What is Complex Post-Traumatic Stress Disorder?
Complex post-traumatic stress disorder (CPTSD) is a mental disorder that affects people who have experienced trauma. While post-traumatic stress disorder (PTSD) may develop after someone experiences a single traumatic event, CPTSD is thought to affect those who have experienced ongoing trauma over an extended period. The symptoms of CPTSD include those of PTSD, but CPTSD also includes a cluster of symptoms distinct from PTSD.
The psychiatric community has not come to a consensus about CPTSD. The World Health Organization recognizes the disorder in its International Classification of Diseases, but the American Psychiatric Association omits CPTSD in its Diagnostic and Statistical Manual (DSM). Some psychiatrists believe that the symptoms of CPTSD are better explained as cases of PTSD that coincide with other mental disorders such as borderline personality disorder or substance abuse disorder.
Symptoms of PTSD
People with CPTSD experience some of the same symptoms as people with PTSD. Common symptoms include:
- Recurrent, intrusive, stress-inducing memories of the traumatic event
- Reliving the trauma through flashbacks
- Distress triggered by reminders of the trauma
- Sleep disruption
- Difficulty with concentration
- Chronic anxiety or fear
- Irritability, anger, or aggression
- Avoiding triggering situations or activities
- Negative thoughts or hopelessness
- Emotional numbness
- Relationship problems
- Memory problems
- Lack of interest in pleasurable activities
Symptoms of CPTSD
In addition to the symptoms of PTSD, CPTSD adds another cluster of potential symptoms, including:
- Problems regulating emotions, including chronic sadness, anger, or suicidal thoughts
- Negative self-perception, including feelings of guilt, shame, or powerlessness
- Dissociation from reality, including loss of memory, flashbacks, or periods of feeling disconnected from one’s mind or body
- Difficulties with relationships, including broad distrust of other people
What Causes Complex Post-Traumatic Stress Disorder?
CPTSD is caused by ongoing trauma over a period of time, in contrast to a single traumatic event that may trigger PTSD. Some causes of CPTSD include:
- Childhood abuse (physical, sexual, or emotional), neglect, or abandonment
- Domestic abuse
- Sex trafficking
- Abduction, imprisonment, torture, or slavery
- Being a prisoner of war, refugee, or target of genocide
Some psychiatrists believe that certain situations can make the symptoms of CPTSD more severe. Aggravating conditions may include:
- Trauma that occurs early in life
- Trauma caused by a parent, caregiver, or another person close to the victim
- Trauma that continues over a long time
- Continued contact with the person who caused the trauma
- Impossibility of escape or rescue from the trauma
Is Complex Post-Traumatic Stress Disorder Hereditary?
CPTSD is directly caused by trauma, but studies have shown that the risk for developing a post-traumatic disorder is strongly connected to genetic predisposition. Studies of twins exposed to the same traumatic situations have suggested that nearly a third of PTSD cases may be explained by genetics.
There is likely not a single inherited gene that increases PTSD risk. Researchers have identified many different genes associated with increased risk, and the risk is likely the result of the interplay between several genes.
How Is Complex Post-Traumatic Stress Disorder Detected?
Early intervention is vital in effectively treating and controlling CPTSD, making early detection of the disorder especially important. Early warning signs of both PTSD and CPTSD include:
- Feelings of hopelessness or negativity
- Anxiety, sadness, irritability, or anger
- Frequent mood swings
- Isolation from friends and loved ones
- Lack of interest in pleasurable activities
- Lack of interest in health or hygiene
- Substance abuse
How Is Complex Post-Traumatic Stress Disorder Diagnosed?
The World Health Organization’s diagnostic manual, the ICD-11, lays out diagnostic criteria for CPTSD. To be diagnosed, an individual must have experienced a traumatic event and exhibit at least one symptom from each of six different symptom categories.
