• All donations and upgrades are manually verified and approved within 24hrs.
  • Upgrades are ongoing. Learn how to save your bookmarked posts.

Understand complex ptsd (cptsd)

Thread starter #1
Complex Posttraumatic Stress Disorder (CPTSD) was coined by Judith Herman, M.D, in 1992. What you are read here is a combination of speculative based on rejected proposed criterion for official recognition, and fact based on CPTSD being an official diagnosis within the ICD11 come 2018 (approx). Unless you are treated by a physician taking part within the World Health Organization (WHO) ICD 11 trials, then you are not officially diagnose with CPTSD.

CPTSD Acceptance

Complex PTSD was quickly adopted within the mental health industry to account for the classification of complex trauma. The unofficial complex PTSD diagnosis is an amalgamation of several diagnoses into one (borderline personality disorder, dissociative identity disorder and somitization disorder). The American Psychiatric Association has denied this attempt for DSM V inclusion, currently classifying complex trauma under the PTSD diagnosis as a sub-type.

Complex Trauma Reality

Complex trauma is a very real and destructive form of trauma, which at present is unsubstantially captured by a diagnosis of PTSD. Complex trauma is often identified in conjunction with a dissociative and/or personality disorder. One of the most misdiagnosed of those disorders is Dissociative Identity Disorder (DID). Formerly known as Multiple Personality Disorder (MPD), DID is often indistinguishable from certain traits of Borderline Personality Disorder (BPD). This often results in a misdiagnosis for those experiencing complex trauma.

The reason a dissociative and/or personality disorder is often present in those with complex trauma is that the perceptions of reality after enduring prolonged trauma are radically altered. This perception is much different than the reality perceived without prolonged trauma. Reality becomes torn, molded, and shaped to fit within a traumatic atmosphere. Due to longevity and exposure, this distorted picture of reality becomes normalized for the patient who experiences complex trauma.

Don't try and fit yourself within the definition of prolonged. Prolonged trauma refers to experiencing years of daily trauma, the threat of your trauma. Domestic violence, ongoing childhood abuse, prisoners of war, these are examples of prolonged exposure to trauma. This is different from Police and other emergency services who are exposed to trauma as part of their job, yet do not live, breathe and are under personal threat of such trauma in their daily living.

Looking toward the cycle of abuse, an example:

The abuse cycle carries from generation to generation, as it is ingrained in the abused child's brain that the way their parents behaved toward them was perfectly natural. If you believe smacking your children across the room is normal, you will continue to pass along traumatic behavior (and thus associated psychological damage). If you break that cycle with your children, and foster an assertive, rather than traumatic, approach it changes their perception of their reality. New, healthier behaviors are normalized. This will in turn affect the way they respond to their own children.

Susceptibility

Complex trauma is not specific to any age group. However, those whom endure complex trauma during early childhood are more prone to long-term and severe consequences - complex PTSD. The brain begins to place patterns and beliefs about the world during the first nine years of life, and is at its most susceptible during this time. The strength of early childhood is also that the brain is robust enough to process traumatic events. Though, this often creates a worse after-effect later in life as the brain matures and comprehends those events. If you put a mature adult through a heavily abusive marriage, a concentration camp or a Prisoner of War (POW) camp, the brain's trauma-processing ability will produce as similar an outcome of consequences as those seen in early childhood trauma.

However, those who endure trauma for an extended period under the age of twelve years are proven to present more devastating results in adulthood than complex trauma afflicted upon someone whom is already an adult. This is because morality, social skills, and life skills are all taught in childhood. The child's sense of right and wrong becomes altered, as well as their understanding of social function and their interpretation of the world around them. This can sometimes result in a personality disorder.

Demographics

Statistically, complex PTSD is found to come from those who are raised within impoverished communities or households. This spreads into populations that are considered third world. Violence is statistically more prevalent within such communities and families. However, no one is exempt from complex PTSD. Even the richest and most powerful of individuals have been convicted of crimes resulting in complex PTSD. This can be seen in the growing awareness of pedophile rings and human trafficking, an example of two money-fueled criminal structures which manifest themselves in large by capturing children and forcing them into sexual acts or slavery for months or years of their childhood.

