The Challenges of Complex Trauma (CPTSD)

Complex Post-Traumatic Stress Disorder (CPTSD) involves some typical symptoms of PTSD but with additional, more severe and disruptive symptoms. These symptoms tend to be longer-lasting than those experienced by individuals with PTSD. CPTSD often arises from inescapable traumatic events, particularly those that are horrific or life-threatening in nature, such as repeated or chronic abusive incidents occurring over months or even years. These traumatic events are frequently experienced during childhood and typically involve interpersonal relationships, often with abusive parents, caregivers, or other authority figures. As a result, CPTSD presents a number of specific challenges.

Quality of Life Can Be Seriously Affected
Individuals with CPTSD may engage in self-destructive behaviours, have very low self-esteem, struggle to trust others, and find it difficult to manage their anger. They may also find it hard to form intimate relationships and may feel persistent hopelessness, worthlessness, guilt, or despair. Common symptoms include:

Constant feelings of emptiness
Intense anger toward the world
Difficulty controlling emotions
A sense of being damaged or worthless
Feelings of hopelessness
A belief that no one else understands
Feeling fundamentally different from others
Struggling with friendships and relationships
Experiencing dissociative symptoms
Physical symptoms such as headaches, dizziness, chest pains, and gastrointestinal issues
Frequent suicidal thoughts

One distinctive feature of CPTSD is the occurrence of ’emotional flashbacks,’ where individuals re-experience intense feelings from their trauma, such as fear, shame, or despair. During these flashbacks, they may react to present situations as if they are causing these feelings, unaware that they are reliving past trauma.

Any or all of these symptoms can significantly impair a person’s daily functioning and overall quality of life.

CPTSD is a Relatively New Term
Although professionals have long recognized that certain types of trauma can cause additional effects beyond PTSD, there has been debate about whether CPTSD is a form of PTSD or a distinct condition. There has also been disagreement on what to call it.

CPTSD is not yet a formal diagnosis. As a result, the National Institute for Health and Care Excellence (NICE), which provides guidelines for best practices in healthcare, has not yet developed specific diagnostic recommendations for CPTSD. Moreover, NICE advises that existing guidelines for PTSD were not created with CPTSD in mind.

Not all professionals are aware of CPTSD, and its symptoms can closely resemble those of Borderline Personality Disorder (BPD). Consequently, some individuals are misdiagnosed with BPD or another personality disorder when CPTSD may be a more accurate fit for their experiences.

Difficulties in Diagnosis
CPTSD can be particularly difficult to diagnose, especially if clinicians are unaware of a patient’s trauma history. For instance, some individuals may be unwilling or unable to disclose childhood abuse. In children, CPTSD symptoms often overlap with those of other conditions, such as depression, eating disorders, sleep disorders, ADHD, oppositional defiant disorder, and separation anxiety. Additionally, other disorders, such as bipolar disorder, can develop following severe trauma, complicating the diagnosis of CPTSD.

It is often not until adulthood that individuals with CPTSD are able to articulate their feelings and seek the help they need. Until then, many remain undiagnosed, prolonging their suffering by not receiving appropriate treatment.

More Research is Needed in Treating CPTSD
Currently, CPTSD is generally treated similarly to PTSD, with a combination of talk therapy, medication, and family or social support. While these standard treatments can be helpful, many people with CPTSD require more long-term, intensive support. Unfortunately, up to half of those living with either condition find that current therapies do not fully alleviate their symptoms. Treatment options may also vary based on geographic location, with wealthier or more urban areas having better access to resources. However, experimental approaches are being explored, and future research may offer better answers for effectively treating CPTSD.