Fear is a healthy and expected response when someone experiences or witnesses something traumatic. In many instances, the emotions that occur due to the event resolve independently after the circumstances that caused the worry or concern end. But this is not the case for everyone. Someone who continues to be fearful or experience other symptoms related to their trauma for weeks or months after the event may be diagnosed with complex post-traumatic stress disorder.

Understanding Post-Traumatic Stress Disorder

Post-traumatic stress disorder, or PTSD, is a common mental health condition that develops after someone experiences a traumatic, dangerous, or scary event. PTSD is often associated with specific individuals and career fields such as active duty military, first responders, emergency room workers, and similar. However, it is important to know that PTSD can occur in anyone, regardless of age or employment. 

How is Complex Post-Traumatic Stress Disorder Different?

In 1988, a researcher at Harvard University suggested the current diagnostic limitations for post-traumatic stress disorder may not fully capture or address those who experience severe emotional harm that arises from recurring and prolonged trauma. As a result, someone with more clinically significant psychological impacts may not receive the comprehensive care and support they need to manage their symptoms and take their first steps toward recovery. This research led to a new diagnosis, complex post-traumatic stress disorder (complex PTSD or C-PTSD).

Mental health professionals use the diagnostic criteria in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, to accurately assess and diagnose mental health conditions. Unfortunately, the current edition of the DSM does not recognize complex PTSD as a separate diagnosis. However, the ICD-11 (the World Health Organizations International Classification of Diseases, 11^th edition, does separate complex PTSD and PTSD, and some practitioners use this reference to diagnose it. 

Recently, several studies into the differences between PTSD and C-PTSD have produced results suggesting that, although they share some similarities, post-traumatic stress disorder and complex post-traumatic stress disorder are distinct conditions. Approximately 29 studies conducted in 15 different countries have consistently returned results showing differing symptoms between complex PTSD and traditional PTSD.

What are the Symptoms of Complex Post-Traumatic Stress Disorder?

Up to 7% of the population experiences post-traumatic stress disorder in their lifetime. Traditional PTSD can occur due to one of many life experiences, including accidents, illness, injuries, natural disasters, violence, etc. Traditional post-traumatic stress disorder is typically related to a single traumatic experience. 

Complex post-traumatic stress disorder is different. C-PTSD occurs after a prolonged event (something lasting days, weeks, or months) or a series of traumatic events (such as frequent abuse). The symptoms of complex post-traumatic stress disorder are similar to those of traditional PTSD but more severe and lasting for a prolonged period of time. 

What are the Symptoms of Complex Post-Traumatic Stress Disorder?

Someone with complex post-traumatic stress disorder may experience symptoms in addition to or more severe than those that accompany a traditional post-traumatic stress disorder diagnosis. Therefore, there are examples of symptoms that characterize both PTSD and C-PTSD, as well as others that are sometimes specific only to complex disorders. Examples of symptoms that occur in both post-traumatic stress disorder and complex post-traumatic stress disorder include:

• problems with sleep and concentration
• actively avoiding people, places, or situations that remind the person of the traumatic event
• experiencing physical symptoms such as dizziness or nausea when remembering the trauma
• hypervigilance or hyperarousal (a continual state of being “on alert”)
• a loss of trust in the world around you
• negative self-image
• difficulties regulating emotion
• problems with personal and social relationships

It is also important to mention that the symptoms of post-traumatic stress disorder can vary from person to person and over time. The symptoms that one experiences in the hours, days, and weeks immediately following their trauma may differ from those that occur as their illness and symptoms persist. 

Also, the above list of symptoms is not definitive. Someone with post-traumatic stress disorder or complex post-traumatic stress disorder may experience symptoms not included in the above list. PTSD, like many other mental health conditions, affects each person in individual and unique ways. Therefore, the most effective treatment programs are those that focus on individualized and highly personalized care plans.

Trauma and Coping Tools

People with either post-traumatic stress disorder or complex post-traumatic stress disorder often use certain behaviors to manage or control their symptoms. These behaviors or activities, referred to as coping tools or coping mechanisms, may not be the most beneficial and often provide only short-term, if any, symptom relief. Unfortunately, many of the unhealthy coping tools someone with a trauma history uses for symptom management can lead to new or worsening physical and mental health conditions outside of their trauma diagnosis. Examples of common coping behaviors someone with post-traumatic stress disorder or complex post-traumatic stress disorder may use include:

• Actively engaging in avoidance of unpleasant situations
• lashing out at others over minor criticisms or perceived wrongs
• engaging in drug or alcohol abuse
• participating in dangerous or risky behaviors that are “out of character” for the individual
• engaging in self-harming behaviors

Who is at Risk for Complex PTSD?

