What is complex PTSD?

When people think of post-traumatic stress disorder (PTSD), soldiers with traumatic experiences of war and people who have lived through disasters often come to mind.

However, trauma can arise from a variety of situations, such as neglect, abuse, domestic violence or abandonment by the primary caregiver.

This trauma often occurs at vulnerable times in the victim's life – including early childhood or adolescence – creating long-term developmental challenges.

The symptoms of complex PTSD are often caused by ongoing or repeated trauma where the victim has little or no control and no real or perceived hope of escape. These experiences can lead to deteriorated self-esteem and having to cope with intense emotions throughout life.

Thoughts, behaviours and emotions commonly associated with complex PTSD include:

• Difficulties expressing emotion – High emotional sensitivity and a reduced ability to respond to situations in a manner that is socially tolerable.
• Negative self belief – A perception fostered by the opinions of others and negative experiences, leading to feelings of worthlessness and shame.
• Problems maintaining healthy relationships – Difficulty feeling close to another person and a general feeling of disconnection, distance or being cut off from other people.
  

What other difficulties do those with complex trauma face?

A diagnosis of complex PTSD can take a long time as symptoms commonly overlap with other mental illnesses such as depression, PTSD and borderline personality disorder.

Symptoms that overlap with other mental illnesses include:

• Avoiding thinking and talking about trauma-related topics because the feelings are overwhelming
• Use of alcohol or other substances as a way to avoid or numb feelings and thoughts related to the trauma
• Engaging in self-mutilation and other forms of self-harm
• People are sometimes unjustly blamed for the symptoms they experience as a result of victimisation
• Alterations in attention and consciousness, known as dissociating.
  
  

How do you treat complex PTSD?

Distress tolerance strategies and self-soothing techniques are important skills for survivors of trauma. It's also important for survivors to be supported in a safe environment to ensure emotional support. This can be achieved with support from a psychologist, psychiatrist or through group therapy. 

One SANE Forums member describes self-soothing like this:

'In the past, I have only got through memories by focusing on what's around me, looking at what I can see and hear right where I am. Once the replay has lessened enough [I can] come back to where I am. When it's at its worse I just want to stay away from everything and everyone.'

The other aspect of treatment focuses on processing unresolved aspects of the trauma in a safe space with the help of a therapist. This technique looks to strengthen a person's confidence and their motivation to engage with others. This helps improve their ability to build social networks and relationships.

This can take time. Another forum member reflects on this process:

'It's hard to find a therapy technique that is effective. It takes a lot of patience and perhaps a long time. I often become frustrated with my supposed lack of progress. But that's my own self-judgement, not my psychologist's opinion.'

Self-care

A helpful part of recovery is maintaining self-care. This involves very simple, day-to-day acts that give a person control over their environment. When in an overwhelming emotional state, a self-care strategy can help ground you, bring you out of the state and help you regain control over the difficult emotions.

'Self-compassion has helped me a lot. We were far from validated as children, so now we have to get in touch with those fragmented parts, the parts we had to detach to cope. We have to comfort and nurture and strengthen on the inside so we're not so impacted by the world.'

SANE Forums member

Some things you can do when distressed include:

• Activities that ground you in your body and encourage you to enjoy the present moment. Take a long bubble bath, listen to classical music, light candles, go for a jog, or watch old movies.
• Make sure your bed and bedroom are comfortable, so when you feel like retreating you have a place that affirms your worth, makes you feel safe and gives you pleasure.
• Undertake activities that have no other function other than the joy they give. Read a special book, not one for school, work, parenting or therapy, but one just for you. Play with pets and animals. Listen to your favourite music.

Recovery from complex PTSD is possible. It involves adopting a set of learned responses to traumatic experiences and developing a new sense of self. This is achieved by acknowledging the trauma and building self-compassion for the horrible events experienced. 

By going through this process and developing a support network it is possible to learn to be close to others and to deal with emotional pain and stress in a healthier way. 

For support contact the Blue Knot Foundation on 1300 657 380 (9am-5pm AEST) or the SANE Help Centre on 1800 187 263 (10am – 8pm Monday to Friday).