endorsed by the U.S. department of affairs to treat veterans with PTSD who have not experienced relief with antidepressants. 

While conversations surrounding PTSD have become more prevalent as the stigma around mental health has decreased, knowing and talking about Complex PTSD is important as well. While the two disorders are similar in that they both result from instances of danger, Complex PTSD often creates more severe symptoms since it results from trauma that is continuous over a long period of time. 

Similar treatments may be used for both types of PTSD, but Complex PTSD has the capability of impacting a person’s life in ways that usually remain beyond the scope of PTSD—it’s important that we all know what they are. 

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