The ocean engulfs me, tossing me with each wave-topped swell, as I struggle to keep my head above water and gasp for air. To the onlooker I am swimming with strength and determination, but inside I am drowning, and outside I am drowning
Complex post-traumatic stress disorder (CPTSD) is a condition related to stress. Unlike PTSD, which usually relates to a single traumatic event or a specific duration of stress, CPTSD arises from chronic, repeated, or prolonged traumatic experiences—“the syndrome that follows prolonged, repeated trauma” (Herman, 1992). Traumatic experiences can range from severe to relatively mild, where the person does not perceive any form of relief from the abuse: psychological, emotional, physical and/or financial abuse and neglect.
Such symptoms could, for example, occur in the face of growing up, working, or being in a relationship with someone with strong narcissistic traits, where there will be a pattern of emotional and psychological manipulation and possible physical and financial abuse. It could include repeated physical and emotional punishments; inappropriate sexual behaviour; bullying; verbal abuse; stonewalling; exclusion from social situations; and much more.
CPTSD is listed in the ICD-11 but is not yet recognised in the DSM. Schwartz (2016) recognises a range of risk factors that may contribute to the development of CPTSD; this knowledge helps us understand why two people can have similar experiences later in life and develop quite different outcomes. She suggests, as does Gabor Mate (2022), developmental factors are key.
C-PSTD is similar to post-traumatic stress disorder (PTSD), but with some additional symptoms. It is defined by the nature of its repeated and prolonged exposure to traumatic experiences, metaphorically like 'water dripping on stone', gradually eroding the very nature of a person's sense of personality. Herman (1992) called the condition "corrosion of the personality," where the victimisation effects are born from a lack of safety. Symptoms have often been misdiagnosed as personality disorders, rather than recognising that a person's inability to thrive in the world results from abuse. CPTSD has some significant symptoms.
- Emotional dysregulation: intense or unstable emotions, difficulty controlling emotions, and mood swings.
- Negative self-perception: feelings of shame, guilt, and worthlessness, negative self-talk, and low self-esteem.
- Difficulty forming and maintaining relationships: fear of intimacy, social withdrawal, and difficulty trusting others.
- Feelings of isolation: feeling detached from others, feeling alone, and difficulty connecting with others.
- Hypervigilance manifests as a constant state of alertness, being easily startled, and a constant search for danger.
- Avoidance: avoiding people, places, or things that remind them of the traumatic event or events.
- Intrusive thoughts: recurrent and distressing thoughts, memories, or nightmares about the traumatic event or events.
- Dissociation: feeling disconnected from one's body, emotions, or surroundings.
- Health issues: digestive, sleep and autoimmune disturbances, addictions, cravings and blood-pressure issues
Treatment approaches are diverse and continually developing, with a growing focus on the integration of various therapeutic modalities to meet the intricate needs of individuals affected by CPTSD. Mind-body techniques, such as somatic healing and yoga, in conjunction with psychotherapy, EMDR, and parts work from Internal Family Systems (IFS), facilitate emotional repair, restoration of emotional regulation, and the pursuit of post-traumatic growth and flourishing.
References:
Herman, J.L. (1992) Trauma and recovery: The Aftermath of Violence. New York, NY: Basic Books
Maté, G. (2022) The myth of normal - Trauma, illness and healing in toxic culture. London, UK: Penguin, Random House .
Schwartz, A. (2016) The complex PTSD workbook: A mind-body approach to regaining emotional control and becoming whole. Berkeley, CA: Althea Press.
van der Kolk , B. (2015) The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma . London, UK: Penguin Books.
Walker, P (2013). Complex PTSD: From surviving to thriving. Azure Coyote