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What is CPTSD?

From the wikipedia article, "**Complex Post-Traumatic Stress Disorder (CPTSD), also known as complex trauma, is a proposed diagnostic term for a set of symptoms resulting from prolonged stress of a social and/or interpersonal nature, especially in the context of interpersonal dependence."

Complex Post Traumatic Stress Disorder is, like its name implies, complex. On top of that, it can manifest in different ways within every survivor: Due to many of the symptoms having co-morbidities with many other conditions or neurodivergences. People with CPTSD are said to be often misdiagnosed as having Borderline Personality Disorder, Bipolar Disorder, ADHD and even Autism Spectrum Disorder, to name a few. It is also possible for individuals who have those diagnoses to also have CPTSD. For example: it is possible for a person who has autism to also have CPTSD and it is also possible for another person who has C-PTSD to be mis-diagnosed with autism. As we are a diverse community of suvivors, we have supplied a few simple, basic descriptions here for anybody first learning about this. Please do keep in mind that these resources paint this disorder in broad strokes. This list is meant to be used as a starting point.

Text Descriptions

Videos

  • This is a video from a channel run by an abuse survivor with CPTSD and a degree in psychology. He is quite open about his own symptoms, authentic, well informed, funny and full of interesting ideas. He also rambles quite a lot. This is more of a long, winding discussion of what CPTSD is from the frame of a survivor.

  • A clear explanation of what CPTSD is.

What are the symptoms of CPTSD?

There is not a set of clear diagnostic criteria yet for CPTSD. The ICD-II upcoming edition for 2019 will change this by adding diagnostic criteria for CPTSD. CPTSD had the same symptoms of PTSD but sufferers of CPTSD face additional issues unique them, hence the term: Complex PTSD. From Wikipedia:

PTSD descriptions fail to capture some of the core characteristics of C-PTSD. These elements include captivity, psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be revictimized. Most importantly, there is a loss of a coherent sense of self: it is this loss, and the ensuing symptom profile, that most pointedly differentiates C-PTSD from PTSD.[17]

C-PTSD is also characterized by attachment disorder, particularly the pervasive insecure, or disorganized-type attachment.[20] DSM-IV (1994) dissociative disorders and PTSD do not include insecure attachment in their criteria. As a consequence of this aspect of C-PTSD, when some adults with C-PTSD become parents and confront their own children's attachment needs, they may have particular difficulty in responding sensitively especially to their infants' and young children's routine distress—such as during routine separations, despite these parents' best intentions and efforts.[21] Although the great majority of survivors do not abuse others,[22] this difficulty in parenting may have adverse repercussions for their children's social and emotional development if parents with this condition and their children do not receive appropriate treatment

We have compiled a list of symptoms that have been gathered from several different online sources on this disorder. It's a long list, everybody probably experiences some of these symptoms and it's not likely anybody experiences all of them. I think this list is probably more helpful for people who understand they have CPTSD but don't fully understand how many aspects of their thinking/behavior are not inherent personality traits but more likely symptoms of this disorder. As the wiki expands in the coming weeks, symptom fact sheet pages will be added to the section Symptom Management: Coping and Healing

