What is complex post traumatic stress disorder
What Is Complex PTSD? The Symptoms Caused By Chronic Trauma
Written by WebMD Editorial Contributors
Medically Reviewed by Dan Brennan, MD on April 12, 2021
In this Article
- Symptoms of PTSD
- What Is Complex PTSD?
- Risk Factors for Complex PTSD
- Conditions Similar to Complex PTSD
- Treatment for Complex PTSD
You may have heard of post-traumatic stress syndrome or PTSD, but you may not be familiar with complex PTSD, sometimes known as c-PTSD. Complex PTSD is caused by prolonged or chronic trauma. Those with complex PTSD usually have at least some of the symptoms of PTSD, but they could also have other symptoms.
Most people experience at least one traumatic event during their lives, and about a fourth go on to develop PTSD. No one knows how many people have complex PTSD.
Symptoms of PTSD
People who experience trauma may feel its effects for days. If the symptoms last weeks or longer, and if they disrupt your life, you may have PTSD. See a trained mental health professional if you're worried that you might have PTSD.
Symptoms of PTSD usually fall into three categories.
Re-experiencing symptoms. Flashbacks and nightmares are probably the best-known PTSD symptoms. Memories of the trauma may trigger powerful emotions. The person may relive the sights, smells, and sounds of the traumatic event.
Sense-of-threat symptoms. Those with PTSD often feel that they must be on their guard. They may be hypervigilant (over aware of their surroundings), jumpy, and easily startled.
Avoidance symptoms. Those with PTSD spend a lot of energy avoiding triggers — people, places, or situations that remind them of the trauma they experienced. They may self-medicate with drugs or alcohol.
What Is Complex PTSD?
Besides the symptoms of PTSD, those with complex PTSD may also have other symptoms.
Problems with self-esteem.
Those with complex PTSD may feel worthless or blame themselves for their trauma. They may believe bad things happen because of something in them.
Emotional dysfunction. Those with complex PTSD often experience intense emotions, which are sometimes inappropriate. Besides anger and sadness, they may feel like they're living in a dream. They may have trouble feeling happy.
Relationship problems. Complex PTSD can make it difficult to trust others. Some people stay in unhealthy relationships because the situation is familiar. If their trauma involved abuse, their feelings about their abuser may be complicated. Or they may obsess about their abuser or focus on revenge.
Risk Factors for Complex PTSD
Originally used to describe the results of childhood trauma, complex PTSD now includes other kinds of chronic trauma.
- Childhood abuse or neglect
- Long-standing domestic violence
- Trafficked or forced into sex work
- Kidnapped, enslaved, or tortured
- Incarcerated in a prisoner of war camp
- Witnesses to repeated acts of violence
There are also additional risk factors for complex PTSD.
- Multiple traumas
- Trauma from an early age
- Long-term trauma
- Abuse by a close family member or friend
- Not having a hope for change when trapped
Conditions Similar to Complex PTSD
A Harvard researcher coined the term "complex PTSD" in 1988. Mental health professionals today may use other terms.
Enduring Personality Changes After Catastrophic Events (EPCACE). To have a diagnosis of EPCACE, the person needs to have a personality change that lasts for 2 years after trauma. EPCACE is no longer recognized by the World Health Organization, which uses complex PTSD instead. Some mental health professionals prefer EPCACE and still use it.
Disorders of Extreme Stress Not Otherwise Specified (DESNOS). This term sometimes is used to mean the same thing as complex PTSD, especially in the United States. The risk factors and symptoms are very similar.
Borderline Personality Disorder (BPD).
The symptoms of complex PTSD and BPD are similar, but BPD does not require a history of trauma. Some researchers believe that genetics or brain function could be at the root of BPD. Some authorities consider complex PTSD a subtype of BPD, but others believe they're two separate conditions.
Treatment for Complex PTSD
Because complex PTSD is a relatively new diagnosis, mental health professionals are still working on treatment options. There are still some options that may help.
- Talk therapy to help process the trauma
- Medication such as antidepressants and anti-anxiety medications
- Exposure therapy in which subjects face their memories in a safe space
- Cognitive Behavior Therapy (CBT), which addresses thought patterns
Some therapists use a relatively new therapy called eye movement desensitization and reprocessing (EMDR). It may be helpful for complex PTSD too. In EMDR, the subject remembers a trauma while following a bilateral stimulus (one that switches from one side of the body to the other) that leads to a back-and-forth eye movement.
