Complex Post-Traumatic Stress Disorder: The Effects of Complex Trauma

Any trauma can leave a lasting imprint on your mental and emotional health. Unfortunately, some prolonged trauma is harder to heal since it feels as if the painful memories have taken root deep into your mind, body and soul. Complex Post-Traumatic Stress Disorder (C-PTSD) can mirror PTSD, but the effects from the condition are even more detrimental to your mental health.

The good news is that help is available. With new techniques in psychotherapy, you can learn to alleviate some of the symptoms of complex trauma.

How PTSD Differs from Complex PTSD

The Diagnostic and Statistical Manual from the American Psychiatric Association and the World Health Organization (5^th Edition, DSM-5) does not list Post-Traumatic Stress Disorder and Complex PTSD as two separate conditions. However, the International Classification of Diseases (11^th Edition, ICD-11) does provide a distinction between the two mental health conditions.

Both forms of PTSD are similar, but patients with typical PTSD symptoms develop the disorder often from a single traumatic event. This event could have been something like a mugging, traffic accident, an attack during wartime, an earthquake, or a home invasion.

Patients diagnosed with Complex PTSD, on the other hand, have usually experienced a series of traumatic events or a prolonged event. Prisoners of war, children or spouses from consistently abusive homes (physical or emotional abuse), and human sex trafficking victims may report symptoms of complex trauma. In many cases, the complex PTSD symptoms are more severe and may take longer to subside.

In one research study, participants were diagnosed as either suffering from PTSD or Complex PTSD. The participants with the complex trauma form of the disorder rated higher according to the ICD-11 for depression (10.7%), anxiety (4%), and suicidal ideation and self-harm (7%), compared to the PTSD patients.

Complex PTSD is a serious mental health condition that may require different forms of treatment as researchers learn more about how complex trauma affects the human mind.

How PTSD Affects Brain Function and Structure

Severe anxiety, like the type present in PTSD and Complex PTSD, alters the brain structure and the brain’s functions. The regions of the brain known as the amygdala and the prefrontal cortex are both affected by PTSD.

The amygdala is a small region of the brain with a big job; it controls the “fight or flight” response we feel when we are afraid. The amygdala releases adrenaline, norepinephrine, glucose, and cortisol to help you get through the crisis. It also stores the memories associated with this response.

The prefrontal cortex of your brain is like the logical friend that tells you that you’re okay when you are overly emotional and helps you to see the situation from a clearer perspective. This region not only regulates emotions, but it also helps in the rational decision-making process and assigns meaning to events. The problem researchers have found with PTSD patients is that the amygdala jumps into a hyper-drive state while the functions of the prefrontal cortex are subdued.

This imbalance creates hyper-awareness and impulsive behaviors in the person with PTSD. With impaired decision-making, the person may make rash decisions and behave in an angry or violent outburst when the memories of the complex trauma are triggered. These triggers could be a newscast about an assault (for a sexual assault victim), loud sounds such as a car backfiring or fireworks (for a war veteran), or the tight space of an MRI machine (for a kidnapping victim).

Complex PTSD Symptoms

Complex PTSD symptoms and PTSD symptoms are similar. If you or a loved one are experiencing any of the following, consult with your primary physician or a therapist.

• You are having difficulty sleeping or staying asleep. You might wake up in a cold sweat or suffer from repeating nightmares about the event.
• Your mind constantly reverts to the trauma. You may find it difficult to focus on tasks at hand due to thoughts about the event.
• You avoid all reminders of the event. You avoid people, places, or things that might trigger the memory of the event.
• You jump when you hear loud noises or feel like you are always in danger. You are startled by sounds. You feel as if your “fight or flight” response is on hyper-drive all the time.
• You no longer trust anyone. It is difficult for you to fully trust other people after the event. For example, if the traumatic event involved an authority figure, you may rebel against all authority figures in your life. Or, people involved in an abusive domestic abuse relationship might have trouble connecting and trusting a potential partner.
• You have a physical reaction when you think about the traumatic event. Reactions such as nausea, vomiting, digestive distress, and panic attacks can occur when you ruminate on the event.
• You can’t seem to connect with the people closest to you. Social isolation and detachment are common “escapism” tactics that PTSD patients employ to protect themselves or as a result of negative perceptions about themselves.
• You develop problems with low self-esteem. You may feel that you are no longer worth the attention or that you no longer deserve to have certain people and things in your life. Although they are not true, you may believe the negative beliefs brought on by the trauma.
• Your emotions control your behavior. You react before you think when faced with a trigger. You might react with a tearful outburst or a violent and angry episode. People around you may feel uncomfortable or make comments about your unpredictable behavior.

The symptoms from Complex PTSD can also lead to the development of other mental health conditions.

Other Conditions that Can Develop with Complex PTSD

Mental health conditions that coexist with Complex PTSD can complicate the diagnosis and treatment for complex trauma. Sometimes the other mental health disorder is so prominent that it masks the PTSD symptoms. Conditions such as depression, anxiety, substance abuse, neurological disorders, and chronic pain can all coexist with PTSD.

Borderline Personality Disorder is another mental health condition that sometimes mirrors PTSD symptoms, and commonly, people can exhibit both disorders. Both conditions are birthed from traumatic experiences and are marked by triggers and mood swings. Patients with a Complex PTSD and Borderline Personality Disorder diagnosis may need to focus on rebuilding their interpersonal skills in order to communicate effectively with others and save close relationships.

Treatment Options for Complex PTSD

The nature of Complex PTSD calls for treatment of the dominant symptoms. A good therapist wants you to get back to living your life, free from intrusive memories and the behaviors they elicit.

Psychotherapy, such as talk therapy, will open the door to realizations. Many people feel guilt or shame after a traumatic event and constantly think about what they could have done differently. Talk therapy helps the PTSD patients work through this emotion to come to terms that there was nothing further they could do, or they were too young to stop the event.

Prescription drugs, like antidepressants, are commonly prescribed to help manage the symptoms of PTSD. Drugs like sertraline (brand name Zoloft) are sometimes used to balance the serotonin levels in the brain of a PTSD patient. If you also suffer from other anxiety disorders, your doctor may prescribe anti-anxiety medications. Commonly, those patients with recurring nightmares may take sleep medication to help them rest peacefully.

Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are both psychotherapy techniques helpful in complex PTSD treatment. CBT helps you to identify the negative thoughts and beliefs. Once you have identified the thought, you can analyze the emotion that the thought created and change both thoughts and feelings, which in turn will give you control over your behavior.

EMDR helps you to safely remember the events of the trauma by changing how your brain processes the event and therefore how you feel about the event. This type of therapy works to assign new meaning to the complex trauma using guided eye movements.

If you are looking for others dealing with Complex PTSD symptoms, consider joining group therapy with a faith-based counselor or a local support group organization. Talking with others who have experienced something similar and are learning to move on with their lives can give you hope and peace of mind knowing you have a future ahead of you.