What We'd like the Public and Journalists to Know about CPTSD

[Kizzie]

There is a story breaking on the horizon that you may want to be a part of. It regards a groundswell of people who are beginning to come together at sites like Out of the Storm to share their experiences about the effects of be exposed to ongoing trauma, and discuss our collective realization that we share a cluster of symptoms known as Complex Post-Traumatic Stress Disorder (CPTSD).

CPTSD is a stress disorder that involves a number of symptoms (Courtois, n/d) including alterations in: the regulation of affective impulses (difficulty being able to self-sooth and with emotions such as anger); attention and consciousness (e.g., commonly suffer from mild to severe dissociation); self perception (e.g., chronic sense of guilt and shame); perception of the perpetrator (loss of trust in others); relationships to others (social anxiety, avoidance, isolation);  systems of meaning (feelings of hopelessness, of being different from others); and, in health (prone to a variety of medical problems relating to prolonged stress).

In terms of the root causes CPTSD  results from traumatic experiences that are: "repetitive, prolonged, or cumulative"; interpersonal and involve "direct harm, exploitation, and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults"; and, "occur at developmentally vulnerable times in the victim's life, especially in early childhood or adolescence"  (Courtois, n/d). CPTSD may be thought of as a psychic injury resulting from prolonged exposure to stress/trauma, most commonly childhood abuse and neglect.

Although the term "Complex PTSD" first appeared in the academic literature more than two decades ago (Herman, 1992), it is only recently that it has become publically accessible through the publication of books for written for sufferers, in particular CPTSD: From Surviving to Thriving by Pete Walker (2013).  It is in his words, written from the point of view of a therapist and someone who suffers from CPTSD himself that many of us have found ourselves, perhaps for the first time ever.  Far too many of us have been wandering in and out of treatment, never quite finding that diagnosis that fit entirely and which promised relief from our pain ..........until now.   

The term "Complex PTSD" first appeared in the book "Trauma and Recovery" written by Judith Herman in 1992.  Since then debate over the diagnostic criteria for CPTSD in clinical and academic circles has led to the use of a confusing array of terms to describe the disorder including Complex Trauma, Disorder of Extreme Stress Not Otherwise Specified (DESNOS), and in the case of children, Developmental Trauma.

It appears that much of the confusion surrounding CPTSD stems from the fact the one or more of the cluster of symptoms are common to other disorders and this has led to a variety of misdiagnoses, typically Post Traumatic Stress Disorder (PTSD).  CPTSD and PTSD can and do overlap, but PTSD involves different symptoms including: re-experiencing the traumatic event - visual flashbacks in which the person feels as though the traumatic events were happening again (CPTSD sufferers tend to have emotional flashbacks), as well as frequent upsetting thoughts or memories about the traumatic event, nightmares and strong feelings of distress when reminded of the traumatic event; avoidance - avoiding thoughts, feelings, or conversations about the traumatic event, and places or people that are reminders of the traumatic event (whereas CPTSD sufferers experience mild to severe dissociation);  and, hyperarousal - having a difficult time falling or staying asleep, feeling more irritable or having outbursts of anger, having difficulty concentrating (while CPTSD is characterized by hypervigilance - constant monitoring of the enviroment for danger). Finally, the cause of PTSD typically involves a single event or a group of events of limited duration (e.g., witnessing a tragedy, being the victim of a violent act, military combat), while with CPTSD trauma is long term and cummulative (e.g. ongoing childhood abuse/neglect, living as a refugee, prostitution, slavery).

CPTSD sufferers are also often misdiagnosed with personality disorders, in particular Borderline Personality Disorder (BPD).  According to Ford and Courtois (2014), BPD and CPTSD do tend to overlap, but like PTSD there are different  criteria for BPD including: terror of abandonment or rejection; and, alternating idealization and devaluation of others.  Further, while the etiology of CPTSD is trauma related, the development of BPD is more multi-faceted in nature. Why is this important? In addition to the obvious, that is, when we are misdiagnosed we do not receive relevant and effective treatment, many of us feel stigmatized by diagnoses like BPD in which symptons are "typically treated as innate characterological defects rather than as learned maladaptations to stress – maladaptations that survivors were forced to learn as traumatized children" (Walker, 2013, p. 9).  What a diagnosis of CPTSD means to many of us is that we have a psychological injury as opposed to a life sentence, and that what we learned in response to the trauma we faced can be unlearned and replaced with more functional behaviour. In short, it gives us hope and it's a message we hope you will help us to pass along.

Since Out of the Storm was rolled out in August 2014, membership has grown to almost 200 people in five short months. It would not be unreasonable to suggest that it will continue to grow exponentially for as Walker (2013) suggests, there are many more of us out there than previously imagined:

I once heard renowned traumatologist,  John Briere, quip that if Cpstd were ever given its due, the DSM {The Diagnostic and Statistical Manual of Mental Disorders} used by all mental health professionals would shrink from its dictionary like size to the size of a thin pamphlet. In other words, the role of traumatized childhoods in most adult psychological disorders is enormous (p. 08).

We greatly appreciate efforts toward raising awareness about CPTSD and what it is and is not. If you have questions please post them in the thread "What would you like to know about CPTSD?" or alternately you may start a new topic in this forum.

References

Courtois, C. (n/d). Understanding Complex Trauma, Complex Reactions, and Treatment Approaches. Available: http://giftfromwithin.org/html/cptsd-understanding-treatment.html.

Ford, J. D. & Courtois, C. (2014).  Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation , 1(9). Retrieved from http://www.bpded.com/content/1/1/9.

Herman, J.  (1992). Trauma and Recovery. Basic Books.

Walker, P. (2013).  Complex PTSD: From Surviving to Thriving.  Azure Coyote Books.