Complex Post-Traumatic Stress Disorder (CPTSD)

Post-Traumatic Stress Disorder or PTSD is a condition that affects many people; the military community has its share of PTSD sufferers much in the same way that police, firefighters, and emergency services personnel do in the civilian sector.

PTSD was initially controversial when it was added as a disorder to the third edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-III.

That happened in 1980 and at the time, the idea of Post-Traumatic Stress Disorder was that the condition was based on external factors, rather than a perceived “weakness” of the individual. The concept of trauma and what it does to the sufferers are important aspects of understanding PTSD.

But Complex Post-Traumatic Stress Disorder (CPTSD) wasn’t on anyone’s radar in the 1980s. That would come later, after much study and observation of those who have suffered from what would later become known as c-PTSD, cPTSD, or CPTSD.

The DSM III was replaced by successive manuals. The DSM-V moved PTSD from its previous classification as an anxiety disorder and into a different classification as a trauma and stressor-related disorder.

VA literature states that PTSD has four types of symptoms:

• Reliving the traumatic event
• Avoiding situations that remind the sufferer of trauma
• Negative changes in beliefs or feelings
• Hyperarousal or being “over-reactive” to certain situations

According to the Department of Veterans Affairs, “PTSD is not diagnosed unless all four types of symptoms last for at least a month and cause significant distress or problems with day-to-day functioning”.

What Is CPTSD?

CPTSD is something that can happen after multiple traumas. A single traumatic event is enough to cause Post-Traumatic Stress Disorder but it does not automatically happen as a result.

Likewise, CPTSD is associated with multiple traumas. Not everyone who experiences multiple traumas may develop CPTSD, but it is a possibility worth understanding more about.

CPTSD shares much in common with PTSD. The symptoms mentioned above may be present, but may be aggravated by other symptoms associated with CPTSD. If you suffer from CPTSD you may experience any or all of the following:

• Self esteem issues
• Self-medication with drugs or alcohol
• Emotional dysfunction
• Relationship issues
• Unhealthy obsessions with traumatic incidents, abusers, etc.

There are risk factors associated with CPTSD that include childhood abuse, childhood neglect, being a prisoner, being a witness to an act of violence, plus other factors including “long-term trauma”, abuse by a trusted person, and being trapped without hope for change.

Where CPTSD Fits In

The National Library of Medicine published a report in 2019 which includes the following data about those who suffer from PTSD and CPTSD:

• Of those sampled, “A total of 7.2% of the sample met criteria for either PTSD or CPTSD”; Of those sample, there were “3.4% for PTSD and 3.8% for CPTSD”
• Women sampled were “more likely than men” to meet criteria for both PTSD and CPTSD
• Cumulative adulthood trauma was associated with both PTSD and CPTSD
• Cumulative childhood trauma was more strongly associated with CPTSD than PTSD

According to the published findings,  “Adverse childhood events were associated with both PTSD and CPTSD, and equally so”.

Those who were identified as having CPTSD reported “substantially higher psychiatric burden and lower levels of psychological well-being compared to those with PTSD and those with neither diagnosis.”

Also Known As…

The condition we understand today as PTSD has gone by many names and interpretations. Here are a few of them:

• Enduring Personality Changes After Catastrophic Events–some still describe PTSD using this term instead
• Disorders of Extreme Stress Not Otherwise Specified–sometimes used instead of the term “complex PTSD”
• Borderline Personality Disorder–some sources hold that complex PTSD and Borderline Personality Disorder may have similar features, but Borderline Personality Disorder is not necessarily caused by trauma–some scientists believe genetics could play a part and that the two are separate issues

Treating CPTSD

There is no magic cure for either PTSD or complex PTSD. There is treatment, which can include the following:

• Medication including anti-anxiety and antidepressants
• Talk therapy
• Exposure therapy (patients confront their traumatic memories in a controlled environment)
• Cognitive therapy

These treatment options are common and can be provided by a military clinic, a private practice, or a combination of both. These conditions do not have one-size-fits-all treatments, much depends on the needs of the patient, the experience and skill of the care provider, and other variables.

Don’t be surprised if you have to try more than one care provider, counselor, therapist, psychiatrist, etc. on the road to wellness–it is common to discover you need a different approach, a different set of expertise, or a different rapport with your doctor, therapist, etc.

It’s not “shopping around” for the right treatment if the previous treatments weren’t working for you, or have stopped working. PTSD and CPTSD sufferers should not feel hesitant to search for a new option, provider, or clinic.

If you are concerned about symptoms that might be associated with PTSD or CPTSD, contact the VA, a private counselor or therapist, or ask your primary care provider to refer you to a licensed, trained professional who can help interpret and treat your symptoms. You are not alone!

Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter for Air Force Television News