Complex PTSD Test: How To Identify And Diagnose C-PTSD
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Complex post-traumatic stress disorder (also referred to as complex PTSD or C-PTSD) usually results from chronic traumatic experiences. This disorder can involve traditional PTSD symptoms like re-experiencing, avoidance, and hyperarousal, as well as emotional regulation difficulties, negative self-beliefs, and relationship challenges. You can take C-PTSD self-report questionnaires to evaluate your symptoms, but for an official diagnosis, a licensed mental health professional must administer official screening tools. Many types of therapy can be effective in treating C-PTSD, including cognitive processing therapy and prolonged exposure.
Identifying complex post traumatic stress disorder (C-PTSD)
Complex PTSD or complex post-traumatic stress disorder can develop in response to prolonged or repeated trauma.
- Childhood abuse or neglect
- Domestic violence
- Repeated physical or sexual abuse
- Torture or slavery
- War and genocide campaigns
Diagnostic criteria for complex PTSD after a traumatic event
C-PTSD usually differs from PTSD in several key ways due to the nature of the trauma and the wide-ranging effects it can have on an individual's mental, emotional, and social function. Here are the criteria for a diagnosis of complex PTSD:
1. Exposure to extreme traumatic events
C-PTSD typically involves uniquely threatening or disturbing circumstances, such as those involving prolonged or repeated violence or abuse.
While each person may have a different level of tolerance for distressing situations, the types of trauma that trigger C-PTSD are generally more extreme and sustained. These traumatic experiences may involve not only direct threats to safety or integrity, but also prolonged or repeated exposure, which can result in a deep-seated impact on an individual's psychological and emotional well-being.
2. Core symptoms of post traumatic stress disorder (PTSD)
C-PTSD normally involves the core symptoms of PTSD:
- Re-experiencing: Intrusive thoughts, nightmares, or flashbacks
- Avoidance: Avoiding thoughts, conversations, people, places, or activities that may trigger traumatic memories
- Hyperarousal: Irritability, difficulty sleeping, difficulty concentrating, feeling jumpy
3. Additional symptoms specific to complex PTSD
Beyond the core symptoms of PTSD, C-PTSD usually involves additional symptoms that strain the way a person relates to themselves and others.
Sometimes, these symptoms may be described as changes in personality, and they can significantly alter the way an individual perceives the world around them.
Symptoms specific to C-PTSD can include the following:
- Severe and pervasive emotional regulation issues: Anger, frustration, persistent sadness, or suicidal thoughts
- Persistent negative self-beliefs: Helplessness, shame, guilt, stigma, or worthlessness
- Persistent interpersonal difficulties: Social withdrawal, trust issues, or problems sustaining healthy relationships
In general, to be diagnosed with C-PTSD, a person must meet all of these diagnostic criteria. In situations where an individual exhibits only some of these symptoms, but not enough to meet the full diagnostic criteria, they may be considered to have PTSD or subthreshold PTSD.
Common C-PTSD tests
Researchers and clinical psychologists have developed several screening tools and questionnaires to help individuals and their clinicians assess and identify symptoms associated with C-PTSD.
Self-report questionnaires for C-PTSD
Some C-PTSD tests are designed to be taken by the individual. These self-report measures can provide a convenient way to assess your symptoms so you can make an informed decision about how to approach treatment.
- The International Trauma Questionnaire (ITQ): This questionnaire is based on the 11th edition of the World Health Organization’s International Classification of Diseases (ICD-11). The ITQ is usually considered a reliable and valid measure for assessing and diagnosing both PTSD and C-PTSD.
- Complex Trauma Questionnaire (ComplexTQ): Specifically designed to assess complex trauma, the ComplexTQ evaluates symptoms across emotional regulation, interpersonal difficulties, and identity disturbances. Preliminary research indicates that the Complex TQ test is valid and reliable.
- Developmental Trauma Inventory (DTI): This inventory is primarily geared toward identifying exposure to trauma during childhood and its long-term effects. It can pinpoint developmental disruptions linked to trauma, which tend to be crucial in diagnosing C-PTSD. While not as well-studied as other tests, preliminary research indicates that the DTI may be promising for assessing PTSD and C-PTSD.