Three of the symptom categories are diagnostic criteria for PTSD. They include:
- Re-experiencing the trauma
- Avoidance of trauma reminders
- Heightened sense of threat
The other three categories are described as “disturbances of self-organization.” They include:
- Emotional dysregulation (chronic sadness, anger, suicidal thoughts, etc.)
- Negative self-concept
- Interpersonal difficulties
To meet the requirements for diagnosis, the symptoms must significantly impair the individual’s normal functioning.
All of the diagnostic criteria for CPTSD in the ICD-11 fall under the American Psychiatric Association’s DSM-V criteria for PTSD.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Complex Post-Traumatic Stress Disorder Treated?
Certain types of psychotherapy are particularly effective at treating CPTSD.
- Cognitive Processing Therapy (CPT). CPT is a version of Cognitive Behavioral Therapy (CBT), which aims to help individuals identify the thought processes associated with their disorder and develop strategies for dealing with those thought processes. CPT helps sufferers find new ways to process and cope with the thoughts surrounding their trauma.
- Prolonged Exposure (PE). PE is another type of Cognitive Behavioral Therapy. In this therapy, the individual learns how to confront the triggers of their symptoms gradually. Exposure to triggers comes through two different approaches:
In-therapy sessions, in which the individual talks through thoughts about the trauma with the therapist present.
“In vivo” exposure, in which the patient confronts triggers outside of therapy after discussing strategies for doing so with the therapist.
CPT and PE are often effective at treating diagnosed cases of CPTSD. They are also often effective at treating PTSD that coincides with disorders such as borderline personality disorder and substance abuse disorder.
How Does Complex Post-Traumatic Stress Disorder Progress?
Left untreated, CPTSD and PTSD can lead to significant long-term mental and physical health complications, including:
- Depression and anxiety
- Substance abuse
- Legal and financial problems
- Eating disorders
- Dysfunctional relationships
- Suicidal thoughts and suicide attempts
How Is Complex Post-Traumatic Stress Disorder Prevented?
Prompt intervention as soon as possible after a traumatic event is the best way to prevent PTSD. Informal support systems can be helpful, but many people can benefit from a course of psychotherapy after experiencing trauma. Timely access to help is, by definition, difficult in cases of CPTSD, where the individual experiences repeated traumatic events without the opportunity for escape.
Complex Post-Traumatic Stress Disorder Caregiver Tips
If you are the caregiver of a loved one with CPTSD, there are things you can do to help them cope and keep them safe.
- Build an environment that’s supportive of your loved one’s mental and physical health. Create a space that’s free from triggers, calm, and predictable. Encourage exercise and good nutrition as well.
- Don’t take things personally. Remember that CPTSD is an illness that can cause your loved one to lash out. Don’t forget that the trauma is the cause, not you.
- Keep yourself and your loved one safe. Don’t encourage any of your loved one’s delusions or unrealistic perceptions. Get help if your loved one becomes aggressive or violent, and don’t keep firearms in your house or any place easily accessible to your loved one.
- Find help when you need it. Local and online support groups can help you and your loved one deal with PTSD.
Many people with CPTSD also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with CPTSD:
Complex Post-Traumatic Stress Disorder Brain Science
Research shows that three different areas of the brain are instrumental in the development of PTSD:
- Amygdala. This part of the brain regulates a person’s response to stress. Its job is to detect threats and then trigger the body’s “fight or flight” stress response to prepare to deal with the threat. In someone with PTSD, the amygdala misidentifies threats and inappropriately triggers a stress response.
- Prefrontal Cortex. This part of the brain regulates decision-making and emotional responses. In a threat situation, its job is to assess the situation and trigger recovery from a stress response when the threat is gone. In a person with PTSD, the prefrontal cortex is underactive and doesn’t control the stress response appropriately.
- Hippocampus. This part of the brain is responsible for memory storage and retrieval. In the case of PTSD, the hippocampus may ineffectively store memories about the trauma. As the individual attempts to recall these memories later, the improperly stored memories may cause recurrent, intrusive, or stress-inducing thoughts about the trauma.
