Complex PTSD

I thought I’d take this opportunity to clear up any confusion regarding Complex PTSD (Post Traumatic Stress Disorder). I’ve used this term in several posts and have received a couple of questions about it. Here’s the scoop.

Complex PTSD is a diagnosis that was originally proposed by Judith Herman, M.D., in Trauma and Recovery, her landmark book on trauma (which I highly recommend.) She noted that people exposed to prolonged, repeated trauma such as ongoing physical or emotional abuse, sexual abuse and exploitation, domestic violence, torture, captivity or hostage situations, and some cult situations, often exhibit a set of symptoms and conditions that is much more complex than that associated with standard PTSD.

The following information comes from the webpage on Complex PTSD from the National Center for PTSD:

What are the symptoms of Complex PTSD?

The first requirement for the diagnosis is that the individual experienced a prolonged period (months to years) of total control by another. The other criteria are symptoms that tend to result from chronic victimization:

  • Alterations in emotional regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
  • Alterations in consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body.
  • Changes in self-perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
  • Alterations in how the perpetrator is perceived. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
  • Alterations in relations with others. Examples include isolation, distrust, or a repeated search for a rescuer.
  • Changes in one’s system of meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.

What other difficulties do those with Complex PTSD tend to experience?

  • Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming.
  • Survivors may use alcohol and substance abuse as a way to avoid and numb feelings and thoughts related to the trauma.
  • Survivors may also engage in self-mutilation and other forms of self-harm.

Blaming the victim

A person who has been abused repeatedly is sometimes mistaken as someone who has a “weak character.” They have been misdiagnosed by mental health providers as having Borderline, Dependent, or Masochistic Personality Disorder. Survivors have been unjustly blamed for the symptoms they experience as a result of victimization. Researchers hope that a new diagnosis will prevent clinicians, the public, and those who suffer from trauma from mistakenly blaming survivors for their symptoms.

There is currently no separate diagnosis for Complex PTSD. My understanding is that those suffering from what would be considered Complex PTSD are given the standard PTSD diagnosis, which may be specified as chronic rather than acute. As the National Center for PTSD notes, those with Complex PTSD may need special treatment considerations.

For additional information on trauma and PTSD, check out my Trauma and Healing page for helpful links. You may also be interested in the following blog posts:

PTSD Symptoms Reduced 43% with New Web-Based Online Computer Therapy

Two Great Books on Trauma & PTSD

Aftermath (Or The Joys of PTSD)

Not So Comfortable With Uncertainty


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