Post-Traumatic Stress Disorder (PTSD) is not a new condition, and the term trauma may be one you have been hearing a lot more lately, but our understanding of them and our need to address its significance has been rapidly shifting. The stigma and go-to associations need to be addressed because, like other conditions, trauma exists on a spectrum. PTSD is a well-recognized mental health condition, while Complex Post-Traumatic Stress Disorder (CPTSD) is relatively less known but equally significant. Both stem from traumatic experiences, but they exhibit distinct characteristics and affect individuals differently.
Post-Traumatic Stress Disorder (PTSD) develops as a result of a single, extremely distressing event. This trauma can encompass various scenarios, such as military combat, sexual assault, natural disasters, accidents, or any experience involving the threat of serious harm or death. Individuals with PTSD often grapple with recurring symptoms, including flashbacks, nightmares, avoidance of triggers, hyperarousal (feeling constantly on edge), and negative mood changes.
Key Features of PTSD:
Single Traumatic Event: PTSD typically arises from one traumatic incident.
Re-experiencing Symptoms: Sufferers may face flashbacks, nightmares, and intrusive thoughts associated with the traumatic event.
Hyperarousal: This condition can lead to heightened anxiety and vigilance.
Avoidance: Individuals often avoid situations or reminders of the traumatic event.
Negative Mood and Cognitive Changes: This may manifest as feelings of guilt, shame, and emotional detachment.
Complex Post-Traumatic Stress Disorder (CPTSD) emerges from prolonged and recurring exposure to trauma, particularly during childhood or an extended duration. It typically arises in contexts involving ongoing abuse, neglect, captivity, or chronic adversity, such as enduring domestic violence or childhood abuse. CPTSD is sometimes referred to as Developmental Trauma Disorder, as it profoundly affects an individual's emotional and psychological development.
Key Features of CPTSD:
Chronic and Prolonged Trauma: CPTSD results from recurrent and long-lasting trauma.
Emotional Dysregulation: Individuals with CPTSD often struggle to manage their emotions, leading to severe mood swings.
Identity and Relationship Issues: CPTSD can significantly impact an individual's self-identity and their ability to form healthy relationships.
Dissociation: This includes feeling disconnected from oneself or experiencing memory lapses.
Somatic Symptoms: CPTSD may manifest as physical symptoms like chronic pain and fatigue.
According to research, CPTSD can affect a person’s life in many ways. It can lead a person to experience:
A negative self-image or self-perception
The loss of a fundamental belief system
A lower tolerance to stress than doctors may consider typical
Difficulty trusting others or interpreting their actions
Issues with substance misuse
Causes of CPTSD
The main signifier of CPTSD is it is caused by prolonged exposure to trauma oftentimes beginning in childhood. Traumatic childhood experiences, also known as adverse childhood experiences (ACEs), can include:
Childhood exposure to violence, abuse, or neglect
A death by suicide in the family
Substance misuse in the family
Mental health disorders in the family
Having incarcerated family members
Chronic poverty or neglect
Growing up in an unsafe or crime-heavy environment
Source: Medical News Today
A survey conducted by The CDC found “about 61% of adults surveyed in 25 U.S. states report having experienced at least one ACE in their childhoods. One in 6 said they had experienced four or more ACEs. Having experienced one or more of these situations does not necessarily mean a person will develop complex PTSD, but the more ACEs a person has experienced, the more likely they may be to develop it.”
Those who have PTSD or complex PTSD can be affected by various life situations as if they are reliving or reexperiencing their trauma. There is no set of triggers across the board. It varies person to person and is dependent on the trauma history. Triggers can be images, smells, situations, or specific words in conversations that cause a person’s brain to perceive danger even if there is none.
Flight, Fight, Freeze, and Fawn
Up until recently our understanding of how we respond to trauma has been limited. The most well-known responses for years were fight or flight but nowadays we know freeze and fawn are also part of the scale of responses from our sympathetic nervous system.
The Fight Response This response comes from the subconscious idea that having power over another and exhibiting control is how you acquire and maintain love, acceptance and safety and often occurs if the person didn't feel that during childhood. While fight often refers to actual physical or verbal aggression, it can encompass any action you take to stand up to a threat or negate it, like:
Posting information about what someone did to you to make the other person look bad
Spreading rumors about people who criticized or upset you
Refusing to speak to someone after they did something to upset you
The Flight Response A flight response is characterized by the desire to escape or deny pain, emotional turmoil, and other distress. Escape might be literal like staying out longer instead of going home or running away. Or it could be more figurative, like throwing yourself into your work to escape. This can lead to perfectionism, relationship difficulties, substance misuse, and avoiding conflict at all costs.