Traumatic Events

Whilst PTSD requires abnormally traumatic events as diagnostic criterion (and though complex trauma is entangled within that requirement), the PTSD diagnosis fails to concede to the longevity and duration that complex trauma encapsulates. Examples of trauma which fit the criteria for complex PTSD include:
  • Physical abuse - ongoing, typically administered within a family or by caregiver / Domestic Violence (DV).
  • Sexual abuse - ongoing, typically administered within a family or by caregiver / friends of family / DV.
  • Imprisonment - prisoner of war / incarceration / forcible confinement for long periods of time.
  • Repeated tours in combat.
  • Other possibilities.
Who Said Combat?

Military combat has been aptly associated with PTSD, and is the most recognizable cause of PTSD in mainstream society today. The problem is that troop numbers are decreasing, and those who are operationally ready are being pushed to their limits. Never seen before in prior operations, the U.S Military and allies have extended service requirements without any choice offered to combatants. Operation time-frames at their peak reached rotations of 12-15 months, with troops returning home for 2-6 months before redeployment. It was only through recognizing the diminished behavioral capacity of soldiers upon their return home that the U.S Military reverted back to its shorter six month rotation.

This cycle has been repeated by some armed forces around the world (some with willing troops, and some otherwise) many times. If you submit a child to three years of physical abuse in an otherwise safe environment and notice the child's behavior has altered as a result, how could one expect soldiers spending long periods within hostile work environments not to develop the same distorted behaviors and reactions? It is now becoming more apparent that some troops are returning with more than just PTSD. Complex trauma is beginning to be seen and recognized in veterans due to long-term deployment exposure.

Proposed Clinical Attributes Of Complex PTSD

After much research on this topic, Wikipedia contains a more recent review from a source (Cook), on the problematic areas which isolate complex PTSD from PTSD. However, after reviewing original documents from Judith Herman (the original proponent of CPTSD), I have instead opted to list the original aspects outlined in her work. They are similar to current claims by others, except that they are listed in a diagnostic criterion rather than as regurgitated and interpretive reviews. Some so-called experts claim six unique differences, some seven. The original author claims seven characteristic differences, which are:
  1. Alterations in the regulation of affective impulses, including difficulty with modulation of anger and self-destructiveness,
  2. Alterations in attention and consciousness leading to amnesias and dissociative episodes and depersonalization,
  3. Alterations in self-perception, such as chronic sense of guilt and responsibility, and ongoing feelings of intense shame,
  4. Alterations in perception of the perpetrator, including incorporation of his or her belief system,
  5. Alterations in relationship to others, such as not being able to trust and not being able to feel intimate with others,
  6. Somatization of medical problems, and
  7. Alterations in systems of meaning, including feelings of hopelessness about finding anyone to understand his or her pain.
More recent claims and modifications to the above, explained in different wording:
  1. Attachment - "problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to other’s emotional states, and lack of empathy"
  2. Biology - "sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems"
  3. Affect or emotional regulation - "poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes"
  4. Dissociation - "amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events"
  5. Behavioral control - "problems with impulse control, aggression, pathological self-soothing, and sleep problems"
  6. Cognition - "difficulty regulating attention, problems with a variety of "executive functions" such as planning, judgement, initiation, use of materials, and self- monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with "cause-effect" thinking, and language developmental problems such as a gap between receptive and expressive communication abilities."
  7. Self-concept -"fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self".
Medical Diagnosis In Lieu

With CPTSD bordering official recognition (2018), it could not be used as a medical term. This is applicable in cases such as submitting to a medical board or insurance agency, or obtaining documentation for diagnosis. There are other factors at play with given diagnoses, in that physicians will often add multiple diagnoses for legal prescribing purposes. Whilst PTSD encompasses anxiety, depression, sleep dysfunction, moods and more, it is classified as a trauma disorder. For legal purposes, you will find an associated diagnosis list for prescription of pharmaceuticals.

