Complex PTSD

By Lucy Gleysteen and Brittany Mitchell

From PHN Issue 41, Winter 2020

What is complex trauma, or complex PTSD?

Complex trauma is a trauma that is repetitive, occurs over a period of time, and is frequently interpersonal in nature. Complex PTSD most often develops in childhood and can include experiences of abandonment at an early age, physical abuse or neglect, sexual abuse, emotional abuse, living in a neighborhood that has high levels of violence, being impacted by war, repetitive and invasive medical procedures, or other experiences of being in a traumatic environment for a prolonged period of time. Not everyone who has had traumatic experiences develops complex PTSD. However, those who do might experience certain difficulties that can be painful to live with.

What is the difference between complex trauma and regular PTSD?

When people hear the term PTSD (post-traumatic stress disorder), the first thing that often comes to mind is the experience of having suffered a traumatic event such as being in combat, exposure to gun violence, or experiencing a natural disaster. This type of trauma is called single incident trauma. Such experiences can contribute to having nightmares, flashbacks, anxiety, fear, depression, anxiety, emotional withdrawal, numbness, hypervigilance (having your senses on high alert), avoidance of reminders of the traumatic event, irritability, guilt, and shame. This article will focus on complex PTSD. There is a lot of overlap between single incident and complex PTSD. While the two types of trauma have a lot in common, complex trauma often involves the set of symptoms below that were classified by Judith Herman in her book Trauma and Recovery: The Aftermath of Violence–from Domestic Abuse to Political Terror.

Relational Impact

Complex trauma can deeply impact one’s sense of self and how they relate to others. If, as a child, a person learns that it is unsafe to have closeness with others, that will impact relationships in the long term. This can create a strong sense of loneliness, isolation, and feelings of disconnection.

Emotional Impact

Complex trauma can create challenges in emotional regulation. This could mean that it might be difficult to control and process feelings of anger, sadness, disappointment, or other forms of emotional distress. Those who have CPTSD might have a difficult time with self-soothing. Sometimes a person’s tolerance for handling difficult emotions can be very low. People with complex trauma are more likely to use substances like drugs or alcohol or engage in other self-harm.

Impact on Consciousness

Individuals who’ve experienced complex trauma might experience difficulty with memory and attention. Sometimes when a traumatic event occurs, our body’s capacity to cope might be overwhelmed, resulting in an emotional and social “shutting down” process called dissociation. Dissociation is a mental process that involves disconnection from emotions, memories, body, or sense of self. Dissociation exists on a wide spectrum, and it is possible to dissociate a little bit (i.e., daydreaming or walking somewhere and suddenly arriving at your destination without fully remembering the process of getting there), or it can
be more severe and involve forgetting one’s own identity. Everyone at some point in their lives has experienced dissociation, but it is more frequent and severe for those who experience complex trauma. This is one of the brain’s ways of coping with feelings of fear, anxiety, and shame—or achieving emotional safety. However, it can be problematic when dissociation occurs so frequently that a person is unable to feel positive emotions or process their more difficult feelings.

Impact on Self-perception

Self-perception is how a person feels about themself. Complex PTSD can cause a constant feeling of guilt, shame, and responsibility for the trauma that occured. Over time, this can create a self-image in which a person views themselves as incapable, inherently bad, unworthy, or unlovable.

Impact on Worldview

Complex trauma can affect a person’s understanding of the world as a safe place. This can cause someone to be on high alert at all times, looking for danger, even when they are in a situation where danger might not be present. This might look like a belief that people are essentially bad, or the world is essentially unsafe. Beliefs stemming from this could include, “Nothing good will ever happen to me,” “No one is safe outside at night,” etc.

Impact on the Body

CPTSD and PTSD in general are associated with significant negative health effects including chronic pain, digestive issues, weight gain or loss, hypertension, and cardiovascular issues. We say about trauma that it “lives in the body,” meaning that our body holds reminders of our emotional states. For instance, a person who experiences a lot of hyperarousal (easily startled, always on guard, quick to fight or run, heart racing, sweatiness, difficulty paying attention) might hold that in the body in the form of muscle tension. This is a very simplistic description of trauma’s relationship with the body, but a whole field of study called Somatics is dedicated to better understanding the relationship between our mental health and its bodily effects and experiences.

What are strategies for managing the impact of PTSD?

• If possible, engaging in individual therapy, group therapy, or both.
• Spending time figuring out what activities help you feel soothed, calm, and in control. These are called “grounding techniques” and can look like mindful coloring, writing in a journal, praying, running, stretching, breathing rhythmically, humming, dancing, tapping, holding something soft or weighted, or playing with a fidget toy.
• Developing safe relationships and seeking support. Think or journal about: Who am I with when I feel like my best self? Who am I with when I feel calm, soothed, joyful, engaged? What qualities about these relationships give me these emotional freedoms?
• Identify triggers (situations that lead to painful reliving of memories or emotions).
• Be gentle with yourself and speak reassuringly to yourself.
• Owning your right to have boundaries AND developing the communication skills to clearly and healthily set a boundary with someone and keep it.