WHAT IS COMPLEX PTSD?

 

     While the origins of diagnosing Complex PTSD focused on extended periods of physical and/or sexual abuse, it is now increasingly diagnosed in clients who have endured ongoing childhood trauma, such as experiencing a death or other significant loss, parental abandonment or severe criticism, family chaos, parental substance abuse, bullying, physical abuse, verbal abuse, and emotional abuse.  Chronic trauma triggers the fight-or-flight response so intensely that the survivor becomes “stuck” in the sympathetic nervous system’s heightened adrenaline state.  Furthermore, the parasympathetic nervous system, which is responsible for creating the relaxation response, can become extremely paralyzed by chronic trauma.  Thus, chronic trauma creates a constant state of hypervigilance and fear.  The symptoms of Complex PTSD are distinct from those of regular PTSD, because they result from repetitive, long-term, and, often, unresolved traumatic experiences, such as growing up in a dysfunctional family environment with a low level of emotional support and a high level of inconsistency and critical treatment which may continue as an unresolved pattern during one’s adult years.

CAUSES OF COMPLEX PTSD

     Another major contributor to Complex PTSD is a repeated mixture of verbal abuse, emotional abuse, rage, and degradation from one or both parents throughout childhood and adolescence.  Furthermore, children who are exposed to severe adversity or neglect are at increased risk of subsequently developing an array of mental health problems, such as ADHD, Borderline Personality Disorder, Antisocial Personality Disorder, Generalized Anxiety Disorder, Panic Disorder, Obsessive-Compulsive Disorder, Major Depressive Disorder, and various substance abuse disorders, during adulthood.  Survivors of childhood trauma are prone to lifelong emotional, cognitive, and behavioral difficulties, putting these individuals at risk for using alcohol and other substances to escape the painful memories and associated fears and self-doubt.  

     Complex PTSD has also been diagnosed in those who have endured abusive relationships as adults, particularly those who have experienced long-term narcissistic abuse.  While a narcissist may appear charming and confident, he or she actually has very fragile self-esteem and hidden insecurities, which causes this person to be extremely vulnerable to the slightest criticisms and to lash out, criticize, and threaten loved ones when not getting the acceptance or compliance needed to continue the narcissist’s cycle of denial and control.  Signs of narcissistic abuse include the following: (1) hyper-critical, judgmental statements, (2) possessiveness, (3) controlling behaviors (such as with money, children, and/or work schedule), (4) dismissiveness of one’s partner’s needs, thoughts, and feelings, (5) repeated attempts to isolate one’s partner from family and friends, and (6) constant disrespect of one’s partner’s boundaries in the relationship.  These toxic relationships are dominated by emotional abuse which can have long-lasting mental health effects upon the person who is the target of this abuse.

LONG-TERM EFFECTS OF COMPLEX PTSD

     The symptoms of Complex PTSD can have severe consequences upon one’s daily functioning.  First, Complex PTSD survivors often struggle with emotional regulation, as evidenced by persistent feelings of depression, helplessness, rage, panic, toxic shame, and a strong fear of abandonment.  Toxic shame can immediately resurface with each trauma-related thought, causing a regression to how the traumatic event was originally experienced.  Toxic shame creates such intense humiliation and self-loathing that the Complex PTSD survivor feels unworthy of seeking support from others and chooses to socially isolate, causing more toxic shame.  Secondly, Complex PTSD survivors often experience cognitive difficulties, such as constant battling against a harsh inner critic, frequent and uncontrollable dissociation, a very fragmented sense of identity, and a self-perception as defective or flawed, due to their trauma.  Third, they are prone to lifelong behavioral difficulties, such as impulsivity, aggression, sexual acting-out, substance abuse, and other self-destructive behaviors.  Lastly, they tend to experience frequent interpersonal difficulties and diverse and chronic somatic complaints.

TREATMENT STRATEGIES FOR COMPLEX PTSD

     Cognitive Restructuring techniques are effective for helping survivors of childhood trauma and narcissistic abuse to become greatly empowered through clarifying, evaluating, and revising their hypervigilant thoughts and disturbing emotions.  The main viewpoint of Cognitive Restructuring is that, while past events cannot be changed, the Complex PTSD survivor can change how these events are viewed and managed.  The three main goals of Cognitive Restructuring techniques are: (1) to create present-focused, strengths-based self-talk, (2) to recognize trauma-related thoughts, and (3) to counteract these trauma-related triggers by applying new reactions.  Another strategy is to teach the Complex PTSD survivor how to create comforting and self-compassionate visualizations when feeling overwhelmed by trauma-related thoughts, thus creating an emotional distance from the past event.  Lastly, the Cognitive Restructuring approach encourages Complex PTSD survivors to take control of their traumatic memories and self-defeating emotions by replacing them with healthier coping behaviors.

     Mindfulness training techniques are also effective for helping Complex PTSD survivors to devote undistracted time toward becoming more fully aware of the thoughts and emotions related to their traumatic memories.  By doing so, the trauma survivor can acknowledge the painful sensations and can choose how to respond to them, rather than being controlled by them.  Mindfulness can be a very powerful lifelong tool for maintaining a keen sense of self-observation and self-compassion.  When a disturbing thought or feeling is detected on one’s “mindfulness radar,” there is freedom to replace old coping patterns with more desirable responses.  Depending on the present situation, the Complex PTSD survivor can choose to “compartmentalize” the thought or feeling until a more appropriate time, to use a redirecting mantra or activity, or to just “sit with” the thought or feeling until it passes.  After truly learning and embracing mindfulness, the Complex PTSD survivor knows that each trigger WILL pass and CAN be managed.  The best news is that the life experiences, although unfortunate and undeserved, of Complex PTSD survivors have given them a great deal of resilience and innate coping resources, as well as opportunities to obtain more effective coping mechanisms than individuals who have not endured such a path.