The typical diagnoses given for someone with complex PTSD are usually presented as: Posttraumatic Stress Disorder, Major Depressive Disorder, or possible depersonalization disorder/dissociative amnesia. It is also common for those with CPTSD to be diagnosed with a personality disorder. (Avoidant, Dependent, Obsessive-Compulsive, Schizoid, Paranoid, Narcissistic, Antisocial, Borderline, etc.) The fail-safe for CPTSD is another unapproved diagnosis, Disorders of Extreme Stress, Not Otherwise Specified (DESNOS), yet this is a lessening event.

Treatment Options

Whilst treatment for complex PTSD is similar to that of PTSD, there are some unique differences. This is due to the nature of CPTSD in that patients will have sustained multiple or enduring trauma. There is also the potential for the patient to have developed a personality disorder they may or may not be aware of. The patient's cognition will have been programmed incorrectly over an extended duration of time as a result of trauma.

Eye Movement Desensitization and Reprocessing (EMDR) may suffice to some degree, though caution must be used due to the likelihood of unknown/suppressed memories that may overwhelm and cause brain dysfunction. EMDR has been proven ineffective at retraining cognitive deficits resulting from extreme and enduring trauma. Most trauma will respond well with EMDR treatment, and often can respond better to EMDR than to CBT, but EMDR is not capable of addressing the long-term issues that complex PTSD brings to the table.

Cognitive Behavioral Therapy (CBT) is the optimal method for dealing with CPTSD to achieve long-term cognitive restructuring. With complex PTSD, CBT is the treatment of choice for long-term results versus short-term results. It is not uncommon for trauma therapists to use a combination of both EMDR and CBT to target traumatic aspects uniquely, depending on emotional severity and sensitivity. CBT includes Dialectic Behavioral Therapy (DBT), as DBT is a varied form of CBT.

One of the largest problems when dealing with complex PTSD is that the sufferer has a high risk of suicidality or self-injurious behavior. Therapists are often stuck between a rock and a hard place with many CPTSD sufferers, due to the legal obligation in treatment to ensure that their patient does not harm themselves or someone else. This can limit how hard they push to achieve the results needed for change.

It is not unusual for those with complex PTSD to be medicated for long durations. This is due to cognitive restructuring, to the extent of undoing personality traits and constructed core beliefs about the world. This can take time to achieve, though that time is subjective to a case-by-case basis. With an excellent trauma therapist, it can be achieved within a reasonable time of one to two years of hard work. The first six to twelve months should be the worst if performed correctly by a good trauma specialist. The complexity, combined with personal factors, will detail the overall time of recovery.

DSM V Theories

The American Psychiatric Association (APA) has rejected complex PTSD as a viable diagnosis in the upcoming DSM V, declaring all proposed options infeasible in objectively covering the broad spectrum of symptoms presented by complex trauma sufferers within clinical practices.

Complex trauma aspects has now been included for diagnosis as a sub-type within the PTSD diagnosis. This diagnosis is now official and legal upon publication of the DSM V. You could call it PTSD-DS (PostTraumatic Stress Disorder - Dissociative Symptoms).

Conclusion

My own personal opinion of complex PTSD is that all involved in compiling it, to date, failed to establish the relevance of this diagnosis the moment they tried attaching it to PTSD. The proposed criterion for CPTSD, and those for PTSD, are vastly different in nature, thus the proposed criterion should not be trying to attach to PTSD as a complex version and instead standalone within the new trauma and stressor category as something more befitting, such as Complex Traumatic Stress Disorder (CTSD), as the criterion just don't match a complex version of the current PTSD criterion.

The ICD 11 inclusion of a CPTSD diagnosis will give a long standing problem a starting point towards an evolving diagnosis that helps bring better solutions to those suffering.
 
Last edited:
S

Scott N Josler

#2
I was under the impression that the newest inclusion in the DSM-V would be DES-NOS (Disorders of Extreme Stress Not Otherwise Stated), which cPTSD would be a part of…maybe not, though?
 
