What is C-PTSD, PTSD’s incalcitrant cousin?

Part of an ongoing series about life with complex post-traumatic stress disorder

My own general, non-clinically trained overview:

Complex post traumatic stress disorder (abbreviated CPTSD or C-PTSD) is caused by ongoing trauma, especially as a child, which can be solely traumatic emotional neglect, and can but does not have to include physical or sexual abuse. (It should be noted that it is not always a caregiver’s intention to traumatize their child; they may have their own mental health issues, or their own generational trauma, etc.)

Children are not emotionally equipped to deal with difficult, adult-like scenarios, and depend on their parents/abusers for survival, so it affects the way they think and develop. CPTSD, like regular PTSD, causes people to get stuck in adrenalized states of fight, flight, freeze, or fawn (codependent) responses, and changes neural pathways to arrest some areas of identity development. When children are forced to parent their caretakers if they have mental health or substance issues, or they are constantly abused regardless of their behavior, they develop extremely strong coping mechanisms that cause their personalities to be affected, and do not have safe space to develop fully into their potential as healthy adults. Without the right types of therapy, and removal from the abusive environment, these defensive constructions can’t come down and continue to affect their behavior long into adulthood.

While CPTSD affects people who grew up in refugee camps, war zones, cults, extreme religious sects, most likely the vast majority of people affected grew up in toxic home environments in which their own caretakers had serious, unaddressed trauma of their own. Often times when people do not get treatment for trauma, they self regulate with drugs, alcohol, or controlling or passive behaviors. This doesn’t lead to healthy environments for children, and affects people across every income class. Think about whether you’ve ever been at a dinner in someone’s home in which one person makes the dinner unpleasant, and you can see that everyone around is watching that person who might suddenly carp, cry, blow or snap at someone else. That feeling of being on tenterhooks is the entire childhood for many people with CPTSD — growing up with no spaces of emotional safety, where they can express their preferences, needs, or desires without constant risk of retribution, ridicule, or indifference.

Some of the distinguishing features of CPTSD are a negative sense of self (often from a, mom hates me, so I must be bad type of internalization), strong inner and outer critics (I hate myself/I hate you), and emotional or body flashbacks, where you re-experience unprocessed emotions/feelings from childhood without the auditory/visual components of standard PTSD. It can also cause avoidance, hypervigilance, depression, anxiety, perfectionism, OCD, emotional dysregulation (angry outbursts, crying jags, difficulty modulating emotion), on/off nightmares, difficulty focusing, workaholism, dissociation (checking out, or feeling like your life isn’t real, or amnesia) and many other symptoms. CPTSD is commonly misdiagnosed as depression, BPD, Bipolar, eating disorders, and other issues (which are not mutually exclusive).

Emotional flashbacks and abandonment depression are not easily distinguished from real-time emotions without understanding their roots. For example, I thought I was always justifiably angry at my roommates for leaving dishes in the sink, but in reality my emotions were being amplified because a family member used to save all the chores, including dishes, for me to do as a child as punishment when I visited. So without realizing it, I was extra angered by the past injustice and taking it out present day on someone else. Or, for people whose parents were chronically late to pick them up/care for them, they might feel excessively upset when people do not show up on time for meetings or engagements with them. These types of extreme emotions can last minutes or hours or days depending on the severity of response, and don’t always correlate to a particular event. Sometimes people will be triggered by dreams, or events before their memories formed concretely as children. Some people react in flight responses where they stay super busy to avoid confronting feelings, whereas others might freeze in depressive states, pick fights, or try to please or control everyone around them to cut down on risk. It is common for people to deny their adversity of their home life growing up and blame themselves prior to diagnosis (My mom was great, she did her best; if I had just been a better student, things would have been ok). Many people internalize a sense of “inner critic” that mirrors criticisms they heard as a child, and can easily trigger bouts of depression, guilt, or apathy. As a child, it is anathema to think of your provider as someone who is bad. So if they are upset, it can’t be the parent’s fault…and the kid then assigns the blame to him or herself.

CPTSD is interesting as it relates to physical illness. Many books point to trauma being stored in the body — like The Body Keeps Score by Bessel van der Kolk, Toxic Parents by Susan Forward, and the (misleadingly titled) Drama of the Gifted Child by Alice Miller. The ACE score study of adverse childhood experiences is especially related to this. It says that people who have experienced ongoing traumatic environments have disproportionate levels of co-occurring health issues. Some examples — it can cause heart rate spikes, body armoring (muscle clenching disorders), nausea, IBS and gastrointestinal issues, and immune system problems. The risks for developing heart disease and some cancers are dramatically higher for people with an ACE score higher than 4 (if that’s you, welcome to the club, fellow comrade. You are not alone, and can still have a fulfilling life).

Types of therapy that are helpful for CPTSD include developmental trauma-focused EMDR, somatic experiencing therapy, sensorimotor therapy, internal family systems, and DBT. Not all therapists are complex trauma trained (sometimes called “trauma-informed”), and CPTSD is a full diagnosis in the ICD 11 (International/Europe), but considered a subset of PTSD for the DSM 5 (US). Sometimes it is also known as “relational trauma response”, “developmental trauma disorder” or DES-NOS. More experimental therapies include TMS and in trial pharmaceutical treatments like therapeutic assisted administration of MDMA or ketamine. While SS/NRIs or mood stabilizers, may be helpful for stabilization, CPTSD does not respond well to anti-anxiety meds like benzodiazepines because it often encourages flight or freeze self-medicating responses that rarely target the real issue. Prazosin is also sometimes a useful tool to ratchet down the severity of fight/flight responses and nightmares. Unlike other issues, trauma does not follow “all wounds heal with time” and requires active treatment work to resolve.

Here is a link to my resources page with more qualified overviews of the disorder, as well as many resources about symptom management and treatment.