What is Complex PTSD?

Although complex post traumatic stress syndrome (C-PTSD) is not yet formally recognized as a diagnostic designation, a case is being made in the psychiatric community for the recognition of this disorder as distinct from the currently defined form of PTSD. PTSD, as it is currently defined and diagnosed in Mansfield and elsewhere, is a result of exposure to acute trauma. It often occurs in individuals who have either witnessed or experienced tragedies, such as combat, a violent death, assault, or a natural disaster. C-PTSD is distinct from PTSD in that complex PTSD results from repeated trauma. It often develops as a result of prolonged sexual, physical, verbal, or emotional abuse. It can also occur in people who have survived a long-term hostage situation.

Causes of Complex PTSD

Whereas traditional PTSD is associated with acute psychological trauma, complex PTSD results from prolonged and systematic trauma exposure. Complex PTSD is often associated with relational abuse, such as spousal or child abuse. One of the distinguishing characteristics of C-PTSD, as opposed to “simple” PTSD, is the presence of disorders and problems with interpersonal attachment. Attachment in individuals who suffer from complex PTSD tends to take a pervasive insecure or disorganized form.

Diagnostic Criteria for Complex PTSD

The Centre for Addiction and Mental Health (CAMH) has put forth a potential set of diagnostic guidelines for complex PTSD:

I.                    Alteration in Regulation of Affect and Impulses

a.       Affect regulation

b.      Modulation of anger

c.       Self-destructive behavior

d.      Suicidal preoccupation

e.      Difficulty modulating sexual involvement

f.        Excessive risk-taking

II.                  Alterations in Attention or Consciousness

a.       Amnesia

b.      Transient dissociative episodes and depersonalization

III.                Alterations in Self-Perception

a.       Ineffectiveness

b.      Permanent damage

c.       Guilt and responsibility

d.      Shame

e.      Nobody can understand

f.        Minimizing

IV.                Alterations in Relationships with Others

a.       Inability to trust

b.      Revictimization

c.       Victimizing others

V.                  Somatization

a.       Problems with the digestive system

b.      Chronic pain

c.       Cardiopulmonary symptoms

d.      Conversion symptoms

e.      Sexual symptoms

VI.                Alterations in Systems of Meaning

a.       Despair or hopelessness

b.      Loss of previously sustaining beliefs

Many researchers advocate differences in diagnostic criteria for children versus adults. In this conceptualization of complex PTSD, the disorder is further divided into an adult symptom cluster and a childhood symptoms cluster.

A child and adolescent symptom cluster for complex PTSD would encompass the following domains:

·         Attachment

·         Biology

·         Affect or emotional dysregulation

·         Dissociation

·         Behavioral control

·         Cognition

·         Self-concept

An adult symptom cluster for complex PTSD symptoms would include:

·         Difficulty regulating emotions

·         Variations in consciousness, including psychogenic amnesia, dissociation, or intrusive flashbacks of traumatic episodes

·         Changes in self-perception, often involving a chronic sense of helplessness, along with irrational self-blame and feelings of shame and guilt

·         Varying changes in perception of the person perpetrating the abuse; this may involve attributing too much power to that person, being preoccupied with revenge, or even idealizing that person

·         Alterations in relationships with others; this may take the form of isolation and withdrawal, inability to trust, or reliance on the idea of a “rescuer”

·         Loss of faith or overwhelming sense of despair

Treating Complex PTSD

As with diagnostic criteria for complex PTSD, researchers advocate differences in treatment approaches in children versus in adults, in order to account for differences between childhood and adult reactions to and results of trauma. Some of the principles and guidelines that have been proposed for treating complex PTSD in children include:

·         Identifying and assessing current threats to the child’s safety and well-being

·         Relational and strength based diagnosis and treatment

·         Treatment aimed toward enhancing the child’s self-regulatory abilities to improve their coping abilities

·          Determine when and how it is appropriate to fully address traumatic memories

·         Preventing and managing psychosocial crises and ongoing relational issues

In adults, complex PTSD researchers have proposed six core components for treatment:

·         Safety

·         Self-regulation

·         Self-reflective information processing

·         Integration of traumatic experiences

·         Relational engagement

·         Positive affect engagement