What is Complex Posttraumatic Stress Disorder?

For the past 20 years, the most recent wave of psychotherapy has been the acknowledgement of and attunement to the prevalence of trauma. With the Adverse Childhood Experiences study in the 1990s, our field began to speak more about the harmful effects trauma has on a person throughout their lifetime. And then when the DSM-5 was being developed, there was a push to add Complex Posttraumatic Stress Disorder (CPTSD) as a diagnosis.

With our understanding of the prevalence of trauma still in its early stages, it is not surprising that CPTSD was not added. CPTSD is still controversial. Our exploration of PTSD and of trauma started through war, with terms like “shell shock” and the “thousand-year stare” less than 100 years ago. PTSD was only added to the DSM in 1980, it was primarily associated with war veterans, despite being advocated for by Holocaust victims and domestic violence victims. In fact, more pervasive interpersonal trauma such as domestic violence and sexual abuse were considered anomalies and believed to be confined to a small number of victims for much of the 20th century.

Today, it is not surprising to hear many clinicians who have been practicing for decades exclaim that they are seeing individuals with more trauma than ever before. While this may be true, I see it more as a function of the increase in acceptance of the prevalence of interpersonal trauma. This rise in acceptance also added credibility to CPTSD. So what is CPTSD?

Complex trauma is:

• Ongoing or repeated with little recovery time between incidents

• Difficult or impossible to escape from

• Occurs within a personal relationship, often by someone who has power over the individual and who should have been a safe person (i.e., a caretaker)

• Begins in childhood

• May have been covered up, kept secret, or denied

• It often occurs in secret and society ignores it

• It impacts childhood development

Its effects are also more complex and pervasive:

PTSD Symptoms	CPTSD Symptoms (also includes PTSD Symptoms)
Concentration issues Inability to feel positive emotions Self-blame Hypervigilance Avoidance of trauma triggers Flashbacks Emotional/physical numbness Depression/anxiety Sleep problems Cope with drugs/alcohol	Difficulty managing emotions Challenges in having safe and stable relationships Memory issues Chronic feelings of helplessness Self-doubt Unsafe to get close to people/difficult trusting Feel others don’t understand them Changes in sense of self and identity Dissociation Feeling suicidal/self-harm Somatization, GI issues Sexual difficulties Low energy and fatigue

Eye-Movement Desensitization and Reprocessing (EMDR) has been used to treat PSTD since its beginnings in the 1980s, starting with war veterans (fitting with the understanding of PTSD at the time). EMDR has become an evidenced-based treatment for PTSD, but what about CPTSD? It is easy to see that CPTSD is true to its name, complex in its development and symptoms. EMDR can be a great fit for treating someone with CPTSD, however it calls for additional preparation, support, and modifications. Consultation for working with pervasive, interpersonal trauma is necessary to safely process trauma with these individuals.