Is a self-administered complex PTSD test a reliable basis for diagnosis?
Note that these tools are generally meant to help you understand how closely your symptoms may align with a C-PTSD diagnosis. However, they are not intended to diagnose the disorder. For an official diagnosis, you will typically need to undergo a clinical evaluation with a licensed mental health professional.
Clinician-administered screening tools
Other C-PTSD tests are meant to be used in clinical interviews with licensed mental health professionals. These may be used to gain a deeper understanding of an individual’s trauma history and symptomatology, as well as to provide a comprehensive diagnostic assessment.
To give you an official diagnosis, your mental health provider may use one of the following tools:
- Symptoms of Trauma Scale (SOTS): The SOTS can measure the frequency and intensity of trauma-related symptoms across various domains, including emotional, psychological, and physical responses to trauma.
- Cameron Complex Trauma Interview (CCTI): The Cameron Complex Trauma Interview (CCTI) is a specialized diagnostic tool normally used to assess complex trauma in children ages five to 11.
- Complex PTSD Item Set additional to the Clinician Administered PTSD Scale (COPISAC): This is an extension of a common PTSD screening tool used by mental health professionals. It is designed specifically to screen for complex PTSD.
How to get tested for complex PTSD
If you are concerned that you may be experiencing C-PTSD, you may benefit from taking self-report measures and formal assessments. Here’s how the testing process might look:
1. Take a self-report measure
You can start by completing a recognized self-report tool like the ones mentioned above. These tests can provide clarity and awareness surrounding your symptoms, and your results can help guide the conversation during your initial consultation with a mental health professional.
2. Seek professional help
If your results indicate that you may be experiencing PTSD or C-PTSD, it may be advisable to connect with a mental health professional for further evaluation. A licensed provider can assess your symptoms and work with you to develop a treatment plan.
Note that, for an official diagnosis, state licensing boards typically require that providers meet with clients face-to-face for a clinical interview. This may be necessary in situations where you need prescription medication, disability accommodations, or insurance coverage for treatment.
3. Undergo a formal assessment
If you need an official diagnosis, your mental health provider will likely ask you to take a formal C-PTSD test. This generally involves a clinical interview in which they will ask you detailed questions about your personal history, symptoms, and experiences.
The goal is usually to establish a comprehensive understanding of your trauma history and its impact on your life. The interview may also assess how your symptoms meet the diagnostic criteria for C-PTSD and differ from other common concerns, such as PTSD or borderline personality disorder.
4. Develop a treatment plan
With a detailed understanding of your condition, you and your mental health provider can work together to develop a comprehensive treatment plan. Treatment for C-PTSD may include psychotherapy, lifestyle adjustments, and, in some cases, medication.
Understanding therapy options for complex PTSD
Experts recommend a few types of trauma therapy for the treatment of complex PTSD. Though the treatment process may differ slightly depending on the type, each tends to target the parts of the brain responsible for memory and emotional regulation.
These therapies usually aim to help individuals process and integrate traumatic memories, reduce the intensity of emotional responses to trauma cues, and improve overall emotional and behavioral control. Here are the treatments most commonly recommended for trauma disorders:
- Eye movement desensitization and reprocessing (EMDR):EMDR is primarily designed to help individuals process and integrate traumatic memories in a way that reduces their lingering effects. This therapy typically uses guided eye movements to help the brain work through traumatic memories, aiming to alter the emotional response associated with those memories.
- Cognitive processing therapy:CPT usually focuses on helping individuals understand and modify their distressing thoughts related to the trauma, aiming to change how they think about the trauma and reduce its ongoing negative effects on their emotions and behavior.
- Prolonged exposure: This therapy normally involves repeated, detailed imagining of the trauma or progressive exposures to trauma reminders. The goal is typically to reduce the distress and avoidance behavior that can come with traumatic memories.
