There have been some truly remarkable research papers written about complex post-traumatic stress disorder (CPTSD) in the past few decades. Some of the research focuses exclusively on CPTSD while others can apply to any mental health disorder.
In this article, I’m going to break the ice in the series about complex post-traumatic stress disorder and new research findings.
A Definition of CPTSD
I realize that many reading this article are familiar with the definition of CPTSD. However, for the sake of those who are not we shall examine a description of complex post-traumatic stress disorder and some older research outcomes.
CPTSD is a psychological disorder formed in response to prolonged exposure to interpersonal trauma. CPTSD forms in the minds of those who have little hope or no chance of escaping the trauma perpetrated against their person.
Used to explain complex post-traumatic stress disorder, the trauma model of mental disorders is associated with repeated sexual, psychological, physical abuse or neglect, and chronic intimate partner violence. CPTSD can form in childhood or adulthood depending on when the traumatic experiences began.
Symptoms of complex post-traumatic stress disorder vary from person to person, but a comprehensive list is below:
- Reliving the trauma through flashbacks and nightmares
- Avoiding situations that remind them of the trauma
- Dizziness or nausea when remembering the trauma
- Hyperarousal, which means being in a continual state of high alert
- The belief that the world is a dangerous place
- A loss of trust in the self or others
- Difficulty sleeping or concentrating
- Startling easy by loud noises
- A negative self-view
- Changes in beliefs and worldview
- Emotional regulation difficulties
- Problems with relationships
- Thoughts or actions of suicide
- Fixating on the abuser or seeking revenge
Neuroimaging of PTSD and It’s relevance to CPTSD
While complex post-traumatic stress disorder has many differences from post-traumatic stress disorder (PTSD), the two are closely related. So, let us examine the outcomes of neuroimaging done on the brains of those living with PTSD to better understand brain changes from trauma.
A study conducted in 2013 concluded that not only were CPTSD and PTSD closely related, but there are also close similarities to borderline personality disorder (BPD) as well (Stevens, Jovanovic, et. al. (2013)1. The similarities allowed researchers to conduct fMRI studies on those with PTSD and use the same data to project that the same damages were in the brains of people who live with CPTSD.
CPTSD and PTSD are not just for those who have experienced severe trauma such as rape or accidents. These two life-altering disorders affect fifty to seventy percent of the citizens of the United States and cost America over forty billion dollars per year. The suffering and impact on families and communities are profound, leaving many adults unable to cope with their lives and losing the ability to work well (Brenner, (2018)2.
Interestingly, some people traumatized individuals may not show symptoms for many years after the traumatic event. In fact, a paper published in the Neuroscience and Biobehavioral Review found that trauma-exposed people who presented without PTSD showed significantly smaller hippocampal volume, smaller amygdalae, and smaller cortical regions than healthy control subjects.
Not only were those brain regions affected, but regions that control intellect, such as the corpus callosum (the wiring of the brain) and smaller than average frontal lobe volume (the seat of intelligence) (Karl, Schaefer, et. al. (2006).3
The Findings from Neuroimaging Post-Traumatic Stress Disorder
Researchers have conducted many research projects using different modes of neuroimaging, including fMRI, PET, and newer forms of visualizing the brain come into existence every year (Bremner, Randall et. al. (1995).
What researchers looked at the brains of those who have experienced severe traumatic events, such as those returning from the war, they found damage to the amygdalae and hippocampi.
A study examined, with the then-new neuroimaging tool functional magnetic resonance imaging (fMRI) in 1980 revealed smaller than normal volumes in both the hippocampi and amygdalae of people living with the diagnosis of PTSD.
What this study shows is how two vital regions of the brain associated with emotional regulation and memory consolidation are damaged when exposed repeatedly to traumatic stress.4, 5
Placing Complex Post-Traumatic Stress Disorder into a Spectrum
Mental health professionals are currently trying to decide if CPTSD is its own disorder, or if it belongs to a spectrum of trauma disorders. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) the diagnostic bible of the psychological world, did not add CPTSD as a separate diagnosis. Now many mental professionals wish to list it under a spectrum of mental health disorders caused by trauma in both childhood and adulthood.