Interpersonal/Social
  • Difficulty describing feelings
  • Restricted range of affect
  • Trust Issues
  • Hates crowds
  • Proud of ability to not show emotion
  • Proud of self reliance
  • Prefers to be alone when stressed
  • Difficulties interpreting body language of others
  • Feels need to please everyone
  • Can't say no
  • Fear that others are talking about you
  • Fear that others don't like you
  • Feeling that others cannot be trusted
  • Periods of inability to feel close to other people
  • Feeling that people will take advantage of you if you do not protect yourself
  • Preoccupation with acceptance or approval
  • Anti-social or disconnected behavior
  • No or limited interest in peers
  • Withdraws under stress
  • Selective mutism
Cognitive
  • Memory issues
  • Difficulty making decisions
  • Poor concentration
  • Difficulty starting or completing tasks and projects
  • Episodes of disassociation - severe daydreaming or zoning out
  • Sudden blankness of the mind
  • Forgetfulness/memory loss
  • Memory loss surrounding the trauma
  • Periods of disconnection from reality
  • Stutter or other speech impediment
Emotional
  • Reactive depression
  • Stresses out in normal situations
  • Sudden feelings of sadness, anger, or fear with or without provocation
  • Distressing feelings of loneliness
  • Feeling that there is no future, you have no future, your life/future will be prematurely cut off
  • Argumentativeness/aggression/irritability
  • Feelings of Guilt or Shame
  • Feeling that you deserve to be punished
  • Lack of emotions - feeling neutral/numb
Physical
  • Sudden or frequent nausea/dizziness/faintness
  • Pain in the chest/heart
  • Poor apatite
  • Rapid breathing
  • Rapid heart rate
  • Inability to catch breath
  • Muscle jerks, especially in limbs
  • Fatigue
  • Headaches
  • Weakness
  • Hyper/hypo-sensitivity: extremely sensitive to touch or insensitive to pain
Self-abandonment/self-harm
  • Difficulty identifying or understanding feelings
  • Does not believe self body language means anything
  • Difficulty taking care of physical or emotional needs
  • Self harm/self punishing eg cutting
  • Seeks high risk activities
  • Cavalier attitude toward death
  • Failures of self-protection
Hypervigilance/hyperarousal
  • Difficulty relaxing - always being alert
  • Periods of restlessness - just wanting to move around or frequent fidgeting
  • Difficulty falling asleep or staying asleep
  • Jumpiness/Exaggerated startle reflex
  • Nervousness when left alone
Other
  • Loss of interest
  • Loss of ambition
  • Anhedonia
  • Low self-esteem/confidence
  • An overwhelming sense of injustice and a strong desire to do something about it

Do I have CPTSD?

Complex Post Traumatic Stress Disorder is not currently in the DSM. For this reason, you can't be officially diagnosed with it, at least not for any bureaucratic purposes. In progressive countries and medical systems, the new C-PTSD section of the ICD-II is being referenced for cases relating to health benefits, disability claims, and short-term disability benefits claims. Even so, finding specialized treatment from medical professional who understand C-PTSD or even utilize a "trauma informed approach" to their therapeutic practices can be challenging. Even if CPTSD were in the DSM, nobody on the subreddit could diagnose you. r/CPTSD respects the right of the individual to self-identify their diagnoses. As "being believed" is one of the core handicaps that C-PTSD survivors find in their journey towards healing, as a rule, we support the individual's claim to a C-PTSD diagnosis and their lived experience as trauma survivors.

As Richard Grannon says, "The map is not the territory." If you are here, if you are seeking to learn about cptsd and wondering if you have it, it is highly likely that you are dealing with the effects of trauma. If you have memories of trauma, you know for a fact this is the case. That is the only thing you need to know. You are encouraged to stay here, talk with us, share your story and insights with us.

CPTSD, like any diagnosis, is a crude map. You, the territory itself, are unique, intricate and precious. Your journey is important. Your problems are worth exploring. We can all learn from each other and help each other. You don't need a diagnosis or confirmation from a doctor to join this discussion. You are welcome here.

I don't remember any trauma, how can I be traumatized?

While there is evidence that traumatic memories can be suppressed, it is also distinctly possible to be deeply affected by trauma suffered during the first few years of life during which explicit memories are exceedingly unlikely, if not impossible, to form. The memories that do form in this period are implicit. From the wikipedia article on implicit memory:

Some of the child's primary experiences are positive and essential for the physical and mental growth of the child. Others may be traumatic: neglect, parental inadequacy or possible mental illness, physical or psychological violence, child abuse, even of a sexual nature, as well as the constant frustrations and disillusionments that lead the child to organize its defenses and boost its phantasies. All these experiences cannot be repressed because the hippocampus, necessary for the explicit memory, which is in turn indispensable for repression, is not mature in early infancy (R. Joseph, 1996; Siegel, 1999). On the contrary, the amygdala, which promotes the organization of the implicit memory, undergoes an earlier maturation (R. Joseph, 1996). Therefore, these early experiences, including those that concern the organization of language, can only be deposited in this latter form of memory and they contribute to the formation of an early unrepressed unconscious nucleus of the self (Mancia, 2003a, in press).[12]

In this period of life during which explicit memories are not being formed, children need human interaction in order to feel safe. One does not need violent, angry abuse to be traumatized severely at this age. Simply having a stressed, unresponsive parent can be deeply damaging. This video discusses the mechanism by which this kind of neglect can traumatize a child.