The stimulus could be one they see such as a finger moving back and forth or a sound. EMDR is effective for PTSD, but experts debate if the bilateral stimulation is really important or if the process could happen without it.
What Is Complex PTSD? The Symptoms Caused By Chronic Trauma
Written by WebMD Editorial Contributors
Medically Reviewed by Dan Brennan, MD on April 12, 2021
In this Article
- Symptoms of PTSD
- What Is Complex PTSD?
- Risk Factors for Complex PTSD
- Conditions Similar to Complex PTSD
- Treatment for Complex PTSD
You may have heard of post-traumatic stress syndrome or PTSD, but you may not be familiar with complex PTSD, sometimes known as c-PTSD. Complex PTSD is caused by prolonged or chronic trauma. Those with complex PTSD usually have at least some of the symptoms of PTSD, but they could also have other symptoms.
Most people experience at least one traumatic event during their lives, and about a fourth go on to develop PTSD.
No one knows how many people have complex PTSD.
Symptoms of PTSD
People who experience trauma may feel its effects for days. If the symptoms last weeks or longer, and if they disrupt your life, you may have PTSD. See a trained mental health professional if you're worried that you might have PTSD.
Symptoms of PTSD usually fall into three categories.
Re-experiencing symptoms. Flashbacks and nightmares are probably the best-known PTSD symptoms. Memories of the trauma may trigger powerful emotions. The person may relive the sights, smells, and sounds of the traumatic event.
Sense-of-threat symptoms. Those with PTSD often feel that they must be on their guard. They may be hypervigilant (over aware of their surroundings), jumpy, and easily startled.
Avoidance symptoms. Those with PTSD spend a lot of energy avoiding triggers — people, places, or situations that remind them of the trauma they experienced.
They may self-medicate with drugs or alcohol.
What Is Complex PTSD?
Besides the symptoms of PTSD, those with complex PTSD may also have other symptoms.
Problems with self-esteem. Those with complex PTSD may feel worthless or blame themselves for their trauma. They may believe bad things happen because of something in them.
Emotional dysfunction. Those with complex PTSD often experience intense emotions, which are sometimes inappropriate. Besides anger and sadness, they may feel like they're living in a dream. They may have trouble feeling happy.
Relationship problems. Complex PTSD can make it difficult to trust others. Some people stay in unhealthy relationships because the situation is familiar. If their trauma involved abuse, their feelings about their abuser may be complicated. Or they may obsess about their abuser or focus on revenge.
Risk Factors for Complex PTSD
Originally used to describe the results of childhood trauma, complex PTSD now includes other kinds of chronic trauma.
- Childhood abuse or neglect
- Long-standing domestic violence
- Trafficked or forced into sex work
- Kidnapped, enslaved, or tortured
- Incarcerated in a prisoner of war camp
- Witnesses to repeated acts of violence
There are also additional risk factors for complex PTSD.
- Multiple traumas
- Trauma from an early age
- Long-term trauma
- Abuse by a close family member or friend
- Not having a hope for change when trapped
Conditions Similar to Complex PTSD
A Harvard researcher coined the term "complex PTSD" in 1988. Mental health professionals today may use other terms.
Enduring Personality Changes After Catastrophic Events (EPCACE). To have a diagnosis of EPCACE, the person needs to have a personality change that lasts for 2 years after trauma. EPCACE is no longer recognized by the World Health Organization, which uses complex PTSD instead. Some mental health professionals prefer EPCACE and still use it.
Disorders of Extreme Stress Not Otherwise Specified (DESNOS). This term sometimes is used to mean the same thing as complex PTSD, especially in the United States. The risk factors and symptoms are very similar.
Borderline Personality Disorder (BPD). The symptoms of complex PTSD and BPD are similar, but BPD does not require a history of trauma. Some researchers believe that genetics or brain function could be at the root of BPD. Some authorities consider complex PTSD a subtype of BPD, but others believe they're two separate conditions.
