Complex Post-Traumatic Stress Disorder (C-PTSD)

Overview

Complex post-traumatic stress disorder (C-PTSD) is a psychological condition that can occur after experiencing prolonged or repeated trauma, such as childhood abuse, domestic violence, or captivity. C-PTSD symptoms can include emotional dysregulation, dissociation, chronic feelings of shame or guilt, and difficulties in forming and maintaining healthy relationships. It is not an official diagnosis in the DSM-5, but is sometimes used by clinicians and researchers to describe a specific type of post-traumatic stress disorder that results from chronic trauma.

How common is C-PTSD?

There is limited available data on the prevalence of complex post-traumatic stress disorder (C-PTSD) specifically in Australia. However, research on the prevalence of PTSD in Australia may provide some insight.

According to the Australian Bureau of Statistics (ABS), around 4% of Australian adults experienced PTSD in the 12 months prior to the 2007 National Survey of Mental Health and Wellbeing. A more recent study conducted in 2019 found that approximately 11.2% of Australian adults reported experiencing PTSD symptoms at some point in their lifetime.

While there is no specific data on the prevalence of C-PTSD, it is estimated that a significant proportion of individuals with PTSD may meet the criteria for C-PTSD. A study of Australian veterans found that approximately 30% of individuals with PTSD met the criteria for C-PTSD.

It’s worth noting that due to the complex and varied nature of trauma and the symptoms of C-PTSD, it can often be under-diagnosed or misdiagnosed, and there may be many individuals who have not sought treatment or have not received a diagnosis. Additionally, there may be demographic or population groups that are more likely to experience C-PTSD but have not been studied in depth. Therefore, more research is needed to better understand the prevalence and impact of C-PTSD in Australia.

Symptoms and causes

Symptoms of C-PTSD

Not everyone who has experienced trauma will develop C-PTSD and not everyone who has these symptoms has C-PTSD, and it is not currently an official diagnosis in the DSM-5, but some researchers have proposed a set of symptoms that may be associated with it.

• Avoidance: People with complex PTSD may try to avoid anything that reminds them of their trauma, such as people, places, or activities. This can include avoiding social situations, going to certain places, or doing certain things that may trigger memories of the traumatic event.
• Difficulty concentrating: People with complex PTSD may have trouble concentrating on tasks or focusing on daily activities. This can be due to intrusive thoughts or emotional overwhelm.
• Difficulty regulating emotions: People with complex PTSD may experience intense emotional reactions to certain triggers, and may have difficulty controlling or regulating these emotions.
• Distorted perception of the perpetrator: People with complex PTSD may have a distorted perception of the person who caused the trauma, such as attributing total power to them or believing they are still a threat.
• Distrust in authority or a negative attitude towards help-seeking: People with complex PTSD may have a negative attitude towards seeking help, and may distrust authority figures or mental health professionals.
• Exaggerated startle response: People with complex PTSD may be easily startled or triggered by sudden noises or movements. This can be due to hypervigilance or an overactive stress response.
• Flashbacks: People with complex PTSD may experience vivid and distressing memories of the traumatic event as if they are reliving it.
• Hypervigilance: People with complex PTSD may feel constantly on guard as if they are always in danger. This can lead to a state of hyperarousal, with heightened sensitivity to stimuli and an increased stress response.
• Insomnia or other sleep disturbances: People with complex PTSD may have trouble sleeping, including difficulty falling or staying asleep, nightmares, or night terrors.
• Intrusive thoughts: People with complex PTSD may experience recurrent, distressing thoughts or memories of the traumatic event.
• Muscle armouring: People with complex PTSD may experience chronic tension or tightness in their muscles, known as muscle armouring. This can be due to a constant state of hypervigilance and stress.
• Negative self-concept: People with complex PTSD may have a negative self-image, including feelings of worthlessness, shame, and guilt.
• Nightmares: People with complex PTSD may experience vivid and distressing dreams related to the traumatic event, which can interfere with sleep and lead to further distress.
• Loss of trust in others and a sense of isolation: People with complex PTSD may feel disconnected from others and may have trouble trusting people, which can lead to feelings of loneliness and isolation.
• Persistent feelings of shame, guilt, or self-blame: People with complex PTSD may feel responsible for the trauma or blame themselves for what happened, leading to feelings of shame, guilt, or self-blame.
• Reduced interest in favourite activities: People with complex PTSD may lose interest in activities that they used to enjoy, and may struggle to find pleasure in things that once brought them joy.
• Risky behaviours: People with complex PTSD may engage in risky or self-destructive behaviours, such as substance abuse or reckless driving, as a way of coping with their emotions.
• Self-isolation and feeling emotionally distant: People with complex PTSD may withdraw from social interactions and may feel emotionally distant from others, which can contribute to feelings of isolation and loneliness.

