Most of us have heard of post-traumatic stress disorder. Once called shell-shock, the disorder develops after being exposed to a highly traumatic situation such as war or a car wreck. However, there is another type of trauma-induced problem called complex post-traumatic stress disorder.
Today we begin to explore together complex post-traumatic stress disorder. Over the next four weeks, we will look at the definition, causes, and treatments of this often-disabling mental health issue.
CPTSD and PTSD in the DMS-5
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), is the bible of the psychiatric world. However, CPTSD is not mentioned because the author’s believed it was sufficient to lump it together with other trauma-related disorders including post-traumatic stress disorder.
The tragedy of complex post-traumatic stress disorder not appearing in the DSM-V is that mental health providers cannot officially give their clients this diagnosis because it is not accepted by the American Psychiatric Association, the publishers of the DSM-5.
However, there is a growing movement among those living with CPTSD and others who are advocating to have this diagnosis receive its own listing in the next edition. The reason this is vital is that the symptoms of CPTSD are different in many important ways than PTSD.
Now you may be wondering, what’s the difference between complex and the other style of stress disorder, (sometimes referred to as “simple” or “classic” PTSD when being compared or contrasted with complex PTSD)
Post-traumatic stress disorder develops when a person experiences or witnesses something which is frightening, shocking, dangerous or scary. Most people recover from such experiences, but some people develop short-term or ongoing symptoms including re-experiencing the event(s) through flashbacks or nightmares, avoiding places, events or objects which remind them of what they experienced, or arousal symptoms like being easily startled.
Complex post-traumatic stress disorder is different in two crucial ways, the trauma is longer-lasting or repeated, and the symptoms are more severe.
CPTSD can form in both children and adults, but in this series of articles, we are going to focus on children and how what they can face will affect them throughout their life span.
What is Complex Post-Traumatic Stress Disorder?
Repeated interpersonal trauma is the main cause of CPTSD. It occurs when the child feels they have little or no chance of escape.
Developmental Trauma Disorder (DTD) has been suggested to differentiate CPTSD from the other form of PTSD better.
The trauma model states that children who experience chronic sexual, psychological, physical abuse and neglect develop CPTSD. However, it also forms in kids who suffer slavery, human trafficking, working in sweatshops, war or survivors of concentration camp environments and cults. The trauma which causes this disorder may also include having experienced betrayal, defeat, and shame.
In short, any repetitive situation where the child cannot escape or believes themselves trapped with no hope of escape.
The symptoms of CPTSD can be life-altering and cause severe disabilities such as many different forms of mental health disorders, including borderline personality disorder, dissociative disorders, and somatization disorder. The emotional damage that precludes complex post-traumatic stress disorder can lead to prolonged feelings of terror, worthlessness, helplessness, and the warping of the identity and sense of self in children.
When these children become adults, they have wide-reaching symptoms with not having a solidified understanding of self and problems regulating their own emotions. However, while the emotional state of young children facing overwhelming life experiences is terrible enough, repeatedly being in a position of being in danger continually changes their brains as well.
The amygdalae of these highly traumatized youngsters, due to its constant bombardment from the stress hormones which make the body ready for fight or flight cannot form correctly. This part of the human brain responsible for emotional regulation has been found to be smaller than average by as much as 20% or more when they reach adulthood.
Other parts of the body are affected as well as the body’s inflammatory response to the ongoing influx of stress hormones, harming the child’s systems. Illnesses in adulthood are directly attributable to trauma in childhood, such as problems with immune system disorders, diabetes, and heart disease.
The ACEs Study
In the early 1990s, a physician named Vincent Felitti who worked for Kaiser Permanente in San Diego asked a patient who had lost a great deal of weight in a weight loss program why they had dropped out. The answer given stunned Dr. Felitti.
That person and many of the other patients in the program that Dr. Felitti interviewed individually expressed that they believed the weight loss made them feel too vulnerable. Many of those he questioned also disclosed experiencing childhood sexual abuse and that they thought deep inside that the excess weight protected them from attack.
The findings of Dr. Felitti were of interest to Dr. Robert Auda who worked for the centers for disease control (CDC), and together they initiated the CDC-Kaiser Adverse Childhood Experiences Study.
In the years between 1995-1997, a study involving 17,000 participants attempt to measure the number of adverse childhood experiences the subjects had experienced throughout their lives. They wanted to understand the relationship between ACEs and the health and life functioning of people who had experienced events in their childhood which were extremely negative.
The study was the first and largest of its kind centered around examining the impact of traumatic events experienced in childhood and their effect on the health of adults.
The findings of the study brought about groundbreaking insights, first of which is that childhood trauma is much more common than previously thought and the prevalence was not limited by race, creed or income.
This finding that children of every demographic group experience abuse and neglect was unconventional, as the prevailing thought that children belonging low socioeconomic status and racial minorities were more often victims of familial violence than white children.
That thought is understandable once you consider the prejudices of the time and the disproportionate number of families from lower socioeconomic status and racial minorities represented in the child welfare system.
The ACEs Study introduced a new narrative on child abuse; it cuts across all populations regardless of income, religion, race, and education.
Through the ACEs study, researchers learned that almost 30% of participants had experienced physical abuse in childhood, and 15% had experienced emotional neglect. However, the results became breathtaking when another study by Dube et al. was reported in a paper published in 2005.
They found that out of 17,337 adults who participated in their study, 16% (1 in 6) men and 25% (1 in 4) women reported sexual abuse before their 18th birthday.
