What is C-PTSD?

In the 1990s, Judith Herman began to notice a trend in some of her patients. She noticed a common “constellation of symptoms” among children and adults with a history of childhood abuse and neglect: difficulty creating and maintaining healthy, balanced relationships, challenges in managing or feeling their emotions, and a particularly negative self-perception. Judith’s observation, along with the observations of other clinicians, led to the creation of Complex PTSD as a clinical term. Complex PTSD is a particular type of PTSD that encompasses the experiences of survivors of prolonged or repeated (often interpersonal) trauma where escape or reprieve was impossible or difficult.

How is it different from PTSD?

Both the similarities and differences between C-PTSD and PTSD can best be understood when we think about both diagnoses as a way to make sense of how the human nervous system responded to a traumatic experience. PTSD tends to develop in response to single incident traumas such as: a traumatic childbirth, a car accident, an assault, a fire. Complex PTSD tends to develop in response to sustained or repeated forms of traumatic events such as: intimate partner violence, prolonged exposure to war or combat, and childhood sexual, emotional, and physical abuse or neglect. Complex PTSD is particularly prevalent among people who experienced trauma in childhood as well as those who were abused or neglected by someone they trusted.

All trauma can be earth-shattering and shift our worldview, but in the case of complex trauma, our new worldview is rebuilt within and around our continued or repeated traumas. In addition to the nervous system survival response we see in PTSD, complex traumas require the development of coping and defense mechanisms that manifest as distortions or disturbances in our perceptions of self and others, our belief systems, and our understanding of relationships.

In addition to the “core” PTSD symptoms:

• Re-experiencing the trauma through nightmares, intrusive thoughts, or flashbacks
• Avoiding people, places, and things that remind us of the trauma
• Changes in thoughts and moods
• Feeling on edge, irritable and hyper-aware of the possibility of danger

Complex PTSD includes 3 additional categories of symptoms.

Difficulty with emotion regulation:
Difficulty feeling positive emotions, chronic anxiety, difficulty regulating or tolerating negative emotions and stress, difficulty identifying and feeling emotions, frequent sense of being detached from themselves or from reality

Poor Self-Image:
Low self-esteem and self-worth, intense guilt, extreme shame and self-blame, feeling helpless to manage their life stressors and hopeless about their futures, difficulties with self-trust and decision making, lack of a strong sense of self

Interpersonal difficulties:
Chronic mistrust of self and others, perceiving the world as filled with malice, isolation and withdrawal, difficulty maintaining healthy relationships, difficulties knowing, expressing, and enforcing their boundaries, difficulties knowing and asking for their emotional needs to be met.

These are just some examples of different ways these symptoms may manifest. Because every individual’s nervous system responds and adapts to their trauma in their own way, complex PTSD exists on a spectrum and can look a lot of different ways. In addition to the above 3 categories, scholars have suggested that folks with C-PTSD may also experience “somatic” body based symptoms such as chronic fatigue and chronic pain.

How do we heal from C-PTSD?

There are a number of ways that we can help ourselves heal from complex trauma:

Learn more about C-PTSD:

Learning more about our own experience can be an incredibly validating experience, and can also help us understand why we may have certain behaviors and reactions and how we can best support ourselves. There are MANY great resources and books out there exploring the experience and recovery from complex trauma, do a little exploring of what is available online or at your local library.

Grounding Techniques:

Emotional dysregulation is a pretty common experience for folks with complex PTSD and can show up as “shutting down” when experiencing strong emotion or experiencing negative emotions as extremely overwhelming and distressing. Grounding can be helpful in both of these cases. Grounding is a skill that helps us to feel more in the present and allows us to create some space from the intensity of emotion.

• Move your body: Going for a walk or stretching can help us get back into our bodies. Do this mindfully! Really focus on the movements and pay attention to how your body feels as it is touching the ground or moving through the air.
• Aromatherapy: A favorite scented lotion, an essential oil, or even a scented lip balm can be a helpful tool when we become overwhelmed with emotion. Inhale the scent deeply and focus on the scent and how your body responds to it.
• The 5-4-3-2-1 method: Naming 5 things you can hear, 4 things you can see, 3 things you can touch, 2 things you can smell and 1 thing you can taste.

Peer Support Groups:

Finding a local or virtual support group, or even an online community, can be incredibly helpful for folks who are healing from complex trauma. Trauma can create feelings of shame and isolation, and groups offer a space where we can share our experiences, feel heard and understood and offer a sense of connection and belonging.

Psychotherapy: 

Both PTSD and C-PTSD can be treated by various psychotherapy approaches including trauma-focused cognitive behavioral therapy and Eye Movement Desensitization and Reprocessing (EMDR). Therapists treating complex trauma may spend time working to help individuals develop skills prior to any reprocessing of traumatic memories, including skills to:

• Build tolerance for and regulate strong emotions
• Reduce reliance on harmful coping mechanisms,
• Create stable, safe, and supportive relationships.