Complex Post-Traumatic Stress Disorder (CPTSD)

What Is Complex PTSD?

Complex PTSD is a condition that can develop in a person who has experienced prolonged or recurring traumatic events from which they often feel they are unable or nearly unable to escape. All of the diagnostic criteria for post-traumatic stress disorder (PTSD) are present along with additional symptoms.

CPTSD presents with affect dysregulation, which is the inability to appropriately regulate emotions. People also experience feelings of worthlessness compounded by shame or guilt and have difficulty maintaining relationships. These symptoms lead to notable impairment in daily functioning related to work, school, and social situations, as well as an increased risk for developing substance use disorder (SUD).

CPTSD And Addiction

A 2023 study from the Frontiers in Psychiatry journal found that SUDs and post-traumatic disorders were among the most common co-occurring conditions. This is likely due to the fact that people with CPTSD experience heightened emotional stress as a result of their prolonged exposure to trauma. To help self-soothe and cope with these intense emotions, some individuals with CPTSD misuse alcohol or other substances, putting them at a greater risk of developing a SUD.

Childhood Trauma

Experiencing traumatic events in childhood can significantly increase the risk of developing a substance or alcohol use disorder (AUD) in adulthood. Trauma, such as physical, emotional, and sexual abuse, can disrupt the development of healthy coping mechanisms and emotional regulation leading a person to turn to substance use to help cope. This often exacerbates underlying issues and creates a cycle of dependence and misuse.

Additionally, experiencing trauma at an early age can impair the brain’s reward and stress-response systems, making these individuals more vulnerable to addiction.

What’s The Difference Between CPTSD And PTSD?

When a person is exposed to repeated traumatic events, especially early in life, there is a greater risk that they will develop CPTSD as opposed to PTSD. Symptoms seen in people with complex post-traumatic stress disorder are usually more severe, debilitating, and persistent than those seen with PTSD.

Differences are seen in the personalities of people diagnosed with PTSD and CPTSD. For example, people with CPTSD experience more episodes of psychosis and struggle with emotion regulation more than those with PTSD do. Those with CPTSD also tend to struggle more with identity issues that can carry over into personal relationships, causing a greater lack in social connections than seen in those with PTSD.

If you present with some of these symptoms and are unsure which diagnosis is more appropriate for you, meeting and talking with a therapist can provide a more accurate diagnosis and, as a result, more accurately targeted treatment.

What’s The Difference Between CPTSD And BPD?

CPTSD and borderline personality disorder (BPD) are separate diagnoses. Borderline personality disorder presents as a persistent disturbance in how a person thinks and feels about themselves, other people, and the world; it manifests in abnormal patterns of thinking, feeling, expressing emotion, and behaving. These consistent maladaptive patterns lead to problems in cognitive and emotional functioning and notably appear in relationships with others. They are seen across a wide range of personal and interpersonal interactions and remain over long periods of time.

Although they are different conditions, both may cause challenges in maintaining personal relationships and lead to increased drug and alcohol misuse. A borderline personality disorder diagnosis differs from complex PTSD as it involves an unstable sense of self that could include an overly positive or negative self-

perception.

Symptoms Of CPTSD

Numerous symptoms must be present, and certain criteria must be met for CPTSD to be diagnosed. These include the following:

Exposure To Trauma

Exposure to a traumatic event or multiple events that are perceived to be extremely terrifying or threatening and from which escaping the situation is very difficult or impossible is the most notable symptom of CPTSD. Examples include:

• Repeated physical or sexual abuse
• Abuse experienced in childhood
• Domestic violence
• Torture
• Exposure to organized violence, such as slavery or concentration camps

Experiencing PTSD Symptoms

Experiencing the three main symptoms of PTSD for several weeks following the traumatic event is a sign of CPTSD. These three symptoms are re-experiencing, avoidance, and ongoing perception of an imminent threat as seen by exaggerated startle response or hypervigilance.

Re-experiencing The Event

Re-experiencing of the traumatic event(s) during which the event(s) are felt as if they were being experienced in the present moment is a symptom of CPTSD. This commonly includes vivid and disruptive memories, flashbacks that can range from mild to severe in which a person loses total awareness of their current surroundings, or repetitive nightmares about the traumatic event(s). Re-experiencing often occurs alongside strong emotions and body sensations similar to what was experienced during the traumatic event(s).

Avoidance

Purposeful avoidance of things likely to remind a person of the traumatic event or events is a common symptom of CPTSD. This can include internal avoidance, such as thoughts or memories, or external avoidance, which could be people, places, or activities that bring up traumatic memories.

Being Constantly Alert

Ongoing perception of a serious current threat, such as heightened reactions to sudden noises or other stimuli or feeling guarded and worried about an immediate physical threat can signify CPTSD. Severe issues with affect regulation, such as intense emotional reactions to minor stressors, reckless behavior, violent or self-destructive actions, dissociation, and the inability to feel positive emotions are examples of this behavior.