Further reading: An In-Depth Look at the Symptoms of Complex PTSD

Causes of C-PTSD

PTSD typically results from experiencing or witnessing a single traumatic event, such as a natural disaster, an accident, or an act of violence. It is characterised by a set of symptoms that can include re-experiencing the trauma through flashbacks or nightmares, avoidance of reminders of the trauma, negative changes in mood and cognition, and hyperarousal.

C-PTSD, on the other hand, results from experiencing prolonged or repeated trauma, such as childhood abuse, domestic violence, or captivity. It is characterised by a broader range of symptoms, including all of the symptoms of PTSD, as well as difficulties with emotional regulation, dissociation, interpersonal relationships, and self-concept.

Some of the key differences between PTSD and C-PTSD include the nature of the trauma, the severity and duration of symptoms, and the impact on daily functioning. C-PTSD is often considered a more severe and complex condition than PTSD, as it can have a more profound and long-lasting impact on a person’s life. PTSD and C-PTSD are not mutually exclusive, and some individuals may experience symptoms of both conditions.

Common triggers

Triggers for individuals with complex post-traumatic stress disorder (C-PTSD) can vary depending on the nature of the trauma and the individual’s personal experiences and triggers. However, some common triggers for individuals with C-PTSD may include:

• Sensory stimuli: Triggers related to sensory stimuli, such as loud noises, bright lights, or strong smells, can be common for individuals with C-PTSD. These stimuli can be reminiscent of the traumatic experience and can trigger feelings of anxiety, panic, or dissociation.
• Intense emotions: Intense emotions such as anger, fear, or sadness can also be a trigger for individuals with C-PTSD. These emotions can be overwhelming and may remind the individual of the traumatic experience, leading to feelings of distress.
• Relational triggers: Triggers related to relationships, such as feelings of rejection or abandonment, can be common for individuals with C-PTSD. These triggers may be reminiscent of past experiences of abuse or neglect, and can lead to feelings of fear, mistrust, or anxiety.
• Situational triggers: Situational triggers, such as being in a crowded space, being alone in the dark, or encountering a specific location or object, can be common for individuals with C-PTSD. These situations may be reminiscent of the traumatic experience and can trigger feelings of fear or panic.
• Anniversary reactions: Anniversary reactions, or feelings of distress that arise around the anniversary of the traumatic experience, can also be a common trigger for individuals with C-PTSD. These reactions may be related to a specific date, season, or time of year.

Triggers for C-PTSD can be highly individualised, and what may be triggering for one individual may not be for another. With appropriate treatment and support, individuals with C-PTSD can develop coping strategies to manage triggers and reduce the impact of trauma on their daily lives.

Diagnosis and treatment

Treatment for complex PTSD

The treatment for complex post-traumatic stress disorder (C-PTSD) in Australia typically involves a combination of psychotherapy, medication, and self-care techniques. Here are some of the treatments that are commonly used:

• Trauma-focused therapy: This type of therapy is designed to help individuals process and come to terms with their traumatic experiences. Different types of trauma-focused therapies are available, including Eye Movement Desensitisation and Reprocessing (EMDR), Cognitive Processing Therapy (CPT), and Prolonged Exposure Therapy (PE).
• Dialectical Behaviour Therapy (DBT): This type of therapy is designed to help individuals develop skills to manage their emotions, communicate effectively, and build healthy relationships. DBT can be particularly helpful for individuals with C-PTSD, as it can address some of the interpersonal difficulties associated with the condition.
• Medication: While there are no medications specifically approved for the treatment of C-PTSD, some individuals may benefit from antidepressants, anti-anxiety medication, or other types of medication to manage symptoms such as depression, anxiety, and sleep disturbances.
• Self-care techniques: Self-care techniques, such as exercise, mindfulness, and relaxation techniques, can help individuals manage their symptoms and improve their overall well-being. These techniques can also help to reduce stress and promote a sense of calm.