By placing complex post-traumatic stress disorder into a spectrum means linking it to a range of conditions by similar symptoms and traits. This spectrum may represent a range of severity from “severe” to “mild nonclinical deficits.”
While classifying trauma disorders into a spectrum may seem to lessen the impact of complex post-traumatic stress disorder, it does not. By putting CPTSD into a spectrum, it will finally receive recognition in the next Diagnostic and Statistical Manual of Mental Disorders.
What Neuroimaging is Teaching Us
Neuroimaging has become a powerful tool in recognizing and treating complex post-traumatic stress disorder. However, studies on CPTSD directly are nearly non-existent. By using neuroimaging techniques and tools such as fMRI, scientists are getting closer to understating how badly trauma impacts both children and adults.
Children who grow up under stress from living in a dysfunctional family where they experienced some type of abuse or neglect, grow up with significant changes in their brains. Since they have damage to their hippocampi and amygdalae, they have problems regulating their emotions and overreacting to triggers in their adult environment that cause conflict in forming adult relationships.
Since the hippocampus and amygdala are vital for memory formation, survivors of childhood neglect and abuse have problems remembering events or even suffer from dissociative amnesia. Dissociative amnesia includes forgetting having said or done something or losing time for short periods without having alters like with dissociative identity disorder.
Clearly, complex post-traumatic stress disorder is highly disruptive to the lives of those living under its influence. However, new and exciting research about not just CPTSD but other mental health disorders as well shine a new light of hope for future treatments.
A Hint of Things to Come
This piece has been a review of the basic knowledge many of my readers already have about CPTSD. In the next article, I am going to share some very important discoveries that could mean not just treatments, but possibly a cure.
Be sure to watch for the next installment in this two-part series because the next article will not only blow your mind but also give you hope and encouragement.
References
- Stevens, J. S., Jovanovic, T., Fani, N., Ely, T. D., Glover, E. M., Bradley, B., & Ressler, K. J. (2013). Disrupted amygdala-prefrontal functional connectivity in civilian women with posttraumatic stress disorder. Journal of psychiatric research, 47(10), 1469-1478.
- Brenner, G.H, (2018). New Study Shows Brain Change After Psychological Trauma. Psychology Today. Retrieved from: https://www.psychologytoday.com/us/blog/experimentations/201812/new-study-shows-brain-change-after-psychological-trauma
- Karl, A., Schaefer, M., Malta, L. S., Dörfel, D., Rohleder, N., & Werner, A. (2006). A meta-analysis of structural brain abnormalities in PTSD. Neuroscience & Biobehavioral Reviews, 30(7), 1004-1031. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/16730374/
- Bremner, J. D., Randall, P., Scott, T. M., Bronen, R. A., Seibyl, J. P., Southwick, S. M., … & Innis, R. B. (1995). MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. The American journal of psychiatry, 152(7), 973.
- Pitman, R. K., Rasmusson, A. M., Koenen, K. C., Shin, L. M., Orr, S. P., Gilbertson, M. W., … & Liberzon, I. (2012). Biological studies of post-traumatic stress disorder. Nature Reviews Neuroscience, 13(11), 769.
My name is Shirley Davis and I am a freelance writer with over 40-years- experience writing short stories and poetry. Living as I do among the corn and bean fields of Illinois (USA), working from home using the Internet has become the best way to communicate with the world. My interests are wide and varied. I love any kind of science and read several research papers per week to satisfy my curiosity. I have earned an Associate Degree in Psychology and enjoy writing books on the subjects that most interest me.
Thank you! I have always been “forgetful”. I forget specifics of conversations and can’t remember previous things that I said. It has always made me feel crazy and i receive a lot of backlash because of how much i forget. Now I know I am not crazy and being forgetful is no fault of my own. Now I just have to figure out how to fix that.
I’m so glad you found my article helpful. Keep us posted on how you are doing. Shirley J. Davis
Are there any studies being done? I have a PTSD diagnosis and when I brought this up to my therapist she had never heard of it. I really think that this fits my experiences a lot more. I would absolutely love to allow someone to pick my brain if it improves the quality of knowledge and care for future patients. The more we know the better the chance of finding the most successful treatment and getting the best help.
