Human brains are hardwired to react viscerally to traumatic events. They then store those emotions in our central nervous, so that when we feel and experience similar future events, we will be alerted to new potential dangers.
Emotional flashbacks, experienced by those living with complex post-traumatic stress disorder, are sudden and horrific, often prolonged, attacks from past highly traumatic events. Although these flashbacks are somewhat different than those experienced in post-traumatic stress disorder, both are very intense, confusing, fear-laden attacks of sorrow, and rage that causes terror and despair.
In this article, we shall examine the history of PTSD and how it has aided our understanding of how trauma affects the brain and thank those who serve or have served in our military forces on Veteran’s Day.
The History of Post-Traumatic Stress Disorder
To understand the differences between the diagnoses of PTSD and CPTSD, we need to understand the evolution of stress-orders and their eventual recognition by the American Psychiatric Association.
PTSD has been around as long as humans have inhabited the earth. It was inevitable that our ancestors would develop the disorder as they lived in constant threat of death.
It could be that long ago post-traumatic stress disorder was adaptive, teaching us to respond quickly to situations, similar to the one that caused us to develop PTSD in the first place.
Although in the present it is common knowledge that post-traumatic stress disorder exists, it wasn’t always so.
Josef Leopold, an Austrian physician, in 1761 wrote about what he termed “nostalgia” among the soldiers he had observed who received exposure to military trauma.
These men experienced problems with missing home, sleep problems, anxiety, and feeling deeply sad.
Dr. Leopold’s description became a model of what physicians, during the Civil War in the United States, saw among fighting men. The doctors of that time suggested the cause of nostalgia was a physical injury.
In fact, United States doctor Jacob Mendez Da Costa, who studied civil war soldiers, determined the racing hearts, rapid breathing, and pulse to be markers of the heart, and described it to be overstimulated. This diagnostic description became known as Da Costa’s Syndrome.
Thus, during the civil war men received drugs to control their symptoms and returned to the battlefield.
Spring forward to World War I. In 1919, World War I ended, but the war continued for many returning to their homes from the battlefields of Europe. By then, PTSD, known as shell shock, got its name because physicians believed the reactions observed in returning soldiers resulted from the explosion of artillery shells.
Men who had served in World War I had the symptoms first observed by Josef Leopold: panic and sleep problems. The Doctors determined that the damage was hidden brain damage from the impact of the firing sound of big weapons. However, they had to reconsider this when they observed men, who had not been near explosions, presenting the same symptoms. Thus, the name “war neuroses” was born.
Once again, soldiers, who received the diagnosis of war neuroses during World War I received a few days rest before returning to battle.
Battle Fatigue or Combat Stress Reaction (CSR)
It was during World War II that shell shock took on a different name, combat stress reaction, more commonly known by the term “battle fatigue”.
Many men during World War II entered the hospital suffering from severe symptoms of PTSD after surviving long surges of battle. Unfortunately, there were many military leaders, such as Lieutenant General George S. Patton, who did not believe in the existence of the disorder and treated men with cruelty considering them to be cowards and deserters.
The fact remained, that almost half of World War II military discharges resulted from combat exhaustion.
The treatment options of the day were extremely limited, and the doctors felt an immense pressure to treat men without delay, allowing them to recover and quickly return to battle. Despite this pressure, these doctors instilled a movement of support for military men, focusing on both preventing the stress-causing battle fatigue and promoting recovery.
It should be obvious that without the men of the past who served our country and sacrificed themselves for it had not allowed themselves to be studied, we would not understand trauma-related disorders today.
Again, we need to thank these brave people for their sacrifice.
PTSD and CPTSD Can Indeed Occur in the Same Person
PTSD and CPTSD have different symptoms but can absolutely cooccur within the same person if that person suffered in childhood from repeated neglect and abuse. The brains of people living in those conditions as children are different because they had to adapt to unnatural conditions to survive and make it to adulthood.
Once these children grow to be adults and then join the service, they are set up for a myriad of difficulties including PTSD on top of the CPTSD they developed as a kid.