Treatment for Complex PTSD
Because complex PTSD is a relatively new diagnosis, mental health professionals are still working on treatment options. There are still some options that may help.
- Talk therapy to help process the trauma
- Medication such as antidepressants and anti-anxiety medications
- Exposure therapy in which subjects face their memories in a safe space
- Cognitive Behavior Therapy (CBT), which addresses thought patterns
Some therapists use a relatively new therapy called eye movement desensitization and reprocessing (EMDR).
It may be helpful for complex PTSD too. In EMDR, the subject remembers a trauma while following a bilateral stimulus (one that switches from one side of the body to the other) that leads to a back-and-forth eye movement. The stimulus could be one they see such as a finger moving back and forth or a sound. EMDR is effective for PTSD, but experts debate if the bilateral stimulation is really important or if the process could happen without it.
Post-traumatic stress disorder (PTSD) | English translation
However, most people realize what happened after a few weeks, sometimes a little longer, and then their symptoms will begin to disappear.
Research shows that certain groups of people are at increased risk of developing post-traumatic stress disorder. The risk of developing PTSD is reduced when a person has:
Any traumatic event can cause PTSD, although the more severe the shock, the more likely it is to develop PTSD. For example, PTSD is more likely to develop if the event:
- is a sudden and unexpected
- lasts a long time
- , it happens when you get into a trap from which
- could not get out by people
- brings many deaths
- leads to injuries
- include children
if you are still stressed and in an uncertain state, this will make it difficult to get rid of the symptoms of PTSD.
How do I know that I have overcome a traumatic experience?
You may have already gotten over the traumatic event if you can:
- think about it without worrying
- not feel like you are under constant threat
- not think about it all the time
Why is PTSD not always diagnosed?
There are a number of reasons why a person with PTSD may not be diagnosed.
Stigma and misunderstanding
People with PTSD often avoid talking about their feelings to avoid thinking about the traumatic event.
Some people believe that the symptoms they are experiencing (such as avoidance or emotional numbness) help them cope and do not realize that they are caused by PTSD.
When people are very ill, it is difficult for them to believe that they are able to feel the way they did before the traumatic event. This may discourage them from getting help.
There is also a common misconception that only military personnel suffer from PTSD.
In fact, PTSD can happen to anyone, and any experience of PTSD is real.
Misdiagnosis
Some people with PTSD may be misdiagnosed with conditions such as anxiety or depression. Some people have other mental and physical health problems that make PTSD go unnoticed.
They may also experience medically unexplained symptoms such as:
- gastrointestinal disorders
- pain syndromes
- headaches
These symptoms may mean that their PTSD goes unnoticed.
Other difficulties
Some people with PTSD may also have other problems, such as difficulties in human relationships or addiction to alcohol and drugs. They may be caused by post-traumatic stress disorder, but these problems will manifest themselves more clearly than PTSD itself.
Can children develop PTSD?
PTSD can develop at any age. In addition to the symptoms of PTSD common to adults, children may also experience:
- Nightmares - In children, these dreams may or may not reflect an actual traumatic event.
- Repetitive play - some children act out a traumatic event during play. For example, a child who has been in a serious traffic accident may recreate the accident with toy cars.
- Physical symptoms - they may complain of abdominal pain and headaches.
- Fear of imminent death - they may find it hard to believe that they will live long enough to become adults.
What treatments are available for PTSD?
There are a number of different treatments for PTSD, including trauma-focused cognitive behavioral therapy (TF-CBT), eye movement desensitization and processing (EMDR), and medications.
Psychotherapy
Psychotherapy for PTSD will focus on the traumatic experience, not your past life. They will help you:
- Acceptance - learn to accept the fact that although you cannot change what happened, you can think differently about the event, the world around you and your life.
- Memory of the event - remembering what happened, you will not feel fear or anxiety. You will be able to think about what happened when you yourself want it, and not through obsessive thoughts or memories.
- Explaining your experiences in words - by saying out loud what happened, your mind can push the memories away and do other things.
- Finding a sense of security - helps you to better control your feelings. This will make you feel more secure and eliminate the need to avoid memories.
All psychotherapy must be administered by a properly trained and accredited professional. Sessions are usually conducted by the same therapist at least once a week, with a total duration of at least 8-12 weeks.