Thread starter #3
The problem is… there is no DESNOS. It didn’t make it into the DSM V, as it too was rejected. This is the issue with the world wide web. Someone says its true, so you may believe it. The problem is… that same person hasn’t actually looked in the DSM V.

I have it sitting in front of me, and I can factually state, DESNOS or any variation of, does not exist within the DSM V. All mistruths… don’t believe everything you read online, even this website. Websites are full of opinions and half truths. Ask for the source and whether they actually have that source in front of them.
 
4

456bee

#4
I am certain I have CPTSD. For my childhood, I was in emotionally, psychologically, and spiritually abusive circles. These were churches, homeschool groups, and the home. I recently got out of these circles and am recovering from the shock. I am in seminary. I found out about the abuse there. I am in therapy now. My therapist said she thinks I wasn’t making progress because it was an excuse to stay the way that I am. Simply no. It would have been dangerous to change too much while I was still in the home. Also, this last time, I had to tell her that therapy with its artificial and pushy qualities was not safe. She assumed it was for everyone until I told her no. It is working better with pastors who I know in many contexts and who don’t push as hard. Perhaps I could pretend they were with me when I went to see my therapist. It is so painful to try to feel and when I think I almost have it, it evades me. I am frustrated because all of this is interfering with every aspect of my life. I am terrified that people will stop giving me grace and won’t be imaginative enough to see what I could do without this problem. I am a nearly completely opposite person than what I have been before. I am afraid to let this new person out because I don’t want to get hurt or embarrassed. My nature is to be very good with people but this was buried deep because of the abuse. My survival techniques are what people react to. These point to that I am not good with people. Because I was brainwashed very badly, I will say things like I was trained to say them and not how they really are which only confirms people’s negative perceptions of me. I am learning but this is so maddening. I want to be free. I am making good progress but it is very slow. I am wondering if I ever will be fully healed. I want to use all this for reaching out to people in a compassionate ministry but right now I need to focus on myself and heal. I need to do the things I know to do and trust that the rest will come.
 
K

Knak1

#5
I am glad to hear they are bringing the topic to the table officially so maybe something more can be done. I so feel I will never live without it after being treated almost all my life.
 
J

Jenny Auryn Wren

#6
Hey there. My name’s Jenny. When last I blinked and felt more “normal” I used to be a writer and read voraciously, was the student work study secretary in the English Department of my university, I studied abroad in England junior year, traveled to various countries using England as a base the year thereafter, and was planning to enter seminary to study theology. When last I blinked and felt more “normal,” I contributed to a poetry journal, was studying three languages, and felt invincible. So invincible….walking around with Keats and Milton and Hans urs von Balthasar and Kerouack elevating my soul and spirits to the point of levitation. God. All the hope and potential in the world.

Something happened. Two nondescript words that, for me, carry in them the crushing weight of my current world. I’m sorry to all of you for your own “something” that “happened”. Somethings bad continued to happen thereafter;born from the one bad thing….
and now…I can say that I changed immediately after being raped. For five years I existed altered without realizing that my new behavior bore clinical name and pattern…I can say now that Stockholm behavior can affect even the valedictorian intellect. The heart knows a reason that reason knows not of kinda thing. Staying in a severely mentally, sexually, and thus physically abusive experience is soOoo denaturing. I can say that I finally broke free and that there’s an ocean between us. I can say that I understand everyone here who feels trapped in the “repetitive theme of self”, your memories replaying to mock you, your better self disassociating, seeing a marionette and knowing, even, what pulls the strings…but not how to quite sever all strings and walk strong again. Trauma survivors live with that Harry Potter-ian lightening bolt scar…that sears when evil is near…but, I’m going to find out how to rise up and out of the evil that is being stuck in a thick negative soup. It sucks to have to realize that you have to rise up and grab your sense of self back…when you feel so affronted and unconsulted on the matter of it having been taken…but you do…we do. Jerry Garcia once had to entirely re-learn guitar. One of the greatest noodleers could no longer noodle and it filled him with rage. His special gift, his connection with divinity, his outlet for creativity, his preferred voice to the world, the vibrations that offered perhaps the best window into his heart and soul….taken away. He had to decide whether or not to fight for it…and got stuck in depression and heroin avoidance games. A man came to his house to inspire and push him…a man came to give him his gift back…but he is the one who had to sit there and take it back whilst feeling embarrassed, small, like it was beneath him, angry, sad…the whole gamut we feel. But………..he’s one of the ones who knew he couldn’t be happy alive without recreating himself. He wasn’t happy staying broken, in between things….and neither am I.