Having Feelings Of Guilt And Shame

Persistent feelings of worthlessness or being defeated or diminished alongside intense feelings of guilt, shame, or failure related to the event or events can plague those with CPTSD.

Use Of Certain Substances

Alcohol is the most common substance abused by both those who experienced trauma in adulthood and those who experienced childhood trauma. Additionally, those with CPTSD symptoms from childhood abuse have higher rates of marijuana, cocaine, and heroin misuse when compared to other addictive substances. 

Struggling To Maintain Relationships

Ongoing challenges maintaining interpersonal relationships and feeling close to other people. This can include avoiding social situations or having little interest in them. Alternatively, a person may experience very intense relationships that are difficult to sustain.

Disruption To Activities Of Daily Life

Difficulties result in notable impairment in everyday functioning in areas such as work, school, or family and social life. Functioning in this area may be maintained, but only with significant effort by the person experiencing CPTSD.

How Is CPTSD Diagnosed?

CPTSD can be diagnosed by healthcare and mental healthcare professionals, including physicians, psychiatrists, clinical social workers, and certified counselors. Related clinical experience and training are required for a professional to diagnose it. Being diagnosed can take place in a multitude of settings, such as outpatient, inpatient, partial hospitalization, and primary care doctors’ offices.

How Common Is CPTSD?

A 2019 study published in the Journal of Traumatic Stress found that the rate of CPTSD in the United States was 3.8%, with women being more likely to be diagnosed with the condition.

The study showed that cumulative trauma in adult years correlated with instances of PTSD and CPTSD and that cumulative trauma endured in childhood more strongly led to the development of CPTSD than PTSD.

Additionally, people diagnosed with CPTSD reported significantly higher levels of psychiatric distress as compared to people who had received a diagnosis of PTSD and those who had received neither diagnosis.

How Is CPTSD Treated?

A 2021 study published in the Journal of Health Service Psychology states that treatment for CPTSD should take a three-part approach: first, learning skills to cope in the present, then addressing the underlying cause of the trauma, and finally, working on moving forward.

Cognitive-behavioral therapy helps treat adults and children who have had traumatic experiences. Interventions for symptoms of CPTSD have been identified and include cognitive restructuring, management of stress and anxiety, development of trauma narratives, tools for emotion regulation, and skills to boost interpersonal effectiveness. Meditation and mindfulness have also been shown to be helpful in treating the emotional and behavioral aspects of CPTSD.

CPTSD may necessitate longer treatment compared to PTSD, particularly if there is the presence of a co-occurring SUD. Therefore, people with this condition may benefit from a multi-intervention approach that focuses on disturbances related to self-organization. Ongoing symptom monitoring and follow-up care are also recommended as aspects of care for this disorder. Treatment should also be tailored based on the type of trauma a person has experienced, such as childhood abuse or refugee trauma.

Other components of treatment shown to be beneficial for those with complex PTSD are psychoeducation, safety training, collaboration between client and provider, and treatment elements composed of teaching clients self-regulation skills.

Medication For CPTSD

Medications that are used to treat PTSD have been found similarly effective in treating CPTSD, having an effect on mood, hyperarousal, flashbacks, avoidance, and impulsivity.

Antidepressants are often used in treatment, and these include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and, less commonly, tricyclic antidepressants (TCAs).

Antianxiety medications can also help treat CPTSD. These can include benzodiazepines as well as other antianxiety drugs, including buspirone, clonidine, and hydroxyzine. Antipsychotics may also be prescribed to treat CPTSD symptoms such as anger, anxiety, impulsivity, and insomnia.

Another pharmaceutical option is mood stabilizers. These include drugs such as lithium, topiramate, and lamotrigine, which work to calm the limbic system. Evidence shows that these may help treat symptoms like impulsivity and explosiveness.

How Do I Take Care Of Myself If I Have CPTSD?

Finding a trustworthy therapist with whom to build a therapeutic alliance is a recommended first step in treating CPTSD. A psychiatrist can help determine if medication could be helpful and which medications to take. Practicing mindfulness and meditation can also be helpful, as they facilitate stress and anxiety management.

When Should I See My Healthcare Provider?

CPTSD can occur at any age or stage of development, and symptoms may also manifest differently in different people.

You should see a healthcare provider if you start experiencing other clinical features including:

• Suicidal ideation
• Depression
• Psychosis
• Substance abuse
• Bodily ailments

It is important to keep an eye on children and adolescents, as they are more vulnerable to developing CPTSD if they have endured ongoing severe trauma such as chronic physical or sexual abuse or forced involvement in drug trafficking or war. Many youth who have been exposed to trauma will go on to experience further trauma. This increases the risk of developing CPTSD and highlights the importance of reaching out to a healthcare provider for help.

Help Is Available

Complex post-traumatic stress disorder can result in substance misuse that creates notable disruptions in daily living and overall health.

If you or a loved one are struggling with CPTSD and substance use, you don’t have to go through it alone. Contact a treatment provider today to discover your rehab options and start your recovery journey.