There is a need to recap the symptoms of each disorder so that those who are new to the condition and perhaps reading about them for the first time may recognize themselves. PTSD is normally caused by exposure to a traumatic event once that is disturbing to how the person sees their world. The main symptoms of post-traumatic stress disorder are as follows:
- spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events
- recurrent distressing dreams in which the content or effect (i.e. feeling) of the dream is related to the events
- flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring
- intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events
- physiological reactions to reminders of the traumatic events
- persistent avoidance of distressing memories, thoughts, or feelings about or strongly associated with the traumatic events or of external reminders
- inability to remember an important aspect of the traumatic events (not due to head injury, alcohol, or drugs)
- persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
- persistent, distorted blame of self or others about the cause or consequences of the traumatic events
- persistent fear, horror, anger, guilt, or shame
- markedly diminished interest or participation in significant activities
- feelings of detachment or estrangement from others
- persistent inability to experience positive emotions
- irritable or aggressive behavior
- reckless or self-destructive behavior
- exaggerated startle response
- problems with concentration
- difficulty falling or staying asleep or restless sleep
- clinically significant distress or impairment in social, occupational, or other critical areas of functioning not attributed to the direct physiological effects of medication, drugs, or alcohol or another medical condition
Complex post-traumatic stress disorder has some similar symptoms to PTSD, but they differ in some basic ways. For one, while CPTSD can form in adulthood, unlike PTSD which forms from exposure to a single event, CPTSD is caused by exposure to repeated abuse and neglect in childhood.
The symptoms of CPTSD may include:
- Losing memories of trauma or reliving them
- Difficulty regulating emotions that often manifest as rage
- Suicidal thoughts or actions
- Sudden mood swings
- Feeling detached from oneself
- Feeling different from others
- Feeling ashamed
- Feeling guilty
- Difficulty maintaining relationships
- Difficulty trusting others
- Seeking our or becoming a rescuer
- Feeling afraid for no obvious reason
- Having a feeling of always on the alert
- Becoming obsessed with revenge on the perpetrator
- Feeling a loss of spiritual attachment and either ignoring or depending upon religion for self-worth
The symptoms of each post-traumatic stress disorder and complex post-traumatic stress disorder are life-changing and sometimes very debilitating.
PTSD and Moral Injury
Our people in uniform did not ask to be put in harm’s way and did so willingly to support and defend their country and their fellow citizens from foreign intervention in our land. If anything, those who have sacrificed so much deserve to be hailed as heroes and their disorders treated with the utmost care and without causing a financial burden on them or their families.
The stigma that goes along with having served in the armed forces and forming PTSD is ridiculous. PTSD is a war wound and people who form it because of being in the armed services should, in my mind, all be issued purple hearts because they received a moral injury.
A moral injury refers to an injury to an individual’s values and moral consciousness from acting in a perceived transgression against themselves or others. This perception of having done something heinous leads to profound guilt, shame, a sense of betrayal, anger, and moral disorientation.
For instance, if a military person is forced to shoot and kill someone or does any other deed that their mind says goes against the very fiber of who they are, they will develop a moral injury that later may transform into PTSD. However, it is not only acts of war that can lead to a moral injury as there are other circumstances of betrayal, such as rape by a fellow soldier, that will leave moral injury scars.
Moral injury is a normal human response to an abnormal traumatic event.
From the CPTSD Foundation; Thank You
The Board of Directors, writers, and other volunteers at the CPTSD Foundation would like to thank our prior and current military personnel for their service and sacrifice to make the United States a freer and safer place to live. We owe you so much more than we can ever pay.
The CPTSD Foundation offers many opportunities to learn how to defeat PTSD and of course CPTSD and would like to formally invite you to visit our blog and participate in our group discussions and call-ins.
Although both PTSD and CPTSD are life-altering, they are certainly not death sentences either. They are obstacles that can be overcome with a lot of self-love and patience. Although most of us have not served in the military, we do understand the war that rages in your mind as you reconnect with who you are as a person outside of the military sphere.
To all our heroes out there the CPTSD Foundation wishes to from the bottom of our hearts thank you once again, and wishes you a safe and happy Veteran’s Day.