When I first learned about CPTSD, everything sort of clicked for me. All the issues I was experiencing in my adult life were symptoms of this condition. All of my struggles and “flaws” aren’t because something was inherently wrong with me. It was due to years of abuse.
Like me, if you had an abusive parent growing up, you likely struggle with a lot of symptoms associated with CPTSD.
Please note that I am not a mental health professional. I am not here to diagnose you or myself (and you shouldn’t either). I simply want to shed a little light on what CPTSD is and how learning about it can help validate a lot of what you might be feeling and struggling with.
CPTSD can develop from different possible causes. But due to the nature of this blog, this post will mostly focus on CPTSD developed from childhood abuse or neglect by a parent or caregiver.
The rest of this post will discuss what CPTSD is, how it’s different from PTSD, its causes, risk factors, symptoms, diagnosis, treatment methods, and various resources you can check out for more information and support.
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What is CPTSD?
Most people are familiar with post-traumatic stress disorder (PTSD) which affects many war veterans and victims of violence. CPTSD is similar to PTSD, but it is more “complex” as the name suggests. It also has additional symptoms on top of PTSD symptoms.
CPTSD or complex PTSD is also known as complex trauma disorder or developmental trauma disorder (DTD).
CPTSD is a psychological condition that can develop due to repeated trauma over the course of months, or more often, years, where the individual perceives little or no chance of escape.
Though there are circumstances where adults develop CPTSD, it is most often seen in those whose trauma occurred in childhood.
For children, repeated trauma interrupts their psychological and neurological development.
Children are still learning about themselves and the world they live in. Their brains are still developing. They usually don’t have the ability to separate themselves from someone else’s actions. So experiencing repeated trauma at the hands of someone close to them can develop into CPTSD.
CPTSD vs PTSD
Despite their overlapping symptoms and similarities, there are significant differences between PTSD and CPTSD that are consistently shown by many studies.
First off, PTSD is oftentimes associated with one traumatic event. Whereas, CPTSD is oftentimes associated with multiple traumatic events that take place over months or years.
Also, PTSD typically, though not always, forms in adulthood. On the other hand, CPTSD is more commonly formed in childhood.
As a diagnosis, PTSD doesn’t take into account how a child’s developmental stage may affect their symptoms. It also fails to take into account how trauma can affect the child’s development, thus their adulthood.
As Beauty After Bruises says, “At the very heart of CPTSD – what causes it, how it manifests internally, the lifelong effects (including medically), and its ability to reshape a person’s entire outlook on life – is what makes it considerably different”.
Causes of CPTSD
Any type of chronic trauma can lead to CPTSD. But it seems to appear most often in people who were abused by someone meant to be their caregiver or protector.
According to research, it’s oftentimes the child’s primary caregiver who causes the complex trauma.
Children usually don’t have the cognitive or emotional ability to understand their experiences. It’s extremely difficult for them to comprehend how someone they know and trust is abusing or neglecting them. So they end up using other ways to cope with the trauma, thus developing CPTSD.
Once CPTSD develops, it changes the child’s life forever.
Possible causes of CPTSD for children and/or adults are:
Long-term emotional, physical, and/or sexual abuse
Long-term childhood neglect
Ongoing domestic and family violence or dysfunction
Living in a war zone for a long period of time
Concentration camps and similar environments
Cults
Being held captive
Human trafficking
Working in sweatshops
Slavery
Risk Factors of Developing CPTSD
Although anyone can develop CPTSD, some people may be more likely to develop it than others based on certain risk factors.
These risk factors are:
Experiencing the trauma at an early age
Inability to escape from the traumatic situations
Underlying mental illness, such as anxiety or depression
A family history of mental illness or PTSD
How the individual’s brain regulates hormones and neurochemicals, especially in response to stress
Lifestyle factors such as having a dangerous occupation, lacking a support network, or abusing substances
Signs and Symptoms of CPTSD
As mentioned before, CPTSD consists of all of the PTSD symptoms plus more.
Please note that symptoms of PTSD or CPTSD can vary widely between people. It can vary widely within one individual over time as well.