Someone who is at risk for complex PTSD often experiences prolonged trauma, such as what occurs with repeated and ongoing emotional, physical, and sexual abuse. Other examples of traumatic circumstances that can cause complex post-traumatic stress disorder include being a victim of war crimes, being a prisoner of war, experiencing human trafficking, or living in a region affected by ongoing terrorism and violence. A research study from 2021 of refugees and asylum seekers indicated nearly 20% met the diagnostic criteria for post-traumatic stress disorder, and almost 50% met the criteria for complex post-traumatic stress disorder.

Who is at Risk for Complex PTSD?

Symptoms of complex PTSD often begin in early childhood. Another key risk factor for complex post-traumatic stress disorder is childhood trauma such as:

• substance abuse by a family member
• chronic neglect and poverty
• early exposure to abuse, neglect, or violence
• losing a family member to suicide
• a history of family mental health conditions
• having a family member who is incarcerated
• housing and security
• growing up in a crime-heavy or unsafe neighborhood or environment

Experiencing one or more of these traumatic childhood situations does not necessarily guarantee someone will develop complex post-traumatic stress disorder as they grow. However, an increased frequency of adverse childhood traumatic experiences such as the above also increases the risk that someone may develop complex PTSD based on early childhood trauma.

What are the Best Treatment Options for Complex PTSD?

Like many mental health conditions, studies into post-traumatic stress disorder treatment show that individuals (regardless of age) with either post-traumatic stress disorder or complex post-traumatic stress disorder benefit from individualized, personalized treatment plans. At Meadowglade, members of our caring and compassionate medical and mental health teams will work with you to learn more about your specific medical and mental health history before recommending the best course of treatment. However, it is important to note that treatment for complex post-traumatic stress disorder often requires a longer duration than traditional post-traumatic stress disorder. Also, successful complex PTSD treatment plans include a wider variety of therapeutic interventions. Complex PTSD treatment plans included a combination of psychotherapy and mental health medications. 

Psychotherapy

Psychotherapy or talk therapy for trauma disorders may occur in both individual and group treatment settings. During the early days of therapy, sessions will focus on helping with stability so you can improve connections with loved ones, address and examine your feelings and learn to manage flashbacks and anxiety when they occur. There are several types of trauma-focused therapy interventions used by our team at Meadowglade. Common examples include the following.

• Cognitive behavioral therapy – a therapy model designed around replacing harmful thoughts and behaviors with beneficial ones. 
• Dialectical behavior therapy- a therapy that helps people manage self-harm urges, stress, and other similar thoughts and behaviors. 
• EMDR (Eye movement desensitization and reprocessing) -When effective, EMDR helps to desensitize the participant to their trauma so they can recall their memories without harmful or adverse reactions. 
• Prolonged exposure therapy- prolonged exposure therapy is another type of therapeutic intervention proven effective in managing post-traumatic stress disorder symptoms. Prolonged exposure therapy, or PE, is a part of cognitive behavioral therapy and focuses on the premise that someone with PTSD will actively yet unconsciously avoid reminders of their trauma. PE aims to reduce this avoidance and help the person approach the memories and triggers of their trauma with fewer adverse reactions. Prolonged exposure therapy often occurs in two parts. The first part, imaginal exposure, involves talking about the trauma or repeated traumatic events individually with a skilled exposure therapy provider. Trauma is discussed, and the present tense and any emotions triggered by the conversations are addressed. The second part of prolonged exposure therapy is in vivo exposure. During this stage, the participant confronts their triggers outside of the therapeutic setting as part of an agreed-upon plan with their provider.

Medication

In addition to therapeutic interventions, some providers may recommend mental health medications as part of a post-traumatic stress disorder or complex post-traumatic stress disorder treatment plan. Although beneficial for some, medications are not ideal for all treatment plans. It is important to discuss adding medications with your mental health provider to weigh the pros and cons and gain a better understanding of how they may help with symptom management and recovery.

Some medications that treat depression (antidepressants) may also improve PTSD symptoms. Again, medications are more effective when used in combination with psychotherapy. Depending on the individual and their specific treatment needs (both now and in the future), medications may be used for short or long-term duration. Examples of antidepressants used to treat complex PTSD include Paxil, Zoloft, and Prozac.

Medication

Recovering from post-traumatic stress disorder or complex post-traumatic stress disorder is possible; however, attempting to do so without support and guidance from a mental health treatment program can be difficult. Therapy helps you better understand the root causes of your symptoms and teaches you vital coping tools you can use to feel confident facing your trauma triggers in the future. 

Everyone’s treatment program is unique. What works well for one person may not work for someone else. Talking to a mental health provider about your treatment needs and goals is crucial so they can work with you to create a treatment plan specifically for you. To learn more about how treatment at Meadow glade can help with complex post-traumatic stress disorder, contact a member of our admissions team today.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8654416/

https://bpded.biomedcentral.com/articles/10.1186/s40479-021-00148-8

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170304/