You can find clinicians who specialize in trauma-informed care through your local mental health clinic or online. If you require an official diagnosis, you may need to attend an in-person appointment with a licensed mental health professional. If you have taken a self-report assessment and are ready to begin treatment without a formal diagnosis, online therapy may be an option worth exploring.
Online trauma therapy for complex PTSD and mental health
Online therapy platforms like BetterHelp generally allow you to attend weekly therapy sessions with a licensed therapist who specializes in treating complex trauma. Through BetterHelp, you can find a mental health provider offering the type of treatment you are seeking, plus attend weekly sessions by phone, video call, or live chat.
While research is still in its early stages, preliminary studies suggest that online therapy sessions can be an effective way to deliver trauma-focused cognitive therapy, EMDR, and prolonged exposure. In traditional face-to-face settings, these therapies are among the most well-founded trauma interventions, having been backed by decades of research.
Takeaway
How do I know if I have complex PTSD?
Knowing the symptoms of C-PTSD can be a first step. They include flashbacks, avoidance, detachment, hypervigilance, frequent negative thoughts, and intense emotions. Someone with C-PTSD may also respond to negative emotions with anger and aggression and experience feelings of failure, shame, guilt, and worthlessness. They can have severe difficulty forming and maintaining meaningful relationships.
You may be at risk of C-PTSD if you have experienced prolonged or multiple traumatic events from being in a situation that you were unable to escape from. Some examples of experiences of interpersonal trauma that can lead to C-PTSD are torture, prolonged domestic violence, slavery, or childhood trauma, like childhood neglect or sexual, physical, or emotional abuse.
C-PTSD is similar to uncomplicated PTSD. The main difference is the length of the trauma that caused the condition and the symptoms. PTSD occurs as a result of short-term trauma or a single traumatic event, like a natural disaster or a physical or sexual assault, while C-PTSD involves exposure to long-term repeated or chronic trauma. Many of the symptoms overlap, but people with C-PTSD are more likely to experience problems with identity, sense of self, emotional regulation, and relationships.
The only way to get an accurate diagnosis of C-PTSD and a personalized treatment plan is to work with a mental health professional. Anyone can develop PTSD after a traumatic event that brings on extreme stress, from combat veterans to those who witnessed a devastating accident or natural disaster. Diagnosing PTSD accurately can ensure you get the care you need to manage it.
What does a CPTSD episode look like?
Here are some features that may occur in people experiencing C-PTSD:
- Avoidance symptoms, like staying away from people, places, activities, and objects that may trigger memories of the trauma, avoiding thinking about the trauma, or being hesitant to talk about the trauma.
- Intrusion symptoms, like repeated flashbacks and unwelcome and involuntary thoughts. Flashbacks can be so realistic that the person may feel like they are re-experiencing the event.
- Cognition and mood symptoms include feeling detached from friends and family, being unable to remember certain parts of the event, having distorted beliefs about self and others, and being unable to experience positive emotions.
- Hyperarousal symptoms like an exaggerated startle response, irritability, behaving recklessly, being prone to angry outbursts, and having trouble sleeping or concentrating.
These intense symptoms can occur in both PTSD and C-PTSD. Unlike PTSD, C-PTSD has additional symptoms, which include the following:
- Affective dysregulation, or the inability to regulate or tolerate negative emotions, which can lead to persistent and severe emotional outbursts or suicidal thoughts
- Relationship difficulties due to difficulty trusting others or a negative self-view.
- Negative self-concept due to feelings of worthlessness, failure, guilt, or shame.
What are complex PTSD triggers?
C-PTSD triggers can include sounds, smells, sights, locations, and feelings. They can be general or associated with something specific about the traumatic events, like locations, anniversaries, seasons, or holidays.
How do complex PTSD people act?
People with C-PTSD may avoid certain places, people, and activities that remind them of their trauma. They may experience repeated and realistic flashbacks that elicit a significant stress and fear response.
Those with C-PTSD may isolate themselves from friends and family and avoid social situations. They may have distorted beliefs about themselves and other people and may be unable to experience joy and other positive emotions. They may behave recklessly, develop sleep disorders, be prone to angry outbursts, or have trouble concentrating.
