Trauma is all around us, with most of it being dealt with just fine by the person having experienced it. However, some trauma is not so easy to shake, and it can mean life-altering changes that affect people all their lives if there is no intervention.

Practitioners of both mental and physical health need to know and understand the changes they see in their clients.

Becoming trauma-informed starts with learning what that means and how to go about awakening to the facts about trauma. Trauma comes in all sizes and shapes, leaving in its wake hurt and struggling individuals looking for help from practitioners, including therapists, counselors, psychiatrists, and medical professionals.

To help practitioners of all kinds understand trauma-informed care and complex post-traumatic stress disorder better, CPTSD Foundation offers a list of questions and answers to help guide you on your way.

This list of information is not all-inclusive, but it is a good jumping-off point for doing your own research to treat trauma in your clients and patients.

What is trauma?

According to the American Psychological Association, trauma is defined as:

“an emotional response to a terrible event like an accident, rape, or natural disaster. Immediately after the event, shock and denial are typical. Longer-term reactions include unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives.”

What is PTSD?

The American Psychiatric Association defines PTSD as:

“a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.”

What is CPTSD?

According to the website Beauty for Ashes, the best definition of CPTSD is:

“Complex PTSD comes in response to chronic traumatization over months or, more often, years. This can include emotional, physical, and sexual abuse, domestic violence, living in a war zone, being held captive, human trafficking, other organized rings of abuse, etc. While there are exceptional circumstances where adults develop C-PTSD, it is most often seen in those whose trauma occurred in childhood. For those who are older, being at the complete control of another person (often unable to meet their most basic needs without them), coupled with no foreseeable end in sight, can break down the psyche, the survivor’s sense of self, and affect them on this deeper level. For those who go through this as children, because the brain is still developing and they’re just learning who they are as an individual, understanding the world around them, and building their first relationships–severe trauma interrupts the entire course of their psychological and neurologic development.”

What are the differences between PTSD and CPTSD?

The simplest definition is found on the website: Insider.com. The online magazine states that the differences between PTSD and CPTSD are:

“You may experience PTSD after going through a single traumatic event, but CPTSD is often linked to ongoing or repeated traumas.

For example, events that may lead to PTSD include:

• A serious accident
• An instance of physical or sexual assault
• A traumatic childbirth experience, such as losing a baby
• A serious health problem that may have required being in intensive care

Events that may cause CPTSD to include:

• Experiencing abuse or neglect as a child
• Ongoing domestic violence
• Repeatedly bearing witness to violence or abuse
• Torture or kidnapping
• Overall, you are more likely to experience CPTSD instead of PTSD if the trauma
• Occurred at an early age
• Was inflicted by someone close to you
• Was inflicted by someone who you continue to have to see regularly

Is there comorbidity of CPTSD and PTSD?

According to a paper written in 2019, there is comorbidity between PTSD and CPTSD.

“High rates of physical and mental health comorbidity were observed for PTSD and CPTSD” (Karatzias, T., Hyland, Philip, et al., 2019)

Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder coincide with individuals who have experienced severe trauma.

Is CPTSD recognized as a separate diagnosis from PTSD?

 Although CPTSD is not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the International Classification of Diseases (ICD-11), ratified by the World Health Organization (WHO) in 2019, recognizes CPTSD and PTSD as separate diagnoses.

“Our findings provide some support for the distinction between CPTSD and PTSD within this population specifically but potentially have broader implications.” (Armstrong et al., 2011)

“CPTSD is different from PTSD in a number of ways. CPTSD is an umbrella term that refers to a form of PTSD that has many other features and symptoms that are not present in PTSD. For example, C-PTSD is characterized by the presence of complex trauma, a long duration of injury, and multiple life traumas, as well as an inability to process trauma-related memories.” (LiveWellTalk.com).

Is CPTSD diagnosis found in the ICD-11?

 The simple answer to this question is yes, complex post-traumatic stress disorder is found in the ICD-11.

What Does Complex Post-Traumatic Stress Disorder Look Like?

There are several various psychological aspects to CPTSD.

Problems with Emotional Regulation. Survivors find they have difficulty experiencing, expressing, and controlling emotions. Not only are survivors unable to describe, comprehend and label them correctly, feeling emotions is terrifying and might express in a volatile manner.

