Understanding complex PTSD

Complex post-traumatic stress disorder (CPTSD) is a trauma-related mental health condition which is onset by prolonged abuse and feelings of powerlessness carried out for a long period of time.

Complex traumatic events frequently begin at a developmentally vulnerable period of someone's life (childhood for instance) and are caused by someone else over a long period of time. Due to this sustained interpersonal trauma, the emotional response will be more intense than trauma that is impersonal or accidental, usually equated with post-traumatic stress disorder (PTSD).

Although there are no specific causes of complex PTSD, circumstances and contexts may trigger the condition including, ongoing community violence and poverty, chronic homelessness, ongoing physical or sexual abuse, severe childhood neglect, prolonged exposure to war, torture, refuge status, prolonged exposure to death or inhumane conditions.

People react and cope differently with experiencing traumatic events. The impact of trauma can be subtle, debilitating or anything in between, with most people experiencing some symptoms as a normal reaction to abnormal traumatic events.

It is normal for reactions to affect your emotions, your behaviour, your mental processes, and your body, as well as affecting your relationships. Reactions often lead to either overwhelming emotions (too much) or numbing emotions (too little.) Reactions can be distressing but are not signs of mental illness but are consequences of responding to traumatic events.

Immediate reactions can include anger, fear, sadness, confusion, agitation, numbness, sweating, faintness, being easily startled, difficulty concentrating, affected memory, sleep problems, apathy, avoiding things and self-medication (drinking and drugs), among others. 

Delayed longer-term reactions can include irritability, anxiety, grief, shame, emotional detachment, avoidance, sleep problems, reduced appetite, poor immune system, stomach problems, flashbacks, intrusive thoughts, depression, suicidal thinking, affected relationships, high-risk behaviour, self-medicating and withdrawal among others. 

Responses to trauma occur in an attempt to respond to and process trauma. When faced with a traumatic event we can be horrified, with our minds unable to comprehend. Overwhelmed by our emotions and responses we are aroused in order to react and survive – fight, flight or freeze – but we have no time to process what has happened to us. This failure to process and store the experience in the usual way means that our brain continues to complete processing by recalling feelings, bodily sensations and snapshots of the event memory until processing occurs. This means that you may continue to experience difficult symptoms such as flashbacks and intrusive thoughts and be left hyperaware of your surroundings and avoidant of triggers.

Seeking therapy with a qualified traumatologist to help process these traumatic events will help reduce and remove symptoms. Techniques such as cognitive behavioural therapy (CBT), narrative exposure therapy (NET), imagery rescripting and reprocessing therapy (IRRT), eye movement desensitisation and reprocessing (EMDR) and exposure therapy have all been found to be effective in allowing your brain to assimilate and store away memories so they do not repeatedly create problematic symptoms.

Therapists will work with you to shift your mindset to view situations, persons or relationships from a slightly different perspective. This is called cognitive restructuring and will allow you to build a set of tools that you will then be able to use independently. This works because it validates your emotions without judging and provides you with a safe opportunity to discuss the experience of the trauma, building an opportunity to engage in healthy self-talk, through a process of patience, effort and time.