The researchers also discovered that of the ten different categories of abuse, neglect and other household stressors related to those acts, the acts rarely occurred as single events. Among adults in the study who reported sexual abuse, 80% also reported at least one other type of abuse perpetrated against them during their childhoods.
However, the following fact really startled the researchers. The men in the study reported they had been perpetrated against women 6% of the time. Women, long thought to be incapable of committing such criminal acts against children were recast into a new light, that of a possible sexual predator.
The Effects of ACEs on the Health of Adults
As has already been said in this article, the effects on the health of an adult who lived through an abusive or neglectful childhood are greatly devastating. These effects include changes in both the mental and physical health of the survivors.
The ACEs study reported another finding that has consequences for millions around the world. Of the participants studied, the higher the total number of ACEs they reported, the more negative health consequences they experienced.
This unexpected outcome meant there was a graded dose-response in the relationship between the number of ACEs experienced by an individual and the adverse health and well-being across the person’s lifespan.
All that means is that the more negative experiences a person had in their childhood, the higher the negative health consequences they will experience.
These negative health consequences can readily be understood if you see the ACEs pyramid (pictured above). Starting at the bottom, with the experiences and going up one can see the immediate consequences are in social, emotional and cognitive abilities. It is challenging to concentrate on social skills and school work when you are busy surviving the unthinkable at home.
Moving up we can see the next phase where, as the child grows, they adopt unhealthy and risky behaviors such as overeating, and experiencing drugs and alcohol to numb their pain.
In the next stage up on the pyramid, the risky behaviors take a toll on the mental stability and physical health of those who lived through childhood trauma.
Finally, the health problems caused by behaviors adopted to deal with childhood ACEs take a toll and the child, now an adult, dies young.
There are enormous consequences to ACEs to a child grown into adulthood. The list below is by far not all-inclusive:
- Chronic Obstructive Pulmonary Disease (COPD)
- Lowered quality of life due to health problems
- Ischemic heart disease
- Illicit drug use
- Liver disease
- Poor work performance leading to losing jobs
- Impaired interpersonal relationships
- Lack of ability to properly handle finances
- An increased risk for intimate partner violence (perpetrator and perpetrated against)
- Numerous sexual partners leading to sexually transmitted diseases
- Suicide attempts or death by suicide
- Unintended pregnancies
- Eating disorders
- The development of Borderline Personality Disorder, Dissociative Identity Disorder, and other serious mental health problems
The Economic Costs to the United States for Adverse Childhood Experiences
Although child abuse is a global phenomenon, it is in the United States where the figures for the economic costs are more readily available.
The total economic amount which results from new cases of fatal and nonfatal child abuse and neglect in the U.S. in 2008 was estimated to be 124 billion dollars. This figure is higher than the cost of all other well-known health problems in the country such as stroke and type 2 diabetes.
It even gets more real when one considers the estimated cost per survivor of nonfatal child abuse and neglect which was also estimated in 2008 to be $210,012 per person.
These costs include:
- Childhood health care costs
- Productivity losses
- Adult medical care costs
- Child welfare costs
- Special education costs
- Adult and child mental health care costs
Upon death, each adult survivor of child abuse has an average lifetime cost of $1,272,900 including all medical expenses and productivity losses.
While these figures are staggering, this is just the cost in one single country.
The Personal Cost of Adverse Childhood Experiences
While it is essential to understand the huge financial costs of ACEs, we can never put a price tag on the enormous personal toll it takes on survivors.
Being a survivor of severe neglect and abuse leaves a person feeling anxious, desperate and forever searching for peace of mind. We are always on the lookout for someone to fill in the gaps left by uncaring or abusive parents in our adult relationships.
Unfortunately, there are so many people walking about wounded that it is inevitable two hurt adults will find one another and experience more trauma when they realize the other person is caught up in a silent prison of their own.
However, there is hope.
Working with a qualified mental health professional who has training in trauma-informed care can significantly enhance the lives of those struggling with the after-effects of childhood trauma. It is a long and hard road, but an improved outlook on life is achievable and will happen with a dedicated effort.
Some of the mental health disorders listed above, borderline personality disorder and dissociative identity disorder, are severe and will take a long time to conquer. However, survivors can and will overcome the effects of these severe illnesses once they decide they crave gaining a life more than remaining stuck in the trauma of their past.
I know, I am one of them.
Prevention of the Impact of ACEs on Future Generations
I think we can all agree that ounce prevention is definitely worth more than a pound of cure. If we are to end the tragedy of adults living shortened and altered lives, we must stop the child abuse from happening in the first place.
To do this an open and honest dialogue needs to take place, and the abuse of children by both men and women shoved into the sunlight and out of the shadows. For, as we all know, evil loves the darkness, but the light tends to stop evil cold in its tracks. Darkness and light cannot coexist.
Once people, ordinary citizens of the world like you and me, force child abuse into the open, then political leaders will be forced to deal with it by appropriating more money to help children who are in danger and living in the hell of child abuse and neglect.
A Shameless Plug for a Wonderful Organization
I joined the Complex Post-Traumatic Stress Disorder Foundation (CPTSD Foundation) as a staff writer several months ago, but have just begun to write for them in earnest. I am very proud to be a member of this wonderful organization and to know the founder, Athena Moberg.
The CPTSD Foundation operated by an all survivor network of people who feel dedicated to taking a revolutionary approach to healing, allowing and understanding each survivor heals in their own time and in their own way.
We offer many helpful resources (you need to search the website, I’m not going to allow you to cheat) which helps people along their healing journey.
By working together, humanity can end the scourge of child abuse and make our future world a safe place to grow up. I firmly believe that and so does the entire team at CPTSD Foundation.