The specific treatment plan for C-PTSD will depend on the individual’s symptoms, preferences, and needs. It is important to work with a qualified mental health professional who can help develop a treatment plan tailored to the individual’s specific situation.

Comorbidity

Complex post-traumatic stress disorder (C-PTSD) is a condition that often co-occurs with other mental health disorders, known as comorbidities. Some of the most common comorbidities of C-PTSD include:

• Depression: Depression is a common comorbidity of C-PTSD, and can manifest as persistent feelings of sadness, hopelessness, and worthlessness. The severity of depression can range from mild to severe.
• Anxiety: Anxiety is another common comorbidity of C-PTSD, and can manifest as excessive worry, fear, and nervousness. Individuals with C-PTSD may experience different types of anxiety, such as generalised anxiety disorder, panic disorder, or social anxiety disorder.
• Substance use disorders: Individuals with C-PTSD are at higher risk of developing substance use disorders, such as alcoholism or drug addiction, as a way to cope with their symptoms.
• Dissociative disorders: Dissociative disorders, such as dissociative identity disorder (DID) or depersonalisation/derealisation disorder, may occur as a comorbidity of C-PTSD. Dissociation is a common coping mechanism for individuals with C-PTSD, and can result in a sense of detachment from reality.
• Personality disorders: Certain personality disorders, such as borderline personality disorder (BPD) and avoidant personality disorder (AvPD), may co-occur with C-PTSD. Personality disorders are characterised by long-standing patterns of thoughts, feelings, and behaviours that are rigid and maladaptive.

These are not the only comorbidities of C-PTSD, and people may experience a range of other mental health conditions. Effective treatment for C-PTSD often involves addressing these comorbidities as part of a comprehensive treatment plan.

Outlook and prognosis

What is the prognosis for C-PTSD?

The prognosis for individuals with complex post-traumatic stress disorder (C-PTSD) can vary depending on factors such as the severity and duration of the trauma, the individual’s age, their coping skills, and the presence of comorbid mental health conditions.

Generally, individuals with C-PTSD may experience a range of symptoms that can affect their quality of life, such as difficulties with emotional regulation, relationships, and self-esteem. However, with appropriate treatment and support, many individuals with C-PTSD can learn to manage their symptoms and improve their overall well-being.

While some individuals with C-PTSD may continue to experience symptoms over the long term, many are able to make significant improvements in their symptoms and overall functioning.

Living with C-PTSD

Healing from trauma can be a complex and individualised process, as the impact of trauma can vary depending on factors such as the type and severity of the trauma, the individual’s personal coping strategies, and the level of support and resources available. However, there are several general strategies and approaches that can help promote healing and recovery from trauma:

• Seek professional help: Working with a qualified mental health professional, such as a therapist or counsellor, can be an important step in healing from trauma. Therapy can provide a safe and supportive environment to explore the impact of trauma and develop coping strategies to manage symptoms such as anxiety, depression, and emotional dysregulation.
• Build a support network: Connecting with supportive friends, family members, or community resources can provide additional support and validation. Peer support groups or online forums can also provide a sense of community and connection with others who have experienced similar trauma.
• Practice self-care: Prioritising self-care can help individuals manage the physical and emotional impact of trauma. This may include engaging in activities such as exercise, meditation, journaling, or spending time in nature.
• Learn coping skills: Developing coping strategies to manage symptoms of trauma can help individuals feel more in control and reduce the impact of trauma on their daily lives. Coping strategies may include relaxation techniques, grounding exercises, and cognitive reframing.

Healing from trauma is a journey that can take time and effort, and may involve setbacks along the way. However, with appropriate support and resources, individuals can build resilience and find ways to manage the impact of trauma on their lives.