Sessions usually last about an hour, sometimes they can last up to 90 minutes.
Therapy for PTSD includes:
Trauma-focused Cognitive Behavioral Therapy
A form of talking therapy that can help you change the way you think.
Over time, this can help you feel better and behave differently. It is usually done individually, although there is evidence that CBT for trauma can also be done in groups.
Eye Movement Desensitization and Reprocessing (EMDR)
A technique that uses eye movements to help the brain process traumatic memories.
You will be asked to remember the traumatic event and what it made you think and feel. While you do this, you will be prompted to move your eyes or receive other "two-way stimulation" such as tapping your hand. It turns out that this reduces the emotional burden experienced in connection with the traumatic memory and helps to cope with the trauma.
The GERD must be carried out by a qualified person. EPDH usually requires 8-12 sessions, lasting from 60 to 90 minutes.
Some other forms of talking therapy may be useful for treating certain symptoms (eg, poor sleep) in people for whom EMRT or CBT have not been effective for trauma.
Medications
If you have tried various treatments for PTSD and find that they do not work for you, your doctor may prescribe antidepressants for you.
Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that can help reduce symptoms of post-traumatic stress disorder. They can also help you if you are suffering from depression.
If SSRIs are not working for you, you may be offered other drugs, but this should usually be done on the advice of a mental health professional.
Which treatment is more effective?
There is evidence that Cognitive Behavioral Therapy for Trauma and Eye Movement Desensitization and Reprocessing are the best first line treatments. Medication can help those who refuse talking therapy or cannot easily access it.
Which treatment should I take first?
Trauma-focused psychological therapy (TF-CBT or EMBT) should be offered prior to medication, to the extent possible. This is in line with the UK National Institute for Health and Clinical Excellence (NICE) guidelines.
How can I help myself?
There are some things you can do to help you get better if you develop PTSD.
Your therapist will help with this and make sure you apply them in a timely manner:
Stick to your daily routine - As far as possible, try to return to or maintain your normal daily routine. By continuing to lead a life as normal as possible, you can gain a sense of support.
Talk to someone you trust - Although you shouldn't feel like you need to talk to everyone about what happened, talking to someone you trust can help you sort out your feelings in a safe environment. It can also help to talk to someone who has gone through the same thing as you, or someone who has gone through something similar before, as long as it doesn't hurt you.
Try relaxation exercises - Try self-meditation and other relaxation exercises. Relaxing with PTSD can be challenging, so talk to your therapist about exercises or activities that can help you.
Return to work or school - if you feel empowered, it can help you return to work, school or university by giving you a sense of routine.
However, you should try to avoid situations in which you may be subjected to further injury or severe stress. It is usually best to work in a supportive, low-stress environment before starting treatment.
Eat and exercise regularly - Try to eat at regular times, even if you don't feel hungry. If you feel fit, try to exercise regularly. It can also help you feel tired before bed.
Spend time with others - Spending time with the people you care about will help you feel supported.
Expect to get better - Concentrating on thoughts that you will feel better over time will be useful for your recovery. Remember that you should not strain yourself in an attempt to recover faster.
Go back to where the traumatic event happened - If you feel you can do it, you may want to go back to where the traumatic event happened. Talk to your therapist or doctor if you are considering this so they can support you through this step.
There are also some things you should avoid while recovering. However, doing the "right things" can be very difficult, and you shouldn't feel guilty if you find yourself doing any of the following:
Self-criticism - PTSD symptoms are not a sign of weakness. This is a normal reaction to violent experiences.
Keep your feelings to yourself. If you have PTSD, don't feel guilty about sharing your thoughts and feelings with others. Talking about how you are feeling can help your recovery.
Expect things to get back to normal quickly - PTSD can take some time to heal. Try not to demand too much of yourself in a short amount of time.
Stay away from other people. Spending a lot of time alone can increase your sense of isolation and make you feel less well.
Drink alcohol or smoke. While alcohol can help you relax, and coffee and nicotine can act as stimulants, they can make you feel worse over time if you're experiencing symptoms associated with post-traumatic stress disorder.
Overwork. Post-traumatic stress disorder can make it difficult to sleep, but as much as possible, try to stick to your regular sleep schedule and stay up late, as this can make you feel worse. You can learn more about good sleep in our resource.
