Understanding Complex PTSD With A Therapist
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According to PTSD UK, between 50–70% of people worldwide will experience a traumatic event in their lifetime. A single traumatic event or series of events can affect a person on a deep emotional level, sometimes causing a condition like post-traumatic stress disorder (PTSD) or complex post-traumatic stress disorder (C-PTSD) to develop. Below, we’ll explore causes and symptoms of C-PTSD in particular as well as therapist and treatment options for those in the UK who have experienced trauma.
Complex post-traumatic stress disorder
Due to repeated or prolonged exposure to complex trauma, C-PTSD often causes even deeper emotional, psychological, and relational challenges than standard PTSD. Research also suggests that people with C-PTSD have an earlier onset age of trauma than people with PTSD, which may be one reason it typically involves more severe symptoms and requires a nuanced and comprehensive trauma treatment approach.
Causes of C-PTSD
C-PTSD can be caused by sustained exposure to traumatic events—especially those that occur in environments where a person feels powerless or unable to leave. Potential causes include:
- Childhood neglect or abuse: C-PTSD is perhaps most often associated with interpersonal trauma during childhood. Since these experiences occur when the individual is still developing emotionally and cognitively, they can have a larger impact.
- Domestic violence: prolonged exposure to an abusive relationship where feelings of safety are compromised
- Captivity or exploitation: situations such as being held hostage, being a survivor of human trafficking, or living in a war zone
- Repeated trauma at work or in caregiving roles: First responders, medical professionals, or caregivers in high-stress environments are at risk of C-PTSD due to repeated exposure to secondary trauma.
C-PTSD is likelier to develop when the individual has no opportunity to process or escape these situations, leaving their nervous system in a constant state of hypervigilance.
Symptoms
Research suggests that people with C-PTSD report lower levels of psychological well-being than people with PTSD. Although symptoms of PTSD can be severe and highly disruptive to daily life, those associated with C-PTSD may be even more so.
Some symptoms of C-PTSD include:
- Emotional dysregulation: Depending on the cause of the trauma, this effect can lead to excessive fear, worry, shame, or guilt, along with other negative emotions.
- Interpersonal difficulties: Forming and maintaining close relationships may become more difficult. For example, someone with C-PTSD may distrust new friends and partners if they’ve experienced abuse in a past relationship.
- Negative self-perception: persistent negative feelings toward oneself due to a traumatic experience
- Dissociation: feeling detached from one’s body, emotions, and surroundings
- Physical symptoms: Chronic pain and fatigue are especially common in people with PTSD, especially if they experienced trauma through a physical injury.
- Re-experiencing trauma: flashbacks, nightmares, or intrusive memories of the traumatic events
- Hypervigilance: being constantly on edge and feeling unsafe even in non-threatening situations
C-PTSD vs. post-traumatic stress disorder (PTSD)
C-PTSD and PTSD share many similarities. However, key differences lie in the cause and severity of symptoms.
PTSD often develops as the result of a single, isolated traumatic event. Some examples include a car accident, a natural disaster, or an experience of assault. Symptoms tend to revolve around reliving that specific incident, avoiding reminders of it, and experiencing heightened anxiety as a result of it.
C-PTSD is slightly different since it develops as a result of prolonged exposure to trauma over multiple occasions. This distinction can have significant implications for treatment, as C-PTSD often requires a more holistic approach that addresses deep-seated emotional and relational wounds.
Severity of symptoms
While PTSD can result in severe symptoms, such as flashbacks and hypervigilance, C-PTSD is often more complex, also involving chronic feelings of shame, significant difficulties with trust, and a fragmented sense of identity. This fact can make C-PTSD more challenging to address, often resulting in a longer duration of treatment.
Also note that researchers have identified various risk factors as well as perfect protective factors that may impact whether the person develops a trauma-related illness and the severity of their symptoms if so. Examples of such factors include whether the person already has a diagnosed mental illness, whether they have social support, and whether they've experienced trauma before.
Type of trauma
PTSD is typically associated with a specific, single, identifiable event. In contrast, C-PTSD usually stems from sustained trauma, such as years of emotional abuse or neglect.
Age of onset
C-PTSD is more commonly associated with trauma experienced in childhood or adolescence. This type can be referred to as developmental trauma, since these years are formative for emotional and psychological development. On the other hand, PTSD can develop at any age.
Treatment
While C-PTSD can feel overwhelming, there are effective treatments that help many people address symptoms. Remember that symptoms of a trauma-related mental illness typically will not resolve without treatment, so seeking professional support via a therapist as soon as possible is generally recommended.
Medication
Medication is sometimes prescribed for individuals living with PTSD or C-PTSD, usually in combination with some form of talk therapy. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may help reduce symptoms of anxiety and depression, while other medications may be prescribed to regulate sleep or stabilize mood. More research on the efficacy of medications is needed for C-PTSD, but studies suggest that SSRIs may be effective in helping reduce PTSD symptoms. Remember to not start, stop, or change any medication without consulting with your doctor.
Speaking with a complex PTSD therapist: Therapy for trauma
Therapy is typically a key component of complex PTSD treatment, offering individuals a safe space to process their trauma and develop healthy coping mechanisms with the help of a therapist. Here are some common types of talk therapy used in the UK for the treatment of C-PTSD:
- Trauma-focused cognitive behavioral therapy (TF-CBT): This form of therapy gives adolescents and children in particular the tools to question and alter existing thoughts and feelings. Research suggests that it can effectively treat grief, anxiety, and depressive symptoms in young people.
