Tag Archives: Complex Post-traumatic Stress Disorder

Complex PTSD

 

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Complex PTSD:

There has been some controversy regarding the difference between post traumatic stress disorder (PTSD) and complex PTSD amongst researchers.

During the early 1990s, the psychologist Judith Herman noted that individuals who had suffered severe, long-lasting, interpersonal trauma, ESPECIALLY IN EARLY LIFE, were frequently suffering from symptoms such as the following:

– disturbance in their view of themselves

– a marked propensity to seek out experiences and relationships which mirrored their original trauma

– severe difficulties controlling emotions and regulating moods

– identity problems/the loss of a coherent sense of self (click here to read my article on identity problems)

– a marked inability to develop trusting relationships

and, sometimes:

– adoption by the victim of the perpetrator’s belief system

Furthermore, some may go on to become abusers themselves, whilst others may be constantly compelled to seek out relationships with others who abuse them in a similar way to the original abuser (i.e. the parent or ‘care-taker’)

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It is most unfortunate that, prior to the identification of the disorder that gives rise to the above symptoms, now referred to as complex PTSD, those suffering from the above symptoms were NOT recognized as having suffered from trauma and were therefore not asked about their childhood traumatic experiences during treatment. This meant, of course, that the chances of successful treatment were greatly reduced.

Research has now demonstrated that the effects of severe, long-lasting interpersonal trauma go above and beyond the symptoms caused by PTSD.

Complex PTSD Symptoms :

The main symptoms of complex PTSD are as follows:

1) severe dysregulation of mood

2) severe impulse control impairment

3) somatic (physical) symptoms (e.g. headaches, stomach aches, weakness/fatigue)

4) changes in self-perception (e.g. seeing self as deeply defective, ‘bad’ or even ‘evil’)

5) severe difficulties relating to others, including an inability to feel emotionally secure or empowered in relationships

6) changes in perception of the perpetrator of the abuse (e.g. rationalizing their abuse/idealization of perpetrator)

7) inability to see any meaning in life/existential confusion

8) inability to keep oneself calm under stress/inability to ‘self-sooth’

9) impaired self-awareness/fragmented sense of self

10) pathological dissociation (click here to read my article on DISSOCIATION)

The DSM IV (Diagnostic and Statistical Manual IV) first named  complex PTSD as: DISORDER OF EXTREME STRESS NOT OTHERWISE SPECIFIED (DESNOS). Now, however, complex PTSD is listed as a SUB-CATEGORY of PTSD.

Whilst it is certainly true that there is an OVERLAP between the symptoms of PTSD and complex PTSD, many researchers now argue that PTSD and complex PTSD should be regarded as SEPARATE and DISTINCT disorders.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2014 Child Abuse, Trauma and Recovery

Why can Effects of Childhood Trauma be Delayed?

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Delayed onset post traumatic stress disorder (PTSD) ,which can occur as a result of a severely disrupted childhood, is defined by the DSM (Diagnostic Statistical Manual) as PTSD which develops at least six months after the traumatic event/s; however, PTSD can take much longer than this to manifest itself.

One reason why PTSD may not become apparent immediately is that the individual who has been affected by  trauma is able, for a period of time, to employ coping mechanisms (either consciously or unconsciously) which keep the condition at bay. During this period, some of the effects of the traumatic experience/s lie dormant.However, due to the experiencing of  further triggers (stress-inducing reminders of the original trauma), the person’s neurobiological processes (already harmed by the original trauma) may be further adversely affected until a ‘tipping point’ is reached and the s/he meets the criteria for being diagnosed with the disorder.

In other words, there is an interaction between the original damage caused by the trauma and exposure to further stressors later on in life. It follows from this that the more severe the original trauma, and the more severe the stressors life throws at the individual subsequently, the greater is the his/her accumulated risk of developing PTSD. Indeed, this is borne out by the research.

ORIGINAL TRAUMA LEADS TO GREATER VULNERABILITY TO EFFECTS OF FURTHER STRESS :

The original trauma, then, makes the individual more susceptible to being affected adversely by further life stressors. In neurological terms, this is thought to be because the original trauma can damage an area of the brain known as the amygdala; damage to this region makes a person’s fear/anxiety response to stressors much more intense than is normally the case (click here to read my article on how the effects of childhood trauma can physically harm the brain).

