What is Complex PTSD?
Updated: Jan 6
Over the past 20 years I have journeyed with many people who have suffered immense pain in their childhood- many of them with substance use issues. This sent me on my path to Grad school, where I endeavored to understand how people can heal from trauma and substance use. Along the way I discovered that most of the folks I had been working with had complex PTSD. More than grad school my clients and friends with complex PTSD have been my greatest teachers and helped me understand complex PTSD in a deeper way.
Complex PTSD is a relatively new term that acknowledges the deep impact of repeated and chronic adversity in a person’s life. Complex PTSD was coined by Judith Herman who wrote one of the first books on Trauma called “Trauma and Recovery”, though it is not an official diagnosis in the DSM V.
She noticed that those who went through ongoing traumatic experiences in childhood the impact was different than those who were diagnosed with PTSD. To understand Complex PTSD it’s helpful to differentiate it from (simple) PTSD.
PTSD (post-traumatic stress disorder) is a well-known mental health condition that we often associate with experiences of violence, natural disaster, assault, accidents, or war, and became centre stage as a result of the experiences of veterans. One of the most important criteria to be diagnosed with PTSD is that what happened to you was life threatening or caused you to fear for your life or your physical integrity. Symptoms include re-experiencing the event (through nightmares and flashbacks) and avoiding anything associated with the event (people who remind you of the event, sounds, and places).
People with PTSD also experience low mood, irritability, and feel easily startled and have high anxiety. They often have negative beliefs that stem from this event and affect how they see themselves, others and the world.
A person can have both PTSD and Complex PTSD but they are different- whereas PTSD symptoms can be traced back to a single identifiable event, complex PTSD often results from repeated abuse or neglect in childhood (*or adulthood in some cases). This is often experienced in the family of origin or by a caregiver (foster care, residential schools), exactly where children need to feel the most safe to explore the world and grow. When the safest place for a child is unpredictably frightening - it means the child’s nervous system is chronically in fight or flight mode.
A child will learn how to survive by developing unique skills to survive these relationships, that are used so often they become their way of being even into adulthood even when they are in safe situations. Survival skills include: self-blame, difficulty trusting others, trusting too easily, tolerating abusive behaviour, numbing out through substances, dissociation, expressing or suppressing intense emotions, putting others’ needs first, and more.
Although in their mind they may know (cognitively in the thinking part of the brain) that they are in a safer situation now, their emotional smoke alarm (amygdala) keeps going off all the time because it can’t tell the difference between the present and the past. This can result in a person having really intense emotions, constantly feeling on guard or anxious, and having difficulty relaxing.
People with complex PTSD are often wounded in relationships, and as a result this is where they experience a lot of difficulties. However, complex PTSD can also be intergenerational, historical, and as a result of systemic oppression on the basis of racial identity.
Healing from Complex PTSD can be a longer journey, but is possible- I have seen people grow and heal in remarkable ways. Therapy includes a combination of working on past issues, and present difficulties with emotional regulation and finding new ways to connect relationally with others and their community.
If you would like to seek therapy for complex PTSD do not hesitate to reach out for counselling at https://www.emotionwise.ca/contact