Since warfare is as inherent to humanity as walking upright, traumatized soldiers are nothing new under the sun. However, it was only recently that medicine began to get to the bottom of the eerie symptoms occurring (not only) in war veterans: At first, the heart was blamed for the horror and the resulting health problems, which gave rise to the term such as ‘war neurosis’ or ‘soldier’s heart,’ later ‘shrapnel shock’ (shell shock)… However, the then-emerging field of psychiatry finally turned its attention in the right direction—toward the invisible scars on the soul (…the brain… or whatever term you prefer). The diagnosis known today as post-traumatic stress disorder (PTSD) encompasses the following categories of symptoms:
- the person has directly or indirectly experienced a highly traumatic situation (in addition to the aforementioned armed conflicts, this may include for example an accident, physical or sexual violence, torture, abuse, or hospitalization due to a serious health problem, etc.),
- following which flashbacks occur, in which the person ‘relives’ the event (so-called flashbacks); nightmares about the trauma are common
- …which is associated with problems with sleep and concentration, extremely heightened vigilance, impulsive and self-destructive behavior, or aggression
- as well as avoiding anything that in any way triggers memories of past horrors (thoughts, physical stimuli, people, places, activities…)
- changes in mood and thinking—a negative perception of oneself and the world, self-blame, loss of interest in previously enjoyed activities, a feeling of “distance” from others.
PTSD is a serious disorder that makes life difficult and can even be life-threatening. Unlike schizophrenia, for example, it is by no means a social taboo—on screens and in the pages of books, veterans, safe in their homes, wake up screaming, drown their flashbacks in alcohol, and revel in seeking out dangerous situations… there is something morbidly fascinating about their suffering, which is why such portrayals of post-traumatic stress disorder are not hard to find in the media.
The more recently defined complex post-traumatic stress disorder (CPTSD) can only dream of getting this much screen time. However, the lack of representation on screen is the least of it—in much of the world, CPTSD is not yet recognized as a separate diagnosis.
So what does this uncomfortable five-letter acronym actually stand for?
First and foremost, it highlights the fact that trauma is by no means always a sudden, intensely concentrated, or strictly time-bound event (such as the horrors of traffic accidents, violent deaths, rape, etc.). Complex PTSD stems from long-term suffering, which, moreover, is often not caused by a stranger, a random person, or an outsider — CPTSD is most often the result of childhood abuse or neglect, or domestic violence; less common causes include, for example, cases of kidnapping or imprisonment. The common denominator is situations from which there is no easy escape (a child can hardly “pack their bags,” and unfortunately, even adulthood offers no guarantee of an easy way out of a toxic relationship). These situations are often characterized by a familial, intimate, or otherwise close relationship between the perpetrator and the victim.
The earliest definitions described CPTSD as “a consequence of complex trauma or long-term trauma with onset at an early age“, more specifically, chronic and interpersonal trauma—“primarily childhood sexual abuse”, but not only that—CPTSD can just as easily result from bullying, humiliation, or disrupted attachment. Later, the concept of CPTSD was expanded to include other types of catastrophically traumatic events, such as “protracted war, being a prisoner of war, refugee status, human trafficking, and prostitution, as well as acute or chronic illness".
In addition to the aforementioned symptoms of post-traumatic stress disorder (re-experiencing the trauma, flashbacks, avoidance of triggers, numbness or, conversely, extreme hypervigilance, etc.), in the case of CPTSD add a whole a series symptoms:
- impaired ability to form and maintain interpersonal relationships—the problem lies in how traumatized people perceive themselves: they feel insignificant, ashamed, unworthy of anything good… Finding a way to connect with the world and its people is incredibly difficult, partly because trust in others is, understandably, gone after traumatic experiences
- serious problems regulating moods and emotions—negativity, anxiety, feelings of emptiness, guilt, anger (outbursts or suppression of anger)
- changes in attention and perception—problems with memory and sustaining attention, as well as dissociation, are common
- disruption of the belief/opinion system – whatever they once believed no longer means anything; any belief and perception of the world’s order is replaced by hopelessness and despair
- physical distress or somatization – the occurrence of physical symptoms not caused by another medical condition (e.g., memories of trauma trigger nausea, trembling…)
In a recent video on the educational YouTube channel, the School of Life summarized the characteristics of people with CPTSD in the following twelve points:
- feel that nothing is safe
- They are unable to relax
- they sleep poorly and wake up early
- their self-image—how they perceive themselves—causes them to feel aversion
- they tend to be attracted to highly unattainable people
- …and repelled by those who want to get close to them
- explosiveness
- paranoia
- they prefer to stay alone (people = danger)
- life is exhausting for them
- spontaneity does not exist
- They try to find “substitute” safety—through money, fame, etc.
If you identify with more than seven of these, you may be struggling with CPTSD, according to the authors article and videos.
Some sources in addition to the symptoms mentioned above, also mention the occurrence of self-harm, suicidal thoughts, significant personality changes, feelings of hopelessness, a distorted perception of the aggressor or perpetrator (either a focus on revenge or idealization of the relationship), and a sense of fundamental difference from other people.
Research into this “subtype” of PTSD is still in its infancy, and because diagnostic guidelines are often lacking, many professionals easily overlook CPTSD in practice or, due to the similarity of some symptoms, mistake it for another diagnosis; very often, for example, with borderline personality disorder (symptoms that overlap with CPTSD include, for example, problems with emotions, mood, and memory; dissociation; self-destructive behavior; feelings of guilt and emptiness; and others). Since an accurate diagnosis is the first step toward improvement, we desperately need a more precise definition of symptoms and criteria—the prevalence of CPTSD is lower than that of “classic” post-traumatic stress disorder more common, and the consequences of this disorder are more urgent.
