Complex Post Traumatic Stress Disorder (cPTSD)

PTSD is a psychiatric disorder that can develop after a person experiences a traumatic event. Complex PTSD, also known as CPTSD, can result if a person experiences prolonged or repeated trauma over months or years. A person with the condition may experience additional symptoms to those that define PTSD.

Traditional PTSD will affect nearly 7%Trusted Source of people in the United States at some point in their lives. Symptoms may result from changes in regions of the brain that deal with emotion, memory, and reasoning. Affected areas may include the amygdala, the hippocampus, and the prefrontal cortex.

Typical PTSD can arise after a traumatic episode, such as a car collision, an earthquake, or a sexual assault. It is generally related to a single traumatic event.

Complex PTSD, on the other hand, is related to a series of traumatic events over time or one prolonged event. The symptoms of complex PTSD can be similar but more enduring and extreme than those of PTSD.

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Complex Post Traumatic Stress Disorder (cPTSD) Summary

Complex post-traumatic stress disorder (sometimes called complex PTSD or c-PTSD), is an anxiety condition that involves many of the same symptoms of PTSD along with other symptoms. First recognized as a condition that affects war veterans, post-traumatic stress disorder (PTSD) can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse.

When the underlying trauma is repeated and ongoing, however, some mental health professionals make a distinction between PTSD and its more intense sibling, complex PTSD (C-PTSD). Complex PTSD has gained attention in the years since it was first described in the late 1980s. However, it is important to note that it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the tool that mental health professionals use to diagnose mental health conditions.

Information Sheet

Procedures offered for Complex Post Traumatic Stress Disorder (cPTSD)

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What Is Complex Ptsd (cptsd)?

Complex post-traumatic stress disorder (complex PTSD, sometimes abbreviated to c-PTSD or CPTSD) is a condition where you experience some symptoms of PTSD along with some additional symptoms, such as:

  • difficulty controlling your emotions
  • feeling very angry or distrustful towards the world
  • constant feelings of emptiness or hopelessness
  • feeling as if you are permanently damaged or worthless
  • feeling as if you are completely different to other people
  • feeling like nobody can understand what happened to you
  • avoiding friendships and relationships, or finding them very difficult
  • often experiencing dissociative symptoms such as depersonalisation or derealisation
  • physical symptoms, such as headaches, dizziness, chest pains and stomach aches
  • regular suicidal feelings.

Other Terms For Complex Ptsd

Complex PTSD is a fairly new term. Professionals have recognised for a while that some types of trauma can have additional effects to PTSD, but have disagreed about whether this is a form of PTSD or an entirely separate condition, and what it should be called.

For example, you may find some doctors or therapists still use one of the following terms:

  • enduring personality change after catastrophic experience (EPCACE)
  • disorders of extreme stress not otherwise specified (DESNOS) – this term is more common in America than the UK.

Complex Ptsd And Emotional Flashbacks

If you have complex PTSD you may be particularly likely to experience what some people call an ’emotional flashback’, in which you have intense feelings that you originally felt during the trauma, such as fear, shame, sadness or despair. You might react to events in the present as if they are causing these feelings, without realising that you are having a flashback.

What Causes Complex Ptsd?

Often, people with complex PTSD have experienced prolonged trauma such as ongoing physical, emotional, or sexual abuse.

The types of traumatic events that can cause complex PTSD include:

  • childhood abuse, neglect or abandonment
  • ongoing domestic violence or abuse
  • repeatedly witnessing violence or abuse
  • being forced or manipulated into prostitution (trading sex)
  • torture, kidnapping or slavery
  • being a prisoner of war.

You are more likely to develop complex PTSD if:

  • you experienced trauma at an early age
  • the trauma lasted for a long time
  • escape or rescue was unlikely or impossible
  • you have experienced multiple traumas
  • you were harmed by someone close to you.

Since complex trauma is prolonged, it can often begin in early childhood. Traumatic childhood experiences, also known as adverse childhood experiences (ACEs), can include:

  • childhood exposure to violence, abuse, or neglect
  • a death by suicide in the family
  • substance dependence in the family
  • mental health disorders in the family
  • having incarcerated family members
  • chronic poverty or neglect
  • housing instability
  • growing up in an unsafe or crime-heavy environment

What Are Dissociation And Depersonalization?