Survivors may experience persistent sadness, suicidality, or explosive anger or be incapable of expressing it. Survivors often feel numb and are incapable of leveling out their moods after they have experienced an extreme emotion, such as joy or grief.

One common symptom any survivors encounter is re-experiencing their childhood trauma through flashbacks. These flashbacks are intrusive, and often the triggers causing them are elusive. This symptom is known as an emotional flashback.

Difficulty with relationships. When we talk about having difficulty with relationships, one might think that we are only speaking about having trouble forming and holding an intimate relationship, but that’s not all there is to it.

Survivors often have feelings of isolation and don’t know HOW to form relationships. The fear of trusting another human being will not harm them leaves these survivors in a morass of harboring the intense need to hide away and refuse to trust others and desperately wanting someone to love them.

However, some survivors swing in the opposite direction and trust too much, leaving them vulnerable to victimization by people who will repeat the pain and abandonment of the past.

Difficulties with Self-Perception. Because of the messages given by their childhood abusers, survivors often have problems with perceiving themselves as worthy of dignity and respect. Unfortunately, because of the signals sent by caregivers, many believe they are fundamentally bad or damaged beyond repair. This leaves survivors feeling powerless, hopeless, and helpless. Many survivors take on the role of rescuer, sacrificing their own health and happiness to care for others, while others feel a sense of entitlement that blocks their healing.

There is also a permeating feeling of not belonging in the world that, somehow, they are a mistake and should never have been born. This brings a deep sense of loneliness that may cause isolation from other people.

However, these beliefs and feelings are far from the truth, as survivors are compassionate, competent, strong, and intelligent human beings.

Attachment to the Perpetrator. Because survivors have such low esteem, many believe that they are making up things about those who harm them, or worse, that they deserve maltreatment.

Many cannot break free from the influence of their abusers, especially if that person is someone they love, like a father or mother. Even though they know their behavior as children or are receiving in the present, telling the truth about their loved one feels like a betrayal. These feelings can sometimes translate into suicidality as the survivor struggles with the impression left by their abuser that if they talk about what happened, then they are dirty, nasty, or will be disowned.

Some survivors feel guilt and sadness in leaving their abusers even knowing how badly they treat them. Perpetrators groom their victims by giving the impression that they love them and make statements relating to their victims that they will never be loved the way the perpetrator loves them.

Other survivors feel inadequate to manage life without their perpetrators in the picture, following up on messages from the abuser that they cannot live without them.

An Interruption of the Survivor’s System of Meanings. A person’s system of meanings involves assessing who they are based on the person’s abilities, weaknesses, feelings, and life. Childhood abuse interrupts a survivor’s sense of self, which leads to a struggle to maintain faith or belief that justice, ethics, and morality are unreal. This leaves the survivor with an unfairly contorted outlook on the world.

As a medical professional, how do you ask a patient about complex post-traumatic stress disorder events?

An article appearing in the American Family Physician offers two scenarios to aid physicians and therapists, etc., on how to reach out to a client or patient who possibly has been exposed to trauma.

The article also states:

“Family physicians commonly care for survivors of trauma, but they may not always realize it. Trauma, which can affect any patient regardless of age or sex, is broadly defined as the experience of violence or victimization, including sexual abuse, physical abuse, psychological abuse, neglect, loss, domestic violence or the witnessing of violence, and terrorism or disasters.

Survivors of trauma experience poorer health outcomes, including the onset of chronic medical and mental health conditions, at a higher rate than those who have not experienced trauma.

Furthermore, shame and stigma may prevent survivors from disclosing their trauma histories during clinical encounters. For these reasons, it is important to incorporate trauma-informed care into practice as a universal precaution to optimally address patients’ health care needs while decreasing the risk of re-traumatization.”

Patients or clients approached by a professional are susceptible, and the clinician needs to be trauma-informed.

What comorbid conditions can accompany CPTSD?   