Yes, there are plenty of studies. You can find them on Google scholar. However, I don’t know if there are studies going on right now. Try Googling it. Sorry I can’t be of more help. Shirley
I have just been diagnosed with C-PTSD. They thought it was Ptsd at first but my symptoms have affected me my whole life it seems.
There doesn’t seem to be much info here in the uk. Is there any articles you can suggest on the above please?
I’m trying to understand who i am at the moment if you can understand my logic. Thank you
I respectfully think that complex PTSD, is far more complicated, I suffer from it and want to interact with researchers, professionals and reach out to those suffering. I have all the symptoms, everyone, of CPTSD, it is too easily dismissed, as a personality disorder, but I believe, no. My mother had post-partum depression, badly, so I didn’t exist. This frustrated my father, who came emotionally/verbally abusive. My mother, against medical advice, went offer birth control and had a daughter, that she always wanted, growing up with all sisters, figuring, what do I have to live for anyway and that was her emotional rock. Obviously, now, my father saw that as betrayal, emotional/verbal abuse escalated, he called my sister, the amazing accident, I got sick of it and after saying it one too many times, I asked him to stop, flapped, hard enough for a room to hear it, not hurt, but a mental wound, his ego, challenged. He apologized, fine, but that fixes nothing. He then left, when I was 10, moving us to a crappy area, having to fit in, in fear of getting bullied, beat up, asked to man up and look after my mother, on disability for mental health, did not know how to drive and a sister, 6 years younger. He returns, lonely, this happened 4 times and I could not express myself at home, so it caused problems at school. It got worse, in other ways, he wanted me to take over a family business, I did not want to, I tried University, did well, but many abused student loans, parental signing of loans, so parents knew coverage mandatory, he wouldn’t sign it, the first time, it seems sunny outside, like a future, that would be mine, denied. Our city had the largest mental health hospital in the country, shut down, for the wrong reason, so I cashed in an insurance policy, with extra equity, asked a student counselor, how to get qualified for something and a community college, counseling course, added suicide prevention/interaction, but also, psychological testing and evaluation, in cooperation, with a large university, some long-distance courses, but my tutor, a professor, taught psychiatry. I was all in, went way above course requirements, ready every book on counseling, ran out, then psychiatric nursing books, ran out, then psychiatric manuals, mastered the DSM 4, interpretive guide, then medical accompaniment guide, less noted, then upgraded to the DSM 5, really, an amendment. I did terrible in grade school, hell at school, hell at home, a 51 to pass, then finished that course, with a 96, dropped to a 94, because, learning psychological testing and analysis, I overqualified for OCD, PTSD, Anxiety disorder, histrionic personality disorder, Major Depression and my assessment was correct, but I didn’t want to accept it, dropped 2 points. That is not brilliance, but the effort and desire to learn. I did my practicum at an addiction clinic, did testing, to help prepared psychiatrists, for consultations, asking for feedback, and usually, they said it was so spot on, the diagnosis, prognosis, tests used, scores, interpretation, medication I would use, they astounded, but it really wasn’t. Hard work, but this might sound selfish, I needed to help myself and in doing so, help others. * It doesn’t explain biological, or genetic disposition, it doesn’t explain happening so young, and emotional, cognitive cancer, if you will, I dropped my position, to the dismay of my clinic, citing, being an impaired professional, keeping my qualification, but this emotional cancer, was eating me alive and if I couldn’t give 100% to others, I was stepped down, hoped to get back, but took something simpler, but that became hard. ** To think about: how, after a family history of mental health, regardless of a living hell childhood? That is not a borderline personality disorder, I helped with that. I taught CBT and this was way beyond that, but helped, more minor cases, none good, but not this bad. I interacted with the U of Penn, looking at the FDA and drugs. How does it work? A drug company makes a drug, picks from, then, 30 researchers, paid $500,00 USD for their time, each tested 3 times and if failed, it failed, but too many passed and could not be repeated, by independent researchers and theirs, was to teach and findings were not good. It was found, that drug companies shared, who was passing drugs, with no chance to