Depersonalization and disassociation refer to a dreamlike state when a person feels disconnected from their surroundings. things may seem ‘less real’ than they should be. These types of sensations vary in severity and can result from a range of conditions, including post-traumatic stress disorder and the use of recreational drugs.

The person may feel as if they are watching themselves from a distance. Some take on a different identity. The person is able to do a “reality check.” They are aware that their sensations are unusual.

Depersonalization is an aspect of dissociation.

  • Dissociation is a general term that refers to a detachment from many things.
  • Depersonalization is specifically a sense of detachment from oneself and one’s identity.
  • Derealization is when things or people around seem unreal.

The exact cause of dissociation is unclear, but it often affects people who have experienced a life-threatening or traumatic event, such as extreme violence, war, kidnapping, or childhood abuse. In these cases, it is a natural reaction to feelings about experiences that the individual cannot control. It is a way of detaching from the horror of past experiences.

According to Mind, a mental health charity based in the United Kingdom, dissociation can be a strategy for calming down, to help a person cope in times of stress. Neurologically, it may involve an imbalance in brain chemicals.

Risk factors

A number of factors can make a person more likely to experience dissociation and depersonalization.

  • Recreational drugs: Some recreational drugs affect the chemicals in the brain. These can trigger feelings of depersonalization.
  • Ketamine: People use this dissociative anaesthetic as a recreational drug. They take it because they seek an “out-of-body” experience.
  • Cannabis use: People have experienced dissociation and depersonalization with cannabis use and withdrawal.
  • Alcohol and hallucinogens: These may trigger depersonalization in some people. People have reported perceptual disturbances such as depersonalization when withdrawing from benzodiazepines.

As a symptom of another condition

Many people who experience depersonalization also have other mental health conditions.Some kinds of dissociation can occur with the following conditions:

  • depression
  • schizophrenia
  • epilepsy
  • obsessive-compulsive disorder (OCD)
  • phobic disorder
  • post-traumatic stress disorder (PTSD)
  • migraine

Dissociation and depersonalization disorders

According to the National Alliance on Mental Illness (NAMI), dissociative disorders that feature dissociation or depersonalization are:

  • Dissociative amnesia: People forget information about themselves or things that have happened to them.
  • Depersonalization-derealization disorder: This can involve out-of-body experiences, a feeling of being unreal, and an inability to recognize one’s image in a mirror. There may also be changes in bodily sensation and a reduced ability to act on an emotional level.
  • Dissociative identity disorder: A person becomes confused about who they are and feel like a stranger to themselves. They may behave differently at different times or write in different handwriting. This is sometimes known as multiple personality disorder.

In some cultures, people seek to attain depersonalization through religious or meditative practices. This is not a disorder.

Treatment Options For Complex Ptsd

The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practices in health care – has not yet developed recommendations specifically for complex PTSD. They caution that the existing guidelines for PTSD weren’t developed for this kind of diagnosis.

You may find standard treatments for PTSD helpful, but many people with complex PTSD need more long-term, intensive support to recover. As part of your treatment, you should also be offered support for other problems you experience, such as depression, drug and alcohol use or dissociation.

  • Trauma-focused cognitive behavioural therapy (TF-CBT): This is a form of cognitive behavioural therapy (CBT) specifically adapted for PTSD. NICE recommends that you are offered 8–12 regular sessions of around 60–90 minutes, seeing the same therapist at least once a week. See our pages on CBT for more information about this therapy.
  • Eye movement desensitisation and reprocessing (EMDR): This is a fairly new treatment that can reduce PTSD symptoms such as being easily startled. It involves making rhythmic eye movements while recalling the traumatic event. The rapid eye movements are intended to create a similar effect to the way your brain processes memories and experiences while you’re sleeping.
  • Medications for cPTSD: People experiencing PTSD aren’t routinely prescribed medications. However, medications may be prescribed for depression and sleep issues. The most commonly used medications are antidepressants (SSRIs and SNRIs).
  • Other therapies: Some people with PTSD say they have found other treatments helpful in managing their condition, such as group therapy, arts therapies or dialectical behaviour therapy (DBT).

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Dr Murli Krishna

Consultant Pain Medicine