In a paper published by PubMed.gov, are available the following findings:

“High rates of physical and mental health comorbidity were observed for PTSD and CPTSD. Those with CPTSD were more likely to endorse symptoms reflecting major depressive disorder (odds ratio [OR] = 21.85, 95 CI = 12.51-38.04) and generalized anxiety disorder (OR = 24.63, 95 CI = 14.77-41.07). Presence of PTSD (OR = 3.13, 95 CI = 1.81-5.41) and CPTSD (OR = 3.43, 95 CI = 2.37-4.70) increased the likelihood of suicidality by more than three times. Nearly half the participants with PTSD and CPTSD reported the presence of a chronic illness. (Karatzias, Hyland, et al., 2011).”

What is the definition of trauma-informed care?

Trauma-informed care is defined as:

“an approach in the human service field that assumes that an individual is more likely than not to have a history of trauma. Trauma-Informed Care recognizes the presence of trauma symptoms and acknowledges the role of trauma may play in an individual’s life- including service staff.

The Five Guiding Principles are safety, choice, collaboration, trustworthiness, and empowerment.

Ensuring that the physical and emotional safety of an individual is addressed is the first important step to providing Trauma-Informed Care.

Next, the individual needs to know that the provider is trustworthy.

Trustworthiness can be evident in the establishment and consistency of boundaries and the clarity of what is expected regarding tasks.

The more choice an individual has and the more control they have over their service experience through a collaborative effort with service providers, the more likely the individual will participate in services and the more effective the services may be.

Finally, focusing on an individual’s strengths and empowering them to build on those strengths while developing stronger coping skills provides a healthy foundation for individuals to fall back on if and when they stop receiving services.”

What are the benefits of being trauma-informed?

Trauma-informed care acknowledges the need to understand a patient’s life experiences to deliver effective care and has the potential to improve patient engagement, treatment adherence, health outcomes, and provider and staff wellness.

We at Complex Post-Traumatic Stress foundation hope this list of questions has been helpful to professionals and survivors alike. If you have questions, please, contact us.

References

Armstrong, R., Phillips, L., Alkemade, N., & Louise O’Donnell, M. (2020). Using Latent Class Analysis to Support the ICD‐11 Complex Post-traumatic Stress Disorder Diagnosis in a Sample of Homeless Adults. Journal of Traumatic Stress, 33(5), 677-687.

Ford, J. D. (2020). New findings questioning the construct validity of complex post-traumatic stress disorder (cPTSD): Let’s take a closer look. European Journal of Psychotraumatology, 11(1), 1708145.

Karatzias, T., Hyland, P., Bradley, A., Cloitre, M., Roberts, N. P., Bisson, J. I., & Shevlin, M. (2019). Risk factors and comorbidity of ICD‐11 PTSD and complex PTSD: Findings from a trauma‐exposed population based sample of adults in the United Kingdom. Depression and anxiety, 36(9), 887-894.

Ravi, A., & Little, V. (2017). Providing trauma-informed care. American family physician, 95(10), 655-657.

If you are a survivor or someone who loves a survivor and cannot find a therapist who treats complex post-traumatic stress disorder, please contact the CPTSD Foundation. We have a staff of volunteers who have been compiling a list of providers who treat CPTSD. They would be happy to give you more ideas about where to look and find a therapist to help you. Go to the contact us page and send us a note stating you need help, and our staff will respond quickly to your request.

Are you a therapist who treats CPTSD? Please consider dropping us a line to add you to our growing list of providers. You would get aid in finding clients and help someone find the peace they deserve. Go to the contact us page and send us a note, and our staff will respond quickly.

Shortly, CPTSD Foundation will have compiled a long list of providers who treat complex post-traumatic stress disorder. When it becomes available, we will put it on our website www.CPTSDFoundation.org.

Visit us and sign up for our weekly newsletter to help keep you informed on treatment options and much more for complex post-traumatic stress disorder.

If you or a loved one live in the despair and isolation of complex post-traumatic stress disorder, please come to us for help. CPTSD Foundation offers a wide range of services, including:

• Daily Calls
• The Healing Book Club
• Support Groups
• Our Blog
• The Trauma-Informed Newsletter
• Daily Encouragement Texts

Mindfulness, Prayer, and Meditation Circle

Meditation can be an integral part of healing from trauma. Our 9-week self-study video course helps you integrate this fantastic method of grounding, centering, and focus. Join the Mindfulness, Prayer, and Meditation Circle today!

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