Managing Complex Post Traumatic Stress Disorder (YouTube video)
Recovery from C-PTSD is a multi-step process involving the development of certain emotional skills, processing of the trauma, and setting goals. This process is intended to return a sense of agency to the traumatized person. C-PTSD is caused when someone is subjected to an ongoing abusive relationship or situation in which they are (or perceive themselves to be) unable to escape. This can include the better-known examples of child abuse (especially child sexual abuse), people fighting or trapped in war zones, but can also include many other situations including some extreme religious groups or cults, victims of human trafficking including slavery and prostitution, and even (as in my case) chronic illness in which a person must undergo painful and frightening procedures, often with cruel and/or life threatening treatment from providers. The long-term affects of this abuse and entrapment changes the way that the victim perceives themselves and how they relate to the larger society.
According to this presentation, the symptoms of PTSD and C-PTSD differ. The symptoms of PTSD listed are a re-experiencing of the trauma (such as flashbacks), avoidant behavior, and a feeling of threat even there is not an actual threat present. I think there are other definitions that include more symptoms such as chronic nightmares. The symptoms of C-PTSD include all of those already listed as well as the development of a negative self-image, emotional dysregulation, and problems with interpersonal relationships. In C-PTSD there is also significant dissociation (which can include episodes of amnesia), extreme problems with concentration and focus, and changes in the person's ability to cope (this may include self-harm, going into rages, etc). Some people include somatic symptoms which means physical medical problems such as pain that is thought to be caused by the mental distress. This is a very slippery slope as it can be used to invalidate the actual medical needs of some people.
The victim may also develop an altered perception of the perpetrator (especially in cases where the perpetrator is a family member, partner, or spouse, who the victim has positive feelings for) as well. These experiences can cause the victim to avoid relationships in general, possibly feeling that abuse is an inevitable aspect of a relationship, or because their feelings of self-worth have been destroyed and they do not feel worthy of love or positive treatment, instead their concept of self is dominated by feelings if shame and guilt. The victim may feel that the trauma has permanently changed them in negative ways.
The International Society for Traumatic Stress Studies has developed a 3-phase approach to treatment. It begins with helping the patient develop the emotional skills needed to become stabilized and to cope with the trauma and it's effects. The next step is to work on processing the memories of trauma with these new skills, and then to increase the patient's involvement with the outside world. The time it takes for a patient to move through these steps can vary tremendously, and the patient may need to revisit an earlier stage from time to time.
One of the barriers that many patients need to move past is a sense that other people can't be trusted and are out to take advantage of, or further abuse, the patient. This means the therapist must focus on establishing a trusting and reliable relationship with the patient who is very sensitized to the perception of negativity and criticism from others, especially the therapist. The first phase of treatment focuses on the development of emotional awareness, regulation, and ultimately flexibility.
From this point the focus shifts to learning to use these skills in relationships and to learn about setting boundaries. Mindfulness is sometimes included in therapy at this stage, especially to address dissociation. Exposure therapy is used as another step- meaning that the patient is helped to re-interpret the trauma (to revisit it in certain ways, with support. Not to just "go back and relive it"). The idea is to reinterpret the trauma as something that can be consistent with a constructive narrative of the patient's life, a way of re-framing the trauma as something that is about survival and hope rather than focusing on the suffering, pain, and helplessness. Traumatized patients often have difficulty remembering and making meaning of the traumatic events that occurred. After this the patient is encouraged to set goals and to work towards developing new aspects of their lives, often things that they never thought were possible for them.
Many clinicians and therapists feel that C-PTSD is not a separate entity, but rather a more intense form of PTSD. This is why in the DSM-V (the current manual for diagnosing mental disorders), the definition of PTSD was broadened rather than including C-PTSD as it's own disorder. In the future both of these diagnoses may be included as part of a spectrum of trauma-based disorders.
