Complex Post-Traumatic Stress Disorder: Information, Symptoms, Treatment and More

Complex Post-traumatic stress disorder (Complex PTSD) is an anxiety-based condition characterised by a traumatised reaction to experiencing or witnessing long-term trauma.

While PTSD is related to reactions to a traumatic event, Complex PTSD involves cases of chronic trauma. This may include long-term neglect, violence or abuse. Being the victim of human trafficking, slavery or false imprisonment, are other possible cases.

Essentially, any situation that involves prolonged periods of distress or terror may induce Complex PTSD. Complex PTSD causes many symptoms – in a similar manner to those seen with PTSD.

Furthermore, Complex PTSD is a severe mental illness, and normally has a tremendous impact on someone’s life – making it difficult to live with. However, with the right treatment and support, many people will gain full remission.

What are the symptoms of Complex Post-Traumatic Stress Disorder?

The symptoms of Complex PTSD are similar to those seen in PTSD. They will cause significant distress, and will make life difficult to live. As with PTSD, initially, symptoms will fall into three categories.

Re-Experiencing:

• Flashbacks
• Nightmares
• Witnessing distressing images
• Disturbed thoughts
• Physical feelings of pain or sickness
• Ruminating over what might have been

Avoidance:

• Avoiding certain people that remind an individual of the traumatic event
• Avoiding certain places that remind an individual of the traumatic event
• Changing the subject if a similar topic is discussed
• Isolating themselves from others, trouble trusting them
• Withdrawing from normal day-to-day activities

Psychological:

• Anger
• Poor concentration
• Insomnia
• Irritability
• Anxiety
• Not trusting others

For an individual with Complex PTSD, they may struggle to control their emotions, causing them to lash out at others. They may even exhibit physical symptoms like headaches and chest pains. Self-harm and substance abuse is a common behaviour too for those with Complex PTSD.

As a result of this behaviour, relationships can be difficult. They may feel hostile towards everyone and the world in general, or feel worthless.

They may also feel isolated, and believe that no one can understand what they went through. Adopting harmful coping strategies like abusing alcohol is common.

Complex PTSD often runs concurrently with other mental health conditions such as Anxiety, Depression, Dissociative Disorder and Substance Abuse.

What are the causes of Complex Post-Traumatic Stress Disorder?

Unlike many mental health conditions, the cause of Complex PTSD is known. Complex PTSD results after exposure to long-term trauma. This involves either experiencing or witnessing prolonged trauma – which generates a troubled reaction.

Examples of long-term traumatic events that can induce Complex PTSD include childhood abuse, violence or neglect. Being the victim of torture, domestic violence, human trafficking, slavery or false imprisonment are other common causes.

Being forced into sex work, being held hostage or being made to watch distressing material are all other likely causes. However, any situation that involves prolonged periods of distress is relevant.

While the cause of Complex PTSD is known, why some people develop Complex PTSD and others don’t is a mystery. Some people may cope fine with life after prolonged distress, or at least may adjust in a short amount of time.

Certain risk factors appear to be involved. It is believed that someone diagnosed with a mental illness in the past is more susceptible to developing Complex PTSD after a long-term traumatic event. Similarly, a family history of mental illness may be a risk factor.

Other factors include being alone during the prolonged trauma, still being in contact or regularly seeing the person responsible or associated with the trauma, if the trauma was caused by a parent, or if the events took place in childhood.

Diagnosis of Complex Post-Traumatic Stress Disorder

It is important for anyone who has been the victim of prolonged trauma to see a Doctor of mental health professional. Help can sometimes be instigated by law enforcement officials in the event of a criminal activity being discovered. But it may also be down to a family member or close friend to try and initiate treatment for the individual.

No laboratory test or other medical examination that can determine whether or not an individual has Complex PTSD. Instead, a doctor can only make a diagnosis based on a meeting with an individual.

At an appointment, a Doctor will discuss the feelings and condition of a patient by asking several questions. The person should be as honest as possible. Questions are normally based around the symptoms involved.

If the doctor suspects Complex PTSD is present, the individual should be referred to a mental health specialist for a full assessment.

A full assessment can be undertaken by a mental health specialist. The specialist will conduct an in-depth assessment of the symptoms of the individual.