Symptoms of PTSD are:
Intrusive memories such as flashbacks and nightmares
Emotional distress or physical reactions to triggers of trauma
Avoiding thinking or talking about trauma
Avoiding places, activities, peoples, or things that trigger trauma
Negative changes in thinking and mood
Memory problems including the inability to remember important aspects of trauma
Difficulty maintaining close relationships
Feeling detached from family and friends
Feeling emotionally numb or having difficulty experiencing positive emotions
Being easily startled or scared
Hypervigilant and always on the guard for danger
Self-destructive behaviors
Sleeping problems
Concentration problems
Irritability, angry outbursts, or aggressive behavior
Survivor’s remorse, guilt, or shame
Researchers suggest that there are seven domains of complex trauma in children that differs from PTSD. Adults with CPTSD may have some of these symptoms as well.
Most adults with CPTSD experienced repeated trauma in childhood rather than adulthood. As mentioned before, this early trauma interrupted their development, thus creating these types of symptoms.
Attachment Issues
When the parent-child relationship is the source of trauma, the attachment relationship becomes severely compromised. Research claims that 80% of maltreated children develop insecure attachment patterns.
Insecure attachment causes a person to feel insecure about their relationship with others. They may:
When you’re hurt by someone who is meant to protect and love you, it’s not surprising that attachment issues develop. And these issues undoubtedly end up affecting your ability to form and maintain healthy relationships.
Adults with CPTSD are also at significant risk of revictimization. Many often find themselves trapped in abusive relationships similar to the one they had with their parents or caregivers.
Biological Issues
Toddlers or young children with complex trauma are at risk of failing to develop brain capacities necessary for coping with stress.
Parents are supposed to guide us. When we come across an obstacle at an early age, they’re supposed to provide support, encouragement, and guidance so we can overcome it.
However, when our parents are the very thing hurting us, it’s no doubt that we never learned to cope with challenges. On top of that, they become the biggest challenge in our life. Of course, this ends up negatively affecting how our brains handle stress and hardship.
When under stress, children with complex trauma tend to react helplessly, confused, withdrawn, or aggressively. This can continue into middle childhood and adolescence, and eventually, adulthood, where the individual never properly learns how to effectively cope with difficult situations.
Because early trauma can significantly affect a child’s development, biologically, children with complex trauma may also struggle with:
Sensory-motor development dysfunction
Integration difficulties
Somatization – feeling physical symptoms with no physical cause
Increased medical issues
Difficulty with Emotional Regulation
Similar to difficulties coping with stress, people with complex trauma also tend to have difficulties coping with uncomfortable emotions.
Also, when raised in an abusive environment, our fight-or-flight response is almost always activated. Thus, we end up becoming oversensitive and hypervigilant to everything that happens to us. The heightened fight-or-flight response we adopted as children to protect ourselves becomes the very thing impairing our day-to-day functioning as adults.
We end up having difficulty regulating our emotions or finding ways to effectively cope with triggers that resulted from our trauma. So it’s common for those with CPTSD to have mood swings and issues managing their emotions. Unsurprisingly, it also manifests into various mood disorders like depression and anxiety in many people.
Cognitive Alterations
Again, childhood trauma oftentimes stunts a child’s brain development. Thus, children with complex trauma tend to have impaired cognitive functioning.
Traumatized infants and toddlers, specifically, show delays in language development as well as deficits in overall IQ. As they get older, they also tend to show less flexibility and creativity than their peers.
Children and adolescents with complex trauma may also struggle with executive functions like paying attention, completing simple tasks, and problem-solving. These individuals tend to have higher dropout rates and lower grades.
Cognitive issues mainly refer to children with complex trauma. However, as adults, they may find a lot of their prior cognitive issues catching up to them and affecting their present life.
Dissociation
In addition to the cognitive issues, people with CPTSD may experience episodes where they feel detached from their mind or body, known as dissociation or depersonalization.
It may have developed as a way for them to cope with their trauma back when they were stuck in that situation.
Individuals with CPTSD may also struggle with amnesia or impaired memory. There may be moments when they can’t recall anything about the traumatic event. However, there may also be moments when they remember everything all too well. It’s possible for them to alternate between both states.
Dissociation can be problematic because it puts the victim at risk of revictimization. It may also lead to an over-reliance on it as a coping mechanism, which will end up creating more issues.
Behavioral Control Issues
Although behavioral control issues in complex trauma victims mainly refer to children, they can apply to adults as well.