In addition to these PTSD symptoms, someone with C-PTSD may be unable to regulate or manage negative emotions and experience emotional outbursts or suicidal thoughts. They may mistrust others and have a negative view of themselves, experiencing feelings such as guilt, failure, shame, or worthlessness.
Do I have BPD or C-PTSD?
Borderline personality disorder (BPD) and C-PTSD have some overlapping symptoms, but they are two distinct mental health conditions. Both conditions can involve feelings of worthlessness, impulsive behavior, and difficulty forming relationships. The main difference between them is that C-PTSD is caused by chronic trauma. BPD is not necessarily linked to trauma, though it is strongly associated with childhood abuse or neglect. BPD usually develops in young adulthood, while C-PTSD can occur at any time.
Because of the overlap and similarity of symptoms and causes of these mental disorders, some experts believe that C-PTSD, PTSD, and BPD may be a spectrum of trauma-related conditions. In the American Psychiatric Association’s Diagnostic and Statistical Manual, C-PTSD does not have its own listing and is categorized as a more severe form of PTSD.
Can C-PTSD be cured?
C-PTSD can be managed with treatment. Several types of trauma therapy can be effective at managing this psychiatric mental health condition, and each targets the parts of the brain responsible for memory and emotional regulation. Treatment options may include the following:
- Eye movement desensitization and reprocessing (EMDR), which uses rhythmic eye movements to help process traumatic memories
- Cognitive processing therapy (CPT) which focuses on helping people understand and change their distressing thoughts about the trauma to reduce the negative effects
- Prolonged exposure therapy, which involves progressive exposure to images associated with the trauma to help reduce the avoidance behavior and other reactions to traumatic memories
These therapies usually aim to help people process and integrate the memories of their trauma and improve their overall well-being.
There are some other treatment options that may also be beneficial. For example, group therapy can be a beneficial approach for PTSD treatment. Accelerated resolution therapy, or ART therapy, is an emerging treatment that has shown promise. Some research also shows that equine therapy may be effective for youth who have experienced trauma. In this type of treatment, a trained mental health professional uses a horse in a therapeutic context to help facilitate social and psychological insights.
What are 5 symptoms of PTSD?
Five symptoms of PTSD may include avoidance, hyperarousal, intrusive thoughts, negative thoughts and feelings, and physical reactivity. People with PTSD may also engage in substance abuse or other self-destructive behaviors.
What are the 4 types of C-PTSD?
C-PTSD is not divided into types. That said, the symptoms of PTSD are often grouped into four types: avoidance, intrusive memories, negative changes in thinking and mood, and changes in physical and emotional reactions.
Can I diagnose myself with C-PTSD?
C-PTSD requires a professional diagnosis from a skilled mental health care professional. Because C-PTSD has symptoms that can overlap with other mental health conditions, a clinical diagnosis is necessary to ensure you get the appropriate treatment and support throughout the healing process.
What are the 5 stages of PTSD?
There are no official stages of PTSD, but some professionals may use the following five stages to talk about disease progression.
The impact stage occurs right after the trauma. In this stage, people may experience disbelief, shock, and fear, and they may begin having flashbacks and experiencing emotional numbness as a stress response.
The denial or numbing stage is next. In this stage, people may try not to let the trauma affect them and refuse to talk about what happened.
Next is the intrusion and hyperarousal stage, during which repetitive flashbacks and nightmares are common. Someone in this stage may experience hypervigilance, heightened anxiety, and avoid triggers.
The recovery and integration stage follows as the person gradually processes their trauma and learns how to use coping mechanisms to regulate their anxieties and emotions. At this stage, they can begin reintegrating into daily life and may have fewer flashbacks, nightmares, and intrusive thoughts. Some people can get to this stage on their own, but getting a proper diagnosis and working with a mental health professional to treat PTSD can benefit the healing process.
The last stage is long-term recovery. In this stage, people experience continued growth and healing as they develop resilience and learn healthy coping skills.
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