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Complex Post Traumatic Stress Disorder: What it is and Why You Need to Know



By: Andy Kovaleski


Post Traumatic Stress Disorder (PTSD) is widely understood to be a mental illness experienced by veterans, survivors of war, people who experienced someone's death, or any number of traumatic incidents. The Diagnostic and Statistical Manual of Mental Disorders (DSM) explains this as the first criterion for PTSD:

Criterion A: stressor (one required)
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): 
Direct exposure
Witnessing the trauma
Learning that a relative or close friend was exposed to a trauma
Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
Criterion B: intrusion symptoms (one required)
The traumatic event is persistently re-experienced in the following way(s):
Unwanted upsetting memories
Emotional distress after exposure to traumatic reminders
Physical reactivity after exposure to traumatic reminders
Criterion C: avoidance (one required)
Avoidance of trauma-related stimuli after the trauma, in the following way(s):
Trauma-related thoughts or feelings
Trauma-related external reminders
Criterion D: negative alterations in cognitions and mood (two required)
Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
Inability to recall key features of the trauma
Overly negative thoughts and assumptions about oneself or the world
Exaggerated blame of self or others for causing the trauma
Negative affect
Decreased interest in activities
Feeling isolated
Difficulty experiencing positive affect
Criterion E: alterations in arousal and reactivity
Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
Irritability or aggression
Risky or destructive behavior
Heightened startle reaction
Difficulty concentrating
Difficulty sleeping
Criterion F: duration (required)
Symptoms last for more than 1 month.
Criterion G: functional significance (required)
Symptoms create distress or functional impairment (e.g., social, occupational).
Criterion H: exclusion (required)
Symptoms are not due to medication, substance use, or other illness.

This type of PTSD is so widely known that it is difficult to conceptualize a second type, and yet, it exists 一Complex Post Traumatic Stress Disorder, or C-PTSD. The DSM does not recognize this as a different type of PTSD, but many doctors and therapists will use this diagnosis nonetheless. The difference between the two regards the first criterion of PTSD; people with C-PTSD did not experience a singular traumatic experience. Instead, they experienced repeated or prolonged trauma. For example, being in an abusive relationship.

The question now is: if it doesn’t fulfill the very first criterion, why would it be considered PTSD at all? Well, C-PTSD fulfills all other criteria for PTSD, B through H. It is experienced as a disorder in the very same way that PTSD is. Understanding C-PTSD as a diagnosis is vitally important for doctors, especially therapists. Without it, those who experience all symptoms of PTSD without a single traumatic event to trigger it are left diagnosed with general anxiety disorders, depression, or obsessive-compulsive disorder. This is not to say that you can’t have any of these mental illnesses alongside C-PTSD, they are often comorbid. However, C-PTSD, like PTSD, requires deep and consistent work addressing the root trauma(s) and tracing the cause and effect to symptoms. It is important to clarify the distinction because treatments for depression and anxiety are not going to address the roots of C-PTSD.

Another difference between the two types of PTSD has to do with the length and severity of the symptoms. Reading that, I would expect you to assume that C-PTSD has less severe symptoms and maybe doesn’t last as long, but it is the exact opposite. Symptoms of C-PTSD are much more severe and debilitating on average, and it generally takes much longer to work towards recovery. I personally believe this is because of the complexity, so to speak, of the many ways C-PTSD interacts with someone’s daily activities, their perspective of themselves, and their experiences. There may also be an aspect of social perception that makes C-PTSD more difficult to address.

The way that society treats the diagnosis of C-PTSD makes the already difficult condition harder to manage. The stigma already surrounding mental illness is much more difficult to manage with such a lack of public awareness of C-PTSD. Like I mentioned before, when the average person thinks of someone with PTSD they think of a war veteran who experiences intense flashbacks. It is hard to accept someone who tells you their diagnosis when you have a narrow understanding/scope of PTSD, and it is hard for them to take themself seriously when that is the only image they have ever had as well. Imposter syndrome is a huge issue for people with C-PTSD. The thought that their trauma isn’t as bad as others and, therefore, they do not deserve the diagnosis is omnipresent for many.

 The best thing you can do is to be informed about this diagnosis, be prepared to validate anyone who it may apply to, and tell them that not only do they deserve the diagnosis, they also deserve all of the help it will get them to manage symptoms and work towards recovery.

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