- Eye movement desensitization and reprocessing (EMDR): This form of talk therapy involves engaging in rapid eye movements which mirror the patterns that occur in the REM sleep cycle while verbally recalling trauma. EMDR may help people consciously process traumatic memories and emotions.
- Somatic therapy: This body-centered approach focuses on reconnecting with bodily sensations and using movement or breathwork to release trauma.
- Dialectical behavior therapy (DBT): DBT may be beneficial for people experiencing emotional dysregulation as a result of trauma. It may help an individual better manage emotions, interpersonal relationships, and overall mood. As with many of these treatments, DBT can also be used to treat other mental health conditions such as obsessive-compulsive disorder (OCD), depression, and anxiety.
Complex PTSD therapist: UK options
There are several different ways for an individual in the UK who is experiencing the effects of past trauma to receive therapeutic support. First, mental health therapy through the National Health Service (NHS) is free for eligible citizens and residents. You can self-refer online or get a referral for a therapist through your GP.
Outside of the NHS, independent providers may treat trauma, though payment for their services is typically required. Some independent providers offer sliding-scale fees to help make their therapist sessions more widely available. In addition, universities, some employers, and mental health charities may also offer support in finding and/or paying for mental health care.
Another option is online therapy sessions through a therapist platform that serves the UK, such as BetterHelp. This type of service can match you with a professional therapist according to your needs and preferences as outlined in a simple onboarding questionnaire. Since feeling comfortable with your therapist can be paramount for effective C-PTSD treatment, BetterHelp also allows you to switch providers at any time for no extra cost. This platform offers subscriptions as low as £65, billed every four weeks, which can be affordable for those wanting to seek out mental health treatment with a therapist.
Online therapy options
Online therapy has become more popular in recent years, and various studies have examined its effectiveness. In general, research suggests that online treatment can often be as effective as in-person care for symptoms of PTSD.
Takeaway
The four Fs of complex PTSD include the different responses of the nervous system to trauma, stress, and trauma triggers, including:
- Fight: People who respond with the fight response try to attack or physically impede danger. This response can look like aggression, yelling, or self-defense.
- Flight: The flight response often looks like physically running away or avoiding a conversation or experience.
- Freeze: In the freeze response, a person may stop talking, physically freeze, or altogether avoid interaction.
- Fawn: People with trauma and PTSD who “fawn” give in to the demands of others to protect themselves and feel safe. This response is also associated with “people-pleasing” behaviors.
Why is C-PTSD so hard to treat?
C-PTSD can be challenging to treat because it often stems from a long period of trauma in early life, often involving repetitive traumatic events and abuse. People with C-PTSD may have low self-esteem, believing they are “permanently damaged” by the trauma. Regular PTSD therapy may not be helpful in the long term, as people with C-PTSD often require long-term support and a unique understanding of the complexities of their condition.
A C-PTSD therapist might use modalities like eye movement desensitisation and reprocessing therapy (EMDR) to offer support, as well as other methods focused on developmental trauma, like internal family systems therapy (IFS). Gestalt therapy may also be effective. Talk to your therapist at your initial consultation to learn which methods might be most effective for you. Despite intrusive thoughts or low self-esteem, C-PTSD is often manageable with treatment and support.
Treat people with C-PTSD with respect as you would treat any human being. Below are some stereotypical phrases you can also avoid saying:
- “Just get over it.”
- “You’re stuck in the past.”
- “Move on already.”
- “You should forgive the people who traumatized you so you can move on.” (Forgiveness is not helpful for everyone)
- “C-PTSD isn’t real.”
- “You’re an attention-seeker.”
- “You’re just making it up.”
- “I’ve been through worse, and I didn’t get a mental illness.” (People can go through the same traumatic event, and both can come out differently)
Every person with C-PTSD is different, and what works for one may not work for another. Some people with C-PTSD experience disability because of their condition, leading to them being unable to work or only able to work certain jobs. People with this condition may work best in fields they’re passionate about. Some people with PTSD or C-PTSD go on to work in mental health to support other survivors of trauma, as doing so gives them a sense of well-being.
What does a C-PTSD episode look like?
A C-PTSD episode can look different for different people. However, some people may experience flashbacks during an episode, which are vivid memories that can seem like “reliving” a past traumatic event. During a flashback, they may become emotional, avoidant, or aggressive. They may react as if other people around them are trying to hurt them.
There is no one medication approved to treat PTSD. However, antidepressants and anti-anxiety medications are often used to reduce panic or sadness associated with the condition, as well as symptoms of co-occurring conditions. Don’t start, change, or stop a medication without consulting a doctor.
The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action without consulting a qualified medical professional.
The freeze response is when someone responds to extreme stress by physically or mentally freezing up, meaning they struggle to form sentences, move their body, or fight back. They may become dissociated from their surroundings and own body. Some people might report looking back on memories as if they were above their body or watching themselves like they were in a movie.
What happens if C-PTSD goes untreated?
Untreated C-PTSD often involves severe symptoms and extreme stress for the individual living with the condition. Treatment can help people develop coping mechanisms, reframe beliefs, and feel safer in their environment. Therapy, medication, or a combination of the two are often effective in supporting people with traumatic pasts.
PTSD has varying severity depending on the individual. C-PTSD is sometimes considered a “more severe” form. However, not everyone with PTSD or C-PTSD has the same symptom severity, and the assumed “severity” of a traumatic event is also not correlated with how severe one’s symptoms may be.
What is the best therapy for complex post-traumatic stress disorder?
Trauma-focused therapies are often the most widely recommended for C-PTSD in the UK. For example, EMDR, trauma-focused therapy, internal family systems therapy, and dialectical behavior therapy (DBT) all deal with intense emotions and the way C-PTSD can show up in an individual.
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