The Freeze Response
The freeze response is something our brain does as a stalling tactic while it's trying to assess the situation and decide if it should flee or fight. Experts have pointed out that when neither seems feasible the brain may “flop” in response to the fright, which presents as dissociating or tonic immobility. Freeze responses can include:
Daydreaming and/or fantasizing to escape day-to-day distress
Choosing solitude and avoiding close relationships
Hiding emotions and feelings
Sleeping or staying in your house to “detach” from the world
Mentally “check out” from situations that feel painful or stressful
The Fawn Response
This is a survival response taken on by learning to appease the person threatening you and keep them happy. This can present in many ways including:
Agreeing to whatever someone asks of you, even if it’s not what you want
Praising others in an effort to avoid criticism
Feeling like you don’t know what you like or enjoy
Avoiding sharing your own thoughts or feelings in relationships out of fear of making others angry
Not having boundaries around your needs
Learn more: The Beginners Guide to Trauma Responses
Negative Coping Behaviors
People with PTSD or complex PTSD may exhibit certain behaviors in an attempt to manage their symptoms. These behaviors can develop as a way to deal with or try to forget about the original trauma and the resulting symptoms in the present. Friends and family of people with complex PTSD should be aware that these behaviors may represent coping mechanisms and attempts to gain control over emotions. The following behaviors may provide temporary relief, but since many are dangerous and destructive, they cause more problems in the long run.
Substance Misuse : This is one of the most destructive negative coping mechanisms and ultimately worsens the condition and exacerbates trauma-related symptoms.
Self-Harm: Some individuals with CPTSD resort to self-harming behaviors as a way to cope with emotional pain.
Avoidance and Isolation: Avoiding triggers and isolating oneself from others can provide a sense of safety in the short term, but can lead to further emotional distress and hinder recovery.
Reenactment of Trauma: Some individuals unconsciously reenact their trauma in their relationships or behaviors, perpetuating cycles of abuse and distress.
Dissociation: Dissociation is a coping mechanism in which individuals disconnect from their thoughts, feelings, or sense of identity to escape distress.
Emotional Numbing: People with CPTSD may suppress their emotions, making it difficult to form meaningful connections and preventing them from addressing the root causes of their distress.
To recover from PTSD or complex PTSD, a person can seek treatment and learn to replace these behaviors with ones focused on healing and self-care.
Treatment and Recovery
The treatment approaches for CPTSD and PTSD share many similarities, including therapy, medication, support groups, and self-care practices. However, therapy for CPTSD often focuses more on addressing complex relational and developmental aspects of the condition.
Here are some of the therapies commonly used for PTSD and CPTSD:
Cognitive-Behavioral Therapy (CBT): CBT is a widely used therapy for both PTSD and CPTSD. Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are specific CBT-based treatments for PTSD. CBT helps individuals identify and reframe negative thought patterns, reduce avoidant behaviors, and confront traumatic memories in a controlled and therapeutic manner.
Eye Movement Desensitization and Reprocessing (EMDR): EMDR is an evidence-based therapy for PTSD that involves bilateral stimulation, typically through eye movements. It helps individuals process traumatic memories and reduce their emotional intensity. EMDR is effective for a range of trauma-related issues.
Dialectical Behavior Therapy (DBT): DBT is useful for individuals with CPTSD who experience emotional dysregulation, self-destructive behaviors, and interpersonal difficulties. It combines cognitive-behavioral techniques with mindfulness and acceptance strategies.
Schema Therapy: Schema Therapy is particularly beneficial for CPTSD, as it addresses deep-seated, long-term emotional patterns, relational issues, and identity disturbances. It helps individuals recognize and change maladaptive coping mechanisms.
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): This therapy is often used for children and adolescents who have experienced trauma. It combines cognitive-behavioral techniques with trauma-focused interventions, offering a structured approach to healing.
Somatic Therapy: Somatic therapies, such as Somatic Experiencing and Sensorimotor Psychotherapy, focus on the mind-body connection, helping individuals release physical tension and process trauma through the body.
Narrative Exposure Therapy (NET): NET is designed for individuals who have experienced multiple traumatic events, particularly refugees or survivors of conflict. It helps them integrate their life narratives and make sense of their experiences.
Group Therapy and Support Groups: Group therapy can provide a sense of community and understanding for individuals with PTSD and CPTSD. Sharing experiences and coping strategies can be highly beneficial.
Mindfulness and Meditation: Mindfulness practices can help individuals manage symptoms of PTSD and CPTSD by increasing self-awareness, reducing stress, and promoting emotional regulation.
Art and Expressive Therapies: Creative therapies, such as art therapy and music therapy, provide a non-verbal way to process emotions and experiences related to trauma.
Medication: In some cases, medication may be used in conjunction with therapy. Antidepressants, anti-anxiety medications, and sleep aids can help manage specific symptoms associated with PTSD and CPTSD.
It's important to note that the effectiveness of therapy and medication can vary from person to person. The choice of therapy should be based on the individual's specific needs and the therapist's expertise. The therapeutic process may involve a combination of different therapies or techniques to address the complex nature of PTSD and CPTSD.
PTSD and CPTSD healing is very personal; different things work for different people. Learning your triggers and what makes you feel safe is important and oftentimes that also means weeding people out of your life that can't respect your boundaries or may mirror the dysfunctional patterns and relationship dynamics that you may have grown up in. When healing from CPTSD, abusive or dysfunctional people can often feel like home because they mirror the dysfunction you grew up in and may be used to living with. A lot of times healing means relearning what healthy love, friendships and relationship dynamics look like.