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Complex PTSD

The standard definition of PTSD refers to the psychological consequences of experiencing a single, isolated traumatic event. But when individuals are forced to endure traumas that are sustained or repeated over long periods of time - such as children living in abusive homes, battered women living with abusive partners, or prisoners of war and concentration camp victims being subjected to repeated torture and maltreatment - the psychological sequalae can be far more pervasive and damaging than simple PTSD. The term Complex PTSD has come to refer to these more difficult situations. This is not a diagnosis that is recognized by the DSM-IVTR, but it is gaining acceptance among clinicians who treat victims of extreme and prolonged trauma.

Complex PTSD differs from standard PTSD in that the symptoms are more pervasive, diffuse and tenatious. They affect more areas of psychological functioning, to the point even of shaping one's personality, and for that reason tend to be far more chronic and difficult to resolve.

In addition to the typical reexperiencing, avoidance and hyperarousal symptoms that characterize PTSD, Complex PTSD includes much more in the way of chronic depressive symptoms, somatization and dissociative symptoms. The dissociative symptoms can sometimes reach the point of causing Multiple Personality Disorder.

The personality disruptions that are characterisitc of Complex PTSD are also quite profound. These individuals usually develop considerable difficulty trusting in others and seeing any meaning or goodness in the world, and they can have significant problems with intimacy and sexuality. They usually carry deep-seated feelings of shame, guilt, and of being damaged, and they suffer from very low self-esteem.

They are also left with conflictual emotions that are very difficult to deal with. For example, they can feel a lot of unresolved rage towards their abuser and hold the desire to inflict back the same kind of trauma that they had received. At times they may have also come to idealize and identify with their abuser as a way to survive the torment. All of these different impulses and states of mind can feel so terrifying and unacceptable that the only way they can be handled is by them being separated and dissociated away from the rest of the person's consciousness. This means that the individual is then left with a fragmented sense of self where these various unacceptable states of mind become inaccessible parts of their personality, though from time to time they can resurface when the individual is in a dissociative state.

The presence of these conflictual and dissociated states of mind may explain why people with Complex PTSD tend to reenact their traumas at times, either by inflicting pain upon themselves, putting themselves in situations where they are again abused by others, or becoming abusers themselves.

Some experts have noted that Complex PTSD that arises from childhood abuse may be similar to, if not the same thing as, severe Borderline Personality Disorder.

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Acute Stress Disorder

Diagnosis