Complex PTSD
Understanding and Healing From Long-Term Trauma
Written by Randi Fine, Narcissistic Abuse Expert
Narcissistic Abuse Awareness and Guidance with Randi Fine
Complex post-traumatic stress disorder, also known as C-PTSD is a response to the chronic stress of social or interpersonal prolonged trauma. C-PTSD is differentiated from PTSD by the length of exposure, inability to escape the trauma, personal violation and exploitation, and fear of re-victimization.
For almost 25 years there has been great debate over whether or not complex PTSD is a separate and distinct disorder. That is not surprising. Over 35 years ago when PTSD was first classified as a diagnosable condition by the American Psychiatric Association, it was a controversial diagnosis as well. Now, according to an August 2015 report by the National Center for PTSD, approximately eight million adults are recognized as having it each year.
Though the American Psychiatric Association has published two Diagnostic and Statistical Manuals updates since 1980, they have not yet recognized complex PTSD as a distinct diagnosis. It was included as a PTSD subcategory in the most recently published manual.
Many mental health professionals disagree. They believe that C-PTSD is a stand-alone diagnosis and have established therapeutic models for treating patients who they believe have it.
In 2000, the Complex Trauma Task Force was assembled to promote a better understanding of complex PTSD and make recommendations for treatment of it. It is only a matter of time before the American Psychiatric Association agrees and puts their stamp on it.
C-PTSD in particular results from captive-type situations where victims experience fear, torture and ultimately lose their sense of self. It is seen in victims of narcissistic abuse and other forms of childhood and domestic abuse, death camp survivors, hostage survivors, and cult survivors.
As a subcategory of PTSD, a cluster of seven behavior adaptations is currently used to identify C-PTSD:
Changes in emotional regulation: • Problems modulating anger: person may alternate between eruptive and inhibited anger • Preoccupation with suicidal thoughts • Self-destructive behavior: self-injury, excessive risk taking, addictions • Dysphoria: depression, anxiety • Problems modulating sexual urges: person may alternate between compulsive and inhibited sexual urges
Changes in attention and consciousness: • Dissociative episodes: disconnecting from mind or body • Amnesia: forgetting traumatic events • De-personalization: losing contact with personal reality, problems with perception, feelings of strangeness • Numbing of feelings • Reliving: intrusive thoughts, preoccupation Randi G. Fine
Changes in relationships: • Unable to trust others: belief that people are users and abusers, dangerous and self-serving • Difficulty sustaining relationships: avoidance, problems with intimacy • Isolation and withdrawal • Re-victimization: always searching for a rescuer, failure to protect self
Changes in systems of meanings: • Loss of hope and feelings of despair: believing no one understands them or their situation, believing they will never recover • Loss of faith or prior beliefs
Somatic and medical conditions: • Pain syndromes • Medical conditions and physical injury related to abuse • Digestive problems • Sexual problems
Changes in self-perception and self-worth: • Helplessness: lack of initiative • Worthlessness: belief of being damaged goods or ineffective • Chronic guilt and self-blame: feeling responsible for the abuse • Disgrace: shame, stigma • Freakishness: belief of not fitting in
Changes in perception of the perpetrator: • Preoccupation with the relationship • Adoption of perpetrator’s belief system • Irrational attachment • Submissiveness: giving perpetrator full control and power • Acceptance of perpetrator’s rationalizations • Preoccupation with revenge • Gratitude toward perpetrator
If based on the above symptoms you believe you are suffering from C-PTSD, please seek professional help with someone who has experience treating this disorder. Choose someone with whom you feel completely safe—someone who will offer skilled guidance and support—someone who will help you re-program and learn how to self-regulate your responses.
Stress Expert Dr. Wingo explained the therapy process as the following:
When you are with a loving, giving caretaker, you feel safe. That feeling of safety activates oxytocin. High oxytocin levels are important for fear extinction—it allows you to be comfortable and safe enough for the dissociation and freeze response to subside so that you can start labeling and putting narratives to the trauma. When that happens, the thought of the trauma slowly becomes decoupled in your hypothalamus from your fight or flight trigger response, therefore allowing you to sever the automatic hair-trigger mechanism responsible for the stress disorder.
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Randi Fine is an internationally renowned narcissistic abuse expert and coach. She is the author of the groundbreaking book Close Encounters of the Worst Kind: The Narcissistic Abuse Survivor’s Guide to Healing and Recovery Second Edition, the most comprehensive, most well researched, and most up-to-date book on this subject. In addition to helping survivors recognize their abuse and heal from it, this book teaches mental health professionals how to recognize and properly treat the associated abuse syndrome. She is also the author of Cliffedge Road: A Memoir, the first and only book to characterize the life-long progression of complications caused by narcissistic child abuse.