For a diagnosis to be made, the following criteria should be met:

• The individual has experienced re-experiencing symptoms pertaining to prolonged trauma
• The individual has showed symptoms of avoidance in reaction to prolonged trauma
• Psychological changes are evident since the prolonged trauma finished
• The symptoms have caused significant distress
• The symptoms have been present for at least four weeks
• The symptoms are considered to be more intense than those seen in PTSD
• The symptoms relate to prolonged trauma
• Symptoms cannot be attributed to substance abuse or a different mental health condition

It is possible that PTSD, or a different mental health condition will be diagnosed, if the specialist believes this is appropriate.

It is also possible that multiple conditions could be diagnosed. Once a diagnosis has been made, treatment can proceed.

How is Complex Post-Traumatic Stress Disorder treated?

Complex PTSD is a serious condition, though treatment is available. In many instances, with the right treatment plan, a full recovery can be made. But as Complex PTSD is a severe mental health condition, it may take considerable time for recovery to be attained.

Symptoms of Complex PTSD are generally severe – meaning treatment should be instigated as soon as possible.

Self help

First of all, the individual involved can do things to help themselves. These are small steps that won’t fix their problems, but can help.

Partaking in hobbies is important, and if possible – either re-starting or beginning work too can help. Both of these are important steps for helping an individual becoming less hostile to others.

Exercise too can help an individual. A healthy diet and joining a self-help group can also provide some help.

Talking Therapy

The majority of treatment however is done through talking therapy. Therapy can help an individual process prolonged trauma in a healthier way, and may help them come to terms with the trauma.

It also helps them to understand their thoughts and behaviour. It is common for grounding techniques to be taught to help an individual separate the traumatic past from the present day. Talking therapy may include:

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

Eye Movement Desensitisation and Reprocessing (EMDR): While more of a newer treatment, EMDR is an exciting intervention that has helped many people cope with trauma-based conditions. This therapy involves an individual moving their eyes from side-to-side, with the therapist directing their eye movements. During this, the individual recalls their traumatic experience. EMDR is believed to help an individual change how they think about the traumatic event, with the therapist aiming to facilitate change.

Hypnotherapy: Hypnotherapy is a form of therapy that uses hypnosis in an attempt to treat a condition. Hypnotherapy normally involves an individual being in a deeply relaxed state. The therapy also uses focused attention and concentration to induce a heightened state of awareness. This allows the patient to focus on specific thoughts or factors. Hypnotherapy will commonly involve suggestion therapy, which allows a person to be more inclined to changing behaviours (including pain management). It can also be used to explore causes of a condition or symptom. This may include events that have been hidden in an individual’s unconscious memory.

Psychoanalytical Psychotherapy: Psychoanalytical Psychotherapy is a talking therapy that aims to help uncover and resolve unconscious beliefs that cause psychiatric conditions. Traumatic experiences that may or may not be buried in the unconscious mind can be highlighted and processed. Psychoanalytical psychotherapy involves talking to a trained therapist. The therapist can show the individual how early memories and past traumas have affected their thinking, behaviour and attitude in the modern day. Psychoanalytical psychotherapy is especially useful for any condition that involves past trauma. Renowned neurologist Sigmund Freud developed this therapy, which is typically completed over a long-term basis.

Along with the above, there are many other types of talking therapies available. Accessing talking therapy can help in many ways. Further information can be found on our Therapy section.

Medication

Complex PTSD may also be treated with medication, if a Doctor or mental health specialist believes this is appropriate.

Only two medicines are actually licensed for use in treatment of PTSD – two SSRI antidepressants called Paroxetine and Sertraline. This makes them the first-line of treatment for Complex PTSD.

Specialists can also prescribe other antidepressants. Antidepressants will normally need to be taken on a long-term basis. Hopefully, they will eventually be able to be gradually withdrawn.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Summary

The hope is that anyone with Complex PTSD is able to receive a combination of treatments that help them to overcome their traumatic past.

It can be so difficult to live with Complex PTSD, but help is available. In the majority of cases, this will lead to an individual enjoying an improved lifestyle, free from symptoms.

More information on Complex PTSD and other mental health conditions can be found across our website.

See Also

• PTSD & Trauma Section
• What Is The Prognosis for PTSD & Trauma Conditions?
• Therapy Homepage
• Medicine Homepage