Finally, you should be careful while driving. After a traumatic episode, people may have more accidents.
What is complex PTSD?
Some people develop complex post-traumatic stress disorder, caused by an experience or series of events that is extremely threatening or terrifying. These events can occur in childhood or adulthood.
Often such events are difficult or impossible to avoid. For example:
- torture
- slavery
- genocide
- living in war zones
- prolonged domestic violence
- repeated sexual and physical abuse
In addition to symptoms of post-traumatic stress disorder, people with complex post-traumatic stress disorder may also:
- emotions and emotional reactions
- have difficulty maintaining relationships and feelings of closeness with other people
How do I recover from complex PTSD?
People with complex post-traumatic stress disorder are characterized by a lack of trust in other people and in the world at large.
Emotional stabilization
During the stabilization phase, you will learn to trust your therapist and to understand and manage feelings of distress and alienation.
As part of stabilization, you can familiarize yourself with the work with supports - "grounding techniques". This can help you focus on familiar physical sensations and remind you that you are living in the present, not the past.
Stabilization can help you "unplug" your feelings of fear and anxiety from the memories and the emotions they evoke, helping to make those memories less frightening.
The goal of stabilization is so that you can eventually live your life free from anxiety or memories.
Sometimes stabilization may be the only help needed.
Trauma Focused Therapy
Trauma Focused Therapy, including EMDR (Eye Movement Desensitization and Processing) or Trauma Focused Cognitive Behavioral Therapy, can help you deal with traumatic experiences.
Other types of psychotherapy, including psychodynamic psychotherapy, may also be helpful. For complex post-traumatic stress disorder, care must be taken as these treatments can make things worse if not used properly.
Reintegration and recovery
Reintegration into normal life can help you adjust to the real world at a time when you have emerged from the dangerous situation you were in before. This can help you begin to see yourself as a person with a choice.
Reintegration can help you:
- be compassionate towards yourself and others
- restore trust in yourself and others
- renew friendships, intimate relationships, and activities that promote your health and well-being
Medications
As with PTSD, antidepressants or other medications may be used along with psychotherapy. Medication may also be used if psychotherapy does not help or is not available to you. It would also be helpful to have a mental health professional help you oversee your medication.
Self Help
If you develop complex PTSD, it may be helpful to try to do ordinary things that have nothing to do with your past traumatic experience.
They can include:
- Bring friends
- Stuck work
- to engage in regular physical exercises
- Learn to relax
- Find a hobby
- to start domestic animals
These things can help you gradually start trusting the world around you . However, this can take time, and there is no need to be ashamed that at first these things will seem difficult to you or you will not be able to do them right away.
How do you know if someone has PTSD?
If you know someone who has just experienced a traumatic event, there are a few things you should be aware of. These moments can be signs that a person is not coping:
- Changes in behavior - low productivity at work, lateness, sick leave, minor accidents.
- Changes in emotions - anger, irritability, depression, lack of interest and lack of concentration.
- Changes in thought - preoccupation with threats or fears, negative outlook on the future
- Unexpected physical symptoms such as shortness of breath, nervousness or abdominal pain.
If you think a person may be showing signs of PTSD, you can suggest that they talk to their doctor. If you don't feel close enough to him for such a recommendation, talk to someone in his family or friends who could do it for you.
They may also find it helpful to refer to information about PTSD, such as this resource, to help identify the difficulties they face.
How can I help someone who has experienced a traumatic event?
For those who have experienced a traumatic event, the following actions may help:
- Be there - invite people to be with them. If they refuse, you can reassure them that you will be with them if they change their mind. Should not be imposed, but try to convince them to accept your help.
- Listen - try not to pressure people if they don't want something. If they want to talk, try to listen without interrupting or trying to share your own experience with them.
- Ask general questions - When you ask questions, try to keep them general and non-judgmental. For example, you might ask, "Have you talked about this with anyone else?" or “Can I help you find more help?”
- Offer real (practical) help - Some people may have difficulty taking care of themselves or doing daily activities. Offer help, such as cleaning the house or preparing meals;
Try not to tell people:
- That you know how they feel - even if you have experienced something like this, people experience situations differently. Comparing your experience with that of others is not always helpful;
- How lucky they are to be alive - people who have experienced traumatic events often don't think they are "lucky".