If you guys are willing to help me to not feel so alone and foreign from the world…I’m willing to help you as well.

I had to leave my master’s degree programme unfinished in 2012
…I walked away after having completed all of the classes and had nothing left to do but sit for the three week period of exams. PTSD burst onto the scene in full glory and my mind could hardly work on translating obscure latin when my mind could no longer see a light at the end of the tunnel. I’ve always been optimistic and extroverted like crazy…I’m tired of being afraid and I’m tired of feeling small when I know what it’s like to feel big. I think I need to talk about my life with people who have PTSD…it’s one thing I have not done in all this time…talk to the only people who are gripped with the same faceless terror. I need to read your words…in exchange I’ll offer mine and all resources/insight I have learned in my fight thus far. So….I’m sending out a beacon…here I am. I wish you all a peaceful, happy, beautiful evening. -Jenny
 
P

Paul ward

#7
Hi all, I was diagnosed c-ptsd 6 years ago. I asked as a kid, what’s shell shock? I was told only soldiers get that. I knew my emotional system was shattered, but accepted the answer, I was 11, and my abuse carried on. Child sex abuse, severe beatings, bullying etc, but I walked in faith. Now 51, I am now coming to terms with the extent of damage I received, I had alters as a kid, voices in my head spoke to, holes in my memory, the list is endless. After being diagnosed, I learned that, c-ptsd is caused by covert narcissism. How does that work? Covert narcissism is the perpetual reminding of abuses by a narcissist. My narc, younger brother, constantly reminded me of my traumas, he got me beaten as a kid, telling lies, shattering my spirit, causing alters. My mind fragmented, soon after was sexually abused, and voices appeared, my younger brother, who I told, then knew my wounds. He spiritualised every emotional wound, and would constantly remind me of the injustices I suffered. For 42 years I suffered covert narcissism, during which time, my brother, had me put in prison, slept with my girlfriend, told people I’d been sexually abused, all to keep me in perpetual pain. For me, ptsd is a one off trauma, c-ptsd is years of covert narcissism, and the media perpetuates it too, people spiritualise when reading media coverage of trauma, which is not empathy, but the knowing of spiritual laws, and manipulation. Pure utter evil.
 
B

Bonnie1

#8
Where does one find an “excellent trauma therapist”? I’ve been looking for years and haven’t been able to find even a good one, much less an excellent one.
 
K

Katy1

#10
Hi Jenny, wonderful piece of writing. I cannot believe I am the first person to respond since you first wrote this hearty account, declaration and call. I would love to talk with you.
 
T

The lost

#11
Hey there. My name’s Jenny. When last I blinked and felt more “normal” I used to be a writer and read v...
Jenny,

Who am I? I was raped, beaten, had a mother that was very mis-guiding. No father. I watched my mother use drugs, have multiple sex partners, carry me on her road side hitchhiking missions from state to state to live her drunken days.

I was breaking the law as a juvenile, serving time in psych hospitals, and juvenile detention centers until I was 16/17 if I can remember right.

I started university at the age of 18 , got my first credit card , and had my first job at UPS, but April 3rd 1996, I was involved in an accident, so I withdrew from school and I couldn’t work. I never went back. My life went down hill from here.

I continue my life. Received 20,000 from my accident , which I spent it on a car the day of. That was gone. Hanging with the wrong people, going to bars, drinking, basically living a lavish lifestyle, but I didn’t have money. I would meet women and use them for money to live my lifestyle, causing them grief because I would have them get loans, ruin their credit, write bad checks, ect. Ruined my credit as well.

My first child was born in 1998. I was there for his birth, but I wasn’t a father. I was still running the streets.

