Complex Post-traumatic Stress Disorder (C-PTSD)
The DSM-5 makes no provision for a specific diagnosis for Complex PTSD.
The reality, however, is that some clients have a variety of presentations that do not exactly line up with the definitions of an acute stress disorder or post-traumatic stress disorder, e.g., significant attachment issues, dissociation, derealisation, and rigid psychological defences.
The term Complex PTSD was first used by Herman (1992), describing a complex of symptoms many clients with a background of extensive abuse and/or neglect, presented with. These experiences may not necessarily have been life-threatening, but due to their high impact on the person, they very often are the source of severe emotional problems. Although in essence, we can refer to them as "small-'t'" traumas, their impact on the person of the victim is all but minor. Mol et al. (2005) found that many childhood incidents that were disturbing, but not diagnosable as PTSD, tended to be more troubling than identified PTSD. The trauma with these kinds of incidents does not reside in a single event, but the cumulative impact as a result of a series of events (small 't' traumas) experienced over time. It is also true that the greater a child's exposure to traumatic events (e.g., domestic violence, parental separation, harsh punishment, or witnessing caretaker addictive behaviours, depression, suicidal potential, or incarceration, the greater the likelihood of a child from such a family, presenting with adverse physical or mental health outcomes, e.g., substance abuse, depression, cardiovascular disease, diabetes, cancer, and/or premature mortality (ACEs; Felitti, 2013; Felitti et al., 1998).
Thus, although a formal diagnosis of C-PTSD does not exist as yet from a DSM-5 perspective, it is a very real condition and it's impact on the victim often is much more detrimental to their mental well-being than a single "large 'T'" trauma.
Note: for a description of Trauma and different traumas, click here
The reality, however, is that some clients have a variety of presentations that do not exactly line up with the definitions of an acute stress disorder or post-traumatic stress disorder, e.g., significant attachment issues, dissociation, derealisation, and rigid psychological defences.
The term Complex PTSD was first used by Herman (1992), describing a complex of symptoms many clients with a background of extensive abuse and/or neglect, presented with. These experiences may not necessarily have been life-threatening, but due to their high impact on the person, they very often are the source of severe emotional problems. Although in essence, we can refer to them as "small-'t'" traumas, their impact on the person of the victim is all but minor. Mol et al. (2005) found that many childhood incidents that were disturbing, but not diagnosable as PTSD, tended to be more troubling than identified PTSD. The trauma with these kinds of incidents does not reside in a single event, but the cumulative impact as a result of a series of events (small 't' traumas) experienced over time. It is also true that the greater a child's exposure to traumatic events (e.g., domestic violence, parental separation, harsh punishment, or witnessing caretaker addictive behaviours, depression, suicidal potential, or incarceration, the greater the likelihood of a child from such a family, presenting with adverse physical or mental health outcomes, e.g., substance abuse, depression, cardiovascular disease, diabetes, cancer, and/or premature mortality (ACEs; Felitti, 2013; Felitti et al., 1998).
Thus, although a formal diagnosis of C-PTSD does not exist as yet from a DSM-5 perspective, it is a very real condition and it's impact on the victim often is much more detrimental to their mental well-being than a single "large 'T'" trauma.
Note: for a description of Trauma and different traumas, click here
Symptoms
People suffering from C-PTSD often present with the following symptoms:
Dysfunctionally stored traumatic memories
Psychological defences and avoidance behaviour
Dissociative personality structure
Derealisation
Lack of emotional regulation
Dysfunctionally stored traumatic memories
- Implicit (not overtly conscious) memories of repeated trauma involving parents and other caretakers, resulting in severe feelings of insecurity and disorganised patterns of attachment to other people in adulthood. These implicit memories may not be connected to visual images or even be recognised as memories, but they still are influential as basic assumptions about self in relationship to other people.
- Explicit memories that due to the high level of disturbance or threat experienced, cannot be incorporated into a person's larger life narrative.
Psychological defences and avoidance behaviour
- Avoidance defences - mental by means of suppression, including addictive behaviours, or physical, withdrawing from life/people
- Unrealistically and overly positive idealisations of others (parents, children, a spouse, or an ex-partner) or of self (as in the case of a person presenting with narcissistic tendencies) or a potentially harmful behaviour (e.g., an addiction) or a religion, political party, geographic location, or employer. Any of these may serve as a defensive action, i.e., it blocks the awareness of unresolved post-traumatic material.
- Shame and guilt defences, i.e., blaming oneself for negative events that were in fact, out of one's control
- Difficulty with relationships, i.e., avoiding relationships with other people and struggling with mistrust, also getting into relationships which are toxic and damaging, but provide a feeling of familiarity with discomfort
Dissociative personality structure
- Experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity, having as its purpose to keep difficult memories of the past at bay
- Recurrent gaps in the recall of everyday events, important information and/or traumatic events that are inconsistent with ordinary forgetting
- Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- Symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behaviour during alcohol intoxication) or another medical condition (e.g., complex partial seizures)
Derealisation
- Experiences of unreality or detachment with respect to surroundings (e.g., people or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted)
- During the derealisation experience, reality testing remains intact, i.e., the person is able to self-check
Lack of emotional regulation
- Emotional regulation is lacking
- Uncontrollable feelings of anger and ongoing sadness.