The more the individual affected by the original trauma subsequently experiences stressful triggers (see above) which cause him/her to relive it, the more damaged, and hypersensitive to the effects of further stress, the amydala (see above) becomes. Eventually, the amygdala’s response to perceived threat and danger (there does not have to be any real threat or danger ; indeed, one of the hallmarks of PTSD is that it causes the sufferer to see threat everywhere, where it does not, in fact, exist)  become so exaggerated that the individual finds him/herself living in what amounts to a state of almost constant terror (indeed, I myself was in just such a state for more time than I care to recall).

VICIOUS CYCLE:

As the individual starts to perceive, irrationally, threat everywhere, the range of triggers (see above) s/he experiences grows ever wider; this, in turn, yet further sensitizes the amygdala and reinforces the individual’s stress response. Thus, a vicious cycle develops.

CRITICAL PERIOD OF BRAIN VULNERABILITY :

I will finish with a quote from the psychologist Shalev, which I think speaks for itself and requires no further elucidation from me :

‘Following trauma there is a critical period of brain plasticity during which serious neuronal changes may occur in those who go on to develop PTSD.’

NB. To learn more about BRAIN PLASTICITY, and how we can take advantage of the phenomenon to aid our own recoveries,  click here to read my article).

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2014 Child Abuse, Trauma and Recovery

Childhood Trauma: Complex Post Traumatic Stress Disorder (with Questionnaire).

 

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Survivors of extreme trauma often suffer persistent anxiety, phobias, panic, depression, identity and relationship problems. Many times, the set of symptoms the individual presents with are not connected to the original trauma by those providing treatment (as certainly was the case for me in the early years of my treatment, necessitating me to undertake my own extensive research, of which this blog is partly a result) and, of course, treatment will not be forthcoming if the survivor suffers in silence.

Any treatment not linked to the original trauma will tend to be ineffective as THE UNDERLYING TRAUMA IS NOT BEING ADDRESSED. Also, there is a danger that a wrong diagnosis may be given; possibly the diagnosis will be one that may be interpreted, by the individual given it, as perjorative (such as a personality disorder).

imagesca5tpxei - Childhood Trauma: Complex Post Traumatic Stress Disorder (with Questionnaire).

Individuals who have survived protracted and severe childhood trauma often present with a very complex set of symptoms and have developed, as a result of their unpleasant experiences, deep rooted problems affecting their personality and how they relate to others. The psychologist, Kolb, has noted that the post-traumatic stress disorder symptoms survivors of severe maltreatment in childhood might develop ‘may appear to mimic every personality disorder’ and that ‘severe personality disorganization’ can emerge.

Another psychologist, Lenore Terr, has differentiated between two specific types of trauma: TYPE 1 and TYPE2. TYPE 1 refers to symptoms resulting from a single trauma; TYPE 2 refers to symptoms resulting from protracted and recurring trauma, the hallmarks of which are:

– emotional numbing
– dissociation
– cycling between passivity and explosions of rage

This second type of trauma response has been referred to as COMPLEX POSTTRAUMATIC STRESS DISORDER (CPTSD) and more research needs to be conducted on it; however, an initial questionnaire to help in its diagnosis has been developed and I reproduce it below:

CPTSD QUESTIONNAIRE

1) A history of, for example, severe childhood trauma

2) Alterations in affect regulation, including
– persistent dysphoria
– chronic suicidal preoccupation
– self-injury
– explosive or extremely inhibited anger (may alternate)
– compulsive or extremely inhibited sexuality (may alternate)

3) Alterations in consciousness, including
– amnesia or hypernesia for traumatic events
– transient dissociative episodes
– depersonalization/derealization
– reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

4) Alterations in self-perception, including
– a sense of helplessness or paralysis of initiative
– shame, guilt and self-blame
– sense of defilement or stigma
– sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

5) Alterations in perceptions of perpetrator, including

– preoccupation with relationship with perpetrator (includes preoccupation with revenge)
– unrealistic attribution of total power to perpetrator (although the perpetrator may have more power than the clinician treating the individual is aware of)
– idealization or paradoxical gratitude
– sense of special or supernatural relationship
– acceptance of belief system or rationalizations of perpetrator

6) Alterations in relations with others, including

– isolation and withdrawal
– disruption in intimate relationships
– repeated search for rescuer (may alternate with isolation and withdrawal)
– persistent distrust
– repeated failures of self-protection

7) Alterations in systems of meaning
– loss of sustaining faith
– sense of hopelessness and despair

Anyone who feels their condition may be reflected by the above is urged to seek professional intervention at the earliest opportunity.

RESOURCES :


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DIGITAL BOOK THUMBNAIL 1 1 - Childhood Trauma: Complex Post Traumatic Stress Disorder (with Questionnaire).

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2013 Child Abuse, Trauma and Recovery