In 1999, I met a great woman, very loving, educated, and we had a child in 2000. In the beginning, I did the same thing. Ruined her credit, gain for money to drink and run with my friends. She left me. I then felt remorse. I had another baby, and I started thinking of the way I grew up and I didn’t want my kids to suffer. I begged for forgiveness, seeked God, and got a job as an electrician. She married me. My life was on task. Fixed my credit, being a father to both children. I gained full custody of my first boy because his mother was unstable. Using drugs and an exotic dancer.

Everything was good until, I got a second job. I bought another motorcycle without my wife’s acknowledgement. Starting hanging with my best friend again, started drinking again, so you already know, my life started to fall apart again.

2005

She left me once again to never give me another chance, but I could see my son. My first son, I took care of for awhile and then sent him to live with his Aunt and Uncle because they were very much a stable family. Then, I could party, start that running around lifestyle, going from job to job. Ruined my credit again. Repeat

One thing I did do right in 2005, I joined the Army National Guard.

2006, I met another good woman, stable, educated, and pretty. I soon convinced her to live together, used her to pay my debts, got my first son back, so it was good again. Stable

2007, we split up because I did the same thing. Drove her off with my ways. Drinking, lack of affection, and just being selfish.

Mid-2007, I went to war in Iraq. I was an infantryman. Thought, I was cool, important, and wanted to fight.

Met a woman in 2008 from on line while in Iraq. She was from Alabama. Returned home 2008.
We met, I convinced her to move to MD. I still custody of my first boy. Soon as she moved to MD, I started drinking, running with other women. Repeat.
Late 2008 I went to war in Afghanistan.
Retuned 2009

Then, we moved to Alabama because I got evicted for being drunk and threatened a security guard from my development. We moved there I got a job and we got a nice house. Marriage. My son was doing well in every school he attended. I always told my boys, school was very important and I let him play baseball and football. I signed up for university and had high GPA.

2010, I got hurt during military training. Fractured my back. Couldn’t work, taking pills, and started running around again. Repeat

2011 I got a job which was high paying because I had to travel overseas. I then met a woman Doctor. Thought it was love. I quit the job so I could stay in her country. I started teaching. We married and now have a daughter. But I left my 2 boys behind. I left my second wife. 2011-2015 everything was good. 2015 I started having flashbacks from war, nightmares, depression and then lost my job. I started gambling, drinking, and buying many things. I found another woman and used for 120,000 usd. 2016 I’m still dealing with after affects of war and my childhood because I did exposure therapy which made me worst.. Doctors have me on different meds. I lost a lot memory of events in 2015 with spending, getting over 40 tattoos in a months period. I got hurt in March of 2016, and they stopped all meds, and treating me with Xanax, and I still take little tramadol which I’ve been taking since I been here. 2015 I was taking a mixture of meds, taking more then I should have.
Now I am trying to figure a way to pay the 120,000 back. I stopped all the meds in March and my mind started to remember what I had done in 2015. Now, I have remorse. Doctors here don’t know how to treat me.

I have thought of ending my life . Everyday now. I have done wrong

Today, who am I?

I never hit women. Just used them.

I have a 2 year daughter and my wife here is having another baby.

I think I’m evil.
 
L

Lisa1

#12
I am just wondering if you were able to have the treatment that Dr. Lipov offers? My Psychiatrist referred me to Dr. Lipov to see if I could get the treatment, however, Dr. Lipov denied it, as he told my Psychiatrist that it could cause an opposite reaction and due to my past hx of suicidal ideation, he was afraid it may trigger the symptoms to become activated again. I was really disappointed, because I felt like I was running out of options. I decided to try ECT treatments, again, as I had 6 of them 2 years ago while hospitalized, and they really were helpful. I had to go back in-patient for the first 2 treatments, and have just finished the 6th one. The doctor wants me to continue with maintenance tx’s, but I do work, and with the ECT causing memory difficulties, and the need to have someone drive me to and from, I can’t do it. I wish you the best of luck in your future road to recovery.
 
Top Bottom