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Post-Traumatic Stress Disorder

Giving Trauma Its Proper Name

Part 1: What is C-PTSD, and how does it show up?

Key points

  • PTSD usually occurs after a single incident; C-PTSD typically develops as a result of repeated trauma.
  • For those living with it, C-PTSD can feel like a great disconnect.
  • People with C-PTSD can still be high-functioning, so their condition tends to be “invisible” to others.
Sadie Culberson/Stocksy
Source: Sadie Culberson/Stocksy

There is so much power in giving something a name.

And with believing that there is power in giving something its proper name, I want to discuss Complex Post-Traumatic Stress Disorder, otherwise known as C-PTSD.

The goal of this post (and this series) is to give form and name and clarity to what can often feel like a complex and hard-to-understand inner feeling state.

C-PTSD is not a term in the current Diagnostic and Statistical Manual of Mental Disorders (the DSM, which is the clinical bedrock textbook of the mental health field). The reasons why are beyond the scope of this post, but because of it, people who experience C-PTSD may be more likely to be diagnosed with Post-Traumatic Stress Disorder (PTSD) or "Other Specified Trauma and Stressor-Related Disorders." I do believe that C-PTSD is a long overdue diagnosis that should be in the DSM, though, and I don’t want anyone experiencing it to feel delegitimized by its current absence in that textbook.

How does C-PTSD differ from other diagnoses?

C-PTSD does indeed borrow its defining symptoms from PTSD, but it expands upon that experience in one important way: PTSD usually occurs after a single traumatic incident, whereas C-PTSD usually develops as a result of repeated trauma.

What does this mean?

It means that the following symptoms—classically associated with PTSD—will likely be experienced with greater intensity, frequency, and duration than with more "straightforward” PTSD and may require a different and more nuanced treatment approach:

  • Reliving the event(s) involuntarily, intrusively, and recurrently. This can show up as distressing dreams and nightmares, flashbacks, and strong, adverse physiological and psychological reactions when implicit or explicit triggers happen or are perceived.
  • Avoiding situations that remind you of the event(s). This can include avoidance (or attempts to avoid) the actual and physical people, places, situations, and events that evoke the traumatic event(s), and it can also include attempts to avoid even thinking about the events or feeling your feelings about the event.
  • Distorted, negative beliefs about yourself, others, and the world. Maladaptive beliefs about one’s capacities, safety, and ability to exist in the world may emerge (e.g., “No one can be trusted”; “My whole life is ruined now”; I’m fundamentally broken”).
  • Persistent, painful mood states. Feeling states such as shame, horror, fear, anxiety, and guilt become the normative feeling states for the individual who lived through the traumatic event(s). Other feeling states (joy, ease, hope, excitement, etc.) may be harder to access.
  • Difficulty in relationships with others. Feeling or being estranged, cut-off, detached, or generally unsafe, untrusting, and disconnected from relationships in one's life.
  • Fractured or forgotten memory. The ability to remember, recall, and give past events a cohesive narrative may be disrupted.
  • The nervous system seems consistently outside the window of tolerance. This can include hyperarousal (easy startle response, insomnia, muscles unable to relax, feeling “on guard”) or hypoarousal (exhaustion, numbness, feeling disconnected from everyone and everything).
  • Self-harming or self-destructive behaviors used to manage intolerable feelings. C-PTSD often presents with co-morbid diagnoses, such as eating disorders, alcohol and drug abuse, compulsive addictive behaviors, and even cutting. All of which are often attempts to help the individual feel less of their painful internal state.

What does C-PTSD actually feel like?

With C-PTSD, exaggerated responses to perceived and actual events can feel much more intense.

One’s inner life can often feel like a raging, wind-whipped hurricane, all contained in a fragile shell of a body projecting normalcy out to the world. Even if one's outer life somewhat looks normative, the inner life feels turbulent, exhausting, terrifying, stormy.

But here’s the thing: So often, you don’t even know that a storm is brewing inside of someone because their “outside” looks so normal.

This leads me to reiterate one of the biggest myths I hear in my work: that you can’t be high-functioning and still live with C-PTSD. That is not the case at all. It’s possible to be high-functioning on paper (academically, professionally, and financially) and still live with trauma symptoms—or, in this case, C-PTSD symptoms.

In the next post, I'll discuss how and why C-PTSD develops and how we can heal.

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