pass, in agreement, marketing would be competition, with billions at stake. One researcher, from an iconic university, had an income of $837,00 USD, but only $237,000 from the university, passing everything, to be picked again, put on lifetime suspension, “whoop de doo”! How many did he pass, wrongfully? There were 30 on suspension, from a year, 6 years, or life, it was predicted by them, it would rise, now 6 years, for bad, life for profound, now 130 lifetimes suspension. Example: Citalopram (Celexa), went generic, you get 7 years, then shareholders want a replacement, there is none, so they looked at, what entered the body, Escitalopram (Lexapro), mild filtering by the liver, more the casing, but it is the same drug, new name and it passed? How? Then Prozac (Fluoxetine) went generic, so did Zyprexa, an atypical antipsychotic (Olanzapine), both now generic, atypicals boost SSRIs (antidepressants), in small doses, so they were combined, called Symbyax and it passed, as new, when both could be combined generic and that is the relationship, between Imipramine (Elavil) and Desipramine (Norpramin), older, Tricyclic Antidepressants, meaning they affect Serotonin, Norepinephrine, and Dopamine, but with side-effects, they all do, underrated by all, but the move to SSRIs, was not better, just less lethal, if downing a whole bottle, if all effected, no kidding and the truth, is these are all stabs in the dark, with acknowledgment, that they have no clue how they work, guessing, fine, better than nothing, but this leads to treatment-resistant depression diagnoses, a number of failed antidepressants, but you may try six, but really, you tried 2 of each version, really 3, not 6. Paxil failed, really, Luvox was taken off the market, basically, I have seen, persons supported, off brutal street drugs, a former addictions counselor and nothing compared to weaning off of Effexor, I did and it was absolutely worse than what I saw, helping others come off of cocaine, heroin, or ecstasy. How could that go unnoticed and true? Why and how are atypicals passing so fast, new antidepressants passing so fast, they should be, better than nothing, some, but this broken system hurts those that are hurting, which is us. I used to be on the other side of the table, so I can see from both sides. It is alarming, that I often know more about medications, than doctors and pharmacists, not being smart, I learned, to be good at my job and I still look at my studies and it is brutal. One company noted, that it was 10% better than another, I wanted to know, what that meant and it meant, it was 1.9% effective, over 0.9% effective, so stats, are worse, than lies and mistruths. Celexa did show good efficacy (it works better than placebo (fake)), so that means Lexapro, has to be the same. Pdocs, look at a number of failed meds, then right them off, but most shouldn’t have passed in the first place, so giving up, is never good. Professional arrogance, is real, thankfully, my co-workers, were great. It really means, not keeping up with the times, or stubborn, or, both. * The seeming, good approach, I say seeming, is CBT, or DBT, (cognitive behavioral therapy and dialectic), needed, but not loving meds, it has to be in combination, but it sucks, for me, to have to find what I need to know out, that skill, not lost, but my pdoc, a good guy, seems to see that, as he knows better, how dare I suggest trying something and that is professional arrogance, even a good person. ** The takeaway and I want to talk to those, that are really looking at this, is CPTSD, is not the same as PTSD, with genetic predisposition a factor, it is not a borderline personality disorder, very responsive to CBT, or DBT, not the same. I remember feeling this, as early as 3 years of age, way before this could happen, not joking and it never stopped and you cannot develop, fully personality disorder, that young, without a genetic predisposition. This belongs, separate, in the DSM, as it is different. For those that don’t know, the DSM is like a maze. If this shows, move to here, if this symptom is there, but not this, move here, if both, move here and that is how it goes, so one symptom, changes everything and it takes communication, experience, an open mind, and cooperation. I do NOT know it all, I work hard to know, ask those that know more, know where to look, ask for validity and it is hard work, to help myself and I want to help others and work with professionals, so things change and their hard work, is not discounted. One form, of professional arrogance, is publication. If published, then shown wrong, that is not good for income, or reputation, but it is alright, to readdress it, being human, in a follow-up. I was asked to work on a manual and procedure guide, thinking, my boss if curious, I rewrote it, with experience learned, I got called into an office, I didn’t