Complex post-traumatic stress disorder

Complex Post-Traumatic Stress Disorder (C-PTSD) is a psychological disorder that arises as a long-term response to chronic and persistent interpersonal trauma. Unlike PTSD, which is typically related to a single or limited number of traumatic events, C-PTSD involves a repeated and prolonged experience of trauma, often in situations where escape is difficult or impossible.

Classification

C-PTSD is not currently recognized as a separate disorder by the DSM-5, the main guide for diagnosing mental disorders in the United States. Instead, it is usually diagnosed as a severe form of PTSD. However, the ICD-11, the global standard for diagnosing health conditions, does recognize C-PTSD as a separate diagnosis.

Signs and Symptoms

C-PTSD symptoms can be severe and debilitating, affecting various aspects of an individual's life. These symptoms may include:

• Emotional regulation difficulties, such as persistent sadness, suicidal thoughts, explosive or inhibited anger.
• Alterations in consciousness, including forgetting traumatic events, reliving traumatic events, or having episodes of dissociation (feeling detached from oneself).
• Changes in self-perception, such as a persistent and pervasive sense of shame, guilt, or being completely different from other people.
• Distorted perceptions of the perpetrator, including attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
• Difficulties in relationships with other people, such as isolation, distrust, or repeated search for a rescuer.
• A loss of, or changes in, personal beliefs and values.

Causes

The primary cause of C-PTSD is exposure to repeated, chronic, and prolonged interpersonal trauma, often occurring in circumstances where the individual has little or no chance of escape. These traumatic experiences can include, but are not limited to, chronic sexual abuse, psychological and physical abuse or neglect, chronic intimate partner violence, prolonged workplace or school bullying, kidnapping, hostage situations, slavery and human trafficking, indentured servitude, being a prisoner of war, surviving concentration camps, residential schools, solitary confinement for long periods, and defection from authoritarian regimes.

Diagnosis

Diagnosis of C-PTSD is primarily based on a detailed clinical interview to ascertain the presence of the characteristic symptoms and a history of prolonged, repeated trauma. Mental health professionals use the criteria from the ICD-11, which distinguishes C-PTSD from other similar disorders, such as PTSD and BPD.

Treatment

Treatment of C-PTSD usually involves a multimodal approach that can include trauma-focused cognitive-behavioral therapy, dialectical behavior therapy, eye movement desensitization and reprocessing (EMDR), and pharmacotherapy. In addition to therapy, self-care practices, peer support groups, and lifestyle changes can also support recovery.

Prognosis

With appropriate treatment, individuals with C-PTSD can experience significant improvements in symptoms and quality of life. However, recovery may be a lengthy process, and ongoing support may be necessary. The prognosis is influenced by various factors including the severity and duration of the trauma, the individual's general health and resilience, and the quality and timing of treatment.

Epidemiology

Due to the overlap of symptoms and lack of separate recognition in the DSM-5, the exact prevalence of C-PTSD is not known. However, it is expected to be higher in populations with a high prevalence of chronic interpersonal trauma, such as survivors of domestic violence, child abuse, and warfare. Within these populations, the prevalence of C-PTSD may be significantly higher than that of PTSD.

Society and Culture

C-PTSD, due to its chronic nature and the systemic and societal factors often involved in its causation, has significant implications on a societal level. Public health initiatives, advocacy for victims' rights, and efforts to reduce societal violence and abuse can play crucial roles in preventing C-PTSD.

Research

Research into C-PTSD is ongoing, with scientists studying the neurobiological basis of the disorder, exploring effective treatments, and advocating for a better understanding of the disorder. One area of research is focused on understanding how chronic trauma affects the brain and body, including changes in brain structure and function, and the impact on the body’s stress response systems.

See Also

• Trauma model of mental disorders
• Dissociation
• Psychological trauma
• PTSD
• Child abuse

References

• 1. Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. European Journal of Psychotraumatology, 4(1), 20706. https://doi.org/10.3402/ejpt.v4i0.20706
• 2. Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391. https://doi.org/10.1002/jts.2490050305
• 3. Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., ... & Reed, G. M. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical psychology review, 58, 1-15. https://doi.org/10.1016/j.cpr.2017.09.001
• 4. Karatzias, T., Shevlin, M., Fyvie, C., Hyland, P., Efthymiadou, E., Wilson, D., ... & Cloitre, M. (2017). Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ). Journal of Affective Disorders, 207, 181-187. https://doi.org/10.1016/j.jad.2016.09.032

Complex post-traumatic stress disorder Resources
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