Complex Post Traumatic Stress Disorder
Complex PTSD is a clinically recognized form of Post-Traumatic Stress Disorder (PTSD) that results from prolonged exposure to trauma.
Experts feel that PTSD and Complex PTSD are different diagnoses as PTSD fails to describe some of the core characteristics of Complex PTSD, which, along with the regular PTSD symptoms, also includes psychological fragmentation, loss of a sense of safety, trust and self-worth, the tendency to be re-victimized and, most importantly, the loss of a coherent sense of self/identity. These symptoms make Complex PTSD a disorder closely linked to and often misdiagnosed as Borderline Personality Disorder (BPD), as was the case in my situation for many years, however, they are quite different.
The main difference between PTSD and Complex PTSD isn’t the length of time the sufferer has had or symptoms, but rather the duration of the trauma and the difference in symptoms and their severity due to the prolonged trauma. Those with Complex PTSD have usually experienced a trauma over a long term period, rather than one event or one period of time.
Please do not think this is downplaying those who suffer from PTSD, as it too is a severe and life altering illness, and I’m not attempting to propose that Complex PTSD is somehow ‘worse’ than PTSD. They are simply different sets of symptoms resulting from different types of traumas. All trauma is potentially life destroying and impacts greatly on survivors.
Some examples of the type of trauma experienced by those with PTSD and Complex PTSD include:
A history of subjection to totalitarian control over a prolonged period, including systems such as in domestic or sexual life, survivors of domestic abuse, childhood physical or sexual abuse, organized sexual exploitation, survivors of some religious cults, concentration camp survivors, prisoners of war, hostages, emotional abuse, torture, chronic early maltreatment in a care giving relationship, war, prolonged exposure to social and/or interpersonal trauma, etc.
This list is by no means exhaustive. Trauma is a very subjective thing and battles are waged routinely in the medical community over what it’s definition is and what constitutes as trauma.
Certainly, not everyone who experiences a traumatic event or events such as above develop PTSD or similar disorders. Scientists and doctors are still unsure as to what exactly determines that a person will react in this way, and why some don’t. There are many theories, but, mostly, it’s a mystery.
Criteria for Post Traumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following were present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior
B. The traumatic event is persistently re-experienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
(Proposed) Criteria for Complex Post Traumatic Stress Disorder
In addition to the above criteria, ‘Complex PTSD’ features many (but not always all) of the following (This is a list of the recommended diagnostic criteria by Judith Herman in her book Trauma and Recovery):
A. Alterations in affect (mood) regulation, including: persistent dysphoria (chronic low mood), chronic suicidal pre-occupation, self-injury, explosive or extremely inhibited anger (may alternate).
B. Alterations in consciousness, including: amnesia or hyper-amnesia for traumatic events, transient dissociative episodes, depersonalization/derealization (feeling cut off/separate from yourself/your body to an extreme degree), re-living experiences (either in the form of intrusive PTSD symptoms or in the form of ruminative pre-occupation).
C. Alterations in self-perception, including: sense of helplessness or paralysis of initiative, shame, guilt and self-blame, sense of defilement or stigma, sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or non-human identity).
D. Alterations in perception of perpetrator (abuser), including: pre-occupation with relationship to perpetrator (includes pre-occupation with revenge), unrealistic attribution of total power to perpetrator, idealization or paradoxical gratitude, sense of a special or supernatural relationship. Acceptance of belief system or rationalizations of perpetrator.
E. Alterations in relationships with others, including: isolation and withdrawal, disruption in intimate relationships, repeated search for a ‘rescuer’ (may alternate with isolation and withdrawal), persistent distrust, repeated failures of self-protection.
F. Alterations in systems of meaning, including: loss of sustaining faith, sense of hopelessness and despair.
More information
Please note that I am not a doctor, and it is also not a good idea to try and self-diagnose. If you suspect you are having problems and need help, please see your local doctor as soon as possible. They will know exactly who to refer you to in your area.
For more information and links on mental health issues, click HERE.