know, what I did wrong, but I was told, they wanted that, as the new policy manual and training manual, not just for them, but colleges and universities wanted it, for teaching and I was asked, if I would be willing to hand over copyright, or trademark rights and I said, of course. The goal is to help and that is not bragging, it happened and from hard work. If I screwed up, I would go back and note it, without hesitation, or arrogance. ** This is real, the symptoms are real, examining and listening to experts, not me, it seems, CBT, or DBT, similar, plus an antidepressant, that offer efficacy, it works, with least side effects, the goal, plus not eliminating benzodiazepines, for anxiety, wrongly hated, the stop panic attacks and it is not mental, for severe, but found, by accident and body overreaction, to high CO2 levels, but not abnormal, like an allergic reaction, which is an overreaction, to something harmless, by our own immune system and that changed the game, when psychopharmacological researchers found, they could induce them in themselves (accident), but only benzodiazepines would stop them, why, who know, but not and ADs, a game-changers. There is some hate, for good reason, but note this. If anyone is started on an AD, the dose is low, increased slowly, to minimize side-effects, biological adjustment, find a therapeutic dose, considered appropriate, but if the same is done, with a benzodiazepine, people scream tolerance, danger, narcotic, but anything, mixed with alcohol, or a street drug, to enhance the effect, is a narcotic, including, many anti-seizure medications. Lorazepam acts fast, with a shorter half-life (time for half to leave the body, metabolize), but clonazepam, has a slow onset and long half-life, so it feels more natural, not like being on an anxiety roller coaster. If Tylenol, enhanced the effects of street drugs, or alcohol, it would be a narcotic. *** This may sound like pushing meds, I hate them, but the information helps, you can dispute it, or look it up, stopping trying is stupid, it is all trial and error right now, but complex post-traumatic stress disorder is unique, it has to have a genetic predisposition, to happen to many so young, or at least, not discounted, not throwing everything under personality disorders, but there is validity when it makes sense, but in my opinion, suffering and those friends I ask, former co-workers, a team, agree, it is nothing, to help myself, others and want to cooperate with those, my educated, more experienced, to help all and they, not discounted. It sucks, to be honest, but giving up, is just dumb. Once something enters the Cochrane manual, the Cochrane Institute, in Scotland, my heredity, invite the best of the best specialists, but when someone challenges the status quo, they are often in a war against a decision, which does not make them wrong, but they face, wrongly, ridiculous and unprofessional hurdles, again, professional arrogance and that is among all professional, not picking on mental health professionals. *** This is for all, but if a professional reads this, I would love to interact with them, why this is so long, also valid, they will no true and cooperation moves forward. All the best, be well and I will use a fake name, with hackers everywhere, but can be contacted, easily. Be well to all and don’t give up, plus, don’t give up, advocating for yourself, or, not being a hater, find a doctor, that is a teammate, mandatory. * Important* I am not asking anyone to agree, mindlessly. I don’t know it all. If any helps, good. If wrong, fine. The goal, is to help everyone and that means helping professionals, hopefully taking note and I respect all other opinions, because you may be right, fine, me wrong, but ego is not in the way. Take care!
I was put on Effexor very high dose for a psychotic depression from Cptsd
My second round after Cptsd all childhood from a malignant narcasstic mother
This time it’s 9 years on and it permanent nothing touches it and I developed a host of severe chronic health conditions and told I have brain damage
My psychiatrist tried everything over 8 years then said nothing more he could do. I’m still on the Effexor that’s 9 years. Do you think beneficial to come off it. I don’t know if it’s doing anything or just making me numb
I think my Cptsd is permanent
3 rounds of it thanks to my evil mum
I would like to be notified when new article is released.
I’m not sure how we would do that, but you can ask about it using the contact us at https://cptsdfoundation.org/contact-us/ Thank you for reading my articles, it means a lot to me. Shirley
This is new to me. Why is it new to me? I am reading and the challenges of my life suddenly make sense. Other people have similar symptoms. I don’t think this information is taught to people training to be therapists.
Interested
Interested Joel Theriot