In children, childhood victimization is linked to aggressive behavior and oppositional defiant disorder.
Children and adults with complex trauma may also have compulsive avoidance behaviors, self-sabotaging or self-harming behaviors, and oversexualized behaviors.
These behaviors might’ve formed as a way for the child to self-soothe or cope with the trauma. And as adults, they may have continued using it as a form of self-soothing or coping mechanism.
These behaviors might’ve also manifested as a reenactment of specific aspects of the individual’s trauma. It might be used as a way to have a sense of control over what happened. Or it’s a way to make sense of the trauma so they can eventually accept it.
Negative Self-Concept
Having a negative self-perception is one significant difference between CPTSD and PTSD. People with CPTSD may have lasting personality disturbances that aren’t typically found in people with PTSD.
Since the trauma happened in childhood, it disrupts the individual’s development of a sense of self. Thus, it affects their personality and sense of identity.
Many people with CPTSD don’t know who they are or what they want in life. They often feel helpless, ashamed, guilty, and stigmatized.
People with CPTSD also tend to struggle with a negative self-image. They tend to believe they’re inherently flawed. Due to their early trauma, they may believe they’re unlovable, unworthy, and unwanted.
Some may even believe they deserved the abuse and everything bad that’s happening to them. They may carry this shame and guilt from the trauma, thinking perhaps it’s all their fault.
To be diagnosed with PTSD, the individual must experience symptoms lasting over a month that causes significant distress or complications with aspects of their daily life.
As for CPTSD, it is not in the DSM so it might be hard to get an official diagnosis from professionals who diagnoses based on the DSM. Like me, the individual may be diagnosed with PTSD instead. However, there are some issues with a PTSD diagnosis rather than a CPTSD one.
As the Department of Veterans Affairs states, “The current PTSD diagnosis does not fully capture the severe psychological harm that occurs with prolonged repeated trauma.” People who experienced repeated trauma often report additional symptoms on top of the usual PTSD symptoms.
Although CPTSD is not yet in the DSM, it is included in the ICD-11. The ICD-11, the International Classification of Diseases, is a global categorization system for physical and mental conditions published by the World Health Organization.
The ICD-11 states that an individual must meet all criteria for traditional PTSD before they can be diagnosed with CPTSD. In addition, they must also show problems with self-regulation, low self-esteem, a sense of guilt or shame related to their trauma, and problems maintaining relationships with others.
How to Heal from CPTSD
If you’ve never heard of CPTSD before, all of this new information can be overwhelming. It was for me when I first learned about it. But at the same time, it can also be eye-opening and validating.
You might’ve downplayed, denied, or dismissed your past experiences. Maybe you kept telling yourself what happened wasn’t that bad. Or maybe you don’t understand why you struggle with certain things that other people don’t seem to struggle with.
I hope learning about CPTSD can help you better understand how your past connects to your present. I hope it can give you some sort of direction so that you can begin healing.
Treatment
When treating CPTSD, most professionals tend to go for treatments for PTSD like CBT and EMDR.
EMDR (Eye Movement Desensitization Reprocessing) is often recommended by the APA for treating PTSD. Many studies have shown it to be effective for treating CPTSD as well.
Experts suggest that treatment for CPTSD should focus on problems that cause functional impairment rather than on PTSD symptoms, which leads us to the Trauma Recovery Model.
In her book, Trauma and Recovery, Judith Lewis-Herman proposed a complex trauma recovery model that occurs in three stages. Experts have also conceptualized a treatment model with similar phases.
The three stages are:
Establish safety: Learn adequate coping skills and address safety concerns
Remember and mourn for what was lost: Decrease avoidance of traumatic stimuli by applying coping skills learned in stage 1
Reconnect with the community, and more broadly, society: Solidify what’s been learned and transfer these skills to future stressful events
In the end, there is no one-size-fits-all treatment for CPTSD because everyone is different.
Consider seeking therapy from a professional experienced with complex trauma who can tailor a treatment plan just for you.
Resources
In addition, here are some resources about CPTSD to learn more or get support.
Having been raised by an abusive mother, I developed an interest in mental health to better learn, understand, and manage the effects the abuse had on me. My experiences inspired me to create Hopeful Panda.
In my free time, you’ll find me cooking, organizing, playing video games, writing, or spending time with my family. You can read more about me and my blog here.
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