Complex PTSD

The shock of falling down. One moment I’m halfway down the stairs with an armload of dirty towels, the next I’m bump, thump, bump at the bottom, feeling bruised and dazed.

Sometimes circumstances hit us like that. Out of nowhere. Their effects can be far more serious and less visible than the bruises that develop on my skin and then fade away.

Maybe it is more complicated than one random slip down the stairs. Maybe every time I use the stairs, one or two give way and I never know which ones or how badly I’ll be hurt. Or maybe it’s not just the stairs; it can be anywhere else in the house, like landmines, making me bleed and keeping me ever-anxious.

Trauma is a strange beast. As is its persistent follower PTSD.

Post-Traumatic Stress Disorder. A phrase coined to label the symptoms displayed by soldiers who returned to the US from Vietnam.

George Carlin used it in a bit about euphemisms. He hated euphemisms and how they separate us from gritty reality.

World War I: Shell Shock. Sharp and succinct.

World War II: Battle Fatigue. A softer term for the same suffering.

Korea: Operational Exhaustion. Is that something that happens to a person or a machine?

Vietnam: Post-Traumatic Stress Disorder.

While George commented on how adding syllables, and then a hyphen, made the issue less immediate and less personal (so we could rationalize keeping our distance and not getting our hands dirty), the change to PTSD has been helpful. Not at first, especially not for the Vietnam veterans he argued needed more help to deal with psychological injury than they received when they came home, but today PTSD is a familiar term.

Those who chose to fight for their country, and those who chose not to run when they were called to go against their will, returned to a country that was mostly ignorant of how to help someone deal with wounded minds, and too many were unsympathetic.

Today we better understand that trauma can change the way a person feels, thinks, processes information and relates to situations and people. We also know that trauma-related disordered emotions, thoughts, beliefs and behaviors do not require war.

PTSD and Complex PTSD

When an accident, act of violence, or natural disaster occurs, we know psychological care is important for victims, as soon as possible. We understand that the mind can be injured, whether or not the body is, by a single, devastating event.

Many combat veterans suffered repeated life-threatening and violent events. Some they recall with vivid detail, when they would rather not. That’s a hallmark of PTSD. Intrusive, overwhelming memories of past trauma. Flashbacks.

But, like all things related to our growing understanding of how the mind works, PTSD is more complicated than flashbacks. Not that dealing with flashbacks and the havoc they can wreak is simple, but not all cases of PTSD even involve flashbacks. Sometimes PTSD goes undiagnosed, or symptoms go unrecognized, because the survivor is not experiencing flashbacks.

Complex PTSD symptoms that in the past were considered comorbid, can be more debilitating than flashbacks and the attendant anxiety and behavior issues.

The psychological and emotional effects of extended exposure to repeated traumatic events, as experienced by combat veterans, POWs, and survivors of concentration camps, sex trafficking, domestic violence or severe childhood abuse, can be difficult to treat.

It is easy to recognize that the ongoing trauma in these situations takes its toll on survivors’ minds, and that their minds can develop coping mechanisms to survive that are difficult to overcome after life changes.

Safe does not always feel safe.

According to the US Department of Veterans Affairs, the following symptoms are common in cases of Complex PTSD:

• Emotional Regulation.May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
• Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body (dissociation).
• Self-Perception.May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
• Distorted Perceptions of the Perpetrator.Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
• Relations with Others.Examples include isolation, distrust, or a repeated search for a rescuer.
• One’s System of Meanings.May include a loss of sustaining faith or a sense of hopelessness and despair.

The Further Complexity of Complex PTSD

The above symptoms can also be seen in individuals seeking mental health treatment who do not report a history of exposure to trauma consistent with a PTSD diagnosis. Although a Complex PTSD diagnosis may not be immediately evident, there are important factors to consider. One is that memories of trauma can be suppressed, as described in the change in consciousness mentioned above. Another is that survivors of abuse or other chronic trauma may not consider their experience severe enough to be classified as trauma or to be the cause of their mental health struggles.

PTSD is a result of the subjective experience of trauma, not the objective evaluation of the event or series of events. Chronic trauma can also be a series of seemingly smaller events that chip, chip, chip away at a mind, at a soul.

Regardless of an objective assessment of the level of trauma, anyone exhibiting symptoms of Complex PTSD deserves an exploration into the possibility of the diagnosis so the root cause, not just symptoms, can be dealt with in therapy.