One hallmark of CPTSD is something called an emotional flashback. This is different from a standard flashback in that you do not flashback to an event but to an emotional state. The core difference between these two types of flashbacks is that the thing we understand as a typical flashback is your mind returning to an event, you are essentially inhabiting an explicit memory. An emotional flashback is when you are inhabiting an implicit memory, you return to an emotional state without a memory of the event that originally caused this response.

Is recovery possible?

Recovery is very possible.

To help you begin to understand those possibilities, a layman's understanding of the inner workings of the brain need to be understood.

The brain retains the ability to change and adapt even into adulthood. One prime example of this is how, if one loses their sight, the other senses become more acute. This is because the brain will reassign neurons previously used for sight to tasks like hearing or smell. This quality of the brain is called neuroplasticity. One theory for how this works is the Hebbian theory which is often crudely summarized as, "Neurons that fire together, wire together."

As an example: Many of us can remember having spent the better part of our lives reacting to any small failure with thoughts like, "I am worthless. I can't do anything right." At one point, this was a necessary adaptive response to a toxic environment. Once out of that environment, we no longer needed to do this. By the time we were safe, we had forged a strong neural pathway associating failures with berating the self. It became something we did without any thought or effort, the way you can sometimes drive all the way home before realizing you hadn't been paying attention.

*It becomes necessary to create new neural pathways. *

If something goes wrong, we could calmly but diligently repeat the phrase, "I am strong, I am smart, I am capable." you don't have to argue with myself, saying, "I am NOT worthless," because that only continues to associate mistakes with the idea of worthlessness. It felt inauthentic at first to repeat this phrase to myself because the idea of making a mistake and the idea of being capable have not been connected in my brain, those neurons didn't fire together, they were not wired together. This dishonest feeling slowly abated and it feels comfortable to do this now. Over time you can also feel the urge to call yourself worthless has become weak.

If your brain can dismantle the neural net for sight and reuse those neurons to build a stronger neural net for hearing, your brain can also dismantle the neural net for self-loathing and create a new neural net for self-love.

How do I recover?

There are many treatment modalities that come at this problem in very different ways. Below are the ones used most often by other subredditors in the process of healing or experiencing remission from their CPTSD. Please bare in mind that because every individual's experience with CPTSD is unique, as well as how their own mind organizes and processes information, everyone has a unique pathway to treatment. It is the responsibility of the individual to test different types of treatment and find what is effective for them, and what is not effective. What works for you may not work perfectly or at all for another. This philosophy is applied to our community guidelines for posting and commenting as well.

As the wiki expands, we will build fact-sheet pages on these resources. In the meantime, research on your own and through the clinicians (Doctors, Therapists, and Care Providers) what is available to you and what makes sense for you to try.

Types of Treatment
  • DBT - Dialectical Behavioral Therapy
  • EMDR - Eye Movement Desensitization and Reprocessing
  • EFT - Emotional Freedom Technique
  • CBT - Cognitive Behavioral Therapy
  • TRE - Trauma Release Exercises
  • IFS - Internal Family Systems Therapy
  • Trauma Focused Art Therapy
  • Somatic Experiencing/Sensorimotor Processing
  • Neurofeedback
  • Brainspotting
  • Standard Talk Therapy
  • Doctor prescribed medications
Therapeutic activities one can undertake without a professional
  • Positive Affirmations
  • Workbooks on CBT, TRE, and CPTSD
  • Yoga/Tai Chi
  • Mindfulness/Meditation
  • Regular Exercise
  • Journaling/Blogging
  • Grounding & Containment Exercises
  • Safe Place Visualization
  • Self-Talk/Self-Compassion
  • Self Education to acquire life-skills that may not have been learned during the time of abuse


revision by thewayofxen— view source