Often they feel guilty about the fact that they survived while others died; - Belittling the significance and seriousness of the experience - try not to tell people that things could be much worse, even if you do it out of good intentions and thereby try to help them. Such statements can make people feel that their experiences are not being taken seriously by others;
- Giving inappropriate advice - Try not to give advice or suggestions, even if it has helped you in the past. All people are different and often they have already tried what you offer.
References:
This information was prepared by the Public Engagement Editorial Board of the Royal College of Psychiatrists (PEEB). It reflects the best available evidence at the time of writing.
Special thanks to PTSD UK for kindly providing feedback on this resource.
Expert Editor: Prof. Neil Greenberg
Full links to this resource are available upon request.
Translated by Elena Fage senior intern psychiatrist
Translated by Elena Fage, Specialty doctor in CAMHS
Post-traumatic stress disorder (PTSD): symptoms, causes and treatment of PTSD
Severe stress, fears, constant nervous tension can be caused by various reasons. For many Ukrainians, these factors were the war and the complete destruction of plans for the future. Post-traumatic stress disorder can also be caused by other activators - terrible events in life experienced by a catastrophe, natural disaster, violence. Any situation that is traumatic for a person can lead to the development of PTSD.
In the majority of diagnosed cases, the disorder is caused by:
- wars, catastrophes, acts of terrorism;
- accidents with serious consequences;
- sexual emotional, physical abuse;
- natural disasters;
- serious illnesses;
- stressful situations at work or at the place of study;
- complex losses, for example, the death of a loved one.
PTSD can develop in all generations. Activating factors for the development of the disorder can be strong feelings, abuse, professional risks (work in the police, armed forces, fire departments, etc.). The presence of psychiatric and anxiety disorders, alcohol and drug abuse can also increase the risk of developing PTSD. Problems may be related to heredity (for example, PTSD is more likely to develop in people whose relatives suffer from similar diseases). The lack of support of loved ones in the most difficult moments of life can become the “last straw” for the onset of symptoms of post-traumatic disorder.
Diagnosis of PTSD
Diagnosis can only be made by a doctor after a series of examinations. The reason for contacting a specialist may be experienced psychological or physical trauma or any of the symptoms, which we will discuss below. To diagnose the disorder, a doctor performs a physical examination, a psychological assessment, and tests the patient for PTSD.
Special questionnaires are used as test material.
Symptoms of post-traumatic stress disorder
It is far from always that the disease manifests itself immediately after the onset of a stressful situation. In many cases, the problem becomes apparent years later. Symptoms of the disease can be divided into 4 categories:
- obsessive memories - often occurring memories of traumatic factors, experienced stress, as well as - terrible dreams, nightmares, a strong stress reaction to such memories;
- avoidance - refusal to remember the traumatic event and any mention of it, including - refusal to visit places associated with the trauma, communicate with people associated with the situation;
- negative changes in the mental sphere - a feeling of loneliness, isolation from the world, negative thoughts about oneself, a feeling of hopelessness, loss of interest in hobbies and favorite activities, emotional burnout;
- physical and emotional changes - the appearance of fright, tremors of the limbs, alcohol or drug abuse, sleep disturbances and problems concentrating on any object or activity, violent outbursts of anger, irritability, aggression, strong feelings of shame and guilt.
In childhood, post-traumatic stress disorder can manifest itself in recreating traumatic situations in a playful way. Among the symptoms of childhood PTSD, sleep disturbances and nightmares can also be distinguished.
Treatment for post-traumatic stress disorder
Treatment for PTSD is done to improve the patient's physical and emotional well-being. The psychotherapist will prescribe therapy that helps to level the influence of traumatic factors on the life and condition of the patient. As a rule, treatment is carried out in a complex manner and includes the use of psychotherapy and drug therapy. Drug treatment involves taking medications that relieve symptoms:
- antidepressants;
- anti-anxiety drugs;
- prazosin, which reduces nightmares.
Psychotherapy can combine cognitive therapy, exposure therapy and desensitization.
In order to prevent PTSD in adults and children after the onset of a traumatic situation, we recommend contacting a specialist.
