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Complex PTSD

A young adult woman with depression is struggling with her mental illness. A supportive friend is reaching her arm out to help her.

Complex PTSD is a type of PTSD that is often caused by ongoing or repeated trauma where the victim has little or no control and no real or perceived hope of escape. Typically, complex PTSD is associated with neglect, abuse, sexual assault, domestic violence or abandonment by a caregiver during any stage of childhood or adolescence and creates long-term developmental challenges. These experiences lead to deteriorated self-esteem, difficulty learning and concentrating and having to cope with intense painful emotions throughout life. 

Complex PTSD is difficult to diagnose because many of the symptoms overlap with the mental disorders of depression, Borderline Personality Disorder and PTSD. However, when a person who has experienced a prolonged period of months to years of chronic victimisation and total control by another, they may develop the symptoms of complex PTSD:

  • Problems with emotion regulation – High emotional sensitivity and a reduced ability to respond to situations in a manner that is socially tolerable. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger. 

  • Negative perceptions and meanings– May include beliefs about the self as totally helpless, shameful, guilty, different to others, and worthlessness, feelings of hopelessness and despair. 

  • Memory loss and perceptual disturbances – forgetting parts of the traumatic event, reliving traumatic memories as if they are happening now, or dissociation – episodes of detachment from oneself or body (depersonalisation) or the environment seems surreal (derealisation)
  • Problems maintaining healthy relationships – Promiscuity and risk taking, difficulty feeling close to another person and a general feeling of mistrust, isolation,  distance or being cut off from other people or else searching to be rescued by a partner.
  • Love/hate for the perpetrator –  Believing the perpetrator has total control, disgust and disbelief that nothing was done by a care giver to stop the abuse, fixating on the relationship to the perpetrator or becoming preoccupied with thoughts about revenge.

Symptoms that overlap with other mental disorders include:

  • Avoiding thinking and talking about trauma-related events and topics because the feelings are overwhelming
  • Self-medicating with alcohol or other substances as a way to avoid or numb feelings and thoughts related to the trauma
  • Acts of self-mutilation and other forms of self-harm
  • Alterations in attention

Like single episode PTSD, and chronic PTSD, it is possible to recover from complex PTSD. Recovery can be a lengthy process that involves learning to think, feel and act differently to the traumatic experiences and developing a new sense of self by acknowledging the trauma and building self-compassion for the traumatic events experienced. However, having trauma-focused evidence based therapy for complex PTSD and developing a network of support can lead to transformation of relationships previously experienced as distant and cutoff and dealing with emotional pain and life stresses in healthy ways.