Just one traumatic experience can trigger PTSD in some people. But some individuals go through repeated, multiple incidences of traumatic events, and this pattern can lead to the development of complex PTSD. Unlike ‘single incident’ trauma (i.e. PTSD), complex PTSD is cumulative, underlying and interpersonally generated.
There are different kinds of traumatic events that can lead to cPTSD. These include ongoing sexual, emotional, physical abuse, torture and severe child neglect. It can also occur in the absence of abuse, for example if caregivers are unable to meet the emotional needs of children due to their own unresolved trauma histories. Dr Shraddha Shah, Consultant Psychology, Jaslok Hospital and Research Centre shares some interesting insights on complex post-traumatic disorder.
People suffering from cPTSD have intense disturbing thoughts and feelings related to the traumatic event. They may re-create the event through flashbacks or nightmares. They may also have low self-esteem, intense guilt and emotional dysregulation. Complex traumatic events are long-lasting and often occur during a developmentally vulnerable stage in the victim’s life.
Symptoms of cPTSD include intrusive memories which primarily make the person relive the traumatic events. A number of times the memories are formed during the traumatic exposure but remain under processed. Such memories stay in the subconscious and appear after months or even years to mentally and physiologically hamper the victim. Victims experience a loss of control that comes with being a victim for an extended period of time. The perpetrator has the power and control over the victim, and as it goes on for so long it can cause serious psychological harm.
There may be negativity in the thoughts about self and other people, feeling lost, a sudden loss of meaning in life. Dissociation from self and changes in self-perception are also important symptoms that affect the victim’s life. Symptoms of avoidance include trying to avoid the memories of the traumatic event or even trying to avoid going to places that may trigger the memories of the traumatic event. A person suffering from cPTSD may show suicidal behaviour, self-destructive behaviour like drinking too much or reckless driving, trouble sleeping (nightmares of the trauma) and concentrating and may show irritability or uncontrollable anger. Other physiological symptoms include hyperarousal and hypervigilance. Sometimes, it has been years since the victim last experienced the traumatic events, but the emotional feedback is so strong that the victim may not remember the traumatic event, but will experience the persisting emotions.
In addition to the above symptoms, young children suffering from cPTSD may also show bedwetting, loss of speech, re-enacting the trauma during play and clinging behaviour toward a parent.
Anyone can be diagnosed with cPTSD following a traumatic event irrespective of their age. However, the condition usually arises from cumulative trauma experienced during childhood. Individuals suffering from PTSD who were exposed to trauma before the age of 14 are more likely to be diagnosed with cPTSD later in life. After surviving a traumatic event many people have PTSD like symptoms at first, such as experiencing a shock, being unable to think clearly about what happened. However, the majority of people who have experienced trauma do not develop cPTSD. Getting timely help following the recognition of even mild stress reactions can prevent it from turning into something like cPTSD. Help can be taken from family, friends or mental health professional.
CPTSD is treatable and the earlier the person gets treatment, better are the outcomes. Both psychotherapy and medications provide evidence-based solutions to treat PTSD. Cognitive behaviour therapy, prolonged exposure therapy, cognitive restructuring therapy and Dialectical behavioural therapy can be used for the treatment of cPTSD. In addition to these, joining various support groups may also help.
It can be challenging to live with complex post-traumatic stress. For many people, it is a lifelong condition. Intense feelings of despair and hopelessness may cause individuals suffering from cPTSD to suffer in silence. However, seeking help is the first step towards recovery.
