Complex PTSD Symptoms and Treatment

Complex Post Traumatic Stress Disorder (Complex PTSD) is a rather severe and hard to treat version of the more widely recognized better known PTSD.

In many trauma situations the person with some luck and resilience moves beyond that incident after a period of adaptation and coping. In PTSD, the individual who is exposed to a traumatic event is impacted in a way that persists and interferes with their effective functioning. While the trauma may be severe, it is not typically chronic and many effective PTSD treatment methods have been identified which help with Post Traumatic Stress Disorder, in its simplest form. These same PTSD treatment methods however are not as effective, and may even be counterproductive, in a Complex Post Traumatic Stress Disorder case.

In Complex PTSD the exposure to the traumatic experience is often chronic, always persistent, and thoroughly debilitating. A hallmark Complex PTSD feature involves a traumatic predicament or setting in which there is no escape such as torture, experience as a hostage, or ritualized child abuse. Other features that impact Complex PTSD are the age at which the trauma occurs, the duration, the lack of support from others, and the relationship between the victim and the agent who is responsible for the trauma.

In a study done for the DSM-IV Field Trial (van der Volk, et al. 1996) it seemed clear that several PTSD symptoms, often assigned a minor or supporting role in Post Traumatic Stress Disorder, are key factors in determining who is driven to seek treatment. These included depression, anger outbursts, self-destructive acts, feelings of shame, self blame, and distrust. These symptoms, along with an impaired sense of identity, dissociation, depersonalization, somatization, and attachment disruption (and intimacy problems) are hallmarks of Complex PTSD. The damage also includes an impaired capacity for self-regulation, and disturbed body image.

in addition, Complex PTSD also includes the the usual PTSD symptoms. Post Traumatic Stress Disorder in DSM-IV often includes recurring memories of the trauma, nightmares of the event(s), distress when exposed to triggers, physiological reactivity, avoidance of thoughts, feelings and places associated with the trauma, memory loss about the predicament, a feeling of detachment, restriction of affect, difficulty sleeping, irritability, hyper-vigilance, and an exaggerated startle response.

Standard PTSD treatment can be quite effective and can result in relatively fast relief. Results from studies of Trauma Focused Cognitive Behavioral Therapy, and EMDR show promise, as does solution focused PTSD treatment and other short term models.

However for the Complex PTSD patient, the attachment disruption and difficulty trusting others or a more gradual approach, that focuses on building a therapeutic alliance in which the patient and the therapist develop a bond that can weather the challenges. While the normal approaches to treatment of PTSD also often build in some grounding, safety and relaxation skills, these are more crucial for Complex PTSD treatment, before the hard work begins.

Another early component of treatment should be to begin to work on regulation of affects, often learning self regulating and self soothing techniques to take the place of substance abuse or risky stimulus seeking. Since dissociation is often more problematic in Post Traumatic Stress Disorder, early treatment often needs to address this as well.

In later stages of PTSD treatment, the usual cognitive behavioral techniques can be useful, as part of the broader task of building a narrative that weaves an understanding into what has transpired. For Complex PTSD that narrative also likely involved the development, often for the first time of a more coherent sense of identity.

van der Kolk, P.A., Mc Farlane, A.C., and Weisaeth, L. (eds.) (1996) Traumatic stress: the effects of overwhelming experience on mind, body and society. New York, Guilford Press.

Herman, J.L. Trauma and Recovery. New York: Basic Books.

Trauma patient (after PTSD treatment) photo by Breahn.