Complex Post-Traumatic Stress Disorder Research
Title: Trauma-focused Psychodynamic Psychotherapy for LGBT Patients With Post-traumatic Stress Disorder
Principal Investigator: John R. Keefe, PhD
Weill Medical College of Cornell University
New York, NY
Despite the high prevalence of PTSD among LGBT individuals, there are no data characterizing the disorder in this population or its treatment. This represents an important under-researched area in LGBT care and treatment. The purpose of this study is: (a) to preliminarily characterize PTSD within an LGBT sample; and (b) to test out the preliminary effects and acceptability of a novel PTSD psychotherapy, trauma-focused psychodynamic psychotherapy, in this group. Participants identifying as LGBT and meeting DSM-5 criteria for PTSD per a structured, reliable clinical interview for PTSD will receive 20-24 sessions of twice-weekly TFPP at no cost. Participants will receive four detailed clinical research assessments, at baseline/study entry, Week 5 of treatment, treatment termination/end (Week 12), and 3-months after the end of treatment.
TFPP is adapted from the only empirically supported, non-exposure-focused psychodynamic therapy for panic disorder and anxiety disorders, panic-focused psychodynamic psychotherapy. TFPP aims to improve patients’ ability to understand and manage strong, intense emotions that appear seemingly “out of the blue,” which links to their tendency to re-experience traumatic events in the here-and-now. TFPP addresses the psychological meanings of symptoms and their relationship to traumatic events to help the patient understand underlying emotions triggering their symptoms and how trauma influences their current experiences. TFPP was developed for patients with complex PTSD, who often have multiple prior trauma exposures with no apparent “index” trauma. Moreover, TFPP also explicitly considers opportunities for patients to explore the broader context of their symptoms and difficulties, including but not limited to LGBT identity or experiences of oppression.
Title: Narrative Exposure Based Intervention For Post-Traumatic Stress Disorder
Principal Investigator: Michael Telch, PhD
Laboratory for the Study of Anxiety Disorders
Post-traumatic Stress Disorder (PTSD) is a debilitating mental disorder that affects approximately 7% of the general population. This project aims to develop a greater understanding of the efficacy and underlying mechanisms of narrative exposure-based treatments for PTSD. Adult participants (N=162) who meet DSM-5 criteria for PTSD will be enrolled in a 3-arm randomized clinical trial consisting of trauma-related expressive writing, trauma-related expressive speaking, or a factual expressive writing control condition. Treatments will be manualized and conducted entirely through the Qualtrics survey platform. Treatment will consist of six sessions, three per week over two weeks, taking place via the internet. Assessments will be conducted pre-treatment, post-treatment, and at 1-month follow-up in the lab. Assessments will be comprised of symptom self-report measures as well as two tasks completed in an eye tracker: a reading task to evaluate mechanisms underlying trauma narrative processing and a sentence production task to evaluate attentional shifts when producing verbal information.
Title: Feasibility Trial of Narrative Exposure Therapy (NET) for Pregnant Women With Posttraumatic Stress Disorder (PTSD)
Principal Investigator: Natalie R. Stevens, PhD
Rush University Medical Center
Post-traumatic stress disorder (PTSD) affects up to 35% of pregnant trauma survivors. Moreover, prenatal PTSD rates are up to 4 times higher among communities of color compared to white populations. PTSD during pregnancy has been linked to an increased risk of adverse perinatal and infant health outcomes and may even contribute to racial disparities in adverse perinatal outcomes. Although front-line treatments exist for PTSD, treatment research that specifically focuses on pregnancy is extremely limited. Clinical studies examining the safety, acceptability, feasibility, and efficacy of treatments for PTSD during pregnancy are virtually non-existent. Thus, pregnant individuals with PTSD, particularly within low-income communities of color, are a vulnerable and underserved group in need of effective treatment approaches for their distress. Investigators propose to conduct a feasibility and acceptability study of a PTSD treatment, Narrative Exposure Therapy (NET), in a sample of pregnant individuals with PTSD in which low-income people of color are highly represented.